8c - Impaired Recognition of Facial Expressions

Posted by Helen St Clair Tracy in Level 8 - CVIs Ventral
Published: 28/01/2020, 12:06am | Updated: 24/02/2020, 7:38am

Video Link: https://vimeo.com/392419237

The facial recognition process starts before you are born. Your brain would appear to come pre-programmed with certain key facial expressions already loaded...

Image of right side of the brain, with the right temporal lobe, coloured green, indicated.Image of right side of the brain, with the right temporal lobe, coloured green, indicated.

Why do we think this?

It is actually because of children with cerebral (cortical) blindness.

Cases have been reported of babies, who are unable to create the image of what they are looking at due to occipital lobe damage, so technically blind, yet responding to a smiling face.

How can they do that?

The visual information received by the eyes not only goes to the occipital lobes, but also goes to the thalamus, near the centre of the brain, where blindsight (lessons 3h Reflex Vision and 6b Blindsight) is processed. The visual information then is recognised and some babies responds appropriately, by smiling back.

Image of right side of the brain with thalamus (coloured pink) indicated with a black arrow. Image of right side of the brain with thalamus (coloured pink) indicated with a black arrow.

For a baby who has never been able to see due to occipital lobe damage, to both see and respond to a smile in this way (called affective blindsight), would suggest that the brain develops with certain key facial expressions before they have actually been experienced in life.

Why? Well, ultimately to indicate safety.

And this tells us something about the fundamental importance of being able to understand facial expressions. Beyond primitive survival, facial expressions help us understand how other people are feeling, and show how we are feeling.

Affective blindsight is only basic, and is not reported to be experienced by all with occipital lobe damage. So, what about everyone else? Because...

90% of more of an emotional message is non-verbal

Daniel Goleman, Emotional Intelligence, ch7 p97

This means the vast majority of an emotional message is visual, which may be a problem if you have a visual impairment.

When born, the mind-stores of images in the temporal lobes will start developing as the baby grows and experiences more, including experiencing facial expressions. In young babies and infants, an instinctive match will be made between nice expressions and nice consequences, and not so nice expressions and consequences. As the baby grows and develops language, names are matched with expressions, starting with the most simple, bold and easily recognisable, for example:

And as the child develops further, and makes friends, they will learn more and more through the experiences of different social relationships, inevitably for us all involving a little trial and error.

Recognising these often subtle and ambiguous expressions is part of a complex learning experience to express and understand emotions, which is the foundation of successful social relationships. It is part of Theory of Mind.

Theory of Mind
Theory of Mind is the ability to understand not only ones own mind, but have an understanding of how others are feeling, for example understanding that a little gesture like offering to make someone a cup of tea is likely to make them feel brighter, or maybe appreciated, or thought about. We all apply theory of mind throughout our interactions with other people, and it is central to happy and positive human relationships and communications.

Do you remember being taught theory of mind? It is not something that is often explicitly taught. It is sort of expected to be picked up, so when a teacher points to a friend who is upset because they have been ignored and says 'look at Mandy, she is really upset', that is meant to make sense and be a learnable experience. That's the teaching most of us got.

'look at Mandy, she is really upset''look at Mandy, she is really upset'

But what about if Mandy can't be seen clearly due to CVI, maybe simultanagnostic vision?

Is this what 'really upset' looks like?Is this what 'really upset' looks like?

CVI can affect just about every level of the facial expression recognition process:

  • 1. The facial expression can't be seen clearly for many different reasons, including the challenges of looking at a face (previous lesson 8b), so...
  • 2. The memory of facial expressions may be absent, limited, and potentially inaccurate if facial expressions have been mistakenly identified, so...
  • 3. When it comes to matching the expression with the memory, this is extremely compromised, because both the mind-store and visual experience are much more difficult, so
  • 4. The facial expressions which most people pick-up through childhood are not learnt, so
  • 5. Important messages about how a person is feeling are missed or misinterpreted, and
  • 6. People are offended, embarrassed and confused, meaning for many...
  • 7. Difficulties with social relationship and emotional development, which for some can lead to depression and others behavioural challenges (which will be featured in future lessons).

What else?

What happens if a person does not learn facial expressions and what they mean?

How do they show their emotions?

Just because a person does not know how to show their emotions through their facial expressions does not mean they lack feelings.

Targeted support

In our previous lesson 8b (on difficulties recognising faces) we gave general advice on making faces more easy to see clearly for the different CVIs. Learning facial expressions adds a further layer of complexity for the person with CVI.

Our advice is very simple - use words!

Whether the CVI is from birth, in a profoundly affected person, a more able person or acquired, use words.

Where a person has little or no language, just use a single simple word consistently to describe each key emotion when it is being expressed and experienced, both for the person themselves and the person with them, for example:

'Funny' when something creates laughter

Where language is more confidently used, get people used to saying how they feel, and also encourage the person with CVI to say how they feel. It is possible they have not learnt to match the commonly understood words to their own feelings and emotions, so help them.

That's it, very simple, use words.

Visual Behaviours

  • Avoiding social situations, especially where there are groups of people or complex situations to interpret.
  • Sticking to a small group of very well-known people
  • Preferring social media or other platforms where facial expressions are not used
  • Seeming uncaring of, or unresponsive to the emotional state of others
  • Asking people how they are feeling, sometimes repetitively (because they don't know and are unsure, possibly anxious)
  • Looking 'emotionless' or cold, because facial expressions are not used.

Self Referencing

We all feel emotions.

If someone does not show their emotions, it does not mean they don't have feelings.

If someone does not respond to your emotions, it does not mean they don't care.

Interpreting feelings in others is extremely difficult for many people, with and without CVI. In a person with CVI, try to find out the ways they express themselves, for example, contentment and interest may be shown as sitting still and quietly.

Ask the people closest to them, how do they show affection and other feelings?

Learn their emotional language. Help them develop their emotional understanding and show them ways to both understand and express how they are feeling.


Before moving on please check that you have understood the following:

  • Where the mind-store of facial expressions is located in the brain
  • The brain process to correctly recognise a facial expression.
  • How CVI affected this brain process (different reasons)
  • What affective blindsight is
  • What can happen when facial expressions are not recognised
  • The importance of using language to tell people with CVI how we are feeling.

Next lesson: Level 8d CVIs Ventral - Impaired Route Recognition

Further reading is not necessary to progress, but if interested you might enjoy the following:

What is CVI: Emotions

What is CVI: Learning Emotions with CVI

Theory of Mind Lecture (from Professor John Ravenscroft)


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At CVI Scotland we are devoted to helping people understand cerebral visual impairments, and together working towards developing the understanding of this complex condition.