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ORIGINAL FRENCH ARTICLE: Le double handicap des sujets défigurés

by Sophie Cremades

Disfigured Subjects Are Under a Double Handicap

Translated Sunday 28 October 2007, by Isabelle Métral

What is it like to be left with no face? Not just to lose one’s face, but to have literally no face at all? Sophie Cremades, a psychiatrist at Amiens’ university hospital, investigates the case.

Anyone is apt to lose their face, as a matter of fact we often do. Often temporarily as a result of illness, or stress, weariness, vexation… and then our face will lose its expressiveness, its singularity. Sometimes we can also lose it for good as we grow old, without even noticing it, only because some part of our face changes. The consumption of toxic substances like alcohol changes a person’s face little by little too: many of the patients I met say ten years ago have changed beyond recognition. They have lost their former faces, but each still has a face.

When one is left with no face at all, in the eyes of others, and one’s own too, one is no longer a human being. Then of course the mind will reason it out, dispel the first impression: “yes, this is a human being all right.” Still the first glance cast on a disfigured patient expresses instant rejection and exclusion. This means that the disfigured person must always make the first move towards others. Disfigured persons must impose themselves upon their community as they will not be spontaneously integrated. And that takes a lot of moral strength and courage, in order to force one’s admission into the group, and then keep one’s place in it.

The key to occupying this space is speech. Speech, as carried by the voice, will restore the link by conveying meaningful signals, which will explain the circumstances in which the face was lost and communicate emotions through the voice itself, since a disfigured person’s emotions can no longer be read on his or her face. the absence of facial expression is another cause of exclusion as we normally read other people’s emotions on their faces. We look for signals that will give away an emotional state. And then we may choose to adjust our own emotions to it, or on the contrary alter the other person’s emotion if we think it misguided. If the other person is afraid when there is no cause to be, then we assuage the fear. If he or she is sad, we may choose either to share the sadness or not to share it. And in the face of anger, we may smell danger and flee. The emotion we perceive opens up possibilities, enables us to react, adjust our behaviour to that of others.

Disfigured persons consequently are under a double handicap: they have no face, and their emotions cannot be immediately perceived. Not immediately – for it is of course possible to make out a disfigured person’s emotions: when I draw close to the bed of a patient who lies perfectly still and with no facial expression, when I meet patients who have been through facial traumas or patients with burns all bandaged up, I can still perceive their emotions; but it takes a lot of concentration and receptiveness as it is necessary to take in the whole body, not just the face. This is not done instinctively: it takes time, and persistence.

Naturally, disfigured patients end up living in restricted circles of close friends or relatives who will interpret their voice, posture and hands… We relate to others through emotions. We need emotions to feel we are human beings.

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