Faces in Flux: Understanding Facial Distortions on Psychedelics

The Brain in a Vat podcast, one of my favourite podcasts – hosted by Dr Jason Werbeloff and Mark Oppenheimer – had as a guest Brad Duchaine, Professor of Psychological and Brain Sciences at Dartmouth. (Brain in a Vat is a philosophy podcast, but this particular episode – a rebroadcast – was more psychology-focused.) The topic discussed, which is Duchaine’s area of expertise, was prosopometamorphopsia (PMO), a condition in which individuals perceive distorted faces. Duchaine set up a website dedicated to the condition.

PMO is distinct from prosopagnosia, or ‘face blindness’, a condition where someone has a severe difficulty recognising familiar faces, including those of friends and family. People’s faces are not distorted; they are just unrecognisable. Someone with PMO, by way of contrast, can still recognise someone familiar – they just see their face as distorted in some way. However, while they are distinct disorders, they can also sometimes occur together.

On the podcast episode, the causes, neural correlates, and psychological and social impacts of PMO were discussed, as was the nature of other facial recognition disorders, such as prosopagnosia. As PMO was being discussed on the podcast, its effects started to sound a lot like what someone might experience on psychedelics, and lo and behold, face distortions on psychedelics were then brought up. Duchaine suggested that psychedelics likely affected the various brain regions involved in face perception. These facial distortions are distinct from the face pareidolia that many people also experience on psychedelics, which is when a person sees faces in everyday objects. Still, one or more of the same brain regions are likely involved.

This article looks at what we know about PMO, the types of face distortions that can occur on psychedelics, and how to prepare for these psychedelic effects (they can sometimes cause unnecessary distress when unexpected or manifesting in a particular way). 

PMO is an extremely rare condition, with fewer than 100 cases reported in the last century, although it may also be underreported. (Werbeloff, one of the Brain in a Vat co-hosts, is one of the case studies listed on the PMO Wikipedia page. In an article for The New Yorker, the journalist Shayla Love covered the PMO that Werbeloff first experienced in 2007, after spending months in bed with a severe case of mononucleosis. He was told to get in contact with Duchaine about his condition. His symptoms are not very severe, however, as he mentions on the podcast.) 

PMO is also known as ‘demon face syndrome’, as it’s common for people to see demonic-looking faces, or faces that look like dragons. Maggie McCart, who has the condition, told Slate:

Sometimes, a person might look exactly like someone I used to know, maybe even someone I haven’t seen in over a decade. Say I’m riding the bus and looking out the window. There, on the street, will be a girl I went to school with in third grade. Except it’s not them—they just happen to be wearing their face.

Other times, these disorders can get truly bizarre and hallucinogenic, like a bad acid trip. The skin texture on a face can change, or their noses or eyes seem to be stretched and exaggerated in grotesque, plastic-y ways. Sometimes a person’s face and mouth are replaced by geometric shapes—triangles, hexagons, and so on. When that happens, I call it “going Picasso” because they remind me of his cubist paintings. I’ve had faces appear to be made of potato skin, or tree bark, like the talking apple trees in Wizard of Oz. And I’ll never forget that time I looked at a manager, and he gazed back at me with—no joke—the head of a dragon, complete with matte, black skin. (Thankfully, that distortion has only happened once.)

No one knows exactly what causes PMO, but it will lie in damage or dysfunction in the brain’s face processing network, which, as we’ve seen, involves several brain areas, including the fusiform face area (FFA) and superior temporal sulcus (STS). The condition has also been associated with damage or abnormalities in the temporal, occipital, parietal, and frontal lobes. Generally, PMO is linked with brain damage or injury (this accounts for around 75% of cases of PMO), which may be caused by head trauma, stroke, lesions, or cysts. PMO may also be a manifestation of epilepsy or migraines. Damage to certain brain areas likely accounts for distortions that appear in specific locations on the face, depending on which side of the brain is affected. The condition is a visual/neurological problem, not a psychiatric one (although it can, of course, be tied to psychological distress, and it may also be tied to other conditions, although it should not be confused with a misdiagnosis like schizophrenia).

PMO facial distortions are often perceived as ugly, with eyes and teeth becoming prominent. Some describe the faces as cartoon-like. Faces are often perceived as contorted, disfigured, and having displaced features. One eye or eyebrow may be higher or lower than the other, eyes may droop, or features may look like they’re melting or be at weird angles. PMO can affect the whole face or just one side. Antidepressants and antipsychotics have not been seen to improve symptoms, although other medications like valproic acid and heparin have helped some patients. Often, those living with PMO come to accept and adjust to their symptoms, although this can take some time, as understandably, seeing people with demon faces or mistaking their identity can cause distress, as well as difficulty in one’s social life, relationships, and at work. McCart said:

[F]or most of my life, I did my best to ignore the symptoms and go about my day. I learned to recognize people by their shoes, or their clothes, or the way they walked. When I’d go on trips with friends and I’d get separated from them, I’d stay where I was and wait for them to find me—rather than walking off with someone who simply looks like them. I could manage. But my prosopometamorphopsia became an issue at an old job at an AV company, which was filled with a bunch of men in their 20s, who—to me—all blended together. I’d think I was talking to Tim, when really I was talking to Joey….

I’ve never been able to determine the cause of my prosopometamorphopsia, and it doesn’t kick in with every face I see. I did get diagnosed with autism a few years back, and Duchaine has told me that the disorder can be a side effect. There is also what I like to call the Sulfa Incident. Years ago, to treat a weird cyst on my leg, I was diagnosed with a sulfa antibiotic that my body reacted poorly to, and I was later told that I might have a sulfa allergy. The point is, afterward, my prosopometamorphopsia was further exacerbated—beyond face blindness and toward “Why does that person have a hexagon over their nose?” I’ve come up with some ways to alleviate those symptoms. Sometimes sitting down and drawing simple doodles of human faces helps me, like a way to remind myself what people look like.

But you know what? At this point, the distorted faces I see don’t scare me anymore. I’m used to it. I’ve made peace with it. Yes, when I first saw that dragon it was truly terrifying. Stuff like that would make me gasp. But now I’m able to relax, take a deep breath, remember that it’s just my stupid brain acting up. People don’t look like dragons, and thank God for that.

Types of Psychedelic-Induced Facial Distortions