After giving birth to twins, playwright Sarah Ruhl (Dear Elizabeth; How to Transcend a Happy Marriage) found herself unable to smile--or even to move the left side of her face. Ruhl soon discovered she had Bell's palsy, a condition characterized by muscle droop and weakness on one side of the face. In her sharply observed memoir, Smile: The Story of a Face, Ruhl chronicles her decade-long experience with Bell's palsy, and the disease's emotional implications for the rest of her life.

Like many mothers, Ruhl was focused on her babies during labor and delivery, especially when both twins had to spend a week in the NICU (Neonatal Intensive Care Unit). But while she was still in the maternity ward, she realized she couldn't close her left eye, or move the muscles on that side of her face. After bringing home both children and adjusting to her newly expanded family (which included an older daughter), Ruhl expected that her Bell's palsy would gradually disappear. It didn't. "In fairy tale logic," she writes, "you must trade something for something you desire. By this logic, I trade my face for my children. And it is a fair trade." But the longer the malady lingered, the more Ruhl began to wonder if her affliction wasn't a simple trade, but a symptom--or an effect--of something deeper.

Born and raised in the Midwest, Ruhl grew up smiling without a second thought at both friends and strangers. "They hand [smiles] out along with lollipops at the bank," she writes of her native Illinois. "Nice, big, broad untroubled smiles that you have to undo when you move to New York City." Although Ruhl had long since adapted to the more reserved style of living and socializing in New York, her work in the theater world meant that she interacted regularly with dozens of people--actors, directors, production staff--for whom affect (theirs and hers) was supremely important. Being unable to smile at hopeful auditionees, colleagues and friends was bad enough, but Ruhl worried constantly about her children. Would they still understand that she loved them, even though she couldn't form expressions of delight? Would her half-frozen face somehow stunt their emotional growth during their formative years? Ruhl meditates on these and other questions in Smile, while also charting her attempts to find a "fix" for her Bell's palsy. She tries a long list of possibilities--acupuncture, Alexander technique, physical therapy, even neurosurgery.

As a playwright and a woman, Ruhl is keenly aware that cultural myths and mores around smiling differ greatly for women and men. She muses on the ways women are perceived--as angry, detached, even lacking in emotional intelligence--if they don't smile when it is expected of them. She considers the role of smiling in pieces of art, from the Mona Lisa to her own plays, and the ways in which smiling has a chicken-and-egg effect on one's emotions. "I felt inside a paradox," she writes. "I thought I could not truly re-enter the world until I could smile again; and yet, how could I be happy enough to smile again when I couldn't re-enter the world?"

As her children grow and her face remains frozen, Ruhl eventually finds ways to move on with the rest of her life: teaching, staging new plays, mothering her children, publishing a book of essays drafted mostly on Amtrak train rides. She is candid about the constant juggling act of being a woman with a career and a family, and also about the added layer of difficulty caused by partial facial paralysis. It isn't all doom and gloom: she takes great joy in her children and husband, and deep satisfaction in her work. But she wants her face--or at least her freedom of expression--back.

It takes a long time, in the book and in Ruhl's life, for her face to reemerge, even partially, from its half-frozen state. "The partial recovery is not terribly dramatic. It is the stuff of life, not art. But the partial recovery is, I believe, very much like life. Most people have partially recovered from something." But in her honest account of life with Bell's palsy, Ruhl has managed to turn her partial recovery into a kind of art: a portrait of a face, and a body, sometimes at odds with the soul inside. Even readers who have never suffered a serious physical injury will recognize that disconnect: the sense that the body and spirit are not always in sync. Ruhl captures this disconnect with honesty, grace and frequent flashes of wry humor, without always needing to wrap everything up into a tidy insight. Smile is at once an illness narrative, a meditation on smiling as cultural practice and symbol, and a compelling, behind-the-scenes look at the life of a playwright and mother. --Katie Noah Gibson

(photo: Gregory Costanzo)

Sarah Ruhl's plays include Stage Kiss, In the Next Room (or the vibrator play), How to Transcend a Happy Marriage and Eurydice. She is also the author of three books, including 100 Essays I Don't Have Time to Write. She lives in Brooklyn with her husband and three children. Smile: The Story of a Face is her memoir chronicling a long struggle with Bell's palsy after her twins were born. It will be published by Simon & Schuster October 5, 2021.

What inspired you to write about your experience with Bell's palsy?

Bell's palsy in some ways dominated my life for years, but I never wrote about it, save for a tiny essay. I thought--"oh, that's my medical life" or "oh, that's a chronic thing to just get through," but it's certainly not a fit subject for a play (which is the form I usually write in). And at some point, I thought, "This inability to smile is dominating my thinking." I needed to get it down on paper, in the hopes that it might help other people, or that I might write my way out of an emotional snowbank where my car (spiritually, if you will) had gotten stuck.

The book is not only an account of your journey of fighting (and eventually accepting) your face with the palsy, but a meditation on smiling and the cultural and psychological implications of the inability to smile.

I've thought quite a bit for the last decade about the chicken-or-egg effect of smiling. In other words, does the smile create the joy or does the joy create the smile? Or both? And if that feedback loop is disrupted, how does one internally experience joy? This is a psychological question: it plays out differently in different cultures and addresses both the body and the spirit. I remember following a meditation practice while I could not physically smile and was told by the author to put a smile on my face in order to create internal relaxation and joy. And I wanted to hurl the book against the wall.

You address the reality that women are expected to smile more often and in different contexts than men, and the accompanying difficulty of being a woman with Bell's palsy.

I've seen women smile through difficult professional situations, and I've even seen women tell other women to smile through difficult professional settings. I think women use smiling unconsciously or strategically to ingratiate themselves in various settings that were built by men. I found that being unable to smile when meeting new people was excruciating, and for a life in the theater, which is so much about how you show affect, confounding. At least I am not an actor, I would tell myself.

I want to make clear that I don't think unresolved Bell's palsy is easy for men by any stretch of the imagination. As a chronic condition, Bell's palsy is a very hard mountain to climb, regardless of gender. But I do think men can, culturally speaking, do their jobs while projecting confidence without being asked to smile in order to reassure people.

As a mother of young children, you worried that your inability to smile "normally" would affect both your relationship with your kids and their emotional development.

Yes. I'd read about a psychological study where mothers with something called "still face," or lack of affect, interacted with their babies and the babies freaked out. I worried that the opacity of my face would lead to my babies not knowing, moment to moment, how delighted I was by them, how much I loved them. As it turns out, my voice was telling them that I loved them all the time, even when I thought my face was not delivering the right message.

Smile is the story of a journey toward healing that is decidedly not linear and doesn't fit in the "normal" box. Did writing about it help you make sense of the experience? What was it like to put together the whole narrative?

Writing the book absolutely helped me towards making sense of the journey. In a concrete but also symbolic way, I put the illness in the past tense, and the healing in the present tense. What an opportunity for a writer, or anyone really, to choose what tense they will put suffering in, what tense they will put healing in. I was both emotionally paralyzed by Bell's palsy and physically paralyzed; the writing of the book untangled a really tricky knot. Writing the book also helped me investigate some modalities I might not otherwise have tried--like physical therapy, which, it turns out, helped me a great deal. Making meaning out of illness--writing the story down, getting rid of unhelpful metaphors and creating new metaphors--was incredibly helpful to me. I also hope I find moments of humor within what can be a bleak medical landscape.

What would you say to readers who have, or have had, Bell's palsy?

If you're reading this and have recently had Bell's palsy, or know someone who has, please try to find the right doctor, get some anti-virals, and get some steroids immediately. And if Bell's palsy is not on your mind in that particular kind of way, I hope that the book finds you as a fellow traveler in the struggle to find joy, no matter if you're grappling with an illness, or just living with the inevitable suffering that life throws at us. --Katie Noah Gibson