Smile by Sarah Ruhl review – what if you could no longer look happy?

“Smiling doesn’t win you gold medals,” the gymnast Simone Biles famously retorted when a judge told her to smile more. While that may be true, few would deny that life without smiles would be diminished in ways we can scarcely imagine. What do they mean to us? Does the physical act of smiling create joy, or the other way around? What happens if you can’t smile, even though you want to? These are questions that the distinguished American playwright Sarah Ruhl explores, with a winning combination of wisdom and erudition.

Ruhl lost her smile for more than 10 years due to Bell’s palsy, which caused the left side of her face to be almost completely paralysed. The morning after she gave birth to twins, a lactation consultant remarked that her eye looked droopy. When she looked in the mirror, she was astonished to see that half her face had fallen. She couldn’t move the left side at all. That moment marked a profound shift in her life. “Before I looked in the mirror, I was the same person. After looking in the mirror, entirely different.” Bell’s palsy can be brought on by childbirth, although the link is not well understood. While most sufferers recover in weeks or months, Ruhl was one of the unlucky few in whom it endures.

At the time, Ruhl was on a professional high; one of her plays had just transferred to Broadway, and was nominated for a Tony award. She had been anxious about the impact of twins on her career (she already had an older daughter, aged three). Soon after they were born, Vanity Fair asked her to do a Tony awards photoshoot. Photographers yelled at her on the red carpet: “What’s wrong with you – you can’t smile for your Tony?” When she saw the photo, she couldn’t bear her expression of existential pain, and resolved not to be photographed again. “I felt inside a paradox: I thought I could not truly re-enter the world again until I could smile; and yet, how could I be happy enough to smile, when I couldn’t re-enter the world?”

The personal implications were more torturous still. What does it do to her babies, she wonders, to look into an unsmiling face every day? Will they know that their mother loves and delights in them? She reads that mothers teach children empathy by mirroring their facial expressions. Will her inability to do so mess her children up? And on it goes, Ruhl’s ability to feel joy maddeningly limited by her inability to express it. She observes that joy is a profoundly embodied experience, and quotes Thich Nhat Hanh: “Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.”

Ruhl makes many interesting observations on the wider significance of smiles, from strangers in the street demanding that women should smile, to the frozen statue of Hermione in The Winter’s Tale. But she wears her academic hat lightly, skipping easily from Shakespeare back to the chaos of her family life, in which theatre rewrites are cut short because all three children are vomiting. This is a book about far more than smiles: some of the most touching sections look back at Ruhl’s childhood, and the experiences that propelled her into theatre. The tale of a health condition is, more interestingly, the tale of the person it afflicts.

The book takes gentle aim at the limitations of conventional medicine, with its stark division between the mind and the body. Like many people who live with chronic health conditions, Ruhl is forced to become part detective, part medical researcher, as she tracks down the people and therapies that work for her. But Smile is not just a medical memoir; it’s the story of a passionate and committed woman trying to forge a life that nourishes her creativity, her children, her health and joy. That’s a journey many of us can relate to – and this book serves as a welcome invitation to worry about it all a little less, and smile a little more.