Smile by Sarah Ruhl is a memoir that covers her diagnosis of Bell's Palsy immediately following the birth of her twins. Bell's Palsy paralyzes half of her face and gives her an asymmetrical look and a new inability to express emotion as she had all her life. The majority of those who suffer with this recover pretty swiftly, but a small percentage don't. Unfortunately, Ruhl is in the smaller percentage. I found this memoir fascinating. She reveals what it's like with this diagnosis and how it hinders her life. She is especially vulnerable about her role as mother and active playwright. Smile reminded me a little of Wintering by Katherine May in the sense that she delves into a huge variety of topics related to Bell's Palsy, facial expressions, emotions, and parenting. If you enjoy memoirs that go beyond the author's perspective and share historical, religious, and philosophical ruminations, you might like this one.

Thank you NetGalley and the publisher for providing this ARC. All thoughts are my own.

Sarah Ruhr is always a genius and this book is no exception of course. So happy to have the chance to read it.

Such a wonderful memoire by the Pulitzer prize winning playwright. A beautiful story of motherhood, success and healing.

“Smile”, a metaphysical and medical odyssey, begins when two-time Pulitzer Prize-winning playwright Sarah Ruhl gave birth to twins a decade ago. Despite a high-risk pregnancy, the twins were miraculously born, after which Ruhl suffered from postpartum depression. She then developed Bell’s palsy, the paralysis of the seventh cranial nerve. In her case, it paralyzed the side of her face. For most people, Bell’s palsy goes away within three months, however she was in the minority of slow, chronic recoverers.

This memoir investigates what it is like to be unable to smile when you want to smile, and what the relationship is between an inner landscape when the outer landscape doesn’t match.

Ruhl finds chronic sufferers shame and self-blame fascinating. Why does the patient feel the illness is their fault?

When Ruhl was in hospital with the twins, she describes how frustrating she found being unable to smile in appreciation at the nurses. Feeling like her face was a flattened out canvas was hard, for a long time it flattened out Ruhl’s inner life because she couldn’t express what was going wrong with her face.

In “Smile” one learns the effects of Bell’s palsy are more than what you see. The cranial nerve is tiny, but responsible for many things. Ruhl found loud noises excruciating and suffered from terrible headaches. After the acute phase passes, so do these symptoms but, for Ruhl, the most pronounced symptoms were the inability to smile or blink. It took her six months to blink again. After ten years, she stopped searching for a cure for the paralyzed side of her face.

Sarah Ruhl’s prose is natural and precise. “Smile” is an intimate, insightful, and inspiring memoir. It is about accepting yourself with your imperfections.

A huge thanks to @NetGalley and @SimonSchuster for the advanced reader’s copy.

Sarah Ruhl's memoir of living with long-term Bell's palsy. As a rule, Bell's palsy lasts a few short weeks and is gone. Sarah's lasted for ten years. While expecting her second child, she discovered she was expecting twins. After a traumatic time with the rest of her pregnancy, she delivered a boy and girl, both requiring NICU time. She also developed Bell's palsy. She described her face as not being able to smile for ten long years and how this might, or might not, affect her children's perceptions of her as a parent. She dealt with uncaring, uninformed doctors, untried treatments, all to no avail. For some time she was unable to write her plays or take part in their performances, until, finally, she decided to get on with her life. Fortunately she had a caring husband and family and friends who could give her a lot of the support she needed. There were parts of the book that were tedious, well-written but tedious and those I skimmed.

Sarah Ruhl is a lauded New York City playwright (Eurydice et al.). These warm and beautifully observed autobiographical essays stem from the birth of her twins and the slow-burning medical crises that followed. Shortly after the delivery, she developed Bell’s palsy, a partial paralysis of the face that usually resolves itself within six months but in rare cases doesn’t go away, and later discovered that she had celiac disease and Hashimoto’s disease, two autoimmune disorders. Having a lopsided face, grimacing and squinting when she tried to show expression on her paralyzed side – she knew this was a minor problem in the grand scheme of things, yet it provoked thorny questions about to what extent the body equates to our identity: "Can one experience joy when one cannot express joy on one’s face? Does the smile itself create the happiness? Or does happiness create the smile?"

Women are accustomed to men cajoling them into a smile, but now she couldn’t comply even had she wanted to. Ruhl looks into the psychology and neurology of facial expressions, such as the Duchenne smile, but keeps coming back to her own experience: marriage to Tony, a child psychiatrist; mothering Anna and twins William and Hope; teaching and writing and putting on plays; and seeking alternative as well as traditional treatments (acupuncture and Buddhist meditation versus physical therapy; she rejected Botox and experimental surgery) for the Bell’s palsy. By the end of the book she’s achieved about a 70% recovery, but it did take a decade. “A woman slowly gets better. What kind of story is that?” she wryly asks. The answer is: a realistic one. We’re all too cynical these days to believe in miracle cures. But a story of graceful persistence, of setbacks alternating with advances? That’s relatable.

The playwright’s skills are abundantly evident here: strong dialogue and scenes; a clear sense of time, such that flashbacks to earlier life, including childhood, are interlaced naturally; a mixture of exposition and forceful one-liners. She is also brave to include lots of black-and-white family photographs that illustrate the before and after. While reading I often thought of Lucy Grealy’s Autobiography of a Face and Terri Tate’s A Crooked Smile, which are both about life with facial deformity after cancer surgery. I’d also recommend this to readers of Flesh & Blood by N. West Moss, one of my 2021 favourites, and Anne Lamott’s essays on facing everyday life with wit and spiritual wisdom. (4.5 stars)

This one is SO GOOD! The writing is amazing and so relatable. You can fee Ruhl's anger and frustration. It is so emotional but also hopeful. I truly enjoyed this one and I understand why it was one of Time's best books of the year.

I felt like this book didn’t captivate my attention like I wanted it to. Was a slow read. I wanted more from the story.

This book blew me away. I had read Ruhl's collection of "100 Essays I Don't Have Time to Write" and enjoyed it, but I almost want to go back now and reread those essays, with a new understanding of the context in which they were written. Ruhl's story of her fight to win back her smile from the vicious grip of Bell's Palsy was agonizing and uplifting. Her vast array of accomplishments during this time (and before) is humbling, especially considering the additional setbacks she's encountered along the way. As a working mom, I love to see someone achieve so much despite the naysayers in a competitive field. Ruhl's accomplishments in the theater and in her writing alone are more than extraordinary; the fact that she achieved them with often severe and chronic illness and while raising three children is near miraculous.

Very good read. I definitely would recommend this book to my friends and bookish friends & family. The book definitely is one that will stay with me for quite sometime. Thank you for the opportunity to review.

Smile: The Story of a Face by Sarah Ruhl is a raw and honest look at motherhood, being an artist, and dealing with a long-term medical issue. In the writer's case, the birth of her children causes the onset of Bell's palsy, which ends up being a ten-year medical odyssey.

This book is for anyone who has ever gone from practitioner to practitioner looking for an answer or those seeking understanding. It's for anyone who has ever been asked, "Have you tried acupuncture?" It's a deeply personal journey, but it's also one that will be deeply felt by anyone who has been felt unseen and bewildered - trying to find a way forward when the existing treatment protocols don't provide relief.

Many thanks to the author, publisher, and NetGalley for sharing this book with me. All thoughts are my own.

Thank you, Sarah Ruhl, for writing this book!

I've never had to face the condition you did as you learned to live with Bell's Palsy, and work your way through your life with an odd ?disability? feature, condition. . . .but I'm grateful to have read through this book and had my eyes opened to life with this . . .condition.

Mostly I enjoyed the writing, the expression of feeling and emotion, the explanation of how regular life presents problems a person without the condition has ever considered. Such an eye-opener, mind-blower and description of this troubling personal catastrophe - talk about full stop! And a double whammy for those who do not return to their "normal" face. I've had one close friend who had this condition - also at the end of a pregnancy. . .but she mostly stayed hidden and away from her usual crowd until it was gone and we just heard about it in the aftermath story.

I loved the haikus at the end, and all the different ways the author approached solutions. Brilliant! And then how she approached acceptance and learning to live with her life, her face as it is, not waiting for one test of perfection to happen before she moves on. . . life just keeps going one foot in front of the other, one smile after another.

An excellent read. Inspiring, practical, realistic and full of love. She knocked me out when she reached out of the book, touched my face and said she loved it. Absolutely stunning. Took my breath away.

What an inspiring raw, veracious journey. Ruhl is an amazing woman, her story full of hope, gratitude and love. A woman demonstrating poise and grace during a difficult trial. Ruhl hit home with me in numerous ways. Wonderful read, highly recommend. Insightful, interesting only begins to scratch at the surface.

Lots of wonderful gems and nuggets and things that encourage thought. I love this cover and how Sarah Ruhl pulls together research, history, drama, theater with her memoir about her Bells Palsy.

Wonderful book by an amazing playwright and poet. I am always so impressed by Sarah Ruhl's range and power.

Sarah Ruhl ushered three things into the world during the same year--a play that opened on Broadway and her twin babies. After spending months on bed rest and closely monitoring her pregnancy due to cholestasis of the liver, her babies were delivered safely. But the next day, her lactation consultant noticed her face was drooping and Ruhl learned that she had Bell's palsy. Then her babies are rushed to the intensive care unit. When they all finally go home, Ruhl wonders if she is living in a fairy tale--did she trade the face she didn't know to cherish for the safe delivery of her children?
This story is both deeply personal and terribly universal. Ruhl writes about the number of women who become depressed while on bed rest, women who develop severe conditions during pregnancy or after giving birth, and the parents who anxiously wait for answers about their babies. Many parents can remember the specific exhaustion of waking up to feed a baby or the uncertainty in helping an older child navigate a changed family. Hopefully, all of us can remember the moments when someone showed up for us like they do for Ruhl--for an important achievement at work, to drive us home from the hospital, or to walk our newborn in soothing circles while we catch a few moments of sleep.

I first experienced the magic of Sarah Ruhl's words when I read some of her plays for a theatre class in college. Playwrights, by necessity, are sparse writers. There is not a lot of room for extra words when actors must keep the audience interested in what is happening onstage. As someone who spends a lot of time thinking about the right words and facial expressions to convey meaning, it was devastating for Ruhl to not be able to pronounce p sounds as she read to her daughter or smile to convey warmth and friendliness. "I felt inside a paradox: I thought I could not truly reenter the world until I could smile again; and yet, how could I be happy enough to smile again when I couldn't reenter the world?"

Smile is indeed the story of a particular face. It's also a chronicle of a mother with an intense career and a woman who has to navigate a health care system that often fails its patients. Ruhl is funny and relatable and there are moments it seems ridiculous that she can make a story about her pain so compelling and delightful to read. I'm glad she decided to share this story with the world and hope that it will help more people discover both her prose and her plays.



Smile: The Story of a Face
By Sarah Ruhl
Simon and Schuster October 2021
256 pages
Read via Netgalley

Smile is the story of Sarah Ruhl's ten year journey with Bell's Palsy. Shortly after Ruhl gave birth to her twins she developed Bell's Palsy, this is a nerve condition where the person looses control of one half of their face. The vast majority of people recover fully in a short period of time. Ruhl was not one of these people. Over ten years, Ruhl saw physical therapists, acupuncturists, neurosurgeons, and many more. During this process Ruhl learned that she had celiac disease when it appeared that the nerves were just not regrowing fast enough. This discovery explained why she spent her childhood sick and saved her oldest daughter to experiencing the same thing. Ultimately this is a story of how we finally accept things we can begin to find the people who will truly help us.

This was a memoir unlike I have ever read. It was very specific in it's scope and while not a topic I in general cared about I was fascinated by her journey. I highly recommend.

https://www.npr.org/2021/10/06/1043641296/sarah-ruhls-smile-records-her-experience-with-bells-palsy

Toward the end of her new memoir Smile: The Story of a Face, playwright Sarah Ruhl parses the distinction between the disappointing and the tragic: "Disappointing things were not for the written word, disappointing things were for the stiff upper lip. Tragic things are for the written word, because in tragedy there is catharsis, not slow, incremental, often invisible progress."

The "disappointing thing" here that Ruhl thought for so long did not deserve to live on the page is her ten-year affliction with the idiopathic — spontaneous, unexplained — condition Bell's palsy, which renders the muscles on the left side of the face paralyzed or weakened due to a damaged seventh cranial nerve. As mysteriously as they descend, about 85 percent of cases resolve on their own within three months; 95 percent resolve within a year. Ruhl's falls in the small percentage that persist permanently, suppressing her smile.

This condition is, indeed, not a calamitous one, especially when considered in the context of a pandemic that has killed one in 500 American residents. Ruhl is aware of how "small" her "half-smile problem" seems, especially as her life has been blessed with "abundance." In the same year that her Bell's palsy appeared alone, she mounted "In the Next Room, or the vibrator play" on Broadway, which was nominated for a Tony Award for Best Play and a finalist for the Pulitzer Prize for Best Drama. She also gave birth to twins, making her a mother of three. It was in the maternity ward, a day after delivering the twins, that Ruhl's face fell. (Bell's palsy is more common during pregnancy and the postpartum period.)

But while the condition is not life-threatening, it can be life-altering precisely because it affects the face, and the smile — the ability to communicate our interior feelings to the world outside of us. As Ruhl notes, not being able to smile presents a conundrum: "How to experience joy when you cannot physically express it?" In this way, the merely "disappointing" merits deliberation.

But while Smile records Ruhl's coming to terms with her new face and the conundrums it presents, it is not limited to "the story of a face," as the memoir's subtitle suggests. For much of the book, Ruhl's condition recedes into the background as she accounts for the goings on of her life over the ten years since her "smile walked off [her] face." Ruhl organizes the book into 32 short chapters, and the first 24 give the feel as much of a memoir of parenting very young children while working as a renowned playwright as a memoir of illness. This is in part because Smile proceeds linearly, and about two-thirds of it takes place in the two years after Ruhl's twins were born and thus after her Bell's palsy diagnosis, with interstitials that scatter away to abstractly explore smiling, symmetry and asymmetry, beauty standards, and loss.

Ruhl's writing on parenting and theater is engaging and insightful, especially in a chapter titled "Three Children Under the Age of Five and Three Kinds of Vomit." Her broader ruminations on topics like Mona Lisa's smile and the idea of having a "good side" are similarly compelling, though a riff on the prevalence of asymmetry and disfigurement in pop culture villains ("Captain Hook. Darth Vader. Doctor Poison in Wonder Woman.") weirdly waltzes past deeper consideration of why disabilities are coded as evil. Later, Ruhl gives credence to the practice of physiognomy without noting that this pseudoscience was used to provide "evidence" for racism. These digressions — some of them belabored with explanation that does not trust the reader's intelligence (do we really need a primer on what gluten is in 2021?) — began to feel as though they served to avoid dwelling on Ruhl's personal experience of persistent facial paralysis and treatment thereof.

Ruhl does transmit what her condition felt like physically — "My face felt like a system of moving parts: this part moved, that part didn't. I felt like anatomy rather than a whole" — and emotionally — "I was full of self-blame for my face not getting better." These insights allow for the reader to empathize, a crucial function of any illness narrative. But for much of Smile, she resists ascribing meaning to her decision-making around her Bell's palsy. She notes at several junctures that she determined not to seek further treatment, that she ducked googling her condition for nearly two years, that she had again given up on getting better, that she didn't call her neurologist friend to discuss her condition in detail until nine years had passed. It is not until the last 50 or so pages of the book that she begins to grapple with why she evaded her own face. The revelation that comes — "I realize I have had such shame over my broken face that I have not even attempted many subtle expressions for a decade" — does not feel like one that needed to be held off on until nearly the end of the book, even if it took Ruhl ten years to ascertain.

At the end of Smile, Ruhl writes, "My many years of writing plays tells me that a story requires an apotheosis, a sudden transformation. But my story has been so slow, so incremental; the chronic resists plot and epiphany...A woman slowly gets better. What kind of story is that?" Like Ruhl's initial belief that "disappointing things" don't warrant "the written word," and the padding of the book with tangents, this betrays a reluctance to tell a story that feels small and slow — odd given her work as a playwright to "make the small, quiet moments theatrical." Her mistake is that memoir does not require a single epiphany, but would do well to offer many moments of retrospective meaning-making.

This memoir by the well-known playwright Sarah Ruhl is moving, inspiring, educational and sobering. It makes me want to see her plays.

Playwright Sarah Ruhl, recipient of a MacArthur Award and two-time Pulitzer Prize finalist, turns her pen to memoir in this exploration of living with Bell's palsy. After surviving a high-risk pregnancy, Ruhl discovers that the left side of her face is completely paralyzed. For more than a decade, she grapples with the emotional aspects of her changed face--a face which can no longer adequately convey her emotions and intentions. Ruhl's book highlights the social construction of both the body and personal identity. While this is a personal memoir, it is also a meditation on the gender construction, on the construction of a public persona, on motherhood, etc. Excellent.