Why I'm Smiling (It's Not What You Think)

A year after the onset of my constant, unyielding headache, my partner Brendan came home from a visit with a close family member visibly frustrated. This loved one, on board since the onset of my pain, had made an offhand comment about how I couldn't be doing that poorly, since every time he saw me I was smiling.

Two years into chronic pain, B and I decided we could not put off international travel plans indefinitely and braved a 2 1/2 week trip to southern Africa to visit a dear friend in the Peace Corps. I vomited three times the first morning in Botswana, going on to average at least one pain-induced puking session a day over the course of our trip. But that first day, I was also given my Tswana name by a few of the locals in Molepolole: "Bitumelo," which literally means "happy." I was smiling.

Pain isn't always written on our faces.

These are just two quick examples of a situation the chronically ill/hurting face on a daily basis. Unless we spend the duration of an encounter crying, whining, or stoically silent, we open ourselves to questions like, "Do you still have [insert condition here]? You seem so energetic." Worse, others don't even ask; they make statements full of assumption: "You look so happy! You must be feeling better."

I understand why people associate smiling with well-being. Studies show that even doctors treat and prescribe differently based on a patient's physical presentation. (For more on this, see my piece on Gender Bias in Pain on Adios Barbie.) But let's face it, there are many socially-sanctioned reasons to smile. Many of them have nothing to do with feeling good, and when dealing with someone who has chronic illness or constant pain, entertaining only one interpretation of a smile can be extremely invalidating of our experiences.

A few reasons I may be smiling:

• It's polite. In our culture, bright eyes and a smile are the easiest ways of making oneself friendly and approachable. This expression says, "I'm paying attention to what you're saying. I'm interested in you." And it isn't exactly socially acceptable to curl up in a ball and whimper, even if that's what I feel like doing.
• I'm happy to see you, despite my pain. This is twofold: As a person who rarely gets out of the house, I genuinely smile as a response to seeing someone I love, but I also particularly make an effort to smile to show you that I'm happy to see you.
• I'm protecting you. I get it. It's hard to maintain a relationship with me when I am so low-functioning. I want our time together to be pleasant, and I recognize that me acting like a Debbie Downer is depressing, and won't encourage you to hang out with me again.
• I'm protecting myself. Sometimes, I just want to pretend I'm "normal" for a little while, to get a mental break from the discomfort and monotony that make up my days. Sometimes, I am in so much pain (or so exhausted) that I feel like I might burst into tears if anyone probes farther than polite greetings.
• It releases endorphins, the body's natural painkillers. It may seem ridiculous to a healthy person, but I have to make conscious efforts to engage in activities that produce particular chemicals in my brain in order to reduce pain/stress and increase feelings of well-being. I eat certain foods, I meditate, I do yoga, I listen to music, I get out in nature... and I smile. It's one of many healthy, natural forms of self-medication.

This is by no means an exhaustive list, and it's important to recognize that the reasons those with chronic pain or illness might smile are as varied and individual as the people themselves. It's merely meant to open the door to discussion and personal reflection. Maybe the next time a loved one makes an assumption about your smile, you'll feel comfortable offering a gentle correction. Maybe the next time you see someone else smiling, you'll think twice before jumping to conclusions, and ask an open-ended question instead.

Why do you smile? Feel free to chime in in the comments section below, or join me on Twitter (suggested hashtag: #ismilebecause).