Socially-awkward people go through intense struggles and play never-ending mind games with themselves. Although the DSM hasn't successfully diagnosed their affliction as yet (Avoidant Personality Disorder comes close), it is real and deeply troubling for those who experience it. Some hope the DSM VI will include a formal diagnoses along with recommended surgical remediation. Fingers crossed.
On with things...
Preston has a severe problem with his face. It's not that he has some macabre disfigurement forcing him to lurk in the shadows. He doesn't suffer from paralysis causing him to dribble food, stare at people, speak slurred. His condition, beyond his perception, is subtle, almost unnoticeable to those around him. Often, Preston is unaware of his condition and its tiny, yet insidious implications. He goes about his days working, playing with his kids, making love to his wife. Day after day, week after week the hours of happy progress, productivity, and vitality pile up. He is the quietly-favored neighbor on the block because he is so friendly, easy-going. Preston's coworkers think he's an affable, agreeable sort who's always pitching-in to get the job done. Preston's home life is pleasant, emotionally fulfilling. Preston, in moments of self-reflection, reckons himself among the luckiest, happiest people he knows. Except. Except that severe problem with his face. If only, Preston often ponders, I could find a way to resolve this one issue, this one piece of life that doesn't square. After these thoughts, Preston lumbers to the bathroom, clicks on the light, takes a deep breath, and laments the reality of his intractable frown.
Doctor Fizinger has exceptionally clean fingernails, a carefully managed vocal intonation and an absolute lack of body odor (sweet, foul or any gradation between). When not working he plays golf. When not golfing or working, he slowly rattles the ice cubes in his gin and tonic, thinks about golf. Just last year he finally got his passport at the age of 56 - he traveled to Scotland to play golf. The good Doctor Fizinger is focused and knows what he likes. He is methodical, promptly throws out each pair of underwear after a single use and enjoys having friends as long as they agree with him. Fizinger tends to golf alone.
Preston finally hit his breaking point, realizes that ultimate happiness is out of reach until the face-problem is resolved. How could something so minor, trivial even, cause such despair, such anguish? Never mind, Preston concludes, schedule a vacation, disappear for a week or so, resolve the damn face-thing once and for all. Preston spent months researching specialists, and to his surprise the world's foremost craniofacial surgeon is a mere 20 blocks uptown. Eight subway stops. As a bonus, Doctor Fizinger is in-network.
On the subway, Preston waxes optimistically about his prospects as the rails clicked. His spirits rising, he works through increasingly fantastic scenarios of an improved life after the perpetual frown is resolved. He will smile at random passersby spreading serendipitous nuggets of happiness around the city. He will explore the myriad fractional smiles residing between indifference and ecstasy and play them like a game of chess with interlocutors, eliciting whatever response his heart desired. He will sit for hours with his former bathroom nemesis, perfecting his craft. Preston imagines better birthdays. Endless vacation slideshows showcasing his contagious smile. Silent jokes insinuated with nothing more than a gentle smirk between cohorts. Preston's brain finds buoyancy in a dopamine-filled skull.
Preston is shocked by the austerity of Dr. Fizinger's office. A coat rack loaded with forgotten coats. A plastic plant shoved crooked into a floor pot. A wall covered with neatly framed accolades. An empty desk large enough to park a car. On the desk resides a tablet, an old office phone like a yellowed plastic switchboard and a pair of immaculate hands over which two thin lips say,
"I'm sorry, you said you can't smile?"
"Yes Doctor. Something is wrong with my face. Perhaps the musculature, the bone structure? I'm not sure, something. Something's preventing me from smiling. No matter what I do, my face simply won't abide. All the little movements, the eyes, cheeks, lips, don't orchestrate, they don't come together."
"Very curious. Tell me more."
"I mean, obviously I have a high degree of muscle control in my face. Clearly I'm manipulating my lips at this moment as I talk! My eyes, my cheeks. Look, I can wiggle my ears."
"So you can. Please go on."
"It's that, well, I've never injured my face and I don't have any birth defects. I don't have any diagnoses. I don't suffer from any pain. Socially, things are usually pretty OK. Except when something funny or amusing happens. I think about smiling. In my head I work through the mental process of activating each specific part of my face to generate the smile, but nothing."
"And, I'm left hanging. Me, there in the room frowning while everyone else is busting a gut at the punch line. Oh, I'm given to the little stochastic gyrations. The heaving. The little body stutters that allude to uncontrollable laughter. Even that little sensation of emotional bliss you get when caught off-guard by humor, I experience that. But, the worst. It's the worst feeling when, while my body is jerking with laughter, I make eye contact with a colleague. He sees me. He sees me! I'm there, appearing to get the joke (why the hell would I be jerking all around if I wasn't?) but my face, the whole time my face. A stone cold frown. A contemptible, unfeeling frown. And then my thoughts, they cascade... does he know I get the joke? Does he wonder if I actually find the joke funny or am I just playing along? If he thinks I am just playing along, does he wonder why I play along so poorly? Is he thinking, why convulse but not smile? Does he think I'm fucking weird? And Doctor, from there the thoughts spiral out of control. It's bad."
"It's just that...I think about smiling. I do! It's very frustrating. I think about smiling often, but, after my brain processes these thoughts, well, my face won't comply."
"That's unfortunate. Though, it sounds to me like a psychological issue. One with a very narrow manifestation. What do you think, any merit?"
"I completely understand why you would say that, and believe me, I've asked myself this question a million times. But, truth be told, I'm not overly concerned about people's perceptions of me. It's not something I lament. I don't spend time thinking about it outside of the moment in which the oddity is happening. I don't recede socially because of this issue and I don't avoid funny situations. For me it's more fixing this one little nagging concern fouling up an otherwise complete, happy life. I'd just like to nix this problem, move on with things."
"Ok, I see. Let's proceed. So, I'm a little confused here...are you actually capable of frowning"?
"Yes. Yes, of course, can't you see?"
"Ah well, ...alright, I see. Subtle, but OK. Your lips do turn slightly down at the corners, but the center of your mouth doesn't necessarily arc. It's just flat, mostly. Never mind. Like I said, subtle. Are you capable of other gestures, say puckering?"
"This is very unusual. Don't take that the wrong way, medically unusual. The inability to physically activate specific muscles given a specific social context. Have you spoken to anyone else about your condition, professionals I mean?"
"No actually, you were highly recommended by ..."
"Do you golf by chance?"
"Hmmm, nevermind. A theory was emerging. It's without merit, moving on. Let's do an examination, hop up on the bed please."
Preston hops onto the bed, lies back, and Doctor Fizinger conducts a thorough examination. Fizinger wants to tell a joke. It's a solid joke, one that's never failed him. However, he decides against it given the entirely non-deterministic nature of Preston's potential responses (and to preserve his coveted joke's perfect response rate). Fizinger's believes the exam went well, procedurally speaking, though it netted nothing actionable for his medical expertise. The good doctor imagines himself putting two similar balls into a grass-circled hole labeled "resolved".
"There is nothing I can do for you."
"Me too, but there is simply nothing I have to offer. You've said you have no injuries, no defects, no pain. Examination verifies your facial structure is perfectly normal, no abnormalities or indications of emerging conditions. At this point, I can only recommend that you seek assistance from a psychiatrist. Perhaps there is something larger going on that you are missing?"
Frustrated, but still committed to resolution, Preston follows Dr. Fizinger's advice and seeks out psychiatrist.
Dr. Gagney has a patchy presence online: a handful of moderately positive comments on various medical websites, his face posted next to his education credentials and board certs on others, and mention of his trout fishing hobby on a hospital website. Through further investigation Preston discovers the hospital closed just over three years ago. Preston rationalizes. Hospitals are businesses. Businesses close. People change jobs. Gagney's nearby and has 13 moderately positive comments across three different sites. Due diligence complete, Preston schedules an appointment with Gagney for the following week.
Preston dithers between two opposing thoughts. One, Doctor Gagney is only partially human (the visible portion) and could possibly be mixed with an alien species. The only reason he (if aliens are classified as "he") became a shrink was of a desire to learn how humans function. Two, Doctor Gagney is trapped in an alternative universe and the only portal for him to communicate with earth-life is through the office space bearing his name. He is not allowed to inform his patients about the alternative universe in which he's stuck (that would sound crazy), so he stares vacantly at his patients, periodically asking banal questions (the answers of which are self-evident). Preston's appointment with Dr. Gagney didn't go well. Preston received three prescriptions: one to calm him, one to improve sleep, and one to cheer him up. Regardless of his long track record of excellent sleep, his super-calm demeanor and his general happiness Preston fills the prescriptions and assiduously swallows pills everyday. Preston's determined to execute all professional advice in the hope that something might work.
To Preston's unsurprised disappointment, Gagney was a fraud. Ninety days of eating chemicals and the smile remains elusive. He attempts mechanical stimulation by poking the corners of his mouth upward to his mirrored reflection. He has spent sleepless nights watching Stand-up while drinking excessively. Desperate, Preston crushes his three pill cocktail into a fine powder, dissolves it in vodka. He shoots it, then smears the residual dregs around the circumference of his mouth as if wasted and engaging in strange, emotionally-distraught behavior. He realizes this is a little pathetic, too showy to be actual sentiment, but worth the try. Nothing happens (emotionally), though the dregs dry to a white crust encircling his frowning mouth, a sad clown our Preston is. Preston, hoping to elicit extreme emotion (an existential howl!), admits to himself he is hitting rock bottom. He knows he isn't (hitting rock bottom that is), but he's willing to go through the motions to possibly discover the next step in his journey toward the smile. He groans, long and low while half-drunk and stretched semi-naked across the broken-down lounge. The comedian works his bit, some well-worn joke about a boob job. Preston scratches the residual white crust off his face, ponders the morning commute. Dr. Hamm's rectangle face lurks in his subconscious.
Dr. Hamm is THE preeminent plastic surgeon in the tri-state region. His ubiquitous subway adverts cataloged the tri-state region's saggy eyelids, doughy chins while preying on the vanity of sleepy commuters. If your ass has too much fat, he can suck it out. If your nose is a bit bulbous, he can file that shit down. His perfectly huge, fluorescent white teeth smile next to the After pictures of many happy customers.
Hamm thinks ugly people are genetically inferior. And stupid. He spends his days cataloging, classifying and minutely articulating the very specific reasons that make people visually repugnant. If someone were to challenge him on the subjective nature of beauty, he would confidently retort and provide nearly unlimited evidence backing his claim. Dr. Hamm's assertion that ugly people are genetically inferior and stupid is not causal in nature, meaning he does not believe ugliness is due to a genetic or intellectual predisposition. To be clear, those who are genetically inferior and/or exhibit a below-average IQ are not automatically assumed to be ugly (though they certainly can be). In fact, Dr. Hamm has a Venn diagram expressing these relationships which he aggressively shares with his accountant in red years (his accountant is quite attractive and intelligent and only mildly put-off by Hamm's eccentricity, a different story altogether, stay focused reader). Rather, Hamm believes that anyone who does not meet the basic average for social attractiveness (a Hamm-defined term with very specific criteria) is playing with a Darwinian fire, and if the choice is made not to rectify the ugliness by way of surgical intervention, then clearly the subject's intelligence level is inadequate to ensure survival in a society favoring physical beauty.
Dr. Hamm's office reminds Preston of Hamm's teeth; gaudy and unnatural to the extent that it forces you to question your own very nice teeth. Roman revival with colonnades and cornices, flowing water, flowing fabrics, and hard smooth surfaces all around. Clearly a man capable of sculpting a suitable smile. Prescience of a win soothes Preston's perturbed psyche.
"Nice to meet you Preston, I am Dr. Hamm. Could I interest you in a drink, some chocolate perhaps?"
"No, thank you, I'm fine."
"Alright good enough, so let's get into it, what brings you here today?"
Preston goes through what has become routine at this point, though this time he goes deep. Our Preston has hit his breaking point. In a gush of repressed emotion, Preston finds himself capable of release in the presence of a perfect stranger. He shotguns his emotions onto Hamm's marble-top desk, then finds himself tethered to the desk by two strings of snot upon lifting his head. The strings wobble momentarily before giving way, snapping back onto Preston's quivering mouth. He considers the tether metaphorically for a moment, but then realizes he's reaching. Stretching for something, anything that ties him to firm, solid ground. He disregards it, reproaches himself in his moment of vulnerability, then raises bloodshot eyes to Hamm who, shaking off clear disgust, manufactures sympathetic eyes. Emotions and their hollow counterparts as compatriots.
"I'm sorry to go on like this [sniffle] ...this is the first time throughout this entire affair that I've broken down, been so out-of-control."
"There's no need to apologize, I understand. In my profession, it's not uncommon to see people reach their wits end, a moment of reckoning where they decide to no longer be the ugly duckling so to speak."
"Well, [sniff] to be perfectly honest, I don't feel like an outcast. I don't feel like I need a physical change to improve my looks. I'm satisfied with my appearance. It's only this issue of generating a smile when needed! Why is this such a challenge? Why does it seem as though there's no solution? I'm here, in a plastic surgeon's office hoping to solve a dynamic problem with a static, surgical solution! Have I gone crazy??"
"It's an entirely fair question. And, it's important to realize here that static doesn't mean broadly immobile or completely non-manipulable. My job is to enhance your face such that you retain maximum control over your expressions. Subtlety goes a long way in this business. Perhaps we only make tiny corrections, tiny adjustments that have broad applicability. Think about this. Our emotions manifest on our face in a million little signals and notes. These individual components have almost zero meaning in isolation. A squint here, a pucker there, a lip raise, a curl, a tightening, down eyebrow, up. All of these movements, all of these arrangements, form the symphony of our expressed emotions. And, of course there is variation between people as well. No two people produce the same type of smile just as no two people produce the same type of smirk. There are a million gradations, and I would suggest that there is no one individual who is perfectly capable of reproducing the exact same facial expression more than once in his life. Every facial expression is a new combination of muscle and skin positions within a socially recognized and accepted range. Our expressions are subtle and fluid, they are not precisely deterministic hence perfectly translatable. That should be our goal, to make small adjustments to your face to reduce the frown, and establish some micro-expressions that signal happiness."
Preston knows this is all bullshit, the snake selling his oil. Preston is at a crossroads. He realizes that the choice is upon him and, working through the math he boils the outcomes down to two scenarios. (1) Frown when others are laughing, or (2) laugh when others are frowning. Preston, being the optimistic sort, weighs all the options. He evaluates, calculates even, all the possible times from this day going forward where he will need either his smile or his frown. The magic of modern medicine offers to give him one or the other. Not both. Preston, in a final fit of desperation, makes a spreadsheet. Two columns, one for smile, one for frown. Under the smile column he lists birthdays, jokes, wedding anniversaries, potential birth of third child and many more. Under the frown column he lists disagreements, financial hardship, automobile breakdowns, gonorrhea (not his, but the idea of it) and others. He gets downright philosophical, quotes Marcus Aurelius to himself, "Dwell on the beauty of life. Watch the stars, and see yourself running with them", before making his decision. Smile. With nerves and clear eyes, Preston frowns at his wife as she holds his hand in the pre-op room and finds himself struck by the fact that "general feelings of optimism" didn't make it onto his "smile" list. Preston goes under the knife.
Later that evening behind a thick roll of gauze, Preston's head enjoys the boozy feelings of 1000 milligrams of Oxycodone. His wife makes a joke about baby birds as she hands him his dinner in a glass, giving him a warm supportive smile. Preston discovers that he no longer feels that tiny twinge of jealousy when other people smile.
Two weeks on, Preston walks toward his office building rehearsing lines about his surgery as he reports to work for the first day post-op. "Yeah, terrible nasal cavity polyps, a slightly misaligned palate...surgery went well. A bastard of a recovery though. All-in-all a success. Fantastic doctor!" Preston is pleased with the authenticity of his excuse though a little irritated that his surgical smile is decidedly less subtle than the one Dr. Hamm sold so vocally in pre-op. "Whatever," thought Preston "I made my decision, to smile is to be alive."
Inside, Preston sees a gathering in the break room and assumes a welcome back party. Butterflies. Walking closer he sees a huddle of morose faces, several women sobbing, fingers raking through hair in search of answers. Dead butterflies. The boss, the owner of the company, and his directors died tragically in a car accident the night before on their way back from the conference. The company's future is in jeopardy. The funeral is on Friday. Frozen, Preston mentally scans the items listed on his spreadsheet.
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