top of page
  • Writer's pictureAmanda Burns

Smiling on the Outside, Emotional or Physical Pain on the Inside

Have you ever noticed someone smiling while telling a traumatic story? Ever had an experience where someone having chronic pain appeared to be more cheerful than you would expect? Ever noticed someone was crying from emotional or physical discomfort, then stop when around their loved ones as if it disappeared? Does it mean they are faking their experience? What do we believe to be true?

In my 25 plus years working in health care, I saw this all the time. I also see it now in my therapy practice. The palliative care patient experiencing pain switch their focus and put on a smile when loved ones enter. The firefighter who, while sharing the horror of a difficult rescue, smiles. The client who smiles while recounting a traumatic life experience. Confusing perhaps, but now I understand what this apparent phenomenon entails.

Typically, we would assume people should have an expression that is consistent with their lived experience. I see that this is not always the case as in my work, when the door is closed to the outside world, when they feel comfortable that I can handle hearing their actual pain, the mask comes off. They no longer must put in the energy into pretending, and they then can permit themselves to share their distress.

The smile and external façade are a defense mechanism, attempting to hide their true experience of emotional and/or physical suffering. Another way to think about the smiling affect amide emotional or physical pain is to see it as wearing a mask. People who are suffering may offer no hint of their problem to the outside world. Still, they nonetheless are, in fact, suffering. Underneath the mask can lie sadness, fear, dread, panic, and various pain experiences, to name just a few.

In a comprehensive article on smiling [shared below], the authors suggest that there are three different types of smiles which have discrete functions, which are:

  • Enjoyment smiles: believed to be displays of positive emotions like happiness indeed.

  • Dominance smiles: refers to the smiles that reflect a dominant social status or control.

  • Affiliative smiles: refers to those smiles that express positive social motives and serve to create and maintain social bonds.

So which category do smiles occurring during pain belong to? Since pain is an agreeably unpleasant experience, likely, smiles during pain are not enjoyment smiles. Dominance smiles could emerge as the person experiencing pain takes on that the distress as an “opponent” and smiles in the face of that pain. The person may see pain as an adversary and something to be controlled. Recall the phase like the term “smiling in the face of danger”? The article finds that more likely, smiles that occur during pain tend to belong to the group of affiliate smiles predominantly. What this means is that the smile is motivated by social factors to create and maintain social connections.

Social connections are vital for all humans. Brene Brown reminds us that “we are hardwired to connect with others, it’s what gives purpose and meaning to our lives, and without it, there is suffering.” People crave to feel connected, particularly when they are in pain. This is often why many first responders and health professionals do not share their work trauma with their loved ones. They do not want to feel alienated by others, particularly if they think that others can’t cope with the truth of what they endure.

Smiling can actually create good emotions and moderate bad ones. One of the first major studies investigating the benefit of smiling was published in 1983 in the journal Science. University of Washington psychologist Marsha Linehan and her colleagues found that when people altered their facial expressions on a purely muscular level, their emotions were affected. So was activity in the nervous system associated with positive or negative emotions. We also understand that the brain region called the Anterior Cingulate Cortex is where the pain receptors live for emotional and physical pain. So, smiling can be a form of pain management.

Things to consider the next time you are perplexed by a smile that does not seem to fit:

  • Smiling, even with no emotion behind it, may help people tolerate pain.

  • Smiling can create good emotions to counteract and cope with the negative pain experience.

  • Smiling may act as a protective mechanism to avoid alienation by others who are not comfortable with distress.

  • Smiling may act to reconnect to the part of themselves that previously the “happy self.”

  • The smile may be a mask to protect the person against the chronic nature of their experience.

  • The person may just need a break from the continual experience of misery.

  • You may be missing important clues and assume someone does not need support.

Do not let the smile fool you if it doesn’t seem to fit!



Smiling in Pain: Explorations of Its Social Motives

If You See Me Smiling Through the Pain

Smiling & Pain

P. M. Niedenthal, M. Mermillod, M. Maringer, and U. Hess, “The Simulation of Smiles (SIMS) model: embodied simulation and the meaning of facial expression,” Behavioral and Brain Sciences, vol. 33, no. 6, pp. 417–433, 2010.

Photo by Javardh on Unsplash

4,717 views0 comments

Recent Posts

See All


bottom of page