The human face performs many important functions. A loss of control over it has massive consequences.

You know me by my face, you know me as a face and you never knew me in any other way. Therefore it could not occur to you that my face is not myself.

Milan Kundera, Immortality, 1991

The mobile expressive face, in its complexity a uniquely human device, evolved as a unique identifier of individuals and as a visible readout of the experience and expression of feeling states or emotions which, in turn, seem necessary to regulate our more complex and larger social groups. Merleau-Ponty suggested, 'I exist in the facial expression of the other, as he does in mine.'[1] The face evolved not only to display but as a means to converse, to exchange, to share emotional experiences. We calibrate how well we are doing socially by the responses of those around us. If language changed everything in terms of our cognitive complexity then the face enabled complexity of emotion and social interaction. As Charles Bell suggested, ‘The thought is to the word as the feeling is to the facial expression.’[2] The face is such a given, so pervasive in our culture and our experience that we need to be awakened to how extraordinary it is.

The full force of this realization may be assisted by the experience of those who live without a mobile expressive face, but before considering this, what is it like to lose face?

John Hull, a professor in Birmingham, UK, knew he was going to lose his sight in his forties. Married with a young family he consciously remembered what his loved ones, friends and colleagues looked like, so he could remember them when he became blind; after all we are our faces. Though Wittgenstein famously wrote, ‘The human body is the best picture of the human soul;’[3] he might have suggested the human face. Remembering worked for Hull for a while, but, slowly, the images faded and with this so did his feeling of knowing his wife and children. He lost what he looked like too, and noted in his diary, ‘The horror of being faceless, of forgetting one’s own appearance, of having no face. The face is the mirror image of the self,‘ (11 January 1984).[4] He became depressed not on going blind but when he lost his visual images of family and friends.  Fortunately, over the next few years, he became more sensitive to the richness of voice in disclosing emotion and indeed one selfhood, such that identity and emotion became embodied in the voice and its prosody. But he described the period between his visual imagery of others to an auditory one as a black and empty void.[5]

In the rare condition, Möbius Syndrome, people are born without the ability to move their faces, or close their eyes or move their mouths. In addition their eyes do not move properly and they can have other problems with tongue movement, swallowing and a range of other areas. Initially the problems focus on feeding – they cannot suck - and eye care; later they need speech therapy, dental care and sometimes teaching support.

Many – most – with Möbius develop a resilience and enjoyment of live as adults. But this is not to say that the absence of facial expression does not have some profound consequences, which allow insights into what the face normally does without our awareness. One woman with Möbius, called Celia, could remember her time as a child quite clearly,

‘I did not do ballet or horse riding; I did hospitals and operations. I had the eye doctor and the foot doctor and a speech therapist, and a face doctor; my limitations a fact of life. I never thought I was a person; I used to think I was a collection of bits. I had all these different doctors to look after all the different bits. ‘Celia’ was not there; that was a name people called the collection of bits.’[6]

She continued,

‘I did not express emotion. I am not sure that I felt emotion, as a defined concept. At my birthday parties I did not get excited. I don’t think I was happy, or even had the concept of happiness as a child. I was saddened by being in pain [and] sometimes I would cry but even that would almost be a delayed reaction.’

A man with Möbius, in his early 50’s, echoed this,

'When meeting my wife, I think initially I was thinking I was in love with her.  It was some time later when I realised that I really felt in love. I think I get trapped in my mind.  I sort of think happy or I think sad, not really saying or recognising actually feeling happy or feeling sad.’[7]

So, without a mobile expressive face and the ability to reveal and share emotional expression, in some people the very feelings of emotions themselves may be reduced. To experience, we may need to express and share on the body and in the face. The miraculous thing is Celia and another woman with a similar impoverishment as a child did capture and embody – enface – emotion as young adults. Celia became an English teacher in Spain and found that by expressing through prosody and bodily gesture, in a supremely expressive culture, she began to feel in herself, for the first time, the emotions she expressed and embodied. The other woman was at music school and describes how during rehearsals for operatic performances she began to experience, for the first time in her 20s, the emotions in and of the music in herself. [8] One might be tempted to ask how we bootstrap emotional experience onto movements of the body and face. But Wittgenstein suggested that we should not seek to separate those two;

‘“We see emotion.” – As opposed to what?  – We do not see facial contortions and make the inference that he is feeling joy, grief, boredom. We describe a face immediately as sad, radiant, bored, even when we are unable to give any other description of the features. Grief, one would like to say, is personified in the face. ..‘The content of an emotion – here one imagines something like a picture. The human face might be called such a picture...’[9]

A better question might be how people with Möbius replace the deeply immersed relations between face, emotion and self with other channels, through gesture, speech and prosody.

Though we have stressed the interactions between people which faces allow, there is an area where the information is one way; fine art. The sitter is portrayed by the artist and the observer interprets the result. This might not be problematic for most people, but during researching a book on Möbius, I invited my co-author, Henrietta Spalding, who lives with Möbius herself, to sit for a portrait before audiences of medical students during a conference, one in the morning and one in the afternoon. Those present thought she looked more nervous from the first portrait in the morning than the second, even though her face, being immobile, portrayed nothing. Henrietta was vexed.

‘The audience could not possibly see physical feeling or emotion. The portrait was open to the artist’s interpretation and the audience’s take. How could they be accurate? For a person with Möbius, the necessity to convey one’s self accurately is enormous. It is scary to be so open to interpretation [from my face] with so much scope for wrong analysis. I cannot put my best face on. I have no control. Someone else may put on that most beautiful or sexy face. I cannot do this. In communication I can control a conversation, but I cannot control anything in the portrait or through my face.’[10]

She had to go away, now aware that people were interpreting her inexpressive face. For that is what we do, that is who we are; defined by our own faces, and always looking at others’ faces. This is so given within us that we sometimes need those who live without our mobile expressive faces, whether blind or with Möbius, to reveal it.

About the author:
Jonathan Cole, DM, FRCP, is Consultant in Clinical Neurophysiology, Poole Hospital, and a Professor at Bournemouth University. His latest book, Losing Touch is published by Oxford in July .

Illustration: Jan Buchczik

Literature references:
(1) Merleau-Ponty, M. 1964. The Primacy of Perception. Evanston; Northwestern University Press.
(2) Bell C. 1824. Essays on the Anatomy and Physiology of Expression. London: John Murray.
(3) Wittgenstein, L. 1953. Philosophical Investigations. Oxford: Blackwell.
(4) Hull, J. 1992. Touching the Rock; an experience of blindness. New York: Random House.
(5) Cole J. 1998. About Face. Cambridge, MA. The MIT Press.
(6) Cole, J. and Spalding, H. 2008. The Invisible Smile. Oxford: Oxford University Press.
(7) Cole J. 1998. Ibid.
(8) Cole, J. and Spalding, H., ibid.
(9) Wittgenstein, L. 1980. Remarks on the Philosophy of Psychology, Chicago: University of Chicago Press.
(10) Cole, J. and Spalding, H., ibid.