Facial expressions are important parts of how we communicate and how we develop impressions of the people around us. In "The Expression of Emotion in Man and Animals," Charles Darwin proposed that facial expressions evolved to quickly communicate emotional states important to social survival. He hypothesized that certain facial expressions are innate, and therefore universally expressed and recognized across all cultures.
In 1971, psychology researchers Paul Ekman and Wallace Friesen tested Darwin's hypothesis. They enlisted members of the Fore tribe in Papua New Guinea, who at the time had little contact with Western culture, to do an emotion recognition task. An interpreter read stories about emotional events to members of the tribe, such as "her child has died, and she feels very sad." The Fore were then asked to match photos of Americans' facial expressions to the story. The researchers also took photos of the facial expressions of the Fore people and showed them to Americans later.
People from both cultures showed the same facial expressions for six "basic" emotions (anger, disgust, fear, happiness, sadness and surprise) and were able to recognize their meaning in others. This is strong evidence that certain emotions are evolutionarily based. In the decades since, research has continued to support Darwin's hypothesis: for instance, showing that congenitally blind people display the same spontaneous expressions as sighted people. Indeed, facial expression may be one of the only universal languages.
So where does that leave people with facial paralysis? As a psychology professor with Moebius syndrome, a condition involving facial paralysis, I'm personally and professionally interested in what happens when the face is no longer the primary means of expression. My Disability and Social Interaction Lab at Oregon State University has been investigating this question.
Types of facial paralysis
Each year, approximately 225,000 Americans are diagnosed with facial paralysis. It can be congenital, like Moebius syndrome or hereditary facial paralysis. It can also result from birth trauma if the facial nerve is damaged in the birth canal or by forceps delivery.
Acquired facial paralysis from an illness or an injury is far more common. Bell"s palsy, acoustic neuroma, Lyme disease, stroke, multiple sclerosis, ear infections, injury to the facial nerve and others can all lead to facial paralysis. Bell's palsy, which typically affects one side of the face, is the most common. While it's usually temporary, approximately 15 percent of people with Bell's are left with paralysis that does not improve.
In a series of published and unpublished focus groups and interviews, my colleagues and I found that people with facial paralysis reported hearing all sorts of "interpretations" of their appearance. Strangers asked them if they had just gotten a Novocain shot, if they were having a stroke, or if the condition was contagious, deadly or painful. Some people made connections to the person's character, assuming them to be unfriendly, unhappy or even intellectually disabled.
Making a first impression
In landmark research published in 1993, psychologists Nalini Ambady and Robert Rosenthal asked strangers to view short (six- to 30-second) silent video clips of high school and college teachers while they were teaching. The strangers then rated their impressions of the teachers' personalities, based on their nonverbal behaviors - things like expressions and gestures. Today this sort of research using very short experiences to form judgments of individual behavior is called thin slice research.
The strangers' ratings were remarkably similar to teaching effectiveness ratings from the teachers' students and their supervisors who knew them and their work very well.
Our social world has an overwhelming amount of information, but numerous thin slice studies suggest we can navigate it efficiently based on a "gut" reaction. People's first impressions are surprisingly accurate in predicting many social characteristics: personality, depression, even gayness.
While facial expressions aren't the only thing that go into a first impression, they are a pretty big element. So basing our impressions of others on their facial expressions is usually an effective strategy. However, the accuracy of impressions breaks down when people encounter someone with facial paralysis. At first glance, a person with a paralyzed face may look unfriendly, bored, unintelligent, or even depressed. And indeed, people with facial paralysis are often mistakenly ascribed these characteristics.
People with facial paralysis compensate
My own research has found that many people with facial paralysis increase expression in their bodies and voices, something I call "compensatory expression."
In a 2012 study my colleagues and I video-recorded interviews with 27 people with different types of facial paralysis. Research assistants (who were unaware of our hypotheses) watched the interviews and rated the vocal and bodily expressivity of the people with facial paralysis.
Interestingly, we found that people with congenital facial paralysis, like Moebius syndrome, used significantly more compensatory expression than people with acquired facial paralysis. For instance, they used more emotion words, vocal inflection, laughter, gestures and head and body movements. They were also louder and more talkative.
It's possible that people with congenital facial paralysis are better adapted, perhaps because they navigated early developmental milestones with facial paralysis.
People who acquired facial paralysis after birth, but have lived with it for a long time, may also adapt well. However, our early data suggest that there may be a unique adaptation advantage for people with congenital conditions.
Thin slice research on facial paralysis
Facial expressions play such a critical role in forming first impressions, so what does that mean for people with facial paralysis?
In a series of experiments, we showed thin slice videos of people with disorders that affect facial movement, including facial paralysis and Parkinson"s disease to strangers. We asked the strangers for their first impressions based on the videos.
People with severe facial movement impairment were rated as less happy and sociable compared to people with mild facial movement impairment. Participants also had less desire to form friendships with them.
Our results across these studies have found that there is a very large bias against people with facial movement disorders.
Crucially, participants rated people with facial paralysis who use a lot of compensatory expression as happier and more sociable than those who use less, regardless of the severity of their paralysis. We are developing communication skills workshops encouraging the use of compensatory expression for people with facial paralysis.
In another thin slice study, Linda Tickle-Degnen along with Kathleen Lyons found that even clinicians with expertise in facial movement disorders viewed people with facial movement impairment in negative ways.
This indicates how hard it is to override the natural human tendency to form impressions based on the face. And for clinicians, it is of special concern. Their facial expression bias may be a barrier to rapport or even clinical judgments of depression and pain in patients with facial paralysis.
Raising awareness can help
In a recent experiment, we found initial evidence that raising awareness improves how people perceive facial paralysis. Some participants read a few educational paragraphs about facial paralysis (much like the information in this article), and some were not given any information about facial paralysis. Next, all participants watched thin slice videos of people with facial paralysis. The participants who read the educational information rated people with facial paralysis as more sociable than those who did not read the information.
We are continuing to develop educational materials for clinicians and the general public to raise awareness and reduce bias.
In our focus groups, the most common comment from people with facial paralysis was a call for greater public awareness. They know firsthand that people are confused by their facial difference. They often wonder if they should explain it to others, but to do so every time they meet someone new would be awkward and burdensome. Widespread awareness would reduce the need to explain their condition, and would educate others to pay attention to the compensatory tactics they use to communicate their emotions.