I Smile Back is a family drama that attempts to show how genetics and addiction can come together in a toxic cocktail that poisons families. Sarah Silverman plays Laney, a New Jersey housewife dealing with a fear of loss through self-destructive behavior. Silverman, a comedienne, does an excellent job here in a dramatic role. If only she had a better script to work with.
The script, written by Paige Dylan, and Amy Koppelman, adapting Koppelman’s novel of the same name, breaks down at the conceptual level. Laney is never given much to do, except self-destruct.  Which is fine. Some characters, like people, are inherently self-destructive and there’s nothing anyone can do about it. However, I’m not sure what I Smile Back is trying to say about her self-destruction. Is it because of her genes? It’s hinted. Is it because of the inherent ennui of housewifedom? Perhaps.  Is she just self-medicating because of a crippling fear of loss? Maybe! A combination of the three? Why not! I Smile Back doesn’t say.
Ambiguity is fine in films. But what I Smile Back lacks are sufficient narrative road maps to generate a thoughtful discussion. Instead, we get to watch Laney slowly drown for 86 minutes. This isn’t a narrative; it’s misery porn.
Script problems aside, the actors gave decent performances, the standout being Silverman. Once during the film, she bumped up against the outer limits of her dramatic abilities (and I’m willing to blame that moment on the script), but other than that, Silverman’s performance impressed me. I hope she does more dramatic roles in the future. Frankly, she’s the only reason to watch I Smile Back.
Bottom-line: the film doesn’t seem to know what it wants to say about addiction and self-destructive behavior, other than those things are bad. But maybe that’s all the filmmakers wanted to say about it. Maybe I Smile Back is just an exercise in nihilism. Either way, unless you enjoy watching a pretty woman suffer and hurt those around her, I Smile Back is not worth your time.