dwarf

dwarf is a general term given to animals, plants, and other things which are significantly smaller than would ordinarily be expected. The term ‘dwarf’ has historically been attributed to people of profoundly short stature, especially those whose bodily proportions are notably different from those of average people. By contrast, the term ‘midget’ has generally been reserved for people of profound short stature whose bodily proportions are consistent with those of average height. Activists of very short stature prefer to call themselves ‘little people’ because of the negative connotations ‘dwarf’ and especially ‘midget’ have accrued, and because, while not all little people fit strict medical definitions of ‘dwarfism’, all little people face the same sorts of social hardships, regardless of the exact cause of their short statures. ‘Little people’ usually refers to people whose height will not exceed 4 feet 10 inches over the course of their lifetimes.

The causes of short stature are very numerous, and not all well understood. In several historically-isolated groups, ‘short’ stature is actually the norm. For example, some peoples indigenous to Africa and the Malay Peninsula rarely grow over five feet tall. (Europeans have tended to lump these peoples together under the single name ‘Pygmy’.) Among ‘average’ sized peoples, short stature can result if children are given inadequate nutrition or inadequate emotional nurturing. Medical researchers believe that the latter kind of phenomenon, known as ‘psychological dwarfism’, occurs when emotional stress in childhood leads to a growth-hormone deficiency and consequent cessation of growth. Major illnesses in childhood, such as kidney failure, can also contribute to stunting. Children whose growth rates appear slower than normal should therefore be examined carefully so that dangerous metabolic diseases can be ruled out.

Medical professionals use the term ‘dwarfism’ to refer to a host of metabolic conditions which result in profound short stature. In the US, about 1 in 10 000 births is of a child with dwarfism, although diagnosis may not occur for several years. The most common form of dwarfism is achondroplasia. The heads and trunks of achondroplastic dwarfs are average, but their limbs are relatively short and thick. Achondroplastic dwarfs are typically healthy and enjoy the same range of intellect as average-sized people. (As adults they may suffer back and limb pain from the hazards of living in a world designed for much larger people.) In a different syndrome, the bodies of hypopituitary dwarfs — while proportioned in the way typical for ‘average’-height people — produce less than the average amount of growth hormone, and so, unless they take regular injections of growth hormone, they will remain small. In contrast to achondroplastic dwarfs, hypopituitary dwarfs often suffer from underlying metabolic health problems. Other conditions, too numerous to mention here, can also result in dwarfism.

Joan Ablon, a medical anthropologist who has studied the lives of little people and their families, has noted that categorizing dwarfism as a disability is inappropriate for at least two reasons. First, ‘although dwarfism is a dramatic, physically distinctive, and immediately identifiable condition, dwarfs are usually not physically disabled or handicapped in the general sense of these terms …’. As one parent of a dwarf child said, ‘Their bodies are just packaged a little differently.’ Short stature is not a disease, nor does short stature necessarily signal an underlying disease state (if we define disease to mean a metabolically dangerous or physically painful condition).

Secondly, as Ablon writes, ‘in our cultural tradition dwarfs belong to the mythic world, not the mundane world of our daily experience or reality. Dwarfs carry with them the historical and cultural baggage of special and even magical status much more than do persons with various other physical differences.’ In centuries past, dwarfs were commonly displayed, held as captive entertainment, and even given as gifts. Still today, adult dwarfs often find themselves the subjects of unwanted attention. Many report encountering strangers who, without permission, insist on picking them up and treating them like children or dolls. For many dwarfs, acting is the only career available to them — employers are reluctant to hire dwarfs, and on the job many suffer harassment — but even then, dwarfs are typically assigned only to play elves or other charmed or ‘cute’ people.

Our culture rewards tall stature and denigrates small stature. (At least for men, income is positively correlated with height, and tall men are more likely than shorter counterparts to be married or elected to office.) For this reason, some parents of short-stature children have sought treatments to increase the ultimate height of their children. (The available treatments do not work well after puberty, and so they are not an option for adults.) These treatments are extremely expensive and are still considered experimental. One involves the cutting and progressive stretching of the bones of the limbs. A more common approach is the regular injection, throughout childhood, of growth hormone supplements. Until 1984, growth hormone supplements were typically derived from cadavers, but the discovery that some recipients thereby developed Creutzfeldt-Jakob disease ended that practice. Since 1985, clinicians have instead employed synthetic growth hormone developed from recombinant DNA technology.

Because injections of growth hormone might make any child grow taller than she or he would otherwise (note that this is not proven), the possibility has arisen that these treatments could be used on any child, regardless of her/his condition. Indeed, some parents of children who are short, but not growth hormone-deficient, have sought these treatments. This raises many ethical issues, touching on the right of parents to take risks on behalf of a child who has a cosmetically-challenging body, distributive justice, the rights of people with atypical anatomies, and so on. These questions about ‘designing’ or ‘engineering’ children have also been raised by the recent discovery, in 1995, of the genetic basis for achondroplasia. Parents are now able to screen fetuses for achondroplasia and selectively abort them. At the same time, given the hardships of raising a child who quickly grows bigger than oneself, some achondroplastic dwarfs have apparently even considered selectively aborting fetuses who, via the genetic screening, are shown not to be achondroplastic.

Alice Dreger

Bibliography

Ablon, J. (1988). Living with difference: families with dwarf children. Praeger, New York.
Berreby, D. (1996) Up with people: dwarves meet identity politics. The New Republic, 214(18), 14–9.