Saturday, April 18, 2009


I never seriously considered dwarfs until I heard a case this week involving a 25-year-old African-American homeless man who is 4 feet 2 inches tall. In childhood he had operations on both legs to straighten them. The operations made it easier for him to walk, but left him with chronic leg pain and swelling. He has a high school diploma with an IQ of about 75. My job was to decide if he is employable.

The medical definition of dwarfism is a person of short stature with an adult height of less than 4 feet 10 inches (147 cm). Dwarfism is fairly rare occurring in about 1 in 10,000 births. While there are many causes of dwarfism, about 70% are the result of a genetic disorder called achondroplasia which results in limbs that are disproportionally short compared to the trunk. These people often also have a larger head with a large prominent forehead.

Like most people I first encountered dwarfism in literature. The use of the term "dwarf" was popularized by the Brothers Grimm in their fairy tale Little Snow White (1812), but had been used much earlier by Jonathan Swift in Gulliver's Travels (1726). I remember reading these and many later literary examples where dwarfs play a leading role including The Tin-Drum and A Prayer for Owen Meany. The term “midget” came into use after Harriet Beecher Stowe used it in her novels in the mid-1800, but the term is now generally considered offensive because of it's link to use of dwarfs in freak shows. Midget is still sometimes used by some to refer to a person of very short stature whose body parts are proportional.

The accepted plural of "dwarf" is "dwarfs", while "dwarves" is usually reserved for mythical creatures. Although the term “dwarf” is widely used and generally accepted, some advocates object to the term because of its mythical and fairy tale origins and argue that “little person” or “person of short stature” is more appropriate. The largest national advocacy group is called “Little People of America, Inc.”

Most of the dwarfs I've ever seen have been in movies: The Wizard of Oz, of course, but also Time Bandits, Willie Wonka, and ET where a dwarf in costume played the title role. Warwick Davis, a popular actor with dwarfism, plays Prof. Flitwick in the Harry Potter films. I've used photos of him to illustrate this story.

How was I to decide whether the little person scheduled to appear in my court was employable? First, I looked at the law. I found the Social Security Law and Regulations contain no specific reference to dwarfism except for a rule that told me I was prohibited from considering “body habitus” in reaching a decision. I initially concluded, therefore, that I had to assume body size is irrelevant and I needed to ignore it as much as possible. Accordingly, I arranged for a vocational expert to be present at the hearing as I would with anyone under the age of 50. My plan was to get a list of functional limits, then ask the vocational expert if such a person is employable and see what would happen.

As chance would have it, just after I prepared for this case Merry & I took a jaunt across the river to southern Illinois to see spring wild flowers on the Trillium Trail at Giant City State Park just south of Carbondale. The day was perfect and our timing was impeccable. We saw dozens of varieties of blooming wild flowers, many of them new to us. The setting in and among towering sandstone cliffs was worth the trip in itself. To find the trail we first stopped at the park visitor's center. I went to get a map while Merry headed to the restroom. The information clerk turned out to be a surly dwarf; a dwarf with a regular job. I was struck hard by the irony of a dwarf giving out information about Giant City.

I heard the case on Monday. The claimant was sharply dressed in a black tee shirt, black jeans, white shoes and a black ball cap with wrap-around shades pushed onto the brim. He was smaller than I expected with extremely shortened arms that did not reach above his head. He had not done too badly in high school but had to drop out of technical college because he couldn't master the necessary math. He tried to work as a bookstore clerk but the walking was too much for him. As we talked I started to get a detailed impression of all the accommodations necessary not only for work but just for everyday life. He was even unable to sit in the witness chair because it was too large, so he had to stand. He said he couldn't reach to stop cord on the bus, so he always needed to sit near the driver. All his clothing and especially his shoes had to be custom made or altered.

In the end I asked the vocational expert whether he was employable. The VE noted that were it not for the multiple accommodations needed, he was. I asked him to tell me realistically whether this person could be successfully placed in a job and he said it would be a challenge. The only hope would be if the person acquired a specialized skill or talent. I actually asked the vocational expert about a park information clerk job, but he said that job generally requires a college education.

I decided a person of abnormally small stature who requires multiple accommodations and special equipment with a high school education and with legs that did not allow standing or walking for more than a hour at a time is disabled.

As I reflect on this experience I have a new appreciation of all the dwarfs in show business who have turned their size into an asset. People are fascinated by difference. We stare and point. We laugh. I still can't stop smiling at the irony of the dwarf clerk at Giant City. In my opinion this cruel fascination can't be avoided. Like other prejudices, it can be blunted by coming to realize just what people need to do to live their everyday lives.

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