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Depiction of intellectual disability in fiction

Anupama Iyer is a specialist registrar in child psychiatry and learning disabilities at the Diana, Princess of Wales Children’s Hospital (Steelhouse Lane, Birmingham B4 6NH, UK. Email: nikanu{at}lycos.co.uk). Her research interests include autism, attention-deficit hyperactivity disorder and behavioural phenotypes.

	Abstract

Top Abstract The power of the... How is the depiction... What function does the... What would constitute an... Conclusions Declaration of interest MCQs References

 
I explore some of the ways in which intellectual disability (learning disability) is depicted in fiction. My premise is that literature both reflects and shapes societal attitudes to people in this vulnerable minority group. People with intellectual disabilities are seldom able to determine, confirm or counter narratives about themselves. This situation, in which the subject is fundamentally unable to participate in their representation, raises unique ethical considerations. I use examples from various English-language novels to discuss how subjective accounts, observable behaviours and physical attributes are all employed to characterise people with intellectual disabilities.

	The power of the narrative

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Fictional images are very powerful because they have a coherence and accessibility not often present in random real-life experiences or scientific descriptions. The holistic images that works of fiction achieve leave us feeling that we know what we may have never seen. However, the primary purpose of fiction is narration not instruction. The narrative is influenced not only by writers’ factual information but also by the story they want to tell. To tell this story, authors rely on triggering a shared understanding between themselves and the reader. For intellectual disability, this shared understanding depends on what is culturally accepted about the condition as well as what is medically known. Thus, literary depictions, unlike medical descriptions, do not have to be accurate or theory driven. Despite this lack of factual fidelity, literary depictions will shape the cultural image of a condition much more than medical information, because of their reach and ready availability.

Literary depictions of intellectual disability and mental illness share some common themes. They both reflect societal views about these conditions in the time that they were written. In describing Bertha Mason in Jane Eyre(1847),¹ Charlotte Bronte drew upon a popular 19th-century stereotype of madness. At the time, the notion that a madwoman should be feared and loathed, shut away from polite society, beyond cure, was never contested. The situation changed considerably with the autobiographical narratives of mental illness of people such as Sylvia Plath (The Bell Jar, 1963). These first-person accounts of experiencing or recovering from mental illness have done much to change how mental illness is now perceived (Oyebode, 2004).

Intellectual disability is fundamentally different in this respect because the very nature of the condition makes it difficult to have a subjective account of what it is to have it. In fictional accounts of people with intellectual disabilities, words are used to describe those who are essentially without access to the medium used to portray them. They are unable to change, contest or confirm how they are portrayed. Thus, the fictional portrayal of people with intellectual disabilities presents unique ethical challenges as to how they are depicted and what the consequences are of this depiction.

	How is the depiction achieved?

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Subjective accounts
Descriptions of people with intellectual disabilities written in the first person are relatively rare in fiction. There are inherent difficulties in fashioning a convincing internal voice for a character whose life and experiences the author cannot share. This difficulty is usually overcome in fiction by the narrator’s empathy and the technical accuracy of the characterisation. In terms of both techniques, intellectual disability poses a fundamental paradox. When writers ‘speak’ for a character with intellectual disability they essentially impose their creative intelligence on what is meant to be the world view of a character defined by intellectual limitations. Even with the most sympathetic portrayals based on real-life observation, it is often difficult to maintain logical consistency in what the character can do, say and think when you have no way of checking beyond observable behaviour.

Both the difficulties and successes of this method are best exemplified in the character of Benjy Compson in William Faulkner’s The Sound and the Fury(1929). The novel about the Compson family in the American South is organised into four sections. In the first of these, the narrator is Benjy, a 33-year-old man who has a mental age of 3 (profound intellectual disability). The second section is narrated by Quentin, who is depicted as insane, the third by Jason, who is sane but affectionless. The fourth (with a third-person narrator), centres on the figure of Dilsey, the Black servant who represents the voice of endurance and stability.

The character of Benjy is unique because we hear him speak before we see him as others do. We engage with Benjy’s world from the inside, often being called on to provide meaning and coherence to the narrative that he himself cannot provide.

Benjy’s narrative is chaotic: events seem to coalesce, characters to wander in and out. It is only when the novel unfolds that we realise how much of the narrative Faulkner manages to convey through Benjy’s inchoate impressions.

Benjy has been depicted as having difficulties with the concept of time because of his intellectual disability. His impressions are a mixture of the immediate and the past. He is unable to separate ongoing experience from distant memory, and because of this the whole of his 33 years reads like the unclouded present.

Benjy’s descriptions are primarily based on what he perceives with his senses. This is vividly illustrated² in his version of a ride in a horse-drawn carriage:

‘I could hear Queenie’s feet and the bright shapes went smooth and steady on both sides, the shadows of them following across Queenie’s back’ (Faulkner, 1978 reprint: p. 9).

This description is based on sight and sound. Its meaning becomes obvious only when Faulkner himself orders it into recognisable images in the closing paragraphs of the book:

‘Queenie moved again [...] her feet began to clip-clop steadily again [...] at once Benjy hushed [...] the cornice and the façade flowed from left to right, post and tree, window and doorway and signboard, each in its ordered place’ (p. 321).

In Benjy’s undifferentiated universe sensations are shown to merge:

‘I couldn’t see it [his sister’s slipper] but my hands saw it and I could hear it getting night. ... I could see the window where the trees were buzzing’ (pp. 70, 73).

Benjy’s lack of conceptual schemas is deliberately contrasted with Quentin’s distorted schemas, which reflect his insanity. This lack of higher-order processing is also reflected in Benjy’s inability to attribute motives and significance to other people’s actions. He describes an emotive interchange between himself and Dilsey by saying ‘She gave me a flower and her hand went away’ (p. 8), seemingly unable to attribute any meaning to her action. Events just seem to happen to him and around him. He does not separate the incidental from the intentional, the important from the trivial.

Despite this, Benjy seems to have an almost instinctive grasp of primary emotions. He does not understand the reason for Mrs Patterson’s distress when her husband intercepts her clandestine correspondence but readily recognises the emotion of the situation:

‘Mr. Patterson was chopping in the green flowers. Mrs Patterson came across the garden running [...] When I saw her eyes, I began to cry [...] Give it to me. Quick [...] Mr Patterson came fast, with the hoe. She was trying to climb the fence [...] He took the letter [...] I saw her eyes again and I ran down the hill’ (pp. 11–12).

His own emotions, however, are expressed in concrete physical terms. His attachment to his sister Caddy is conveyed through his possessiveness over her slipper. Faulkner describes Benjy’s comfort in inanimate objects such as cushions and flowers and his distress when these are taken from him. Benjy’s need for sameness is also vividly evoked, especially in the closing passages of the book when he is shown to be very disturbed by the change in the direction of his routine drive around the Confederacy Statue. In describing these precise minutiae of behaviour, Faulkner uses his observations of Benjy’s real-life model to great effect (Halliwell, 2004). He manages to convey the purity of Benjy’s sensate universe despite the reader’s misgivings about someone with a mental age of 3 speaking fluently, in perfect syntax, perceiving things he could not possibly perceive. The reader ignores, in happy complicity, the fact that Faulkner’s intelligence can never speak for Benjy’s lack of it. Despite logical inconsistencies the reader is carried along by the power of the narrative voice.

Physical description
Describing the physical form of a character with intellectual disability has the advantage of visually delineating the abstract concept of the disability: a character who cannot be heard must be seen. It also plays on the often unspoken assumption that people are as people look. This belief is so widespread that people with visible anomalies are often assumed to be intellectually disabled, even if they are not.

Harper Lee in To Kill a Mocking Bird(1960) describes Boo Radley as

‘about six feet tall, judging by his tracks; he dined on raw squirrels and any cats he could catch, that’s why his hands were blood-stained – if you ate an animal raw you could never wash the blood off. There was a longjagged scar that ran down his face; what teeth he had were yellow and rotten, his eyes popped, and he drooled most of the time’ (Lee, 1997 reprint: p. 14).

Mannerisms and accessories are used to further demarcate individuals with intellectual disability from other people. Charles Dickens in his novel Barnaby Rudge (1840–1841) uses Barnaby’s clothes to emphasise his difference:

‘His dress was of green, clumsily trimmed here and there – apparently by his own hands with gaudy lace [...] He had ornamented his hat with a cluster of peacock’s feathers, but they were limp and broken, and now trailed negligently down his back [...] The fluttered and confused disposition of all the motley scraps that formed his dress, bespoke [...] the disorder of his mind’ (Dickens, 1998 reprint: p. 28).

Resemblance to and kinship with animals is often called forth to emphasise the difference of people with intellectual disabilities and signal that they are not quite human. Barnaby speaks of his pet raven almost as he would of another person:

‘He takes such care of me besides! [...] He watches all the time I sleep, he practises his new learning softly’ (p. 131).

Eccentricity suggestive of autism seems to go hand in hand with visible anomalies. Even if we take into account the relatively higher rates of autistic-spectrum disorders in people with intellectual disabilities, it remains remarkable that many authors use this facet disproportionately often to depict characters with intellectual disabilities. Hilary Dickinson (2000) has suggested that this device shields the reader from what she deems the ‘literary inelegance’ of intellectual disability. Eccentricity and autistic traits confer what she calls ‘stylishness’ that intellectual disability lacks. Eccentricity suggests mysterious, often spiritual, gifts and exotic possibilities. Joseph Conrad uses this in emphasising the spiritual aspects of Stevie, a character with intellectual disability in The Secret Agent(1907), describing him as:

‘drawing circles, circles, innumerable circles, concentric, eccentric, coruscating whirl of circles that by their tangled multitude of repeated curves, uniformity of form, and confusion of intersecting lines [...] suggested a rendering of cosmic chaos’ (Conrad, 1996 reprint: p. 46).

In addition to making the individual stand out visually, eccentricity and anomaly also serve the psychological function of distancing from the reader characters who have intellectual disabilities. Gilman (1988) proposes that in fiction disabled figures are overwhelmingly cast as ‘other’. This signalling of difference protects readers from the fear that the character described could possibly be them. This recognised social phenomenon of exclusion is what the proponents of ‘normalisation’ (Nijre, 1976) want to minimise and eventually abolish. Nijre writes: ‘The application of the normalization principle will not make retarded people more normal. But it will make their life conditions as normal as possible’.

Behavioural description
The casting of the intellectually disabled character as the other is also achieved by calling on distinctive mannerisms and nuances of behaviour.

In Barnaby Rudge, Barnaby’s exaggerated mannerisms serve to highlight his difference in the same way as his eccentric attire:

‘He nodded – not once or twice, but a score of times, and that with a fantastic exaggeration which would have kept his head in motion for an hour’ (Dickens, 1998 reprint: p. 27).

John Steinbeck uses the simple act of drinking to signal his character Lennie’s disabilities in this evocative passage from Of Mice and Men(1937):

‘[Lennie] flung himself down and drank [...] with long gulps, snorting into the water like a horse’ (Steinbeck, 2000 reprint: p. 4).

Conrad uses Stevie’s motor restlessness to convey the fear and perplexity that are a part of the character’s psyche:

‘A brusque question caused him to stutter to the point of suffocation. When startled by anything perplexing he used to squint horribly’ (Conrad, 1996 reprint: p. 17).

Rohinton Mistry in Such a Long Journey(1991) uses his character Tehmul’s distinctive speech to describe him:

‘the words of Tehmul-Lungraa’s abbreviated vocabulary always emerged at breakneck speed, whizzing incomprehensibly past the listener’s ears [...]. Tehmul’s cascading utterances were always bereft of commas, exclamation marks, semi-colons, question marks: all swept away. [...] The verbal velocity only allowed for the use of the full stop. And it was not really a full stop [...] rather, a minimal halt anywhere he chose to re-oxygenate his lungs.

GustadGustadrunningrace.fastfast.chicken first’ (pp. 31, 32).

Fiction may also emphasise the lack of normative social functioning. For instance, Conrad calls on Stevie’s inability to hold down a basic job to characterise him:

‘as an errand boy he did not turn out a great success. He forgot his messages, he was easily diverted from the straight path of duty by the attractions of stray cats and dogs [...]; by the comedies of the streets, which he contemplated open-mouthed’ (Conrad, 1996 reprint: p. 17).

Alternatively, their unusual occupations are highlighted, as in the case of Tehmul, who for a nominal fee disposes of rats caught by other tenants of his building.

Drawing on theories of causation
Authors usually make an effort to account for the intellectual disabilities of their characters. This aetiology varies widely depending on cultural notions, prevalent medical theories and, perhaps most importantly, the thrust of the narrative.

In Barnaby Rudge, Dickens evokes the supernatural in describing the cause of Barnaby’s intellectual disability:

‘They recollected how the change had come [on Barnaby’s mother] and could call to mind that when the son was born, upon the very day the deed was known, he bore upon his wrist what seemed a smear of blood but half washed out’ (Dickens, 1998 reprint: p. 41).

Salman Rushdie in Shame(1983) mixes mystical and medical aetiologies to account for his character Sufiya Zinobia’s intellectual disability. Her mother turns to the local doctor to cure Sufiya’s brain fever:

‘a local hakim prepared an expensive liquid distilled from cactus roots, ivory dust and parrot feathers [This] had the unfortunate side-effect of slowing her down for the rest of her years [...] because the unfortunate side-effect of a potion so filled with the elements of longevity was to retard the progress of time inside the body of anyone to whom it was given’ (p. 100).

Here the theory chosen has more to do with the effect that Rushdie wants to create and less with prevailing medical ideas.

In contrast to this, Dickens in the 19th century has created a medically accurate portrait in the character of Maggy in Little Dorrit (1855–1857). Traces of the encephalopathic origins of her intellectual disability are visible in her dyspraxia and echolalic fragmented speech (Dickinson, 2000). Dickens introduces her into the narrative as follows:

‘an excited figure of a strange kind bounced against them [...] fell down, and scattered the contents of a large basket, filled with potatoes [...] and she then began to pick up the potatoes [...] Maggy picked up very few potatoes, and a great quantity of mud.

"This is Maggy, Sir."

"Maggy, Sir", echoed the personage presented.

[...]

"You can’t think how good she is, Sir", said Little Dorrit.

"Good she is" echoed Maggy’

(Dickens, 1996 reprint: p. 97).

	What function does the depiction serve?

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At the most literal level, the depiction serves to drive the narrative forward. However, figures with intellectual disabilities have seldom been depicted as active agents, even when central to the narrative. They are rarely shown to purposefully drive the narrative forward.

In Dickens’s historical tale about the Gordon Riots of 1780, the eponymous Barnaby Rudge is shown as a passive participant in events that nearly lead to his hanging. He joins the rioters to wear their uniform and carry their flag. Dickens describes how Barnaby marches with the other rioters:

‘forgetful of all things in the ecstasy of the moment [...] heedless of the weight of the great banner [...] mindful only of it’s flashing in the sun and rustling the summer breeze, on he went [...] the only light-hearted, undesigning creature in the whole assembly’ (Dickens, 1998 reprint: p. 371–372).

Even afterwards:

‘He had no consciousness [...] of having done wrong [...] no new perceptions in the merit of the cause’ (Dickens, 1998 reprint: p. 528–529).

Far from being active protagonists, characters with intellectual disabilities are often portrayed as passive victims of exploitation. For instance, Tehmul in Such a Long Journey is used as a receptacle for spells to reverse the ill-fortunes plaguing the protagonist Gustad’s household. Ms Kutpitia, the local herbalist in the novel, has very few scruples in casting the spell on Tehmul. She convinces Gustad’s reluctant wife by saying:

‘ "How much brain does he have to begin with [...] so what difference will it make [...] Tehmul himself will not notice anything. What I say is that we should be happy that for the first time he will do something good for another person." ’ (Mistry, 1991: 110).

When given affection it is never expected that intellectually disabled characters can or may reciprocate. In Shame, Sufiya Zinobia receives affection from both her father and her governess with no expectation of a return.

Characters with intellectual disabilities are often the butt of ridicule and casual cruelty. This careless cruelty may even come from a caregiver, as described poignantly in Of Mice and Men (Steinbeck, 1937). Lennie’s friend and protector George brags about Lennie’s devotion to him, saying:

‘ "Why he’d do any damn thing I tol’ him to [...] One day a bunch of guys was standin’ around up on the Sacramento River [...] I was feeling pretty smart. I turns to Lennie and says ‘Jump in’. An’ he jumps in [...] couldn’t swim a stroke. He damn near drowned before we could get him. An’ he was so damn nice to me for pullin’ ’im out. Clean forgot I told ’im to jump in" ’ (Steinbeck, 2000: p. 41).

People with intellectual disabilities are depicted as being unable to regulate their sexual drives and aggression. Tehmul in Such a Long Journey displays an unreasoning cruelty in disposing of the rats:

‘A bucket of water was filled and the rats ducked one by one. He pulled them out before the end, gasping and suffocating, and kept on till he was bored with the game, or a miscalculation drowned the rats. Sometimes for variety, he boiled a large kettle of water [...] he poured the boiling water a little at a time. As the rats squealed and writhed in agony, he watched their reaction with great interest, particularly their tails, proud of the pretty colours he could bestow on them’ (Mistry, 1991: 33).

In Shame, Sufiya Zinobia is shown to internalise hate and rage as self-harm:

‘[she would] tear each damaged hair in two, all the way down to the roots. She did this seriously, systematically. Her eyes, while she worked, acquired a dull glint, a gleam of distant ice or fire from far below their habitually opaque surface; and the torn cloud of hair stood around her face and formed in the sunlight a kind of halo of destruction’ (Rushdie, 1983: p. 136).

This association of intellectual disability with violence is so prevalent that characters with intellectual disabilities are often invested with a sinister aura without really having to do anything.

In her description of Boo Radley, Harper Lee (1960) uses the voice of her child narrator Scout to spell out this recognised stereotype:

‘Inside the house lived a malevolent phantom [...] People said he went out at night when the moon was high and peeped in windows. When people’s azaleas froze in a cold snap, it was because he had breathed on them. Once the town was terrorized by a series of morbid nocturnal events: people’s chickens and pets were found mutilated: although the culprit was crazy Eddie [...] people still looked at Radley Place, unwilling to discard their suspicions’ (Lee, 1997 reprint: p. 9).

Boo does very little and typically we hear more about him than from him in the novel. The myth of his malevolence is never contested.

Intellectual disability as a narrative device
In essence writers use figures with intellectual disabilities as a narrative device, where they function as contrasts to the other characters, various marginal groups or the world they find themselves in. Barnaby Rudge’s innocence is a foil to the rioters’ rage and complex political motives. Boo Radley is a foil to another marginalised group in the story: Black people in the American South. Tehmul’s simple life in the here and now is in contrast to Gustad’s agonised search for meaning. Stevie’s blind loyalty is a mirror to the corruption and inept plotting of the anarchists who set him up.

When used as a counterpoint, characters with intellectual disabilities become passive receptacles of various abstract qualities that the author ascribes to them. These symbolic qualities assume centre stage and displace the human figures.

What do characters with intellectual disabilities symbolise?
Lennie, Benjy, Sufiya, Stevie and Barnaby are all symbols of a lyrical innocence, untouched by worldly reason. This is reflected in Barnaby’s return to his idyllic rural home:

‘He lived with his mother on the farm [...] He was known to every bird or beast about the place and had a name for everyone. Never was there [...] a creature more popular with the young or old, a blither or more happy soul than Barnaby’ (Dickens, 1998 reprint: p. 634).

This childlike innocence is highlighted by the characters’ rapport with animals, which reflects on their being closer to nature than to man. This is seen in Lennie’s feeling for mice, Stevie’s sympathy for carthorses, Barnaby’s affection for his raven and Tehmul’s delight in things that fly.

This symbolism is inverted when the cruelty or sexual disinhibition of an intellectually disabled character are emphasised. Intellectual disability then comes to represent dysregulation and destruction unchecked by reason.

In Shame, Sufiya Zinobia alternates between these two. As ‘Sufiya the Saint’ she ‘suffers in our stead’ (Rushdie, 1983: p. 141), becoming a voiceless symbol for the disenfranchised. As ‘Sufiya the Beast’ she uses her superhuman powers to decapitate four young men and comes to represent the aggressive powers of unreason. Her use as a symbol does not allow her to be ordinary. She is either less than human or superhuman.

Such symbolism is powerful because it is subliminal. It is not overtly stated and, hence, never consciously examined. However, in perpetuating unspoken stereotypes about intellectual disability, it serves to minimise the identity of intellectually disabled people as ordinary individuals and undermines their lived experience.

Even when the descriptions have positive connotations, they are often used to minimise and rationalise real situations in the real world. When portrayed as symbols and stereotypes, people with intellectual disabilities are not allowed the dignity of ordinary abilities, difficulties and assets. Instead, their disability bears what Susan Sontag (1983) calls ‘the metaphorical and symbolic weight’ of the images assigned to them.

A character with an intellectual disability becomes a silent Rorschach ink blot onto which society projects its devices and desires through the agency of the author.

	What would constitute an ‘ethical’ representation?

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The issue of ethical representation of disabilities has been discussed at length by Thomas Couser (2005). He does not advocate a wholly ‘positive’ image of individuals with disabilities overcoming their impairments. He suggests instead reasonable precautions that may be exercised in descriptions. He also suggests consultation where possible with people who themselves have the disability: ‘Nothing about Us without Us’ (Charlton, 1998). In the absence of this individual voice, he recommends that authors:

• consult advocacy or support groups to minimise the possible harm of the representation
  
• do not depict people with disabilities as ‘alien’, albeit they may be ‘different’
  
• avoid making one particular trait the overarching, defining facet of the individual
  
• avoid symbolism that generates set, stereotyped images
  
• avoid moral attributions to what is, in effect, a part medical (impairment), part social (disability) condition
  
• acknowledge that disability is the concern not just of the individual but of the world in which that individual is living.
  

It may be argued that Couser’s recommendations may better serve journalists than a creator of narratives. However, they are cautionary rather than prescriptive. The need for uncluttered creative space has to be balanced against not harming a vulnerable group.

	Conclusions

Top Abstract The power of the... How is the depiction... What function does the... What would constitute an... Conclusions Declaration of interest MCQs References

 
Fictional images significantly influence how people with intellectual disabilities are viewed by society. This inevitably affects the lives of these individuals and of the people who care for them. Knowledge of fictional images enhances clinicians’ understanding of individual lives. It also raises awareness of the unspoken stereotypes that exist in popular culture regarding people with disabilities as a group. This may prove to be a valuable tool for reasoned and informed advocacy when clinicians speak for or about persons with intellectual disabilities.

Key learning points for this article are listed in Box 1.

Box 1 Key learning points Social perception shapes fictional images of people with intellectual disabilities Images in fiction in turn shape social perception People with intellectual disabilities cannot contest or confirm these images People with intellectual disabilities are used in fiction as symbols Symbolic representation perpetuates stereotypes and undermines the real-life situation of intellectually disabled people Ethical representation should aim to minimise stereotypes and promote recognition of the differences between (social) disability and (medical) impairment

 

	Declaration of interest

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None.

	MCQs

Top Abstract The power of the... How is the depiction... What function does the... What would constitute an... Conclusions Declaration of interest MCQs References

 

1. Depiction of intellectual disability is different because:
   1. the subject matter deals with complex disorders
      
   2. the persons depicted cannot participate in their representation
      
   3. depiction is determined by medical descriptions
      
   4. depiction overrides societal opinion
      
   5. support groups are commonly consulted by authors.
      
   
   
2. The means used to depict persons with intellectual disability in fiction include:
   1. psychological accounts
      
   2. description of behaviours
      
   3. theories regarding motives
      
   4. medical descriptions
      
   5. findings from research.
      
   
   
3. The symbolism commonly assigned to persons with intellectual disabilities includes:
   1. innocence
      
   2. assertiveness
      
   3. creativity
      
   4. self-determination
      
   5. self-control.
      
   
   
4. Use of literary characters with intellectual disabilities as ‘symbols’ is damaging because it:
   1. minimises stereotypes
      
   2. emphasises individual differences
      
   3. hampers literary depictions
      
   4. undermines lived experiences of disability
      
   5. offends people with intellectual disabilities.
      
   
   
5. An ethically acceptable portrayal of persons with intellectual disabilities will:
   1. always involve consultation with support groups
      
   2. not describe people with disabilities
      
   3. not stray from strict medical descriptions
      
   4. emphasise only positive qualities
      
   5. avoid generating set stereotypes.
      
   
   

MCQ answers

1 2 3 4 5 a F a F a T a F a F b T b T b F b F b F c F c F c F c F c F d F d F d F d T d F e F e F e F e F e T

	Footnotes

 
¹ Works of literature are referenced to the date of first publication. The reference list shows the reprint from which quotations are taken.

² Italics in quotations are my own, used to highlight aspects of the thesis.

	References

Top Abstract The power of the... How is the depiction... What function does the... What would constitute an... Conclusions Declaration of interest MCQs References

 
Bronte, C. (1847) Jane Eyre. Reprinted 1996. Penguin.

Charlton, J. I. (1998) Nothing about Us without Us: Disability, Oppression and Empowerment. University of California Press.

Conrad, J. (1907) The Secret Agent. Reprinted 1996. Penguin

Couser, G. T. (2005) Paradigms’ cost: representing vulnerable subjects. Literature and Medicine, 24(1), 19–30.[CrossRef][Medline]

Dickens, C. (1855–1857) Little Dorrit. Reprinted 1996. Wordsworth Classics.

Dickens, C. (1840–1841) Barnaby Rudge. Reprinted 1998. Wordsworth Classics.

Dickinson, H. (2000) Idiocy in nineteenth century fiction compared with medical perspectives of the time. History of Psychiatry, 11, 291–309.[Abstract/Free Full Text]

Faulkner, W. (1929) The Sound and the Fury. Reprinted 1978. Chatto and Windus.

Gilman, S. L. (1988) Disease and Representation: Images of Sickness from Madness to AIDS. Cornell University Press.

Halliwell, M. (2004) Images of Idiocy: The Idiot Figure in Modern Fiction and Film. Ashgate Publishing.

Lee, H. (1960) To Kill a Mocking Bird. Reprinted 1997. Arrow Books.

Mistry, R. (1991) Such a Long Journey. Chatto and Windus.

Nijre, B. (1976) The normalization principle and its human management implications. In Normalization, Social Integration and Community Services (eds R. J. Flynn & K. E. Nitch). University Park Press.

Oyebode, F. (2004) Fictional narrative and psychiatry. Advances in Psychiatric Treatment, 10, 140–145.[Abstract/Free Full Text]

Plath, S. (1963) The Bell Jar. Faber and Faber.

Rushdie, S. (1983) Shame. Jonathan Cape.

Sontag, S. (1983) Illness as Metaphor. Penguin.

Steinbeck, J. (1937) Of Mice and Men. Reprinted 2000. Penguin Classics.

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