Short-changed by society
Small people like me face life-long discrimination – and now size has been “medicalised” for profit by drugs companies
My feet reached halfway down the gurney and I remember my mum was sitting on the other side of the plastic curtain. The specialist let the elastic of my pants snap back and declared to my mother, “Well Mrs Bartosch, your daughter is definitely displaying signs of pubescent development, we need to make a decision soon.” I was 12 and brimming with tears of humiliation and shame. To my childish brain it seemed the weight of the medical profession was telling me that there was a problem with my body which needed fixing. As a fit and healthy child, until that point my 5ft 2in father and 5ft 1in mother had reassured me that the only “problem” with my short stature was other people’s ignorance.
Many of the generation of short people who preceded me had treatments with growth hormone taken from the pituitary glands of cadavers. Decades later, hundreds have died from degenerative brain disease carried in doses of the drug. By 1995 the world had apparently moved on: I was assured that the hormones used would be synthetic. But progress stopped short of not medicating otherwise healthy children for entirely cosmetic reasons. Today medical intervention to “correct” those who do not conform is more common than ever.
I rejected the treatment; looking back some 25 years, and from the dizzying height of 4ft 7in, I know that my life would have been easier had I undergone the years of daily injections and gained that couple of extra inches. I might have reached nearly 4ft 9in, which would have seen me rise from the “extremely short” to the “short” category; as it stands I’m shorter than 99.98 per cent of my peers.
But being visibly different has given me insights into human behaviour that are missed by those who are able to pass through life without comment on their appearance. Indeed, had I not developed armour-plating through years of jibes about my height I would have struggled to weather the online critics who like to share their feelings about articles like this.
Getting to the point where I can see the benefits to my visible “outsider” status has been tough. As a child I looked around half my age, and to spare all-round embarrassment I would often pretend to be when in public. Kids in local playgrounds wouldn’t want to be seen with me, and with no hope of competing in most sports against my peers I developed solitary pursuits which have served me well during the bizarre period of social distancing. As with other middle-class kids, I was sent to activities sessions through the summer months.
I would often instead hide away on my own, returning home with fantastic stories to entertain my parents about what I’d been up to and the friends I’d made — in retrospect, not a bad apprenticeship for a writer. Pointing out to well-meaning distant friends of the family that at 12 I was a bit old for Noddy just seemed a bit churlish, so I became adept at acting as I was expected to. It gave me both a certain licence to retain playfulness into adulthood, and crucially, an understanding that those in authority might be well-meaning, but they can often be wrong. This sceptical approach sparked a lifelong fascination with politics and power.
Adolescence is when the social milestones of transitioning from childhood come fast. For me, it was the point when it was no longer possible to balance my internal sense of self as a bright, capable young person approaching adulthood with how I looked to the outside world. Four years on from my appointment with the paediatrician I found myself yet again in a shabby NHS building, this time for an appointment at a child and adolescent mental health assessment unit.
I sat down, once again with my mother, and waited for the psychiatrist to look up from his papers. The slightly severe, stereotypically bearded and bespectacled man seemed out of place with the soft toys and children’s drawings on the walls. Addressing my mother, he asked: “So Mrs Bartosch, have you noticed any developmental abnormalities? For example, what toys does she play with?”
My mother replied, somewhat stonily, “She’s 16, have you looked at your notes?”
Kids in local playgrounds wouldn’t want to be seen with me, so I developed solitary pursuits
Thinking back on that moment now it’s clear: the problem with my mind was due to the perception of others about my body. But at 16 there was no way to change this, nor realistically to challenge everyone around me who through ignorant kindness underestimated my abilities and treated me as a very young child. It occurred to me then that, until my age became inescapably obvious, I would just need to find a way to deal with it, I would need to grow a thick skin, and I did.
Today at 37, I am one of the few women I know to have cheered at my first wrinkle and to be looking forward to grey hair. Unlike those who consider themselves “born in the wrong body” I am at ease with myself and aware that the barriers I face are social, not physiological. It is up to me not to change myself, but rather to work to raise other people’s expectations of people like me.
Historically, it was not only short stature that was deemed worthy of medical intervention. From the 1950s onwards in the US, tall girls were given high doses of a drug called diethylstilbestrol (DES). From debilitating short-term side-effects to devastating longer-term consequences (including increased risk of cancer and infertility), the justification for stunting female growth was essentially that tall girls might struggle to find husbands. Interestingly, as opportunities for women began to expand the height at which DES was deemed to be necessary rose; from around 5ft 8in in the 1950s to 6ft in the 1970s and 1980s. Today, while the stigma of being a tall woman has lessened, the stigma of being a short man remains entrenched.
Some studies suggest there is a long-term economic cost to not measuring up to society’s idea of “man”. Writing in 2015 in the journal Economics and Human Biology, researchers found an additional 1cm in height is associated with a 0.39 per cent increase in hourly earnings, and that “a height premium in terms of work and life satisfaction exists for paid employees”. These findings are contradicted by other studies, and as with so much research that explores the boundaries of self and society, it is impossible to tell whether the stunted earning power of short men is indicative of a lack of individual ability or the prejudice of others.
From my own experience, as a short and baby-faced young woman it was nearly impossible to assert myself in normal workplaces. For example, dealing with clients I would frequently be asked if I was on work experience or assumed to be a very junior member of staff. When I tried to counter this by asserting myself, colleagues would roll their eyes knowingly and whisper to one another that I had a chip on my shoulder. When I was preparing for an interview at the age of 31, a senior member of staff wandered past. Looking at my smart clothes and the folder containing my certificates and credentials, she carelessly exclaimed, “Oh, you’re a good girl. You’re just so sweet.” This offhand and probably not unkindly- meant comment was a wake-up call. How could I progress in an organisation where despite ability and commitment I was effectively considered a child by those in whose hands my career rested? Unsurprisingly, I fluffed the interview.
Today, as a writer who works remotely, I am freed from subconscious biases based on my appearance. Interestingly, often the first thing those who follow my work as a writer and a campaigner say on meeting me is, “Oh! I expected you to be much taller!” I have never been sure what the correct response to this is, though I generally bite my tongue to avoid replying with equally fatuous observations about the attractiveness or weight of the person commenting. As ever, I understand the intention is not badly meant, however revealing it might be.
It is well known that other inherited characteristics also impact upon one’s life chances, yet the idea of, for example, whitening the skin of black children to alleviate racism would rightly be considered abhorrent. The problem does not reside with those who are “outsiders” or minorities in any community; the issue is how the majority treat those who are visibly “different”. Underscoring the use of hormone treatments for tall girls and short boys is a brutal truth about the social codes of sex: short women are valued as petite, and fetishised as doll-like and precious, whereas short men are considered as having failed at masculinity.
The fetishisation of short women is something I became acutely aware of from my late teens, and to use a somewhat Victorian euphemism, through my youth I was “not neglected”. I was approached by a number of men offering to make me famous as a performer in pornography; I was assured that looking so young I could not fail but to be successful. In retrospect, and with the knowledge that by the grand age of 37 I would in all likelihood be either addicted to drugs or dead, I am pleased to have declined.
Throughout my twenties, and in fact until I met the woman who has become my civil partner, my boyfriends were often assumed to be my father when I went out in public. There are few things funnier or more humiliating that going into a restaurant with a man you fancy only for him to be asked if he needs a children’s menu for his daughter.
On the darker side were the knowing looks and snide comments when we reached for one another’s hands in public. With the benefit of hindsight, I sometimes do find myself musing on the motivations of former lovers. Were they attracted to me because I of my child-like height? It casts an unsettling shadow over the memories of some past relationships.
Without question, it is more socially acceptable to be a short woman than a short man. Strangers frequently pass comment on my height, in shops, pubs and when going about my business. Their words are always inappropriate and unwelcome but not always outright offensive. But being rude about short men is a national comedy staple. To be a short man is to be emasculated, to be stripped of dominating masculine prowess. Naturally, those men who push back and strive to assert themselves are deemed to have “a Napoleon complex”. This is a cruel social bind.
Consequently, in the US, short boys are three times more likely than short girls to be treated with growth hormone, even though equal proportions of both sexes fall under the “normal” height threshold. The disparity between the numbers of short girls and short boys who are medicated to make them grow makes it clear that such treatment is a pharmaceutical fix for multi-layered social prejudices.
Nearly a century ago medical pioneer and neurosurgeon Harvey Cushing warned of the temptation to mine the “endocrine goldfield”. In their book Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height, Susan Cohen and Christine Cosgrove make a compelling case for synthetic growth hormone as the product which launched the biotech industry. In 1984 vice-president of Genetex, the company which manufactures Human Growth Hormone (HGH), claimed that the US would see “the supply of growth hormone defining what the deficiency is”. A year later HGH was approved for use by the Federal Drug Administration (FDA), and a few thousand patients with what was termed “pituitary dwarfism” were referred for treatment.
In the years that followed, the idea of “idiopathic short stature” (ISS) — short stature where there is no known cause — was popularised. Cohen and Cosgrove suggest that this was due to lobbying by pharmaceutical companies like Genetex. HGH was approved for use to “treat” ISS in 2003, expanding potential eligibility for growth hormone treatment, from 1 in 3,500 children to the shortest 1.2 per cent of the US population. In this ever-growing market more patients are created as the height bar is raised ever higher. For the first time in history, “curing” some children will lead to others being defined as “sick”. There’s big money in manufacturing insecurity about height.
An industry report last year valued the global HGH market size at $4.6 billion, with a predicted to rise to $8.5 billion by 2027. For the parents of children receiving HGH this amounts to around $70,000 per inch. Medical professionals suggest that in the more affluent parts of the US the use of growth hormone to treat otherwise healthy boys has become almost as routine as vaccinations. In an interview with This American Life, a paediatric endocrinologist who declined to be named, explained that around half of the referrals she receives are for HGH and that “parents will find out that one child in their community is being treated and will assume that because they’re below average [height] their child needs it too … if you say something like his predicted height is 5ft 9in, you might have a response like, ‘Well, that’s unacceptable.’” When refused treatment for cosmetic reasons, parents often “doctor shop” until they find a medical professional with fewer scruples.
There are many subtle ways that the low social status of short people manifests itself. When adults relate to children the usual rules of personal space are changed. Children’s physical boundaries are not considered as important as adults’ and consequently they are leaned over, spoken over and pushed out of the way. To a lesser extent, the same power dynamic exists between men and women: a man will carelessly put his hand on a woman’s back or arm in a way that he probably wouldn’t with another man. This is referred to by some psychologists as a “body buffer zone”.
Socially, short people are at the bottom of the pecking order when it comes to personal boundaries. When entering any public area, the onus will be on me to weave out of the way of the 99.98 per cent of people who are taller than me, and deep down I know that were I to stand my ground I would probably come off worse. It is both frustrating and fascinating, an insight into a deeply-rooted social bias toward taller people.
It might seem like a stretch but anyone who has seen works of art from the ancient civilisations of Babylon, Egypt and Greece will not fail to note that victors and gods are depicted as significantly larger than conquered armies and slaves. That those who opt for treatments to increase the height of their sons are wealthy prompts a further ethical problem.
Prejudice against short men in countries where growth hormone is used will be reified, as tall stature will become indicative of financial and social success. This is already the case in China, where certain professions are actively barred to short people. In an attempt to game the system, some are opting for expensive, excruciating and risky leg-lengthening operations in order to succeed in their careers.
In developing nations, treatments designed to increase the marriageability of children (in particular girls) as adults are rightly decried as cruel and harmful. The United Nations is resolute in condemnation of practices such as breast ironing, forced feeding and, of course, female genital mutilation. Those overseeing these practices do so in the belief that it is in the best interests of their children. While the impact of taking a course of daily injections through puberty might not be as painful or detrimental to health, the intent is the same: healthy bodies are irreversibly altered at the behest of parents.
Most parents want to protect their children, and the idea of giving treatments for no medical reason should be grotesque to most right-thinking people. When prime ministerial adviser Dominic Cummings and “super forecaster” Andrew Sabinsky were reported as having supported eugenics, the liberal media frothed with righteous indignation. And yet how many of those Guardian-reading social justice warriors would be happy with a son of 5ft, or a daughter of my height? How many would allow their children to stand out, to go through life with their bodies treated as public property ripe for comment and ridicule?
The use of HGH is the first step in the march toward human homogeneity. Today it’s the short kids, tomorrow it could be neuro-diverse kids, the kids with the “wrong” noses, the kids who might grow up to be homosexual. The life chances of any child outside the norm could be improved with intervention.
The thoughtless and at times deliberate prejudice that I have learned to navigate is a part of what makes me who I am. There is no escape: one can either develop a sense of humour about it or else a complex. Today, were I were offered a magic pill to make me “normal”, I wouldn’t take it for all the world. By medicalising those who are different we will change who they are. We risk giving in to intolerance and short-changing the world of the insights brought by outsiders.
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