Pediatric Annals

Feature Article 

Charles Dickens and Barnaby Rudge: The First Description of Williams Syndrome?

Darren Eblovi, MD, MPH; Christopher Clardy, MD

Abstract

Williams syndrome, a disorder caused by a genetic deletion and characterized by moderate intellectual disability with relatively strong language skills and a hypersocial personality, was first described in the medical literature in 1961. However, 120 years earlier, Charles Dickens wrote the novel Barnaby Rudge, which follows an “idiot” through London's Gordon Riots of 1780. We propose that Dickens based this character on a person he knew with Williams syndrome. Common features include an “elfin” face, decreased cognitive ability and dependence on a caretaker, strong language skills with emphatic and perseverative speech, anxiety, and an empathetic, overly trusting personality. In the novel, these traits lead the character Barnaby to be duped into actively participating in the riots, which nearly results in his hanging. This example of fiction providing a description of a disorder more detailed than that of medical journals more than a century later should encourage physicians to look to sources beyond traditional scientific articles for valuable clinical information. [Pediatr Ann. 2016;45(2):e67–e69.]

Abstract

Williams syndrome, a disorder caused by a genetic deletion and characterized by moderate intellectual disability with relatively strong language skills and a hypersocial personality, was first described in the medical literature in 1961. However, 120 years earlier, Charles Dickens wrote the novel Barnaby Rudge, which follows an “idiot” through London's Gordon Riots of 1780. We propose that Dickens based this character on a person he knew with Williams syndrome. Common features include an “elfin” face, decreased cognitive ability and dependence on a caretaker, strong language skills with emphatic and perseverative speech, anxiety, and an empathetic, overly trusting personality. In the novel, these traits lead the character Barnaby to be duped into actively participating in the riots, which nearly results in his hanging. This example of fiction providing a description of a disorder more detailed than that of medical journals more than a century later should encourage physicians to look to sources beyond traditional scientific articles for valuable clinical information. [Pediatr Ann. 2016;45(2):e67–e69.]

In 1961, J.C.P. Williams1 described four patients with common dysmorphic facial features, supravalvar aortic stenosis, and intellectual disability. Williams syndrome, as this condition has since been named, is caused by a sporadic hemizygous deletion of 26 to 28 genes on chromosome 7q11.23. Research on patients with genetically confirmed diagnoses has shown that these people have moderate intellectual disability with relatively strong language skills and hypersocial personalities.

One hundred and twenty years prior to Williams' seminal article, Charles Dickens published Barnaby Rudge,2 a novel that follows the “light-hearted idiot”2 (p. 387) Barnaby Rudge through London's Gordon Riots of 1780. What began as a peaceful protest led by Lord George Gordon in response to the Papists Act of 1778, a law intended to reduce discrimination against Roman Catholics, quickly became the most destructive riots of 18th-century London, requiring a robust military response that left more than 285 people dead.3 Dickens' novel follows Barnaby, a 27-year-old man living with his widowed mother, as his naïve and overly trusting manner allows him to be duped into engaging with the riot's ringleaders, which nearly results in his hanging. Throughout the novel, despite his ability to produce grammatically correct soliloquies of advanced vocabulary, both Dickens and other characters describe Barnaby as an “idiot”2 (p. 37), “an animal”2 (p. 111), with the “absence of soul”2 (p. 35) and “blindness of intellect”2 (p. 377), and even as God's “most slighted and despised work”2 (p. 208). Because Dickens died decades before the elucidation of the concepts of genetic deletions, he could not have proposed any molecular basis for Barnaby's characteristics. However, it is our position that the character of Barnaby was based on a person whom Dickens knew with the aforementioned deletion. This article describes how Barnaby's character embodies decades of extensive social and psychological research on Williams syndrome.

The typical IQ range among people with Williams syndrome is 42 to 68,4 and the vast majority remain dependent on caregivers for their entire lives.5 Poor motor skills, combined with difficulty in visuospatial construction and low tolerance for frustration lead to decreased willingness to learn new skills for self-care.5 Despite his fluent speech and apt social abilities, Barnaby remains dependent on his mother, requiring her “care and duty in his manly strength as in his cradle time”2 (p. 154). Barnaby's mother reflects frequently on his “dawn of mind” that never came, and how “his childhood was complete and lasting”2 (p. 209). In one instance, Barnaby displays his numerical ineptitude by grossly misjudging time, expressing that he has not seen his mother in over a year, when in fact it has only been several days.

Despite the inability to live independently, people with Williams syndrome typically demonstrate ease in using complex syntax and even show a proclivity for unusual words.6 Multiple studies find they understand grammatical structures and use correct tense,4 although responses are often “perseverative.”7 In a discourse about his shadow, Barnaby announces:

He's a merry fellow, that shadow, and keeps close to me, though I am silly. We have such pranks, such walks, such runs, such gambols on the grass. Sometimes he'll be half as tall as a church steeple, and sometimes no bigger than a dwarf. Now he goes on before, and now behind, and anon he'll be stealing slyly on, on this side, or on that, stopping whenever I stop, and thinking I can't see him, though I have my eye on him sharp enough2

In addition to their relatively advanced grammar and vocabulary, people with Williams syndrome tend to use more emphatic markers in conversation,8 which Barnaby does throughout the novel. For example, when asked if he would join the anti-Catholic movement, “Barnaby, trembling with impatience, cries ‘Yes! Yes, yes I do,’ as he had cried a dozen times already”2 (p. 397).

In addition to such enthusiasm, people with Williams syndrome typically exhibit more empathy and are more willing to approach strangers than are people with typical development or those with other genetic syndromes.4 This manifests in early childhood, when people with Williams syndrome are eager to establish interactions with others, are frequently noticed by others, and show a clear attunement to others' emotions.9 Barnaby, consistent with this description, is “known along the road by everybody”2 (p. 92), and “the children of the place came flocking round him”2 (p. 209).

Superficially strong skill in communication and excessive sociability can give the impression that adults with Williams syndrome are more able than they actually are.5 In the novel, this assumption is made by both an abrasive gentleman who accuses Barnaby of pretending to be disabled in order not to work, and by Lord George Gordon himself when accepting Barnaby into his movement: “He has surely no appearance of being deranged? And even if he had, we must not construe any trifling peculiarity into madness”2 (p. 400).

Unfortunately, this language skill and hypersocial personality makes people with Williams syndrome susceptible to being taken advantage of. In one survey, many parents of adults with Williams syndrome reported that their offspring's overaffectionate manner and naiveté exposed them to serious risk of exploitation and abuse.5 Years before he is led enthusiastically into the riots, a friend warns of Barnaby's overly trusting manner: “I tremble for the lad – a notable person, sir, to put to bad uses”2 (p. 220). Functional brain magnetic resonance imaging has demonstrated that people with Williams syndrome have less reactivity in the amygdala, an area of the brain that is important for monitoring danger, to angry and fearful facial expressions.8 Barnaby demonstrates this characteristic through his warm interaction with Hugh, a “rough companion”2 (p. 433) and a ringleader of the riot, who is eventually hanged for his role.

Another reason people with Williams syndrome are overly trusting is their inability to interpret nonliteral utterances,9 and to determine the difference between lies and ironic jokes.7 In being convinced to join the movement, Barnaby neglects to notice the “many nods and winks”2 (p. 406) passed between Hugh and Dennis, another riot leader. Despite their language abilities, people with Williams syndrome are often easily distracted and have difficulty maintaining the topic of conversation,8 adding to their vulnerability. In addition to “yielding to every inconstant impulse”2 (p. 207), Barnaby's distractibility is demonstrated when Hugh and Dennis easily make him forget that they are about to attack the house of one of his friends: “The look of mingled astonishment and anger which had appeared in his face when he turned towards them, faded from it, as the words passed from his memory, like breath from a polished mirror”2 (p. 441).

It is perhaps their susceptibility to exploitation that leads people with Williams syndrome to also be prone to persistent fears, specific phobias, and general anxiety.4 Multiple studies indicate children with Williams syndrome have higher rates of anxiety than children with other forms of intellectual disability, and between 43% and 54% meet criteria for specific phobia.8,9 One family reported their child with Williams syndrome was unable to overcome a persistent and debilitating phobia of balloons.5 Barnaby, despite his eagerness to participate in the riots, is described as having an “eager and unsettled manner”2 (p. 35), a “terror of certain senseless things”2 (p. 37), and a “terrible restlessness”2 (p. 51). In one instance, he experiences “such an ecstasy of terror that the locksmith could scarcely endure to witness his suffering”2 (p. 37).

Finally, Dickens describes Barnaby as being “elfin-like in face”2 (p. 209), a description commonly used to characterize the wide mouth, small upturned nose, widely spaced teeth, and full lips of people with Williams syndrome.1

Although these common characteristics would indicate that Barnaby's character was indeed based on a person with Williams syndrome, Dickens could not have understood the genetic etiology of this phenotype. However, Dickens does describe how “before [Barnaby's] birth, his darkened intellect began”2 (p. 209), indicating, in language consistent with the scientific understanding of 1841, that Barnaby's condition was congenital rather than acquired.

As the human genome continues to be more precisely cataloged, the field of medicine must continue to draw upon the skills of minds such as Charles Dickens. Although fiction may not provide us with biologic mechanisms, subtle behaviors and characteristics described by keen observers may contribute to the diagnosis and treatment of patients suffering from genetic syndromes that have yet to be described.

References

  1. Williams JCP. Supravalvular aortic stenosis. Circulation. 1961;24:1311–1318. doi:10.1161/01.CIR.24.6.1311 [CrossRef]
  2. Dickens C. Barnaby Rudge. London, UK: Penguin Books; 2003.
  3. Babington A. Military Intervention in Britain: From the Gordon Riots to the Gibraltar Incident. London, UK: Routledge; 1990.
  4. Martens MA, Wilson SJ, Reutens DC. Research review: Williams syndrome: a critical review of the cognitive behavioral and neuroanatomical phenotype. J Child Psychol Psychiatry. 2008;49(6):576–608. doi:10.1111/j.1469-7610.2008.01887.x [CrossRef]
  5. Udwin O, Howlin P, Davies M, et al. Community care for adults with Williams syndrome: how families cope and the availability of support networks. J Intellect Disabil Res. 1998;42(3):238–245. doi:10.1046/j.1365-2788.1998.00122.x [CrossRef]
  6. Mervis CB, Klein-Tasman BP. Williams syndrome: cognition, personality, and adaptive behavior. Ment Retard Dev Disabil Res Rev. 2000;6:148–158. doi:10.1002/1098-2779(2000)6:2<148::AID-MRDD10>3.0.CO;2-T [CrossRef]
  7. Bellugi U, Lichtenberger L, Jones W, et al. The neurocognitive profile of Williams syndrome: a complex pattern of strengths and weaknesses. J Cogn Neurosci. 2000;12(Suppl 1):7–29. doi:10.1162/089892900561959 [CrossRef]
  8. Mervis CB. Williams syndrome: 15 years of psychological research. Dev Neuropsychol. 2003;23(1–2):1–12. doi:10.1080/87565641.2003.9651884 [CrossRef]
  9. Morris CA. The behavioral phenotype of Williams syndrome: a recognizable pattern of neurodevelopment. Am J Med Genet C Semin Med Genet. 2010;154C(4):427–431. doi:10.1002/ajmg.c.30286 [CrossRef]
Authors

Darren Eblovi, MD, MPH, is a Resident Physician, Department of Pediatrics, University of Chicago. Christopher Clardy, MD, is an Associate Professor, Department of Pediatrics, University of Chicago.

Address correspondence to Darren Eblovi, MD, MPH, Department of Pediatrics, University of Chicago, 5839 S. Maryland Avenue, Chicago, IL 60637-1470; email: Darren.eblovi@uchospitals.edu.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00904481-20160113-03

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