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Author info: Correspondence should be sent to: Pranesh Bhargava, Department of
Humanities and Social Sciences, Birla Institute of Technology & Science, Pilani -
Hyderabad Campus, India pranesh@hyderabad.bits-pilani.ac.in
North American Journal of Psychology, 2023, Vol. 25, No. 1, 151-160.
NAJP
Bibliotherapy with Context: Interpreting the
Symptoms of Disability in ‘Flowers for
Algernon’
Pranesh Bhargava & Krithika Nambiar
Birla Institute of Technology & Science, India
Many works of literature depict human psychological conditions,
including mental disorders. Becoming familiar with these depictions can
help real patients, health care providers, and members of the society by
providing a unique understanding of real-world experiences of
psychological conditions. Often literary writings, such as the short story,
Flowers for Algernon, are presented as a true depiction of the struggles of
a person with mental disability, and used as important text for
bibliotherapy for young adult readers. Moreover, there is a corresponding
growing interest in analyzing the depiction of disabilities and medical
conditions in art. Taking this view, this paper examines Flowers for
Algernon as an attempt to establish if this literary work is really fictional
science and should be treated as such, or is there any merit in reading it
as a literary but scientific record of the real struggles of a fictitious
person. Such analysis helps to underscore the need to establish context
before presenting works of literature in bibliotherapy, so that readers can
identify fictional elements and have realistic expectations.
Keywords: bibliotherapy, mental health, reading literature
Flowers for Algernon (FFA) is a popular short story published in
1959 (Keyes, 1959). Though it was later expanded into a novella, movie,
and several stage productions, in this write-up we refer to the 1959 short
story, which is the most popular version of this literary work (Keyes,
1972)
1
.
It is a captivating story about Charles (Charlie) Gordon, the
protagonist, who is a willing participant in an audacious and potentially
life-threatening science experiment. Born originally as a person with low
IQ, Charlie is subjected to a novel psychosurgery, which transforms him
within days into a person with an exceptionally high IQ. His progress
1
Available in the public domain at
https://archive.org/details/storiesofsuspens00mace/page/76/mode/2u
p
152 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
from a mentally challenged person before the surgery, to a brilliant
polymath after the surgery is narrated in first-person in the form of diary
entries. These entries are called the “progress reports” by Charlie.
In these progress reports, before the surgery, Charlie records his
struggles, fears, and desires in the form of sentence stubs laden with
spelling errors, indicating the low IQ. After the surgery, these progress
reports gradually get more complex and coherent in language, and also
become the record of Charlie’s new-found insights into matters of serious
research in science, reflecting the growing maturity and intelligence as
the result of the surgery. After a few months of a life of genius in which
he comes to terms with his past, Charlie realizes the value of his
relationship with others, and gives rise to valuable scientific innovations.
Then his IQ begins to tumble as the positive effects of the surgery abate.
FFA as Bibliotherapy Text
This story has been variously read and interpreted. Many consider it a
science fiction masterpiece, evidenced from it receiving the 1960 Hugo
Award for Science Fiction, and the 1966 Nebula Award for Science
Fiction (“1960 Hugo Awards,” 2007; “1966 Nebula Awards,” 2019). It
has even been analyzed to determine whether the neuroscience depicted
in the psychosurgery is actually possible (Collins, 2019). However, there
is a growing trend of viewing this work as a depiction of disability. The
story is considered to be a great attempt at bringing difficulties of mental
challenges to the public eye, and is presented as a true depiction of the
struggles of a person with mental disability.
One of the implications of this interpretation is that the short story is
used as a credible text for bibliotherapy. Bibliotherapy is the use of
literature as therapeutic adjuvant in medicine and psychiatry
(Bibliotherapy Committee, 1966). In the process of bibliotherapy, the
readers must personally identify with a particular character in the
recommended literary work, and seek psychological catharsis through the
experiences of the character (Reitz, 2004). As a part of bibliotherapy,
young readers and developing adults are put into programs to read
literature like FFA. It helps them with “…any social or emotional
struggles or developmental needs by identifying with a character in a
book who shares a similar struggle or need” (Fisher, 2009). Bibliotherapy
also allows young readers to understand the barriers and inequities faced
by disabled persons (Shaver & Curtis, 1981). There is a growing trend of
compiling reading lists that can be used for recommendations for
bibliotherapy (Dyches et al., 2001; Prater, 2003; Shaver & Curtis, 1981).
In order to serve the purpose of bibliotherapy for disability, it is
important that the work of literature represents the struggles and
challenges associated with disability with as much accuracy as possible.
Bhargava & Nambiar SYMPTOMS OF DISABILITY 153
The largest readership of this short story (and its associated novella) is of
youngsters, who are prescribed the text in universities and high schools
(Ickes-Dunbar, 2004; McCarthy, 2015). For the young readers in
bibliotherapy programs, to identify with the struggles of the characters,
the main aspects of the disability should follow the real life as much as
possible, even if the characters and events in the work of literature are
fictitious. Thus, it is important that while reading the story, readers know
what aspects of it are a real-life depiction of a specific disability and what
parts of it are fictional.
Objective of this Article
In the aforementioned context, in this article, we seek to establish the
following: Is the short story FFA really fictional science and should be
treated as such, or is there any merit in reading it as a literary but
scientific record of the real struggles of a fictitious person? In other
words, are only the characters fictitious, or are the purported condition
and symptoms fictitious too? The idea is not to undermine the story as an
important part of the history of literature, but merely to establish if the
disability depicted in the narrative should be considered realistic or
purely fictional.
Our attempt corresponds to a growing interest in analyzing the
depiction of scientific events not only in written fiction (Flohr, 1999;
Reboul, 2014) but also other art forms (Kaptein et al., 2020; Kaptein &
Thong, 2018).
Why do we consider the possibility that the story might be an attempt
at depicting the real-life mental disability? Firstly, we know that the
author, Daniel Keyes, was preparing to study medicine, and was a
freshman as a pre-med major at New York University (Cassedy, 2001).
Even though he did not pursue the medical degree, he did end up at
Brooklyn College as a psychology major (Coules, 1993). He even took a
year of postgraduate work at City College of New York, again majoring
in Psychology. Additionally, while training to become a psychoanalyst,
he had himself undergone psychotherapy.
We also know that he was teaching a class of special children from
where he found the inspiration to write the story (Sova, 2006). Thus, we
have reasons to believe that the author was in a position to portray the
real-life disability correctly.
To ensure that such depiction indeed is real, we closely examine the
various conditions and symptoms that are portrayed in the short story,
and compare them with DSM-V and other clinical resources that are used
to define, classify, diagnose and treat mental disorders.
154 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
ANALYSIS OF CHARLIE’S SYMPTOMS
Is it intellectual disability?
Charlie’s mental disability is one of the most important elements of
the short story. It appears that the author identifies his condition as
feeble-mindedness or mental retardation. In one of the progress reports,
Charlie considers himself to be ‘mentally retarded’ as he identifies his
own symptoms in another boy: “I felt sick inside as I looked at his dull,
vacuous smile, the wide, bright eyes of a child, uncertain but eager to
please. They were laughing at him because he was mentally retarded.”
On other occasions, he identifies himself as ‘feeble-minded’, e.g. “could
I have been that feeble-minded?”, and “Even a feeble-minded man wants
to be like other men.”
Mental retardation was a standard public health term during the 1950s
as is evident from the names of organizations that were working for the
welfare of the people with mental disabilities, like National Association
for Retarded Children (NARC) established in 1953 (History of The Arc,
n.d.), and American Association on Mental Deficiency named in 1933.
So, it appears that the author was referring to a standard and clinical
condition through this diagnostic term.
Charlie also claims in his progress reports that his IQ level is 68.
which would be categorized as mild mental retardation or borderline
mental retardation at the time of the writing of the short story (Redden et
al., 2002; The Minnesota Governor’s Council on Developmental
Disabilities, 2022).
In the present time, the term ‘mental retardation’ has been replaced
with the term ‘intellectual disability’ (Office of the Secretary,
Department of Education, 2017). As of now, IQ scores below 70 are
taken to indicate deficits in intellectual functioning. There is a
measurement error of 5 points in most IQ tests, which allows the cutoffs
for determining intellectual disability to be between 65 and 75 points
(Weis, 2008). Prima facie, this indicates that at 68 points, Charlie may be
considered to have an intellectual disability today.
However, intellectual disability is not based on the IQ number alone,
but also has a necessary criterion of limited adaptive behavior, i.e.,
restricted interaction with family and friends, limited ability to
communicate with others and understand them, and diminished ability to
feed and dress oneself. If only one of the two criteria is present, a person
is not considered to be intellectually disabled (Weis, 2008).
Readers see that during his disability phase, Charlie did not show
restricted adaptive behavior in the story. He was communicative with his
colleagues at his work place, and enjoyed their company as much as they
enjoyed his. In fact, he became less communicative and distant as he
became more intelligent after the surgery. Ironically thus, it was his
Bhargava & Nambiar SYMPTOMS OF DISABILITY 155
friends and interaction that he missed the most when he lost his
disability.
The matter of his interaction with his family is not explored much in
the story, but we do get the hint that he spent quality time with his family
visiting places and doing fun activities: “I found a picture of them with
me taken at a beach. My father has a big ball under his arm and my
mother is holding me by the hand.”
His father would hug him often, nullifying the possibility of lack of
childhood attention, especially hugs, leading to a psychological problem
(Khamsi, 2005; Paroma Basu, 2005): “He never shaved much and he
used to scratch my face when he hugged me.”
There is no indication in the story that Charlie could not dress or feed
himself. Contrarily, he is considered to be motivated and smart enough
already to be recommended for the psychosurgery.
People with intellectual disability may also have a lack of
coordination. Some interpretations of the short story do include the lack
of coordination into the production, e.g. the radio play production for
BBC by Bert Coules makes a clever use of mic bumps to make a
dramatic point about the lack of coordination in Charlie’s actions
(Coules, 1993). In the short story, one occasion, we do get a hint that
Charlie may have suffered from lack of coordination. This happens when
he sees himself in the dishwasher boy who crashed the chinaware.
However, the lack of coordination is not explicitly mentioned in the short
story’s manuscript. There is no mention of Charlie suffering from
handwriting or pen-grip issues either, which would have been a major
problem for his writing the progress reports. He was also employed at the
bakery, doing physical and manual work at the factory. This indicates
that Charlie’s hand-eye and muscular coordination may not be
pronounced, if even present.
These observations preclude the possibility of Charlie’s condition
being intellectual disability.
Is it language disability?
Since the short story is epistolary in nature, it provides conspicuous
hints about Charlie’s condition through his use of sentences and words.
For this reason, we look at the symptoms related to his linguistic
performance to make sense of his disability.
(i) Spelling: The most notable linguistic deficiency in Charlie’s
writing is his spelling mistakes, by way of adding, omitting, or
substituting vowels and consonants, e.g., ‘progris riport’ instead of
progress report. He spelled the words phonically, i.e. as pronounced. The
words are recognizable when pronounced out loud, the reverse of which
is what Charlie must be doing in order to spell the words. However, it is
156 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
notable that there seems to be no pattern to the spelling mistakes. A word
spelled incorrectly at one place is often correctly spelled at another place
in the report before the psychosurgery.
(ii) Grammar: His problems in grammar seem to be restricted to his
inability to use the correct punctuation. Before the surgery, the only
punctuation mark he seems to consistently use is the period at the end of
a sentence. People with linguistic disability often have problems with the
morphology of a language, e.g., in using irregular forms of a verb. They
often replace the irregular forms with regular forms (e.g., ‘childs’ in
place of ‘children’). In Charlie’s case, the prefixes and suffixes of the
words may be incorrectly spelled, as mentioned before, but are not
incorrectly formed. This means that he is shown to have no problems
with morphology of the language.
(iii) Speaking: The textual nature of the short story makes it difficult
to judge the pronunciation that the author intended for Charlie. However,
we do not note any mention of events where people could not understand
Charlie’s speech. We also know that Charlie would spell phonically
when writing things down, which is a strong indication that he had no
pronunciation related oddity. We can thus conclude that Charlie had no
speech impediment.
(iv) Reading: There are clearer indications of deficiency in Charlie’s
reading skills. We are told that Charlie attends special education classes
with Miss Kinnian, who gives him simple books to read. We also know
that he reads his own progress reports from earlier, but finds books like
Robinson Crusoe too complex to read. So, one can conclude that he is
able to do basic reading, slow reading, and he is not comfortable with a
more advanced vocabulary.
(v) Listening: Charlie finds it difficult to follow conversations when
people use long and difficult words and talk too fast. But in general, he
seemed to have no comprehension issues and followed the conversations
with his colleagues and even the scientists very well.
Social disability?
(i) Self-awareness: Charlie is aware of his condition, and the fact that
he is not ‘normal.’ Besides, he has a strong desire to become not just
‘normal,’ but smart. So, he has a clear, even if limited, understanding of
what mental disability is, and that he has such a mental disability. He
also has a similar understanding of what smartness is, and that he would
like to be smart.
(ii) With others: Charlie is portrayed to have problems in
understanding others’ intentions. His colleagues make fun of him and
laugh at him, but he is not able to understand it. The two scientists
monitoring his progress also express strong opinions about him in front
Bhargava & Nambiar SYMPTOMS OF DISABILITY 157
of him, but he is not able to understand them. Yet, he tries to follow the
conversations, and tries to recall the conversations for his progress
reports. What is remarkable is that he can identify emotions in others,
and feels empathy for them, not only for the people, but also for animals
(e.g., the lab mouse called Algernon). Since he likes to spend time with
his colleagues and Miss Kinnian, we know that he likes to socialize, and
does not have social anxiety.
Conclusion
Thus, Keyes presents the following as Charlie’s main problems in the
initial half of the short story: (i) an IQ of 68, (ii) inconsistent spelling
errors, (iii) punctuation problems, (iv) deficiency in reading fluency, and
(v) difficulty in following conversations. He is portrayed to have none to
mild problems with adaptive behavior. Thus, Charlie’s mental problems
are usually low IQ with linguistic disabilities.
According to DSM-V, the deficits in Charlie’s language primarily
indicate Down syndrome. People with Down syndrome have limited
vocabulary, their sentence structure is impoverished and their grammar is
simplistic (Diagnostic and Statistical Manual of Mental Disorders, 2013;
Dykens & Hodapp, 2001). All of this seems to be true in Charlie’s case.
There are quintessential facial features associated with Down
Syndrome, e.g., flattened nose bridge, flattened face, eyes slanting up,
short neck, and low ears. It is impossible to determine from the short
story whether Charlie had these features, but we do not read in the
progress reports if anyone made fun of him for his appearance. Thus,
even though it is plausible that Charlie was intended to be portrayed as
having Down Syndrome, it is not clear from the short story.
We conclude that the mental disability depicted in the short story
FFA could remotely be Down Syndrome, but most likely is not
analogous to any real mental disability. It is possible that instead of
carefully portraying one disability, Keyes has given an eclectic mix of
clinical symptoms to Charlie’s character. Why would the author do that?
We think that this could be because, at the time of writing this story, the
classification and differential diagnosis of mental disabilities were in a
seminal state. The first version of DSM was published in 1952, and it
was the first attempt to standardize the nomenclature in the field of
mental health and disability. Therefore, it is likely that Keyes was not
familiar with the classification of symptoms based on DSM-1 despite his
background in psychology.
Another reason why Keyes may have not given too much thought to
the uniformity of the symptoms is because the portrayal of symptoms of
mental disability with high fidelity was perhaps not the main objective
for the short story. Before writing the story, Keyes possibly had already
158 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
envisaged a certain impact he wanted to have on the reader’s mind. Then,
he worked his way back to the psychological characteristics of the
character to produce that impact.
This conceptualization implies that Keyes used Charlie’s clinical
symptoms as a plot-moving device instead of portraying a real-life
condition. This makes sense, provided that the story was published in a
science-fiction magazine, where the reader accords a willing suspension
of disbelief to the scientific principles presented in stories. Since this
literary work is a short story, the limitation on the length of the story
must have also muffled the scope of exploring many themes. Since the
story was written in the 1950s, much of the content matter may be
outdated, misrepresenting the science, or simply not scientifically valid.
The implication of our findings is that the young readers in
bibliotherapy programs must be presented with the story of FFA with the
caveat to consider the medical condition of the protagonist as not an
entirely real condition, but a work of fiction. A context to interpret the
story must be provided before the reading is undertaken. Generally, a lot
of care is exercised in choosing and curating the work of literature
prescribed in bibliotherapy. We recommend that an analytical discussion
about the condition portrayed in works of literature be discussed with the
readers as well as to assist them in identifying the elements of fictionality
matter in the medical condition portrayed in the literature. One cannot
change the piece of literature, and it is not fair to reject it altogether. But
this kind of analysis is important to establish a context allowing the
readers to identify fictional elements from real issues, and harbor a
realistic interpretation and expectations from the story. This view will
also help readers to understand how things have changed in society,
science, and education since the days the piece of literature, e.g. the short
story FFA, was written and published.
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Author Note: Pranesh Bhargava https://orcid.org/0000-0002-7737-1841
Krithika Nambiar https://orcid.org/0000-0001-9868-4954
We have no known conflict of interest to disclose.
