Can a play with a mentally challenged cast be reviewed by critics in the standard way?

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On the stage of the Young Centre in Toronto these days, an actor with Down syndrome is confronting audience members with their own prejudice, demanding, "You think I'm retarded? Look at yourself!"

Toronto playwright and director Judith Thompson is the hand behind this harrowing moment: She is the director and co-creator of Rare, a show in which nine Down syndrome adults talk about their lives, their pain and their hope. The show, which opened this week, almost defies criticism – Globe and Mail theatre critic J. Kelly Nestruck has declined to assign it a star rating while Toronto Star reviewer Robert Crew has given it four stars – but not contextualization.

In a still controversial 1994 case during the AIDS epidemic, New Yorker critic Arlene Croce refused to review Still/Here, a dance piece by the U.S. choreographer Bill T. Jones, because it included voices and videos of real people with life-threatening illnesses. In an essay, Croce argued that by evoking the participants' status as victims the choreographer was placing his work beyond the reach of criticism.

Today, the presence of performers who can only operate outside the standards of conventional theatre is less controversial. The Italian director Pippo Delbono, something of a collector of unusual bodies onstage, has made long-time collaborators out of one man with Down syndrome and another who is a deaf mute he rescued from an asylum. His confrontational work often provokes audiences to walk out but, in Europe, where he is critically revered, his choice of actors is seldom questioned by reviewers.

Young Centre director Albert Schultz, who invited Thompson to mount Rare at the Distillery District venue, said there was no discussion about using non-Equity performers nor whether critics should be invited to the opening. He presumes critics would judge the show by how well it achieves its goals, not by the standards of the Stratford Shakespeare Festival.

"What I find compelling about Judith's position is that she insisted these people are artists and not people with Down's Syndrome. She believed they are artists who should be treated as professionals and otherwise would not have a home for this project," he said, noting the performers were paid from the start.

Still, Nestruck said he chose not to give a star rating because the cast was not professional – a decision he had made previously for Thompson shows featuring civilian casts.

"Star ratings flatten a review into a number and provide a point of comparison for the reader," Nestruck said. "This show is unique, rare, as its title says. Trying to assign it a rating on a scale of one to four seemed absurd."

For Thompson, a playwright whose scripts have often featured abused, disabled or violent characters, Rare is a continuation of her theatrical work with non-professional actors. It's a technique she feel into coincidentally in 2008 when the soap and cosmetics manufacturer Dove commissioned her to create a play about aging and beauty that would use "real" women rather than actresses talking about the issues. Her work with the Down syndrome actors, and her plans to do future shows with people in wheelchairs and the deaf, make her part of a short, irregular and often controversial line of contemporary directors working with the physically or intellectually disabled.

Historically, there is no nice precedent for this work: Once, the circus freak show was the only home for the handicapped performer. When the talkies started, dwarfs, in particular, were occasionally called on to play clowns or villains but today the film industry actually has an increasingly realistic approach to presenting the handicapped, including Down syndrome characters played by similarly disabled actors in everything from episodes of Glee to the Canadian film Café de Flore. Meanwhile, independent film has often embraced the idea of casting marginalized, non-professional actors such as street kids in the belief it will produce more honest acting.

That approach is much more difficult in live theatre, where shows are built from continuous performances that can't be reshot or edited, but Thompson is determined to break through the artificiality she sees in theatre.

"I have just had an instinct to deal with marginalized people," Thompson said. "The idea of theatre as our betters – Hollywood actors are all better looking [than us], living in better homes and with theatre, it's Noel Coward, people with cocktail glasses – I wanted to break through it."

Thompson exploded onto the Canadian theatre scene in 1980 with Crackwalker, a play set among down-and-out characters in Kingston and inspired by her experiences on a summer job as a social worker's assistant whose clients included a woman whose boyfriend killed her baby. More recently, Thompson has stopped creating fictional characters and gone straight to the people.

"I have always had my students tell their own stories," said Thompson, who also teaches theatre at the University of Guelph. "It's so authentic. They are never better actors; they are never better stories."

The commission from Dove was controversial in the cultural community because of a fear of corporate influence, but Thompson insisted Dove was not interfering with her artistic process in any way and Body and Soul was successful enough that she subsequently remounted the show independently. In 2010, she created Sick, a show featuring 14 youths suffering from everything from diabetes and Crohn's disease to cancer. Krystal Hope Nausbaum, a young woman with Down syndrome who appeared in that show, then provided the inspiration for Rare. Nausbaum co-created the show with Thompson, who spent hours listening to the participants she had chosen through auditions while her assistant director Nick Hutcheson took copious notes.

"Often they would say what they thought we wanted to hear, things they had said before, all camp courage. You have to peel back the layers," Thompson said.

When Schultz saw the show when it premiered at the Fringe Festival last summer – "I was humbled by its directness and honesty," he said – he not only invited Thompson to remount it at the Young Centre, but also suggested her small company take up residence to do two more projects. She has approached Spinal Cord Injury Ontario for help finding actors to do a show featuring a cast in wheelchairs that may also be mounted at the Pan American Games, and is planning a show with deaf performers in 2015.

The obvious Canadian precedent for her work is Diane Dupuy's Famous People Players, the company of adults with intellectual disabilities who perform black light puppet shows. It was formed back in the 1970s and is still thriving as an exercise in inclusiveness, but in at least one respect it is crucially different from Rare.

"It's an amazing show, because their challenges are all hidden," Hutcheson said. "Here, their challenges are all visible."