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Literature and Medicine 21.1 (2002) 132-146
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Friends in Need:
Illness and Friendship in Adolescent Fiction
Marilyn Chandler McEntyre
One of the most peculiar and unsettling dimensions of illness or accident may be the way such crises reconfigure relationships within families and among friends. The demands of the sickroom, even for those who are not principal caregivers, may be too distressing to meet, so even some who wish to help may flee, turn a false front, or emotionally abandon the sufferer.
In the wide array of recent young adult novels that focus on situations of illness, accident, and recovery, loss of or change in important relationships figures as a central theme. Young patients watch parents, siblings, or best friends react to their own sorrow, guilt, and fear by backing off. But then gifts come from unexpected places. Suddenly an aunt, a teacher, a night nurse, or an acquaintance barely acknowledged turns out to be a mainstay. These caregivers bring skills others lack: fearless tenderness, a capacity to tolerate another's pain, tough-minded encouragement, timely humor, inventive antidotes to tedium.
The best of such characters serve to show us the many faces of fidelity. And the best of the novels provide rich instruction and inspiration for readers who turn to stories of illness as a resource for recovery—patients, parents, siblings, support-group leaders, and friends of the afflicted who want to know what real help looks like. In some of them the protagonist is the patient; in some, the one who finds him- or herself in a new role as caregiver from which unsuspected satisfactions emerge. Suffering itself is neither sentimentalized nor valorized; the Victorian tradition of the angelic dying heroine or the romantic consumptive is far behind us, since we live in a postmodern environment. But we are moving away from the more mechanistic, highly individualized medical models of the early twentieth-century "microbe [End Page 132] hunters," who tended to diagnose and treat illness as though it were largely independent of cultural context. Now, as David Morris points out, the terms of illness—our expectations of both illness and cure—have changed. We have become generally aware that the "long dominant biomedical model" by which we have understood illness in the West is a "dubious grand narrative: a theory that reduces every illness to a biological mechanism of cause and effect." Rather, we are moving steadily toward a more complex understanding of illness in social contexts and of the "elaborate interconnections between biology and culture." 1 While such theorizing may seem too sophisticated to apply to fiction for young adults, explicit treatment of how family systems and social relationships directly affect the delicate process of healing can serve as one measure of excellence in such fiction. The way in which the novels reflected upon in this essay articulate those complex relations recommends them as useful instruments for understanding and coping with serious illness or disability in a changing medical and social environment. 2
In focusing on "young adult" fiction, now an established market genre, I hope to foreground issues which, if not exclusive to teens, affect them in a peculiar way. Teens are not yet empowered to make their own medical decisions. They are still living in families of origin, though the attachments they seek often put them at odds with family members. And the irony of sudden illness or disability in their lives can seem especially cruel, poised as they are in the midst of preparation for independence and adulthood. The young adult market abounds with second-rate books—formulaic, dumbed-down page-turners that offer little challenge. But there are very fine books for young adults available, and these can be invaluable aids in adapting to the full range of the hardships against which youth, affluence, and happy birth offer no protection. In my experience, such novels are helpful not only to young people themselves but also to those of us who work with them.
The best of the many fine authors of young adult fiction recognize that they work in a genre...