Themes in Young Adult Literature: Death, Illness, and Loss

Start Free Trial


Download PDF Print Page Citation Share Link

Last Updated on January 12, 2022, by eNotes Editorial. Word Count: 2827

Titles Discussed

Conversion by Katherine Howe

The Fault in Our Stars by John Green

Going Bovine by Libba Bray

Thematic Overview

Literature is rich with stories about what it feels like to lose a loved one. In Roman poet Ovid's Metamorphoses (8 CE), Niobe offends the gods and suffers the...

(The entire section contains 2827 words.)

Unlock This Study Guide Now

Start your 48-hour free trial to unlock this Themes in Young Adult Literature: Death, Illness, and Loss study guide. You'll get access to all of the Themes in Young Adult Literature: Death, Illness, and Loss content, as well as access to more than 30,000 additional guides and more than 350,000 Homework Help questions answered by our experts.

  • Summary
Start your 48-Hour Free Trial

Titles Discussed

Conversion by Katherine Howe

The Fault in Our Stars by John Green

Going Bovine by Libba Bray

Thematic Overview

Literature is rich with stories about what it feels like to lose a loved one. In Roman poet Ovid's Metamorphoses (8 CE), Niobe offends the gods and suffers the loss of her fourteen children and her husband as punishment. Overwhelmed by her grief, she turns to stone. In English poet and playwright William Shakespeare's Hamlet (1603), the title character wishes for the opposite after the death of his father. “O that this too too solid flesh would melt / Thaw and resolve itself into dew!” he says, when, after almost two months, his mother asks him why he cannot just move on already. Grief for the dead is a force that shapes the living, and people have developed a wide range of images to express it.

But what of the dying? Societal attitudes toward death and dying—particularly in regard to those who are dying not from old age but from illness—have evolved since the days of Shakespeare and Ovid, when superstition informed both the medical treatment of the dying person and how the dying person was treated by the healthy. Just as Niobe's actions brought about the death of her family, so too must there be a reason why people were stricken by disease, the thinking went. Even into the twentieth century in the United States, terminal diseases such as cancer, particularly breast cancer in women, were considered taboo. In the 1980s the AIDS epidemic ravaged the country, disproportionately killing gay men, and outdated ideas about human sexuality and ignorance about how the virus was spread exacerbated the spread of the human immunodeficiency virus that causes the disease. It was not until the media began publicizing the cases of “blameless” victims, such as those who had acquired the disease from a blood transfusion and heterosexual women who had gotten it from their husbands, that major efforts were made to study the treatment of AIDS and disseminate information on its prevention. In 2014 an outbreak of the deadly Ebola virus in West Africa caused panic in the United States, where only a few cases were reported and, ultimately, successfully treated.

Illness may be frightening, but for most, it is not unfamiliar. As Susan Sontag wrote in Illness as Metaphor (1978), “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” In regards to cancer, the American Cancer Society estimated that more than 1.6 million new cases of cancer would be diagnosed in the United States in 2015—more people than live in the city of San Diego, California, which had a population of 1.3 million as of 2013. Given the number of people with a history of cancer—an estimated 13.7 million people in the United States in 2012—most people know someone who has had or has died from cancer. So many people are afflicted, in fact, that appropriate narratives have been fashioned about the treatment of the disease. Cancer is a battle to be won, as the popular narrative goes, and positivity and courage are the most effective weapons.

The novel The Fault in Our Stars (2012) by John Green challenges this narrative by focusing on what novelist Gayle Forman called, in an article for Time magazine in February 2015, “the messy stuff of human mortality.” It also explores deeper philosophical questions, one of which provides the centerpiece of the novel Going Bovine (2009) by Libba Bray. Bray's surrealist tale, based on Miguel de Cervantes's Don Quixote (1605–15), explores the nature of reality and deals with the question of what happens to a person's mind when he or she dies. Meanwhile, the illness in Katherine Howe's novel Conversion (2014) is not terminal, but it does provide the opportunity to examine the interplay between illness and societal attitudes toward certain groups of people (in this case, teenaged girls).


The mysterious affliction at the heart of Katherine Howe's novel Conversion is not terminal, but thanks to its unknown origins, it is arguably just as frightening as one that is. Howe based one of the novel's two intertwining plots on a 2012 case in which a number of teenage girls in Le Roy, New York, were stricken with a strange ailment that caused them to suffer from uncontrollable physical tics, such as twitching and flailing. According to an article by Susan Dominus in the New York Times in March 2012, one girl could not stop hitting herself in the face with her cell phone. In real life, as in Howe's telling, the diagnosis is something called conversion disorder: the girls were converting mental and emotional stress, doctors argued, into actual physical symptoms. “And because so many students were afflicted with similar symptoms, it was also considered to be mass psychogenic illness, which is another way of saying mass hysteria,” Dominus wrote. The conclusion seemed fishy to Howe. When she first heard the story, she immediately thought of a similar “affliction” from the past: the ailments suffered by a handful of young women in Salem, Massachusetts, in the late 1600s, who claimed to be possessed by witches. The fictionalized testimony of Ann Putnam, the only one of the girls to admit that the witch trials began with a ruse, provides the second thread of Conversion.

Howe's novel is less about the illness itself than what the illusion that illness affords the privileged high school students in her story, as well as the more unfortunate pilgrims of the Salem witch trials. Books dealing with serious physical illness also touch on the ways in which the protagonists are treated differently because they are ill. In The Fault in Our Stars, protagonist Hazel Grace Lancaster sardonically refers to certain gestures as “Cancer Perks.” For example, a flight attendant happily pours Hazel and her boyfriend Gus a glass of champagne even though they are not of legal drinking age. In Going Bovine, the protagonist, Cameron, is reviled at his high school. When he is diagnosed with a terminal illness, the same students who taunted him throw him a pep rally.

In Conversion, the young girls of old Salem lead thankless lives of servitude. They are invisible, particularly to the town elders who use them physically (the girls hardly ever sleep for all their labor) and, as Howe suggests at one point, sexually. For these young women, “illness” was a remedy for their powerlessness. Their illness was a way of being seen. The modern girls of Salem (Howe sets her Le Roy–inspired tale in the town) are similarly damned and exalted, though their plight is vastly different from that of Ann and her ilk. Twenty-first-century teenage girls are crumbling under societal pressures to succeed, Howe argues, and when they stumble they are accused of being hysterical.

John Green's novel The Fault in Our Stars has been included in a subgenre known as “sick-lit,” but to label his complex tale about two teenagers diagnosed with cancer as such does it a disservice. Green defies nearly all of the genre's tropes, taking particular aim at its most sacred: the one in which the dying person is a hero in the battle that is disease. Green prefers to focus on the essential humanness of his characters rather than create mythologies around them. “I think generally we have a habit of imagining the very sick or the dying as being kind of fundamentally other,” he told Rebecca J. Rosen for the Atlantic magazine in February 2013. “I guess I wanted to argue for their humanity, their complete humanity.” In doing so, Green builds a powerful picture of love and loss. Most people—over half of Americans—die in a hospital or another institution such as hospice. For many of those people, these settings leave much to be desired. In Going Bovine, an old woman complains of her sterile surroundings, saying, “This is not how I'm supposed to die.” When the protagonist asks her how she is supposed to die, she replies, “In a house by the sea in an upstairs bedroom.” Hospitals and bodily fluids are prevalent in The Fault in Our Stars—toward the end of his life, Gus has a tube inserted into his stomach—as are the mundaneness and disappointment inherent to living with a terminal disease.

For Hazel and Gus, every day is not a battle won; every day is another day. The tension between their desire to be “normal” teenagers and their extraordinary circumstances gives the story its texture and a layer of fundamental truth. Hazel's experience, buoyed by Green's honesty, does not jive with popular cancer narratives. While Gus is preoccupied with all of things he will never be, Hazel is happy, or at least content, to work with what she has. She has made her peace with the fact that most people do not die the way they would have wanted to die and may not even be remembered for the things they want to be remembered for, and she encourages Gus to adopt the same outlook.

However, Hazel's philosophical attitude toward her own death does not protect her from the pain of losing a loved one. Green applies as much realism to this experience as to that of the illness itself. Hazel watches the disingenuous Facebook condolences pour in when Gus dies and, at his funeral, kisses his “plasticized” face. But before all that, she dreads the phone call in the middle of the night, and when she finally gets it she feels an unbearable and suffocating pain. “Every second worse than the last,” she says. Green uses iconic imagery to describe her indescribable pain, the only “ten” on the pain scale she has ever felt. “And here it was,” she says, “the great and terrible ten, slamming me again and again as I lay still and alone in my bed staring at the ceiling, the waves tossing me against the rocks then pulling me back out to sea so they could launch me again into the jagged face of the cliff, leaving me floating faceup on the water, undrowned.” For Hazel (as for Niobe and Hamlet before her) the death of a loved one feels like almost dying but not quite.

Libba Bray's Going Bovine takes a central theme of The Fault in Our Stars and pushes it to the outer limits of thought. In Stars, Hazel muses on her and Gus's big trip to Amsterdam that it will be the first and only time she sees the beautiful city. Hazel and Gus share a deep love for one another, and together, they get to share new and incredible experiences with their limited time. But Cameron, the protagonist of Going Bovine, does not even have a real friend. However, over the course of the book, he travels to distant places and forges romantic and friendly relationships without ever leaving his hospital bed. Cameron suffers from a rare disease called Creutzfeldt-Jakob disease, a transmissible spongiform encephalopathy similar to mad cow disease. The illness literally eats away at his brain, causing him to hallucinate giants made out of fire, a hooded knight wielding a sword, and an angel with torn fishnet stockings and pink hair. These illusions are very real to Cameron, and as his illness progresses, the line between reality and hallucination is blurred. Bray weaves together an impressive array of images from Cameron's real world to construct his fantasy, but some of the most notable additions are scientific concepts such as the theory of quantum physics, which says, in part, that you can be in two places at the same time. As Cameron builds the relationships he never did in life, Bray suggests that the adventures people take in their minds are just as significant as the ones they take with their bodies.

Going Bovine also employs a trope common to science fiction and fantasy and rooted in philosophy of Swiss psychologist Carl Jung, in which the thing a person fears is actually a version of him or herself. In Bovine, Cameron is chased by a specter he calls the Wizard of Reckoning. When the Wizard takes off his hood at the end of the book, Cameron sees that the Wizard has his (Cameron's) face. The same concept provides the backbone for the plot of A Wizard of Earthsea (1968) by Ursula K. Le Guin, in which the hero is trailed by a Shadow of his darker deeds. In The Amber Spyglass (2000), the third book of Philip Pullman's His Dark Materials trilogy, each character discovers that they are followed, throughout their entire life, by their own personal Death embodied in a haunted-looking person cowering just out of reach.

The “death-with-my-face” trope encompasses both intimacy (like a friend) and fear (like a murderer), which perhaps accurately describes people's relationship with their inevitable deaths. Like Bray, Pullman employs scientific concepts such as the multiverse to explain the mysterious nature of reality. Both authors imagine death as one among the infinite universes, wrought with classical imagery. Pullman's land of the dead is accessible by boat—harkening back the River Styx, the body of water that the ancient Greeks imagined separated Earth from the underworld. Bray's concept of death, too, features boats and a river, but with a modern twist: it looks, to Cameron, curiously like the It's a Small World river ride at Walt Disney World.


As evidenced by these three novels, modern young adult literature is moving toward a more honest portrayal of death, illness, and dying—though the theme itself is not new. The star-crossed lovers of Shakespeare's Romeo and Juliet (1597) commit suicide, as does an acquaintance of Holden Caulfield in J. D. Salinger's 1951 novel Catcher in the Rye, an event that sets the teenager on his existential drift through New York City. In Katherine Paterson's classic 1977 novel, Bridge to Terabithia, a young boy grapples with the sudden death by drowning of his best friend, and there is an entire subgenre of young adult literature, derisively termed “sick-lit,” that deals with terminal illness. But for every book like Sylvia Plath's The Bell Jar (1963), a semiautobiographical narrative about mental illness, there are many more that avoid the subject or dealt with it less honestly. Most books about teenagers, until the late 1960s, favored plot over emotional truth. In early serial books featuring teens, such as Nancy Drew and the Hardy Boys, characters never aged, much less got sick or died, and if a peripheral character really did die, it was usually done offstage. When not ignored completely, death was usually treated melodramatically, as in Louisa May Alcott's Little Women (1868–69), where young Beth does not so much die as ascend to heaven in a haze of purity and goodness. In the 1980s and 1990s, young adult literature was largely educational. Characters died, but most often they did so as a warning or a lesson, having brought death on themselves by making mistakes such as drinking and driving or taking drugs.

In the twenty-first century, authors are pushing the boundaries of the genre by tackling more complicated subject matter. The novels discussed above are not merely about death and illness. They portray how the sick are both exalted and damned, how a departure from the familiar tropes of “sick-lit” can uncover deeper truths about the process of dying, and how questions regarding the physical bounds of reality can help people gain a better understanding of death. Like any adult reader, teenagers look to literature to apply meaning to seemingly meaningless events. Why do people fall ill? Why does society at large ostracize people who suffer? And why do people have to die? The three books discussed in this article—which could not, on the surface, be more different from one another—seek to address these questions in their own unique ways. The “dark” themes pervading young adult literature, Forman wrote, are really “about life,” and how catharsis and a better of understanding of death can enhance the experience of being alive.

Further Reading

  • Wallis, Rupert. “Why Death Is So Important in YA Fiction.” Guardian. Guardian News and Media, 18 Aug. 2014. Web. 13 May 2015. < adult-fiction-rupert-wallis>.
  • Wilson, Laura W. “Helping Adolescents Understand Death and Dying through Literature.” English Journal 73.7 (1984): 78–82. Print.


  • Dominus, Susan. “What Happened to the Girls in Le Roy.” New York Times. New York Times, 7 Mar. 2012. Web. 13 May 2015. <>.
  • Green, John. “How John Green Wrote a Cancer Book but Not a ‘Bullsh*t Cancer Book.’” Interview by Rebecca J. Rosen. Atlantic. Atlantic Monthly, 25 Feb. 2013. Web. 13 May 2015. <>.
  • Forman, Gayle. “Teens Crave Young Adult Books on Really Dark Topics (And That's OK).” Time. Time, 6 Feb. 2015. Web. 13 May 2015. < adult-i-was-here/>.
Illustration of PDF document

Download Themes in Young Adult Literature: Death, Illness, and Loss Study Guide

Subscribe Now