Salutogenesis and Young Adult Fiction Establishing Cognitive and Affective Balance in Contemporary Sick-Lit Deborah de Muijnck 1 Introduction Grounded in a postclassical narratological framework and combining cognitive and rhetorical narratology with a medical humanities approach, this chapter highlights the promising potential for future research about the healing as well as the salutogenic value of literature. It explores ways in which fictional characters and readers alike benefit from relativisation strategies and points to future possible, empirical studies with real flesh-and-blood readers. This contribution therefore situates itself in the larger context of the growing field of the medical humanities, in which scholars from varying research areas combine their methods and insights to increase the life quality of patients and of (normatively) healthy audiences alike. The benefits of narrative for mental health and society’s awareness thereof are not limited to the narrativisation of mental distress in therapeutic contexts. Rather, as the eudaimonic turn in literary and cultural studies highlights (see Nünning and Nünning 2020), it also concerns the stories which human beings surround themselves with in their personal and professional lives. By examining the cognitive and affective properties of the subgenre of sick-lit (specified below), this contribution highlights the innovative properties of salutogenic approaches toward literature. As a response to the rising popularity of the medical humanities and to the eudaimonic turn in literary studies (see also Heidi Liedke’s contribution to this volume), which both explore the potential of the healing benefits of literature, this contribution addresses how narrative strategies can support human beings cognitively and affectively in the process of establishing emotional balance when exposed to topics that may evoke intense emotional pain. It discusses why teenage readers specifically might value sick-lit narratives for their emotional properties and 10.24053/ REAL-2024-0010 1 These novels were chosen based on their representativeness of the sick-lit genre, as well as due to their wide success among young adult readers. Although The Fault in Our Stars (Green 2012) has received some attention from literary studies, no research has yet been done about either of these novels that highlights their cognitive and affective dynamics. 2 Cis-gender refers to the gender identity that a human being was assigned to at birth (Aultman 2014: 61). 3 For a detailed overview over the history of sick-lit in the twentieth and twenty-first century, see Elman (2012). sketches how concepts such as experientiality and embodiment influence the reading process of YA (young adult) audiences. This contribution engages with current scholarly discussions of the cognitive and affective properties and resulting salutogenic effects of young adult fiction. It examines the textual and readerly dynamics of three particularly successful novels which portray terminally ill female teenagers. In the first part, I introduce the concept as well as some of the forms and functions of narrative relativisation techniques, arguing that both fictional characters and readers apply these stra‐ tegies to re-establish an emotional equilibrium cognitively and affectively when being confronted with highly distressing topics. In the second part, I explore the value of novels popularly referred to as sick-lit for young adult audiences by highlighting their emotion-balancing properties through the concepts of experientiality and embodiment. I analyse three of young adult fiction’s most prominent novels of the past two decades: The Fault in Our Stars by John Green (2012), Nicola Yoon’s Everything Everything (2015), as well as Five Feet Apart (2019) by Rachael Lippincott, Mikki Daughtry, and Tobias Iaconis. 1 The term sick-lit refers to a subgenre that features (typically cis-female 2 teenage) characters who struggle with physical or mental illnesses, (attempted) suicide, or self-mutilation (see Elman 2014: 94). 3 Instead of presenting a detailed close reading of each novel, this section will highlight the textual and readerly dynamics shared by these narratives to explore their cognitive and affective influence on (young adult) audiences. 2 Sick-Lit and the Rising Awareness of the Salutogenic Potential of Literature in the Twenty-First Century The past two decades have seen globally rising numbers as well as increased acknowledgement of mental health issues, with depression being at the forefront of these damaging developments (WHO 2022: n.pag.). The past years have also seen a rise in popularity of novels and movies that can be categorised as sick-lit and sick-lit cinema. If we regard literature as a mirror of society, the parallels 10.24053/ REAL-2024-0010 224 Deborah de Muijnck 4 See also Stella Butter’s contribution to this volume on forms of (in)consolability in response to various crises. 5 The boundaries between narratives of illness and disability can be fluid, so that even the attempt to conceptually grasp corresponding phenomena with terms such as illness narrative, deviance narrative, or sick-lit already becomes a starting point for research (Holst et. al. 2016). between both developments may appear logical. However, as will be argued in the following, one should not regard the rising popularity of novels featuring suffering individuals as only a symptom of its time but also as a response to cognitive and affective needs which contemporary readers attempt to satisfy by reading these stories. 4 In this contribution and in line with the eudaimonic turn in literary and cultural studies, I argue that literature may be used to target psychological needs to the point where it might prevent the development of certain illnesses. Salutogenic narrative theory (see Nünning and Nünning 2017; Mittelmark et al. 2017) should therefore be regarded as a highly relevant new direction in the study of literature in the twenty-first century. Despite the contemporary rise of the sick-lit novel, the trope of the dying girl in literature is far from new. Between the early depictions of physically ill childlike figures and the current expression of chronically ill young adolescents, a development has emerged that is shaped by more dynamic ideas of disability, psychological and physical illness, and gender. 5 Characters such as Beth March in Louisa May Alcott’s Little Women (1868) and Milly Theale in Henry James’ Wings of the Dove (1902) were typically portrayed as the angelic and quietly suffering young female. In contrast to previous canonical novels that equally apply the trope of the dying girl, contemporary sick-lit fiction typically figures a first-person narrator, giving the dying protagonist a voice of her own. This way, the intensely personal physical and emotional experience of dying is presented in a taboo-breaking, brutally honest, yet often romanticised manner. The formula in these novels is frequently the following: a terminally ill cis-female teenager meets a (terminally ill or psychologically suffering) teenage cis-boy. Slowly but gradually, the two fall in love and start to explore their romantic feelings. Due to her (or their shared) state, obstacles must be overcome. This tends to culminate in a brief moment of escape from normality, the climax of the story, in which the two protagonists go on a romantic adventure together, before her or their approaching death forces them to return to their everyday, non-normative reality which is dominated by end-of-life care. Topics of intense friendship and close relationship with one’s family are additionally thematised, as the shortened lifespan of the protagonist leads to the usually reciprocal wish to live life in a condensed manner by closely interacting with one’s loved ones. 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 225 6 It should be highlighted that I deliberately do not theorise readers’ enjoyment of sick-lit; after all, not all reading is done purely for the joy of it but serves other, equally relevant purposes. However, as will be shown, I argue that momentary reading experiences which convey a sense of joy are necessary for audiences to continue the reading process. The popularity of novels thematising dying teenagers raises a few questions and highlights the necessity to critically reflect on phenomena in (popular) culture and their potential impact on diverse audiences. The fact that these novels have become such a globally successful phenomenon emphasises that there is a wide international readership that wants to engage with these types of stories. Their taboo-breaking topic, I argue, offers promising potential for research particularly in the medical humanities, as well as in cognitive and rhetorical narratology. After all, one might ask: what do people gain from reading stories that portray the perspective of a slowly but gradually dying, young woman? 6 The theoretical approach of this chapter is rooted in postclassical narratology, more specifically in cognitive and rhetorical narratology combined with the medical humanities. According to David Herman, “[p]ostclassical [n]arratology […] contains classical narratology as one of its ‘moments’ but is marked by a profusion of new methodologies and research hypotheses; the result is a host of new perspectives on the forms and functions of narrative itself ” (1999: 2f.). I apply Herman’s definition of cognitive narratology, which he describes as presenting “a focus on the mental states, capacities, and dispositions that provide grounds for - or, conversely, are grounded in - narrative experiences” (Herman 2014: 46). Cognitive literary studies invite scholars to combine more traditional critical approaches with psychological, medical, and anthropological insights and methodologies. This allows for new observations of and inquiries into salutogenic literary studies and the effects of narrative on the human mind, as exemplified in this chapter. The rhetorical theory of narrative emphasises “the recursive relationships between authorial agency, textual phenomena, and reader response, even as it remains open to insights from a range of critical approaches” (Phelan 1996: 2), and hence conveniently pairs with a cognitive narratological inquiry. The medical humanities are an interdisciplinary field of medicine which includes, among a variety of other disciplines, insights from the humanities, social sciences, and the arts (Kirklin 2003). They address questions such as what it means to be human in the context of health/ -care and include narrative as not only expressive but as transformative and therapeutic for those sharing their stories of grief and pain (Woods 2015). Combined with rhetorical narratology’s focus on textual and readerly dynamics, i.e. readers’ cognitive and affective responses to the plot (Phelan and Rabinowitz 2012: 6), this chapter explores how fictional characters as well as readers cognitively and affectively 10.24053/ REAL-2024-0010 226 Deborah de Muijnck cope with the topic of terminal illness by applying narrative-emotion balancing techniques, and how experientiality and embodiment support (specifically YA) readers in deriving value from the addressed types of stories. 3 Strategies of Containment: The Concept of Narrative Relativisation Techniques It is primarily through narratives that we as human beings construct ourselves, and actively change and manipulate our emotional landscape and our cognitive perception of reality. Through purposive communication, narrative allows indi‐ viduals to shape specific versions of circumstances consciously, subconsciously, and unconsciously according to their varying needs across time and space (Phelan and Rabinowitz 2012: 3; cf. also Fivush 2012). By combining cognitive and rhetorical narratology within a medical humanities framework, this chap‐ ter introduces the concept of narrative relativisation techniques. These are conceptualised as strategies applied within and through narrative which help individuals purposively shape their cognitive and affective conceptualisations of negative circumstances, hence supporting them to either contain or actively live through intense emotions. This, as will be highlighted in the following, can be achieved by either emphasising positive experiences that have come into existence because of the originally negative event, or by counterbalancing losses connected to the event. They can directly be used as verbalisations, or indirectly as themes and motifs which both influence the interpretation of the negative event. By applying these strategies, human beings may find emotional balance in distressing circumstances, such as experiencing terminal illness themselves, or reading about it through a gradually dying homodiegetic narrator that one empathises with. Emotional balance is here conceptualised as a state in which human beings allow themselves to feel, identify, and accept their emotions without being overwhelmed by them. The concept of narrative relativisation strategies is inspired by narrative techniques of neutralisation, which are rooted in narrative criminology and which are “verbalizations actors use to tell themselves that their actions are not in violation of the norms they are otherwise committed to” (Presser and Sandberg 2015: 6). Through the use of narrative techniques of neutralisation, (autobiographical) storytellers can de‐ crease cognitive dissonance and hence shape the way they perceive themselves and are perceived by others. I argue that emotion-balancing techniques serve a comparable cognitive and affective purpose. It should be highlighted that the negativity of the original event cannot be extinguished by the application of these strategies, neither is the painful 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 227 7 I conceptualise narrative empathy according to Suzanne Keen, whose seminal definition states that narrative empathy is “the sharing of feeling and perspective-taking induced by reading, viewing, hearing, or imagining narratives of another’s situation and condition” (Keen 2014: 521). 8 This article applies an anthropocentric conceptualisation of love, although it acknowl‐ edges that human beings can experience deep and tender feelings of affection for animals as well. Since these are, however, not thematised in the analysed novels, the focus remains on the loving relations between romantic partners, family members, and friends. experience itself emotionally neutralised. Rather, relativisation techniques add an additional layer to the perception of the circumstance, hence not simplifying the human experience but making the destructive force of certain events more bearable for both characters in the story and readers who experience narrative empathy. 7 In the following, this chapter discusses some relativisation strategies that are present in the textual and readerly dynamics of The Fault in Our Stars (Green 2012), Everything, Everything (Yoon 2015), and Five Feet Apart (Lippincott, Daughtry, and Iaconis 2019). I highlight their forms and functions and furthermore explore why they may help fictional characters and readers alike to come to terms with the topic of dying. As these novels’ main protagonists are all cis-female, this chapter will continue to refer to the protagonist as she/ her. 3.1 Highlighting Positive Experiences Connected to the Negative Event: Romantic Love and Affectionate Relationships The most dominantly applied relativisation technique in the analysed novels is the highlighting of positive experiences that are connected to the negative event. In the analysed YA novels, this is most prominently achieved through the thematisation of (mostly romantic) love and affectionate familial and friendly relationships that the protagonists experience. 8 Hazel Grace Lancaster (in The Fault in Our Stars, 2012), Madeline Whittier (in Everything, Everything, 2015), and Stella Grant (in Five Feet Apart, 2019) all consider themselves, due to their diagnoses of terminal illness, as physically flawed, which leads to varying levels of real and perceived physical and emo‐ tional isolation from their surroundings. Sixteen-year-old Hazel Grace suffers from stage IV thyroid cancer with metastases forming in her lungs, forcing her to constantly carry around an oxygen tank. Likewise, sixteen-year-old Stella Grant, whose lung function is fatally influenced by cystic fibrosis and who requires a lung transplant, requires breathing support from an oxygen tank to survive. Madeline Whittier turns eighteen in the novel and, for most of the story, is diagnosed with severe combined immunodeficiency (SCID). Because of this 10.24053/ REAL-2024-0010 228 Deborah de Muijnck 9 By the end of the novel, we find out that Madeline actually does not suffer from SCID, but was deceived by her mother, a medical professional, all of her life. After losing her husband and son in a car accident, Madeline’s mother forces her daughter to stay inside the protective walls of her house at all times out of fear of losing her as well. Although Madeline relishes her health by the end of the story, she lives as isolated as if she really were suffering from SCID for the majority of the plot. Additionally, she suffers a cardiac arrest due to a multiviral infection after suddenly entering the world with an immune system that is unprepared for the varieties of pathogens that exist. 10 See also John Keats’ “Ode on Melancholy” (1819), in which he argues that knowledge of our own mortality can intensify the aesthetic perception of beauty. diagnosis she must stay away from all potential allergens and pathogens, which results in her literal isolation from the rest of the world as she is unable to leave her home. 9 The main protagonist’s male love interest is affected by a similar suffering. Augustus Waters (The Fault in Our Stars, 2012), as we later in the novel find out, is dying from osteosarcoma. Five Feet Apart’s male protagonist Will likewise suffers from cystic fibrosis but, due to an additional fatal bacterial infection, is no longer eligible for a lung transplant (Lippincott, Daughtry, and Iaconis 2019). Olly, the young man that Madeline in Everything, Everything falls in love with, although physically healthy, isolates himself from the world because of his physically abusive father. Painful circumstances hence drive the character to mirror Madeline’s behaviour, which becomes a contributing factor in their shared process of falling in love (Yoon 2015). Terminal diagnoses impact the protagonists’ physicality and their ability to interact with others. As their everyday lives are dominated by end-of-life care or constant health-monitoring, the possibility of being perceived as attractive does not occur to either of them. Hence, when Hazel Grace, for example, starts to interact with Augustus Waters and slowly falls in love with him (Green 2012: 37ff.), her life, previously dominated by physical pain, is suddenly rendered unexpectedly joyand beautiful. Statements such as “you are so busy being you that you have no idea how utterly unprecedented you are” (Green 2012: 123) accentuate that, in contrast to Hazel’s self-perception, it is not the cancer that renders her painfully unique, but that Augustus genuinely falls in love with her warm personality. In fact, the analysed novels are not stories of dying, but stories that deal with the intensity of falling in love and loving wholeheartedly despite challenging circumstances. It is this beauty of (momentary) happiness that also invites the dying protagonist to momentarily value her own body, as suggested in the following quote: “The space around us evaporated and for a weird moment I really like my body; this cancer ruined thing I’d spent years dragging around suddenly seemed worth the struggle, worth the chest tubes and the PICC lines and the ceaseless bodily betrayal of the tumors” (Green 2012: 203). 10 Although the 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 229 11 It is on this holiday that the two share their first sexual encounter. It is also the time when Madeline suffers a cardiac arrest due to a multi-viral infection and, in the context of being treated by doctors other than her mother, is informed that she was previously maldiagnosed with SCID. 12 This chapter conceptualises ‘tellability’ according to Monika Fludernik as ‘what makes a story worth telling’ (Fludernik 2010 [1996]; Ryan 2005; Herman 2014 [2007]). Originally, ‘tellability’ has its roots in the analysis of conversational storytelling (Fludernik 2010 [1996]), but since then has proven itself relevant and applicable to various other forms of storytelling analyses. ability to explore their sexualities is limited due to their illnesses, Hazel, Madeline, and Stella experience intense emotions and sentiments with their counterparts, voiced through statements such as “I will love you forever” (ibid.: 264). The fact that their life-spans are expected to be shorter than the average person’s life expectancy influences the characters’ perception of the singularity of their romantic feelings. Statements such as “we can’t have a lot of things. But we could have this” (Lippincott, Daughtry, and Iaconis 2019: 161) and “I believe in true love, you know? I don’t believe that everybody gets to keep their eyes or do not get sick or whatever, but everybody should have true love, and it should last at least as long as your life does” (Green 2012: 75) highlight the singular importance of feeling (and receiving) romantic love. Going through this positive affective experience tends to culminate in a brief but exhilarating adventure in which the young lovers escape from their medical care-dominated existences. Hazel and Augustus travel to Amsterdam to have one last wish fulfilled (Green 2012: 234-288). Olly and Madeline likewise travel to Hawaii to share a life-changing experience together (Yoon 2015: 267-312). 11 Heavily limited in their breathing capacities and hence unable to perform such travels, Stella and Will escape from the hospital to walk through the snow and see the lights of the skyline that Stella has been limited to gazing at from the hospital roof (Lippincott, Daughtry, and Iaconis 2019: 220ff.). It is this adventurous journey that presents the climax of the story, before a catastrophe, connected to one or both of the characters’ limited health, forces them to re-enter their medically dominated world and initiates the parting of the characters. At the same time, statements such as “there is no glory in illness. There is no meaning to it. There is no honour in dying of” (Green 2012: 217, original emphasis) highlight that the characters (and therefore also the readers) always remain aware of the impending fate of the protagonists. Romantic love is the most dynamic positive experience which drives the plots of the analysed works. It facilitates Hazel’s, Madeline’s, and Stella’s stories’ increased tellability and supports them cognitively and emotionally in finding a reason to not just fight for their futures, but to also enjoy the present moment more intensely. 12 These momentary experiences of pleasure likewise influence the cognitive, affective, and 10.24053/ REAL-2024-0010 230 Deborah de Muijnck aesthetic responses of the audience (see Phelan 2012: 6). Due to the universality of the concept of falling in love, readers’ ability to empathise with the characters increases. At the same time, the general willingness to assume the perspective of the character equally increases, as the story is not only filled with the depiction of suffering, which might evoke the emotional rejection of empathy from readers unwilling to feel the momentary pain, but is equally filled with joyful experiences. These moments of joy increase the potential for finding emotional balance during the reading process despite the negative intensity of the topic of dying. Romantic relationships are not the only intense bonding experiences that are narratively highlighted in sick-lit. In fact, all of the protagonists are presented as emotionally strongly connected to their parents and their friends. While these relationships do not drive the textual dynamics of the narrative, they are still worth mentioning as creating a solid foundation of love. These relationships create a storyworld (see Ryan 2014: 12) in which a closely-knit network of peers and family members support the individual, de-isolating the protagonist despite her suffering and leading to additional experiences of joy for characters and their readership alike. 3.2 The Relativisation of Loss of Time Through Mental Growth These novels also address questions of ‘quality of life versus quantity of time’ and thereby relativise the sense of lost time. The analysed works specifically address the experience of living in a teenage body and knowing that, despite one’s youth, there is only a limited amount of time left. This restricted amount of time actively lived equally restricts the individual’s possibility to develop their unique personality as the adult they could have become, to grow not just physically older but also emotionally wiser. The female protagonists’ thought processes and speech, however, in The Fault in Our Stars (Green 2012), Every‐ thing, Everything (Yoon 2015), and Five Feet Apart (Lippincott, Daughtry, and Iaconis 2019) often appear to be more grown up than their physical age would suggest. The conceptual metaphor (see Lakoff and Johnson 2003 [1980]; Richie 2013) of G R O WIN G TH R O U G H P AIN applies to these stories, as the protagonists’ mental development excels the limits of usual teenager development. Due to their physically painful symptoms, tiring experiences of endless hospital stays, exhausting medical trials, and by being forced to confront themselves with their mortality, these female teenagers appear to be ahead their biological age. On the level of readerly dynamics, this relativisation of the perceived loss of lifetime functions as a counterweight to the characters’ young age. Although readers remain aware that the texts deal with the approaching deaths of young 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 231 women, the grown-up presentation of these characters makes the loss appear a little less extreme. On the textual level, this circumstance is not mentioned by either the terminally ill characters themselves, nor by their loved ones. 3.3 Quality versus Quantity of Time: Living Life More Intensely Next to the experience of positive events that are grounded in the original, negative diagnosis, and the relativisation of lost time, the analysed novels present a third relativisation technique which is the relativisation of the loss of future experiences. All of the presented female protagonists, as well as their equally terminally ill counterparts, Augustus (Green 2012) and Will (Lippincott, Daughtry, and Iaconis 2019), use what has become known as ‘bucket lists’. These are enumerations of the experiences or achievements each of them hopes to have or accomplish before they die. This list allows characters to regain a sense of control despite having lost the agency over their bodies. By identifying important milestones, aspirations, and hopes, the protagonists collect goals, such as being kissed for the first time (see Green 2012; Lippincott, Daughtry, and Iaconis 2019), or “snorkeling […] off Molokini to spot the Hawaiian state fish - the humuhumunukunukuapuaa” (Yoon 2015: 2) which support them and their audience in creating the perception that the majority of hopes and aspirations the protagonist has or had have been fulfilled. Bucket lists give their writers the opportunity to make life seem more manageable; they summarise aspirations into bite-sized steps that one can accomplish, making it easier to summarise what has been achieved in the past and what can still be done in the future. Although they can only ever be momentary and reflect a person’s wishes and needs at a fixed point in time, these bucket lists do help the protagonists to find answers to the question what makes theirs a good life and hence supports fictional characters and readers to cognitively and affectively counterbalance the topic of dying. Most importantly, the analysed novels ask: What is a good life? Notions of quantity versus quality are challenged, as a long life does not necessarily accumulate more happiness than a life that has been lived for a comparatively shorter amount of time. Characters and readers alike are hence confronted with reflections on what makes life worth living, which may result in a variety of responses. Will, for example, aware that he is no longer eligible for a lung transplant and expecting to die within the next three to five years, states that the “treatment crap is what stops us from being down there and actually living” (Lippincott, Daughtry, and Iaconis 2019: 78). Stella retorts “[t]heir treatment crap is what keeps us alive” (ibid.). This interaction highlights fundamental questions of agency, autonomy, and happiness. 10.24053/ REAL-2024-0010 232 Deborah de Muijnck The characters’ developments throughout the plot also highlight that there is no definitive answer to the notion of quality vs. quantity. Stella, for example, who is introduced as a well-structured, rule-abiding individual, is initially adamant about the necessity to live a cautious, risk-averse existence to increase her chances of survival. However, after having fallen in love, she (momentarily) decides to break out of the hospital, which poses a great risk to her lung functions. Stating that she is “tired of living without really living. I’m tired of wanting things” (Lippincott, Daughtry, and Iaconis 2019: 223), the narrative highlights that life is not just equated by heartbeats per minute, but also by what makes the heart beat faster. At the end of the novel, however, both approaches to the question of quality vs. quantity are validated: Will spends the rest of his shorter lifespan travelling with friends and family, hence filling his time left with as many experiences and interactions as possible. Stella, who eventually receives a lung transplant by the end of the story, has increased her chances of survival because of her careful and reserved demeanour. As the story ends with the two (previous) lovers accidentally meeting at an airport, the narrative suggests that no matter whether focused on quality or quantity, the outcome of life will be the same. What readers may take from this narrative is that while there is no general answer to the question ‘What makes a good life? ’, a definitive answer exists for every unique individual based on their own needs and wishes. This knowledge supports characters to come to terms with their fates. It also supports readers in coming to understand that a good life, whether it is defined by agency, autonomy, relationships, health, or other factors, varies from individual to individual. 4 Salutogenesis and the Minds and Bodies of Young Adult Readers This chapter so far has explored the textual and readerly dynamics of narrative relativisation techniques in a subgenre of literature popularly referred to as sick-lit. It will continue the analysis of the cognitive and affective properties of this genre from a salutogenic perspective by discussing how and why young adult readers may benefit from such novels. It begins by applying the concept of experientiality to highlight the benefits of sick-lit. Specifically, it explores the educational and de-isolating value of these novels for specific readers and argues that they offer a space for extremer emotions to readers who want to explore these. I will conclude this exploration of the salutogenic potential of sick-lit with a discussion of embodiment, highlighting the embodied nature of the stories, 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 233 and argue why specifically young adults may be drawn to this subgenre of twenty-first century literature. 4.1 Experientiality and the Emotionality of Sick-Lit A memorable quote from John Green’s novel The Fault in Our Stars states “[p]ain demands to be felt” (2012: 57), and the fates and diagnoses presented in the discussed novels certainly contain potential for considerable amounts of pain. A question that needs to be addressed in the context of literature that deals with/ narrates the suffering of young adults is why it attracts an audience so wide that it turns into a literary phenomenon. To explore this question, one needs to consider the concept of experientiality which, according to Monika Fludernik’s seminal definition, is the “quasi-mimetic evocation of real-life experience” (Fludernik 1996: 12), and its impact on teenage readers. Experientiality in literature refers to the ways in which “narrative taps into readers’ familiarity with experience through the activation of ‘natural’ cognitive parameters” (Caracciolo 2014: 149; see also Fludernik 2003), and particularly “the embodiment of cognitive faculties, the understanding of intentional action, the perception of temporality, and the emotional evaluation of experience” (ibid.). When readers engage with stories of terminal illness, they relate to the char‐ acters’ painful experiences by activating cognitive structures that are connected to their own past and present suffering. Particularly relevant is therefore the emotional evaluation of experientiality that happens when (young) readers engage with these novels. First empirical studies addressing this question highlight that sick-lit may be “a positive instrument for making adolescents aware of mortality” (Testoni et.al. 2016: 1), and there is a case to be made for the heightened awareness of one’s own body after experiencing a first-person narrator’s struggle for survival. This focus on mortality partially comprises the educational purpose and value of these stories, but does not take into account teenagers’ motivation to read novels such as The Fault in Our Stars (Green 2012). YA fiction can sensitively explore difficult topics that are not targeted by canonical literature. Especially individuals who have been diagnosed with an incurable disease may find inspiration when engaging with stories that address the beauty of life despite physical and/ or emotional suffering. Terminal illness may be a devastatingly isolating experience when in fact, social relations are considered the most important factors for the perception of a good quality of life (cf. Corsano et al. 2006; Helseth and Misvær 2010). By reading stories of characters who face their terminal fate with humour, love, and courage, people who feel isolated due to their own illnesses may temporarily overcome their 10.24053/ REAL-2024-0010 234 Deborah de Muijnck 13 For detailed discussions of the concepts of identification with literary characters and immersion in storyworlds, see also Jacobs (2015); Dixon and Bortolussi (2016); de Graaf et al. (2016); van Krieken et al. (2017). sense of loneliness by bonding with the protagonist. This sense of identifying with the characters, and being immersed in the positive events that happen despite (or even because of) their diagnoses, may help certain individuals reach a higher level of emotional balance. 13 Due to the broad, international readership of the discussed novels, it is safe to assume that the majority of their audiences are not suffering themselves from terminal illness, nor is it very likely that many of them are accompanying a loved one’s process of dying. As this chapter has argued so far, sick-lit addresses issues that especially young adults may sympathise with, such as the intensity of teenage love, the existential question of ‘What makes a good life? ’, and the development of one’s personality in times of crisis. Through experientiality, narratives create a safe space in which readers may temporarily explore the feelings and realities of others. Through these stories, readers can indulge in extreme emotions and situations which might societally be frowned upon but which readers might have the urge to experience themselves. This certainly does not mean that readers of sick-lit wish to receive a terminal diagnosis, or to watch their loved ones die. But it suggests that there is the need to create a space for highly intense experiences of self-reflection, which are targeted in these novels. After all, going through puberty may be regarded as an (emotionally and physically) challenging experience that triggers existential crises. Stories which address the most existential crisis there is, namely the struggle to survive, paired with questions such as ‘What do I need in my life to be happy? ’ create a narrative that addresses many contemporary young adults’ needs for self-reflection, (romantic and familial) companionship, and the search for one’s changing and developing identity. Through experientiality, YA readers can address certain needs they might be faced with, which consequently supports them in the process of reaching emotional balance. From a salutogenic perspective, this may have a positive effect on their emotional balance and may consequentially reflect in their mental and physical well-being. 4.2 Embodied Experiences of Autonomy Recent approaches of 4E cognition highlight that human thinking does not exclusively happen inside the brain, but is embodied, embedded, enacted, and extended through extra-cranial processes (Rowlands 2010; Carney 2020; Carac‐ ciolo and Kukkonen 2021). Although all four aspects generally show potential 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 235 for a salutogenic approach towards literature, the concept of embodiment is the most relevant for a discussion of young adult readers and the cognitive and affective relativisation dynamics they apply during the reading process. I will therefore briefly sketch the impact of embodied cognition for a young adult readership of sick-lit. The experience of living in a body that is (comparably) rapidly changing can both be positive as well as scary for human beings. Whether somebody enjoys the process of witnessing their body changing and growing up, or feels overwhelmed by this, sometimes even resulting in psychological destabilisation (see Tarazi-Sahab et al. 2021): Puberty comes with a pronounced lack of control over one’s own body. This lack of physical control is furthermore combined with a lack of legal self-determination until having reached judicial adulthood. This makes young adult readers curious cases of individuals right between the mental and emotional properties of children and adults. The experience of puberty, I argue, impacts the way narratives of physical change will be received by an audience that can identify with a pronounced lack of control over one’s physique. Although physical and hormonal changes experienced throughout puberty are certainly in no way comparable to the experience of cancer, cystic fibrosis, or severe combined immunodeficiency, young adult readers might be particularly attracted to stories that deal with losing control over one’s body. A teenage reader, who brings their own embodied experiences of going through puberty to the reading process, might have a different sense of identifying with the protagonist’s lack of control over their body than a fully grown adult might. As their own bodies may at times appear to be acting out, storyworlds in which the protagonist similarly seems to have no agency over her physiological state of being may appear surprisingly close to home. Living in a body that is experiencing changing sensorimotor capacities because of growing up, one could argue, influences the way the immersed reader may position themselves in the storyworld and identify with the sick character. At the same time, as the cultural context of puberty denotes the end of one’s childhood, YA audiences may feel a sense of connection between the protagonist’s departure from life, and their departure from life as they knew it. Typically, the experience of puberty also encompasses first romantic and potentially sexual encounters. Sick-lit, while it targets teenage romance and budding sexuality, does so in a limited capacity that may appeal to certain readers. The analysed novels’ protagonists are restricted in exploring their sexuality and in engaging in sexual activities with their romantic counterpart. Due to their weakened physical states, the protagonists approach sexual activity 10.24053/ REAL-2024-0010 236 Deborah de Muijnck very carefully, and only after having been emotionally engaged with their partner for a certain amount of time. This approach to getting physically intimate with a partner suggests a didactic purpose, as it strongly contrasts with other medial representations of sexuality in which (grown-up) characters in movies, series, and computer games may engage in casual sexual activities that entail little emotional connection between the parties. Teenagers who are starting to explore their changing bodies and their sexual preferences may, in my reading of these narratives, be more comfortable being immersed in storyworlds in which the characters approach each other slowly, tenderly, and necessarily with caution and heightened respect of the others’ boundaries. These narratives therefore represent a didactic (heteronormative) approach towards exploring one’s sexuality consensually as a teenager and in light of one’s individual conditions. Young adults’ changing bodies as well as their lack of control over these changes make sick-lit stories particularly attractive for YA audiences. They increase the potential for identification with the protagonist, change the em‐ bodied reading process, and offer young people on the verge of exploring their own sexuality a storyworld in which sexual encounters are dominated by romantic feelings and extremely careful physical interactions. Sick-lit hence offers a unique reading experience to those YA readers who feel attracted to these intense, taboo-breaking stories and, from a salutogenic point of view, may support them cognitively and affectively to work through specific emotional states. However, it needs to be highlighted that all narratives written for children and young adults carry moral, didactic, and social responsibility and that stories of dying teenagers cannot, and certainly should not, be generalised and considered suitable for all audiences. 5 Conclusion In this chapter, I have discussed the cognitive and affective properties of textual and readerly dynamics in young adult novels from a salutogenic point of view. More specifically, this chapter has explored how characters and readers alike re-establish an emotional equilibrium when confronted with distressing topics. This emotional equilibrium may either be out of balance because of intratextual circumstances situated on the plot level, which are targeted by narrative relativisation strategies, or because of real-world issues readers are faced with, which may consequently lead them to seek out these types of stories. In order to find emotional balance in (stories that target) the process of dying, a variety of narrative strategies can be applied. Exceptionally positive events, 10.24053/ REAL-2024-0010 Salutogenesis and Young Adult Fiction 237 circumstances, or experiences that are a result of the original, negative state can be narratively highlighted, which in turn result in a positive cognitive and/ or affective response. Another option to counterbalance the painful experience is to relativise the perception of loss. This can either be achieved by highlighting characters’ growth, presenting them as mentally more mature than they are biologically, hence relativising the perceived sense of loss of life-time. The second option that has been detected in the analysed novels is the minimisation of the perceived sense of loss of experiences, emphasising that quantity of time does not mirror quality of life. Furthermore, this chapter has argued for the impact of experientiality on young adult readers, which supports audiences in the emotional evaluation of their own painful experiences in the process of growing up. This contribution has concluded its discussion of cognitive and affective textual and readerly dynamics in sick-lit with an exploration of embodied cognition, which, as was argued here, is specifically relevant for audiences who experience lack of physiological as well as legal control in the process of growing up. Despite the values and the potential of these novels for YA readers, one needs to acknowledge that their taboo-breaking properties and the general trope of the dying girl can also be dangerous for impressionable audiences. Some stories of this subgenre romanticise the process of dying, and especially the creators of novels, movies, and television series that target topics such as self-mutilation and suicide must be constantly aware of the moral and social responsibilities that their works carry. Sick-lit novels can, when depicted responsibly, i.e. with honesty and based on state-of-the-art research, confront the realities of children and young adults with serious mental and physical conditions, thereby serving as starting points for necessary dialogues about mental health and mortality. At the same time, they have the dangerous potential to romanticise death and reckless behaviour that challenges one’s physical and/ or mental health. This chapter has highlighted how readers and characters may narratively, cognitively, and emotionally respond to existing negative states. As already argued by Fludernik (2020), especially the movement towards empirical literary studies highly benefits from cognitive approaches toward literature, as they allow the inclusion of knowledge structures and emotions triggered when actual (flesh-and-blood) readers process and assign meanings to narrative texts. Future studies with actual readers will benefit from focusing on the salutogenic properties of specific types of stories, hence exploring how literature can foster physical and emotional well-being (see Nünning and Nünning 2017). Certain medical conditions, such as high blood pressure, depression, or stress-related cardiovascular or gastric issues might, for example, be forestalled by certain 10.24053/ REAL-2024-0010 238 Deborah de Muijnck 14 Elena Semino et al.’s pioneering Metaphor Menu for Cancer Patients (2018) serves as an example here of how metaphors as central cognitive tools shape the way human beings speak and think about coming to terms with potentially terminal illness. 15 See also Heidi Liedke’s contribution to this volume. narratives that, quite literally, foster readers’ emotional and thereby also their physical well-being. 14 This contribution has highlighted the innovative potential of the eudaimonic turn 15 in literary and cultural studies by exploring readers’ and characters’ tendency to find emotional balance in and through narrative(s). Salutogenic narrative theory should therefore be regarded as a promising conceptual approach in literary and cultural studies in the twenty-first century. 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