The next greatest spike in percentage is in the early 1900s which is when World War I and horror and carnage of its existence spreads throughout the European nations and beyond alongside the great epidemic of influenza that occurred in 1918. All these events that occurred during these time periods are illustrated in the term “sick literature’s” use. Most of the documents associated with these years using “sick literature” means just that—sick literature. They are articles and medical journals that cover the actual physical illness of the body, not a type of genre or trend in literature .
Early Emergence of Sick Lit as Young Adult Literature
However, it is in the 1960s that the term emerges to be used on a greater and continual scale than ever before, though it is still a very recent term and used in small amounts. Sick-lit flows in the same vein as other traditionally controversial topics for teens—teen sexuality, violence, and teen drug use most commonly—as it addresses tough issues of real life. While young adult literature as defined by these issues emerged in the 1960s, sick-lit first emerged later in the 1970s and 1980s . These were the years of upheaval and social change and reform, particularly in the United States of America. There were also incredible medical and technological advances being made allowing knowledge to become more accessible to the average citizen. This was made possible especially with the creation of the internet. The first prototype of the internet was created in the 1960s, and later became a household item in the 1990s and 2000s . With the awareness created by reform, coupled with the easy access of knowledge, previously taboo or unknown topics such as AIDS, cancer, eating disorders, and mental illnesses, slowly became more of a public discussion and more fully understood. Sick-lit became another means by which teen life could be portrayed, with sicknesses such as cancer, self-harm, and emotional illnesses as the vehicles to examine the “coming of age” theme apparent in most young adult literature.
Literature is also a way for people to connect to others-a mode of communicating values or ideas. Authors write their ideas and passions, while readers intake these ideas, thus creating an intangible communication between author and readership. There is also an invisible connection between a reader and those who have previously read the same book. They have read the same words together, and though they may have internalized these ideas in different ways, it still creates symbolic relationships between all readers as it creates a common mode of discussion and foundation for further conversation  This connection, though unseen, influences readers as they come to understand ideas and with the possible subconscious embodiment of the ideas presented. Because of this powerful connection between readers and authors, as well as the influence literature can have on readers, the topic of disease and sickness in literature can become a means to share personal struggles with these diseases and help people feel moved by these characters’ stories.
Therefore, it is no surprise that with the recently emerging genre of young adult literature that these topics of various sicknesses in their many forms would become a focus for readers as people are aware of their effects and the voices of the people experiencing these struggles are better heard than in previous years. It is also a moving source of subject matter that people can find connection to and communicate with one another about. Sick-literature, fusing social and medical awareness of tough topics supplemented with discussion of everyday events, is a genre that is reaching numerous ages and has become a recent and emerging genre within young adult literature which continues to grow in popularity.
Sick Lit Today
Sick lit depicts a protagonist either dealing with a disease or having a close relationship with another character who is dealing with sickness. The conflict is usually that the character lives in the real world where life is moving fast, but he or she must deal with the burden that is disease. The disease prevents him or her from leading a “normal” teenage life. Instead of getting ready for the prom or getting a driver’s license, the character is scheduling his or her next doctor’s visit or going through chemotherapy. And if it’s not cancer or another physical illness that the character is dealing with, he or she is struggling with depression or other mental illness that may cause him or her to inflict self harm or be unable to enjoy life. The general characteristic of sick lit is that the person with the sickness must try and balance a fight to live and overcome the diseases with the whirlwind of activity and relationships that come with adolescence. In some cases this fight against the disease and determination for a “normal” life is won by the characters. Even if they don’t literally beat the disease, they find fulfillment and enjoyment in life and relationships. On the other hand, however, some sick lit is much more bleak and portrays characters who are unable to overcome their circumstances. Because of this, sick lit often overlaps with what is referred to as “Bleak literature.” Because of the nature of sick lit, dealing with tragedies, it is often characterized as bleak lit. But sick lit is itself a separate genre with certain characteristics that cause it to be either bleak or romanticized.
Within the bleak spectrum of sick lit, there is a general sense of hopelessness expressed by the characters as well as conveyed to the reader. An example of a bleak version of sick lit is Thirteen Reasons Why by Jay Asher. This is a young adult novel about two teens named Clay and Hannah. Hannah has committed suicide and leaves behind audio tapes of the thirteen reasons why she killed herself. Clay is listening to the tapes and so the novel is a dual narrative of Clay’s life in the present, and Hannah’s commentary via the tapes. This novel can be classified as sick lit (dealing with mental illness) because of the analysis that Hannah is suicidal and most likely suffers from depression. However, her depression is not necessarily recognized by her, nor is it explicitly stated by Asher, which is why Hannah places the blame of her suicide on other people. Her inability to see a way out of her suicidal tendencies causes the plot to become bleak. The story starts off with Hannah already dead and so addresses mental illness as something unrecognizable until after the tragedy. This is just one example, but sick lit that is bleak shares these characteristics in that it portrays a state of mental illness or physical disease as triumphant over the protagonist.
An example of a more romanticized version of sick lit is the novel The Fault in Our Stars. This novel tells the love story of two teens (Hazel and Gus) with cancer who really act more concerned with adolescent issues than the diseases that are killing them. Though still portrayed as tragic, Gus especially seems to romanticize the notion of death by chronic disease as he uses it as the reason for his “live life to the fullest attitude.” Hazel catches on to this notion and their love story is not only a result of their trivial interests and intriguing conversations, but the connection they have because of cancer and the prospect of dying. So in this case, having cancer is romanticized because it is essentially what brings Hazel and Gus together. Though the novel does not sugar-coat having cancer and dying, the idea presented, of connecting with someone over a shared struggle, is romantic. Unlike Asher’s more bleak novel, The Fault in Our Stars does not present a hopeless case because Hazel and Gus “beat cancer” by living the way normal teenagers would live, even if that means not living for as long.
Overall, the genre of sick lit gives characters realistic struggles that are not easily (or ever) overcome. The lack of an ideal or happy ending is common. However, on the other hand, sick lit is also often characterized as romanticized or purposefully inspirational.
Sick-lit has evolved since it was first widely introduced, but the appeal of sick-lit has remained the same; from graphic images of sickness to emotionally complex story lines, sick-lit often requires the characters to mature quickly and deal with unprecedented situations in their lives. The underlying conflicts or emotions within sick-lit have to deal with strained family relationships, developing or desired romantic relationships, hopes and aspirations, or social acceptance—more times than not, the focus of sick-lit revolves around how the protagonist’s life is affected by the illness, rather than the actual illness itself. The element of possible or impending death in sick-lit amplifies the normal concerns of an average teenager, leading to this necessary maturation within the protagonist.
Responses to Sick Lit
The response to sick-lit also affects the way it is defined; though many sick-lit scenarios are depicted as realistic, the argument against sick-lit is two-fold—many parents and teachers argue that sick-lit should be censored because of its graphic nature and possible endorsement of self-harming behaviors, while it is also argued that sick-lit is romanticized and reinforces misconceptions of illnesses.
In a podcast called Questioning Teen Sick-Lit Amanda Craig (children’s book expert) claims that many adolescent readers are in a state of vulnerability and are strongly affected by the books they read.  Because they feel connected to the books they read, and take them personally, they will be negatively affected by the depression and hopelessness conveyed in sick lit. Robby Auld, a teen book critic, counters Craig and shows a more positive response to sick lit. His argument is valid because he speaks for teen readers, who are in fact the intended audience of this literature. Auld says that he appreciated the realism in sick lit and the respect that authors show for teens when they write these books. Many teen responses to sick lit, and reasons for reading this genre mirror Auld’s. Because the books are not just about the sickness, but are also about real adolescent struggles, teens feel discredited when critics like Craig demand that sick lit be less “depressing.” Auld claims that many young readers can step back and learn from these books from an outsider’s perspective.
Though many of the more outspoken criticism about sick lit says that it is detrimental to young readers, these young readers themselves appreciate sick lit and how the authors do not try and cover up reality. Fred Hutchinson Cancer Research Center interviewed teenage cancer patients or cancer survivors about the popular book, The Fault in Our Stars.  The overwhelming response of many of these teens was not that cancer was romanticized in the book, but rather it provided an insight into their lives that other people wouldn’t otherwise be able to understand. These teens and other teens like Auld aren’t the only people in favor of sick-lit. A small publishing company specializing in “child focused and parent-friendly” books, called Nosy Crow, argued through a blog post that sick-lit is an important way for children and teens to explore tough, emotional issues. 
From claims that books about mental illness—leading to cutting and suicide—have actually caused readers to inflict self-harm, to parents who are right alongside their teens reading these books, these arguments for and against sick-lit shape the way we perceive this popular genre.  
Rather than define sick-lit as completely realistic portrayals of illness, sick-lit can better be defined as coming of age stories told through the lens of sickness. These unique coming of age stories are both popular and controversial because they are driven or influenced by sickness and the emotions that surround these experiences.
- [Coleman, Daniel. In Bed with the Word: Reading, Spirituality, and Cultural Politics. Edmonton: University of Alberta, 2009. Print.].
- Tremonti, Anna Maria, Amanda Craig and Robby Auld. “Questioning Teen Sick-Lit” Podcast audio. The Current. CBC Radio. 9 Jan. 2013. Web. 2 April 2015.
- Mapes, Diane. “Teen cancer patients weigh in on ‘Fault in Our Stars’” Hutch News. Fred Hutchinson Cancer Research Center. 6 Jun. 2014. Web. 2 April 2015.
- Wilson, Kate. ““Sick Lit” and other challenging books for children and teenagers: Are they bad for readers?” “Nosy Crow Blog.” Nosy Crow. 3 Jan. 2013. Web. 2 April 2015.
- Carey, Tanith. “The ‘sick-lit’ books aimed at children: It’s a disturbing phenomenon. Tales of teenage cancer, self-harm and suicide…” The Daily Mail. Dailymail.co.uk. 2 Jan. 2013. Web. 2 April 2015.
- Witham, Emily. “Sick-Lit: Exploitative or Entertaining?” GENYU. New York University. 4 Nov. 2014. Web. 2 April 2015.