On Romance and Pre-Existing Conditions by Cat Sebastian

I know I’m not the only one watching in horror as millions of Americans stand to lose their healthcare. Pretty much everyone I know has some kind of pre-existing condition that could disqualify them from insurance coverage under the bill that recently passed the House. One of the unsettling aspects of this discussion is the term “pre-existing condition” because it presumes that there is such a thing as a human body that exists in a state of perpetual health, and that health care should only extend to those already-healthy bodies. It’s truly a bizarre and logic-defying notion.

In reality most of us have health issues, either major or minor, either physical or mental. And if we don’t, we almost certainly will.

I’ve been thinking about how fiction can sometimes ignore this reality of our bodies. When you’re living with chronic pain or anxiety (as I do) it can be truly bizarre to read 300 pages in which all the characters are totally free these issues, or indeed any health issues. When I read a book that reflects my lived experience, it feels so validating. For many of us, finding love and happiness and a place in the world despite mental and physical limitations is our reality, and those are the stories that I want to read.

Bad representation of disability ruins a book for me—a character who miraculously regains the ability to walk in the final chapter, the villain who is motivated by vague “madness,” the stereotype of the nobly depressed artist, portrayals of autism that devolve into quirks. These clichés not only ruin the book, but they harm disabled people. The idea that a HEA is only possible if a person is cured harms those of us who will never be cured and those of us whose issues are simply a part of who we are and how we’re wired. The conflation of mental illness with either villainy or genius (or both) harms those of us who already have to fight against those prejudices.

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I tend to write characters who have some kind of disability or other condition that affects their daily lives—PTSD, anxiety, chronic illness, chronic pain, autism. I like my characters to have happy endings without miracle cures and without their issues being ignored (either by the narrative or by their partners). Oliver in The Soldier’s Scoundrel is never going to be able to walk without pain, and I wanted to make sure his HEA reflected his own awareness of this and also his partner’s understanding. Lawrence in The Lawrence Browne Affair will always have anxiety and autism spectrum issues, but he learns how to structure his life so he can thrive. He also has a supportive partner and a pet who functions as a service animal. In The Ruin of a Rake, which is coming out in July, one of the main characters has a recurring health problem that has shaped the course of his life.

Here are some of my favorite romance novels with characters who live with a disability:

  • Garrett Leigh’s Misfits has a character with Tourette’s Syndrome whose arc doesn’t involve his condition improving; instead he finds a job he likes and people who love him and accept him for who he is. His partners treat him as the expert on his own condition.
  • Half, by Eli Lang, might be the best representation of the day-to-day grind of chronic illness that I’ve ever read—and it’s a magical illness. Watching Luka figure out how to live and fall in love despite pain, despite the fact that he might be dying, was poignant and lovely.
  • KJ Charles’s An Unseen Attraction has a main character with dyspraxia who might be on the autism spectrum; his HEA involves him finding love and friendship–and also the brutal and highly satisfying murder of someone who treated him as defective.
  • In Elinor Gray’s hilarious and touching Sherlock Holmes retelling, To Compound a Felony, Watson has recurring malaria and Holmes has addiction issues and watching them help one another is really beautiful.
  • Courtney Milan’s Unveiled has a character with a serious learning disability; her Trial by Desire has a character with bipolar disorder (or possibly severe depressive episodes—it’s the 1830s so things are necessarily unclear). In neither case is the character cured by the tender ministrations of his True Love, or anything equally pat.
  • Alexis Hall’s Glitterland has a character with severe bipolar disorder. He’s had very bad manic episodes in the past and he’s terrified of it happening again. He also has anxiety that makes basic tasks very difficult, and he’s alienated most of his friends. He looks back to a time when his future felt hopeful and relearns how to live over the course of the novel.

This is such an incomplete list. I asked on Twitter for recommendations and was reminded of how many of my favorite books center around characters with disabilities, and how many readers want to see characters who have fully fleshed out lives that include their physical or mental limitations. On a really basic level, I want to see characters like me and the people I love living happy lives—or killing zombies, or fighting Napoleon, or whatever direction their adventures take them.



Cat Sebastian writes steamy, upbeat queer historical romance. She lives with her husband, three kids and two dogs in an improbably small house. After growing up in the Northeast, she now lives in a part of the South where every body of water seems to contain alligators or sharks, and every restaurant serves biscuits and gravy. She likes the biscuits, but not so much the alligators. Learn more at or follow her on Twitter or Facebook.

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4 thoughts on “On Romance and Pre-Existing Conditions by Cat Sebastian

  1. Thank you for your post. May I also add Eli Easton’s When Ethan Loved Carter, and Heidi Cullinan’s Carry the Ocean.

  2. Great post! I’ve read s few of the books you’ve listed and totally agree. Have you read the Rosie Project and The Rosie Effect? If you haven’t these would tick your boxes.

    Love your books btw

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