How Ascendance of a Bookworm depicts the challenges and triumphs of chronic illness

Content Warning: Chronic Illness, medical injustice, coerced child marriage

Spoilers for the entire Ascendance of a Bookworm anime to date, as well as Part 3 of the original light novel series which has an anime adaptation scheduled for 2026.

In the crowded field of fantasy isekai light novels, Kazuki Miya’s Ascendance of a Bookworm light novel series stands out for its extensive worldbuilding, gripping character drama, and rich themes. Bookworm follows Urano Motosu, a college student studying library science who is fatally crushed under a bookshelf during an earthquake. Urano is surprised to awaken as Myne, a five-year-old commoner girl in the Duchy of Ehrenfest. Her new body is affected by a disabling chronic illness, and books are such an expensive luxury in Ehrenfest that she cannot access them. Rather than let these obstacles crush her spirit, Urano embraces her new identity as Myne and swears to spread literacy and reading throughout the kingdom by developing the same kind of printing technology she learned about on Earth. 

While Myne brings a wide variety of Earth knowledge to bear on her new life, the series puts a much greater focus on how Myne adapts to her incurable condition in a highly class-stratified society. Bookworm thoughtfully examines the interplay between disability, socioeconomic class, and community support while eschewing the shallow tropes found in some fantasy series.

Representing Chronic Illness: The Devouring

Kazuki writes about Myne’s illness in a refreshingly grounded way, portraying this fantasy scenario with a sharp eye for how people live with chronic illness and disability in reality. While Myne’s condition has a magical element to it, it is (for the most part) not depicted as a benefit or “disability superpower,” and like a real chronic illness it can be managed but not cured. Myne was born with an illness called the “Devouring” characterized by excess mana production that harms the body; left untreated, this mana will eventually crystallize, killing the person afflicted with the disease. Myne’s symptoms include severe fatigue and weakness which limit her mobility, as well as frequent fevers accompanied by pain which keep her on bedrest for days at a time. The Devouring also slows down her physical growth; at the start of the story, Myne is small for a child her age, and the effect becomes more dramatic over the course of the narrative as her peers hit puberty and growth spurts, while she remains the height of a young girl. 

While Myne is distressed by the limitations imposed on her by the Devouring, she remains committed to finding a way to create her own books. Myne is eager to leave the house so she can learn to read and write from a literate colleague of her father. However, at first she is barely strong enough to make it to the street from her family’s tiny walk-up apartment, and she frequently collapses from pushing herself too hard. Like anyone grappling with a new chronic illness, she must first learn her body’s needs and limits. Myne’s parents encourage her to tune in to how her body feels each day, and predict what type of activities she will be able to manage. This parallels the real-life “spoon theory” metaphor coined by Christine Miserandino to describe what it’s like to manage limited energy with a chronic illness. Once she has a realistic grasp of how many spoons she is starting with, Myne works to expand her daily capacity by walking a little bit further up the street each day, accompanied by her sister Tuli or their friend Lutz, who carry her home when she falls. After a few months, she finally has enough spoons to attend tutoring or forage in the forest a couple times a week. 

As someone living with chronic illnesses, I recognized the novels’ descriptions of Myne’s fever building and overflowing, her frustration at having to meticulously plan her activities, and the embarrassment of collapsing and causing panic among friends and family. I also saw myself in Myne’s stubbornness and mistakes. Like so many of us with chronic illness, Myne does learn a lot about her limits, but that doesn’t mean she always heeds them perfectly! She is deeply passionate about books and reading, and when she gets excited she often zooms right past her limits without realizing it; this usually leads to her collapsing, and needing a day or two of rest to recover. Balancing our enjoyment of life with taking care of ourselves is a difficult task, and while Myne minds her spoons better as she gets older, she still needs a reminder from her loved ones to check on her body. 

It is also noteworthy that, while the Devouring is not a psychological condition, Myne’s emotional and mental state does contribute to how her symptoms manifest on a day-to-day basis. While sudden bursts of joy and excitement can cause her mana to swell, the impact of negative emotions like anger or sadness is even greater. This mirrors the relationship we see between mental health and many chronic illnesses, where each can influence the other. Keeping a positive outlook becomes an important part of Myne’s self-care, and ends up motivating her to try and better her new home beyond just establishing a book printing industry. Still, the story never makes the mistake of portraying the Devouring as being purely an issue of poor willpower, or only being in Myne’s head.

Diseases of Poverty: Social Class and Medical Care

The narrative is not content to let Myne’s health struggles exist in a vacuum, but instead brings the socio-economic context of her illness into sharp relief. After beginning an apprenticeship under the merchant Benno, Myne is introduced to Frieda, another young girl with the Devouring who educates Myne about the disease. Myne is surprised to learn that that social class plays a large role in what it means to have the Devouring in the first place. Mana (and therefore, magic) is a trait associated with the nobility, while commoners normally lack this trait. While noble children use special magic tools to drain and store any excess mana they produce, it is illegal for commoners to buy these tools. This law essentially condemns commoner children with the Devouring to die, in the name of upholding a strict class hierarchy. In this sense, the Devouring becomes a disability for the poor because society chooses not to treat it. This could be seen as an example of the Social Model of Disability, a perspective promoted by the disability rights movement that sees disability not as a feature of the body, but as a result of the gap between an individual’s needs and the support (not) provided by society. 

In Ehrenfest, as in our world, social class and wealth determine whether we can access the medical care that determines the length and quality of our lives. Frieda confesses that she has consistent access to medical treatment only because she signed a contract stating that when she comes of age, she will become the concubine of a nobleman; in exchange for this pledge, the nobleman provides her access to magical tools to drain her mana. Most of Ehrenfest’s nobility are obsessed with guaranteeing that their children will inherit a large mana capacity and good elemental affinities for spellcasting. Noblemen who are wealthy enough typically practice polygamy to conceive children with multiple wives, while those who can’t may seek out young women with the Devouring (like Frieda) as concubines to bear children. Far from being a mere invention by the author, this dehumanizing and eugenicist system reflects the long history of misogyny and reproductive control that has continued to the present day, from the sexual exploitation of enslaved women to the fall of Roe v Wade. Furthermore, it is clear that in Ehrenfest the harms of this system fall disproportionately on those with less privilege (in this case, class privilege), just as women of color in the United States have borne the brunt of White patriarchal violence since the days of colonization. 

Frieda acts unbothered by her arrangement with her noble patron, even espousing what she sees as its benefits, but Myne (with her “modern Earth” values) is understandably horrified that her new friend had to sell her freedom to avoid dying of a treatable illness. Though Frieda urges Myne to seek out such a contract herself, Myne refuses on the grounds that she is not willing to live as another person’s property. On the face of it, Frieda and Myne (and their families) want the same thing: to live, and mitigate the pain of their illness as much as possible. But Frieda’s family has survived (and thrived) by finding ways to be useful to the nobility, and she has internalized the belief that you have to be willing to compromise your own autonomy to get the things you want. By contrast, Myne’s parents are poor, working-class people who have seen how casually the nobility will have a commoner executed for minor offenses. Myne may be unwilling to seek a contract because she sees it as undermining her human rights and dignity, but her parents back her up because they simply cannot trust that their daughter would be safe living under a noble’s “protection.” These contrasting viewpoints seek to take advantage of the system, rebel against it, or stay safe within its confines, yet they are all understandable reactions to oppression under an unjust system.  The scenes depicting Myne’s struggle with this dilemma are highly emotional, holding space for both Myne’s courage and the deep injustice of the choices that she and Frieda have to make. 

Fortunately, Myne devises an alternative means of prolonging her life, by becoming the first commoner to ever serve the local temple as an apprentice priestess. Far from being a convenient loophole, breaking the “class ceiling” in this way is hazardous in its own right and sets the larger narrative of the story in motion. Ascendance stands apart from some other fantasy stories with disabled characters by refusing to have abled characters “graciously” rescue Myne from her life of poverty and disability. Joining the temple is Myne’s own means of seizing agency and advocating for herself, with the support of her friends and family behind her. Ingenuity and the will to live are powerful assets for chronically ill and disabled people, though we are always working within the larger structures of society, whether they be just or unjust. 

As Myne secures increased access to magic-based medical care at the temple, it would be very easy for Kazuki to simply hand-wave away Myne’s illness with a spell, or turn her excess mana into an advantage with no drawbacks. Instead, Myne is constantly braving a series of medical treatments that parallels real life in a variety of ways. Myne’s doctor provides her with potions and magical tools to drain and process her mana, and works for over a year to arrange the necessary materials for a kind of magical surgery to remove her hardened mana clumps. As would be the case for a real chronic illness of this severity, these treatments all help Myne manage her condition, extending her life expectancy and improving her quality of life, but they do not eliminate her symptoms completely or cure her. I found this to be a pleasant surprise, given how many works of fantasy treat illness and disability as an aesthetic or minor bump in the road for protagonists to overcome. 

Social Solidarity: The Role of Working-Class Community

Ascendance of a Bookworm also does not overlook the importance of community support in the lives of the disabled, the chronically ill, and the working class writ large. When Myne awakens to her new life in Ehrenfest, she is accustomed to living as a loner. Assuming the identity of a small child, utterly dependent on her family, is frightening and stifling to her at first. However, Myne gradually realizes that her new family is the most important factor in her survival; she comes to fiercely cherish them and their unwavering support as a result. From the start, her parents, sister, and childhood friend Lutz, all help her learn her limits, and provide her physical support when needed to help her get where she wants to go. If Myne falls in the street and cannot continue walking, Lutz will simply hand off his pack to someone else, put Myne on his back, and continue on without any fuss. (But please remember, if you see someone with a disability who seems to be having trouble, you should always ask what kind of help they want, if any. Don’t touch people or their mobility devices without permission!) Research in medicine and psychology has found an abundance of evidence that social support is critical for well-being, even more so for disabled and chronically ill people. The support of my own loved ones has been crucial to me on my own journey with chronic illness, so I empathized immediately with Myne as she began to draw strength from her family and friends. 

Though some fictional depictions of disabled characters receiving help from able-bodied people can sometimes cross into ableist stereotypes, Bookworm deftly avoids this by making clear that Myne is not the recipient of this altruism just because she is ill; all commoners of the lower city regularly accept aid from their neighbors without shame, maintaining an interdependent neighborhood in which everyone lends a hand when needed. For example, we see adults babysit one another’s children, share the work of preparing food stores for winter, and leap into action when a pregnant neighbor goes into labor. For readers from middle or upper-class backgrounds, this may call to mind the concept of mutual aid and its applications in activism, but working-class readers might recognize it from their own experiences. Social science backs this up, with one study by a psychologist studying social class identifying this type of reciprocal exchange of social support as being common in working-class communities in the United States. 

Myne is acutely aware that her life in Ehrenfest would have been a short and painful one without all of the support she found in the lower city, whether it be the love of family, mutual aid exchanged with neighbors, or the educational opportunities she enjoyed thanks to Benno and others. Despite the fact that she thinks of herself as self-absorbed, Myne finds ways to pay this support back (and pay it forward) at every opportunity. After she takes on a new identity as a noble, she continues to improve the lives of the commoners and help the “less fortunate,” to the point that she develops a reputation as an eccentric philanthropist. But in private, with those who know her true origins, she confesses that she doesn’t see any of her good deeds as charity from on high; she is just a proud commoner at heart, committed to continuing to contribute to the community that helped her thrive. 

In our own society, disability and chronic illness often go hand-in-hand with poverty, especially for those living under outdated and underfunded disability programs. The mutual aid ethos of “solidarity, not charity” therefore represents a crucial point of intersection between disability justice and economic justice. Bookworm creatively honors and examines these ideas throughout its run as Myne tries to live up to the ideal of class solidarity no matter her current social station. 

Illness Evolves, but Remains Part of Us

Over the course of the Bookworm series (which takes place over about a decade of in-world time), Myne’s medical care improves in leaps and bounds. After joining the ranks of the priesthood, and then the nobility, she benefits from the very best magical tools, potions, and other treatments for the Devouring. Still, she must navigate each day with her mana in mind to avoid causing a flare-up of her symptoms. She deals with side effects from her treatments, like muscle deterioration from a medical treatment that left her asleep for several years. Even improvements in one area of her condition can lead to new challenges, as when the removal of her crystallized mana clumps drastically increased the flow of mana in her body. At the climax of the story, Myne still faces some of the same obstacles she started with: a long day of physical activity can land her in bed with a fever for several days. As she manages her condition better, this happens less often and no longer threatens her life, but it still slows her down.

These experiences are a relatable representation of the challenges of living with an ill body that doesn’t always cooperate with you. Too often in fantasy fiction, magical afflictions are simply shallow metaphors for illness and disability. Isekai stories, in particular, are fond of giving the protagonist a weakness that turns out to be a major advantage (like being unable to cast spells, but able to instantly dispel anyone else’s magic). In other cases, protagonists may start out frail or disabled, but see their condition cured as a way to empower them to begin a quest. I imagine those stories are an enjoyable fantasy for some, but realistic representation of chronic illness and disability is also crucial for those of us who yearn to see our experiences acknowledged and celebrated in fiction. Fictional depictions of disability and chronic illness often reinforce harmful ableist biases. Depicting disabilities as superpowers can absolve society of ableism by suggesting that there are “good” (strong and inspirational) and “bad” (lazy and burdensome) disabled people, or commodify disability based on how useful it is for other people. Meanwhile, stories where illness and disability are quickly overcome communicate to the audience that these differences can and must be left behind in order for us to accomplish great things in life. Tropes like these have been around since the ancient Greeks (and even earlier), but they haven’t gotten any less reductive or harmful in the last two thousand years. Ascendance of a Bookworm stands out among the fantasy genre in its willingness to move past these shallow stereotypes. 

Myne’s experience as a chronically ill and disabled protagonist is nuanced and non-linear, just like the real thing. Society often fails to understand chronic conditions (especially “invisible” illnesses), so representation like this is rare. As a reader, I was continually moved by the relatability of Myne’s struggles and the many ways that she cultivates a network of solidarity and mutual support. Furthermore, Kazuki’s work highlights the ways that disability intersects with social class, critiquing the way that access to medical care is concentrated among the wealthy. While Myne often claims to only care about creating books, she also works to improve the lives of her fellow commoners at every step. In the end, Myne’s “ascension” brings enormous changes to the society she lives in, but her commitment to using her experience and newfound power to make life better for other people with chronic illness honors the working-class of solidarity and interdependence that made it possible for her to survive in the first place.