This is honestly closer to a theory-type essay, as I’ve already talked about more concrete angles like prostheses and assistive devices (in Year Four), and this time around I’m looking more at the dynamics of presenting physical disability in fiction.

Activists for better representation of disability often object to worldbuilding that imagines magic or advanced technology has erased that issue from existence, and advocate for greater visibility for disabled characters in our stories. I want to take a moment to say: in any setting that doesn’t have such handwavy solutions, quite frankly, disability ought to be vastly more common than it is.

Let’s take the specific example of trachoma and its accompanying condition, trichiasis. It roughens the inside of the eyelid and causes it to turn inward — eyelashes and all — resulting in repeated abrasion of the cornea. Though it was eliminated in the developed world during the 20th century and a 21st-century push has thus far wiped it out in thirty countries where it was still endemic, historically, this has been one of the leading causes of infectious blindness. It ran rampant through army camps and other crowded environments; it spread in cities; it infected people repeatedly throughout the course of their lives, until they lost their vision entirely.

How often have you seen it in a story?

Or consider osteoarthritis. We may occasionally note an elderly character being “stooped” or groaning at their stiff joints, but the reality is that any person whose job involves a lot of heavy manual labor is at high risk of developing such problems . . . and “heavy manual labor” is a great description of agrarian life at any point prior to industrialization. (During industrialization, it depends a bit more on what type of factory you’re working in.) Archaeologists can look at a skeleton and judge what social class that person belonged to just by comparing their age to the wear and tear on their joints: two sets of remains recently found in Pompeii were fairly clearly identifiable as some middle-aged lady of the house and some younger male servant or slave, based on the damage to his bones — and the lack of such damage to hers.

Injury in particular plays a key role here. Just in my lifetime, the tendency to send someone to physical therapy after an accident or surgery has skyrocketed, because we now have a much better idea of how to return the body to full function. But in the past? People often had to return to work as soon as they were anything like physically capable of it, instead of taking time to fully heal — or, if they were wealthy, they got coddled with bed rest that actually made their recovery harder. How often do we see the results of that in fiction, though? Sure, we all know the trope of the character with old injury who can tell when it’s about to rain . . . but we say much less about reduced range of motion, persistent loss of strength, or the ways that compensating for one problem (like an uneven gait) can screw up some other part of your body (like your back).

Of course, this is in part because we complain most about discomfort and limitations when we feel like we shouldn’t be subject to them. If literally everybody around you starts experiencing arthritis by the time they’re thirty because you’re all constantly doing backbreaking labor, then when your own aches and pains begin to set in, that’s more apt to feel like par for the course. It’s a mark of how far medicine has come in the last century that we in the developed world expect we ought to continue to feel good for decades on end.

But also, I suspect that if we were to depict physical disabilities being as widespread as they were in historical reality — and still are, in many parts of the world — it would come across as unrelenting misery porn. If we tried to represent the honest rate of painful and disfiguring scars, missing teeth, deteriorating vision, weak grips, backaches, neck pain, reduced mobility, disturbed digestion, and more that probably afflicted the average rural village, market town, or overcrowded city of the past . . . frankly, I’m horrifying myself just trying to imagine it.

And even if you’re writing science fiction of the sort that imagines a more technological future, this won’t all go away — or at least, it won’t for all of the characters. Anyone on the bottom end of the social scale is liable to experience more disability relative to the elite, who can afford time to heal or expensive treatments and therapies to address their problems. The nature of the problems in question may change, and might include fictional ideas like neurological issues caused by the use of brain implants, but they’re still likely to be there.

I am not, for the record, advocating that half of all characters under the age of forty should have some kind of disability, and every single character above that line. I suspect the result would end up distracting rather than effective — one of those situations where truth winds up seeming less realistic than fiction. But I do think that all of us, not just the disability activists, would benefit from acknowledging more often how much this can be threaded into characters’ lives, without them being explicitly marked out as Characters With Disabilities.

Especially because, when these issues are so widespread, they’re no longer going to define someone’s identity in the same way we might expect today. Having a bum knee or terrible vision or a stomach that regularly sends you to the privy at a run is just going to be how people are. That character can’t walk without a cane? The same is true for six other people in the village. Some disabilities will still stand out — seizures, for example, are going to be rarer, and quite possibly attributed to supernatural causes rather than ordinary life — but many of them will seem like business as usual.

Which means that, in fiction, noting their presence can be done through simple traces of description. Two characters are having a conversation; one of them, upon being given a heavy object to look at, grimaces and transfers it to her stronger hand. The other one, standing up to leave, leans on the arm of his chair and then gently eases his weight onto his right hip. The servant, summoned to escort him out, stops rubbing at the infection reddening their eyes. The narrative doesn’t have to stop and explain that these people have physical problems; it’s just part of the descriptive texture, used to break up the dialogue and exposition.

Am I thinking of these things more right now because I’m moving through my forties? Is that “right hip” example possibly drawn from personal experience, which I only recently mitigated with physical therapy? Nahhhh.

But man, does age give me more sympathy for characters whose bodies don’t work perfectly on command, every time.