This book was a bit of a mixed bag, but absolutely one of the most memorable ace novels I've read.
[Note: This is not so much a review informing buy/no-buy decisions, and more of a critique. It may contain mild spoilers.]
It's a romance/mystery featuring an ace ensemble. There are three perspective characters, Cara, Jana, and Damien. Cara and Damien became romantically entangled at an ace retreat several years ago, but lost contact. In the mean time, Cara developed Chronic Lyme Disease and various associated conditions, most notably OCD. When Cara and Damien find each other again, she doesn't tell him about it, and there's some miscommunication drama, including a doomed love triangle. Luckily they have a shared interest in true crime that keeps them together.
The ace retreat felt unreal the moment it was mentioned. It was a dating retreat that placed British aces into Mallorca and took their phones away. The part that gets me is that it's not even segregated by age, mixing together 60-somethings and 20-somethings. I also don't think older characters act age-appropriately in general. But, I accept the excuse to put ace characters together.
The ace ensemble has demisexuality, gray-asexuality, and asexuality represented, but I was disappointed at how little meaningful difference there was in their experiences. They have slightly different boundaries, but seem to share identical outlooks on dating, and even identical internal monologues about visual attractiveness. However, the book fulfills my ace version of the Bechdel test, having a) two ace characters b) who disagree with each other.
This is a book that isn't shy about mistreating its characters, subjecting them to bigotry, overt denial, and threats of violence. This is apparently a sticking point with some reviewers who wanted something a bit lighter. Personally I find it to be a refreshing departure from the common approach, where everyone is unreasonably accepting and supportive, except for that one ex who didn't get it. And I really don't think it would work any other way--what, would we have two characters walking in sunshine and rainbows, while the third is struggling with OCD?
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The book motivated me to look up Chronic Lyme Disease. CLD is not recognized by mainstream medical associations. The CDC takes the stance that the syndrome is real, but they call it Post-Treatment Lyme Disease Syndrome, because "Chronic Lyme Disease" tends to imply a certain etiology, namely that Lyme bacteria continue to exist in the body. People with CLD frequently seek out alternative doctors who recognize CLD and prescribe treatments based on this theory, usually long-term antibiotics. The CDC says there is no evidence that long-term antibiotics are better than placebo, and point to the risk of harm of such treatments.
I don't like how the medical associations frame this as "chronic lyme doesn't exist"--they basically agree that it exists, don't they? I think this framing turns patients against doctors, and also communicates the wrong thing to doctors when they look it up. In the book, mainstream doctors outright deny Cara's symptoms, refuse to offer treatment, refuse to perform diagnostic tests, and generally subject her to unconscionable abuse. Rather than following the official stance that the cause is unknown, doctors act like they know the cause, which is to say it's caused by mental illness, or nothing at all, or both (because mental illness ain't real, the doctors think).
But the flip side is that the alternative doctors are selling very expensive treatment that isn't proven to work, and may actively harm patients, or contribute to antibiotic resistance. Cara is explicitly shown as taking long-term antibiotics, explicitly suffers negative side effects, as well as financial hardship necessitating crowdfunding. Although I cannot assess the medical evidence, the book felt very one-sided and uncritical.
But I admit, it still works as a story. CLD aside, I suspect Cara's experiences with chronic illness and doctors are fairly common, even for illnesses that are officially recognized--such as OCD. Cara feels like a sympathetic and well-realized character to me. She doesn't fall into any of the problematic tropes I'm aware of; she's not treated as an inspiration, nor an object of pity, she's a person who is more than her illness.
Honestly the more problematic aspect of the novel is the true crime thing. Detectives going over the heads of police is common enough in these stories, but it feels really bad when it's framed as true crime fans nosing into victims' lives. Isn't this precisely what gives the true crime fandom a bad reputation? They don't really have the evidence to justify their actions, it's just, "well they were right in the end, weren't they?"
Part of the issue is that the mystery is just paper thin. It functions more as a metaphor for CLD than as an actual mystery. Everyone denies that a crime has occurred, except for the protagonists, so they need to circumvent proper authorities to solve the problem for themselves. The only characters who speak a critical word about what they're doing are basically villains. It feels like a refusal to consider the ethical implications of story events, and that makes it a little less compelling.