Each Stricken was afflicted with an ailment that eventually would have cost his life. Stricken battled and conquered disease with the aid of their Geist, having challenged the Reaper to a game for their own life and won. Coming out through the other side of death, the Stricken Sin-Eater understands that survival is an active thing. The Ravaged One does not endure: her survival is an active thing, and that survival brings with it a supernatural grace. She looks upon the existence of the unquiet dead as a challenge, a puzzle to solve, an adversary against whom to pit herself. The geist drives her to see the dead as a challenge, and in return, the Sin-Eater engages in a battle of will and wits for ultimate control of her soul. The penchant for finding winning solutions, then, is the one thing that the Stricken can be said to have in common with each other. Nearly every illness, from HIV to a simple cold, can lead to death in the right (or wrong) circumstances, but it's the particular injustice (or justice) of a case that attracts a Geist and let him propose the Bargain. Poisoning and psychological illnesses can also lead to the creation of a Stricken.
The Geist of a Stricken tends to reflect the disease of its host in some way: a charred, eyeless corpse-woman in a bloodied and filthy nurse’s uniform, grasping scalpels in both of her hands; a figure made of a swarm of insects that buzzes around him, forming and reforming, staring out through eyes made of iridescent wings, speaking with a tongue made of insect bodies; a thin man coated in choking dust, who talks in wheezes and coughs.
The Deathsight of a Stricken activates itself in stages, but too fast that the Bound could notice before it's too late: a person may seem to be perfectly healthy in the first moment, in the next the disease can be seen in its body, as if it has a weird sort of non-color all of its own.
- , p.103-106