The title of this engaging memoir exploring Emmett de Monterey’s life growing up gay and disabled (he has cerebral palsy) in 1980s London comes from James Baldwin: “You have to go the way your blood beats. If you don’t live the only life you have, you won’t live some other life, you won’t live any life at all…”

What follows across 26 chronological and self-contained stories of the self is how hard this proclamation is to obey in an ableist and homophobic society. Much of the book’s emotional weight comes from the way in which the world built in the family home, or with friends and peers, is constantly thrown up against reductive and violent language from outside institutions: the medical establishment, the education system, the church, members of the public who stare or infantilise. He comes out to his mum, who is sweetly welcoming and comforting, just after his GCSE year at school. For him, as so often for people discovering their sexuality (me included), the first words you hear connected to it are insults from peers.

There is a tension, brilliantly evoked throughout, in the paradoxically hyper-visible but invisible disabled body and how it relates to notions of being “out”. In one harrowing and vivid moment, De Monterey, on the train to his first Pride event, overhears two men talking about how they hope to attack attendees. The author fears for his safety but then one of the two would-be assailants asks him if he needs any assistance. “Watching him go,” writes De Monterey, “I realised I was invisible. For all my careful, costly preparation, I was a ghost. The handsome queer-basher didn’t see a target…”

Interestingly, De Monterey’s mission also involves accepting the limits of memoir writing. “My memories of the next week are confused. I’m never sure which are mine and which I’ve seen on TV,” he says after having revolutionary new surgery in the US. Still, there are frequent moments of insight, deftly and succinctly captured: “What I didn’t see until much later, when I was no longer the only person with cerebral palsy I knew, is that there are as many ways to be disabled as there are to be alive.” Reflecting on how he feels after that first-of-its-kind operation and the whirlwind of media intrigue, and the sometimes grating interest and sympathy that followed, he writes: “I felt like a stranger in all the ways I had once felt familiar… That home no longer felt like one… everyone’s kindness meant I could never forget myself, could never have a day off from my difference.”

Towards the end, he describes an early encounter in a gay bar when a man called Nick buys him a drink and spots his crutches underneath the table. He asks whether De Monterey has “busted his leg” or if he’s [HIV] “positive”; when the author responds that he has cerebral palsy, the guy’s reaction is swift and unpleasant: “You should be at home. You shouldn’t be in a place like this, wasting my time…”. De Monterey confesses that it was more than a year before he returned to a gay bar and that he didn’t go alone.

The epilogue, which at first suggests a happy ending, confounds expectations when De Monterey is subjected to ableist abuse in a supermarket queue, making him realise that while his life may have moved on in many ways, some things haven’t. “Everything had changed, and nothing had. There was no choice but to keep walking,” he concludes, reminding the reader that change is only evident when it affects us all.

Andrew McMillan is a poet. His most recent book is pandemonium (Jonathan Cape)

• Go the Way Your Blood Beats by Emmett de Monterey is published by Viking (£18.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply