Reflective Book Review: Still Alice by Lisa Genova

Genova, L. (2009). Still alice. New York, NY: Pocketbooks. $15.00. ISBN:1439102813.

    I cannot remember the last time I read a book from beginning to end, completely hooked the entire time! Still Alice by Lisa Genova really reminded me what that experience was like. Genova’s remarkable novel captures the devastation of early onset Alzheimer’s through the eyes of a Harvard neuropsychologist diagnosed at only 50 years of age. Although Alice is “lucky” enough to catch the disease early, there is no way to completely avoid its progression. Author Lisa Genova has a very natural way of teaching so that the reader doesn’t feel too distracted by the learning process. Actually, I was so emotionally connected with the characters that I almost didn’t realize the density of facts I was simultaneously absorbing. Still Alice is a rarity in literature as it fully captures the personal, subjective experience of Alzheimer’s, while also reassessing essential priorities in life.

    Although Alzheimer’s brings many losses to Alice’s life, the illness may have brought some underlying positive attributes that may be considered in analysis. In one aspect, she bonds closer to her family, and is forced to live for day to day pleasures. Alice says herself later in the novel, “My yesterdays are disappearing and my tomorrows are uncertain, so what do I live for? I live for each day…I will forget today but that doesn’t mean that today didn’t matter.”2 She also grows closer to her free-spirited daughter Lydia, whom she was never able to relate to in the past. Now Alice’s hard set opinions on Lydia’s life become less important as it is the relationship and emotional connection that suffices. Even through the lens of a tragic illness, the story brings a few positive, philosophical themes.

    The viewpoint of this book was very striking. Although it is in third person, it is very subjective to Alice’s experiences. My very first reaction reading the novel was disappointment that we didn’t have the advantage of first person perspective. What I began to notice was how the viewpoint focuses solely on Alice, and tells objectively what she would subjectively observe. The text is then able to present quotes from her internal dialogue without the reader losing sight of what is real and what is not. As you can imagine, this stability within the narration is important to maintain reader clarity as the disease continues to progress. For example, when Alice doesn’t recognize family members, quotations are expressed by “The pretty lady in pajama’s said…”2 when in fact this is Alice’s daughter Anna, an extremely well known character to the reader. There is also an advantage to the third person narration as a major secret to a theme is revealed toward the end of the story. I was very impressed how the author was able to balance the objective and subjective while also being informative throughout.

    Overall, I have no real criticisms for the book or author. The novel has a foundation based upon very accurate information on Alzheimer’s since Lisa Genova is a neuropsychologist herself2. The cognitive experience of the main character seems so spot-on that it is almost unsettling. As it turns out, the author’s grandmother had Alzheimer’s and I can imagine that she spent a great deal of time with her to be able to take on the perspective she does. After reading her short biography, it makes sense how she blended her grandmother’s condition in with her own life to create a deep new perspective for her book. The only conflict I have in my mind comes toward the end, when Alice is faced with a heavy life or death situation. It brings the question, is life worth it once a person has progressed to a certain point in the disease? However I would not want to spoil this major scene since it is what I consider to be the climax of the story.

    Unlike many fiction books, the authors main points are strong and backed by research. One prominent statistic that was significant to Alice, is how a gene for Alzheimer’s has a 50% chance of passing onto a child1 2. Statistically, since Alice has three children, it is likely that at least one of them will be affected by the disease. She already feels so much resentment toward her father who could have passed the gene onto her and does not want this guilt placed onto herself. This infers a valid point that once the gene is detected, an individual may factor this in toward their own family planning. Most of the time, unfortunately, people have no reason to get tested for the gene until they see symptoms of early dementia3. This could mean that by the time these symptoms arise, the gene has passed on already.

    Alice is not alone. There could be as many as 5.1 million people with Alzheimer’s in the United States, though only about 5% of these cases are early onset Alzheimer’s4. This shocking minority is addressed when Alice was unable to find a support group with others who have this rare variation. In addition, there are 10 early signs and symptoms cited by the Alzheimers Research Foundation3. A few of these include disruptive memory changes, and difficulties completing regular, familiar tasks3. These difficulties are what shocks Alice at first, but it wasn’t until the symptom, “confusion with time or space”3, presented itself that she knew it could be something serious2. It makes sense how early onset Alzheimer’s often goes undetected since it can be passed off as a side effect of stress or normal aging. Though still in debate, some sources claim that early onset Alzheimer’s has a faster progression than its late onset counterpart4.

    What can we take from all this research in which the novel relates? Remarkably, there is one major study that caught my attention as inspiration toward our future direction. A long running study regarding approaches toward care taking, suggest that those who incorporate non-medical therapies in addition to medicine alone, on average stay 329 days longer at home (outside of a care facility) than those caretakers who did not1. Non-medical therapies, include three interventions: education about the illness, counseling for the whole family, and improving ties to social support 1. This program acknowledges the holistic complexities of the disease beyond pure science. The details of this study are valuable since this approach provides a better quality of life–both for the individual, and for the family.

    This particular novel, Still Alice, is uniquely similar to the philosophy behind these additional therapeutic components as it looks beyond the one-sided broad medical perspective. It actually takes into account the dynamics of an effected individuals life, family, and emotion. I didn’t realize how much understanding I lacked until I started reading it. I highly recommend this book to everyone!

Video: Lisa Genova discussing Still Alice

1 Alzheimers research on caregiving. (n.d.). Retrieved from http://www.alzinfo.org/ research/alzheimers-research-on-caregiving
2 Genova, L. (2009). Still alice. New York, NY: Pocketbooks. $15.00. ISBN:1439102813.
3 Know the 10 signs: early detection matters. (2009). Retrieved from http://www.alz.org/alzheimers_disease_know_the_10_signs.asp
4 Van der Viles, A., Koedam, E., Pijenberg, Y., & Twisk, K. (2009). Most rapid cognitive decline in apoe epsilon4 negative alzheimer. Psychological Medicine, 39(11), 1907-11. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19335933