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by Lisa Genova
Pocket Books, 2009
Review by Christian Perring on Apr 7th 2009

Still Alice

Early-onset Alzheimer's Disease is devastating and generally swifter in its progress than its more common version that affects older people.  Still Alice is a novel following a distinguished Harvard psychologist, 50-year-old Alice Howland with EoAD from her initial worry about her memory loss to the stage where she hardly recognizes her own children.  The narrator takes Alice's point of view, so we get some sense of what it is like to experience the symptoms as they develop in the course of the illness.  We see that the problems are not just remembering words and the names of people and objects, but also disorientation, visual distortions, erratic behavior, and powerful emotions.  She fears for the future and grieves the loss of her abilities and the future she had expected.  The novel is poignant since Alice is a psychologist herself and recognized the tests performed on her, but that does not help her with them.  She and her family have a great deal of adjusting to do to her new condition, especially since it has a genetic cause, and so there's a chance her children and grandchildren will also have EoAD.  Her husband John is at Harvard too, and he and Alice even co-authored a book, so they have a close relationship.  Yet he is focused on his career and so is reluctant to let Alice's disease hold him back.  Furthermore, he finds it very painful to see Alice's decline, and sometimes prefers to avoid it.  Alice's relationship with her children is another part of her life that changes as she loses her autonomy; she even changes her perspective on their life choices, which makes her less judgmental about one daughter. 

Still Alice is a well-written and informative book.  Author Lisa Genova is unusual in having a Ph.D. in Neuroscience from Harvard and also being a professional actress, and she brings both sides of her life to the story.  Occasionally it feels as if the plot is driven by the aim of setting out the details of Alzheimer's, but this has its own value, since one could use the as a way to help to explain the disease to people.  The most controversial aspect of the book will be the instructions Alice writes to herself when she is competent, telling her to take an overdose when she has lost too much of her former abilities.  Readers will wonder whether her former self should have a say over her future self's right to live, when she does not really know what it will be like.  This raises major questions about when life is worth living and whether people with Alzheimer's to be able to end their lives rather than suffer a gradual decline.  Another ethical concern prominent in the story is what responsibility family members have to sacrifice their own goals in order to care for the person with Alzheimer's.  Genova herself does not take a strong stand on these ethical in her book: rather she lets the plot play out leaving readers to make up their own minds. 

© 2009 Christian Perring

Christian Perring, Associate Professor of Philosophy, Dowling College, New York.