Still Alice (Genova, 2009) is a captivating debut novel about a 50-year-old woman’s sudden decline into early onset Alzheimer’s disease. The book is written by first time author Lisa Genova, who holds a PH.D in neuroscience from Harvard University. She’s also an online columnist for the national Alzheimer’s association. Her other books include Left Neglected and Love Anthony. She lives with her husband and two children in Cape Cod. The theme of the book is related to the early onset Alzheimer’s disease and how the main character, Alice Howland’s quality of life or in other words her lifestyle is affected due to the disease she is diagnosed with (Genova, 2009). The novel sheds light on the lives of those struggling with this horrendous disease of the mind and how their lives and people in them are affected and disturbed because of it. The life and daily activities of an early on-set Alzheimer’s disease patient worsens with time, if proper counseling sessions and treatment are not conducted; their situation will get worse and result in severe damage to their mental health. As the story begins, everyday quarrels reside in the Howland household.
From their youngest daughter Lydia’s ongoing dispute about her future, to Alice and John’s own relationship, all while their busy lives ensue. Why couldn’t Lydia be like the rest of her family? Her brother Tom and sister Anna followed in their parent’s footsteps. Going to college and having successful careers was their way of life. John is a biologist and Alice a professor of linguistics, both of them work at Harvard University. Lydia is the outcast of the family. She travels the world, is worry free, and aspires to be an actress. The hectic lives of both Alice and John weigh on their relationship. Tension increases with the story as Alice is diagnosed with early onset Alzheimer’s disease. The coping skills of Alice and her family with her diagnosis set the tone for the story. Alice’s internal conflict consumes her, although she tries to never let Alzheimer’s disease define her. She is upset with herself for forgetting things, yet tries to come up with reasons as to why she is forgetting.
Her father takes the brunt of all Alice’s anger. Her hatred for him grows. Why did he have to take the lives of her mother and sister? Is it his fault Alice has Alzheimer’s? Alice continues with a strong desire to contribute to society. The once estranged relationship between Alice and her daughter Lydia gradually improves, and a daughter finds solace in a mother she never knew. A husband, who at one time stood by his wife through everything, surprises his family and leaves his ailing wife behind for a new job opportunity. Still Alice is told in the third person point of view with limited omniscience. The narrator is Alice Howland, the main character of the story. Through the book we are able to read the way Alice is feeling, looking through her eyes as the story unfolds. However, in the final chapter of this novel the point of view changes to her husband, John Howland. Readers are able to look on as John lives his life away from Alice in New York. The primary setting for still Alice (Genova, 2009) is in Cambridge Massachusetts were the main character Dr.
Alice Howland lives with her husband, John Howland, and teaches cognitive psychology at Harvard University. Other settings include their home in Chatham Massachusetts where Alice and John go to vacation. The main character is Dr. Alice Howland a modern middle aged professional woman. She’s a brilliant professor experiencing mental glitches like forgetting a word while giving a lecture, misplacing keys, etc. Alice thinks this is due to impending menopause, middle age or possibly stress. But she hasn’t gone through menopause and she’s not feeling stressed. The defining moment is when Alice forgets her way home while jogging in Harvard square (p. 21). Suspecting that something is wrong and without telling her husband, Alice chooses to see Dr. Davis a neurologist who diagnoses her with early onset Alzheimer’s disease (p. 70).
The diagnosis hits Alice and her family like a death sentence. Alice realizes that she doesn’t have enough time left and decides that it should be spent with her family. Her two older children Anna and Tom decide to undergo genetic testing for the Alzheimer’s gene. Her oldest daughter Anna tests positive for the gene (p. 108). Alice becomes completely reliant on her blackberry to get through her day and becomes a great list maker though she can’t always make sense of her lists. As the disease progresses Alice resigns her teaching position at Harvard University and gives up jogging because she has lost her sense of depth perception. Although the disease robs Alice of her memories, she retains her sense of humor e.g. when she tries to wear her underwear as a sports bra, “she laughs at her own absurd madness” (P. 199). Alice’s character is very compelling, engaging, and holds your attention throughout the book.
John Howland is Alice’s husband; he is a professor of biochemistry at Harvard University. When John finds out about Alice’s diagnosis, he thinks that she has been misdiagnosed. He insists on genetic testing, which would show that Alice has the Alzheimer’s gene. John struggles to deal with Alice’s diagnosis. He becomes her primary caretaker, but refuses to look at Alice when she takes out her pill box. He manages to continue working by leaving Alice large reminder notes on the refrigerator not to go running alone (p. 196). John is obviously grieving the loss of his wife but is unable to express his emotions in a positive way. A breakthrough finally happens when John is able to comfort his wife when she experiences an incontinence episode (p. 150). Anna is Alice’s oldest daughter; she’s a successful lawyer and is married to Charles, also a lawyer.
Anna is strong and fiercely independent just like her mother. Anna deals with her mother’s disease by suggesting that if her mom “thinks for a second” then maybe she’ll be able to remember things (p. 173). Anna, however still makes time to care for her mom when her dad is away. Alice’s only son Tom is a minor character in the book. He is present during family gatherings and important moments e.g. when Alice discloses that she has Alzheimer’s disease (p. 103). He deals with his mom‘s diagnosis by being distant. The main antagonist in the book is Alice’s youngest daughter Lydia Howland. She defies the family’s educational tradition and chooses to take acting classes in Los Angeles in hopes of becoming an actor. Lydia’s decision causes a lot of conflict between her parents.
She’s the only one that refuses to participate in the Alzheimer’s genetic testing. However, as Alice’s condition deteriorates, Lydia becomes the most valuable player of the family; she becomes Alice’s number one advocate. She doesn’t try to “test” Alice’s memory but is there for her when she needs her (p. 162). The relationship between Alice and Lydia improves. Lydia eventually listens to her mother’s advice and enrolls at Brandies University to study theater (p. 258). The imagery in Still Alice is captivating. It keeps the reader on their toes, wondering what will happen next in the story. The story is so moving that the reader can essentially picture the characters and endure their experiences through all five senses. One model of imagery that is intriguing is when Alice is a guest speaker at Stanford. Her confidence and love for her career is enticing.
She had talked about the particular subject numerous times and every time she had done this, she felt respected. Alice had always talked without reading her notes with ease. Well into her discussion she suddenly becomes puzzled. “The data reveal that irregular verbs require access to the mental…” (p. 10). The word was lost even though she understood fully what she had intended to say. As the scene is described, the reader can get a sense of panic that Alice is experiencing (pp. 8-11). An unforgettable illustration of imagery is when Alice goes for a run through Harvard Square, blocks from her home and cannot remember her way back. The description of her surroundings is etched in the reader’s mind. “Steady stream of joggers, dogs and their owners, walkers, rollerbladers, cyclists, and women pushing babies in jogger strollers, like an experienced driver on a regularly traveled stretch of road” (pp. 20-21). “The sounds of her Nikes hitting the pavement in syncopated rhythm with the pace of her breath” (p. 20). “She knew she was in Harvard Square, but she didn’t know which way was home” (p.21). “People, cars, buses, and all kinds of unbearable noise rushed and wove past her” (p. 22).
The reader can sense Alice’s state of fright during this scene. A memorable instance of imagery is when Alice visits her primary care physician. At one point and time Dr. Moyer’s office held no negative links for Alice. “I don’t think your memory problems are due to menopause” (p.41). “She fought the impulses growing louder inside her, begging her to either lie down or get the hell out of that examining room immediately.” The reader can perceive the state of anxiety Alice is in (p.41). Other doctor visits were just as interesting. “Alzheimer’s disease….The words knocked the wind out of her…The sound of her name penetrated her every cell and seemed to scatter her molecules beyond the boundaries of her own skin” (pp. 70-71). The visit to Mount Auburn Manor Nursing Center was striking. “Walkers crowded the spaces between the tables…There was no socializing, no conversation…The only sounds other than eating came from a woman who sang while she ate” (p. 113). The reader gets the impression that Alice feels she doesn’t belong there. Another prominent illustration of imagery is when Alice gets lost in her own home.
“She hastened back down the hall and opened the door to the bathroom…Only, to her utter disbelief it wasn’t the bathroom” (p. 149). The reader understands that Alice’s disease is progressing, especially when she doesn’t recognize her own daughter or her own family. “Leave me alone! Get out of my house! I hate you! I don’t want you here” (p. 211). Alice couldn’t understand that it was her family having a dispute about her, nor did she understand why. “She wasn’t sad or angry or defeated or scared…she was hungry” (p. 264). The most remarkable moment in the novel that captures the audience is when Carole returns Alice to her home after their walk. As Carole and Anna converse about Alice, Alice smiles and nods her head as to concur, not knowing that they are speaking of her. Shortly after, Lydia and Anna converse about their father coming to visit. “Is Dad coming this weekend? asked the actress” (p. 291) The reader comprehends that John has decided to take the new job offer, instead of fulfilling Alice’s wish for them to stay together.
There are many symbols within the story of Alice Howland: objects, actions, or characters that hint a meaning beyond themselves. Clocks play a role throughout the entire book. For Alice clocks are guidelines to what she should be doing at each moment of the day. In the start of her story, the clocks are more of a reference, but as her disease progresses they are much more than that. Alice becomes dependent on the clocks to tell her the things she is supposed to do according to time. Alice’s Blackberry device is probably one of the most significant symbols in Still Alice. The Blackberry becomes a part of her as Alzheimer’s takes over; Alice refers to her Blackberry for everything. To Alice, if something was not recorded in her device, it never existed. Within the Blackberry, she had an alert asking her five questions every day. These five questions became a reflection of her cognitive level, testing herself to see if her disease has progressed. The questions she quizzes herself include a P.S. “if you have trouble answering any of these, go to the file named “Butterfly” on your computer and follow the instructions there immediately” (p.119).
The file named “Butterfly” signifies dignity to Alice; the file instructs her to commit suicide when she can no longer remember her family. This would have become the last thing she could do for herself. Alice also has a butterfly necklace that had been passed down from her mother. This butterfly necklace seems to calm Alice and to give her hope, clarity, and strength. Genova’s use of figures of speech brings the reader into the world of a person with Alzheimer’s disease. When Alice first suspects that there is something wrong with her, she is referred to a specialist for testing. Having completed various tests, Alice begins to feel overwhelmed, comparing her thoughts to a roller coaster that she was riding with her eyes shut, unable to know when the next turn would be (p.40). Later, in the same doctor’s office, Alice learns of her official diagnosis of early-onset Alzheimer’s disease and is stunned. With the use of language, Alice and the reader are brought back to the harsh reality of losing herself. “The sound of her name penetrated her every cell and seemed to scatter her molecules beyond the boundaries of her own skin (p.71).
Genova relates Alzheimer’s disease to a beast that is unable to be slayed, giving the reader the knowledge that this disease cannot be beat. In reference to the medications Alice is taking to try to prevent the further decline in her mental state she compares them to aiming squirt guns at a blazing fire (p. 117). Throughout the book, Alice feels embarrassed and like a burden to those around her. The use of personification of her disease tells the reader exactly how embarrassed she is “there it was, her Alzheimer’s, stripped and naked under the fluorescent lighting” (p.129). It is further conveyed to the reader when Alice thinks her husband looks at her the same way he looks at his labs rats (p. 135). In a later scene when Alice refuses to go to dinner with friends the use of simile brings the disease to colorful life in Alice’s world. “I’m a cotton candy pink elephant in the room.
I make everyone uncomfortable. I turn dinner into a crazy circus act, everyone juggling their nervous pity and forced smiles with their cocktail glasses, forks, and knives” (p.218). To keep the book from not being completely negative, there is humor to Alice’s Alzheimer’s symptoms. When she was unable to recall which door in her house lead to the bathroom, Genova’s use of humor is exactly what the reader needs to get through the scenes. “She swung the door open like an illusionist revealing her most mystifying trick, but the bathroom didn’t magically appear” (p.150). Nearing the end of the novel, Genova leaves the reader with one last insight into Alice’s cognitive decline. In a moment of clarity Alice reads the cover of the book she wrote with her husband “The words she read seemed to push past the choking weeds and sludge in her mind to a place that was pristine and still intact, hanging on” (p. 284). The story of Still Alice is based on an ironic situation.
Dr. Alice Howland is a psychology professor at Harvard University and an expert in linguistics (the study of language and its structure). She finds herself at a crossroads when she is diagnosed with Early Onset Alzheimer’s Disease at the age of fifty. Dr. Howland also keeps remarkable care of her well-being by eating healthy, running Harvard square each day, keeping her mind active between teaching classes, and attending conferences. While talking over her new diagnosis Alice comes to realize she may have misjudged her father, assuming he was a belligerent alcoholic, in reality she realizes he was likely suffering from undiagnosed Alzheimer’s disease (p.76). To top off the ironic chain of events Alice receives her diagnosis of Early Onset Alzheimer’s on January 19 (p. 67) which happens to be the date of her mother and sister’s deaths. Towards the end of Alice Howland’s story, her disease process has taken its toll on Alice’s mind and she can no longer care for herself independently.
Dr. Howland becomes dependent on her daughters and son, whom she can no longer identify as such, for her care while her husband choses to take a job in New York (p.286-292). In conclusion, Still Alice is the story of a happily married professor with three grown children at the peak of her career who is diagnosed with early onset Alzheimer’s disease. As the story unravels, Alice struggles to maintain her lifestyle, independence, and to live in the moment. The book not only brings to light the devastating effects of Alzheimer’s disease on its victims, but also on the lives of their friends, families, and relationships. Tension increases within the story from the time Alice is diagnosed with early onset Alzheimer’s disease until her husband leaves. It was heartbreaking that Alice’s husband chose to abandon his beloved wife for a new job opportunity in another city.
He failed to stay by her side as this disease robbed her of herself. Still Alice is a strong and engaging fiction work which brings truth to the average reader about the onset and the impact of Alzheimer’s. However, it fails to address those families who are not as equipped as the Howland’s to care for their loved ones at home, and are forced to institutionalize them. As Alice’s condition deteriorates, her children begin to worry about their futures, fight amongst themselves, and ultimately change their lives as a result of their mother’s disease. This story teaches the valuable lesson that no matter how strong relationship or family ties are, the failing health of a love one could have a devastating impact on everyone.