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Still Alice

Read this Web-Exclusive Book Review by Wendy Smith

Lisa Genova’s debut novel about a 50-year-old woman diagnosed with early-onset Alzheimer’s disease follows Alice Howland over the course of two years, from disquieting episodes of forgetfulness to the sad final scene in which she sits, holding her first grandchild without really knowing who the baby is. Its early chapters are likely to be especially unnerving for readers over 40, who almost all have moments when they fear that normal middle-aged memory lapses are symptoms of something more serious.

On this front, Still Alice actually provides reassurance. Genova, who holds a Ph.D. in neuroscience and is an online columnist for the Alzheimer’s Association, skillfully explains the difference between ordinary forgetfulness caused by age, stress, menopause, or lack of sleep and the accumulating cognitive failures that signal Alzheimer’s. But this is not a medical textbook masquerading as fiction; the author has created a believable, appealing heroine and placed her in a loving but imperfect family atypical only in its level of achievement.

Alice and her husband, John, are professors at Harvard. Daughter Anna is a high-powered corporate lawyer trying to get pregnant; son Tom is in his third year of medical school. Only Lydia is a source of conflict—Anna is dismayed that her brilliant youngest chose not to go to college and angry at John for supporting Lydia’s decision to study acting in Los Angeles. It’s one of the novel’s many nicely judged emotional developments that Alice becomes closer to Lydia as her disease progresses; with her own intellectual powers weakening, she becomes less judgmental, better able to appreciate her daughter’s intuitive gifts.

That’s pretty much the sole happy outcome as the narrative traces Alice’s increasing impairment. She has trouble following conversations. She gets lost. By the time a Ph.D. candidate she’s advising hands her his thesis, she can’t understand it; introduced to his wife at a party, she forgets that they’ve met a few minutes later. Genova goes easy on readers only in slightly scanting the rage Alzheimer’s sufferers sometimes display; aside from one painful scene in which Alice smashes a carton of eggs when she can’t remember a recipe she’s made for years, we mostly see her descending into bemused acceptance of her altered state.

The author is unsparingly honest, however, in her depiction of John’s reaction to his wife’s disease. First he denies it, then he obsessively researches it, and when he realizes there is no cure he clings desperately to his thriving career. Offered a prestigious job in New York, he wants to accept it despite their children’s furious objection that taking Alice away from familiar Cambridge will hasten her decline. John loves his wife, but he’s not impeccably altruistic—who would be?

The novel climaxes in March 2005, 14 months after Alice’s diagnosis, when she delivers a speech to the Annual Dementia Care Conference. “Being diagnosed with Alzheimer’s is like being branded with a scarlet A,” she tells the audience. “But I am not what I say or what I do or what I remember. I am fundamentally more than that…. Please don’t look at our scarlet A’s and write us off.” Alice’s family refuses to write her off, making compromises and adjustments to keep her at home and in their lives.

This warmhearted conclusion does not address the heartbreak of those forced to institutionalize relatives with Alzheimer’s who become a danger to themselves or others, and it could be said that Genova slightly softens the sharpest edges of the issues posed by dementia. Nonetheless, she looks closely and compassionately at a frightening disease in an engaging work of fiction—and that’s quite enough for any first novelist to accomplish.

Wendy Smith reviews books for The New York Times, the Los Angeles Times, The Washington Post and dozens of other publications. She previously reviewed When Will There Be Good News? on AARP The Magazine Online.