Still Alice

A poignant and moving novel, Still Alice is the story of a Alice Howland, a fifty year old wife, mother and renowned linguistics professor at Harvard University. She is gratified by her professional success, content in her marriage and while she has some doubts about the ambitions of her youngest daughter, Alice is proud of her three children. When Alice begins to experience memory lapses she feels they are readily explained by the combined effects of her busy, often stressful, lifestyle and the approach of menopause, until one morning when she becomes disorientated during her daily run. Diagnosed with early onset Alzheimer's disease, Alice's professional and personal life begins to unravel as her mind deteriorates.

What ensures that Still Alice is so affecting is that it is told from Alice's perspective. As the story unfolds, Alice desperately tries to hold on to her sense of self. Her occasional memory lapses slowly become more frequent, at times Alice is heartbreakingly aware of her deterioration, at others she is blissfully ignorant. The shifts between lucidity and disorientation are skilfully written illustrating the terrible toll the disease takes.

“I often fear tomorrow. What if I wake up and don’t know who my husband is? What if I don’t know where I am or recognize myself in the mirror? When will I no longer be me? Is the part of my brain that’s responsible for my unique ‘meness’ vulnerable to this disease? Or is my identity something that transcends neurons, proteins, and defective molecules of DNA? Is my soul and spirit immune to the ravages of Alzheimer’s? I believe it is."

I have never given much thought to the idea that I could be risk at developing Alzheimer's. My grandfather was in the disease's early stages when he passed. In the moments when his mind slipped away he forgot that his wife of 63 years, my grandmother, had died two years earlier and it was heartbreaking to witness his fresh grief each time we had to remind him. As far as I know there was never any genetic testing done while he was alive but the possibilities are terrifying.

Still Alice was originally self published by Lisa Genova, a Harvard trained Neuroscientist, and Meisner-trained actress. It was eventually bought at auction by Simon & Schuster US and has since won numerous awards, been translated into more than 25 languages and has been adapted for film, due for release in January 2015 (starring Julianne Moore, Kirsten Stewart, Alec Baldwin and Kate Bosworth).

I didn’t plan to read two well regarded stories about dementia – Elizabeth is Missing by Emma Healey and Still Alice by Lisa Genova – so close together but that’s the way it happened. The novels are very different but both are incredibly sad.

Elizabeth is Missing is the story of Maud, an elderly woman whose memories and daily life is crippled by dementia. Much to the frustration of those around her, Maud is on a desperate quest to find her best friend, Elizabeth, who she believes has disappeared. In searching for Elizabeth, a dual narrative unfolds, revealing secrets in Maud’s past.

I suspect that it is very difficult to write from the perspective of someone with memory loss – how do you mention something on one page and then convincingly ‘forget’ it on the next? Healey pulls it off perfectly, with some beautiful and creative writing to boot. Maud is so convincing that you feel as befuddled as her and at the same time, feel her family’s frustration and occasional loss of patience over the constant need to repeat things to Maud.

“I have made a note of what she’d said, or some of it… I write everything down. There are bits of paper all over the house, lying in piles or stuck up on different surfaces… My paper memory. It’s supposed to stop me forgetting things. But my daughter tells me I lose the notes. I have written that down too.”

The ‘mystery’ part of Elizabeth is Missing was not as mysterious as I’d hoped. Maud’s search for Elizabeth became a little repetitive and although that may be the reality of living with dementia, it wasn’t difficult to work out the simple explanation for her disappearance. More interesting was the mystery in Maud’s past, however, although it was a well constructed plot line, the resolution felt forced and far-fetched. As a result, the ending of the book fell flat. 3/5

In contrast, Still Alice by Lisa Genova is a story told in chronological order and in a plain and simple way. It’s told from the perspective of Alice Howland, a professor at Harvard, wife, and mother of three grown children. One day, Alice sets out on her usual running route and soon realizes she has no idea how to find her way home. Medical consults reveal early-onset Alzheimer’s. The story reveals Alice’s increasing memory loss through repeated scenes in the doctor’s office, as well as her disconnection with family, friends and colleagues.

Although Genova’s words didn’t have me pausing to reread and savour, I did admire how she built tension. It is partly because Alice is relatively young (aged fifty) that the story is terrifying but it’s also attributed to Genova’s clever handling of memory loss – compared to Elizabeth’s Maud, Alice is aware and frustrated by her own errors for much of the story. Here she searches for the word ‘hammock’ –

“Alice named the rest of the pictures without further difficulties, but she couldn’t activate the neuron that encoded the missing name of the napping net.”

Genova also explores ideas of where love is ‘stored’ – the head or the heart – and similarly examines all the traits, skills, faults, interests and memories that make a person who they are –

“‘Have you thought about whether or not you’d like to donate your brain to research?’
She had thought about it. She imagined her brain, bloodless, formalin-perfused, and Silly-Putty-colored, sitting in the cupped hands of a medical student. The instructor would point at various sulci and gyri, indicating the locations of the somatosensory cortex, the auditory cortex, and the visual cortex. The smell of the ocean, the sounds of her children’s voices, John’s hands and face… the enlarged ventricles would be striking. The empty spaces where she’d once resided.”

Purely because of my own interests, I found the scenes dealing with genetic testing for Alzheimer’s thought-provoking. Overall, a tough but gripping read. 4/5

I received my copies of Elizabeth is Missing and Still Alice from the publishers, Penguin Books Australia and Simon & Schuster Australia respectively via NetGalley, in exchange for honest reviews.

(I received a free copy of this book from Net Galley in exchange for an honest review.)

Alice Howland is proud of the life she worked so hard to build. A Harvard professor, she has a successful husband and three grown children. When she begins to grow forgetful, she dismisses it for as long as she can, but when she gets lost in her own neighbourhood she knows that something has gone terribly wrong. She finds herself in the rapidly downward spiral of Alzheimer's Disease. She is fifty years old.
Suddenly she has no classes to teach, no new research to conduct, no invited lectures to give. Ever again. Unable to work, read and, increasingly, take care of herself, Alice struggles to find meaning and purpose in her everyday life as her concept of self gradually slips away. But Alice is a remarkable woman, and her family, yoked by history and DNA and love, discover more about her and about each other, in their quest to keep the Alice they know for as long as possible.
Losing her yesterdays, her short-term memory hanging on by a couple of frayed threads, she is living in the moment, living for each day. But she is still Alice.

This turned out to be a far different book than I had expected. I am not sure how that came to be - I think maybe that the story was told from the first person (Alice's POV) that contributed to such a reaction.

And what a POV it is - a woman who is a Harvard professor, has a family and only fifty years of age, suddenly faces life with Alzheimer's Disease. The step-by-step, day-by-day disintegration of her memory and lifestyle is heartbreaking - without being too overwrought or dramatic. I think the author must have done so much research to get the fine balance between telling a story and "playing doctor" - filling us with long, boring, technical details that would have taken from the flow of the novel. And I thank her for that.

Don't read this book thinking it is another "insta-heal cancer" novels, nor does it trivialise the lives of others around them. It doesn't take anything for granted nor does it pile on the tear-jerker passages as a lot of these kinds of books do.

It certainly deserved all the praise it received - it is a very good book!


Paul
ARH