by Lisa Genova
Alice is fifty years old and a cognitive psychology professor at Harvard University. She has a successful husband and three grown children. Her life is turned upside down when her periods of disorientation and forgetfulness are diagnosed as early-onset Alzheimer’s disease. As the inevitable descent into dementia begins, Alice must reevaluate her relationships with her husband and children as she struggles to live in the moment and find her new place in the world.
1. When Alice becomes disoriented in Harvard Square, a place she's visited daily for twenty-five years, why doesn't she tell John? Is she too afraid to face a possible illness, worried about his possible reaction, or some other reason?
2. After first learning she has Alzheimer's disease, "the sound of her name penetrated her every cell and seemed to scatter her molecules beyond the boundaries of her own skin. She watched herself from the far corner of the room" (pg. 70). What do you think of Alice's reaction to the diagnosis? Why does she disassociate herself to the extent that she feels she's having an out-of-body experience?
3. Do you find irony in the fact that Alice, a Harvard professor and researcher, suffers from a disease that causes her brain to atrophy? Why do you think the author, Lisa Genova, chose this profession? How does her past academic success affect Alice's ability, and her family's, to cope with Alzheimer's?
4. "He refused to watch her take her medication. He could be mid-sentence, mid-conversation, but if she got out her plastic, days-of-the-week pill container, he left the room" (pg. 89). Is John's reaction understandable? What might be the significance of him frequently fiddling with his wedding ring when Alice's health is discussed?
5. When Alice's three children, Anna, Tom and Lydia, find out they can be tested for the genetic mutation that causes Alzheimer's, only Lydia decides she doesn't want to know. Why does she decline? Would you want to know if you had the gene?
6. Why is her mother's butterfly necklace so important to Alice? Is it only because she misses her mother? Does Alice feel a connection tobutterflies beyond the necklace?
7. Alice decides she wants to spend her remaining time with her family and her books. Considering her devotion and passion for her work, why doesn't her research make the list of priorities? Does Alice most identify herself as a mother, wife, or scholar?
8. Were you surprised at Alice's plan to overdose on sleeping pills once her disease progressed to an advanced stage? Is this decision in character? Why does she make this difficult choice? If they found out, would her family approve?
9. As the symptoms worsen, Alice begins to feel like she's living in one of Lydia's plays: "(Interior of Doctor's Office. The neurologist left the room. The husband spun his ring. The woman hoped for a cure.)" (pg. 141). Is this thought process a sign of the disease, or does pretending it's not happening to her make it easier for Alice to deal with reality?
10. Do Alice's relationships with her children differ? Why does she read Lydia's diary? And does Lydia decide to attend college only to honor her mother?
11. Alice's mother and sister died when she was only a freshman in college, and yet Alice has to keep reminding herself they're not about to walk through the door. As the symptoms worsen, why does Alice think more about her mother and sister? Is it because her older memories are more accessible, is she thinking of happier times, or is she worried about her own mortality?
12. Alice and the members of her support group, Mary, Cathy, and Dan, all discuss how their reputations suffered prior to their diagnoses because people thought they were being difficult or possibly had substance abuse problems. Is preserving their legacies one of the biggest obstacles to people suffering from Alzheimer's disease? What examples are there of people still respecting Alice's wishes, and at what times is she ignored?
13. "One last sabbatical year together. She wouldn't trade that in for anything. Apparently, he would" (pg. 223). Why does John decide to keep working? Is it fair for him to seek the job in New York considering Alice probably won't know her whereabouts by the time they move? Is he correct when he tells the children she would not want him to sacrifice his work?
14. Why does Lisa Genova choose to end the novel with John reading that Amylix, the medicine that Alice was taking, failed to stabilize Alzheimer's patients? Why does this news cause John to cry?
15. Alice's doctor tells her, "You may not be the most reliable source of what's been going on" (pg. 54). Yet, Lisa Genova chose to tell the story from Alice's point of view. As Alice's disease worsens, her perceptions indeed get less reliable. Why would the author choose to stay in Alice's perspective? What do we gain, and what do we lose?
(Questions issued by publisher.)
After I read Still Alice, I wanted to stand up and tell a train full of strangers, "You have to get this book."
Beverly Beckham - Boston Globe
Reads like a gripping memoir of a woman in her prime watching the life she once knew fade away....A poignant portrait of Alzheimer's, Still Alice is not a book you will forget.
Craig Wilson - USA Today
Neuroscientist and debut novelist Genova mines years of experience in her field to craft a realistic portrait of early onset Alzheimer's disease. Alice Howland has a career not unlike Genova's—she's an esteemed psychology professor at Harvard, living a comfortable life in Cambridge with her husband, John, arguing about the usual (making quality time together, their daughter's move to L.A.) when the first symptoms of Alzheimer's begin to emerge. First, Alice can't find her Blackberry, then she becomes hopelessly disoriented in her own town. Alice is shocked to be diagnosed with early onset Alzheimer's (she had suspected a brain tumor or menopause), after which her life begins steadily to unravel. She loses track of rooms in her home, resigns from Harvard and eventually cannot recognize her own children. The brutal facts of Alzheimer's are heartbreaking, and it's impossible not to feel for Alice and her loved ones, but Genova's prose style is clumsy and her dialogue heavy-handed. This novel will appeal to those dealing with the disease and may prove helpful, but beyond the heartbreaking record of illness there's little here to remember.
First novel efficiently showcases the experience of developing early-onset Alzheimer's. In 24 months, 49-year-old Harvard psychology professor Alice Howland exchanges the role of high-achieving teacher, wife and mother of three for that of a disoriented, inarticulate, forgetful shell of her former self. Stricken much earlier than most by this progressive, degenerative disease for which there is no cure, Alice loses her profession, independence, clarity and contact with the world with shocking rapidity in a narrative that sometimes reads more like a dramatized documentary than three-dimensional fiction. Genova, an online columnist for the National Alzheimer's Association, has a brisk style and lays out the facts of the disease-statistics, tests, drugs, clinical trials-plainly, often rather technically. The responses to Alice of her three grown-up children, who are also at risk of the disease; the struggles of her equally high-flying husband, a Harvard biologist; and Alice's own emotional responses, including fear, suicidal thoughts, shame and panic, are offered in semi-educational fashion, sometimes movingly, sometimes mechanically. Alice's address to the Alzheimer's Association Annual Dementia Care Conference is an affecting final public statement before her descent into fog and the loving support of her children. Worthy, benign and readable, but not always lifelike
The big A, Alzheimer’s disease, may have overcome the big C, cancer, as a diagnosis that strikes fear in aging people’s minds. Many people develop some type of cancer, many of which are now cured and/or stopped in their tracks. Not so the big A – there is no cure for this condition, which can last up to 20 years and make a formerly intelligent, high-energy person into a speechless child unable to dress or feed herself, unable to speak or recognize family members, prone to wandering. A few new drugs can slow the disease’s path.
Lisa Genova, a Ph.D. in neuroscience who writes extensively about Alzheimer’s, has written a stirring novel, Still Alice, about a woman in her early 50s who learns she has early-onset Alzheimer’s. Somewhat ironically, Alice lives by words and how the brain works or doesn’t: she is a professor at Harvard in cognitive psychology and presents at a conferences around the world annually. The novel details how Alice discovers the disease, how she deals with telling her family and, most difficult, her colleagues, and how she pares down her daily activities to accommodate her diagnosis and increasing limitations.
More than many other books on the disease, this book takes the reader into the daily life of the patient – forgetfulness, losing direction, putting things in the wrong place – things that increasingly happen to this brilliant, vibrant woman who is faced with leaving her professorship, her primary self-definition for more than 20 years. She can no longer give lectures; she sometimes shows up and then leaves, not realizing it was her class to give. One of the first signs is this: Forty minutes into a fifty-minute lecture, “She simply couldn’t find the word. She has a loose sense for what she wanted to say, but the word itself eluded her. Gone. She didn’t know the first letter or what the word sounded like or how many syllables it had. It wasn’t on the tip of her tongue. Maybe it was the champagne. She normally didn’t drink any alcohol before speaking…” Alice no longer knows who she is.
As mentioned earlier, cancer has become a more hopeful diagnosis than Alzheimer’s. Alice expresses this so well:
“She wished she had cancer instead. She’d trade Alzheimer’s for cancer in a heartbeat. She felt ashamed for wishing this, and it was certainly a pointless bargaining, but she permitted the fantasy anyways. With cancer, she’d have something that she could fight… There was the chance that she could win… And even if defeated in the end, she’d be able to look them [her family and the Harvard community] knowingly in the eyes and say goodbye before she left. …Alzheimer’s Disease was an entirely different kind of beast. There were no weapons that could slay it…. The blazing fire consumed all. No one got out alive.”
Fairly early on, her wits still about her, she forms a support group of others stricken with the disease far too young. Luckily, she has an amazingly supportive spouse, John, who is careful to do what is best for her and who shows no signs of loving her less, or, as sometimes happens when a spouse is diagnosed with the big C, of leaving her/him. He is in it for the long haul. But is Alice?
Alice finds it increasingly difficult to imagine who she is. When she starts not to recognize her children – or calls her daughter by her long-dead mother’s name – she puts a plan of action in place. She gives herself mental tests on a daily basis, and she decides that when she can no longer answer these fairly straightforward questions, she will pull her own plug.
The book is entirely sympathetic to Alice, detailing her quite rapid decline. It takes place only over two years, month by month, showing deterioration in its stages. The tone of the book, though, is somewhat chilly, a bit scientific. This is not surprising as the author is a scientist. But it also may be intentional, indicating a clinical distance from which Alice is watching her own changes and decline. In fact, I preferred the narrative and its pace to the actual writing. Still, the novel gripped me.
I have loved many books about the experience of Alzheimer’s, most especially Elegy for Iris, for novelist Iris Murdoch by her husband, John Bayley. I will add Still Alice to my increasingly long bookshelf of such memoirs and novels. This quiet and powerful novel is highly recommended for people who fear they may acquire the disease because it runs in the family, or for caregivers who deal with the elderly and/or memory-impaired. Readers with Alzheimer’s have highly praised the book’s accuracy and honesty. A portion of the sales of this book goes to the Alzheimer’s Association.
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