Still Alice

Still Alice

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Still Alice by: Dr. Lisa Genova

Review by: Chelsea Lowther

As a scientist in training I am acutely aware that my single greatest asset is my mind. Everything we (academics) do on a daily basis requires Herculean cognitive effort. Whether it is developing a study design, writing a grant proposal, or peer reviewing a manuscript, the hamster upstairs is usually in perpetual motion. I try to do my best to preserve the health of my brain–eat right, sleep, exercise–but what if my DNA is working against me? In a too-close-for-comfort tale of a Harvard psychology professor with early onset Alzheimer’s disease we learn that a mutation in Dr. Alice Howland’s genetic code has slowly been damaging her most prized possession. Still Alice is a personal tale of one woman’s experience of Alzheimer’s disease and the unravelling of family dynamics that ensues.

At fifty years of age and at the height of her academic career, Alice is a celebrated cognitive psychologist trained in linguistics. Alice and her husband John, also a Harvard-employed scientist, have three grown children: Lydia, Anna, and Tom. The story focuses heavily on the strained relationship between Alice and Lydia, the so called black sheep of the family. Lydia is an aspiring actress living in Los Angeles and the only Howland child to not have pursued a college degree. Ironically, Lydia is the first to attribute Alice’s increasingly frequent memory lapses to something larger than age-related forgetfulness. Alice’s cognitive decline begins insignificantly enough–a lost Blackberry charger, a forgotten word–and escalates dramatically. Soon Alice is unable to remember the instructions to her favorite recipe or recognize her own neighborhood.

Told as a first person narrative, author Dr. Lisa Genova (PhD) gives the readers a candid look into the first-hand experience of Alzheimer’s disease. As a Harvard trained neuroscientist it is obvious that Genova’s background has suited her well to write such a fictional tale. Still Alice incorporates “current” (circa 2008) research on Alzheimer’s disease into the story line and is full of interesting information. Genova does an excellent job detailing the critical role genetic counselors are increasingly playing in the US (and Canadian) health care system. During the genetic counseling session, the readers learn that Alice carries a mutation in PS1 (the presenillin-1 gene), one of only three known susceptibility genes for early onset Alzheimer’s disease. The mutation is transmitted in an autosomal dominant fashion, meaning all of Alice’s children are at a 50% risk of inheriting the disease-causing mutation.

I read enthusiastically to see how each of the three children would react to the genetic findings; I wanted to understand how they would grapple with the decision to get tested themselves. However, my curiosity was never satisfied and the issue was quickly swept under the rug. It is not clear whether this was an attempt to get the readers to explore their own personal beliefs about genetic testing or simply poor character development. The only purpose it served was to reconfirm that Lydia is indeed the family outcast as the only Howland child not to receive the genetic testing.

As Alice’s disease progresses, John is offered his dream job in New York City, several hours away from their Boston home. He eventually decides to take the job and leaves his wife in Boston to be cared for by his two daughters (Lydia has relocated back home) in a swift decision that feels somewhat insincere. John is largely portrayed as a self-absorbed scientist; however, there are affectionate moments throughout the story that made me question the authenticity of his decisions. Overall, Still Alice does a good job of communicating interesting research findings in the context of a relatable story.