Still Alice

Alice Howland is a linguistics expert and professor teaching at Harvard University, thus when she forgets what the word ‘lexicon’ means while delivering a lecture, it is more telling than if someone else were to have forgotten it. So begins 50-year-old Alice’s downward slide into early-onset Alzheimers in the novel Still Alice, by Lisa Genova. The book was a New York bestseller in 2007, and the film adaptation (2014), won Julianne Moore a string of awards, including an Oscar for her role as Alice Howland.

When I realised what Still Alice was about, I didn’t want to go there. As someone who woke one day in 1991 with full-scale retrograde amnesia, vestiges of which dog me to this day, I don’t like contemplating the possibility of getting a cognitive degenerative disease. So what eventually changed my mind? I realised my reviews here are not meant to be about my own case. I am exploring what other people have created in books and films about human forgetting and remembering. Still Alice marked a milestone in Alzheimer’s awareness. With this in mind, I braced myself to read it.

The plot

While a good film that captures the essence of the book, I still suggest reading the book before watching it. There are things the film doesn’t quite cover and ways in which it is less convincing. Alice’s decline seems to go too fast. But more to the point, think of it this way: a book takes much more time to read, the author’s original research and intent is laid down there, much of which can’t be squeezed into the time frame of a standard film. One of my favourite scenes, at the conference, doesn’t even feature in the film. Mind you, the film is a work in its own right. As an adaptation, it is true to the book, and Julianne Moor’s performance is unarguably brilliant.

Alice Howland is proud of the life she has worked so hard to build. A Harvard professor, she has a successful husband and three grown children. Her youngest, Lydia, has steered away from her parent’s academic orientations and is trying to make it as an actor in New York. Alice is disapproving of Lydia’s choices. When Alice begins to grow forgetful at first she just dismisses it, but when she gets lost in her own neighbourhood she realises that something is terribly wrong. She sees a specialist and is diagnosed with Alzheimer’s disease.

While Alice once placed her worth and identity in her celebrated and respected academic life, now she must re-evaluate her relationship with her husband, her expectations of her children and her ideas about herself and her place in the world.
Her changing identity allows her to enjoy a newfound bond with her youngest daughter, who becomes the person with the most empathy for Alice’s rapid decline. With her short-term memory hanging by frayed threads, Alice has to learn to live in the moment. ¹

The stakes are high

Still Alice is very well written and well researched, with nuanced characters and a satisfying storyline. That said, it is a confronting portrayal of the disease. There is no way around that Alice’s decline is a tragedy that might happen to anyone. That she is an academic makes it more tragic, as her identity and life’s work rests on her impeccable memory. Furthermore, hers is a version of the disease in which her children have a 50% chance of inheriting it. In other words, the stakes here are high. Somehow, despite the harsh realities, the novel doesn’t plunge the reader into depression. It is unarguably sad—how could it not be, as currently there is no cure for Alzheimer’s?—but there is enough enlightened observation, nuanced characterisation, warmth, and interesting information about the condition to make it well worth reading. Besides, the family is well-off and remains united throughout. No one becomes homeless because of medical bills, which may well be other people’s reality. Given the nature of the high flying family portrayed, it draws a realistic picture of how a person with this condition has to adjust to their diminished capabilities, and how their family members have to adjust too. Often, Alice’s husband and children make imperfect adjustments, like her husband, Dr John Howland, a career academic like Alice herself used to be, wants to cart Alice out of New York when he gets a career break in another city. At her advanced stage of forgetting, this obviously won’t work for Alice. This is a far more convincing story than one where all family members immediately rally and come to Alice’s help. Denial, the inability to adjust, or simply neglecting the call to prioritise a sick person in a family, are very real reactions in contemporary society to someone with impaired memory.

Novel Factoids

Author Lisa Genova has a background as a neuroscientist. Facts about the disease are skillfully interwoven with the plot. This was the author’s debut novel, which she self-published with iUniverse. In the very early days, apparently, Lisa could be found selling copies of the book from the boot of her car. In 2009, Still Alice was acquired by Simon & Schuster and published by Pocket Books (now Gallery Books). It was on The New York Times bestseller list for over 40 weeks. It has been sold in 30 countries and translated into more than 20 languages. Today she is a bestseller many times over. [see below]

An amnesiac’s perspective

For me as a former amnesiac, I liked the way this book charts not only Alice’s decline but her stubbornness and denial in the face of the disease. She tries to hang onto her career for as long as she can, hiding her symptoms as best she can. There is a scene set at a conference Alice attends while still working, where just as she is commending herself privately for managing to appear normal to her academic peers, she asks the same question, word for word, that she asked only moments earlier. It is a heartbreaking moment, and I understood it only too well. The drive to hang onto one’s former competence and working memory is very strong.

I enjoyed the way the author hasn’t tried to make the reader like and admire Alice. When she says “I wish I had cancer,” Alice reveals a streak of selfishness, but this comment is realistic. She will explain bluntly that Alzheimers makes her feel ashamed, whereas cancer patients are supported. This highlights the idea that Alzheimer’s research is comparatively underfunded, a fact that Professor Donald Weaver says is partly behind why there is no cure for it yet. ²

The novel shows this disease impacting Alice when she is 50, thus relatively young. Many people consider Alzheimer’s an old person’s disease, yet we learn it is not.

I also like the way reviewer Jess Just Reads describes among the strengths of the novel its open-endedness.

Finally, for me, Alice’s daughter Lydia’s question struck a chord: it is such a great question, but not always one that’s asked of a person with a deficient memory.“What’s it like? What does it actually feel like?” Lydia asks her mother.

This is a groundbreaking moment in the film. Alice’s other children and husband, in the name of caring for her, often treat her like she isn’t there. My experience of telling people I had amnesia, either when I was experiencing it, or later, has been that very few actually ask what it’s like. They tend to be either uncomfortably silent, or ask “was it a car accident?” or “have you got your memory back?”

I like the way this book is told from Alice’s perspective and shows the uneasiness that Alice’s illness brings into even the most solid, privileged and loving family. You don’t need a first-person narrative to get close to a protagonist; this third person, parrot on the shoulder technique works brilliantly here. Just look at the book’s impact!

Critic Beverly Beckham of The Boston Globe wrote, “After I read Still Alice I wanted to stand up and tell a train full of strangers, ‘You have to get this book.'” Beckham notes that the story is told from the inside: “This is Alice Howland’s story, for as long as she can tell it.” ⁵

About the author

Her first work of nonfiction, Remember: The Science of Memory and the Art of Forgetting, published March 2021, was an instant New York Times bestseller. Her website is at : https://www.lisagenova.com/

Lisa Genova graduated with a degree in Biopsychology and has a Ph.D. in Neuroscience from Harvard University. Lisa has captured a special place in contemporary fiction, writing stories that are equally inspired by neuroscience and the human spirit. She is the New York Times bestselling author of the novels Still Alice, Left Neglected, Love Anthony, Inside the O’Briens and Every Note Played.

Lisa speaks around the world to raise awareness of Alzheimers disease. You can keep up with her:

https://alzheimer.ca/bc/en/take-action/fundraise-participate/breakfast-remember

The film

The film Still Alice was directed by Richard Glatzer and Wash Westmoreland. It is fairly faithful to the book and critically acclaimed. For her performance as Alice Howland, Julianne Moore won an Academy Award, BAFTA Award, Golden Globe Award, Screen Actors Guild Award, and Critics’ Choice Movie Award.

1. Some of this plotline was drawn from https://www.lisagenova.com/book-inner
2. Article in The Conversation. https://theconversation.com/why-dont-we-have-a-cure-for-alzheimers-disease-156473, Donald Weaver, Professor of Chemistry and Director of Krembil Research Institute, University Health Network, University of Toronto Published: March 19, 2021
3. https://theconversation.com/why-dont-we-have-a-cure-for-alzheimers-disease-156473, Donald Weaver, Professor of Chemistry and Director of Krembil Research Institute, University Health Network, University of Toronto Published: March 19, 2021
4. [http://jessjustreads.com/tag/still-alice/
5.  Beverly Beckham, “Despite monster, she is ‘Still Alice'” (Archived 2015-02-25 at WebCite), Boston Globe, 16 March 2008, accessed 1 June 2014