Neurology Now:
doi: 10.1097/01.NNN.0000359082.34572.87
Department: the Waiting Room: Reading Room

Still Alice

Chung, Sean

Free Access

In Lisa Genova's debut novel, Still Alice (Pocket Books, 2009), 50-year-old Alice Howland is at the pinnacle of her career—enjoying acclaim as a distinguished professor of psychology at Harvard and savoring the accomplishments of her grown children and Harvard professor husband—when she begins to experience moments of confusion and forgetfulness. The episodes increase and intensify until Alice can no longer dismiss them as signs of routine stress and aging. After Alice takes a genetic test, her neurologist delivers the devastating diagnosis: She is positive for a mutation linked with early-onset Alzheimer's disease. When Alzheimer's affects someone before the age of 65, it is known as early-onset. According to the Alzheimer's Association, there are approximately 5 million people living with Alzheimer's disease in the United States. And 500,000 of them—or 10 percent—are under the age of 65. While earlier cases have been documented, early-onset Alzheimer's typically affects people in their 50s.

Each chapter chronicles a consecutive month in Alice's life. Genova, who holds a Ph.D. in neuroscience from Harvard, details the disease's progression over a two-year span with sensitivity and scholarship. We observe Alice as she explores her treatment options, participates in a clinical trial of a promising drug, and attempts to cope with the unpredictable nature of her condition. Written from Alice's point of view, readers are able to experience her frustrations, confusion, and terror first-hand.

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Genova's novel is also an inquiry into personal identity. As her career and memories fall apart, Alice is forced to question who she is.

“Is the part of my brain that's responsible for my unique ‘me-ness’ vulnerable to this disease?” she asks. “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?” Genova affirms that the person who remains—in spite of her diminishments—is still valuable and often vibrant; and she shows how personal identity is derived in part from the love and memories of those around us.

The novel's success today belies the challenges it faced finding a publisher. Passed over by several publishing houses, an endorsement from The National Alzheimer's Association gave Genova the conviction to self-publish. It went on to win the 2008 Bronte Prize for best love story in North America and was then picked up by Simon & Schuster's Pocket Books. Upon its release in January 2009, it debuted at #5 on The New York Times Bestseller List.

Sean Chung

©2009 American Academy of Neurology

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