Still Alice

Lisa Genova

4 ideas

1. Harvard professor loses memory at fifty

   Alice Howland, a 50-year-old Harvard psycholinguistics professor, gets lost running in Harvard Square, a place she has known for decades, and is diagnosed with early-onset familial Alzheimer's caused by a dominant PSEN1 mutation. Her three adult children each face a 50% chance of inheriting it: Anna tests positive and uses IVF with embryo screening, Tom tests negative, and Lydia declines to know. Over about two years Alice loses her teaching post, her ability to read and recognize her daughter, and her place in her husband John's plans when he takes a job in New York.

2. High cognitive reserve delays diagnosis

   A highly educated, verbally practiced brain can reroute around damage and compensate with lists, context and social fluency, so outward decline lags well behind the pathology. Alice's slips get read as stress, menopause or overwork by her, her family and her colleagues until the disease is advanced. The same intellect that masks the illness then makes the fall steeper once compensation fails.

3. Future self cannot execute present self's plan

   Alice writes a self-test into her phone and hides a computer file telling her future self to swallow a stash of sleeping pills once she can no longer answer basic questions. When that moment comes, she finds the file but forgets the instructions between rooms and cannot carry them out. A plan that depends on the impaired self's competence fails because the condition that triggers it also removes the capacity to act on it.

4. Self persists after memory and intellect

   The novel locates identity in present-moment feeling and relationship rather than in recall, achievement or verbal skill. In her speech to a dementia care conference, Alice says she is more than what she says or does and is learning 'the art of losing' while still living in the moment. At the end, unable to name Lydia, she still correctly says that Lydia's monologue was about love. Read this way, dementia care becomes an effort to meet the person who remains rather than to mourn the one who is gone.

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