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Title: Still Alice
Author: Lisa Genova

Summary: This book is about a young woman’s descent into dementia. And of course, we see her struggle against this horrifying and inevitable descent. But interestingly, as her cognitive capabilities diminish, we also get to see her grow. As her symptoms worsen, Alice loses her cerebral life at Harvard, where she’d placed her worth and identity, where she’d been valued and respected. Without it, she embarks on a desperate search for answers to questions like ‘Who am I now?’ and ‘How do I matter?” and is forced to search for meaning and intimacy beyond career success in her relationships with her husband and children, relationships previously neglected or on autopilot. But has too much time and distance passed in those relationships, and has Alice already lost too much of herself to reconnect before she dies? --Lisa Genova

Author Biography: Still Alice is a compelling debut novel about a 50-year-old woman's sudden descent into early onset Alzheimer's disease, written by first-time author Lisa Genova, who holds a Ph. D in neuroscience from Harvard University. She has done research on the molecular etiology of depression, Parkinson's Disease, drug addiction, and memory loss following stroke. She is a proud and active member of the Dementia Advocacy & Support Network International.

How Lisa Genoa came to write the book (Listen to the link at the author’s name above):
“My grandmother had Alzheimer's when she was 85, and I watched this disease systematically disassemble her. As her granddaughter, I was heartbroken. But as a neuroscientist, I was fascinated. I read a lot in the scientific literature about what was going on inside her head at the molecular level. I read a lot of nonfiction written by clinicians and caregivers. But I couldn't find a satisfying answer to the question, "What does it feel like to have this?" By the time my family was caring for my grandmother, she was too far along to communicate an answer to this question. But someone in the earliest stages could. This was the seed for Still Alice.”

Observations and Questions:
1. Now Still Alice is a best seller, but originally, no publisher wanted it and first-time novelist, Lisa Genova, could not even secure an agent to help her sell her book. The story was thought to be one to appeal only to those who have dear ones with Alzheimer’s Disease. Clearly, the appeal of this book is widespread. What aspects contribute to the book’s close-to-universal appeal?

2. Are the characters in Still Alice credible? Which ones support Alice? Which ones disappoint her? Where do John’s actions and responses fall? Are any of the characters less than believable? Why?

3. 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?

4. 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?

5. Is Alice’s speech to the convention chronologically out of place? At that point, does Alice really seem capable of composing and dramatically delivering this politically powerful speech?

6. Each of Alice’s children decides whether to take the genetic test. Would you?

7. 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?

8. Alice answers the same several questions each day. One day she cannot answer them and begins to follow the steps of her suicide plan. How do you view Alice’s attempt at suicide?

9. "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?

10. Why is her mother's butterfly necklace so important to Alice? Is it only because she misses her mother? Does Alice feel a connection to butterflies beyond the necklace?

11. Lydia is accepted at two colleges to study acting. It makes very little sense that anyone who is accepted at NYU would prefer Brandeis (although Brandeis is a great school in general). This flaw in the plot bothers me. Does it bother you? Or am I missing a subtle detail? Is Lydia sacrificing NYU for the sake of allowing her mother to stay where she can see her grandchildren?

12. In my experience with a friend who began showing signs of early-onset Alzheimer’s Disease in the early 1980s, the loss of physical coordination was the most visible sign. She was clumsy and tripped up on things. She couldn’t stuff envelopes and lick stamps without a great effort. How is Alice’s physical deterioration made known?

13. 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?

14. "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?

15. 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?

16. How do you rate the ending of Still Alice? What other endings can you imagine?

Related Information:
Lisa Genova’s Blog

Alzheimer’s Research Forum Interview with Lisa Genova

Alzheimer’s Association

Questions and discussion provided by Audrey Kupferberg

This discussion guide made possible with public funds from the New York State Council on the Arts, a State Agency. Sponsored by the Mohawk Valley Library System and participating member libraries.

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