Still Alice
A Harvard professor who has built her life on her mind learns that it is slipping away, and must decide who she is without it.
When it was written
- Written
- Mid-2000s, before 2007
- Publication
- 2007, self-published by Lisa Genova; reissued by Simon & Schuster (Pocket Books) in 2009
Lisa Genova, a neuroscientist with a PhD from Harvard, wrote the novel after seeing how little fiction showed what Alzheimer's disease feels like from the inside. Her own grandmother had Alzheimer's, which shaped her interest in the subject.
Unable to interest a traditional publisher at first, she published the book herself in 2007. It drew attention through word of mouth and was then picked up by Simon & Schuster, which reissued it in 2009. A film adaptation followed in 2014.
What it’s about
Spoiler-freeAlice Howland is a Harvard professor of cognitive psychology, respected around the world for her work on language. She is married to John, a fellow scientist, and has three grown children: Anna, Tom and Lydia. Her identity rests on her sharp mind, and she is quietly critical of Lydia, who is pursuing acting instead of college.
In autumn 2003 small things start to go wrong. Alice loses a common word during a dinner party, misplaces her phone, and while jogging on a familiar route near Harvard Square she suddenly does not know where she is. She blames stress, fatigue and perimenopause, but a growing dread sends her to a doctor.
The novel follows Alice as the possibility of a progressive illness becomes hard to deny. She hides her fears from John, leans on notes and routines, and quietly makes plans for the worst. Her central struggle is to stay herself while the very faculties she trusts most begin to fail.
This summary stops at roughly the end of the first act. Everything after that sits behind a spoiler gate.
Themes
Spoiler-freeIdentity and the self
Alice has always defined herself by her intellect. The book asks what remains of a person when memory and skill start to fade, and whether a self can exist apart from achievements.
Memory and loss
Genova shows memory not as a single skill but as the thread that holds daily life together. Lost words, lost routes and lost names are shown from the inside, with scientific accuracy.
Family and caregiving
The illness reshapes every relationship in the Howland household. The book looks at how a spouse and children cope with duty, fear and their own ambitions.
Dignity and being heard
Alice insists she is a whole person and not just a patient. The novel explores how society listens to people with dementia, and how much they still have to say.
Mother and daughter
Alice's strained bond with Lydia is one of the emotional centres of the book. Their relationship asks what it means to truly see another person.
Characters
Fates hiddenAlice Howland
Harvard psychology professor, protagonistA brilliant linguist and cognitive psychologist who prizes her mind above all else. She is in her fifties and used to being in control.
What happens to Alice HowlandHideSpoilers
What happensHer Alzheimer's progresses until she is largely nonverbal and living with Lydia in Los Angeles. Even so, she can still respond to love and connection.
John Howland
Alice's husband, cell biologistA busy, ambitious scientist and Alice's partner of many years. He becomes her caregiver as her symptoms grow.
What happens to John HowlandHideSpoilers
What happensHe takes a position at the NIH in Washington while Alice lives with Lydia. His career often comes before her care.
Lydia Howland
Youngest daughter, actorShe is acting in Los Angeles rather than attending college, which Alice has long disapproved of. She and her mother slowly grow closer.
What happens to Lydia HowlandHideSpoilers
What happensLydia becomes Alice's most present caregiver and takes her in to live with her in Los Angeles. Her acting wins her mother's real validation.
Anna Howland-Barnes
Eldest daughterAlice's practical, driven eldest daughter, married to Charlie and starting a family of her own.
What happens to Anna Howland-BarnesHideSpoilers
What happensShe remains part of the family circle, with her husband Charlie and her twins, as it adjusts to Alice's growing needs.
Tom Howland
Son, medical studentThe middle child, who is training in medicine and is the most reserved of the three.
What happens to Tom HowlandHideSpoilers
What happensHe stays involved as the family faces the question of Alice's care, but the book keeps its main focus on Alice and Lydia.
Dr. Tamara Mooney
Alice's doctorThe physician Alice first consults about her memory problems. She orders tests to rule out treatable causes.
What happens to Dr. Tamara MooneyHideSpoilers
What happensShe appears early in the diagnostic process and has no further major role in the story.
Charlie
Anna's husbandAnna's husband and the father of their twins, a regular presence at family gatherings.
What happens to CharlieHideSpoilers
What happensHe is present when the family gathers and Alice can no longer recall her grandchildren's names.
Plot summary
Contains spoilersStill Alice in 3 parts, in our own words.
This section gives away the whole storyThree short summaries, one per part, including the ending. Open it only if you have finished the book or don’t mind knowing.
Show spoilersHide spoilers
Three short summaries, one per part, including the ending. Open it only if you have finished the book or don’t mind knowing.
- Beginning
Cracks in a Brilliant Mind
In autumn 2003, Alice Howland is at the peak of her powers. She is a Harvard cognitive psychology professor, a confident lecturer, and the hostess of a dinner party for John's colleagues. John is a cell biologist, and they have three grown children: Anna, Tom, and Lydia. Alice disapproves of Lydia, who is acting in Los Angeles instead of going to college. Her sense of worth rests on her mind.
Small failures begin to pile up. She loses a common word at the dinner, struggles to follow a faculty meeting, and misplaces her BlackBerry. While jogging near Harvard Square she suddenly cannot recognize a route she has run hundreds of times. She explains each slip away as stress, tiredness, or perimenopause, but her fear grows, and she decides to see a doctor.
Alice describes her symptoms to Dr. Tamara Mooney, who orders blood work to rule out treatable causes and gives a brief screening that Alice passes. She keeps most of her fear from John. By early 2004 she is getting lost again and conceals it, while the possibility of a progressive illness becomes impossible to deny.
Through spring 2004 the decline becomes harder to hide. Alice loses words in lectures and leans on notes, reminders, and routines. Alone, she plans for the worst, and in April she finds a document she wrote for herself called Butterfly. It tells her to answer questions and, if she fails, to take pills stored in her home. She cannot remember writing it, cannot find the pills, and is distracted away by ordinary events. Meanwhile John is being recruited by a university in New York, which worries her.
- Middle
Speaking Out, Losing Ground
In May 2004 Alice speaks at a Dementia Care Conference about living with early-onset Alzheimer's. She rewrites her remarks repeatedly to compensate for her memory. She describes the terror of losing words and familiar places, and insists she is still a whole person, not merely a patient. The audience is moved, and she calls for people with the disease to be heard while they can still speak. A similar speech to Harvard Medical School alumni earns a standing ovation.
Her bond with Lydia changes. In June, Alice travels to Los Angeles to see Lydia in a play, though finding her way there is frightening. She is moved by her daughter's talent and drops her old judgments. On Cape Cod over the Fourth of July she watches Lydia rehearse a monologue and feels the same tenderness, even as she loses the thread of conversations. John is now her caregiver as much as her husband.
In August, Alice runs her usual route and again cannot recognize where she is, until she spots Harvard Stadium and finds her way home. She tells John, who offers measured reassurance. She later finds her Butterfly instructions on her laptop, fails the questions, and goes to her bedroom for the pills, but is interrupted and never carries out the plan. In the following months Lydia returns home to help care for her.
In September 2004 a follow-up assessment shows decline, and Alice is classified as being in the moderate stage. In October she loses her train of thought mid-lecture in front of her students and relies obsessively on her BlackBerry. She worries about whether her children carry the genetic mutation. She joins a support group at a church, where she is younger than the others, and finds understanding there. By December she is preparing for Christmas with effort, still holding that she is more than what she can remember.
- End
Presence After Memory
By January 2005 Alice relies on her computer's reminders to get through each day. At a faculty meeting she cannot follow the conversation or remember colleagues' names. Teaching ends painfully when she loses her thread in front of her class and a student gently prompts her. In February she gets lost on a run near Harvard and cannot find her way back to her office. After she is found and helped, she can no longer run alone. John weighs a major career opportunity that would mean relocating.
In March she gives a lecture at the psychology department. John helps her get dressed and organized, and she gets through it by reading from a prepared text, knowing she is performing a version of herself. In April the family gathers at home with Anna's husband Charlie and the twins. Alice cannot remember her grandchildren's names and repeats herself. The family quietly senses that her care needs will outgrow their arrangements, and Lydia simply sits with her.
In June 2005 Alice and John fly to Los Angeles to see Lydia perform. Despite her disorientation, Alice is deeply moved and tells Lydia that the acting was real, giving her the validation Lydia has longed for. Over the summer Alice loses more independence, and John is often preoccupied with his career while Lydia is the most emotionally available.
The epilogue, a year or more later, finds Alice largely nonverbal and living with Lydia in Los Angeles, while John has taken a position at the NIH in Washington. Lydia acts out a scene from a play in the living room. Asked what it was about, Alice says a single word: love. The moment suggests that feeling and connection endure even after memory and language have been lost.
Who it’s for
- Readers of family drama
- People touched by dementia or caregiving
- Fans of medical or scientific fiction
- Book clubs looking for discussion
- Readers who like emotional, character-led stories
Content notes
- Progressive dementia and loss of independence
- Genetic risk and testing for a hereditary illness
- Contemplation of suicide
- Family conflict and caregiver strain
Suggested age: 14+
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The full version contains spoilers, including the ending.
FAQ
What is Still Alice about?
Still Alice follows Alice Howland, a Harvard cognitive psychologist who is diagnosed with early-onset Alzheimer's disease in her fifties. The novel tells the story from her point of view as she loses words, routes and routines. It also shows how her husband and children respond.
Is Still Alice based on a true story?
No, Alice and her family are fictional. Lisa Genova is a neuroscientist, and she researched the disease closely, including talking with people living with Alzheimer's, to make the portrayal accurate.
Is Still Alice a sad book?
Yes, it is often painful to read, because it follows a gradual and permanent loss. It is also tender and notable for moments of love and connection, so many readers find it moving more than bleak.
Who wrote Still Alice and when was it published?
Lisa Genova wrote it and first published it herself in 2007. Simon & Schuster later reissued it, and it became a bestseller.
Is there a movie of Still Alice?
Yes, a film adaptation was released in 2014. Julianne Moore played Alice and won the Academy Award for Best Actress for the role.
What is the Butterfly file in Still Alice?
Butterfly is a document Alice writes for herself while she still can. It sets out questions she should be able to answer and tells her what to do if she cannot. She finds it in April 2004 and does not remember writing it.
Is Alice's illness genetic in the book? Spoilers
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Yes, Alice has early-onset familial Alzheimer's, which means the gene mutation can be passed on to her children. She worries about whether her children carry it, and this adds a second layer to her fear.
Does Alice go through with the plan in Butterfly? Spoilers
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No. She tries to follow the Butterfly instructions in August 2004 and fails the questions, but she is interrupted and never carries out the plan. The illness takes away her ability to follow it through.
How does Alice's relationship with Lydia change? Spoilers
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Alice drops her old judgments after seeing Lydia act, and the two become close. Lydia returns home to help care for her and later becomes the family member who is most emotionally available to her.
How does Still Alice end? Spoilers
This answer explains how the book ends.Show spoilersHide spoilers
In the epilogue, a year or more later, Alice is largely nonverbal and living with Lydia in Los Angeles, while John works at the NIH in Washington. Lydia acts out a scene, and when asked what it was about, Alice says one word: love. The ending suggests feeling endures after language is gone.
Is Still Alice hard to read?
The prose is plain and clear, and the chapters are short. The difficulty is emotional rather than technical, particularly in the later sections as Alice's decline deepens.
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