Although Still Alice primarily follows Alice Howland’s individual experience with Alzheimer’s, her marriage, family, and the ways her illness changes her relationships are some of the most important elements of the book. Both Alice and her husband, John, have worked their whole lives to accomplish their goals and give their three kids the best possible life, even though sometimes they disagree about what that means for their youngest daughter, Lydia. As Alice starts showing symptoms of Alzheimer’s, she’s forced to confront some major unacknowledged issues in their marriage. However, while her illness puts a strain on an already strained marriage, it creates a new kind of closeness between Alice and Lydia. In portraying Alice’s personal struggle with Alzheimer’s, Genova also provides a compelling glimpse in the unpredictable effects of one family member’s illness has on those closest to them—both positive ones that bring people together through the creation of a mutual understanding, and negative ones that drive others apart.
Alice has dedicated most of her life to her career, even at the expense of her relationship with her husband and time with her children. When faced with the knowledge that she’s about to lose all these things, Alice realizes what she really values, is time with her family. When Alice is forced to accept that she has a limited amount of time as herself, she makes a list of what she wants to do before her condition worsens and is surprised to find that “nowhere in that list was there anything about linguistics, teaching, or Harvard.” This reveals just how much importance she had formerly placed on her career, and how much she took her family for granted. Alice knows Alzheimer’s will steal her memories over time, but she also believes that her love for her children is “safe from the mayhem in her mind, because it lived in her heart.” Ironically, this means that the one thing she’ll truly keep is the one thing she had taken most for granted in her quest for success: her family.
Alice and John have many qualities in common: they’re ambitious, intelligent, successful, and love their children. However, even before Alice receives her diagnosis, it becomes clear that things aren’t as they should be, and her deteriorating memory highlights deeper, unacknowledged issues. For years, Alice and John enjoyed a “relaxed intimacy” with one another. Using this term to describe their relationship makes it seem idyllic, but it also implies that they have stopped trying to impress each other, romantically or otherwise. When John finds out about Alice’s Alzheimer’s, he goes through a period of denial followed by anger and finally acceptance. But perhaps his most striking response is “humiliation” when Lydia tells him she had noticed something was wrong, and he, “someone so smart, a scientist, [could] not see what was right in front of him.” This response reveals his dawning realization that he hasn’t paid enough attention to his wife, and is interpreted by him as his failure as a husband.
Finally, when John is offered a job in New York City and decides he wants to go despite Alice’s desire to stay and enjoy what time she has left with their kids, Alice realizes that “he’d always loved her, but she’d made it easy. This implies that this love for her, when truly challenged, isn’t equal to the love she has for him, as shown by her willingness to sacrifice all and his unwillingness to do the same. Rather than coming to the same realization about the importance of family, Alice’s diagnosis only seems to create more emotional distance between her and John, and ultimately to drive him away.
Although her marriage begins to deteriorate in stride with her mental health, Alice’s relationship with Lydia goes in the opposite direction and they grow closer as she gets worse. Alice is a strong believer in formal education, but Lydia initially decides to pursue acting instead of going to college. This is something Alice interprets as “rebelling against who we are,” as she tells John. As her condition worsens, Alice decides to read Lydia’s diary to get to know her before she forgets. By doing this, Alice “saw Lydia. And she loved her,” marking her readiness to understand and accept Lydia as she is and allowing herself to drop her walls so they can grow closer. Ultimately, it’s Lydia who best understands Alice, interpreting her confusion and offering answers without making Alice embarrass herself by asking for them. By portraying Alice and Lydia’s relationship this way, Genova highlights how an unexpected tragedy like an illness can bring formerly estranged loved ones together.
Alice’s Alzheimer’s has a profound effect on every member of her family, but not all those effects are negative. In Still Alice, Genova illustrates the complexities of dealing with a loved one’s Alzheimer’s and its ability to simultaneously wedge people apart and draw others together.
Related Themes from Other Texts
Illness, Marriage, and Family ThemeTracker
Illness, Marriage, and Family Quotes in Still Alice
How could he, someone so smart, a scientist, not see what was right in front of him?
They used to walk together over to Harvard Yard every morning. Of the many things she loved about working within a mile from home and at the same school, their shared commute was the thing she loved most. […] When they were first married, they even held hands. She savored the relaxed intimacy of these morning walks with him, before the daily demands of their jobs and ambitions rendered them each stressed and exhausted.
But for some time now, they’d been walking over to Harvard separately.
Time and again she’d watched with dread as the most promising careers of her reproductively active female colleagues slowed to a crawl or simply jumped the track entirely. Watching John, her male counterpart and intellectual equal, accelerate past her had been tough. She often wondered whether his career would have survived three episiotomies, breast-feeding, potty training, mind-numbingly endless days of singing “The wheels on the bus go round and round,” and even more nights of getting only two to three hours of uninterrupted sleep. She seriously doubted it.
They’d played this scene out together before, and this was how it ended. John argued the logical path of least resistance, always maintaining his status as the favorite parent, never convincing Alice to switch over to the popular side. And nothing she said swayed him.
She’d rather die than lose her mind. She looked up at John, his eyes patient, waiting for an answer. How could she tell him she had Alzheimer’s disease? He loved her mind. How could he love her with this?
In the month since their visit to the genetic counselor, he’d stopped asking her for help finding his glasses and keys, even though she knew he still struggled to keep track of them.
John had agreed to walk with her to Harvard every morning. She’d told him she didn’t want to risk getting lost. In truth, she simply wanted that time back with him, to rekindle their former morning tradition.
She laughed a little, surprised at what she’d just revealed to herself. Nowhere in that list was there anything about linguistics, teaching, or Harvard. She ate her last bit of cone. She wanted more sunny, seventy-degree days and ice cream cones.
And when the burden of her disease exceeded the pleasure of that ice cream, she wanted to die.
Lydia reached out across the dishes and glasses and years of distance and held her mother’s hand. Alice squeezed it and smiled. Finally, they’d found something else they could talk about.
In the beginning, they did. They lived their lives together, with each other. But over the years, it had changed. They had allowed it to change. She thought about the sabbaticals apart, the division of labor over the kids, the travel, their singular dedication to work. They’d been living next to each other for a long time.
She tried to be understanding. He needed to work. But why didn’t he understand that she needed to run? If something as simple as regular exercise really did counter the progression of this disease, then she should be running as often as she could. Each time he told her “Not today,” she might be losing more neurons that she could have saved. Dying needlessly faster. John was killing her.
They talked about her as if she weren’t sitting in the wing chair, a few feet away. They talked about her, in front of her, as if she were deaf. They talked about her, in front of her, without including her, as if she had Alzheimer’s disease.
She wanted to tell him everything she remembered and thought, but she couldn’t send all those memories and thoughts, composed of so many words, phrases, and sentences, past the choking weeds and sludge into audible sound. She boiled it down and put all her effort into what was most essential. The rest would have to remain in the pristine place, hanging on.
“I miss myself.”
