‘Still
Alice’ and the Politics of Alzheimer’s
02.09.15 6:45 PM ET
Nicolaus Mills
It’s
a small miracle that Still Alice,
Lisa Genova’s novel about Alice Howland, a 50-year-old linguistics professor
faced with early-onset Alzheimer’s disease, got made into a feature film
starring Julianne Moore. Genova self-published her novel in 2007, and it wasn’t
until two years later that Simon & Schuster picked up Still Alice and gave it mass distribution through
Pocket Books.
Moore’s
portrayal of Alice, which has earned her an Academy Award nomination, reminds
us of how movingly Alzheimer’s disease has been captured in
films. Like Judi Dench in her 2001 portrayal in Iris of novelist Iris Murdoch’s battle with
Alzheimer’s and Meryl Streep in her 2011 portrayal in The Iron Lady of British Prime Minister Margaret
Thatcher’s mental decline, Moore manages to inhabit her character from the inside
out.
What’s
different about Genova’s novel and the film made from it by the writer-director
team of Wash Westmoreland and Richard Glatzer is that they take on the politics
of Alzheimer’s. Book and novel are concerned not only with the treatment
of those suffering from Alzheimer’s but how much leeway we grant them in the
life-and-death decisions they must make about dealing with the disease.
Still
Alice is
in this respect a companion piece to surgeon Atul Gawande’s recentBeing
Mortal: Medicine and What Matters in the End. Still Alice is above all a mediation on the end of
our lives. The key to Alice’s thinking comes in a speech that she
delivers at the Annual Dementia Care Conference. Alice, who up to this
point in her life has done her best to conceal
her Alzheimer’s, makes no effort in her speech to minimize all that she cannot
do.
“My
yesterdays are disappearing, and my tomorrows are uncertain,” Alice confesses.
But at the same time that she makes this admission, Alice insists that her
condition does not erase her reasons for wanting to go on. “I live for
each day. I live for the moment,” she declares.
The
speech constitutes the most didactic moment in
the novel and the film. In the mass-market paperback edition of the novel, the
ideas in the speech are even repeated in an interview with Lisa Genova, a
Harvard Ph.D. in neuroscience, who speaks in detail of her work with the
Dementia Advocacy and Support Network.
Neither
the novel nor the film is, however, a sermon on
Alzheimer’s masquerading as a story. Alice’s brave
speech about continuing her life must compete with a scene in which she comes
upon a note she wrote to herself on her computer when she was still in the
early stages of Alzheimer’s. The note, at once terse and self-aware, is based
on the idea that when Alice has reached a point when she cannot answer certain
basic questions about herself, it’s time for suicide.
“You
are not living the life you want to live,” Alice writes in the note, which
provides her with instructions on how to take a fatal
dose of the pills she has hidden in a drawer. “You have chosen an outcome that
is the most dignified, fair, and respectful to you and your family,” the note
assures her.
It
is a confusing moment for the now severely compromised Alice, and the scene
ends with her bungling her suicide attempt. Would she be
better off had she succeeded? Neither the book nor the movie provides a
definitive answer, but in both we have a succeeding scene in which Alice,
despite the increasing severity of her Alzheimer’s, takes enormous
pleasure in cradling her newborn grandchild. She is not, the scene implies, so
far gone that she can’t respond to one of life’s deepest pleasures.
In
the New York movie theater in which I saw Still
Alice, I heard a woman in the row behind me whisper “Thank God” after Alice
failed to swallow the pills she had saved up. I was reminded by her remark of
the point in Dr. Gawande’s Being
Mortal in which, after
railing against medical treatments that needlessly prolong
life, he registers his misgivings about physician-assisted suicide.
It’s
hard to quarrel with the tenderness of the woman I overheard
in the theater or with the caution of Dr. Gawande, but missing on the part of
both is how those with Alzheimer’s need to get the final vote, along with help
from their doctors, on how and when they leave life.
I
think of my mother, who in the early stages of her Alzheimer’s asked a close
family friend if he would mind holding open the elevator doors in the building
that she was leaving so she could jump down the elevator shaft. The
friend, who might still be in prison if he had complied with my mother’s
wishes, still feels guilty about saying “no” to her, but he should, I believe,
rest easy.
The
deeper truth, as Still Alice makes clear, without being
proscriptive, is that people like my mother and Alice deserve better legal
options and more assistance than they now can get when Alzheimer’s strikes and
their primary concern is with ending their lives, not palliative
care.
