STILL ALICE by Lisa Genova and THE WILDERNESS by Samantha Harvey

This review was first published in Books and Culture online (June 2009) as "Into the Abyss with Alice and Jake: Two novels about Alzheimer's disease"

Early this year, two improbable first novels hit the market. Both feature a protagonist with Alzheimer's disease, and both tell the person's story from his or her point of view alone. As dementia mounts, no omniscient narrator intervenes to explain, correct, or fill in the widening gaps.

Still Alice, by Lisa Genova, a 38-year-old American actress and neuroscientist with a Harvard PhD, enjoyed a good run on the New York Times bestseller list. Alice Howland, 50 years old and a well-known Harvard professor, is troubled by occasional forgetfulness. Is it menopause? A brain tumor? The lapses increase in frequency. She gets lost on her usual jogging route. She blows off a speaking appointment in Chicago. She is diagnosed with early-onset Alzheimer's.

Genova tells Alice's story in familiar hen-lit style, focusing on Alice's relationships, especially with her husband and children, as well as on her sense of self. The story is straightforward and linear, covering three years in Alice's life. Though the point of view is third-person, it is always Alice's, growing more confused as her condition deteriorates. The book is emotionally gripping and a bit romantic: through it all, Alice, though greatly diminished, is still Alice.

By contrast, The Wilderness, by Samantha Harvey, a 34-year-old British woman with degrees in philosophy and creative writing, has received glowing reviews but few American sales. This is probably because Harvey tells Jake Jameson's story through the medium of literary fiction—a genre in which, as its detractors are keen to point out, nothing much happens, a great deal of thinking goes on, chronology is a puzzle rather than an anchor, and at the end of the book, the main character is even more miserable than at its beginning.

Most readers, myself among them, prefer likable characters, a page-turning plot, and manageable conflict that leads to some sort of satisfactory resolution. But Alzheimer's disease isn't like a romance or a mystery or even a fairly realistic piece of hen lit. It is, rather, very much like a literary novel, and Harvey's use of this genre gives her book a feeling of realism that Genova's more conventionally realistic novel can only approximate.

Four people I loved had Alzheimer's disease: my father, my mother, my mother-in-law, and my best friend's mother. I know the grief of a disease that wipes out memory, destroys knowledge, alters personality, stirs up emotions, impairs judgment, removes control of bodily functions, and finally turns its victims into little more than the skin and stuffing of their former selves. I have wondered how this disease, so devastating to the people who observe it, must feel to the person who has it.

Samantha Harvey knows.

Well, she can't really know, any more than anyone can really know what it feels like to be dead. Near-death is not the kind of death that stays dead, and no amount of experience with Alzheimer's patients can put us in their heads. Still, Harvey convincingly sees through Jake's eyes, even though she tells his story in the third person.

Jake, a 65-year-old architect, is driving to his office along familiar roads:

He looks around his car and tries to remember what make it is; he cannot. He opens the window to feel what month it is. It isn't a month. There aren't months. There are just happenings, a lack of signposts … . He pulls up at the side of the road, lifts his glasses, and rubs his eyes. He has been doing this journey to and from work every day for thirty-five years. He pores over the map.

He is about to retire, and none too soon. He has spent all day trying to figure out what to do with the architectural drawing that has been passed to him for approval. He can't recall his secretary's name or what exactly she does. But he is polite and articulate, and he can rise to the occasion. "I am going to spend my retirement seeking beauty," he announces at his going-away party. Instead, he spends it searching for himself.

His confusion would be intolerable were it not for his rich memories, most of them about women: his formidable Jewish mother, Sara; his devout wife, Helen; his beloved daughter, Alice; his childhood friend, Eleanor; the girl in the yellow dress, Joy. Through recalled events, scenes, stories, and conversations we piece together a picture of his life and that of his family.

Jake is a disappointed man. He was once a successful architect, but his modernist buildings fell out of favor. He loved his wife, but she died of a stroke and now he is suspecting she was unfaithful to him. He had two children that he adored, but Henry is in prison after an alcohol-fueled rampage, and Alice is dead.

Or not. The stories change in the telling and retelling, and the reader—like Jake himself—comes to doubt even the bare outline of his life. Themes, images, characters weave in and out. Who climbed the cherry tree, Helen or Alice? Did Alice die young—of an accident, or was it an illness?—or is she still alive, or was she never born at all? What happened to the money under the bed? Who is writing all the letters—the ones from Joy, the ones to Helen, the one from Eleanor? Who ran over the dog?

Is it possible for Jake, or the reader, to know anything for sure?

In his brain are countless cells—countless, but not infinite. To say infinite would be reckless. Inside each cell a little piece of him is packed, and every time a cell dies a piece of him dies. His past is just an electric impulse. Static flashes on a petticoat. Gradually he is being scattered and lost—hundreds of unread messages floating out across the sea.

Unlike Still Alice, The Wilderness is not a typical book-club selection, though I can imagine book-club participants avidly trying to sort out the factual from the invented, the real from the hallucinatory. Such an exercise would certainly elucidate Harvey's amazing art, and it might well lead to a good discussion on the importance of memory to personhood. Some readers would side with Jake's wife, talking about her war-injured father:

That man with only one foot was still my daddy. If he'd had no feet, no hands, no legs, he'd still be my daddy. So we can't be our bodies alone. And if we are not our bodies we must be something else."
"Our brains," he said.
"More than that, Jake.
"Why more than that?"
"His soul shone out through his eyes. I saw his soul."

Others, more pessimistic, would resonate with Jake's anguish:

There were times—there are still—when he would face the darkness of three a.m. and be terrified by the idea of entropy: nature dismantling every human object, and eventually every human being, until there was just an unfettered, cold chaos. Other people had God to protect them from such an outcome, but he had nothing—nothing except himself.

Who, then, is "himself" after his brain succumbs to chaos and all the messages have floated out to sea?
I used to think that a person with Alzheimer's was completely different from the rest of us. "Senile," we said of the old lady who shared the board-and-care home with my grandmother. She was clearly out to lunch—her words made no sense to any of us, and her behavior was bizarre. "I hope I never get like her," said Grandma. (She didn't.)

But when my parents developed Alzheimer's, I came to realize that the disease did not immediately destroy the persons they once were. Flashes of normality sometimes cut through the fog. Reasoning and logic persisted, even in the absence of accurate information. Imagination stepped in and filled in the blanks. My father, who loved to travel, told us of his travels to Israel and India—where he had never gone—which he now remembered happily, and in detail. Emotions continued to register, even after my mother lost the ability to talk.

Still Alice, as the title indicates, takes the popular sanguine view: despite the ravages of Alzheimer's, whatever makes Alice herself remains. Jake shares this view, at least while his disease is still only moderately severe:

When he looks in the mirror he does not see an old man, nor does he see a brain that lacks logic. He sees himself, greatly changed, but undeniably himself, and he is grateful to this self for persisting this long.

Eventually, ineluctably, the man in the mirror becomes unfamiliar. In one of the book's last scenes, Jake recognizes a man in a photograph but does not know he is looking at himself. Is he still Jake?

Harvey captures the mix of understanding and mystery that is Alzheimer's disease and that is also the human condition. She raises thought-provoking questions about memory and personhood and the soul. If you prefer a fast-paced, informative, easy-to-understand novel, read Still Alice first. But when you are ready to plunge into the abyss and experience Alzheimer's first-hand with all its confusion and tears and unanswerable questions, find a quiet place where you can ponder and weep, and read The Wilderness.