Lisa Genova couldn’t find a publisher for her first novel, about an Ivy League linguistics professor dealing with early-onset Alzheimer’s disease. So she published it herself in 2007 and sold it out of the trunk of her car. Simon & Schuster eventually picked it up, and Still Alice spent 59 weeks on the New York Times bestseller list. It was translated into 37 languages and adapted into a 2014 motion picture starring Julianne Moore, who won an Oscar for her portrayal of Alice Howland.
Genova, who penned the story because she couldn’t find anything written from the perspective of someone living with Alzheimer’s after her grandmother was diagnosed, had her hunch confirmed: Stories about what it’s like to live with conditions such as Alzheimer’s were sorely needed. With a PhD in neuroscience from Harvard University, she thought, This is what I can do. After four more novels — about ALS, autism, traumatic brain injury and Huntington’s disease — and a nonfiction book about memory, Genova turned her attention to mental illness.
In Genova’s new novel, More or Less Maddy, New York University student Maddy Banks rejects the stability and approval that a traditional career might bring to pursue standup comedy while navigating the effects bipolar disorder has on her relationships, identity and goals.
More or Less Maddy hit bookstores on Tuesday. This Thursday, January 16, Pentangle Arts presents a special screening of Still Alice at Woodstock Town Hall Theatre. Then on Friday, January 17, Genova, who lives on Cape Cod, visits the theater to discuss the new book with Woodstock-based neurologist, neuroscientist and novelist Melodie Winawer. The talk is presented by the Bookstock literary festival in partnership with the Yankee Bookshop and Pentangle Arts.
“This definitely is not going to be dry,” Winawer said of the upcoming talk. “We have, in some ways, even though our books are extremely different, a similar passion, which is to use fiction and storytelling to bring understanding to something not only difficult to understand — neurology, neuroscience, psychiatric disease — but also, for some people, very difficult to even think about.”
Even when writing fiction, Genova presents the science and the medicine factually. “I take it as a very important responsibility to tell the truth under the imagined circumstances,” she said.
Genova talked with Seven Days about melding neuroscience and novels, an advantage fiction has over nonfiction, and how to take better care of our brains.
You have a PhD in neuroscience from Harvard University. Why did you start writing novels about neurological conditions?
Alzheimer’s was not my area of expertise, but when my grandmother was diagnosed, I figured I am the neuroscientist in my big Italian family. I read up on disease management and clinical treatment, and I read up on caregiving. But what was really missing was anything written from the perspective of the person with Alzheimer’s. I found that when I was spending time with my grandmother, who I loved very much, I felt really uncomfortable around her. I felt a lot of sympathy for her, but I didn’t have empathy. And that’s what you gain when reading stories. You get a chance to walk in someone else’s shoes.
What can fiction do to instill empathy that nonfiction cannot?
I think that a really good memoir can do that. If I have a loved one, say, with bipolar disorder, then I will maybe seek out a nonfiction book about bipolar disorder. But if it doesn’t affect me personally, I’m probably not going to seek that out.
I think that fiction is just more accessible. I can be anyone and read a book about a woman with early-onset Alzheimer’s. Now, when I come across someone, maybe in the grocery store, who appears to be confused and not know how to check out because they have dementia, or someone who might be talking really fast and really loud and excitedly and is a bundle of massive energy and grandiosity, [I think] Oh, that might be a manic episode. Instead of being uncomfortable and turning away, or being judgmental, I can stay with that person from a place of kindness and compassion. And that’s social change.
More or Less Maddy represents a pivot for you. Why did you want to write about mental illness?
It’s made up that it’s called “mental illness.” Things like bipolar disorder, schizophrenia, depression, anxiety disorders, PTSD — these are classified as mental illness. There’s no biological reason for that. These are conditions that are a result of an impairment or a deregulation of neurotransmission and neural functioning in the brain. But there’s an additional level of judgment, dismissiveness and fear, I think, that’s attached to something if we call it mental illness. That’s an unfortunate and unnecessary burden layered on these already difficult conditions. [Mental illness is] so prevalent, and I think it’s hiding in plain sight everywhere. And because there’s so much stigma, we’re not talking about it.
What do you want readers to learn about bipolar disorder?
The story should lend a lot to people understanding the nuanced lived experience of becoming diagnosed, what it’s like to be on medication, how hard it is to stay on those medications, what it feels like to become hypomanic and then manic, what those depressions feel like, and how it can mess with your identity.
If you’ve got a disorder that’s a deregulation of mood, energy, sleep, thought, [and] if you start to get really excited and happy about a life experience, well, how happy are you allowed to be before you have to worry that this could be a sign that you’re swinging manic? And if you’re upset about something, how sad or bummed out are you allowed to feel without worrying that this could be a depression? Recognize how tough it is to have a disorder that makes you question your human right to feel.
There’s a lot of judgment around people with bipolar who “go off their meds.” And one of the things I hope people get from my book is how challenging it is to stay on these medications, which are not designed for bipolar disorder. They are serendipitously discovered drugs — often for other illnesses — and because of their non-specificity [for bipolar disorder], they have a lot of side effects. Which, at times, would make any person question: Are these side effects that I’m dealing with worse than the symptoms of the illness that they are being used to treat?
How can we take care of our brains and our nervous systems?
There’s so many answers to this. The top one is sleep. Our human brains are designed to get seven to nine hours of sleep a night. This is scientifically backed evidence. We are not in an unconscious state of doing nothing when we sleep. We’re very biologically busy. This is a time for repair.
In your brain, you are clearing away the metabolic debris that accumulated while you were in the business of being awake. The janitors go to work in your brain while you sleep, so if you don’t get the right amount or the quality, then those janitors won’t have completed their jobs, and so your brain won’t be as functional the next day.
We know that a Mediterranean or MIND menu of foods is optimal for your brain function today and for preventing neurological diseases like Alzheimer’s in the future. We know that daily exercise is critical for our brain health — and by daily exercise we mean at least 30 minutes of walking a day, at a bare minimum.
Reduce your reactivity to chronic stress through things like yoga, mindfulness meditation. If you are chronically stressed and you’re dumping cortisol, adrenaline into your system every day, your brain’s receptors that would normally turn off the fight-or-flight response become desensitized. You’re just going to be constantly flooded in this fight-or-flight state if you don’t get a handle on chronic stress.
This interview was edited and condensed for clarity and length.