Still Alice (Movie): A Scene-by-Scene Portrait of Alzheimer’s

Article Highlights

• Still Alice is about the life of Alice Howland, who is stricken with Alzheimer’s disease
• The film accurately portrays many of the signs across the three stages of Alzheimer’s: Early, Middle and Late Stage
• The film also provides an accurate depiction of the difficulties and emotions experienced by a person with Alzheimer’s
• There are minor objections regarding the film’s truthfulness such as Alice’s rapid deterioration
• Sandra Bem was a real-life Alice; her experience resonates with Alice’s descriptions of what it’s like to have dementia
• Caring for an Alzheimer’s patient demands an extraordinary amount time and attention
• Despite some literary issues, the film offers a symbolic statement of the value of life

Overview

The Roman poet Horace claimed that the purpose of the arts is to “please and instruct.” This insight has stood the test of time, of 2100 years to be precise. Artists create because they have something to tell us. . . to “instruct” us. And people look at art because it’s pleasing in more ways than one. This doesn’t mean that a book or a painting or film has to be happy or uplifting. An even earlier critic, Aristotle, wrote a famous treatise explaining why tragedy is pleasurable even though it’s distressing. We flock to disaster movies as eagerly as we flock to romantic comedies.

On the whole, whether a film is happy or sad, Hollywood aims more to please than to instruct. But when movies are made about illnesses that disrupt or destroy people’s lives, most of us would agree that producers, directors, writers, and actors are obligated to represent these illnesses accurately, at least for the most part. As Julianne Moore, who stars as Alice in the film Still Alice says, “When you’re playing something based on fact, you have a real responsibility to do the research.” People who read a novel about breast cancer, bipolar illness, Alzheimer’s disease, or some other dementia, are likely to be learning about the illness as well as enjoying the book— that is, in that paradoxical “Aristotelian” way in which distress can be enjoyed.

Julianne Moore

Still Alice largely fulfills the mandate to be truthful. Moore, who won an Oscar for her role as Alice, did indeed do her research. She Skyped with women who had early-onset Alzheimer’s, her condition in the film, and throughout the project, she continued to consult in person with one of these women, Sandy Oltz. Oltz actually became a consultant for the film, consulting with the screenwriters Richard Glatzer and Wash Westmoreland, who were also the directors. Oltz speaks about her condition in the special feature segment of the DVD, and she’s in the audience in the scene in which Alice speaks to the Alzheimer’s Association.

In addition, Still Alice received the stamp of approval for its accuracy from many sources, including Ken Hepburn, Education Core Director for Emory University’s Alzheimer’s Disease Research Center, who has said the film’s depiction of the disease is so authentic that he would show it to his students as a teaching tool.

I want to first look at the ways that Still Alice portrays Alzheimer’s disease, including a consideration of the effect of dementia on caregivers. I’ll then discuss some objections people raised about the film’s accuracy. I’ll also compare Still Alice to the story of a real-life Alice, Sandra Bem, a brilliant professor who taught at Cornell and who, like movie Alice, was afflicted with Alzheimer’s disease. Lastly, I’ll consider some literary features of the film that bolster its accuracy while also delivering a message of consolation to viewers.

If you’re planning to see the Oscar-winning movie, let me give you a spoiler alert; I’m going to tell all, the entire story, including the ending, and I’ll look closely at scenes. However, when it comes to Alzheimer’s, there regrettably isn’t a lot of suspense about what’s going to happen. Alzheimer’s disease is a degenerative condition without a cure that gradually robs a person of both identity and the capacity to function because it takes away the ability to think. Drug therapies can aid with mitigating the worst effects of the symptoms, but nothing stops the progression of this terrible disease.

The story of Still Alice goes as follows:

Alice Howland is an exceptional woman who has it all when she is stricken with early-onset Alzheimer’s disease. When the film begins. Alice holds a professorship in linguistics at Columbia University and has conducted groundbreaking research on language acquisition in children. Her academic specialization holds an ironic touch, in that language is one of the essential features that Alzheimer’s ultimately destroys.

Other aspects of her life are equally story-book perfect: she has a great marriage with a successful medical researcher and three wonderful, grown children. Alice and her husband live in a gorgeous brownstone near Columbia University, and they have a house by the beach as well. When Alice begins to notice unusual forgetfulness, and she can’t figure out for a moment where she is on her way home while out for a run, she consults a neurologist and is diagnosed. The film follows her as the disease progresses, showing her deterioration, her strategies for coping with her ailment, and the impact of Alzheimer’s on her relationships with members of her family.

Still Alice and the Stages of Alzheimer’s

Some descriptions of Alzheimer’s disease divide it into seven stages, others into three. I’m going to follow the three-part depiction, since this is what Still Alice does. Each of the benchmark phases of Alzheimer’s is portrayed in the film.

Mild Cognitive Impairment/ Early Alzheimer’s Disease

Mild Cognitive Impairment is just what it sounds like, a gentle decline in cognitive capabilities, or more simply, a compromised ability to think. This is noticeable but not debilitating. People with Mild Cognitive Impairment experience increased forgetfulness, as seen in misplacing objects, forgetting appointments, having difficulty remembering the names of people they meet, and forgetting conversations or finding them difficult to follow. People with Mild Cognitive Impairment might not be able to run a business, but they can function adequately at many less demanding jobs. They can take care of themselves, and they interact more or less normally with others.

In Still Alice, Alice’s refers to her condition as Mild Cognitive Impairment to begin with. But actually, right from the start, her symptoms fit the profile for Early-Stage Alzheimer’s disease. Early-Stage Alzheimer’s includes all the signs mentioned for Mild Cognitive Impairment, but they are intensified. The forgetfulness is much more frequent and debilitating. People with Early-Stage Alzheimer’s experience significant trouble planning and organizing, and so tasks that they used to perform easily become increasingly challenging. Yet, people at this stage still remember who they are as well as many significant details about her lives.

By combining these categories, Still Alice makes a statement about what should be counted as Mild Cognitive Impairment and Early-Stage Alzheimer’s. Some organizations don’t make the distinction between these two conditions, while others are clear that they are separate. Still Alice follows the second model. If we merge these two conditions, we see that the film portrays many of the signs of Mild Cognitive Impairment/Early-Stage Alzheimer’s accurately, as in the following scenes:

• Alice momentarily can’t think of a word during a presentation. That she has been invited to speak by UCLA’s Department of Cognitive Science indicates her accomplishments in the field.
• At a Christmas dinner, Alice welcomes her son’s new girlfriend when they arrive and then again at the dinner table because she can’t remember having done this five minutes earlier. The girlfriend is confused by this repetition. However, Alice prepares a complicated meal, keeping track of many dishes and getting them on the table all at the same time—if you’ve ever cooked a holiday meal, you know just how impressive this is! Even so, Alice needs to look up the recipe for bread pudding, despite having made it many times in the past. We know this because Lydia (the younger daughter) sees Alice picking up a loaf of bread and asks Alice if she’s going to make her favorite dish, which tells us that Alice forgot a familiar recipe.
• Alice sees a neurologist because she is worried about her memory loss. He tells her that she has sporadic memory impairment that is totally disproportionate to her age (she just turned fifty), and that there is evidence of decline in her level of mental function. He wants to send her for further testing because she fits the criteria for Alzheimer’s disease.
• Alice gets lost while out for a run in her neighborhood. She has a moment of not knowing where she is while on the Columbia University campus. She has been a professor at Columbia for years, and she lives in the neighborhood, where she frequently runs.
• Alice meets with her department chair. He tells her that her student evaluations were very negative and reads her some comments: One student writes, “I was thoroughly disappointed. The content was muddled, and delivered with little focus or care.” Another comments, “The course was erratic. I had a hard time following Dr. Howland’s lectures. It seems like even she gets lost in them.” Alice confesses that she has Mild Cognitive Impairment, and that she has been diagnosed with Early-Onset Alzheimer’s Disease. She assures her Chair that she will do a better job in the coming semester and that she would like to remain in the department for “as long as we all think it’s possible.” From subsequent scenes, it’s clear that the powers that be decided this wasn’t a good idea. Alice has to stop working.
• Alice forgets a dinner date with her husband’s boss and spouse. He’s upset, but she explains that she has Alzheimer’s and that’s why she forgot. She says that maybe that’s for the best: “I don’t know what I would have been like at a dinner party. I might not be able to remember names or answer simple questions—never mind get through an anecdote.”

Moderate (Middle-Stage) Alzheimer’s Disease

During Moderate-Stage Alzheimer’s, symptoms become much more acute. People have increasing difficulty performing routine tasks, and complicated jobs are out of the question. They increasingly confuse or forget words. They forget where they’ve put objects, or put them away where they don’t belong. For the most part, they still remember who they are, although they might forget facts and events from their personal history, such as their address or the schools they attended. Confusion about time and place is common; they might be confused about what day it is, or where they are, especially if their surroundings aren’t familiar. For this reason, some people in this phase are in danger of “wandering”, leaving their homes in an attempt to return to a familiar place. They might begin to confuse past and present, to think they are children, or to live in the past. Personality changes might occur, such as an outgoing person might become withdrawn. Other uncharacteristic traits and behaviors might occur, such as paranoid delusions, or compulsive behavior, like tearing up papers. Help might be needed with ordinary tasks, such as getting dressed. Some people have problems with bladder control. This phase can last for many years as the condition gradually worsens.

• In the first shot of this segment, we see Alice wearing a bracelet that says “Memory Impaired.” Her condition has worsened to the extent that she might wander off and get lost.
• Alice repeats herself a lot, asking questions she asked a few minutes ago.
• Alice can’t remember where the bathroom is, and she wets herself. She and her husband are at their beach house rather than their apartment in town, so this is a less familiar place, but no one who isn’t suffering from dementia would have forgotten the layout of a house they know well.
• The film shows shots of Alice’s memories of her mother and sister, who died in a car accident when she was eighteen. She is starting to think of them more, and to live more in the past. This is typical of Alzheimer’s patients, since memories of past events are retained longer than more recent memories.
• Alice has an argument with Lydia who is angry because Alice read her journal. Alice claims she didn’t realize what she was doing, which might well be true. She apologizes the next day, confessing that she remembers that they had an argument but can’t remember what it was about.
• Alice and her family see Lydia in a play. After the play, Alice compliments her daughter, talking to Lydia as she would to an actress whom she didn’t know; she doesn’t realize for a moment whom she is speaking to. Her other daughter Anna says, “Mom, it’s Lydia, your daughter.” Alice recovers quickly, but this was a significant lapse.
• Alice gives a speech to the Alzheimer’s Association. She marshals all her effort to write this. She must use a highlighter when she reads her words back so that she doesn’t read the same line over and over again.

Severe (Late-Stage) Alzheimer’s Disease

The last stage of Alzheimer’s involves an intensification of moderate-stage symptoms, with increased loss of function. Patients often fail to realize what’s going on around them, as well as where they are. Their ability to communicate becomes drastically impaired. They begin to lose physical as well as mental capability; some have trouble walking, sitting, or even swallowing. These physical symptoms tend to come very late in the disease. They need help with all the everyday activities of life: dressing, eating, bathing. In fact, they require full-time, 24/7 help; someone must be available in the middle of the night if they wake up. Late-stage Alzheimer’s patients can’t be left alone.

• In the first part of this phase of the disease, Alice can’t keep track of time. When her husband, John, finds her phone stashed in a drawer, she thinks she had been looking for it the previous night. She lost it a month ago.
• Alice starts calling her older daughter “Anne,” confusing her with her sister who died in a car accident at age eighteen. She retreats more and more into this world of the past.
• When Anna has her twin babies, John must help Alice get dressed to go see her. When they get to the hospital, Alice has forgotten that Anna was pregnant and asks if she’s there because she’s ill.
• John observes, “There are days she knows where she is, but just as many days when she doesn’t. Maybe she thinks she’s a child back in New Hampshire.” Anna says, “It’s happening more and more. . . . She doesn’t know what’s going on.”
• In the later stages of the severe phase, when John left to take a job with the Mayo Clinic in Minnesota, and Lydia returned home to care for Alice, Alice doesn’t recognize her hired caregiver, although she sees her every day. She does, however, still remember Lydia, or at least realizes she is someone close and familiar. This once brilliant linguist has almost completely lost the ability to speak. In response to a question of Lydia’s, she manages to eke out a single word.

What Does It Feel Like to Have Alzheimer’s?

Just as important as any matching of scenes and symptoms, Still Alice is accurate in yet another vital way: it conveys what it’s like to have Alzheimer’s disease. The film emphasizes this topic by making it the subject of important scenes in which Alice is asked to speak about the disease. Still Alice is a very streamlined film, with virtually no extraneous detail or narrative. Everything counts. By having Alice answer the question directly, the film ensures that we pay attention to this very subjective aspect of Alzheimer’s. Alice speaks about what it feels like to have Alzheimer’s in scenes throughout the film, but I’ll concentrate on two scenes with this viewpoint as the primary focus.

In the first of these scenes, Alice’s daughter Lydia asks her: “What’s it like? What does it actually feel like?” Her answer is worth quoting:
“I have good days and bad days. On my good days, I can almost pass for a normal person. And on my bad days, I feel like I can’t find myself. I’ve always been so defined by my intellect, my language, my articulation, and now, sometimes I can see the words hanging in front of me but can’t reach them, and I don’t know who I am and don’t know what I’m going to lose next.”

Alice ends her description with a thank you: “Thanks for asking.” This is important, part of the film’s instruction to its viewers. It tells us that it’s important to ask—we all want the people close to us to understand how we feel, and this applies to our loved ones afflicted with Alzheimer’s. They will thank you, perhaps silently, for asking.

The second scene in which Alice discusses what Alzheimer’s feels like portrays Alice giving a speech at a chapter meeting of the Alzheimer’s Association. An earlier scene depicts her reading a draft of the speech to Lydia over Skype; Lydia criticizes it for not being personal enough. Although Alice hangs up in frustration, we realize, when we hear the finished speech, that she took Lydia’s advice and revised it once again. Here are some of Alice’s observations on having Alzheimer’s:

“Elizabeth bishop once wrote, the art of losing things isn’t hard to master: so many things seem filled with the intent to be lost that their loss is no disaster. I’m not a poet, I am a person with Early-Onset Alzheimer’s, and as that person, I find myself learning the art of losing every day. Losing my bearings, losing objects, losing sleep, but mostly losing memories . . . Everything I accumulated in life, everything I’ve worked so hard for—now all that is being ripped away. As you can imagine, or as you know, this is hell. And it gets worse. But for the time being, I’m still alive. I still have people I love dearly. I rail against myself for not being able to remember things—but I still have small moments in the day of pure happiness and joy.”

For those who object that Alice would not have been capable of such a speech in her condition, there are two points to keep in mind. First, it makes sense that Alice would be able to hold on to the capacity to write and deliver a talk even when other capabilities were greatly compromised. After all, she has been a student, a scholar, and a teacher her entire adult life. The neurological functions needed to write and deliver presentations to groups of people is far more firmly entrenched in her brain than it would be for many others afflicted by her condition and at her stage of the disease. Secondly, Sandy Oltz, the consultant who shares Alice’s condition, gave a speech to the Alzheimer’s Association when she was at a similar stage of the disease. Glatzer and Westmoreland (scriptwriters) even incorporated some of Oltz’s lines into Alice’s speech.

Indeed, unevenness in talents and capabilities is a hallmark of Alzheimer’s, and so to portray the uneven course of disease—Alice needs a highlighter to read the speech but is nevertheless capable of writing it—again testifies to the film’s accuracy. There are other instances that show the uneven progression of the Alzheimer’s. The scene where Alice forgets where she is while out on a run occurs during the phase of the movie devoted to Mild Cognitive Impairment/Early-Alzheimer’s, and yet this is a symptom whose severity makes it more appropriate to the second, moderate phase of the disease. Even in the severe phase, people have moments of clarity when they suddenly remember something or someone that they haven’t thought of in years.

It’s important to bear in mind that we impose phases on the disease based on how regularly groups of symptoms appear together and the levels of dysfunctionality that such symptoms invoke. But Alzheimer’s doesn’t progress in a straight line, and there are many steps forwards and backwards although the general progression is towards deterioration.

Inaccuracies in Still Alice

Still Alice is a drama, not a documentary, and it takes poetic license in small ways that compromise its accuracy. Here are some of the objections people raised about the film’s truthfulness:

• The first objection is the time scheme. Alice deteriorates way more quickly than is almost always the case with Alzheimer’s. Most Alzheimer’s patients decline slowly, and live with the disease for upwards of ten years or more. There actually is a form of Alzheimer’s disease known as “rapidly progressive Alzheimer’s disease” in which the deterioration is far more rapid than is usual with this disease. Those with the rapid onset version of Alzheimer’s tend to decline and die within four years or less after diagnosis. But Alice’s deterioration is extreme, even for the rapidly progressive form of the disease. While it’s possible that Alice might have been experiencing symptoms for a much longer time than we see, and compensating with her high intellect, her decline from the time of diagnosis to the end of the film is nevertheless remarkably swift, although never absolutely impossible. The writers want her disease to progress with the seasons, a nice touch even if medically unlikely.
• The neurologist’s explanation of why Alice is declining so rapidly is false. When John tells the neurologist that they are alarmed by the rapidity of her decline, the doctor explains that this is often seen in people with Early-Onset Alzheimer’s. And with people who have a high level of education, the progression can be even faster. There isn’t evidence to support this claim. In fact, medical researchers know very little about why some people contract the rapidly progressive version of the disease, and there is no consensus among those who work on this problem.
• Although Alice begins to look disheveled, she loses bladder control in one scene, and Moore does an excellent job of portraying changes in facial expression as Alice’s Alzheimer’s progresses, the film doesn’t show the full range of physical deterioration that can accompany Alzheimer’s.
• Some people have objected that the neurologist’s use of a PET scan to reveal that Alice has Alzheimer’s disease is unrealistic. But this isn’t true. As of 2012, the Food and Drug Administration approved using a molecular tracer during imaging to indicate the presence of amyloid plaques within the brain, a feature of Alzheimer’s. Because people who don’t have the disease can have such plaque buildup, these scans are used only in conjunction with other indicators of the disease to make a diagnosis. The neurologist is clear about this.

The inaccuracies in Still Alice are minor. Most people who have written about the film agree that it offers a true-to-life portrayal of Alzheimer’s disease.

A Real-Life Alice

Sandra Bem, a brilliant professor of psychology and gender studies at Cornell University, whose groundbreaking work has influenced generations of students and scholars, was also afflicted with Alzheimer’s disease. After her diagnosis, shortly before her 65th birthday in 2009, she kept a journal of the disease that resonates with Alice’s descriptions of what it’s like to have dementia, including the frustration of being all there one moment and unable to think or remember the next. One doctor encouraged Bem to try to keep this journal for as long as possible in order to let others know what the descent into the later stages of dementia felt like. But this wasn’t something Bem wanted to do. She decided to take her life before the disease had a chance to take her identity.

Bem still had much to live for before that time came. She became a grandmother and relished taking care of her grandson; actually, the fierce intellectual, pre-Alzheimer’s Bem, might not have gotten such joy out of this. Bem didn’t want to die, and she tried many treatments for Alzheimer’s, including experimental ones. But when, late in 2013, she could no longer play the simplest melodies on the piano, she decided it was time. Her deterioration was notable in other ways as well. She didn’t remember her relationship to her daughter, or know what to do when she was hungry. Her family and friends helped her to choose a date. On May 20, 2014, five years after she had been diagnosed with Alzheimer’s, Bem had a party, took a lethal cocktail of drugs afterwards, and died peacefully in her bed at home.

In the film, Alice makes the same decision as Bem, to take her life before the dementia robs her entirely of her identity. She makes a video for herself during the moderate stage of her disease, with instructions on how to kill herself when she has reached the point of deterioration when she can no longer answer basic questions about her life. When she gets to that stage, she finds the video, and she attempts to follow its instructions: to find a bottle of pills she had hidden in a dresser and take all of them with water. She goes upstairs to get the pills several times, but can’t remember what she started to do by the time she enters the room with the dresser. Finally, she takes the computer with her, gets the pills, goes to the bathroom to get water, and it looks like she will succeed. But Alice is interrupted by the arrival of her caregiver. We see her startling and dropping the pills.

Although we don’t see what happens next, we might infer that her plan was discovered, and that she was stopped from killing herself. Or maybe she dropped the pills and forgot why she was in the bathroom. We don’t know. Unlike Bem, Alice didn’t enlist accomplices in this attempt. She must have assumed that no one in her family would have been willing to help.

But this might not have been true. A few scenes later, when she and John are eating frozen yogurt at an eatery in their neighborhood, John asks her if she still wants to be here. She thinks he means where they are literally, in the shop, and she says she hasn’t finished her yogurt yet. It’s unlikely that John would have asked the question if he’d known about Alice’s interrupted suicide attempt. Perhaps the caregiver didn’t understand what was going on and simply cleaned up the pills. Perhaps she didn’t want to tell anyone what she had discovered. And perhaps no one interpreted her actions as a suicide attempt. We are left wondering what would have happened if Alice had been able to understand the question. That John even asks suggests that he might have been willing to help her take her life. After the failed attempt and this conversation, we know that Alice will live until the disease or some other medical condition causes her death.

Whether you think that Alice’s failure is a good or a bad thing depends on your attitude towards suicide; the film itself presents this episode matter-of-factly, with no clues as to whether we should feel sad or relieved. The writers wanted to follow Alice throughout her decline, and having her die before the story is over wasn’t an option. But it was courageous of them to bring this issue to their viewers’ attention. One of the writer/directors of the film has A.L.S., a degenerative disease which, like Alzheimer’s, doesn’t have a cure; Glazer passed away in 2015 at the age of 63. In the special feature section of the DVD, his partner and fellow scriptwriter/director Wash Westmoreland says that he became Glatzer’s primary caregiver. These parallels between fact and fiction weren’t lost on these men.

Alzheimer’s Disease and Caregivers

If you’re reading this article and others on the Kindly Care web site, it’s likely that you already know that caring for someone with Alzheimer’s disease or some other form of dementia (or any other serious illness, for that matter) can take a huge toll, interfering with work, family life, relaxation, and long-term goals. Reactions on the part of caregivers span a spectrum, from complete devotion to the loved one’s care to complete abandonment—letting someone else cope and disengaging from the situation. (I’m referring to morally responsible actions; responding with cruelty or abuse is a different issue.) Of course, very few of us end up at the extremes of the spectrum. But we do choose the extent to which we will allow our loved one’s condition to interfere with our own lives. Alice’s husband, John, and her youngest child, Lydia, represent alternative reactions, although neither belongs at the extreme end of this spectrum of options.

John chooses to go on with his life, delegating the care of Alice to others, although not entirely. When Alice tearfully tells him that she might have Alzheimer’s disease, he says: “Two things are true. We don’t have a diagnosis yet, and I’ll be here for you.” The diagnosis was made, yet John was “here” for Alice to a limited extent.

While she’s still in the Early-Stage/ Mild Cognitive Impairment phase of the dementia, Alice asks John if he would be willing to take a year off to be with her, since, as she says, “this might be the last year I’m myself.” He refuses, saying this is impossible financially. In addition, it would irrevocably damage his career as a medical researcher; he tells her that academia gives sabbaticals but the medical profession does not.

John again chooses to prioritize his career over Alice’s care when he decides to take a job heading a research team at the Mayo Clinic. He asks Alice to move with him to Rochester, MN, but she says that she would be leaving all that is familiar to her. She’s right to object; keeping dementia patients in familiar surroundings helps them to feel more comfortable. Alice is forgetting the places she knows already, as when she can’t find the bathroom at their beach house. So, to adjust to a new environment would be challenging and likely frightening. When it comes time for John to leave, Lydia returns home from California, where she pursued an acting career. As John prepares to leave, father and daughter tearfully embrace. “You’re a better man than I am,” John tells Lydia.

As this suggests, Lydia is closer to the other end of the spectrum, abandoning many aspects of her own life to care for mother. Lydia and Alice have always had a close relationship; indeed, Alice is closer to Lydia than to her other two children. The film makes this clear by showing scenes that show their intense emotional connection. We see Alice “interfering” in Lydia’s life by asking her to go back to college rather than devote herself wholeheartedly to acting; conversations on this topic take place both before and after the diagnosis. In the later scene (post-diagnosis), Lydia objects that Alice can’t use her situation, saying that she wants to see Lydia secure before she dies in order to get Lydia to do what she wants. Alice says, “Of course I can, I’m your mother.” In close relationships, there are indeed times when intimacy borders on intrusiveness.

The film emphasizes this intimacy by contrasting Alice’s relationship with Lydia with her relationship with her older daughter, Anna. Alice and her older daughter Anna keep in touch largely by playing “Words With Friends” (another nice touch: as Alice’s Alzheimer’s progresses, the words she makes become simpler). They love one another, but such love is expressed through a game that is cerebral and detached, one that reveals nothing personal about the player except the skill with which she plays the game. In contrast, Alice and Lydia tend to speak on Skype, which enables a much richer connection than is possible through any other electronic medium, including speaking on the phone or writing, because it lets people see one another’s facial expressions. We humans get as much information through such non-verbal channels (called social signals) as we do from what we actually say to one another. Anna lives in New York and Lydia in California, but in emotional terms, Lydia is the much closer daughter.

Caring for Alice involves a sacrifice that Lydia is willing to make and John is not. We might say that exceptional circumstances prompt John to delegate the bulk of Alice’s care to others and to leave her for long stretches as she faces her inevitable decline. The offer from the Mayo Clinic is a once in a lifetime opportunity, and to turn it down would be to truncate a brilliant career as well as the opportunity to engage in research that might benefit many other people. And Alice’s deterioration is so rapid that it’s clear that within the next few years, she won’t even know who he is. However, it’s not as though Lydia doesn’t make sacrifices in order to be with Alice. She recently acquired a new manager who is poised to jump-start her acting career. She puts that career on hold, knowing that such an opportunity was hard to come by and that it might not be available again. And one gets the feeling that Lydia would have come home whatever her circumstances. The situation faced by John, Lydia, and the other siblings captures the quandary that confronts all caregivers: how much of my life do I relinquish to care for my loved one?

While John and Lydia respond differently to Alice’s crisis, the film wisely does not blame John for deciding to take the Mayo Clinic’s offer, or even for deciding not to interrupt his career to be with his ailing wife. Some people can do less than others because they have fewer emotional and/or financial resources, but that doesn’t make them guilty or bad people. It isn’t wrong to invest resources that will have ongoing returns, such as in a career.

John is fortunate in being able to ensure that Alice’s world is minimally disrupted; in addition to Lydia’s care, the family is wealthy enough to hire abundant at-home help, not an option for many others. In this sense, you might say the film does not reflect the reality of most of its viewers who probably don’t live in wealthy neighborhoods in Manhattan or own beach houses. But even if John had put Alice in a nursing home, like the one she looks at earlier in the film, he wouldn’t have been wrong. Caring for an Alzheimer’s patient makes extraordinary demands on time and attention; it eventually means giving up everything else in one’s life. Few of us can make such complete sacrifices. And it’s questionable whether that is the right choice even if we can.

We all do the best we can do for our loved ones, and what we can offer is subject to our financial, situational, and emotional recourses. Still Alice is clear about this; John remains a sympathetic character. Although we might love Lydia for what she does, this doesn’t mean condemning John for his choices.

Conclusion: Some Literary Issues that Matter to Accuracy

Alice is a very unusual name, one which hasn’t been popular or common for generations. If it sounds old-fashioned and Victorian to you, that’s probably because the most famous Alice was a Victorian: Alice of Lewis Carroll’s novel, Alice in Wonderland. If you think it’s a stretch to suggest that the film is alluding to this particular Alice, look at Alice’s other unusual last name: Howland. Is it a coincidence that Howland has the word “land” in it, and the name of Carroll’s famous novel is Alice in Wonderland? No way!

When Carroll’s Alice falls down the rabbit hole into Wonderland (and notice that this is a fall, a decline, a common metaphor for deterioration), she finds herself in a strange land where the laws of physics and reality no longer apply. Magic potions make her grow larger and smaller, talking animals have tea parties, playing cards come to life, pigs turn into babies, and cats disappear, leaving only their smile behind them (real cats don’t even smile). The decline into Alzheimer’s—we use a metaphor of descent, like falling down a rabbit hole—also brings people to a strange new land. Things that used to be familiar are now alien. Activities that used to be automatic now take concentration. An excellent moment in the film shows Alice slowly and deliberately tying her shoelaces, having to concentrate on an activity that she would have done without thinking before the dementia.

The “how” of her name is also symbolic in this regard. Alzheimer’s de-familiarizes the familiar world, sending people to a strange land where they often have to “wonder,” to ask “how,” and indeed use all the question words much more frequently: How do I tie my shoelaces? Where is the bathroom? What day is it? Why is this happening to me? Who is this person who seems familiar but I don’t recognize? Who am I? Alice has indeed entered the land of “how,” a nightmare “wonderland” but one with no eventual return. Like the novel, the film is spot-on about this.

Another literary matter to do with accuracy concerns the ending. Although Still Alice portrays Alzheimer’s accurately for the most part, it is worth asking whether it sells out at the end to appeal to audiences. In the last scene, Lydia reads Alice a beautiful but cryptic passage from the play Angels in America, and Alice appears to be listening. When Lydia asks her what the passage is about, although she can barely speak, Alice manages to say the word “love,” which is indeed a valid interpretation.

Has Alice, against the odds, understood what Lydia has read? It would actually be impossible for Alice, at this point in her decline, to be capable of the sustained cognition needed to interpret a difficult literary passage. It’s much more believable that Alice says the word “love” in recognition that Lydia’s reading to her is an act of love. But if you think that Alice understands the passage, you can also think that she’ll still be Alice even as the disease reaches its endpoint. Nevertheless, at that juncture, Alice would no longer still be Alice in anything but body. Even if Alice were still in there, in that body and brain, she would be beyond the reach of the living or of her own self-consciousness. Because that’s what dementia does to people: It robs them of their identities. The film shows this throughout. So, does Still Alice contradict the essence of the film and compromise its accuracy with an inappropriately optimistic ending?

Not necessarily. The writers were clever enough to offer an ending that on the surface panders to what some viewers would want to see— a happy if unrealistic ending—while also preserving the integrity of the film. This is because there are other ways that that Alice will always still be Alice, even when the ravages of Alzheimer’s have completely robbed her of her identity.

This suggestion comes from within the film itself. Earlier, during the moderate phase of the disease, Alice tells Lydia that when she was a girl and discovered that butterflies live only a short time, she got very upset. Her mother said, “yeah, but they have a nice life.” Alice points out that this applies to her mother and sister, who died prematurely in a car accident, and to herself as well. Indeed, Alice had a spectacular life, and nothing can take that away from her. Alice can be robbed of her future, but not of her past. In that past, Alice is Still Alice.

But the film suggests in a more subtle way that Alice will always still be Alice, even when the ravages of Alzheimer’s have destroyed her brain. This claim hinges on the extract from Angels in America that Lydia reads to Alice, which I’ll quote a part of:
Souls were rising, from the earth far below, souls of the dead, of people who’d perished from famine, from war, from the plague, and they floated up like sky divers in reverse, limbs all akimbo, wheeling and spinning. And the souls of these departed, joined hands, clasped ankles and formed a web –a great net of souls. And the souls were three-atom oxygen molecules of the stuff of ozone, and the outer rim absorbed them, and was repaired. Nothing’s lost forever.

The passage is an allegory, a symbolic statement, about the value of life. It suggests that even if people die, their lives are not wasted because they continue to have a positive effect on those who are still among the living, just as if they are being taken up into the ozone layer where they repair the damage that has been done to it so that we can breathe more easily. The dead live on in the hearts and minds of those they loved and who loved them in in return. Alice will always still be still Alice to her husband and children. And the wealth of love she leaves to them will be passed along to others, even when her name and their names are no longer remembered. And so it is for all of us, and for the ones we love and care for.