The Flickering Light

Still Alice
This review contains plot spoilers (in order to examine
some Exit-related issues in detail). Some readers may
choose to see the movie before reading the review.
However, if your main interest is the Exit-related issues,
knowing them in advance will hopefully not spoil your
enjoyment of the movie. Still Alice may still be in some
cinemas now, or the DVD is scheduled for release in July
2015 (UK) and May (USA). The book by the same name
(author: Lisa Genova) is available in paperback and
kindle editions from bookshops and online.

How do you plan to cope if you get Alzheimers?

There is a heart-warming TED talk by Alanna Shaikh
called, How Im preparing to get Alzheimers. Having
watched her fa ther prog ress into late-stage
Alzheimers and knowing that, in spite of anything
you do, it may run in families, she hopes never to get
Alzheimers. She is, however, trying to be prepared if
the worst happens. Her plan has three elements:
Im changing what I do for fun;
Im working to build my physical strength; and
(This is the hard one!) Im trying to become a
better person.

She explains that it does get harder to enjoy yourself,

yet the sort of activities that are easier are ones that are
familiar: hands on, and open-ended. (Ask yourself,
what would my carers find to do to have fun with
me?) Physical activity is associated with a lower risk of
cognitive decline. Yet she explains that her fathers
habits of being loving to all his family still shine
through at his advanced stage of dementia and make

the family want to be around him. It is a skill she feels

she has never excelled at. Now she says, I need a
heart so pure, that if its stripped bare by dementia it
will survive.
What is the movie about?
Still Alice is a powerful, positive and breathtakingly
beautiful film that won Julianne Moore an Oscar for
Best Actress this year. Remarkably well-researched
and skilfully performed in its examination of Alzheimers (a type of dementia), it demonstrates how an
ordinary intelligent person tries to change her outlook
swiftly and as effectively as possible without much
warning, rather like Alanna Shaikh is doing with foresight. It also shows the obstacles that her caring family struggle to deal with. Some of Alices challenges
may be of particular interest to many Exit members.
It a film both full of sadness and also a certain underlying joy (even fun, as the
script is full of wit, some lines provided by experimental psychologist Stephen Pinker). Cancer and stroke
have lost much of their taboo, but knowledge of
Alzheimers is still largely hidden from day-to-day
awareness. Writing in the British Medical Journal,
consultant psychiatrist in dementia Kallur Suresh
describes the film as technically flawless and goes
on to say, Watching the film made me relive the
human cost of such a devastating illness. For professionals dealing with such a cruel disease on a regular
basis, it is easy to become somewhat detached from
the human and experiential side of it, and hide behind
our role as doctors focussed on the technical side of
diagnosis and treatment. It is also perhaps one of our
coping mechanisms, helping us maintain a sense of

Stewart & Moore play semi-estranged daughter and mother whose respective skills bring them together as
Alices Alzheimers disease progresses.
AP Photo credit: Sony Pictures Classics, Linda Kallerus.

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At a period when she is fairly lucid, she records a

video for her future self, explaining who she is and
what to do. For some time, Alice has devised games
for herself where she tests her own memory to assess
the rate of her decline. At a point where she cannot
answer simple questions, such as her daughters
names, she is directed to a folder on her computer
containing the video. We watch the recording of the
video being played back with Alice watching attentively trying to follow the instructions. Her former
self speaks from the computer screen with clear
instructions:

Alice goes jogging through familiar streets suddenly to

discover one day that she has no idea where she is.

objectivity and control in the face of our helplessness

in treating the disease and its inevitable progression.
Mo o r e p lay s A l i ce
Howling, professor of linguistics who is struck down
with early-onset Alzheimers. She makes considerable
plans for her own increasing incapacity, from keeping
fit and eating good food to daily memory exercises.
She even devises a sophisticated plan to enable her
own self-euthanasia when her faculties have reached a
stage where she cannot answer simple questions, such
as her daughters first name. A deeper examination of
the films subject also prompts questions about values
the sort of values that could for instance be included
in an advance statement and also how to be the sort
of person that one would wish to be in the middle
stages. The films title hints at the philosophical
question of identity.
What about self-deliverance?
How does Al ice hope to com plete her own
self-deliverance at a time when her illness is fairly
advanced? This is a common dilemma, and some
people with dementia tragically decide to die earlier
than they ideally would want to, simply to ensure they
do so at a time when they have the capacity not to
make mistakes. Alices strategy, as we will see, is
ingenious but not foolproof.
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Hi, Alice. Im you. And I have something

very important to say to you. Huh... I
guess youve reached that point when
you cant answer any of your questions.
So this is the next logical step. Im sure
of it. Because whats happened to you,
the Alzheimers, you could see it as
tragic. But your life has been anything
but tragic. You have had a remarkable
career, and a great marriage, and three
beautiful children. All right. Listen to me.
This is important. Make sure that you are
alone and go to the bedroom. In your
bedroom, theres a dresser with a blue
lamp. Open the top drawer. In the back of
the drawer, theres a bottle with pills in it.
It says take all pills with water. Now,
there are a lot of pills in that bottle, but
its very important that you swallow them
all, okay? And then, lie down and go to
sleep. And dont tell anyone what youre
doing, okay?
Alice goes upstairs to the bedroom and sees the
dresser but cant remember what comes next. She
goes back downstairs and replays the instructions,
then climbing the stairs repeating to herself, blue
lamp. She opens the dresser drawer, taking out the
first thing she finds which is a bracelet, and as she
handles it realizes that she has forgotten what she was
to do next. Watching the video for the third time, she
carries the laptop with her upstairs, listening to the
instructions on the video as she does so, and finds the
pills. Quickly she goes to the bathroom and pours
herself a full cup of water then empties the pills into
her hand to swallow them. The audience is on the
edge of their seats hoping that at last she will succeed:
yet at that moment someone, maybe her daughter,
opens the front door downstairs, calling, Hello!
and startling Alice so that she drops her pills.
There are at least two
further (Exit-related) issues we might wish to
consider when watching this movie. How might we

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relate to someone close to us who is dying through

dementia? Another is how we ourselves might want
to prepare and, over and above any medical or
rationally suicidal issues, how we might want to be.
There are persons in the movement who say, I hope
someone gives me a pill if I get to that stage, and
equally persons who say, If there is someone that is
happy to look after me and I dont appear to be in
great distress, then I would be happy to continue.
Neither of these future states are quite the way they
sound when expressed like that. No-one is likely to
give you a pill. In spite of books talking about such
a pill, no peaceful single pill1 exists, and you might
question how reasonable it is to ask someone else to
break the law for you (moral blackmail).

further worry is the daughter who is undergoing IVF:

will her baby be affected?

What about living wills? They are not featured in

the film but optimism over them is to a large extent
ill-founded. If you are a citizen of a European country
that permits euthanasia, you may be able to use
advancing dementia to request it. Alice lived in no
such advanced society (at the time of going to press,
no such provision had been accepted in those few
states that allow physician-assisted suicide). Secondly,
advance directives are contingent on refusal of treatment. (Mere refusal of treatment does not bring about
death in Alz hei mers. Only if you develop an
underlying physical condition which, if left untreated,
will cause death, then can a dementia clause in your
Living Will have the effect that the underlying disease
will be allowed to take its course. What about
Dignitas? Dignitas has helped people with dementia
but it is not an on-demand service and you still need
to use it while able to express your competent
decision. Alices disease progressed too quickly for
that. If you are considering such an approach you
should make plans, both financial
and through membership, as far in
advance as possible.

Communicating in the moment

Lydia is sufficiently sure of herself to resist the loving
coercion. When she looks at her mother, she looks at
the person before her, not whether she has a great
intellect or not. Their differences about life paths and
career have been a constant source of friction
between them before the disease, with Alice wanting
Lydia to go to college. But with that in the past they
learn to communicate in a different way, through an
awareness of the moment that is being shared (a
practice of ten con nected with mind ful ness
meditation, briefly covered in the Epilogue of Five
Last Acts The Exit Path). At the end of the film,
Lydia reads her barely articulate mother a section
from a lyrical screenplay, deep in beautiful symbolism.2 Afterwards she looks up at her mother and asks,
Do you know what it means? Alice struggles to get
the words out, but eventually manages to force her
body (now almost paralyzed by the disease) to say,
Love. It is about love. Somehow she has cut to the
core of the screenplay that it takes the
audience still a few more seconds to
understand.

Moral blackmail is addressed in the film when the

well-meaning, rapidly declining Alice uses her illness
as an excuse to pressure her youngest daughter,
Lydia, to go to college. All the members of the family
are high achievers whereas Lydia has followed her
dream as part of a small theatre company. Of all the
family, Lydia is most in touch with her emotions.
When Alices disease has reached the stage where she
doesnt recall being a famous professor, and the
intellectual conversations of the loving family are
becoming meaningless, it is Lydia who will be able to
reach out and speak to the person that Alice becomes.

How will others react? In the

movie, we see Alices loving family
initially react with all the classic
signs asso ci ated with be reavement, in cluding disbe lief and
anger. Reacting to Alzheimers in a
loved one is a steep learning curve.
Learning about the disease is a
good start and, given the high
incidence, one worth embarking
on before someone you know
know is affected. (The novel of the
same name which inspired the film
is recommended by care associations to both those affected and to
their carers. It was written by a
neu rol o gist, Lisa Genova.) A

For FactSheets on Alzheimers, you may

wish to visit http://www.alzheimers.org.uk/
Still Alice trailer:
http://sonyclassics.com/stillalice/
For the TED talk go to:
https://youtu.be/J8FyHI00ELY

Notes
1. The eponymous book of that name refers only
to the search for a peaceful pill.
2. The monologue spoken by Lydia in te film is
from the award-winning TV-movie, Angels in
America and often called Harpers Monologue.

Above: Lydia, who has developed her emotional skills through her humble job
in amateur theatre, is the only one able to communicate with Alice when the
Alzheimers reaches an advanced stage.

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