Wednesday 28 September 2016

Books: The heart follows the head through a genetic gamble

Inside the O'Briens, Lisa Genova, Simon & Schuster, €16.99

Sarah Caden

Published 06/04/2015 | 02:30

Julianne Moore in Still Alice
Julianne Moore in Still Alice
Lisa Genova
Inside the O'Briens cover

When she began writing in the mid-Noughties, American neuroscientist Lisa Genova took to heart the advice that you should write about what you know. She knows about the brain, and it has been her subject, over four novels to date, her latest being Inside the O'Briens.

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Genova self-published her first novel, Still Alice, which was concerned with early-onset Alzheimer's, as no one else was convinced that writing about what she knew could engage readers. Alzheimer's is not sexy, and it's not scary in a best-selling horror novel way, either, and she couldn't find a market for Still Alice. Until it became a word-of-mouth best-seller, that is.

Since then, Still Alice has sold more than two million copies worldwide and, in 2015, became the film that won Julianne Moore her first Oscar. And, since then, Genova has had a publisher and scored best-sellers with Left Neglected, about a woman with a brain injury, and Love Anthony, which tells of a non-verbal boy with autism.

Genova's latest, Inside the O'Briens is about a working-class Boston family of Irish extraction, and the effect that the father's diagnosis with Huntington's Disease (HD) has on all of them.

Huntington's is a hereditary neurological disorder, caused by an altered gene that can be passed from one generation to the next. Typically, it affects people aged between 30 and 45, causing degenerative physical and cognitive impairment, for which there is no cure and leads to death within 10 to 15 years. If a person has the mutated gene, there is a 50/50 chance that their children will then also have the gene and develop Huntington's.

Joe O'Brien, a Boston cop, doesn't know that the gene is in his family until he is diagnosed with HD at the age of 43. Growing up in Charlestown, traditionally a poor and old-school Irish Catholic neighbourhood, his mother had been labelled a messy drunk, who drank herself to death at a young age.

When Joe gets his diagnosis, which he is driven to seek when colleagues and family begin to suspect he's drinking or on drugs, he learns that his mother had HD and, further, that his kids might have it, too.

The story unfolds as we follow Joe through his deterioration, and we also closely follow Katie, his 21-year-old daughter, as she decides whether or not to get tested for the gene.

Ninety pc of people at risk of having the HD gene do not get tested, choosing to live without the knowledge altering their existence, Genova tells us, in one of the information bulletins that pepper the book, and serve a purpose, even if they take us away from the story to some extent.

Huntington's is lesser known than, say, Alzheimer's, and Genova has chosen to step outside the narrative to explain some facts, as to weave them in to the narrative might have been more clunky. And she is a writer with a very light touch, who manages to explore a very dark, discomfitting disease with great heart.

The O'Brien family dynamic and their Boston district, which seems very familiar to an Irish reader, are well drawn and appealing, while the illness that overshadows them is anything but.

What is slightly awkward, however, is that 43-year-old Joe is a father of four grown-up children, one of whom is married and trying for a baby as the story begins.

The Huntington's plot makes this a narrative necessity. Joe's kids need to be adults in order to make adult decisions about whether or not to be tested and the prospect of a grandchild lends greater emotional impact to the hereditary nature of HD.

So, Genova makes Joe and his wife Rosie childhood sweethearts who had their first child straight out of high school, but there are times when all the characters read as of an age, rather than parents and children.

Following the film success of Still Alice, it's hard not to notice that Inside the O'Briens is ideal for adaptation to a movie. It has an episodic nature, as Genova flashes forward several months from chapter to chapter, allowing Joe's disease to progress noticeably between each. Also, the Boston setting is a tried and tested fit for films, having provided the backdrop to Mystic River and The Town.

Genova has made an art of what she knows about brain science, fashioning the science into stories that are full of universal truths about the human desire to be cherished and cared for in our most vulnerable moments.

The living grief that comes with HD is very powerfully portrayed in Inside the O'Briens, and it's a moving read.

Lisa Genova has turned her knowledge of the head into another novel full of heart, the likes of which never go out of fashion.

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