Of all the trite writing adages tossed around, perhaps one of the most often repeated is to “write what you know.” Whether budding authors heed that advice with eager ears or scoff and promptly ignore it, Lisa Genova’s writing career may indicate its truth. After studying a P.h.D. in neuroscience at Harvard University and working as a healthcare industry consultant, she became … a novelist? Since Simon & Schuster snapped up rights to her debut, Genova has gained popularity for her probing insight into neurological diseases and their effects.

Inside the O’Briens

Lisa Genova
Simon & Schuster
April 7, 2015


In her latest novel, “Inside the O’Briens,” Boston police officer Joe O’Brien discovers he has the genetic defect that causes Huntington’s disease. Though initially oblivious to the disease’s existence, Joe’s involuntary spasms and growing inability to control nervous-system functions teach him exactly what the degeneration of nerve cells wrought by this neurological disease entails. More painfully for him, he also learns how it hurts his family in terms of potential inheritance and the burden of caring for a terminally ill parent. Even though it sounds morbid, the family’s resilience makes this a story about living, not dying.

For those who have read Genova’s previous bestselling novel-turned-film, “Still Alice,” many of the themes in this story will seem familiar. A character initially diagnosed with the eventually fatal disease struggles to define his/her identity, especially once the symptoms escalate to the point where he/she cannot do their jobs anymore. And yet, “Inside the O’Briens” seems to expand on concepts that didn’t get much focus in her other work. At first, it comes off as repetitive. Where “Still Alice” settled its narrative focus on Alice herself, “Inside the O’Briens” gathers the entire family into the folds.

The story centers on Joe at first, but then breaks into parts that delve into his children and how they live their own lives. The children must decide whether to take a test to see if they have Huntington’s, too. The test itself is a simple blood draw, but its implications span much broader psychological effects. Once you know, what happens next? The solution requires individual courage and decision-making, but also taps into a complex interplay of personal relationships — how to proceed living and loving others knowing that you’ll contract a disease with no cure, how to support other family members dealing with their gene statuses regardless of your own. While Genova’s previous work touched upon the psychological aspect of chronic illness, only in “O’Briens” did she really illuminate what is a deeply important and engaging issue.

However, the dialect-infused narration sometimes verges on grating. Though told in the third person, Genova tries to emulate Joe’s Irish-Catholic police officer colloquialisms in more than just his dialogue by peppering words like “ain’t” and “friggen” into narration. Though this brings the reader closer to him as a character and allows for more intimate access to how his beliefs and goals evolve during and after his diagnosis, the execution often feels unnatural. Fortunately, the latter parts of the book bring marked improvements in this area, though the narrative distractions from the rest of the storyline don’t disappear entirely.

Still, the novel as a whole takes us beyond the book club. What Genova does best in all of her work is gracefully weaving scientific and psychological knowledge into her storylines. The readers learn facts about how Huntington’s is inherited and the symptoms it causes as they are unveiled to the characters themselves. It’s an organic means of advocacy. She probes deep into characters we can imagine meeting on the street, peeling back the layers and recasting acquaintances into people who we care about. We care about their feelings, we care about their fate and readers who may have never even heard of the disease before now care about Huntington’s.

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