Inside the O'Briens

Lisa Genova invented the genre of "neurofiction," which seems to be a mash-up of pedantry about neurologic diseases and kind of banal fiction. Maybe I would have enjoyed it more if I didn't know anything about Huntington. Since I almost certainly know more about Genova does about HD (in that I'm a board certified clinical geneticist and she's...not.) I just got a kind of run-of-the-mill family tension novel.

As part of my job, I get referral e-mails from our international medicine team, bulky with attachments of clinical charts from all around the world. Often this results in me reading them while pacing my office and swearing as the diagnosis dawns on me and I can't tell if the referring team has figured it out. That's how I felt for the first 90 pages of this book: a laundry list of textbook symptoms of HD that seemed to happen absent plot or character development. To the point where I could see it in my own e-mail shorthand in my head: "40s yo m w new onset invol mvmts and labile emotions, ?subacute duration up to 10y. Fhx notable for mother w poss same. High concern for HD, rec urgent appt w genetics for counseling & HTT repeat expansion analysis." Needless to say, I found those 90 pages stressful rather than enjoyable.

Once the HD cat was out of the bag, the novel swung to focus on Katie, the youngest daughter, stopping along the way to rack up treacly family scenes. Katie was supposed to be the audience self-insert character, but I found her paralysis and self-absorbed self-pity infuriating rather than sympathetic. After the HD textbook checklist had been marked off, it kind of felt like HD could be replaced with basically any family tension McGuffin and the book just felt really generic.

My other complaint was the portrayal of the genetic counselor. As the only authority figure appearing in the book, it really annoyed me that he was a man, while most GCs are female. It seemed to be done on purpose for sexual tension between the GC and Katie, which is just so inappropriate and gross.

Reviewing it, I think it sounds like I hated the book; I didn't, I just found it really bland. I also think this genre is important for encouraging more awareness of HD and genetic disease in general, but I didn't need it.

This is an emotional roller coaster of a novel. Joe O'Brien is an Irish Catholic cop living in Charlestown, MA. His problems start simply enough - he forgets where he put his gun one morning and then his temper flares as he blames his wife and kids for it. He trips and falls, bumps into people, and "fidgets" according to his wife Rosie. The problems become progressively worse and finally Rosie insists that Joe go to the doctor. It is there he learns he has Huntington's Disease (HD) - and he probably inherited it from his mother, who died in an institution. There is also a 50/50 chance that each of his four children also inherited HD from him.

"Inside the O'Briens" details how the O'Briens - Joe, Rosie, Patrick, JJ, Colleen, Meghan, and Katie - deal with HD, each in their own way. Patrick, the eldest child, is a bartender and the blacksheep of the family. JJ and his wife Colleen are expecting their first child. Meghan is a ballet dancer and Katie is a yoga instructor. The family has to deal not only with Joe's diagnosis and treatment, but also with the fact that his children are also at risk of developing HD.

Joe has always been strong and independent, supporting his family and protecting his community and now he can no longer do that. Because of the HD, people who don't know about his condition often think he has a drinking problem. He also feels immense guilt over the fact he has transmitted HD to at least two of his children.

Genova does a wonderful job making the characters come to life in this book. You quickly come to identify with them and care for them. I actually had to put the book down several times because I was about to cry. I can't remember the last time a book made me feel that way, especially a fiction one. Genova imparts information about HD little by little. You never feel overwhelmed by it and her style is never preachy. I think I know and understand more about HD now than I would had I read a textbook about it.

I won an ARC of this book through a giveaway with my group, "Life of a Book Addict."

Highly recommended.