Inside the O’Briens by Lisa Genova

Family dynamics after a diagnosis of Huntington’s disease, exquisitely portrayed with poignancy and tenderness.


In her fourth novel, Inside the O’Briens, Lisa Genova (Still Alice) introduces a traditional Irish Catholic family who have to cope with a neurological disease.

Over several years, Joe O’Brien, a proud, hardworking Boston cop, has been increasingly irritable and quick to anger, and has trouble concentrating on his paperwork. He starts stumbling and dropping things; there are murmurs of drink or drugs. When they finally see a doctor, the O’Briens learn about Huntington’s disease, an inherited neurodegenerative disease that over the course of 10 to 20 years will rob Joe of his ability to move, speak and eat on his own. It’s been causing his short temper and confusion. And there’s a 50-50 chance that each of his children has it.

Each of these young adults has a decision to make: they can be tested for the gene marker that predicts Huntington’s or they can live with uncertainty. The eldest has been trying to conceive; a baby would be at risk, too.

Sympathetic, absorbing, multifaceted characters compel the reader’s compassion. While Genova’s background in neuroscience allows her to portray medical issues accurately, the heart of the O’Briens’ story is human: how each member of the family copes with the news of Joe’s pending mortality; whether each child chooses to be tested; how knowing or not knowing guides how they live their lives. Their insular Irish Catholic community is likewise evoked with sensitivity and precision.

Poignant and painful, warm and redemptive, Inside the O’Briens displays Genova’s established strengths in bringing neuroscience to the lay reader, and portraying the power of love.

This review originally ran in the April 14, 2015 issue of Shelf Awareness for Readers. To subscribe, click here, and you’ll receive two issues per week of book reviews and other bookish fun!

Rating: 8 sippy cups.

4 Responses

  1. Some of the details sound exactly like those in her “Still Alice” — the adult kids may also have the gene, they each have to decide whether to get tested for it, they have to consider that they could pass it on to their own children…. Did the similarities bother you, or not, since they’re still valid issues within this story?

    • Great question. While all of Genova’s novels follow something like a pattern, these two – Still Alice and Inside the O’Briens – are the most alike in the ways you’ve stated. For me, the formula (dirty word!) works. And despite the similarities that you stated so well, there’s a lot of nuance that makes the stories very different. The families involved are so much what the books are about, and these two families are very different: the O’Briens are the first Genova-created family that is roundly working-class, for one thing. So you’re right about the similarities, but I thought it worked wonderfully well. If you’re a Genova fan, I venture this one continues to interest. Does that answer it?

      • Yes, that answers! I think I would like the working class part, but if there’s much emphasis on the Catholicism, that might trip me up a little. BTW, did you see the “Still Alice” movie? I heard it was pretty good but have not seen it.

  2. Haven’t seen the movie. I’m torn. It was supposed to be excellent, but I love the book, and we know where that gets us.

    I am no good with religion, either, but it’s a plot device only and worked fine for me in this usage. I think it’s safe!

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