Inside the O'Briens

“You are either Now Here or Nowhere.”

― Lisa Genova, Inside the O'Briens

First & foremost, this book is a phenomenal read and I had a hard time putting the book down once I opened it! This story is about Huntington's disease, and was told through the life of the O,Brien family, which made it so much more realistic. It was so interesting to learn about the disease but also see how the family copes with this disease. It was very eye opening to see that the person with the disease is not the only one affected, but also everyone in that person's life. Huntington's disease (HD) is a horrible neurodegenerative disease characterized by a progressive loss of voluntary motor control and an increase in involuntary movements. There is no cure and, in other words, if you test gene positive there is no way out.

The main character Joe O'Brien is a loving father and husband living right outside of Boston in a neighborhood called Charlestown where he works as a police officer. Joe begins having a change in behavior, such as outburst of anger, memory impairment, and weird movements, that were noticeable by his wife and coworkers. These types of behavior are relatable to the non-clinical stage of HD called "prodrome" which may appear fifteen years before motor problems appear. After several doctor visits, he receives terrible news that he carries the gene for HD and his kids have a 50/50 chance of carrying it as well. Joe is married to Rosie and together they have four adult children. Two of the four children decided to get tested as well and turns out that they are also carrying this gene.

This book gives perspectives from numerous viewpoints, whether it's being diagnosed with the disease, fear of testing positive for the disease, learning how to cope with this disease, living with someone with the disease, or simply what it is like being a friend of someone who carries the gene. My favorite quote from the book relating to this is, “As they lurch down the hallway and finally make it to the kitchen, it occurs to Joe that this is the best anyone can hope for in life. Someone you love to stagger through the hard times with.” Joe came home to find Rosie hysterical after everything that she has been through, but Joe encourages her that even though things may be different, everything is going to be okay, and they will get through it together. Although this family is experiencing one bad thing after another, they show how to keep living life to the fullest. Although I am still very upset with the ending, this book did an amazing job on showing what Huntington's disease looks like & I highly recommend this book!


Genova, L. (2015). Inside the O'Briens. New York City, NY: Gallery Books.

Joe O'Brien

DOB: unknown

Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	Huntington’s disease (HD) is an inherited neurodegenerative disease characterized by a progressive loss of voluntary motor control and an increase in involuntary movements. Initial physical symptoms may include a loss of balance, reduced dexterity, falling, chorea, slurred speech, and difficulty swallowing
Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	-Husband, dad, grandfather, brother, police officer, community member of Charlestown, dog owner, baseball fan -A few symptoms that Joe showed throughout the book include depression, difficulty focusing/prioritizing, involuntary movements, and impaired balance. These were all symptoms that Joe was experiencing slowly over time. He mood could instantly change, he fell early on in the book hurting his knee, he began to have trouble writing police reports because he was not able to focus or remember, he was unable to hold his grandchild because of his chorea, he had thoughts of killing himself due to depression, and was not able to keep his job because it was not safe for him to drive nor be around a gun
Personal interests and values (p. S7)	-Being a strong and loving father & husband, cheering on the Boston Red Sox, protecting his community, having Sunday dinner with his family, spending time with his best buddies, Tommy and Donny
The client’s occupational history/life experiences	-Client experiences knee problems due to falling, his mother died from HD -Client lives in 3 story home with wife, children, and dog, Yaz -Work duties include driving police car to monitor safety around town, type police reports, and work security at big events going on in the community -Home duties include walking the dog, repair/replace items in home, provide for family
Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)	-Roles: husband, father, grandfather, coworker, police officer, friend, community member -Routine: wake up, go to work, drive around to monitor community, respond to calls, type reports, go home, eat supper, spend time with family -Client has temper outbursts towards his children and wife, Rosie. His chorea has caused him trouble with sitting still and he has broken several glasses at the dinner table. He has a hard time writing his police reports due to memory, and many complaints are filed assuming he is on drugs due to chorea. -Habits: walking dog, eating dinner with family, drinking beer and watching tv -Client has balance issues so walking his dog might cause him to fall
Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
Physical	-Client lives on first story of home -Walking his dog is good exercise -Katie introduces him to Yoga	-Street can be crowded so client may have to park a good distance from home  -Chorea may cause him to fall walking dog -Driving police car could be dangerous
Social	-Client has loving and supportive family -Friends to watch out for him and protect him	-Dinner table too small for the whole family -He passed down HD to his kids and it is difficult to stay strong for them
Cultural	-Client has always been known as backbone of family -Tough mindset of policeman	-HD caused him to quit his job so he is no longer to provide for his family -Client is embarrassed of involuntary movements and does not want to be considered an alcoholic like his mother
Personal	-Male, 44 y/o, father, husband, police officer	-Client is afraid of dying after watching his mother suffer in the hospital
Temporal	-Client symptoms HD are slowly progressing, but he still has time to spend with his family and friends	-Client’s children have 50/50 chance of getting HD, but symptoms shouldn’t show until around 35 y/o
Virtual	-Client has cell phone to contact wife & children when needed	-n/a
Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)	-Learn the best way to cope and help his family cope with this disease -Be strong for his family -Learn how to better manage his symptoms