Counting Backwards

by Binnie Kirshenbaum

A married couple deals with the husband’s decline from Lewy body dementia in a profound and deeply moving novel shot through with Kirshenbaum's lacerating humor.

It begins with of a man on stilts, an acting troupe, Ghandi. At first, these seem benign, almost comical, and are likely connected with an ocular issue. It’s something he and his wife can make jokes about. But soon he starts to experience other cognitive symptoms, memory problems, disorientation. He’s a scientist, an auto-immune researcher, and still middle aged. Too young for Alzheimers. She is a moderately successful college artist. They live together with a cat — a pleasant, quiet New York City marriage. Then he receives the diagnosis of Lewy Body Disease, and its march of aphasia, difficulty with simple tasks, losses of lucidity. 

He has a life expectancy of 3 to 8 years. There are moves as his care becomes more difficult, or he lapses into periodic and uncharacteristic acts of from Leo and his wife’s apartment, to his sister’s house, then an assisted living, then another assisted living, then hospice. Health aides, a continual outflow of money. His wife does what she can, but is able to do so much less than she wants. Watching him die — too fast, and yet not fast enough. 

Kirshenbaum captures the couple’s final years and months together in short scenes that burn with anger, humor, love, and pain. With no sentimentalizing whatsoever, she tracks the brutal destruction of the disease, as well as the small moments of beauty and happiness that still exist for them amidst the larger tides of loss.

Genres: Fiction, Audiobook, Literary Fiction, Contemporary, Adult Fiction, Medicine

393 pages, Kindle Edition

First published March 25, 2025

About the author

Binnie Kirshenbaum is the author of two short story collections, six novels, and numerous essays and reviews. Her work is noted for its humorous and ribald prose, which often disguises themes of human loneliness and the yearning for connection. Her heroines are usually urban, very smart, and chastened by lifetimes of unwelcome surprises. Kirshenbaum has been published in German, French, Hebrew, Turkish, and several other languages.

Kirshenbaum grew up in New York and attended Columbia University and Brooklyn College. She is the chair of the Writing Division of the Columbia University Graduate School of the Arts, where she has served as a professor of fiction for more than a decade.

Called, “a humorist, even a comedian, a sort of stand-up tragic,” by Richard Howard, Kirshenbaum has twice won Critics’ Choice Awards and was selected as one of the Best Young American Novelists by Granta Magazine. Kirshenbaum was also a nominee for The National Jewish Book Award for her novel Hester Among the Ruins. Her new novel, The Scenic Route, was published in May, 2009. Of the novel, Gary Steyngart says, “The Scenic Route is warm, wise, and very difficult to put down."

Binnie Kirshenbaum lives and works in New York City.

Binnie Kirshenbaum was born in Yonkers and grew up in Westchester County. After attending Columbia University as an undergraduate, Kirshenbaum earned her MFA at Brooklyn College. She taught at Wagner College before joining the faculty at the Writing Division of Columbia University's School of the Arts.

Reviews

[jocelyn • coolgalreading · Rating 5 out of 5]

oof. this was a painful read especially bc it reminded me so much of my dad when he was diagnosed w brain cancer. beautiful and harrowing all at once

[Carol · Rating 4 out of 5]

Addie and Leo are a middle-aged couple living in New York when Leo develops hallucinations which ultimately are diagnosed as Lewy body dementia. Addie, the narrator, struggles with the reality of caring for someone she loves as Leo slowly disappears to the point where he has to be fed, clothed, and bedridden.

This was an intimate portrayal of grief that begins even before death. The novel explores the hardships of caregiving, the strain on their relationship and decisions about prolonging life. Addie even wrestles with her decision of whether or not to take her husband off life support even as she wishes him to die.

It was a believable, unflinching and emotionally compelling novel.

[Phyllis · Rating 5 out of 5]

Heartbreakingly honest story of a woman, Addie, living through the years of watching her brilliant loving scientist husband, Leo, slide into Lewy body dementia at just 54 years old and through to his death.

I had never heard of this author before, but it turns out she has been writing since the 1990s. I really like her way with characters and voice, and I am looking forward to trying some of her other works.

[Keiko · Rating 4 out of 5]

Counting Backwards by Binnie Kirshenbaum is a deeply affecting novel that explores the devastating effects of Lewy body disease on both the individual suffering from it and their loved ones. The story follows Leo, a scientist who begins experiencing hallucinations and cognitive lapses that gradually worsen. His wife, Addie, an artist, struggles to navigate the emotional and logistical challenges of his decline. Told in fragmented, sharply observed vignettes with a unique second-person narration, the novel captures the heartbreaking deterioration of their relationship, the frustration of unanswered medical questions, and the moral complexities of caregiving.

The use of second-person narration is a bold choice that adds to the novel’s immersive quality, placing the reader directly into the unfolding tragedy. The structure—brief glimpses into specific moments—mirrors Leo’s disjointed reality, reinforcing the impact of his neurological disease. The author does an exceptional job of portraying Leo’s decline, starting with subtle hallucinations and progressing to more severe symptoms like memory loss and auditory delusions. The pacing of his deterioration feels natural, making his condition’s worsening all the more poignant.

However, there are a few inconsistencies that stand out, which could be due to this being an advanced copy. The timeline is somewhat confusing; at one point, Addie references an eye doctor Leo has had since 1923, suggesting an earlier time period, but a later mention of a cell phone contradicts this. Similarly, there’s a discrepancy regarding Addie and Leo’s relationship—one passage states they’ve been together for 24 years, while another suggests they’ve been married for less than a year. These minor inconsistencies may be polished before publication, but they momentarily pulled me out of the narrative.

Addie’s journey is just as emotionally raw as Leo’s, though her character arc is at times difficult to sympathize with. Her growing resentment and exhaustion are understandable—caring for a loved one with dementia is an immense burden—but her emotional detachment feels abrupt. While it’s clear she struggles with guilt, her eagerness to move Leo into a facility and then a separate apartment, without fully exploring more measured options, raises questions. Her jealousy toward Larissa, Leo’s caretaker, also seems contradictory—she doesn’t want to be responsible for Leo’s day-to-day needs, yet she resents Larissa’s role in providing that care. These complexities make Addie a well-developed but sometimes frustrating character, which may be the novel’s intent.

Overall, Counting Backwards is a raw and unflinching portrayal of love, loss, and the emotional toll of degenerative illness. It’s not an easy read, but it’s deeply thought-provoking, offering a realistic, if at times painful, look at the experience of watching a loved one disappear before your eyes. Fans of literary fiction that tackles difficult themes with sharp prose and emotional depth will find much to appreciate here.

Thanks to Soho Press for the advance edition, received through a Goodreads giveaway!

[Tina · Rating 4 out of 5]

I watched a family member suffer from lewy body dementia. This book is raw and realistic in the depiction of the disease. It was not an easy book to read, but it was relatable.

[Christine Timmo · Rating 4 out of 5]

What a heartbreaking book. I knew this would be a difficult read, but I figured that that would be because of Leo's decline - and while that's part of it, most of it was because of Addison's reaction. I was grateful for the way the book is structured out of short vignettes, which provide a bit of a breather and make everything easier to take.

[Claire Curtis · Rating 3 out of 5]

Maybe a 4?
I read it quickly and I was engaged: woman narrating her husband’s decline from Lewy body dementia.
However, I had concerns. First off, this woman’s friends are so terrible, I just don’t know what to say. There is a difference with a friend struggling over how to react and a friend saying what the character Z does here. Second, the caretaker is lovely. Like out of a utopian novel lovely. And finally, the wife? Maybe I just don’t like cats, but this woman needs to get a grip and look her life head on. And her art seemed too ditzy. But I get that is rude of me to say. So imagine I did not include that. Maybe a 2?

[Brad Angle · Rating 3 out of 5]

A strange way to talk about dealing with a spouse's dementia. The details of watching the husband fall prey to the stages of the disease were very real and interesting. However the wife's reaction to it all was surprising. Little to no grief was shown. She just kind of checks out and does a lot of whining about how it affects her life, without letting the reader feel the sadness and loss. She also makes a lot of odd decisions - wasting money was killing me - and she seems to get by for years with almost no contact with any friends or family. Yet she can't be bothered to spend more than a few minutes with her spouse. Odd, yet still an interesting book.

[Peacejanz · Rating 1 out of 5]

Save your time and money. I read a couple of reviews that praised this book - a woman's diary/feelings as her husband goes more and more into Alzheimers or Lewy Body Disease. I learned nothing new - yes, these diminished brain diseases are difficult to diagnose and there is no medication that seems to help, yes - it is exhausting for the caregiver and family who really care about the person who is fading and diminishing before our eyes.
I felt that the focal person, the decision maker, the speaker was not very patient or understanding. She would bring her husband's favorite candy and not pay attention to what he was interested in at the moment. The book demonstrated a lot of attitudes that are negative. She was always so tired after being with him --- so what?? All of us are tired after being with a loved one after any health problem. AD is just like many other diseases, especially terminal ones; they are tiring for all parties involved. The medical community does not always give careful information. Problems seem to abound and never ease up.
I kept reading thinking there would be some light at the end of a long dreadful tunnel - there is not. I read the entire book, including the ending where the focal person (the wife) gives up and leaves the paid attendant to stay with the patient
This book is not worth reading if you have any experience with people who have AD or something similar. There is nothing new here - we have lived it, read it all before. Skip the book.

[Melissa Dunlap · Rating 4 out of 5]

Not an easy read emotionally - how a debilitating illness in a partner impacts a marriage. I found the story telling excellent - short narrative snapshots of moments giving a glimpse of the larger whole.

[Christie · Rating 5 out of 5]

4.5 stars: In Manhattan, the narrator’s husband descends into Lewy Body dementia, an affliction I am somewhat familiar with because my FIL had it. The thing about LBD that Kirshinbaum gets exactly right is the day-to-day variability: one day fine, the next “who is that little girl standing on the table?” And eventually, trying to eat napkins with a knife and fork. She has an amazing eye for detail, and the emotion shines through the trenchancy.

A half marked off for a section about the narrator’s struggling career as a professional collage artist desperate to fund her husband’s care which was not very interesting (possibly because collage art is not very, but possibly because in the middle stages of the disease life go this way). Otherwise narrator is funny and moving by crabwise steps.

[Larry K · Rating 5 out of 5]

There may be no medium as self-conscious or self-absorbed as writing. Every book is about writing, something I’ve come to take for granted so much that I don’t notice it. Until a book like Binnie Kirshenbaum’s Counting Backwards comes along and shows what can happen when a skilled writer puts her craft to work for a purpose other than demonstrating what a good writer she is. Counting Backwards achieves the emotional intensity and connectedness of theater while still drawing on the unique powers of literature to create vast interior landscapes. The identification achieved by this novel had me feeling the protagonist’s discomfort, impatience, guilt, and love, before she articulated them herself. I sometimes thought I was feeling her emotions with her in real time, a trick of the mind I’m sure.

It would have been easy for Ms. Kirshenbaum to tell the story of early onset dementia (specifically, Lewy body disease) and its inescapable trajectory and destination, wrapped in sentimental, “life affirming” tropes. She doesn’t. She gives the reader an honest experience of life as lived through an honest, imperfect protagonist, who can say she is alive and not need to put a bow on it.

This wonderful book may be too subtle, too self-effacing, for its own good. Ms. Kirshenbaum doesn’t draw attention to the skill that makes her novel work, so the reader may feel the emotional knots without realizing how difficult they are to tie. And I suspect Ms. Kirshenbaum would say that’s just fine, that she didn’t write the novel to show off her knot tying ability or anything else.

I hesitate to add this, but for point of view nerds (I count myself among you) this novel offers a rare second person narrator and protagonist, demonstrating what this difficult point of view can accomplish, bring the reader uncomfortably close to the narrator, feeling the story through and in the narrator in a way I don’t think could be done in straight first-person or the popular third-person limited points of view.

[Andrew Manzi · Rating 4 out of 5]

I received an ARC from RBmedia.

A heart-breaking book, Counting Backwards gives an insight into the impact of Lewy-bodies dementia on carers and loved ones.

The book tells the relationship of married couple Addie and Leo as they slowly learn Leo has dementia with Lewy bodies. Kirshenbaum uses 2nd person narration which took some time for me to settle into but draws you into the narritive. There’s no getting away from the fact this book is sad and there’s a feeling of hopelessness, but there are also funny comical moments, giving some relief. Kirshenbaum doesn’t shy away from the complicated feelings and emotions of being a carer and the moral and philosophical questions that emerge when someone you love has a degenerative illness.

[Nina · Rating 5 out of 5]

A quick and pithy read. Having lived with my father who lost everything to Alzheimer’s Disease this book rang true. It is the story of an upwardly mobile New York couple: Leo a research scientist and Addie an artist. Told in brief chapters the book is told in Addie’s voice and she doesn’t mince words. Leo starts exhibiting strange behavior; it progresses in stages and robs him of his self. It is sad and real, a tale of transformation not just of Leo but of Addie as an artist. Well written and compelling; I intend to read more by this author. Highly recommend for the writing and the insight into what happens when one loses a loved one who still exists but is not and will never be the same.

[Marika · Rating 4 out of 5]

Husband and wife Leo and Addie are living a comfortable life when he is diagnosed with early-onset Lewy Body dementia. The first signs are hallucinations, and Leo being a scientist, is self aware enough to realize that they are not real. A real and raw look at a marriage rocked by a horrible disease and heavy burdens on the surviving spouse. Kirshenbaum is such a talented writer that readers will believe that they are reading a memoir.

*I read an advance copy and was not compensated.

[Samantha Bean · Rating 5 out of 5]

I received this book as an arc. It was truly an amazing and heartbreaking story. Addie watches her love Leo turn into someone she doesn’t know when he’s diagnosed with lewy body dementia. I couldn’t imagine the love of my life losing himself. I highly recommend this book!

[Dan Dundon · Rating 4 out of 5]

I have a friend who was recently diagnosed with Lewy body disease, so I was interested in this book by author Binnie Kirshenbaum. The beginning of “Counting Backwards” was compelling with an intelligent, thriving couple coming to grips with this devastating disease. My Dad died of Parkinson’s disease so I can attest to the reality of the author’s description of the slow degeneration into dementia with its hallucinations and erratic behavior. On some days a patient seems to be perfectly normal and the next they become a stranger in your home. This frequently results in family and friends rationalizing the bad days and while focusing only on the good days.
The author takes this slide one step farther when the victim becomes violent and even engages in sexually deviant behavior. This is an area I’m not familiar with so I can’t comment whether it is typical of such cases. Nevertheless, the author’s ability to capture the atmosphere in nursing homes is spot on. They can be so utterly depressing it is difficult for even sane people to cope with the hopeless environment in so many of them.
Perhaps my biggest issue with this novel is the miraculous caregiver the wife manages to find to take care of her husband in the last stages of his life. Such caregivers are extremely rare. In most cases such level of individualized care is extremely expensive and out of reach of most families. To me this is where the well-written novel becomes untethered from reality.
Nevertheless, this novel will evoke deep emotions for most readers, many of whom have probably experienced their own similar tragedies.

[Laura · Rating 3 out of 5]

This novel explores the difficulties a loving couple encounter when the husband, Leo, develops Lewy Body Disease, which leads to hallucinations and dementia-type behaviors. His wife, Addie, struggles as Leo requires increasing levels of care. However, it is her responses to his decline that make this novel so difficult. She is quick to move her husband to a care center then to a personal apartment with private care giver, all while worrying about the expense. Her emotional connection to her husband is lost and she avoids seeing him at times. Addie initially struggles in her professional work as an artist, then finds a way to use her art to express her distress. She also turns her back on her social circle. By the end of the book, Addie is a completely different person than she was before her husband became ill, showing that serious medical issues impact more than just the affected individual.

[Joann · Rating 4 out of 5]

Kirshenbaum delivers a story at once insane, sad, funny, and hopeless due to the circumstances involved. As I read the book I kept wondering how crazy I would become were I in Addie’s shoes. (I don’t think I’d get a cat but….). The reader is apprised of the myriad difficulties involved caring for someone who is slowly losing connection with life and dying, not the least of which is the cost involved. Addie did make me clench my jaw numerous times but all that did was point out the situation she was involved in more clearly. It would have been fun to know how Addie and Leo got together.

[Kerry Pickens · Rating 4 out of 5]

This story is about a New York couple and the husband starts having visual hallucinations, and after a long series of testing and misdiagnosis is found to have advanced Lewy body disorder. The husband’s dementia increases and the wife goes through the process of trying to find assisted living to the tune of $12k a month which depletes their financial resources and alienates their friends as the wife can no maintain her previous social life. The author’s writing style reminds me of Joan Didion’s The Year of Living Dangerously.

[Evelyn Horsky · Rating 4 out of 5]

A poignant and moving novel about a loving married couple’s struggle with the husband, Leo early onset Levy body dementia. One can relate to to so much of the dementia impact on someone that we love dearly. It is so difficult to come to terms with and the author’s depiction is so révèlent to those of us who have felt and witnessed the insidious ravages of this horrendous disease on our loved ones. She was lucky to find a wonderful caregiver who gave her and Leo so much love and compassion in their most dreadful years of their marriage. It was sad but yet in many ways a heartwarming novel….one that will not forget soon.

[Levi Arnold · Rating 5 out of 5]

this book made me audibly weep

[Matt Kray · Rating 4 out of 5]

Wow. Roller coaster of emotions with this one. Dementia has touched my life personally, so I felt as if I could relate to both Leo and Addie. I appreciated the humor used throughout much of this book because the subject matter is far from humorous. Towards the end I was getting very annoyed with Addie, but who am I to judge?

[Molly Zhang · Rating 4 out of 5]

This was a heart-wrenching novel exploring the impact of early-onset Lewy Body Disease that offered fresh perspectives on loss. While not immediately captivating from the start (which is why it took me a couple weeks to really get into it), the author writes beautifully, although I found that the characters lacked depth in more ways than one, especially as the book progressed. As the disease progressed further, it felt like Addie had just decided to give up for no explained reason - there wasn’t an in depth exploration of her grief or her love and why it led to the choices she made throughout, it just seemed like she decided one day to not care, and continue doing what she did out of obligation, without any rhyme or reason. There are, of course, different forms of grief and I’m sure in complex scenarios such as this, it manifests in different ways, but it felt like there was an overall lack of sincerity at times. Other than bits and pieces here and there, it didn’t seem as if she missed him or still loved him even a little bit, it just seemed like she wanted it to be done. That being said, I really enjoyed the exploration of anger and frustration associated with loss, and while devastating, it was also witty and incredibly interesting.

[Tracye Jorgensen · Rating 4 out of 5]

Leo and Addie are a loving married couple until Leo starts experiencing bizarre hallucinations, a man on stilts, a pair of swans on Manhattan streets. first, Leo who is a research scientist believes that perhaps he's having problems with his eyesight But after going to specialist after specialist who really give them no answers, Addie phones a helpline for people that have suicidal thoughts and depression just to talk to someone and the person who she connects with on that line gives her the number of a woman who correctly diagnoses what Leo has and that is early onset dementia in the form of Lewy body disease.

it is a devastating disease (I'm sure some of you remember that before Robin Williams took his life, he was also diagnosed with Lewy body disease).

This story is told in very short chapters. sometimes only a couple of sentences and sometimes two pages. And it captures the slow decline of Leo and of the emotional and physical sacrifices that Addie must go through watching her husband wither away and die.

it was very sad and quite emotional for me because my own mother passed away from dementia and it took her 10 years to leave us, a stroke actually took her which is quite common in dementia patients.

This was a very gut-wrenching novrl. it did not soften the blow of what happens when you are diagnosed with Lewy body disease.

I would definitely recommend this novel.

[Kathleen Dang · Rating 1 out of 5]

I just experienced the worst travel day of my life, and having only this grating book to keep me company made circumstances that much more unpleasant.

[Natalie · Rating 4 out of 5]

This is a tough book on a heartbreaking topic - the main character, Addie, slowly loses her 53-year-old husband, Leo, to Lewy Body Disease (a form of dementia). The books starts near the end, then backs up to the early days of his decline. From there, the reader experiences the loss of Leo right along with Addie, made all the mode real because the book is written in second person (“While Leo sleeps, you Google: Lewy body disease.”).

It is a hard story to be immersed in, and the reader is there with Addie through it all. But the pacing is fast, with short chapters (some just a few lines, the longest only a few pages), and though it is hard to read at times it was also propulsive and compelling. There are also parts that a funny - the epitome of darkly comic. My personal favorite example (tied to my earlier quote, in fact) is: You wouldn’t be surprised if, instead of showing you how many times you have visited this site, Google tells you, “enough already.“ (this is a full chapter, aptly titled “Artificial Intelligence”).

I’m glad I read this and would recommend it.

[Cindy · Rating 5 out of 5]

This book is gutting…thank goodness it is also funny. Addie, a female artist, lives with her 56 year-old physician husband, Leo, and their cat in NYC. He starts experiencing hallucinations, leading to the eventual diagnosis of Lewy Body disease, a form of dementia. This is their story, told from Addie’s perspective and experience. It is a moving story about love and what “in sickness and in health” might mean. Addie is a realist and darkly funny, and we see her struggle to stay present in the face of his incremental deterioration. I highly recommend adults 40+ read and discuss.
The audiobook is well narrated except for the home health worker’s Jamaican accent that sounded way off the mark to my ears.
My thanks to the author, publisher, RB Media, and #NetGalley for early access to the audiobook of #CountingBackwards for review purposes. Publication date: 25 March 2025.

[Susan · Rating 4 out of 5]

My family and I thought that my mother had Lewy Bodies dementia after we went down the rabbit hole of websites devoted to the description of the disease.

I recognized the character of Addie and her behavior - I experienced much of the fear and anxiety of the early days of my mother’s fall into dementia. She didn’t have Leo’s pronounced hallucinations but she must have had something similar because she told so many stories of occurrences that didn’t make sense. She wasn’t as young as poor Leo but the pain doesn’t go away. I wish I had someone like Larissa to take care of Mom. While she was very expensive and did seem to take advantage of Addie’s kindness, her heart was in the right place.
I could not have read this book 5 years ago when my Mom passed but today it was Cathartic. Loved it.

[Carolyn Crocker · Rating 4 out of 5]

Collage artist Addie faces her 54-year-old research scientist husband's descent from brilliance to the dementia of Lewy body disease in a narrative that's furious, exasperated, despairing, poignant, and humorous as she struggles to survive. Heartening.

"...but she is a Chihuahua in the shape of a person and has been calling every other day to ask how it's going, and because you don't want her to piddle on the floor, you tell her, 'It's going great. I'm , almost there.'" p.17

"... you say, 'Well, hello there.' If a Hostess Twinkie could talk, it would sound like you." p. 338

"You wouldn't be surprised if, instead of showing you how many times you have visited this site, Google tells you, '_Enough already._' p. 327