In which I review Asleep, a nonfiction book by Molly Caldwell Crosby about epidemic encephalitis.
Today, I’ll be reviewing Asleep: The Forgotten Epidemic That Remains One of Medicine’s Greatest Mysteries by Molly Caldwell Crosby. This is the first time I’ve done a review for a long time, and the first time I’ve ever reviewed a nonfiction book (despite my love of nonfiction), so I’m really excited.
Obviously there won’t be any spoilers because this isn’t a story. I don’t know what I could possibly spoil.
What’s It About?
This book is about the encephalitis lethargica epidemic of the early 20th century, a truly bizarre and terrifying disease that many people have never even heard of. Stuff You Missed in History Class (one of my favourite podcasts) did a great episode on it.
This disease caused a wide variety of symptoms. The classic one that earned it the nickname “sleeping sickness” was extremely prolonged sleep. But patients might have just the opposite happen, where they were unable to sleep at all. It could also cause really bizarre tics that the patient couldn’t control. One person died of hiccoughing. There was a young boy that couldn’t stop jumping up and down on all fours, looking absolutely terrified all the while. Things like that.
Many patients died during their long sleep. Some because their respiratory system shut down (this was before you could keep someone alive on a ventilator). Others had heart attacks during the sleep.
For those who contracted encephalitis lethargica, there were three basic outcomes:
- survival with severe complications, which might not show up for many years
In adults, the complication was usually postencephalitic Parkinsonism. Outcomes for children who survived were even more unfortunate. Extreme personality changes and inability to control their impulses resulted in many of these child-survivors committing horrific acts against themselves and others. Sadly, most of these children spent the remainder of their lives in institutions. The worst part is that there was no psychosis present in these cases; these children were fully aware of—even afraid of—their actions. Some asked to be restrained so they wouldn’t hurt anyone. This quote from a patient in the book breaks my heart:
“It’s so sad to be like me. This is only the beginning; it’s going to get worse. You don’t understand how it is not to be yourself. I feel so vicious at times. I was always good and kind to people. There are other people in the world like me. I feel sorry for them. I know a little girl like me, and I only pray that something will happen to her before she grows up. I want to tell you about this because the time is coming when I won’t be able to. But you’re well, you can’t understand!” (pg. 124)
This book also goes into the advances in neurology that were spurred by the epidemic. In the time period in which the epidemic began, people were very much about Freudian ideas, and very reluctant to accept that anything other than buried psychological trauma could cause mental illness. This epidemic and the intrepid doctors who tried to unravel it did much to advance neurology as a field of medicine, and to prove that there could be physiological causes for mental illnesses, as well as psychological ones. So that whole history is really interesting as well.
Basically, Asleep does a great job of highlighting how terrifying and bizarre the disease was, without losing sight of its impact on real people, their families, and the medical field. It explores the horror-worthy aspect of it without losing its grip on compassion.
Style and Structure
The writing in this book was gorgeous. Crosby has a flair for the bringing out drama of her subject, without losing sight of the seriousness of it. I was shocked by how poetic this book was. I was reading it for informational purposes, but I was also entertained and carried pleasantly along by the style.
Bookending this book is the story of Crosby’s own grandmother, an encephalitis lethargica survivor, which adds a nice personal context. I feel that the opening sentence is very strong:
My grandmother was sixteen when she fell asleep.
Why this sentence works well as an opener:
- Short and simple statement
Crosby does a beautiful job of highlighting the humanity of the people that are included in this book. She delves into their background and who they were as people, outside of their work with the disease (in the case of the doctors) or how the disease destroyed their life (in the case of the patients and families). She embellishes quite a lot, of course (by that I mean she describes how the patients felt and what their surroundings were like, and she would have had to imagine much of that), and this isn’t a technical work. That’s not what it’s meant to be. But it does pack in a lot of information.
I really like the structure of this book, divided into different case histories with location, name of the patient(s), and physician(s). I suppose you wouldn’t technically have to read the book in order—you could just read a case history that interested you. But I read it linearly, and would definitely recommend that.
I found myself tearing up quite a lot while reading Rosie’s story (Case History 5, beginning on pg. 120.) Her story had the potential to be gross-out, can’t-believe-that-happened, cheap entertainment, but Crosby wrote it in a very respectful and compassionate way so that its true heartbreaking nature would not be missed. It’s definitely not something I’ll be forgetting anytime soon.
I read this book because I was curious to know more about this disease and just wanted some information, but it was very entertaining and moving as well, and I was pleasantly surprised by that. I was impressed by Crosby’s style and liked her tendency to end chapters on what I call a “duhn duhn DUHN” note. I couldn’t put the book down, not just because the subject matter was fascinating, but because she built so much suspense that I had to know how each case turned out.
This was a brilliant read, and I highly recommend it if you’re interested in medical topics (particularly neurology and psychology), history (particularly WWI and the early 20th century, with a heavy focus on New York), or if you’re just feeling the need to read some nonfiction this summer.
Have a lovely day!