Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (9 page)

For Adam, it was maddening. He would lock himself in the bathroom, turn on the faucets, and run water in the cast-iron basin to try to keep from waking his family members with the sniffing. Still, he could not stop the tic. It was like wheezing with asthma or suffering from breathing spasms. The sniffing would stop only if something distracted Adam; if his attention was diverted, the attack would come to a halt.

As strange and random as his symptoms seem, they actually made sense within Adam’s brain. The brain is an intricately wired communication system where signals run along pathways to other parts of the brain, almost the way a telephone signal runs along telephone lines. And like a person-to-person call, those signals deliver a message to receptors in the brain telling them to perform a movement or to start thinking or to begin feeling certain emotions. The messages are sent through a system, a switchboard, the same way a telephone operator will connect one voice to another. In the brain, that switchboard is called the basal ganglia, and they connect messages within the brain and to the body, including the nerves that ultimately control movement. The basal ganglia also connect messages going to and from the frontal lobe, the part of the brain that controls personality, behavior, inhibitions, and emotions. In the brains of encephalitis lethargica patients, the basal ganglia are damaged.

The basal ganglia also serve another important purpose: they send messages to the thalamus and neighboring hypothalamus, the small part of the brain von Economo identified as the electrical switch for sleep or the lack thereof. Even today researchers can’t explain the exact relationship between those two parts of the brain, but they do know the basal ganglia send messages to the hypothalamus to
halt
certain movements so others can take place. Even with something as simple as falling asleep, the brain is put to work, telling the arms and legs not to move, relaxing muscles, keeping eyelids closed, slowing the beating heart and breathing lungs.

In a damaged brain, as messages rapidly travel through the basal ganglia and thalamus to trigger movement, emotion, thinking, or sleeping, they pass through the mangled switchboard and are redirected, sending garbled messages to the body. Disorders associated with the basal ganglia are Parkinsonism, Tourette’s syndrome, attention deficit disorder, obsessive-compulsive disorder, cerebral palsy, and stuttering, among others. Whenever these signals, carried by chemicals called neurotransmitters, are interrupted, receptors in the brain waiting to receive the signals get mixed messages instead.

In Parkinsonism, for example, the cells that produce dopamine begin to die off and mixed messages overwhelm the muscles’ nerves that control movement. With static messages coming through, the body may have trouble moving at all or lose the ability to stop unwanted movements. In cases of obsessive-compulsive disorder, the basal ganglia forward mixed messages back and forth to the frontal lobe. In an OCD patient, those messages are sent too quickly and too frequently. When that happens, the message overrides logic and tells the person to keep doing the same action again and again. An OCD patient could no more keep from the obsessive thoughts or compulsive behaviors than a Parkinson’s patient could keep from shaking, because it is the wiring in the brain automatically controlling the impulse, not their own willpower. Both Parkinsonism and OCD, among many others, were conditions common in encephalitis lethargica patients.

The messaging center of Adam’s mind had been damaged when he first contracted encephalitis lethargica. The physicians and his family did not even realize it was a case of encephalitis—they saw symptoms of flu or a bad cold and diagnosed it as such. Adam, like so many other people, would learn only later that his brain had been harmed during his illness. Messages going through the basal ganglia in Adam’s brain became rewired, and actions that he normally did automatically, without thinking, were happening out of his control—sniffing over and over again, shaking, stuttering, and other odd movements. The “stop and go” part of his brain would not stop these behaviors. But it was the messages going to and from the frontal lobe that would make the dramatic changes in Adam’s personality.

Adam was taken to see several doctors. One found an obstruction in Adam’s nasal passage, and surgery was planned, but then Adam was involved in a car accident and the surgery was postponed. That was in August 1922, and Adam soon left again for school. But it was apparent something was wrong with the boy. He could not pay attention and fell asleep at his desk. He was accused of being lazy and lacking enthusiasm. Adam felt tired all of the time, but was rarely able to fall asleep before 2:00 A.M. Teachers threatened that if he would not stay awake, he would have to leave. He managed to finish the school year, but failed two of his subjects. To those who knew him, it was clear a distinct change had happened. Adam had always been sociable, easy to get along with, funny, a boy who loved music and playing pranks. The Adam that left school at the end of that school year was none of those things.

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t had been over a year since Adam’s case of the flu, if that’s what it was. By the summer of 1923, new symptoms began to arise. The breathing spells became rapid and painful. His face would grow stiff, his hands and feet stiffen, and he began drooling. His brother told Adam it looked like he was foaming at the mouth, and his mother reminded him repeatedly to use his handkerchief. His feet began to shuffle, and he walked strangely. As Adam’s condition grew worse and more inexplicable, he was taken to an institution for treatment, where he continued his downward spiral, often refusing to get out of bed until a nurse threw cold water on him.

Adam had been suffering for two years from this strange disease, frequently falling into a trance, panting, and salivating like someone possessed. He had been hospitalized several times, had his tonsils removed, been sent to boys’ camp, lived with a physician for a spell, stayed at a farm with a male nurse for a while, and seen numerous doctors. As a last resort, Adam was finally taken to see one of New York’s premier psychoanalysts: Smith Ely Jelliffe.

CHAPTER 9

Smith Ely Jelliffe

S
mith Ely jelliffe had an idyllic childhood in a city home with a clear view of Manhattan. Like Tilney, he grew up in Brooklyn, and most of his memories are of his family’s brownstone in Park Slope, which, like many houses in the neighborhood, had just been built. In the vacant lots where homes were yet to be constructed, Jelliffe played baseball with his brother, who was only one year younger, and neighborhood kids. Having free roam of the neighborhood, the boys also played “catch one, catch all,” climbed the pear and cherry trees lining the streets to steal fruit, and swiped the noonday milk left for the corner grocery. There were croquet games in Prospect Park, as well as kites, marbles, and tops. Jelliffe was the kind of boy who rushed through all of his studies on Friday so he could leave Saturday and Sunday free for play. As with the other neighborhood children, only nightfall brought him home.

Jelliffe had few negative remembrances from childhood. Although he could outrun almost anyone, his arms were weak, so he avoided fisticuffs. And, ever the psychoanalyst, he remembered a distinct sadness one Christmas when he awoke to find his stocking empty on the mantel as punishment for hitting his brother on the head with a hammer. “On several occasions in my later life when I have done some mean or unworthy action ... this same mood of deep sadness has come over me.”

Jelliffe’s father was a renowned schoolteacher, the first to organize a kindergarten program in Brooklyn. His mother was an intelligent and vivacious woman who, even at the age of seventy, visited Egypt to ride a camel and see the pyramids; she also traveled through the Panama Canal the year it opened. And she had a wonderful sense of humor that her son inherited.

Jelliffe was also a gifted student. His kindergarten teacher showed up at his doorstep in tears one afternoon, only to tell Mrs. Jelliffe that her son had finished the whole year’s work in the first two weeks, and there was nothing left to teach him. Jelliffe attended the public schools in Brooklyn, and at age sixteen he met and fell in love with the girl who was to become his wife.

Although Jelliffe obtained a certificate to teach school like his father, graduated from the Brooklyn Collegiate and Polytechnic Institute, and studied botany at the New York College of Pharmacy, he chose to attend medical school, graduating from Columbia University’s College of Physicians and Surgeons in 1889. His schooling seems to have been indicative of not only his wide variety of interests, but his difficulty in choosing one path. In medical school, Jelliffe was drawn to several subjects except one: bacteriology. He recalled that every day during his 11:00 A.M. class, he suffered a migraine each time his professor of surgery said the words “healthy laudable pus.” Throughout his career, Jelliffe would find fault with surgery as a cure for disease, believing it to be an “effort to cut ideas out of the body.”

After graduating from medical school, at the age of twenty-three, Jelliffe traveled to Europe. As passports did not yet use photos, Jelliffe’s provides a detailed description of his appearance at the time: five feet, nine inches, wide forehead, light blue eyes, ordinary nose, small arched lips, square chin, oval face, light brown hair, freckles. Jelliffe spent a year studying in various clinics in Vienna and in Berlin, even visiting Koch’s laboratory and stopping in Paris to hear lectures from Jean-Martin Charcot, the most renowned neurologist in Europe. Jelliffe was particularly interested in the broad availability of knowledge in Europe, where he studied pediatrics, ear diseases, eye diseases, gynecology, internal medicine, and even botany. But he expressed no interest in either neurology or psychiatry at that point. Jelliffe was taking longer than most young men to find his specialty and seemed entrenched in “finding himself.”

Meanwhile, an epidemic of influenza was forming in Europe. Jelliffe would call the 1890 flu epidemic his “baptism” into medical practice. In its aftermath, there seemed to be a strange number of illnesses splintering from the flu—epidemic headache, a sort of influenzal meningitis, unusual cases of encephalitis, and oddest of all, a sleeping sickness. It was called nona.

Jelliffe was frustrated with the medical community and its dismissive diagnoses when it came to this disease. He criticized the tendency among the population, as well as the physicians, to “name a peculiar, bizarre, and noisily inconsistent set of symptoms, especially when occurring in women, as hysteria.” Jelliffe continued, “To stick pins in an individual and when he does not feel it, or gives no evidence of feeling it, and then say—hysteria—is bumble puppy and not diagnosis.”

There was one area in which he showed no indecision whatsoever : his future wife. He wrote letters to her during his year away and quoted poetry. He also encouraged her to follow her own aspirations, which were in science. “It would look fine,” he wrote to her, “for a doctor’s wife to be a scientist also.”

After his return from Europe, Jelliffe hung a sign on his parents’ home in Park Slope and started his medical practice. Not surprisingly, patients did not flock to the steps of the cheerful brownstone. But when a cholera scare and a smallpox epidemic hit, jelliffe found work with the board of health. He also earned money as a medical examiner for a life insurance company.

Still trying to choose a medical specialty and find a viable income, jelliffe married his childhood love, Helena Dewey Leeming. They would be married twenty years and have five children. They left Brooklyn for good and moved to West Seventy-first Street in Manhattan to flee the “aid of a considerate father-in-law.” In the coming years, jelliffe taught medicine, and he started writing and editing medical articles with the help of his wife. His first published piece was an article on botany, “A List of the Plants of Prospect Park.” The move across the river, as jelliffe called it, also changed him personally. He saw it as a physical separation from his mother, from the comfort and security of his childhood home to a place of independence, even danger, and it was a powerful feeling. The intense feelings made him realize that he knew very little about the mind, and he wanted to learn more.

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n retrospect, jelliffe could see many instances in his life that led him to neuropsychiatry. He had long seen a connection between the health of the mind and the health of the body. “There was no antithesis of body and mind,” wrote jelliffe. “They were one and inseparable but, above all, function determined structure and then structure directed function.”

Jelline’s mind, which at times seemed indecisive and noncommittal, was sharpening into true innovation. His ideas were new age, and his philosophies often controversial. He was known to launch into lengthy, philosophical debates and earned the nickname “Windy Jelliffe” among his students. He was also known to be a fierce opponent—not because he was aggressive or competitive, but because he was so knowledgeable. He had a vast knowledge of medicine and science, as well as a remarkable memory, which, as one biographer wrote, “was more than a match for the average critic.” As Jelliffe’s career ascended, he continued his own practice, taught medical students, remained active in the American Neurological Association, served as president of the New York Neurological Society, and made frequent study trips to Europe to polish his professional knowledge. He corresponded steadily with his acquaintances abroad. A biographer wrote that Jelliffe became the “conduit through which European medical innovations in nervous and mental disease specialties came to the United States.” Jelliffe would be remembered in history as the father of psychosomatic medicine and a pioneer of psychoanalysis.

Jelliffe also served as an alienist. He testified in the famous society case of Harry K. Thaw, who was tried for the murder of Stanford White, a story made famous in modern times by the novel, musical, and film Ragtime. Thaw, wealthy and privileged, was married to a beautiful chorus girl named Evelyn Nesbit. When he learned of a past liaison between his wife and famed New York architect Stanford White, he became enraged. In 1906, in the shadows of the Moorish tower atop Madison Square Garden, a building White himself had designed, Thaw fired three shots at close range into White’s face. Jelliffe testified for Thaw’s team, and in 1908, Harry Thaw was found innocent by reason of insanity. Jelliffe later had to sue Thaw’s legal team in order to receive payment for his services.