This novel follows two storylines. One is the epidemic of encephalitis that occurred after WW I. It left many of the patients in a stupor, prone to tics that were repeated and an unawareness of surroundings. This often led to hospitalization in a mental hospital as it was unclear to doctors of that time what was occurring. Much of the book is set in such a hospital and follows the story of a doctor, Zachery Busner, who brought the patients out of their stupor with the prescription of l-dopa.

The other storyline is that of the Death family. One member goes to serve on the front in the war. Another member, Audrey, was one of the patients in the mental hospital and her tics and jerks were the repetitive movements she had learned as she worked in a war industry factory. The last member of the Death family was another son, who was intelligent and had risen high in the government overseeing the production and distribution of munitions.

This is not an easy book to read. It is full of stream of consciousness language, moving on quickly and repetitively, reminiscent of the mutterings of the patients in the mental hospital. The viewpoint shifts constantly between Audrey, her brothers and the doctor, often in the middle of a sentence, so the reader must attend closely to the story. The language is babbling and full of imagery. This novel was shortlisted for the Booker Prize and for those willing to surrender themselves to its flow, is a rewarding look at the time period between the two world wars. This book is recommended for literary fiction readers.