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Last Updated on May 7, 2015, by eNotes Editorial. Word Count: 539

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In 1973, Oliver Sacks published the first edition of Awakenings, a brilliant account of his work with a group of elderly patients who had contracted sleeping sickness (encephalitis lethargica) in the great epidemic after World War I and had later developed symptoms of Parkinson’s disease. Sacks presents twenty case histories, in which he describes the remarkable “awakenings” these patients experienced when, beginning in the spring of 1969, the new drug laevo-dihydroxyphenylaline (L-Dopa) was administered to them. Many of these patients had been existing in a catatonic state for decades, since the onset of their illness, “dormant volcanoes” whose lives were suddenly transformed when they were “awakened.” In the third edition of Awakenings, published in 1987, a new foreword, an epilogue in which he updates the case histories of his twenty patients since 1973, and a section discussing the aftermath of their awakenings have been added.

In 1969, Sacks was a young neurologist, one year out of his residency, working with postencephalitic patients on the wards of his fictionalized Mount Carmel Hospital (actually Beth Abraham Hospital in the Bronx). As he witnessed the effects of the then-new miracle drug L-Dopa, he started keeping careful notes and urging his patients to keep journals to record their remarkable transformations. Dissatisfied with the limitations of clinical case histories, Sacks decided to keep biographical accounts of his patients’ experiences as they awakened from their isolation and struggled to recover their lives. Sacks writes of the tremendous excitement felt by the staff and patientsat seeing lives which had once been thought irremediably blighted suddenly bloom into a wonderful renewal, at seeing individuals in all of their vitality and richness emerge from the almost cadaveric state where they had been frozen and hidden for decades.

Unfortunately, the awakenings experienced by Sacks’s patients were often temporary or were followed by bizarre neurological reactions that necessitated curtailing the medication, thus returning the patients to an even more severe state than before. Many of his patients found themselves in the ironic position of needing L-Dopa but being unable to tolerate it. They found themselves living on a razor’s edge, trying unsuccessfully to balance between too much and too little medication. With great compassion, Sacks charts this cycle of awakening, tribulation, and accommodation. He raises some profound questions about the nature of health and illness and demonstrates that no human life can ever be dismissed as being beyond the concern of a caring physician.

The text of Awakenings is divided into three sections: “Introduction,” “Awakenings,” and “Perspectives.” In his introduction, Sacks provides detailed clinical descriptions of Parkinson’s disease, of the ten-year sleeping sickness epidemic of 1917 through 1927, and of the lives of the afflicted patients between 1927 and 1967. Then he provides a sketch of institutional life at Mount Carmel Hospital, contrasting the euphoric hopes that accompanied the introduction of L-Dopa with the treatment of parkinsonian patients twelve years later in 1981. The major section of the book, “Awakenings,” provides a detailed clinical case history of each of twenty selected patients, tracing each person’s history before the introduction of L-Dopa, describing his response to L-Dopa, and giving a clinical follow up. The last section, “Perspectives,” presents an overall disease pattern for postencephalitic parkinsonism and offers a philosophical perspective on the nature of this affliction.

Bibliography

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Last Updated on May 7, 2015, by eNotes Editorial. Word Count: 49

Klawans, Harold L. “Awakenings,” in The Journal of the American Medical Association. CCLX (July 8, 1988), pp. 273-274.

Kohn, Marek. “Oliver Sacks,” in New Statesman. CXII (November 28, 1986), pp. 19-20.

Liebmann-Smith, Richard. “More Clinical Tales,” in The New Yorker. LXIII ( May 4, 1987), pp. 30-31.

Prescott, P. S. Review in Newsweek. LXXXIV (July 15, 1974), p. 85.

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