Awakenings by Oliver Sacks

First published: 1973; revised, 1987

Type of work: Science/psychology

Principal Personages:

• Oliver Sacks, the author, a neurologist
• Rose R., ,
• Miriam H., ,
• Leonard L., and others, some of his patients

Form and Content

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 patients

at 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.

Critical Context

Before Oliver Sacks began his literary career with the publication of Migraine: The Evolution of a Common Disorder (1970), there was relatively little popular interest in the clinical narrative or case history, particularly in the field of neurology. Physicians contributed highly technical articles to medical journals, often written in a style that Sacks considers the drab and soulless productions of assembly-line medicine. Though there has been a long and honorable tradition of the physician as author, stretching back as far as Hippocrates, Sacks has a remarkable gift for the compassionate portrayal of the interior lives of his patients. Perhaps the only other neurologist with comparable gifts was the nineteenth century Philadelphia physician H. Weir Mitchell, who contributed lively and interesting case histories for popular magazines and wrote fiction as well. With the publication of Awakenings, followed by A Leg to Stand On (1984) and the great success of The Man Who Mistook His Wife for a Hat and Other Clinical Tales (1985), Sacks has emerged as one of the major clinical writers of the twentieth century. A professor of clinical neurology at the Albert Einstein College of Medicine in New York and a private practitioner, Sacks still finds time to contribute regularly to The New York Review of Books, the London Review of Books, and other literary publications.

What is most remarkable about Awakenings is Sacks’s ability to convey both the human and the scientific dimensions of this neurological drama. Hailed as a masterpiece when it was first published, Awakenings has served as the inspiration for a play by Harold Pinter, A Kind of Alaska, part of his trilogy Other Places (1982), in which he dramatizes the plight of one of Sacks’s patients, Rose R. While presenting the human drama, Sacks also reflects upon the underlying philosophical issues of health and illness raised by his studies. After reading Awakenings, one comes away with a chastened awareness not only of the humanity of the most deeply afflicted patients but also of the delicate and miraculous nature of the good health that many people take for granted. Sacks is a mental voyager who has returned from the hell of neurological illness with reports describing the ways in which his patients have struggled to maintain their humanness as they struggled with their afflictions. Theirs are stories of uncommon courage, heroism, and endurance. If Awakenings has taken on a life of its own, it is because, unlike the world of fiction, the world of Sacks’s patients continues. Their story has not yet ended.

Bibliography

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.