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Awakenings by Oliver Sacks
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Awakenings (1973)

by Oliver Sacks

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In the years after WWI, an epidemic of encephalitis swept the world. Many people died but others seemed to recover only to suffer from a kind of Parkinson's which led to their permanent hospitalisation years or decades later. Often they were shunted off into side wards and forgotten about. In 1969 Oliver Sacks decided to try them on a new drug called L-Dopamine.

The core of the book is the stories of some of the patients and how L-Dopamine benefitted them until reactions to it took over. Extended introductions give background information about Parkinson's and the epidemic of encephalitis and its aftermath. An epilogue and postscript to later editions give updates on the patients, while appendices explore some of the themes of how the patients experience the world, later medical understandings, and the various dramatisations of the book.

The book can be a bit heavy-going in places if you don't have a medical background, but through it all Dr. Sack's human compassion for the patients and the patients' own resources of courage and character shine through. Dr. Sacks argues for a medicine that does not just focus on scientific puzzles and cases but also on the care of human beings. A wonderful book. ( )
1 vote Robertgreaves | Jul 30, 2017 |
Summary: Chronicles the experience of post-encephalitis patients existing as prisoners in their own bodies in a trance-like state, who, when treated with L-DOPA, experienced dramatic "awakenings" nearly always followed by debilitating side effects, often resulting with withdrawal of the drug, and a return to their former state.

From 1916 to 1927, there was an epidemic of encephalitis lethargica, or "sleeping sickness." The sickness often resulted in a period of profound lethargy, sometimes ending in a return to normal or nearly normal life. A number of patients experienced symptoms of Parkinsonism, leading to increasing paralysis and necessitating institutionalization. Many lived as prisoners in their own bodies, limited in movement and speech.

Oliver Sacks, in this book chronicles his work with a group of such patients, some institutionalized for as long as forty years in Mount Carmel Hospital in New York. During the time that he was caring for them, a new drug, L-DOPA, began to be used with great effect on Parkinson's patients, and since these patients symptoms were similar, Saks, and other attempted to use the drug with them with dramatic, and ultimately, troubling, effects.

After introductory chapters on Parkinsonism, sleeping sickness, Mount Carmel, and L-Dopa, he describes the patient history of twenty patients who he treated with this drug. It turns out they responded very differently than Parkinson's patients. Nearly all of them experienced "awakenings" where they regained the ability to move and speak. One patient, Leonard L. described the experience as follows:

"I feel saved. . . I feel like a man in love. I have broken through the barriers which cut me off from love. . . . I have been hungry and yearning all my life, . . . and now I am full. Appeased. Satisfied. I want nothing more. . . . L-DOPA is a blessed drug, it has given me back the possibility of life. It has opened me out where I was clammed tight shut before. . . . If everyone felt as good as I do, nobody would think of quarrelling or wars. Nobody would think of domination or possession. They would simply enjoy themselves and each other. The would realize that Heaven was right here down on earth."

Sadly, with few exceptions, these awakenings did not last but turned into wide awake nightmares. Coherent speech would become rushed faster and faster, and degenerate into repeating of words or phrases. "Tics" would appear and become debilitating. Movement would accelerate to the point that the person could harm themselves. Psychological changes occurred as well and a normal personality would generate into mania.

The histories describe the heart-wrenching efforts to bring these symptoms under control by reducing dosages. Sometimes things were so bad that they had to withdraw the drug, leading to a return to a trance-like or coma-like state. He also describes three stages he observed patients going through: awakening, tribulation (side effects is too mild to describe this stage) and accommodation. Some are able to resume L-DOPA, and some not. What is striking is how they come to terms with their dashed expectations and suffering. Leonard writes, "I am a living candle. I am consumed that you may learn. New things will be seen in the light of my suffering."

Sacks also observes how significant the human connection is with his patients, and how they do significantly better when there is at least one person in their lives with whom they connect, whether someone on the ward, or a family member or friend. For one patient, the chance to cobble shoes again enhanced his physical well-being and checked his descent into profound Parkinsonism.

He concludes with some profound reflections on the nature of disease and the human personality. Sacks then includes series of fascinating appendices at the end of the book exploring the history of "sleeping sickness," the past experiences of "miracle drugs," and the electrical basis of awakenings. Two of the most fascinating were his studies of the different perceptions of space and time of his patients, and the application of chaos theory to understanding patient responses to L-DOPA, which did not follow any orderly progression.

The last appendix is an account of the various radio, stage, and screen adaptations of Awakenings. Most notable is his description of working with actors Robert De Niro and the late Robin Williams and director Penny Marshall on the film version of Awakenings. He pays a wonderful tribute to their craft in getting "inside" what it was like to be one of these patients and the portrayal of fifteen "awakenings" at once and the chaos, brilliantly choreographed by Marshall.

Sacks gives us a narrative that helps us understand the often heartbreaking process of medical research, where advances and setbacks often come together, and where, more than science, the bond between doctors and other caregivers and patients remains paramount, whether treatments effect cure or not. Through one rare condition, Saks gives us a lens into the human condition we all share. ( )
1 vote BobonBooks | Feb 12, 2017 |
I like this author a lot, and the premise of the book was interesting, but Sacks being a neurologist infuses his stories w/a bit too many technical terms, and it soon starts to read like a medical record after awhile. ( )
  homeschoolmimzi | Nov 28, 2016 |
Awakenings by Oliver Sacks; (5*);

This is fascinating stuff!

I am not nor was I ever a medical student nor have I ever worked in the medical field. But I am so thankful that I read this book & must say, even at the beginning of my thoughts & comments, that I highly recommend this work of Sacks. The man has a brilliant mind, very worthy of our appreciation.
I could not have read this book, had I not read ALL of the preliminary notes which take the reader well into the book and give one such as myself a good background before going into the case studies of these special patients.

The "sleepy sickness" that masks itself as Parkisonism would be difficult to garner understanding from without those previously mentioned notes. Oliver Sacks is a gifted writer. His prose is often times overly medical but again, please read the notes before beginning the case studies. The beauty of his words in regards to how medicine should be practiced and how the overly technical aspects of medicine are denying the original feeling & healing that is the true basis of the medical practice have made this book a must read for all those going into the medical field. I could go on and on but will just say: Please read this book if you have any interest in an extraordinary disease and the extraordinary processes which both the patients, other doctors, nurses & medical personnel go through along with Dr. Sacks.
__________________________________________________​
From Wikipedia regarding the "sleepy sickness":

"Encephalitis lethargica or von Economo disease is an atypical form of encephalitis. Also known as "sleepy sickness" (distinct from tsetse fly-transmitted sleeping sickness), it was first described in 1917 by the neurologist Constantin von Economo and the pathologist Jean-René Cruchet. The disease attacks the brain, leaving some victims in a statue-like condition, speechless and motionless. Between 1915 and 1926, an epidemic of encephalitis lethargica spread around the world. Nearly five million people were affected, a third of whom died in the acute stages. Many of those who survived never returned to their pre-existing "aliveness". "They would be conscious and aware - yet not fully awake; they would sit motionless and speechless all day in their chairs, totally lacking energy, impetus, initiative, motive, appetite, affect or desire; they registered what went on about them without active attention, and with profound indifference. They neither conveyed nor felt the feeling of life; they were as insubstantial as ghosts, and as passive as zombies." No recurrence of the epidemic has since been reported, though isolated cases continue to occur." ( )
  rainpebble | Nov 23, 2016 |
Jonathan Davis, Oliver Sacks
  jmail | Mar 21, 2016 |
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Author nameRoleType of authorWork?Status
Oliver Sacksprimary authorall editionscalculated
Bekker, Jos denTranslatorsecondary authorsome editionsconfirmed
Wensinck, F.Translatorsecondary authorsome editionsconfirmed
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To the memory of W.H. Auden and A.R. Luria
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The theme of tis book is the lives and reactions of certain patients in a unique situation - and the implications which these hold out for medicine and science.
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... and now, a preternatural birth in returning to life from this sickness / Donne
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Book description
In zijn beroemde boek Ontwaken in verbijstering, indrukwekkend verfilmd als
'Awakenings', loont de befaamde neuroloog Oliver Sacks zich als altijd een
warm-menselijk waarnemer met ccn groot inlevingsvermogen. Hij beschrijft
in dit boek zijn ervaringen ntet de patiënten van een mysterieuze en slopende
ziekte die woedde in de jaren twintig: de slaapziekte Encephalitis lethargtca.
De patiënten die deze ziekte overleefden veranderden in zombies. In de jaren
zestig leek Sacks met behulp van het geneesmiddel L-dopa deze mensen ie
kunnen verlossen uit hun apathie. "X'at er vervolgens gebeurde is verbijsterend
en wordt door Sacks niet fijngevoelig medeleven beschreven. Het ontwaken
bfijkt niet in alle gevallen een zegen.
In Stemmen zien biedt Sacks de lezer een uniek inzicht in de wereld van de
doven. Toen hij in 1986 voor het eerst in aanraking kwam met doven en hun
unieke taal. ging er een volstrekt nieuwe wereld voor hem open. Voor hem als
neuroloog was het bijzonder interessant dat de hersenen van doven die met
gebarentaal zijn opgegroeid een heel eigen, ongebruikelijke ontwikkeling doormaken. Maar het meest gegrepen was hij door de individuele levensgeschiedenissen an de doven; hun strijd om de muur van ge luid loosheid en onbegrip die hen omringt te doorbreken. Sacks benadrukt in dit boek op zijn
eigen onnavolgbare manier dat dove kinderen die echt de kans krijgen met anderen te communiceren, zich kunnen ontwikkeien tot normale, volwaardige
De neuroloog Oliver Sacks (Londen, 1933) verwierf als auteur internationale
faam met de beide werken in deze bundel, en met zijn boeken Een been om op te staan en De man die zijn vrouw voor een hoed hieU.

De auteur is neuroloog en schrijver van enkele boeken op het grensgebied van medische wetenschap, geneeskunst en letterkunde en biografiek. In dit boek behandelt hij de ziekte "encephalitis lethargica", de "slaapziekte" die in de jaren na de Eerste Wereldoorlog als een epidemie in de wereld rondging. Van de mensen die destijds ziek werden maar de ziekte overleefden, zijn nu uiteraard nog slechts enkelen in leven; van een aantal van hen veranderde het bestaan als chronisch afgetakelde patient in 1969 drastisch doordat toen een medicament beschikbaar kwam waarmee de neurologische restverschijnselen behandeld konden worden. Sacks (onlangs bij Van Dis) beschrijft uitvoerig en grondig gedocumenteerd de neurologischeen menselijk-biografische avonturen die deze mensen, na een bestaan van soms bijna een halve eeuw als "zombies", doormaakten toen ze door de behandeling "ontwaakten"; de tekst en de aantekeningen zijn bovendien gelardeerd met veelal treffende filosofische bespiegelingen. Register en lijst van moeilijke woorden.
Haiku summary

Amazon.com Amazon.com Review (ISBN 0375704051, Paperback)

It hardly seems fair that so many great doctors are also great writers. Perhaps it's qualities like sensitivity, craft, and dedication that keep physicians like Oliver Sacks in hospitals all day and at writing desks all night; if nothing else, these qualities shine in books like Awakenings. This powerful set of case histories rises above its pathological foundation to find new literary territory, a medical-spiritual synthesis equally stimulating for the mind and the soul. It's no wonder Hollywood producers chose to turn it into a feature film--anyone can see the universal human struggle against bondage and despair in these pages.

The sleeping-sickness epidemic of 1918 caused hundreds of survivors to slip into a bizarre rigid paralysis with similarities to advanced Parkinson's disease. These patients, only occasionally able to communicate or move, were nearly all institutionalized for life, their ranks increasing every now and then with similarly afflicted men and women. Sacks came to work at a long-term care facility shortly before the first exciting results with L-dopa and Parkinson's in the late 1960s; his patients soon embarked on dramatic, difficult recoveries from up to 50 years of torpor. He documents their spiritual and medical obstacles with great care to portray their individual personalities, long suppressed but finally released. Though many great doctors are also great writers, few can compare with Oliver Sacks for expressing the relation of medicine to the human spirit. --Rob Lightner

(retrieved from Amazon Thu, 12 Mar 2015 17:58:27 -0400)

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Describes the author's work with institutionalized patients at Mount Carmel Hospital and the dramatic effects of the drug L-DOPA on twenty patients suffering from encephalitic Parkinsonism.

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