Awakenings: The romantic science of Oliver Sacks
By: Gavin Lamb
Tags: Rejection, Philosophy, Knowledge, Science, Perseverance

Photo by Matt Hardy on Unsplash

After one week of treatment (and on a dose of 2 gm. L-DOPA daily), Mrs B. started talking -quite audibly for the first time in many years, although her vocal force would decay after two or three short sentences, and her new-found voice was low-pitched, monotonous, and uninflected…With raising of the dose to 3 gm. L-DOPA daily, Mrs B…now showed considerable spontaneous activity…She was much more alert, and had ceased to show any drowsiness or ‘dullness’ in the course of the day. Her voice had acquired further strength, and the beginnings of intonation and inflection: thus one could now realize that this patient had a strong Viennese accent, where a few days previously her voice had been monotonous in timbre, and, as it were, anonymously Parkinsonian. – Oliver Sacks in his book ‘Awakenings,’ pp. 69–70

The above excerpt comes from one of several case studies Oliver Sacks conducted as a young physician in the spring of 1969 at Mount Carmel, an institution housing post-encephalitic patients who contracted encephalitis lethargica or sleeping-sickness, only to suffer from “post-encephalitic parkinsonism” for decades, lasting until the end of life. Sleeping-sickness was an epidemic that lasted for a brief time after World-War One and “disappeared” in 1926, however it left affected individuals in a perpetual state of a severe kind of quasi-immobility, only able to make the subtlest of movements with great and concentrated effort.

The story of Dr. Sacks’ exciting time in 1969, when after administering the newly discovered ‘miracle drug’ L-DOPA he witnessed patients who had been thought of as ‘extinct volcanoes’ suddenly come alive with vibrance and vitality was dramatized in the 1990 film “Awakenings” starring Robert DeNiro and Robin Williams.

Oliver Sacks and Robin Williams on the set of the 1989 movie ‘Awakenings.’ Credit: Oliver Sacks

Although the story itself is fascinating, something I found intriguing was Sacks’ falling out with the medical community and the difficulty he had in publishing the dramatic descriptions of his patients’ awakenings which were however followed by a complex aftermath of “sometimes bizarre, and unpredictable states,” too unpredictable and complex to be simply considered as “side-effects.” Sacks emphasized:

“These could not, I indicated (in a letter to the Journal of the American Medical Association published in 1970), be seen as ‘side-effects,’ but had to be seen as integral parts of an evolving whole. Ordinary considerations and policies, I stressed, sooner or later ceased to work. There was a need for a deeper, more radical understanding” (p. xxxi).

He received ample backlash from the medical community, some saying he was against the ‘miracle drug’ L-DOPA by mentioning its ‘side-effects’ while some claiming he was just making it all up. He wrote up his year’s worth of research findings on his patients at Mount Carmel into a properly formatted medical article, complete with “statistics and figures and tables and graphs” and then submitted it to various medical journals: all rejected his paper, sometimes with “vehemently censorious, even violent, rejections, as if there were something intolerable in what I had written…”

“This confirmed my feeling that a deep nerve had been struck, that I had somehow elicited not just a medical, but a sort of epistemological, anxiety — and rage.”

Sacks would later publish the full account of his time at Mount Carmel a few years later in his 1973 book Awakenings, with several descriptively rich case-studies of over a dozen patients. And although it was well-received by the general public, according to Sacks it elicited a heavy silence — or as he put it, “a mutism” on the topic– from his colleagues in the medical field which left Sacks feeling alienated from the medical community.