Dr malcolm sayer l dopa

INTRODUCTION to “AWAKENINGS”

from www.filmeducaton.org/pdf/film/awakenings.pdf

In the winter of 1916-1917, an epidemic of a rare disease occurred, springing up, as virus

diseases sometimes do, seemingly out of nowhere. It spread over Europe and then to other

parts of the world and affected some five million people. The onset of the disease was sudden

and took different forms. Some people developed acute restlessness or insomnia or

dementia. Others fell into a trance-like sleep or coma. These different forms were recognised

and identified by the physician Constantin von Economo as one disease, which he called

encephalitis lethargica, or sleepy sickness.

Many people died of the disease. Of those who survived, some recovered completely. The

majority remained partly disabled, prone to symptoms reminiscent of Parkinson’s disease.

The worst affected sank into a kind of ‘sleep’, unable to move or speak, without any will of

their own, or hope, but conscious and with their memories intact. They were placed in

hospitals or asylums. Ten years after the epidemic had begun, it just as remarkably

disappeared. Fifty years later, the epidemic had been forgotten.

In 1966, when Dr. Oliver Sacks, a neurologist trained in London, took up his post at Mount

Carmel, a hospital in New York, he found there a group of eighty people who were the

forgotten survivors of the forgotten epidemic. It was clear that hundreds of thousands had

died in institutions. Dr. Sacks called them ‘the lepers of the present century’. In his book,

‘Awakenings’, he tells of his attempts to understand the nature of their affliction, but also of his

growing appreciation of them as individuals, with their own unique histories and experience.

In 1969, Dr. Sacks tried out a remarkable new drug, L-DOPA. For some of his patients, there

then followed a rapid and brief return to something like normality. They were suddenly

restored to the world of the late nineteen sixties. His book documents this remarkable

awakening, as experienced by twenty of his patients. L-DOPA was not, however, the magic

cure that it first seemed. The normality that it promoted soon broke down, with patients

subject to all kinds of bizarre behaviours.

In the film of ‘Awakenings’, Robert de Niro plays Leonard Lowe, someone affected by sleepy

sickness as a young man. He is in a state of near sleep, unable to move or speak. Every day,

his mother comes into hospital to care for him, as she has for many years. Robin Williams

plays Dr. Malcolm Sayer, the neurologist who, like Dr. Sacks himself in 1966, takes up a post

at a New York hospital, discovering there the forgotten survivors of the sleepy sickness

epidemic. He finds himself drawn to this group of chronically disabled people, and especially

to Leonard.

Robert de Niro’s Leonard is based on the Leonard L. who Sacks describes in his book - an

intelligent and courageous man with a wry sense of humour, who is able only to communicate

in a very limited way, using a letter board. Sacks says how thoroughly De Niro

prepared himself for his role, spending a great deal of time with post-encephalitic patients in

an effort to understand something of how it feels to be so chronically disabled, and to

represent as accurately as possible the quality of if disablement.

In the film, we are shown Leonard’s awakening under L-DOPA. Leonard sees the world to

which he has awoken truly wonderful. He has lost many years of his life. Now he wants to

live. He wants his independence. Briefly, we see him determined to achieve this before his

damaged nervous system pulls him back into a catatonic state.

In the book ‘Awakenings’, Dr. Sacks writes that Leonard says to him after the last futile trial of

another drug:

“Now I accept the whole situation. It was wonderful, terrible, dramatic and comic. It is finally -

sad, and that’s all there is to it. I’ve learned a great deal in the last three years. I’ve broken

through barriers which I had all life. And now, I’ll stay myself and you can keep your L-DOPA.”

A note about sleepy sickness:

Encephalitis lethargica (sleepy sickness, or sleeping sickness, as it is called in the U.S.A.) is

caused by a virus attacks the brain. In particular, it attacks a part of the mid-brain - the

substantia nigra - damaging the nerve cells this area and severely reducing their ability to

produce the chemical nerve impulse transmitter, dopamine. In respect, the disease is similar

to Parkinson’s disease. The cerebral cortex (the part of the brain concerned with conscious

awareness, thought and memory) is unaffected. When in the early 1960’s a substance (LDOPA) closely related to dopamine was found to alleviate the symptoms of Parkinson’s

disease, there was the hope that it would do the same for post-encephalitic patients, that is,

people suffering from the after-effects of sleepy sickness. In event, the effect of L-DOPA on

such people was variable and unpredictable. For some, except for a brief return something

close to normality, it was a failure. For others, its effects were beneficial over a longer period,

and for a few, there was a return to a long lasting near normality. The drug raised enormous

expectations in those who been worst affected by sleepy sickness, who for thirty or forty years

had been in a kind of catatonic sleep. Tragically, for some of them, their awakening was all

too brief

Leonard’s poem:

THE PANTHER by Rainer Maria Rilke (1875-2926)

His vision, from the constantly passing bars,

has grown so weary that it cannot hold

anything else. It seems to him there are

a thousand bars; and behind the bars, no world.

As he paces in cramped circles, over and over,

the movement of his powerful soft strides

is like a ritual dance around a centre

in which a mighty will stands paralysed.

Only at times, the curtain of the pupils

lifts, quietly -. An image enters in,

rushes down through the tensed, arrested muscles,

plunges into the heart and is gone.