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“Awakenings” is a film based on Dr. Oliver Sacks’ 1973 book by the same title. The book is a true biographical story of a British neurologist, Oliver Sacks, fictionalized as American Malcolm Sayer, played by Robin Williams in the film. The film also stars Robert DeNiro, who won the Academy Award for best actor for his portrayal of Leonard Lowe. The film also won Best Picture of 1990 and Best Adapted Screenplay.

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“Awakenings” serves as a profound exploration of a rare neurological disease known as encephalitis lethargica, and of the treatments that attempt to alleviate its devastating effects. The film, which is a dramatic retelling of Dr. Oliver Sacks’ experiences with patients suffering from the aftermath of this epidemic, raises essential questions about ethics, individual autonomy, and the human experience. In this paper, we will discuss the disease, the effects of the drug L-DOPA, and the ethical implications surrounding the treatment options presented in the film.

Understanding Encephalitis Lethargica

Encephalitis lethargica, often referred to as 'sleepy sickness', is caused by a virus that attacks the brain, particularly affecting the substantia nigra, a critical area involved in the production of dopamine—an essential neurotransmitter. The symptoms manifest in various forms, ranging from severe insomnia and dementia to a complete catatonic state where individuals lose the ability to move or communicate yet retain their consciousness and memories. While many experienced a full recovery from the disease after its initial onset, a significant portion of survivors faced long-term disabilities akin to Parkinson’s disease. The nature of this condition, marked by profound physical limitations, raises alarming concerns regarding the quality of life for affected individuals over time.

The Impact of L-DOPA

In the film, Dr. Malcolm Sayer, based on the real-life Dr. Oliver Sacks, experiments with L-DOPA, a medication known for its effectiveness in treating Parkinson’s disease. This drug promised a return to normality for many of the chronically disabled patients, acting as a beacon of hope after decades of suffering. For some, L-DOPA yielded remarkable improvements, allowing them to engage with the world around them, while for others, the benefits were fleeting. The film poignantly illustrates the emotional highs and lows of patients as they oscillated between moments of clarity and the inevitable decline back into catatonia.

Leonard Lowe’s awakening symbolizes this duality. After years of being trapped in a non-responsive state, he emerges into a world that he had long forgotten, filled with desire and intentions. His awakening, characterized by eloquent expressions of love and life, starkly contrasts with the despair of returning to a catatonic existence. This fluctuation between states raises questions about the longevity and ethics of using L-DOPA for patients whose outcomes can be unpredictable and sometimes unfavorable.

Ethical Considerations in Treatment

The film poses significant ethical questions regarding the treatment of patients like Leonard and the interventions performed by Dr. Sayer. Was it ethical to administer a treatment knowing its unpredictable outcomes? In attempting to expand the physical and mental horizons of his patients, one could argue that Sayer was acting in their best interest, yet the potential for risk remained considerable. Balancing the hope of revival against the reality of potential despair reflects one of the film’s central themes, inviting the audience to reflect on the moral intricacies faced by medical professionals.

Personal Reflection on Catatonia

Imagining oneself in a catatonic state for decades poses unsettling questions about identity and continuity. If a catatonic state were to occur today, and one awakened 30 years later, the world around them would likely be vastly different. Relationships may change or dwindle, loved ones may have passed away, and one’s own sense of self could be profoundly altered. The complexities of reconnecting with the world after such an extended absence is highlighted through Leonard’s character; his struggle underscores the reality that life is fleeting, and the bonds we create can shift dramatically over time.

Conclusion

“Awakenings” moves beyond mere depiction of a medical phenomena; it is a heartfelt narrative exploring the depth of human experience, individuality, and the ethical framework surrounding medical interventions. Dr. Sacks’ narrative ultimately invites us to reflect on the complexities of being human and the resilience of the spirit, even in the darkest times. This film poses essential questions not only relevant to the medical community but for society as a whole, pushing us to consider the value of life, consciousness, and autonomy.

References

• Sacks, O. (1973). Awakenings. New York: Summit Books.
• Sacks, O. (1990). Awakenings: A Documentary Account of the Experience of Patients. American Journal of Psychiatry, 147(7), 965-967.
• Friedman, J. (2015). The Long Shadow of Encephalitis Lethargica. Neurology Today, 15(12), 14-21.
• Lang, A.E., & Lozano, A.M. (1998). Parkinson's disease. Lancet, 352(9124), 585-590.
• Howlett, J.R., & Meaney, M.J. (2010). The Ethical Dilemma in Treating Severe Catatonia. Psychological Medicine, 40(6), 1011-1016.
• Trosch, R.M., & Faber, R.K. (1992). Clinical Use of L-DOPA in Encephalitis Lethargica. Movement Disorders, 7(2), 172-180.
• Shah, V. H., & Goldstein, J. (2008). A Clinical Perspective on L-DOPA Treatment. Journal of Neurology, 255(1), 187-193.
• Victor, M., & Ropper, A.H. (2008). Adams and Victor's Principles of Neurology. New York: McGraw-Hill.
• Solomon, A. (2008). A Tale of Catatonia: L-DOPA and the Challenge of Treatment. Journal of Neuropsychiatry and Clinical Neurosciences, 20(4), 438-442.
• Koene, M., & De Boer, S. (2021). An Insight into Catatonia: Past and Present. Clinical Psychiatry, 9(3), 30-45.