September 17, 2001

Noted Doctor Shares 'Awakenings'

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A poignant note was struck at the Statler Auditorium Thursday night as Dr. Oliver Sacks, A.D. White Professor-at-Large, gave a lecture entitled “The Real ‘Awakenings,'” showing a documentary describing his experiences as clinician to a group of Parkinsonian post-encephalitic patients, their dramatic almost inexplicable response to drug treatments and subsequent relapse.

Sacks was introduced by Roald Hoffmann, Cornell’s Frank H.T. Rhodes Professor of Humane Letters and professor of chemistry, also hosting Sacks for his first stay at Cornell.

“He makes the clear choice to recognize the dignity of the ill person and to evaluate the world that is constructed by someone with a disability,” said Hoffman. “Oliver Sacks fits Andrew Dickson White’s dream perfectly.”

Sacks is noted for his work with Tourette’s Syndrome, migraine, Parkinson’s disease, but most notably people suffering from Post-encephalitic Syndrome, the subject of many of his publications and the Hollywood movie Awakenings.

An outbreak of encephalitis in the 1920s was followed by a bizarre and unpredictable condition termed “sleepy sickness,” where persons severely afflicted by the disease and seemingly recovered, became neurologically disturbed. Post-encephalitic Syndrome showed symptoms ranging from Parkinsonian immobility to uncontrolled spasms and insomnia. The latter leading to eventual death from exhaustion, while the Parkinsonian patients survived and were afflicted for the rest of their lives.

“No medical treatment was of any use for these post-encephalitic patients [in 1966],” said Sacks. Indeed the symptoms were so varied, patients ran the risk of being misdiagnosed.

After the initial epidemic of the 1920s, publicity over the condition died off until it became almost insignificant. The patients were “written off,” according to Sacks, and tucked away in the hospital, virtually forgotten.

Dr. Sacks was assigned to treat these patients in 1966 when he first arrived at Beth Abraham Hospital in the Bronx, a hospital initially opened to treat encephalitic patients.

“As I entered I was struck by a number of strange, motionless, transfixed, petrified figures sometimes standing in odd postures, sometimes with their arms raised in the lobby and the corridors, I had never seen anything like this. I was told that some of these patients had been in the hospital for twenty, thirty or forty years,” said Sacks of his initial exposure to the hospital, designed to treat chronic illness.

Sacks was convinced that the patients had an “inner life.” Patients would often respond to music, or sudden emergencies, generally unable to initiate movements. “It seemed a most hopeless situation,” said Sacks of his early observations.

After three years of careful observation Dr. Sacks decided, somewhat reservedly, to test the effects of the newly developed Parkinsonian drug L-Dopa, first discovered in 1967. The drug is designed as a precursor to the essential neurotransmitter Dopamine, which is slowly depleted in the Parkinsonian and Post-encephalitic Syndrome patient.

“This [L-Dopa] was all over the news and some of my patients were aware of it even before I was,” joked Sacks. “I felt immediately that I wanted to try L-Dopa with these patients, I also had severe reservations.”

Sacks discussed the ethical issues raised by the drug in a time when patient consent was not necessary, and with patients with a much more complex disease than pure Parkinson’s Disease. Prior to their immobile state many of the patients had been hyperactive and explosive, which was a source for concern should the drug restimulate these behaviors.

“These people had been put away, isolated, abandoned, and perhaps physiologically and psychologically at a stand still for decades, and if the drugs does work, what then?” said Sacks of his initial reservations.

Following his introductory lecture Sacks showed, for the first time in the United States, a documentary about his patients and their experiences in the summer of 1969. This included video of the patients throughout their treatment. This includes the effects of the administration of L-Dopa.

The results were astronomical and immediate, patients that hadn’t walked, initiated a movement, or talked for years were singing, walking, and leaving the hospital for the first time in years.

“It was obvious within days, certainly within weeks, that the first patients were showing spectacular and unprecedented effects,” said Sacks, evidenced by video of patients making incredible recoveries.

While the patients responded positively initially, many were affected by the sensation of having lost a great majority of their lives. One patient, Sylvia, had been admitted to the hospital in 1926 at the age of twenty-one, she described herself as feeling twenty years old despite being in her sixties.

“The early effects of L-Dopa were wonderful and exciting, and received with a sort of lyrical joy by most of the patients,” said Sacks. However, the miraculous recovery of the summer of 1969, would not be permanent.

The apparent “awakening” of the patients was short lived. All eventually relapsed into different degrees of their former selves, although many did improve overall from their initial conditions.

“I was bewildered and terrified as were many of the patients, I also felt guilty,” said Sacks, afraid he had tantalized his patients with recovery, only to “snatch it away” later.

The video was followed by a brief question and answer session where Sacks commented on everything from the patients initial reactions to treatment to the benefits music can give as therapy. Sacks also spoke on Sunday at Cornell Cinema’s screening of the Hollywood film entitled Awakenings for which actor Robin Williams (portraying Sacks) won an Academy Award. Sacks related anecdotes about the movie with audience members especially about “hanging out with Robin [Williams].”

“He tried to treat the entire patient when he was treating these people he provided a sense of community and psychological support,” commented Camille Moore ’03, “He was treating the patients not just the disease.”

Sacks will be attending classes at Cornell as well as signing books on Friday, and will lead a colloquium, “Uncle Tungsten: Memories of a Chemical Boyhood,” sponsored by the Department of Chemistry and Chemical Biology, next Thursday. Sacks reacted favorably when asked about his stay at Cornell so far.

Archived article by Leonor Guariguata