Awakenings--which inspired the major motion picture--is the remarkable story of a group of patients who contracted sleeping-sickness during the great epidemic just after World War I. Frozen for decades in a trance-like state, these men and women were given up as hopeless until 1969, when Dr. Oliver Sacks gave them the then-new drug L-DOPA, which had an astonishing, explosive, "awakening" effect. Dr. Sacks recounts the moving case histories of his patients, their lives, and the extraordinary transformations which went with their reintroduction to a changed world.
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Preface to the Original Edition
A preface is an introduction to a text that will state its subject or claims.
Preface to the 1990 Edition
As you read the introductory material to the text, consider what the author feels you need to know in order to understand both the medical issues dealt with in the text but also the personal issues that accompany his patients' care.
Foreword to the 1990 Edition
A foreward is similar to a preface, but it may be written by someone other than the author. In this case, the author writes the preface to set the mood and reiterate the purpose of the text: it is not simply an informational piece about his patients. The author believes that his medical and personal approach to the care of his patients directly contributed to their reactions to the course of treatment they received.
The highlighted excerpt reinforces the author's belief that treating patients should be
It is important to consider the medical community's reaction to the author's "experiment" with L-Dopa. Why did the medical community have such mixed reactions about the author's approach to his experiment? To help you answer this question, view the chart below about hypothesis and the scientific method. (This annotation contains an image)
Based on the letters in support of the author's text, what does the phrase "Romantic Science" most nearly mean?
Based on the author's tone, you can infer that he cares deeply about his patients and does not view them as simply an element of an experiment. To review the definition of tone and how it differs from mood, please click on the link below. (This annotation contains a video)
Please click on the link below to review the definition and purpose of prologue. (This annotation contains a link)
What is the key difference between post-encephalitic patients and Parkinson's patients?
Footnotes are an important tool when reading a text. In this text, the author describes in greater detail a patient's condition or may include other medical data or evidence to support his conclusions.
When the "sleeping-sickness" first appeared in 1916-1917, physicians diagnosed the cases as "epidemic delirium, epidemic schizophrenia, epidemic Parkinsonism, epidemic disseminated sclerosis, atypical rabbis, [and] atypical poliomyelitis." This variety and range of diagnoses suggests
There are many words in this text that may be foreign to you. Click on the word and use the DEFINE feature to find the definition of unfamiliar words. It is important to do this because the author uses some medical terminology.
The author refers to Gunn's poem "The Sense of Movement" in order to illustrate
The author uses excerpts from literature to help illustrate or emphasize his points throughout the text. In this case, the author alludes to Donne to exemplify how isolating encephalitis is physically and emotionally. Donne claims that "solitude is a torment which is not threatened in hell itselfe." The loneliness is the worst side-effect of the disease.
Why did the hospital staff at Mount Carmel decide to relocate the encephalitis patients onto one centralized ward?
To read a brief overview of L-Dopa and its effects, click on the link below. (This annotation contains a link)
According to the author, which realization did the Vogts make about the link between the muscular and neurological systems in the human anatomy?
Though the author advocates for the use of L-Dopa on certain patients, he is not referring to the drug as a panacea or a cure-all. If you read the footnotes about mystical medicine and the claims that some medicines are "magic bullets," it is evident that he does not agree with these determinations.
Miss D.'s diagnosis of her "banal symptoms" as other diseases or mental states illustrates the author's argument that Parkinsonian diseases are difficult to diagnose and treat because
As you read, be sure to note how the disease impacts each patient differently. Even if two patients experience akinesia or inability to control muscle movement, the patients may have different forms of akinesia. In this case, Miss D. could move with ease up the stairs; it was if the stairs provided an impetus for her to move. But she was stuck or "frozen" at the top of the stairs.
Which literary device does Miss D. use to describe the side-effects she experiences from the L-Dopa?
Please click on the link below to review figurative language. Use the information to answer the following question. (This annotation contains a video)
The author asked his patients to keep journals or diaries whenever possible. This helps to give us insight into how they are emotionally dealing with the disease. This also helps to illustrates the author's purpose in writing the text: to illustrate how far-reaching the impacts of a physiological and neurological disease are.
The author discloses that Miss D.'s diary reveals "deeper and still more threatening feelings" that are associated with her stopping and withdrawing from L-Dopa. Which conclusion does he draw from this evidence?
Many of the patients included in this text face the same predicament: they cannot tolerate the side effects of L-Dopa, but they become considerably more "Parkinsonian" when they cease using L-Dopa.
Based on the highlighted passage, what conclusion do you draw about Miss D.'s treatment? If you were her doctor, what would you recommend to help her symptoms and effects of the disease? Use textual evidence to support your conclusions.
There have been studies done about the impact of music on Parkinson's patients. Click on the link below to read or listen to an NPR story entitled, "Your Brain's Got Rhythm, and Syncs When You Think." There are also video clips included with the story. (This annotation contains a link)
The author contends that the encephalitic patients at Mount Carmel during the spring and summer of 1969 were sensitive to the communal influence of their living situation. He states, "This sensitivity, this influence, went in different directions." What can you infer based on this statement?
Mrs. B.'s reaction to L-Dopa is also common among the author's patients: she does not want to stop using L-Dopa, but she wants the side effects to cease. Many patients are so overjoyed to have movement and a "normal" feeling return to their bodies that they are willing to endure the side effects to a certain degree.
Mrs. B.'s insistence that she was about to die and subsequent death despite all medical tests that contradicted her claim illustrate that this text is NOT
Miss R.'s appearance is also typical of encephalitic patients. She has not aged normally.
Aside from physical tics and involuntary movement, another side effect of L-Dopa is
Miss R.'s reaction to L-Dopa seems extreme. How do you think you would react mentally and emotionally to the physical side effects that Miss R. suffered?
When Rose was given L-Dopa, she acted in "a way that was strange." What was strange about her behavior? Did she have a mental illness? If not, what was the cause for her "confusion"? Use textual evidence to support your response.
The author refers to Robert O. as "Gogolian." This is reference to the author Nikolai Gogol. He is known for his realist works. He achieved his realism through caricatures of people in order to draw attention to their flaws or certain characteristics.
Based on Robert O.'s condition, which conclusion can you draw about the patients who started and stopped course of L-Dopa treatments?
Using the DEFINE feature, define the term "infinite." What does the author's choice of this term reveal about Hester Y.'s condition?
Based on the highlighted excerpt, which term best describes the author's feelings about Hester Y.'s responses to L-Dopa?
The structure of the text is a narrative with dates and journal entries. This is important because it allows you to understand the rollercoaster of emotions and responses the patients experienced in a very short period of time.
What is unique about Hester's tics?
Hester's response to L-Dopa is dependent upon many factors, but an influential factor is her "personal relations." When she is surrounded by those she loves, she does much better than when she feels alone. Do you feel the same way? Are tough situations easier to deal with when you are surrounded by your support system?
The author includes the anecdote about Hester "playing ball" with his students to illustrate how
Many of the patients that the author includes have a family member who supports them unconditionally. This is important, because without this support the patient may never have a chance at recovery or healing.
How does Roland P.'s situation differ from most of the other patients the author has included thus far?
In a more traditional experiment, the author may not be able to adjust the dosage of medication at will. He would have to justify his adjustments with medical data. His t-chart of side effects is somewhat scientific, but overall his practices do not adhere to the scientific method.
How is Roland P. similar to Hester Y.?
Do you think the author included Miram H.'s story after Roland's on purpose?
Hypalgesia is a lack of reaction to painful stimulus, and hyperpathia is an extreme reaction to stimuli. Miss H. suffered from both ailments on her left side. What can you infer about her condition based on this description and the rest of her ailments?
The author alludes to the fable of the "Ugly Duckling" to describe Miss H.'s transformation while on L-Dopa. What do you think this implies about Miss. H (aside from a physical transformation)? Click on the link below to review the Hans Christian Andersen version. (This annotation contains a link)
Based on the author's final characterization of Miss H., ALL of the following terms characterize her except
Miss. K's relationship or attachment to the male orderly seems to have a direct impact on her overall mood and well-being. Consider the argument the author is making by including this anecdote. Do you think the author is an advocate of multiple forms of "medicine"?
Based on the highlighted statement, what does the author admit?
The author includes biographical details about each of his patients to reiterate his feelings that the patients are people first and patients second. Do you think this approach helps or hinders his approach to medicine?
Based on the patient stories you have read thus far, what is one commonality among most of the patients the author treats?
Many of the patients on L-Dopa experience a side effect of frenetic activity following their years of dormancy. Do you think this is a side effect of the medication or a combination of factors?
Hypophonia is a condition that is often associated with Parkinson's patients. It is speaking softly. This is due to the lack of muscular coordination. In Miss. A.'s instance, she was not simply speaking softly but whispering with effort.
Which adage best describes the effect music has on Miss A.'s condition?
Miron V.'s encephalitic state worsened when he felt he was becoming useless. Once given a purpose or a place to work, his condition greatly improved.
Using the DEFINE feature, describe the difference between "rapt" and "inert." Provide at least two examples of each to support your response.
Though Mrs. C's hallucinations were a side effect of the L-Dopa, both she and the author were not concerned about them because
What does the highlighted excerpt suggest about Miss N.'s tics?
Patients like Miss N. may receive an exorbitant amount of attention once they react to L-Dopa. For many of these patients, they have not received that type of undivided attention in years - if ever. So it is understandable that they may continue to exhibit "side-effects" in order to retain the personal attention of nurses and doctors.
Aside from the use of L-Dopa, what does the author attribute to Ida's recovery from her forty-eight year encephalitic state?
Like a few of the patients the author includes in the text, Mr. G.'s death was medically unexplainable. What do you think could be the cause for his death?
While on L-Dopa, Miss G. exhibited violent tendencies, but without L-Dopa she "seemed scarcely alive." Which term best describes the situation the author is faced with?
Mr. E.'s case is interesting because he is a twin. A fraternal twin is the result of two separate eggs fertilized by two separate sperm. The babies do not have identical DNA and may be different genders. They both share a womb and gestational duration.
What emotions may the other patients have upon seeing Mr. E. leave Mount Carmel?
According to the author's footnote, why does he include Mr. E's story in the text?
Consider what Mr. W's story reveals about the use of L-Dopa. Thus far you have read about patients who reside in the hospital and have no real lives due to their illnesses. Mr. W does not reside in a hospital and is still able to function daily on his own. Why do you think he is more hesitant about using a drug with potential side-effects?
How does Mr. M's reaction contrast to the majority of the other patients included in the text? Use textual evidence to support your response.
Mr. L. demonstrates that a patient's cognitive abilities are not accurately demonstrated by their physical abilities. Remember that many of these patients were misdiagnosed as having other diseases that ranged from mental retardation to schizophrenia.
The highlighted passage is an example of which literary device?
Though Mr. L. is an intelligent man and can express himself through his writing and at times spoken word, he suffers from sexual repression. This is clearly demonstrated through his "sexual and hostile phantasies." The majority of the patients in the text demonstrate some sort of repression and then violent outburst while on L-Dopa.
Based on the summary of "Dr. Heidegger's Experiment," compare and contrast Mr. L. and Dr. Heidegger's "patients." What lessons did they learn? Use textual evidence to support your response.
Click on the link below to read a summary of the short story "Dr. Heidegger's Experiment." (This annotation contains a link)
The author insinuates that Mr. L.'s relationship with his mother was somehow incestuous and sexual. A dysfunctional dynamic between caregiver and patient is not unusual in the cases presented in the text. Why do you think this occurs with encephalitic patients?
Based on the structure of the text and the highlighted excerpt, what do you think the author values as highly as concrete medical data?
The author uses the simile, "I felt like a slum-child suddenly transplanted to Africa or Peru" to capture the awe and unanticipated effects of L-Dopa he witnessed on his patients.
What is the difference between a "subjective" approach and an "objective" approach?
What issue do you think many doctors have with L-Dopa? Do you think it gives the patients a false sense of hope or makes them believe they are cured when they are not?
Based on the author's definition of "awakening," would you say that the term is a technical and medical term, or does it encompass more than simply the patient's medical condition? Use textual evidence to support your response.
According to the author "awakenings" are double-edged swords. Though the patient recovers mobility and lucidity for a few days, weeks, months or a year, they may also suffer from having to deal with the realities they have avoided for many years.
Reread the highlighted passage. Which statement best summarizes the author's point?
The author reiterates in several ways how a patient is afflicted with a disease, and the disease affects the patients both mentally and physically.
Why does the author believe that "therapeutic 'titration' of drug-dosage" is not the solution for patients who have "crashes" following the use of L-Dopa?
Essentially, the author argues that L-Dopa does not cause extreme emotional pain or stress in the patients. It is because L-Dopa reignites a patient's ability to move, speak, or communicate, that patients must deal with their past, present, and future. This is why he uses the metaphor "strange and personal time-machine."
The author includes allusions to Boswell and Freud to illustrate which point?
The highlighted passage is important because the author clarifies that L-Dopa is not simply a dangerous drug. Any "cerebral stimulants and depressants" may negatively impact the patient.
Which term best characterizes the way the author views doctors or medical professionals who "publish complicated tables ... for proper dispensing of the "magical stuff"?
Ultimately, the author does not want to wage a war with nature. He believes that nature cannot be controlled and cannot be easily explained. This must be expected.
What does the simile "these seven ears have seemed like a single long day" imply?
The treatment of encephalitic and Parkinsonian patients is complex and multi-dimensional. As evidenced by the footnotes, there are environmental factors that may play a role in triggering episodes in these patients.
What is the tone of the highlighted passage?
Do you agree with the author's belief that art is an important part of treating patients? Has art, in some form, had a great impact on your life?
The painting by Dali is known as "The Persistence of Memory." Below is an image of the piece. (This annotation contains an image)
The author includes an excerpt from Darwin's autobiography in order to illustrate which point?
The author describes Hester Y. as experiencing "violent drives, but she herself is 'above' them." Which term best describes this dual state?
An epilogue is a section of the text where the author may comment on the content of the book. Here, the author admits that some of his characterizations of his patients may not have done them "justice." This is important because it not only clarifies the text, but it also reveals the author's humility.
Mr. V's condition does not improve despite using a variety of medications to treat his condition. Which argument is supported by his case?
Sometimes the benefits of medication outweigh the costs - but by a slim margin. In Martha and Gertie's cases, they sacrifice some degree of mental stability for improved physical condition.
What point do you think the author illustrates by consecutively including the dichotomous stories of Martha and Ida? Use textual evidence to support your conclusions.
The author describes Leonard L.'s two year hiatus from L-Dopa as "elegiac" detachment of mind. Using the DEFINE feature, look up the definition of elegiac. What do you think the author is implying about this time in Leonard's life?
Lazarus is a biblical allusion. To read the story of Lazarus, click on the link below. (This annotation contains a link)
Why does the author blame a hospital strike for the deaths of some of the post-encephalitic patients?
Some people believe that a new epidemic is possible, especially after the outbreaks of West Nile virus that occurred in the late twentieth and early twentieth century. Remember, the term encephalitis refers to any disease that results in the inflammation of the brain. In encephalitis lethargica, patients suffer from the "sleeping sickness," but the cause of this type of encephalitis is unknown. Theoretically, any encephalitis case can result in some form of encephalitis lethargica.
What does the author imply by the title "Miracle Drugs" and then referencing Freud's preoccupation with cocaine?
After reading this section of the text, do you think L-Dopa is similar to other "miracle drugs" that were discovered and used throughout history? Why or why not?
Which textual excerpt supports the use of EEGs to help treat encephalitic patients?
Click on the link below to read a Time Magazine article about the 1982 incident referred to in the text. (This annotation contains a link)
Based on the author's statements and tone about Parkinson's advancements, which statement is true?
Imagine living in a world where your judgement of scale is slightly off. Think about how this would impact everything you do: how you walk, how you place a cup on a table, how you write, and how you speak. It would also be impossible to do things such as drive because precision is needed to park and stay in your lane.
How are Parkinson's patients impacted differently than other patients who suffer from dementia or other cortical disorders?
The author warns his audience that the Parkinsonian patient tries to strike a balance between conforming to accepted standards of movement and mobility and not being harmed by unattainable expectations.
Based on the author's own admissions about L-Dopa and its side effects, do you think the drug is effective? Use textual evidence to support your response.
The explanation about why L-Dopa's effects are erratic and unpredictable is confusing. Basically, the author is saying that an encephalitic patient's world is not linear and easily followed. It is chaotic and in a delicate balance. Therefore minor changes in the patient's chemical balance may have major impacts on his or her behavior and reactions.
What is ironic about the author's use of EEG and other scientific reasoning to analyze the encephalitic patients?
Ultimately the author is an advocate for understanding a patient's needs as a whole. He does not contend that science has all the answers, yet he concedes that science can help to understand "natural law" and therefore lead to a better treatment of the patient.
Have you ever been assigned Oedipus Rex or Antigone in your class? These are both prime examples of Greek tragedies. In a Greek tragedy the characters' issues are resolved and the characters experience growth, but they also experience extreme pain and loss. Click on the link below to read more about the origins and purpose of Greek tragedy. (This annotation contains a link)
Click on the link below to view the author's account of Pinter's rendition of Awakenings as a play. (This annotation contains a link)
Though each adaptation of the text diverges slightly from the original, what does the author believe they all capture?
Below is a clip from Johnny Carson's show where Robin Williams describes making the film "Awakenings." (This annotation contains a video)
According to the author, when the actors had to simulate the patients' inertness or hyperkinesia, the actors were frightened because
Click on the link below to view a short scene from "Awakenings" featuring Robert DeNiro as Leonard. (This annotation contains a video)
The only version of the text the author did not appreciate was one that he considered