An Essay on Awakenings

22 11 2009

This is an essay I’m writing for one of my classes. It is a critique of the portrayal of psychological abnormalities in the media, in this case Awakenings. (As a side note, I must comment that I grin every time I see the character Waheedah, credited simply as “Hysterical Woman.”)

“The Knife-Edge We Live On” [1]

Not long after the end of World War I and the onset of an epidemic of influenza, another virus attacked almost five million people throughout the world, and then suddenly disappeared in the 1920s. Encephalitis lethargica, or sleeping sickness, killed about one third of its victims and left the health of many others devastated. Years after a seeming recovery, many began take a turn for the worse, eventually having to be hospitalized. Awakenings (1990) takes place in New York in 1969, decades after the outbreak of encephalitis lethargica. Robin Williams plays Dr. Malcolm Sayer, a newly hired neurologist at Bainbridge Hospital who finds that a good number of his patients are like “living statues,” cut off from the world by their immobility. Intrigued, he investigates their histories, finding a common thread in their cases of encephalitis in the 1920s. He also begins to suspect that their symptoms add up to an atypical form of Parkinsonism. After some research, he becomes intrigued by an experimental drug, L-DOPA, and manages to get permission to start one of these patients on it. That patient, Leonard Lowe (Robert De Niro), experiences a seemingly miraculous awakening, but his wellness is short-lived—before long, tics and severe schizophrenia-like side effects begin to appear. As the movie focuses so closely on Leonard, I will, as well.

Awakenings is based upon the book of the same name originally published in 1973 by Dr. Oliver Sacks, the person upon whom the fictional Dr. Sayer is based. Leonard Lowe is based upon one of Dr. Sacks’ patients at Beth Abraham Hospital (a chronic hospital in the Bronx that is referred to as Mount Carmel in the book) who is presented in one of the book’s case studies. Called Leonard L., Dr. Sacks said of the man that he was “an ‘ideal’ patient” (p. 204)[2]. In contrast to his fictional counterpart, Leonard L. communicated readily with Dr. Sacks, despite his inability to speak, by indicating letters on a letter board. That had been his only method of communication for more than a decade. When asked what it felt like to be in his condition, Leonard said, “’Caged. Deprived’” (p. 205). He spent much of his time reading, as long as someone could turn the pages for him, and quickly became the hospital librarian and source of book reviews for the hospital’s monthly newsletter.

Dr. Sayer becomes fascinated by Leonard Lowe and, despite the mocking of his colleagues, sets out to find a cure. In the beginning, Lowe is confined to a wheelchair and wears a bib. He appears to be completely unresponsive, like all of the other “living statues” who have essentially been cut off from the world for about three decades. They all have a highly similar presentation, which by itself raises red flags as far as medical accuracy. All of them are wheelchair bound, nonverbal, and unresponsive unless an object is tossed at them (something that Dr. Sayer discovers when a patient’s glasses fall off) or a pattern is presented to them (such as music or a checkered floor). When Dr. Sayer discovers a drug so new that no one truly understands it, he becomes determined to try it on his patients. Lowe is the only one to receive it at first, due to the astronomical cost. This is a major point of historical inaccuracy—Dr. George Cotzias experimented with L-DOPA on Parkinson’s patients and he and his colleagues published a paper that helped bring the new drug into the spotlight, such that “[b]y March 1967, the…patients at Mount Carmel had already heard of L-DOPA: some of them were eager to try it at once …” (p. 34). The price began to decline sharply in late 1968 and that, in combination with other factors, led Dr. Sacks to start trying L-DOPA in early 1969. Leonard was the first to receive it, but not the only one.

Lowe shows no reaction at first, so methods of administering the drug and dosages are changed. Impatient, Dr. Sayers slips into the pharmacy in the middle of the night to get more to give to him. Within hours, Lowe is wandering the darkened halls of the hospital and determinedly writing his name in black crayon (his name is used throughout the movie as a symbol of his mental and physical status). Over the next couple of days, Leonard makes a full return to normalcy—he becomes the hospital celebrity as the first to overcome his illness. Dr. Sayer is then determined to start all of the patients like Lowe on the experimental drug without waiting to see Leonard’s reaction to the drug. Amazingly enough, the only thing holding him back is money, a hurdle that he quickly jumps. All of the other patients return to normal and begin making up for lost time. Dr. Sayer begins to worry when Lowe begins to display a minor tic. When Lowe explodes and is isolated to a high security ward, the other patients begin to worry as well—will that be them? After Lowe attacks him, Dr. Sayer does not report the incident, or tell anyone about it. Luckily, the incident snaps Lowe out of his paranoid state and he is able to return to the general population, where his tics gradually worsen until he is in the same state as he was before L-DOPA. Lowe’s experience suggests that the other patients will follow in his footsteps. Many of the other patients whose courses on L-DOPA were quite different from Leonard’s—in some cases much more successful—are ignored in favor of telling a more heart-wrenching story.

Though it never names them as such, Lowe’s symptoms greatly resemble schizophrenia, induced by L-DOPA as his Parkinson’s was induced by encephalitis lethargica. As is a common conception, he becomes very dangerous while experiencing these symptoms. He becomes delusional and paranoid as his tics grow more pronounced, leaving a hospital full of doctors completely helpless toward or ignorant of his condition. When the shocking nature of his own behavior catches up with him, however, he is able to overcome his delusions and no one seems terribly concerned about a relapse. Though Robert De Niro spent a significant amount of time watching documentary footage of Leonard L. to nail down his depiction of the tics displayed by the post-encephalitic patients, it does not seem that the same dedication was present in the rest of this movie. It is hard to believe that so many medical professionals had no idea how to address schizophrenic symptoms in their star patient, especially when it was likely that other patients would begin to show the same effects. Dr. Sacks notes in his book that they had been using other treatments for Parkinsonism before beginning L-DOPA, which was not the first drug to treat Parkinson’s, but the best at the time. A synthetic alternative to the neurotransmitter dopamine, it was meant to replace the dopamine found to be lacking in Parkinsonian brains. This is briefly covered in the movie. It neglects that L-DOPA’s effects were unpredictable from person to person; thus, it would have been irresponsible for Dr. Sayer, using a very new and highly experimental drug, to assume success after a trial consisting of only one person using the drug for only a few days. It is, however, spot on in its derision of “miracle drugs,” such as Freud’s belief in cocaine.

One of the major failings of this movie is that it attributes this amazing discovery about post-encephalitic patients to one person, who fought against all odds and managed to cure all of his patients, even if that cure was fleeting. It plays on the fact that none of the other characters in the hospital were familiar with the sleeping sickness, which was still very much in the public consciousness at that time, even though it’s almost forgotten today. All in all, the movie adaptation of Awakenings seems to be more concerned with showing the development of Dr. Sayer as a person, both socially and personally, after interacting with a man who finds joy in life despite an extraordinary illness. It depicts the growth of a relationship between Dr. Sayer and a nurse named Eleanor as he gains social confidence. Because of this, and despite De Niro’s research into Leonard L., Awakenings tends to neglect some of the most fascinating parts of this unusual illness. On the other hand, it is engaging to the layman where the book it is based upon is not (being too full of medical terminology and probably too dry for someone not already interested). The attitude displayed in this movie can be summed up in Dr. Sayer’s words: “What we do know is that…another awakening took place; that the human spirit is more powerful than any drug…This is what we’d forgotten – the simplest things.” It is a good introduction to the subject, when taken for a fictionalized story and followed by reading and research, but is ultimately a very sentimental movie that sacrifices much of its accuracy to the cause of a good story.

[1] Title borrowed from a quote about the book by Doris Lessing.

[2] Sacks, Oliver. Awakenings. New York: Vintage Books, 1990.