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
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
“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
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.
PSY1879 Movie worksheet: “Awakenings” Name _______________________
“Awakenings” is a 1990 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.
Pre-movie Questions (you will need to do some outside research to find the answers – check Handouts area in D2L):
1. What is encephalitis lethargica? What are the symptoms?
2. What does it mean to be catatonic?
3. What is LDopa? What other major neurological disease is commonly treated with
4. What were the effects of LDopa on the catatonic patients?
5. What seems to mean the most to Leonard after his awakening?
6. For Leonard, what were the eventual side effects of taking LDopa?
8. Do you think what Dr. Sayer did in awakening the patients was unethical? How and
9. If you went into a catatonic state this year, what people and things in your life might
be different if you woke up in 30 years?
10. Did you like this movie? Why or why not?