Book Reviews

Review of Awakenings by Oliver Sacks, London, Duckworth, 1973

British Journal of Psychiatry, 126, 1975, p. 92

   In the 1920s and later one of the more pathetic duties that fell to the lot of a junior doctor at any large neurological or psychiatric out‑patient clinic was to care for the sufferers from the chronic sequelae of encephalitis lethargica. Despite their very distress­ing symptoms, parkinsonism, bradykinesia, salivation and oculogyric crises being among the commonest, as a rule they maintained a remarkable equipoise and a good deal of stoicism, contrasting strongly with the general run of neurotic patients. Though very little could be done for them, they could as a rule naintain very good rapport with their doctors and their families. Those who could not went into mental hospitals. Particularly interesting for the psychiatrist were obsessional‑like psychic symptoms, such as forced thinking, that gave a hint to the open‑minded that neuroses and encephálopathies might share some of their neurophysiological mechanisms.

   In the course of the years these patients have practically disappeared from clinical practice. The world epidemic of encephalitis lethargica of 1916‑1917 caught a cohort of individuals of whom now only the youngest survive. Dr. Sacks has had the almost unique experience of working in a hospital, the Mount Carmel Hospital, which cares for the largest surviving group of post‑encephalitics in America and, one supposes, the largest in the world. In 1967 Cotzias introduced treatment by laevohydroxy­phenylalanine (L‑DOPA); and in 1969 it could be given to the patients at Mount Carmel.

   Dr. Sacks describes in excellent clinical detail the remarkable experiences undergone by his patients when put on this drug. He gives us twenty informative and striking case histories. Nearly all, about 90 per cent, of the patients showed at least some degree of 'awakening' from their blocked and frozen state. In some it was to near normality, and in some it occurred with almost explosive suddenness. Most of those who recovered like this subsequently relapsed. The pattern of reaction in these post‑encephalitic patients seems to have been atypical, much more acute and more unpredictable than in the now standardized treat­ment of Parkinson's disease.

   The story Dr. Sacks has to tell centres on the psychic reactions of mental cripples suddenly finding themselves alive again. The case histories are the substance of the work and are a valuable record of very strange events. Dr. Sack's concluding chapters of philosophical ruminations, adorned by quotations from ancient and modern belles lettres, add little to the value of the annals, which remain unique.