Perhaps one that most stuck with me is how little we understand about the brain. This book is a unique experience, and there are many things one can gain from it. An exploration of Parkinsonism, the hidden biological nature of behaviour, and as with all of Sack's books, an exploration of humanity. When everything went right, when everything went wrong, and anything in between.

Throughout the book, Sacks gives the stories of his patients and how they reacted to L-Dopa. Rigidity is replaced by spontaneous irregular ticks, and cognition now seems to be in a pathological and permanent overdrive. While a lack of dopamine causes a trance-like state, L-Dopa often seemed to cause an excess. However, this miracle soon becomes apparent that this is indeed the real world, and while L-Dopa has recovered the souls of many patients, it's not always the case, and it's not free of complications. Reading the stories of these patients, re-emerging into the world, and being cured almost overnight, feels like reading a novel. That awakening being extreme enough that sometimes people were miraculously cured, having little or no symptoms of Parkinsonism. With L-dopa, however, most seem to experience an 'awakening', and hence the title of the book. The book describes Sack's experience with this treatment on his patients.Īs Parkinsonism progresses, people become more and more 'shutdown', losing touch with reality and increasingly self-absorbed into a reality of nothingness. Unlikely dopamine itself, it could pass the blood-brain barrier, increasing dopamine concentrations. In the 1950s and 60s, L-Dopa appeared as a treatment for Parkinsonism. The disease causes the death of cells in the substantia nigra (a region of the midbrain), which makes it not being able to have sufficient dopamine, which is largely responsible for motivational salience (motivation that elicits behaviour). The book brilliantly captures the lives and the experiences of these patients, and how they experience the world and themselves. People become speechless and motionless as if their 'soul' has left. While the disease is known more for its motor symptoms, like bradykinesia (slowness of movement), rigidity of the limbs, and postural instability, it also impacts mood and cognition.

It tells the story of Sack's patients affected with either Parkinson or most often encephalitis lethargica, also known as sleeping sickness, which resembles Parkinsonism, with perhaps somewhat more severe symptoms. My 4th book from Sacks and it didn't disappoint.

Awakenings by Oliver Sacks