Fitness Awakenings Oliver Sacks Pdf


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Awakenings--which inspired the major motion picture--is the remarkable story of a group of patients who contracted sleeping-sickness during the great epidemic. Read Awakenings PDF - by Oliver Sacks Vintage | Awakenings--which inspired the major motion picture--is the remarkable story of a group of. Br MedJ7 ; 24 Yeats WB. In: Wade A, ed. The letters of W B Yeats. London: Hart-Davis,. The origin of "Awakenings". OLIVER SACKS.

Awakenings Oliver Sacks Pdf

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'Awakenings' author, neurologist Oliver. Sacks dies at 30 August , byMalcolm Ritter. This is a Nov. 26, file photo of Dr Oliver Sacks, receiving his. Hailed as a medical classic, and the subject of a major feature film as well as radio and stage plays and various TV documentaries, Awakenings by Oliver Sacks. Download Best Book Awakenings, ^^PDF FILE Download Awakenings when Dr. Oliver Sacks gave them the then- new drug L-DOPA, which.

Other causes of Parkinsonism - coal-gas poisoning, manganese poisoning, syphilis, tumours, etc. Parkinson's disease has been called the 'shaking palsy' or its Latin equivalent - paralysis agitans for some centuries. It is necessary to say at the outset that the shaking or tremor is by no means a constant symptom in Parkinsonism, is never an isolated symptom, and is often the least problem which faces the Parkinsonian patient. If tremor is present, it tends to occur at rest and to disappear with movement or the intention to move 7 , sometimes it is confined to the hand, and has a characteristic 'pill-rolling' quality or in Gower's words a quality 'similar to that by which Orientals beat their small drums'; in other, and especially in post-encephalitic patients, tremor may be extremely violent, may affect any or every part of the body, and tends to be increased by effort, nervousness, or fatigue.

The term 'post-encephalitic' is used to denote symptoms which have come on following an attack of encephalitis lethargica, and as a direct or indirect consequence of this.

The onset of such symptoms may be delayed until many years after the original attack. There are many actors, surgeons, mechanics, and skilled manual workers who show severe Parkinsonian tremor at rest, but not a trace of this when they concentrate on their work or move into action. The second commonly mentioned symptom of Parkinsonism, besides tremor, is stiffness or rigidity; this has a curious plastic quality - often compared to the bending of a lead pipe - and may be of intense severity 8.

It must be stressed, however, that neither tremor nor rigidity is an essential feature of Parkinsonism; they may both be completely absent, especially in the post-encephalitic forms of disease with which we shall especially be concerned in this book. The essential features of Parkinsonism, which occur in every patient, and which reach their extremest intensity in post- encephalitic forms of disease, relate to disorders of movement and 'push'. The first qualities of Parkinsonism which were ever described were those of festination hurry and pulsion push.

Festination consists of an acceleration and with this, an abbreviation of steps, movements, words, or even thoughts - it conveys a sense of impatience, impetuosity, and alacrity, as if the patient were very pressed for time; and in some patients it goes along with a feeling of urgency and impatience, although others, as it were, find themselves hurried against their will 9.

The character of movements associated with festination or pulsion are those of quickness, abruptness, and brevity. These symptoms, and the peculiar 'motor impatience' akathisia which often goes along with them, were given full weight by the older authors: thus Charcot speaks of the 'cruel restlessness' suffered by many of his patients, and Gowers of the 'extreme restlessness.

It was observed by Charcot, and is observed by many Parkinsonian patients themselves, that rigidity can be loosened to a remarkable degree if the patient is suspended in water or swimming see below the cases of Hester Y. The same is also true, to some extent, of other forms of stiffness and 'clench' - spasticity, athetosis, torticollis, etc.

Thus festination 'scelotyrbe festinans' is portrayed by Gaubius in the eighteenth Century: 'Cases occur in which the muscles, duly excited by the impulses of the will, do then, with an unbidden agility, and with an impetus not to be repressed, run before the unwilling mind.

There are many different forms of akinesia, but the form which is exactly antithetical to hurry or pulsion is one of active retardation or resistance which impedes movement, speech, and even thought, and may arrest it completely.

Patients so affected find that as soon as they 'will' or intend or attempt a movement, a 'counter-will' or 'resistance' rises up to meet them. They find themselves embattled, and even immobilized, in a form of physiological conflict - force against counter-force, will against counter-will, command against countermand.

For such embattled patients, Charcot writes: 'There is no truce'- and Charcot sees the tremor, rigidity, and akinesia of such patients as the final, futile outcome of such states of inner struggle, and the tension and tiredness of which Parkinsonian patients so often complain as due to the pre-emption of their energies in such senseless inner battles. It is these states of push and constraint which one patient of mine Leonard L. Analogous concepts are used by William James, in his discussion of 'perversions' of will Principies, 2, xxvi.

The two basic perversions delineated by James are the 'obstructive' will and the 'explosive' will; when the former holds sway, the performance of normal actions is rendered difficult or impossible; if the latter is dominant, abnormal actions are irrepressible.

Although James uses these terms with reference to neurotic perversions of the will, they are equally applicable to what we must term Parkinsonian perversions of the will: Parkinsonism, like neurosis, is a conative disorder, and exhibits a formal analogy of conative structure.

At this point we must introduce a fundamental theme which will re-appear and re-echo, in various guises, throughout this book. We have seen Parkinsonism as sudden starts and stops, as odd speedings and slowings. Our approach, our concepts, our terms have so far been of a purely mechanical or empirical type: we have seen Parkinsonians as bodies, but not yet as beings We must come down from our position as 'objective observers', and meet our patients face-to-face; we must meet them in a sympathetic and imaginative encounter: for it is only in the context of such a collaboration, a participation, a relation, that we can hope to learn anything about how they are.

They can tell us, and show us, what it is like being Parkinsonian - they can tell us, but nobody else can. Indeed we must go further, for if - as we have reason to suspect - our patients may be subject to experiences as strange as the motions they show, they may need much help, a delicate and patient and imaginative collaboration, in order to formulate the almost-unformulable, in order to communicate the almost incommunicable.

We must be co-explorers in the uncanny realm of being-Parkinsonian, this land beyond the boundaries of common experience; but our quarry in this strange country will not be 'specimens', data, or 'facts', but images, similitudes, analogies, metaphors - whatever may assist to make the strange familiar, and to bring into the thinkable the previously unthinkable.

What we are told, what we discover, will be couched in the mode of 'likeness' or 'as if', for we are asking the patient to make comparisons - to compare being-Parkinsonian with that mode-of-being which we agree to call 'normal'. All experience is hypothetical or conjectural, but its intensity and form vary a great deal: thus patients able to achieve some detachment, or patients only partially or intermittently affected, will describe their experiences in metaphorical terms; whereas patients who are continually and completely engulfed by their experience will tend to describe it in hallucinatory terms Thus, images such as 'Saturnian gravity' are used with great frequency by patients.

One patient Helen K. I seemed to weigh tons, I was crushed, I couldn't move. I couldn't stay put, I weighed nothing, I was all over the place. It's all a matter of gravity, in a way - first there's too much, then there's too little.

In some patients, there is a different form of akinesia, which is not associated with a feeling of effort and struggle, but with one of continual repetition or perseveration: thus Gowers records the case of one patient whose limbs ' Arrest akinesia or profound slowing bradykinesia are equally evident in other spheres - they affect every aspect of life's stream, including the stream of consciousness.

Thus, Parkinsonism itself is not 'purely' motor - there is, for example, in many akinetic patients, a corresponding 'stickiness' of mind or bradyphrenia, the thought stream as slow and sluggish as the motor stream. The thought stream, the stream of consciousness, speeds up in these patients with L-DOPA, often speeding too far, into a veritable tachyphrenia, with thoughts and associations almost too fast to follow. Again, there is not merely motor, but a perceptual inertia in Parkinsonism: a perspective drawing of a cube or a staircase, for example, which the normal mind perceives first this way and then that, in alternating perceptual configurations or hypotheses, may be absolutely frozen in one configuration for the Parkinsonian; it will unfreeze as he 'awakens' and may then be thrust, with the continuing stimulation of L-DOPA, in the opposite direction, with a near-delirium of perceptual hypotheses alternating many times a second.

These characteristics - of impulsion, of resistance, and of perseveration - represent the active or positive characteristics of Parkinsonism. We will later have occasion to see that they are to some extent interchangeable, and thus that they represent different phases or forms or transformations of Parkinsonism. Parkinsonian patients also have 'negative' characteristics - if this is not a contradiction in terms.

Thus some of them, Charcot particularly noted, would sit for hours not only motionless, but apparently without any impulse to move: they were, seemingly, content to do nothing, and they lacked the 'will' to enter upon or continue any course of activity, although they might move quite well if the stimulus or command or request to move came from another person - from the outside.

Such patients were said to have an absence of the will - or 'aboulia. To a greater or less degree, all Parkinsonian patients show alteration of 'go', impetus, initiative, vitality, etc.

A special form of negative disorder, not described in the classical literature, is depicted with Hester Y. Thus Parkinsonian patients suffer simultaneously though in varying proportions from a pathological absence and a pathological presence.

The former cuts them off from the fluent and appropriate flow of normal movement and - in severe cases - the flow of normal perception and thought , and is experienced as a 'weakness', a tiredness, a deprivation, a destitution; the latter constitutes a preoccupation, an abnormal activity, a pathological organization, which, so to speak, distends or inflates their behaviour in a senseless, distressing, and disabling fashion.

Patients can be thought of as engorged with Parkinsonism - with pathological excitement 'erethism' - as one may be engorged with pain or pleasure or rage or neurosis. The notion of Parkinsonism as exerting a pressure on the patient seems to be supported, above all, by the phenomenon of kinesia paradoxa which consists of a sudden and total though transient disappearance or deflation of Parkinsonism - a phenomenon seen most frequently and most dramatically in the most intensely Parkinsonian patients 14 Thus one may see such patients, rigid, motionless, seemingly lifeless as statutes, abruptly called into normal life and action by some sudden exigency which catches their attention in one famous case, a drowning man was saved by a Parkinsonian patient who leapt from his wheelchair into the breakers.

The return of Parkinsonism, in circumstances like these, is often as sudden and dramatic as its vanishing: the suddenly 'normal' and awakened patient, once the call-to-action is past, may fall back like a dummy into the arms of his attendants.

Dr Gerald Stern tells me of one such patient at the Highlands Hospital in London who was nicknamed 'Puskas' after the famous footballer of the s. Puskas would often sit frozen and motionless unless he were thrown a ball; this would instantly call him to life, and he would leap to his feet, swerving, running, dribbling the ball, with a truly Puskas-like acrobatic genius.

If thrown a matchbox he would catch it on the tip of one foot, kick it up, catch it, kick it up again, and in this fashion, juggling the matchbox on one foot, hop the entire length of the ward. He scarcely showed any 'normal' activity; only this bizarre and spasmodic super-activity, which ended, as it started, suddenly and completely.

There is another story of the post-encephalitic patients at Highlands.


Two of the men had shared a room for twenty years, but without any contact or, apparently, any feeling for each other; both were totally motionless and mute.

One evening, while doing rounds, Dr Stern heard a terrific noise coming from this room of perpetual silence. Rushing to it with a couple of nurses, he found its inmates in the midst of a violent fight, throwing each other around and shouting obscenities.

The scene, in Dr Stern's words, was 'not far short of incredible - none of us ever imagined these men could move. The moment they were separated, they became motionless and mute again - and have remained so for the last fifteen years.

In the thirty-five years they have shared a room, this is the only time they 'came alive.

Instantly she starts juggling them - she can juggle up to seven, in a manner incredible to see - and can continue doing so for half an hour on end.

But if she drops one, or is interrupted for a moment, she suddenly becomes motionless again. With another such patient Maurice P.

The entire 'performance,' which was flawless and brilliant, occupied no more than a few seconds. Less abrupt and complete, but of more therapeutic relevance, is the partial lifting of Parkinsonism, for long periods of time, in response to interesting and activating situations, which invite participation in a non-Parkinsonian mode.

Different forms of such therapeutic activation are exemplified throughout the biographies in this book, and explicitly discussed on P. It is scarcely imaginable that a profound deficiency can suddenly be made good, but it is easy to conceive that an intense pressure might suddenly be relieved, or an intense charge discharged. Such conceptions are always implicit, and sometimes explicit, in the thinking of Charcot, who goes on, indeed, to stress the close analogies which could exist between the different forms or 'phases' of Parkinsonism and those of neurosis: in particular Charcot clearly saw the formal similarity or analogy between the three clearly distinct yet interchangeable phases of Parkinsonism - the compliant-perseverative, the obstructive-resistive, and the explosive-precipitate phases - with the plastic, rigid, and frenzied forms of catatonia and hysteria.

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These insights were reinforced during the s, by observation of the extraordinary amalgamations of Parkinsonism with other disorders seen in the encephalitis epidemic. They were then completely 'forgotten', or thrust out of the neurological consciousness. The effects of L-DOPA - as we shall see - compel us to reinstate and elaborate the forgotten analyses and analogies of Charcot and his contemporaries.

Footnotes from "Frances D.

Oliver Sacks

Eliot , is quite fundamental, and seen in every patient. This was shown beautifully, and discussed with great insight, by Edith T. She said that she had become 'graceless' with the onset of Parkinsonism, that her movements had become 'wooden, mechanical - like a robot or doll', that she had lost her former 'naturalness' and musickness' of movement, that - in a word - she had been 'unmusicked'. Fortunately, she added, the disease was 'accompanied by its own cure'.

I raised an eyebrow: 'Music', she said, 'as I am unmusicked, I must be remusicked. In this state, this statelessness, this timeless irreality, she would remain, motionless-helpless, until music came: 'Songs, tunes I knew from years ago, catchy tunes, rhythmic tunes, the sort I loved to dance to. I am often asked what music can serve to awaken such patients, and what precisely is going on at such times.

Rhythmic impetus has to be present, but has to be 'embedded' in melody.

Raw overpowering rhythm, which cannot be so embedded, causes a pathological jerking, it coerces instead of freeing the patient, and thus has an anti-musical effect. Shapeless crooning 'slush', Miss D. One is reminded here of Nietzsche's definition regarding the pathology of music: here he sees, first and foremost, 'degeneration of the sense of rhythm'. This was precisely Miss D. Would any music, then, provided it was firm and shapely, serve to get Frances D. By no means.

The only music which affected her in the right way was music she could enjoy; only music which moved her 'soul' had this power to move her body. Equally striking, and analogous, was the power of touch. At times when there was no music to come to her aid, and she would be frozen absolutely motionless in the corridor, the simplest human contact could come to the rescue. One had only to take her hand, or touch her in the lightest possible way, for her to 'awaken'; one had only to walk with her and she could walk perfectly, not imitating or echoing one, but in her own way.

But the moment one stopped she would stop too. From his youth, Sacks wanted to write history and biography.

This reflected the influence of his parents—doctors who were fond of telling medical stories. Trained at the former Middlesex Hospital Medical School, Oliver Sacks was influenced by the neurologist Michael Kremer —88 —urbane, suave, polished and ever attentive to his patients although history relates that Kremer read novels under his desk as the elderly ladies of north London catalogued their many excruciating symptoms.

As a child, Oliver read philosophy and detective stories.

Starting neurological practice in at the Beth Abraham Medical Centre in the Bronx NY , where for many decades had been accommodated the victims of encephalitis lethargica, suddenly Sacks had something unusual to say. This was more than chemical challenge; and Professor Sacks was fearful of what might happen once these victims were released from the suspended isolation of their ancient world—their ability to interact and express emotions now suddenly re-awakened.

Rose R had lost the entire period from ; she remembered George Gershwin — and was aware that the date was now but could give no account of the intervening 40 years apart from one or two headlines. How flattering is it when, for the doctor who writes for a broader readership, his book becomes a movie and a ballet—as happened with Awakenings? In Musicophilia , Oliver Sacks extols the virtues of music therapy in post-encephalitic parkinsonism and other neurological disorders.

Music allows us to register and reconcile the ambiguities of time. It is specifically human to synchronize with a beat; and the biology of rhythm is innate.

Without rhythm there is no music. Humans bond through rhythm—clapping their hands and dancing in unison. Language and music overlap. In an occasional paper in the current issue see page , Oliver Sacks describes eight patients with text hallucinations of musical notation. As a result it has not proved possible for any of the patients to set down the notation of their experiences.

Most of his patients are musicians with musical eyes but one, whose hallucinations are less elaborate than the others, is not. Revealing the depth and warmth of a clinician who has spent a lifetime examining and communicating these phenomena, his views are expressed in a style that transcends the capabilities of his fellow authors in the field.

Hallucinations is not just neurological anecdote and cultural tourism, it is a serious analysis that the authors of Diagnostic and Statistical Manual of Mental Disorders DSM-6 would do well to heed in linking sensory deceptions to the neurobiology of perception and the semiology of people who attend psychiatric clinics. Here, a recently separated woman, whose husband has been unfaithful, befriends a middle-aged man heading back to Ireland and retirement after 25 years as a planter in the Federated Malay States.

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An annual analIn one hospital in particular — the Beth Abraham in the Bronx — some 80 patients, long regarded as effectively moribund, returned explosively to life. One must allow, instead, that their possibilities of continued well-being were actively precluded or prevented because they became 'incompossible' with other worlds, with the totality of their relationships, without and within. For Permissions, please email: journals. Product Details. And, concentrating fiercely, totally absorbed in his own activity, he falls once again into the grossest festination.

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Sometimes the patient can do this for himself - employing his ingenuity, his cerebral cortex, to bypass the subcortical transfixion of attention, to compensate for the subcortical emptiness of attention. Compulsively readable…a brilliant and humane book. Focal dystonias and occupational cramps emerged from the mists of 19th century descriptive neurology and the assumption that these are psychiatric disorders with the work of David Marsden —98 who swung the pendulum sharply in the direction of a strictly organic basis for these conditions.

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