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this, to assist this, and, finally, to describe this. All this was at the junction of biology and biography.
    This sense of the dynamics of illness and life, of the organism or subject striving to survive, sometimes under the strangest and darkest circumstances, was not a viewpoint which had been emphasized when I was a student or resident, nor was it one I found in the current medical literature. But when I saw these post-encephalitic patients, it was clearly and overwhelmingly true—indeed, it was the only way in which I
could
view them. Thus what had been dismissed disparagingly by most of my colleagues (“chronic hospitals—you’ll never see anything interesting in
those
places”) revealed itself as the complete opposite: an ideal situation in which to observe, to care, to explore.
Awakenings
would have been written, I think, even if there had not been any “awakening”: it would then have been
People
of the Abyss
(or
Cinquante Ans de Sommeil,
as the French edition has it), a delineation of the stillness and darkness of these arrested and frozen lives, and of the courage and humor with which patients, nonetheless, faced life.
    The intensity of feeling for these patients, and equally of intellectual interest and curiosity about them, bound us together as a community at Mount Carmel; and this intensity rose to a peak in 1969, the actual year of the patients’ “awakenings.” In the spring of that year, I moved to an apartment a hundred yards from the hospital and would sometimes spend twelve or fifteen hours a day with our patients. I was with the patients constantly—I grudged the hours of sleep—observing them, talking with them, getting them to keep notebooks, and keeping voluminous notes myself, thousands of words each day. And if I had a pen in one hand, I had a camera in the other: I was seeing such things as had never, perhaps, been seen before—and which, in all probability, would never be seen again; it was my duty, and my joy, to record and bear witness. Many others also dedicated themselves, spent countless hours in the hospital. All of us involved with the patients—nurses, social workers, therapists of every sort—were in constant communication: talking to each other excitedly in the passage, phoning each other on weekends and at night, constantly exchanging new experiences and ideas. The excitement, the enthusiasm, of that year was remarkable;
this,
it seems to me, was an essential part of the
Awakenings
experience.
    And yet, at the start, I scarcely knew what to expect. I had read the half-dozen reports on L-DOPA published in 1967 and ’68, but felt my own patients to be very different. They did not have ordinary Parkinson’s disease (like the other patients reported), but a post-encephalitic disorder of far greater complexity, severity, and strangeness. How would
these
patients, with their so-different disease, react? I felt I had to be cautious—almost exaggeratedly so. When, early in 1969, I embarked on the work which was later to become
Awakenings,
I conceived it in quite limited and narrowly “scientific” terms—as a ninety-day, double-blind trial of L-DOPA in a large group of patients who had become institutionalized after having encephalitis. L-DOPA was considered an experimental drug at this time, and I needed to get (from the Food and Drug Administration) a special investigator’s license to use it. It was a condition of such licenses that one use “orthodox” methods, including a double-blind trial, coupled with presentation of results in quantitative form.
    But it became obvious within a month or less that the original format would have to be abandoned. The effects of L-DOPA in these patients was decisive—spectacular; while, as I could infer from the precise 50 percent failure rate, there was no significant placebo effect whatever. I could no longer, in good conscience, continue the placebo but had