Awakenings - Movie Review

This review was part of an assignment I had to submit in my Basic Neuroscience course at grad school, which I just felt like posting just so.

"Out of the mountain of despair, a stone of hope" is what struck me as I was watching the movie Awakenings. When Dr. Malcolm Sayer (Robin Williams), a researcher by heart and mind, joins a chronic illness hospital in the summer of 1969, despair is his disposition. Despair on being asked to treat patients at limited facilities, with no conviction of them getting better. Through this despair arises hope when he meets Lucy - an old woman who had been seemingly ‘frozen’ for the last 40 years, in spite of which could catch a ball tossed at her perfectly well. With meticulous, yet wild skills of experimentation, observation, and interpretation, Sayer hypothesised that Lucy and several other patients in the hospital are actually suffering from a severe form of Parkinsonism. He proposes that the patient's motor impulses cancel each other out, making the patient incapable of moving or not moving, unless the cancelling out is overcome by certain triggers, like a ball being tossed at them, enabling them to catch it. 

At this juncture in the pharma market arises a new wonder drug - the L-Dopa, an outwardly perfect cure to Parkinson’s. This leads Sayer to theorise and hope that L-Dopa could bring these people back - bring them back to the world. Though interesting, the theory is met with scepticism by his colleagues at the hospital, who yield after relentless pursuit by Sayer and allow him to experiment with the drug on one patient, Leonard Lowe (Robert De Niro).

We first get a glimpse into Leonard’s head when he communicates ‘Rilke’s Panther’ to Sayer. The poem ends with the following stanza, “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.” At this moment, we become painfully aware that contrary to the understanding at the time, these patients are not cognitively impaired, that they are aware of their frozen state. In fact, aware to the extent where they could connect it to a piece of literature they read. It hence brings us so much content to see this prison-like life end for Leonard, and slowly the other patients. To see their wonder and gratitude in being able to do simple, regular things. 

Rosy as it was, roses wilt. Soon we realise that the drug is not as miraculous as we first thought, with side effects cropping up. Side effects that are so severe that they affect the normal quality of their lives. We realise that Science is a progressing field, where there are questions that we need to understand better, and then we might end up creating a drug that could be indeed a wonder. 

Now, decades later, we understand how movement is controlled by the brain. There are several regions in our brain that are interconnected by cells in the brain, called neurons via long finger-like projections called axons. Indeed they form a circuit very similar to the electrical circuits we have, where certain regions can be turned on and off, which decide whether ‘to move or not’. These kinds of circuits are present for every process - perceiving vision, smell, and the other senses, in learning and memory, sleep and anxiety. The turning on or off of neurons (called firing) is mediated by molecules - basically chemicals, one amongst which is dopamine. You may have heard of dopamine in the context of rewarding and memory, but it is also a key player in regulating movement. In Parkinson’s patients, the part of the brain producing dopamine is disrupted - thus disrupting movement. 

In this case, Dr. Sayer encountered patients who had suffered from a disease called encephalitis - basically an infection of the brain. Over the years, even after the infection subsided, the system changed, where the immune cells (the soldiers of the body) began perceiving some neurons in the brain (in the dopamine-producing part) as ‘enemies’ and began attacking them and killing them, again disrupting movement. The ‘wonder’ drug L-Dopa was nothing but a booster of dopamine - thus restoring movement. But with time it led to side effects because dopamine is involved in multiple functions - sensory, motor, cognitive and emotional. Constitutive dopamine treatment over activates these other systems leading to mood disorders, tremors, and tics. 

In the movie, despite the technological limitations of the age and the lack of understanding to the extent we currently possess, the power of scientific curiosity is brilliantly portrayed. As Sayer connects one dot to the other, we as the audience are left hanging to see what awakening is going to be made. His out-of-the-box theories where he says “She is borrowing the will of the ball”, sound so wild, but like Eleanor (the nurse in the ward), we are left wondering if that could be true. Yet despite the brilliance of his mind, what strikes us is his genuine intent to help his patients - to help them lead a better life, a normal life. Williams plays this role brilliantly - not just by balancing both ideologies but by bridging them. 

On the other hand, De Niro does a perfect job of not just capturing the essence of a Parkinsonian patient, but also giving him his own personality.  We can perceive this through the absolute wonder he portrayed on awakening, the conviction he held in his freedom, the anger felt in its denial, and the courage he demonstrated despite his suffering. The writing in the movie also requires merit for delivering all possible emotions, while maintaining subtle humour and a tone of positivity throughout the plot, and for ultimately leaving us with a renewed appreciation for life and a reminder of what it means to be alive.

This movie portrays hope to me in the best possible way, hope in life, in science, and in humanity. The beauty of it is the portrayal is very subtle - so subtle that one can perceive it as other qualities like faith, courage, and compassion. But as the driving force for all of these qualities acts hope. It is hope that led to the discovery and the treatment, hope held by both the caregivers and the cared. And it is hope that propelled Sayer to finally ask Eleanor out towards the end. It is also hope that kept Dr. Sacks, the real-life Dr. Sayer and other scientists to keep looking for solutions, even today, decades after.