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from Awakenings by Oliver Sacks


The weapons of use in the tribulations of L-DOPA are those we all use in conducting our lives: deep strengths and reserves, whose very existence is unsuspected; common sense, forethought, caution, and care; special vigilance and wiles to combat special dangers; the establishment of right relations of all sorts; and, of course, the final acceptance of what must be accepted.  A good part of the tribulations of patients (and their physicians) comes from unreal attempts to transcend the possible, to deny its limits, and to seek the impossible:  accommodation is more laborious and less exalted, and consists, in effect, of a painstaking exploration of the full range of the real and the possible.


Accommodation lacks the glamour of Awakening.  It lacks its sudden, spontaneous, 'miraculous' quality.  It does not come 'of itself' - easily and effortlessly.  It is earned, worked for - with infinite effort and courage and trouble.  It does not reflect some local change in the basal ganglia, and can in no sense be regarded as localized process:  it is an achievement of character, of negotiation, in its widest possible sense.  What is achieved in this way, with work and difficulty, is secure and enduring - unlike the facile 'flash' of 'awakening,' which goes, as it comes, too easily, too quickly… The qualities of the first DOPA-awakening are essentially those of innocence and joy - like an anomalous return to earliest childhood:  the 'awakened,' in this sense, irrespective of their age, come to resemble the 'once-born' of whom William James speaks.  Tribulation is an ordeal, a dark night of the soul, which challenges to the utmost those who must face it.  A number are broken and fail to survive; others endure and are forged by their suffering.  These survivors - the 'accommodated' - have (in James's words) “drunk too deeply of the cup of bitterness ever to forget its taste, and their redemption is into a universe two storeys deep.”  These, then, are the 'twice-born,' who after bitter division, physiological and social, finally achieve a real reunion, a reconciliation of the deepest and stablest kind.


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