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to try L-DOPA in every patient; and I could no longer think of giving it for ninety days and then stopping—this would have been like stopping the very air that they breathed. Thus what was originally conceived as a limited ninety-day experiment was transformed instead into a historical experience: a story, in effect, of life for these patients as it had been before L-DOPA, and as it was changed, and as it was to become, after starting treatment with L-DOPA.
    Thus I was impelled, willy-nilly, to a presentation of case-histories or biographies, for no “orthodox” presentation, in terms of numbers, series, grading effects, etc., could have conveyed the historical reality of the experience. In August 1969, then, I wrote the first nine case histories, or “stories,” of
Awakenings.
    The same impulse, the same sense that one had to convey stories and phenomena—the drama of stories, the delight of phenomena—led me to write a number of letters to the editor, which I dispatched to the
Lancet
and the
British Medical Journal
early the next year. I enjoyed writing these letters, and as far as I could gather, readers of these journals enjoyed reading them too. There was something about their format and style that allowed me to convey the wonder of the clinical experience, in a way that would have been quite impossible in a medical article.
    I now decided to present my overall observations, and my general conclusions, while still adhering to an epistolary format. My earlier letters to the
Lancet
had been anecdotal (and everyone loves anecdotes); I had not yet attempted any general formulations. My first experiences, the patients’ first responses, in the summer of ’69, had been happy ones; there had been an astonishing, festive “awakening,” at the time—but then all of my patients ran into trouble and tribulation. I observed, at this time, not only specific “side-effects” of L-DOPA, but certain general patterns of trouble—sudden and unpredictable fluctuations of response, the rapid development of oscillations, the development of extreme sensitivity to L-DOPA, and finally, the absolute impossibility of matching dose and effect—all of which I found dismaying in the extreme. I tried altering the dose of L-DOPA, but this no longer worked—the “system” now seemed to have a dynamic of its own.
    In the summer of 1970, then, in a letter to the
Journal of
the American Medical Association,
I reported these findings, describing the total effects of L-DOPA in sixty patients whom I had maintained on it for a year.
All
of these, I noted, had done well at first; but all of them, sooner or later, had escaped from control, had entered complex, sometimes bizarre, and unpredictable states. These could not, I indicated, be seen as “side effects,” but had to be seen as integral parts of an evolving whole. Ordinary considerations and policies, I stressed, sooner or later ceased to work. There was a need for a deeper, more radical understanding.
    My
JAMA
letter caused a furor among some of my colleagues. I was astonished and shocked by the storm that blew up; and, in particular, by the tone of some of the letters. Some colleagues insisted that such effects “never” occurred; others that, even if they did, the matter should be kept quiet, lest it disturb “the atmosphere of therapeutic optimism needed for the maximal efficiency of L-DOPA.” It was even thought, absurdly, that I was “against” L-DOPA—but it was not L-DOPA but reductionism that I was against. I invited my colleagues to come to Mount Carmel, to see for themselves the reality of what I had reported; none of them took up my invitation. I had not properly realized, until this time, the power of
wish
to distort and deny—and its prevalence in this complex situation, where the enthusiasm of doctors, and the distress of patients, might lie in unconscious collusion, equally