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“Malformed” Is the Best Brain Book I Read This Year (and Maybe Ever)

Of all the glossy photo books to showcase on your coffee table, your first choice might not be one of decaying human brains. But it should be, so long as that book is “Malformed.”

The first few pages give a sense of what you’re in for: hauntingly beautiful photographs of brains (see slideshow above). One photo shows a seemingly normal brain, plump and pink-gray, floating in cloudy liquid inside a glass jar. Another shows a thick slice of each hemisphere sitting on top of wet, white gauze. In another, three small brains are tucked inside a jar with a yellowing label noting the condition their donors were born with: Down’s Syndrome.

Photographer Adam Voorhes took these photos and dozens of others in a forgotten storeroom at the University of Texas at Austin. There, on a wooden shelving unit, sit about 100 brain specimens from people who once lived in the Austin State Hospital between the 1950s and 1980s. The hospital was once called the Texas State Lunatic Asylum, and its residents were (or rather, were considered to be) mentally ill.

These stunning photos of their brains make up the bulk of the book, but they are accompanied by several equally lively essays about the history of the collection, written by journalist Alex Hannaford. Together, the pictures and text tell two compelling stories. The first is the sordid history of this asylum and others like it, and how we’ve changed our approach to treating mental illness. The second story — one that, by the way, has no end in sight — is how the material goo of the brain interacts with the environment to shape our behavior.

The Austin State Hospital, formerly known as the Texas State Lunatic Asylum. Photo via Wikipedia.
The Austin State Hospital, formerly known as the Texas State Lunatic Asylum. Photo via Wikipedia

The Texas State Lunatic Asylum was founded, in 1853, with a quarter million dollars from the federal government and a surprisingly progressive mandate. Its supporters believed that the best treatment for the mentally ill was fresh food, fresh air, and a little peace and quiet. So the asylum grounds, enclosed by a cedar fence, included vegetable gardens, fruit orchards, oak and pecan trees, and even a string of lakes. Patients could roam as they pleased.

Within two decades, though, this idyllic picture began to crack. “Overcrowding, illness, escape and even some fairly horrific suicide attempts — all were documented in the pages of the local paper,” Hannaford writes.

Some of the most interesting parts of the book are the descriptions of these early asylum patients. Many, as you might expect, were diagnosed with insanity or mania. Others had conditions that we don’t typically associate with mental illness today, such as epilepsy, stroke, Alzheimer’s, and Down Syndrome. Still other diagnoses were, at least to me, wholly unexpected: love, masturbation, menopause, “excessive study,” “religious excitement,” and even “melancholia caused by deranged menstruation.”

None of these early patients had their brains removed at death. The brain collection began in the 1950s, apparently at the whim of the hospital’s pathologist, Coleman de Chenar. When he died, in 1985, six major scientific institutions, including Harvard Medical School, wanted his brain collection. It ended up at the University of Texas.

Why such interest in these homely lumps of dead tissue? Because of the tantalizing idea that brains can reveal why a sick person was sick. In some cases, gross anatomy indeed provides answers, albeit vague. There are many pictures in “Malformed” showing brains with obvious abnormalities, such as an asymmetrical shape, dark, blood-filled grooves, or a complete lack of folding.

It’s satisfying to think, ‘A ha, that’s why they were disturbed.’ Hannaford tells a fascinating story, for example, about a man named Charles Whitman. One day in 1966, the 25-year-old engineering student at the University of Texas went on a shooting rampage, killing 16 people and wounding 32 before being shot by police. In a note he left behind, Whitman asked to be autopsied, “urging physicians to examine his brain for signs of mental illness,” Hannaford writes. De Chenar performed the autopsy. When examining the killer’s brain, the doctor found, right in the middle, a 5-centimeter tumor.

A later report concluded that this tumor, which was highly malignant, “conceivably could have contributed to his inability to control his emotions and actions.” On the other hand, Whitman also allegedly suffered from child abuse and mental illness. So there’s no way to know, for sure, what caused what.

And that’s the case for all postmortem brain investigations, really. A couple of years ago I wrote a story for Scientific American about researchers in Indiana who are doing DNA analyses on century-old brain tissue that once belonged to mental patients. It’s unclear whether the DNA will be useable, after all this time. Even if it is, the researchers will be left with the unanswerable question of cause and effect. Did a particular genetic glitch cause the patient to have delusions? And how many healthy people are walking around right now with slightly abnormal brains that will never be subjected to scientific scrutiny?

This sticky issue, by the way, persists whether the person in question is mentally ill or mentally exceptional. Earlier this year I wrote about Einstein’s brain, which was stolen at autopsy, carved into 240 pieces, and (eventually) distributed to several laboratories. These researchers have published half a dozen studies reporting supposedly distinctive signatures of Einstein’s brain. “The underlying problem in all of the studies,” I wrote in that piece:

“…is that they set out to compare a category made up of one person, an N of 1, with a nebulous category of ‘not this person’ and an N of more than 1. With an N of 1, it’s extremely difficult to calculate the statistical variance — the likelihood that, for example, Einstein’s low neuron-to-glia ratio is real and not just a fluke of that particular region and those particular methods. Even if the statistics were sound, you’d still have the problem of attributing skills and behaviors to anatomy. There’s no way to know if X thing in Einstein’s brain made Einstein smart/dyslexic/good at math/you name it, or was just an X thing in his brain.”

“Malformed” is able to make that point more subtly and beautifully than anything else I’ve read. By looking at these brains, each photographed with such care, the irony is obvious: At one point not so long ago, we were willing to take away a person’s freedom — perhaps the ultimate sign of disrespect — for innocuous behaviors considered “abnormal.” And yet, at the same time, we went to great lengths to remove and preserve and label and, yes, respect these people’s dead brain tissue.

It would be wonderful if these specimens someday make a solid contribution to the science of mental illness. If they never do, though, they’re still valuable. They tell a story of a dark chapter in our history — one that I hope is never re-opened.

11 thoughts on ““Malformed” Is the Best Brain Book I Read This Year (and Maybe Ever)

  1. “dark chapter in our history” is a mischaracterization, especially in that they provided care and medical support for severely (mentally) ill people.

    this care provided unfathomable relief for families and addressed major safety concerns…for the patients, families, and communities.

    24×7 care is what many today dream of for them and/or their relatives, as they terribly deteriorate mentally and physically.

  2. They were dark by our standards, but progressive compared to what they replaced (prison and church almshouses with no prospect of treatment).

    Of course many of these places operated for 100+ years. There were probably times when conditions were better than others, and it probably varied by what your condition was.

    I studied one of these hospitals in Athens, Ohio which eventually came to specialize in lobotomies. There’s a whole fascinating story about the building itself. It was gigantic. A similar one nearby in Columbus was reportedly the largest building under one roof until the Pentagon was built. Apparently they used paving bricks, three thick, built to stand for ages.

    The architect was a Quaker named Dr. Kirkbride who believed that he could classify people’s illness and segregate them by severity (with a theory that less severe cases might be harmed by exposure to more severe cases). From the central administration wing the patients were progressively more deranged as you went outward (the two wings segregating them by sex).

    Kirkbride worked with the famous landscape architect Frederick Law Olmsted who designed the grounds as gardens. They aimed for a pastoral environment that would be calming (trying to avoid any dramatic mountain vistas which they thought would be too jarring). They thought maybe urban living was causing or exacerbating mental illness.


    Early treatments were apparently very crude. One alternated patients rapidly between very hot and freezing cold baths. Patients who seemed to be depressed were sometimes thrown off a cliff into a pond as a method of shaking them out of it. From there onto the electroshock and lobotomies and thorazine shuffles.

    Eventually a patients’ right movement caused the Ohio legislature to establish a minimum wage for them and that, combined with another trend of de-instutionalization, caused a lot of these hospitals to close. For all their flaws, were relatively well supported because the patients worked as part of their therapy, producing their own food and other necessities. The hospital in Athens had almost every service you can imagine in a small village from tailor, tinshop, woodshop, gardens, orchards, dairy, eggs, pork, etc. When a patient died, other patients cut the trees and made a coffin, dug a grave, made a marker and buried them.

    For all the horrors of suicide and abuse, there were also people who had made a home for themselves that was all they knew, and who committed suicide when told they were to be discharged because they couldn’t face life in the world at large. I suspect from all I know that these places embodied all the complexities of being human at the extremes of caring and cruelty.

  3. Can I recommend that you (and other journalists) stop linking books to Amazon pages? I realize it might seem convenient but for people who are generally engaged in online media and social issues, it strikes me as a strange naivete that so many online journalists do this like there’s no social or ethical aspect to it. Why, in mentioning a book, should you support a particular commercial retailer? And why, of all retailers, one of such notoriously poor business practices and working standards?

    This isn’t intended as a harsh criticism, though I realize text can make it seem that way. It’s intended more in the tone: “Hey, have you ever really considered..?” This just seems like an encroaching journalistic standard that needs to be nipped in the bud. Readers should not be encouraged to an Amazon page every time they read a book review on a news site, and if there are any financial incentives for doing this, the site/journalist should make it clear that that’s the case.

  4. Regarding using amazon links: great idea imo.
    Via a simple CLICKED LINK, Amazon provides sample content, various vendors and prices and conditions(new/used) to buy from.
    Its REALLY hard to beat THAT.

    While Apple has colluded to the global anti-consumer crime of price fixing,
    Amazon has proven their pro-consumer interest in bringing DOWN prices.

    Amazon and their Kindles are to books, what google is to search, what kleenex is to tissues: genericized trademarks.

    For the above reasons, it is rational and helpful to use amazon links.

  5. What interests me is just how far from ‘normal’ the brain can be (Or be set to.) while still maintaining ‘normal’ function. Such as the case of that Chinese woman recently who turned out to be missing quite an important piece of brain but who, aside from some developmental delay, was able to live a perfectly normal life.

  6. Gordon Rattray Taylor, “The Natural History of the Mind”, Secker and Warburg, 1979

    – don’t know if it is on Amazon (I plead laziness, but I am not even going to check 🙂

    This is a fantastic book, I’m only in 4 chapters out of 20, but it has inspired me so much I feel I’m now ready to start with some neurosurgery and psychoanalysis of my own 😀

    No, seriously, what this book has revealed to me about this marvelous microcosm each of us carries around in our eggshells, is that more has been discovered about the functional architecture and allocation in the brain through people who have survived with hereditary, congenital or traumatic brain injury than all the Pavlovian and Skinner testing on animals. They may be our furry friends, and they may even be very much loved and doted on, but they are not persons. Their brains and their minds do not function like those of a person, they are inherently animal and instinctive.

    And so to “Malformed” :

    Even the most brain damaged person, the most psychologically scarred person, the most abused and neglected person, has personhood in the manifestation of free will and the desire to find meaning in life. And in spite of limited, even debilitating capacities in their psyches, they still form a valuable part of society, appreciating and studying what they can do with their limitations.

    1. ” they are inherently animal and instinctive.” Yes we are!
      We are all animals, more specifically mammals. Brain architecture and function is shared and impressively comparable among us mammals.
      Some of us are more social.
      Some of us more impulsive.
      Some of us can communicate incredibly rapidly and well and manipulate the environment.
      Some are outcasts. Some are mean. All decieve. All use body language.
      Relationships, bonds, memories, learning, identifying with groups, hierarchies, emotions…we all have them.

  7. Aren’t we (all (us persons) ) substantially above our animal instincts?

    Yes we do have many facets, but the “me” in me are my thoughts, the things I ascribe meaning to, indeed the quest to find meaning. The animal part of me is only there to support this – don’t you think?

  8. Great suggestion. I saw this book earlier and was thinking about buying it. I´m highly interested in this topic, especially since I saw Robert Sapolsky´s bio lectures on Youtube. And what would be my suggestion for this years best readers choice? I think I would go for Joyous Health, a great read especially for those who believe in a holistic approach to things.

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