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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.

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The Hopes and Heartaches of Curing HIV

It’s one of the most incredible stories in medical science: a cure for HIV. It happened first in 1998 with Christian Hahn (a pseudonym), and then again in 2008 with Timothy Ray Brown. Both cures took place in Berlin, but involved very different scientific approaches and very different scientists.

In her new book, Cured, scientist and science writer Nathalia Holt tells the personal stories of the so-called Berlin patients, their families, and their doctors. She also delves into the complex — and still largely befuddling — science of the HIV virus, and shows how this research has influenced the cancer field.

I learned a lot from Natalie’s book and was eager to pick her brain about how it came together.

Photo by Jon Cohen
Nathalia at work. Photo by Jon Cohen

VH: You’re a scientist studying HIV. When did you get into science writing?

NH: I stumbled into it because I wanted to tell this story. It’s an important story that has had tremendous influence on HIV medicine. Yet little has been written about what these cases mean and how they’ve shaped clinical trials today. However, it wasn’t until I learned the personal stories of the people involved that I decided it had to be a book. Their stories were just too good. I had no idea when I first started working on this project how much I would fall in love with science writing. It’s hard to imagine it not being a part of my life today.

VH: The HIV field has undergone an enormous transformation since the 1980s, both in terms of scientific discoveries and in overcoming stigma. Do you think people are generally well informed about the disease today?

NH: We’ve come so far from those early, fearful days of HIV. It’s hard to imagine that only a few decades ago people living with the virus were kept out of schools, denied emergency services and even barred from some hospitals. Today, HIV transmission and prevention is common knowledge in a way we could have only dreamed of in the late 1980s. Unfortunately, the stigma attached to the disease hasn’t faded away. A recent example is HIV shaming where young men find themselves called “Truvada whores” and the dating world becomes increasingly fragmented between those with the virus and those without. Our ability to treat and cure HIV in the future is threatened by the continued stigma, apathy and ignorance surrounding HIV.

VH: That continued stigma makes it all the more impressive that you managed to get not only Christian, who has chosen to stay anonymous, but also Timothy Ray Brown and Dr. Heiko Jessen to open up about quite intimate things — their fears and hopes, their family’s reactions, even details about their sexual experiences. How did you approach them initially? Was it difficult to develop that kind of trust?

NH: Being an HIV researcher I was fortunate to get introductions through mutual acquaintances. Slowly, our relationships grew. It didn’t happen overnight. From the beginning I knew I wanted to push character development in the book; to show not only the good but also the troubling moments we all have. It was an incredible experience to have these men open up their lives to me. There’s something magical about learning all the little details that make up a person’s life. I’m very grateful for the many hours these men, and their families and friends, spent with me. They inspired me to open the book with an embarrassing story about myself. It seemed only fair.

VH: I won’t say what the embarrassing story was because everyone should go buy the book to find out.

But what about your relationships with your scientist-sources? Part of what’s so interesting about this story is the intense competition (and even, in some cases, backstabbing) among HIV scientists the world over. Do you think your scientific background and professional connections helped you when it came to asking the big players to tell you their stories? Or did some of them see you as entrenched in a particular camp?

NH: Being in the field both helped and hurt. It allowed me to get the details of fights over authorship, backstabbing and clinical trials in a way that would have been difficult otherwise. On the other hand, I entered this stage of reporting with biases that a science journalist probably wouldn’t have. I think this is where being a relatively young scientist is an advantage. I didn’t have decades of these biases to contend with so no one saw me as entrenched in a particular camp. Instead I felt like the big players I spoke with were trying to explain their perspective honestly. Writing about these tense moments wasn’t always easy but I felt it was important to show the influence intense competition can have on research, particularly follow-up studies.

VH: Your writing is often cinematic. I was repeatedly amazed by the way you were able to set up scenes to make the patients’ stories come alive. Here’s one example, in which you describe the dorm room in which Christian takes his HIV meds for the first time:

“The room had one window, awkwardly framed. It was a small pane that came down only to Christian’s chest. He looked out into the evening sky, watching the snowflakes circle down past his window and land in the yard below. The sky was dark gray, the evening creeping into daylight hours as the calendar approached the longest day of the year. Christian had been sick for six months. He had endured endless mornings of retching and dry heaves. He had suffered extreme exhaustion, could barely work, and had kept a chilling secret from friends and coworkers. Now, for the first time in months, he was beginning to feel like himself again.”

From a reporting standpoint, that’s an amazing paragraph. Can you tell me how you constructed it? Did you go visit this room in person, or see photos? Did you have a lot of interviews with Christian, pressing him over and over for more details?

NH: This chapter in particular took a lot of time. I saw pictures of the room, visited the campus, looked up weather reports (I got this idea from an interview I read with Rebecca Skloot) and chatted with Berliners about what winter is like. The moment where Christian is standing at the window is a powerful turning point for him. Although many years have passed he remembers it clearly. It’s an overwhelming memory; I watched him both with tears in his eyes and a smile on his face while describing it. We spent a ridiculous amount of time going over every detail of ten minutes in November 1996.

VH: It was interesting to read that Christian’s doctor, Gero Hütter, was nervous about the big Wall Street Journal article in 2008 that revealed his findings before they were published in a scientific journal. I hear that all the time from scientists — this notion that if they talk to the press before publication they will be ruined. And yet, in Hütter’s case, the article did exactly the opposite. It gave him legitimacy among HIV scientists and seemed to help him get published in a prestigious journal.

Since you now have a foot in both camps, how do you feel about scientists talking to the press about their work? Do you have any advice for scientists looking for recognition, or for journalists trying to get scoops?

NH: I sometimes wonder what would have become of Gero Hütter’s research without Mark Schoofs, the Wall Street Journal reporter. Consider this: Mark Schoofs was able to spot the importance of Timothy’s case in a way that thousands of researchers couldn’t. His coverage of the case influenced the New England Journal of Medicine to accept a paper they had previously rejected. Without that publication it’s hard to say where we would be today. Multiple agencies have cited that one paper as the reason they are funding HIV gene therapy. Mark Schoofs’s reporting may one day lead to millions of lives spared of HIV. So this is my advice to science journalists. Go for the stories you believe in, even if some researchers discourage you. Never forget that you’re an essential part of science and medicine and that your reporting may make all the difference. For scientists, it’s important that we recognize journalists as part of the scientific community and not be afraid to develop relationships.

VH: I like that advice!

There’s a tension in this story that probably exists in every story of a medical science breakthrough, and that’s the balance between hype and cynicism. Nobody wants to praise a result so much that it raises false hopes among patients, and yet, you don’t want to downplay science so much that the whole pursuit comes off as pointless. Any thoughts on how science writers should walk that tightrope?

NH: This is one of the reasons I felt the story had to be told as a book instead of an article. I needed the space to describe what’s happening in HIV medicine today. For me the best way to walk this tightrope was to keep the science sophisticated. To this end I discuss a range of topics: how HIV hides in the body, gene therapy, humanized mice and elite controllers. I wanted readers to feel as if they had enough information to assess for themselves. At the same time, I used interviews with experts in the field to give guidance. No one is ever going to agree with everything but finding that balance between hype and cynicism is so important.

VH: Is there another book in your future?

NH: Book writing is addictive. I’m working on my second book but I can’t talk about it quite yet.

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Book Review: OBSESSED

A great long-form narrative demands at least one irresistible character. If a writer finds a protagonist who is quirky, contradictory, charming, sadistic, or interesting in any other way, the reader will follow that character through any number of complex ideas.

In OBSESSED: The Compulsions and Creations of Dr. Jeffrey Schwartz, released this past weekend, writer Steve Volk finds that special character and describes him beautifully. According to Volk’s depiction, Schwartz is a socially awkward, belligerent psychiatrist whose research has been unfairly shunned by the scientific establishment. He is an unsung hero whose revolutionary behavioral therapy has rescued thousands of people from the irrational fears and repetitive behaviors of obsessive-compulsive disorder (OCD). If his success continues, Schwartz may even rescue the withering concept of free will.

Great long-form science writing is not only about the yarn, however. It’s also about pulling away from the character’s seductive orbit in order to put his or her ideas into a wider scientific context. And Obsessed, unfortunately, doesn’t do that well. Volk tells a slanted truth about Schwartz, the man, and about how his work fits into the larger field of anxiety research. That shortcoming is particularly disappointing given that Obsessed is the debut long-form e-book of an established science magazine, Discover.

It’s obvious from the first few pages of Obsessed that Volk, a senior writer at Philadelphia Magazine, is a master of narrative. If there was ever a dull moment in the book’s 13,000-plus words, I don’t remember it.

I worry, though, that because of its compelling and seemingly authoritative story, readers will come away from the book with inaccurate ideas about anxiety disorders and how the mind works.

Take Schwartz’s therapy, for example, which is a combination of mindfulness—a technique borrowed from Buddhist meditation in which you try to detach yourself from your emotions by focusing on breathing or some other innocuous behavior—and reappraisal, or explicitly focusing on naming and re-framing your emotions. Volk describes Schwartz’s therapy as novel and even revolutionary—a thorn in the side of the psychiatric establishment and its beloved pharmaceuticals.

But Volk largely ignores the fact that Schwartz’s approach is only a slight variation of other kinds of cognitive behavioral therapies (including exposure therapy, which Schwartz oddly villifies). These treatments have been around for decades and are firmly established among psychiatrists as effective for some people with anxiety disorders.

So the fact that Schwartz’s therapy works for many people with OCD is not at all surprising. The brain changes with our day-to-day experiences—it’s why even adults can learn new things, and yes, why some people with addiction, depression, and anxiety disorders can overcome them without drugs. There aren’t many neuroscientists or psychiatrists who would disagree with that.

Where Schwartz stirs up trouble, Volk explains, is in his leap from the existence of an adaptable brain to the existence of free will:

“We’re talking about people with a biological brain disorder,” says Schwartz, “who learn through the use of neuroplasticity to change their brain function! That’s free will in action!”

It is a claim that flies in the face of most modern neuroscientific research, which suggests an ever-increasing number of our “choices” are somehow hard-wired into us—from which candidate we vote for to which flavor of ice cream tops our cone.

But there are actually lots of neuroscientists who believe in free will. (Even David Eagleman, one of the three scientists whom Volk puts in the anti-free-will camp, is on the fence about it.) It’s an age-old question that people have debated forever. I suspect that Schwartz’s colleagues don’t like him for two of his other, crazier ideas, neither of which is adequately challenged in the book.

The first is Schwartz’s theory about the physical processes underlying free will. In one head-spinning chapter, Volk explains how a combination of wave-particle duality, quantum Zeno, and Hebb’s law might prove that the mind is separate from the brain. Volk tells us that “this is an idea in its infancy”, yet neglects to include any outside comments from independent physicists or neuroscientists. The reader is left with no sense of how plausible—or crackpot—this theory is.

The second overlooked part of Schwartz’s biography is his recent conversion to Christianity. Here’s how Volk describes it:

The most important new development in Schwartz’s life underscores the schism between the champion of free will and the academics who oppose him: Schwartz has become a devoted Christian, his faith formed in great part by reading the essays of Deitrich Bonhoeffer, the German Lutheran pastor executed by the Nazis for insurrection. His faith seems odd at first—the young Jew, turned Buddhist, scientist and then Christian. But in the life-story of Deitrich Bonhoeffer, Schwartz’s guidepost for Christianity, there is a finer and firmer example of Schwartz’s own tough-mindedness. Bonhoeffer believed so strongly he died for it, openly opposing the Hitler regime that ultimately assassinated him.

What’s never mentioned, however, is that in accepting Christ, Schwartz also seems to have rejected evolution. He is one of several hundred scientists to sign A Scientific Dissent from Darwinism, a document put together by the Discovery Institute, a conservative Christian think tank that lobbies for creationism. The signatories of that document, including Schwartz, endorse the statement: “We are skeptical of claims for the ability of random mutation and natural selection to account for the complexity of life.”

With that kind of public rejection of a fundamental law of biology, is it any wonder that some scientists are skeptical of Schwartz’s other ideas?* And doesn’t his alignment with creationists deserve at least a mention in a story of his scientific career?

Jeffrey Schwartz is a character, and one that I thoroughly enjoyed getting to know. But ultimately, the man’s obsessions corrupted his work—and Volk’s work, too.


*Update, 9/8/13: Schwartz signed the Discovery Institute document in 2004, years after being condemned by his peers. So that couldn’t be part of his critics’ motivations, as I speculated in the review, and I regret that error. Since my review appeared, Volk and Discover In-Depth have issued an updated version of the book that includes a paragraph about Schwartz’s ties with the Discovery Institute. You can download the book here.

Maia Szalavitz contributed much to the reporting and thinking behind this review

This review also appears at Download the Universe, a site for science e-book reviews

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Review: Written in Stone by Brian Switek

Written_in_stoneRocks are full of stories. They contain the petrified remains of long-dead animals and in every fossilised bone, scale and track, there are awe-inspiring accounts of the history of life on this planet. Of course, fossils themselves are poor narrators. To uncover their tales, you need a storyteller with an expert’s knowledge and a writer’s flair. Brian Switek is that storyteller.

In his first book, Written in Stone, Switek uses the remains of prehistoric creatures to illustrate how the first tetrapods (four-legged animals) invaded the land from the sea, how the ancestors of whales went back to the sea from the land, and how a special branch of the dinosaur family eventually took to the air as birds. This is thrilling stuff, full of memorable characters including shovel-tusked elephants, huge leviathans, and fuzzy dinosaurs. In a wonderful penultimate chapter, Switek even tackles our own origins in one of the best accounts of the topic that I have read.

These stories haven’t been chosen at random. Each one reveals a subtle new aspect about the nature of evolution, which Switek brings home with uncompromising accuracy. The book is the richer for it. Instead of the claims of “missing links” and direct ancestors, we get a much subtler picture of life’s history, complete with failed experiments and bursts of diversity. There is grandeur in this view of life and Switek captures it well. Immersing yourself in these stories, you get a true sense of life’s incredible diversity, the great panoply of forms of which today’s species are a small and ever-shrinking part.


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Not Exactly Rocket Science Review of 2009

I don’t really like end-of-the-year lists. They seem a bit too self-knowing and forced, and there are just so many of them, particularly because we’re heralding the end of a decade too. I half-expect someone to create a Top Ten Years of the Decade list (and Time Out would probably put 1977 in there just to be edgy).

This might seem like a funny way of introducing an end-of-the-year list, but I’ve tried to make this one a bit different. This is not a collection of the “top” scientific discoveries of the year. I’m not calling them “breakthroughs”. I’m not judging them on such abstract and subjective measures as “quality” or “significance”. There is no Ardi and no ice on the moon.  

Instead, this is a list of stories that have made you and I widen our eyes in collective excitement. It was chosen by you readers through a series of nine polls. It reflects the fact that science has a value that goes well beyond practical applications. The coolest discoveries expand our knowledge about the world around us and our place in it. They make us wonder. They make us want to know more. I’ve learned a great deal through writing for this blog over the last 12 months and I hope that I’ve been able to share at least some of that successfully with you lot.

So without any further fanfare, the list:


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Not Exactly Rocket Science Review of 2008

Fireworks.jpgPhew. Another year almost over and it’s been a really good one. This time last year, I was still blogging at WordPress, and it was only in late February that I beamed aboard the mighty ScienceBlog mothership. It’s been a great experience and all in all, I’ve managed to rack up about 190 posts on new research (excluding reposts and random stuff), over 1,500 comments and over 400,000 page views in a year. Elsewhere, I published a book based on this blog, I wrote about 2% of another book called “Defining Moments in Science“, and I wrote three features and several news pieces for New Scientist.

And given all that, it’s nice to take some time for reflection and with that in mind, I’m going to continue a tradition that I started last year – choosing some of the favourite stories from 2008. This list has no pretensions to be a catalogue of the year’s biggest stories or its most important breakthroughs. It’s just what I personally deemed to be the most interesting and just plain, downright cool.

So, without further ado, here are my picks. Once again, a massive thanks to anyone who read, commented on, or linked to this site over the last year. I hope you’ll join me for 2009.