“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 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 Americanstory 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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