It’s been nearly 20 years since the last feature by meticulous animation maestros the Brothers Quay — identical twins Stephen and Timothy, born in Norristown, Pennsylvania, in 1947. Combining childlike stop-motion and the garish morbidity of gothic horror, the duo’s macabre flourishes set them apart from the storybook charms of frame-by-frame contemporaries like Wes Anderson and the folks at Aardman and Laika (the studios behind “Wallace & Gromit” and “Coraline,” respectively). 

An otherworldly reflection on sickness and death, “Sanatorium Under the Sign of the Hourglass” finds them turning their stop-motion sights on the Kafkaesque works of Bruno Schulz, the Polish author and critic killed by the Gestapo. Based on Shultz’s 1937 novel “Sanatorium Pod Klepsydrą,” the 76-minute feature follows a man visiting his dying father in a remote Galician sanatorium, a tale the Quays translate through surreal, phantasmagorical puppetry in an unusually impactful marriage of emotion and form.

This isn’t the first time the brothers have adapted Shulz’s work; their breakout 21-minute short “Street of Crocodiles” (1986) was loosely based on his 1934 collection “The Street of Crocodiles” (or “The Cinnamon Shops”). That film transformed Schulz’s metaphor-laden, semi-autobiographical tale into a rich and rhythmic performance by the forgotten porcelain dolls that populate nearly all the brothers’ films, resembling the products of some mad Victorian workshop too twisted for children to play with, but childlike enough to evoke and contort childhood nostalgia. 

Nearly four decades after “Street of Crocodiles,” “Sanatorium Under the Sign of the Hourglass” maintains all the twins’ signature flourishes, none more so than the sense of rot and melancholy that seems to haunt each dusty surface. In the Polish-language “Sanatorium,” the original story of a man named Josef visiting his father’s deathbed remains largely intact, though it unfolds within the liminal state between dreams and waking, as slowly rotating sets are rendered with impossible dimensions. 

An otherworldly reflection on sickness and death.

The brothers’ absurdist live-action elements compliment their eerie animation and draw on uncanny visual techniques they’ve long since perfected. The story’s black-and-white framing device — in which an elderly Polish auctioneer (Tadeusz Janiszewski) and his youthful assistant (Wioletta Kopańska) try to sell onlookers on a mysterious, enclosed automaton with tiny viewing windows — has the same haze texture as their asylum-set 2000 short “In Absentia,” in which hard, directional lighting shapes characters and surfaces, only to be softened and de-focused through dreamlike filters.

Upon inspecting the openings in the automaton, the monochromatic live-action characters are pulled into a long train journey, where Josef — a weary porcelain marionette whose skin is chipped away, appearing diseased — nods off and finds himself in disturbing corners of a sanatorium wing where his father is said to have taken a turn for the worse. However, all is not as it seems in this gloomy realm, where time can tick backward and images stretch, twist and repeat in mesmerizing ways. 

Like a sudden rush of emotions in the throes of grief, the frame becomes unstable and unpredictable, changing in aspect ratio and shape; at times, the usually rectangular screen becomes amoebic, resembling paper burnt or torn at the edges. Ghoulish, hand-stitched creatures — animal-human hybrids with uncanny proportions and too many limbs — greet Josef, and show him even newer, smaller images through viewfinders. These tiny, anthropomorphized dolls, as though imbued with life and mischief, tell stories and fables of their own. 

Josef learns that the sanatorium’s unfamiliar temporal nature implies that his father, whom he believes has died, may still be alive, owing to the strange passage of time within the building — a nod to how time can stretch infinitely and loop back on itself in dreams. The stories within stories and dreams within dreams suggest the influence of the film’s executive producer, “Inception” director Christopher Nolan. Like the brothers’ other landmark films (especially the dreamscape epic “The Comb,” in which characters descend a ladder into a collective subconscious), “Sanatorium” takes on the appearance of a wish from deep within the human psyche. The denial of mortality, and the desire to conquer it, become physically manifest in the brothers’ grotesque odyssey. Josef may be an invalid himself — his mouth is usually wrapped in a cloth mask, as if to stave off some airborne plague — but he suffers most from the inevitability of death and disease.

Josef’s quest is complicated when the sanatorium’s furry, multi-armed doctor allows him to peer into various windows and keyholes, through which he’s confronted with live-action images of what appear to be his father’s sexual fetishes. The son must learn to accept not only his father’s death, but his life in all its perversion and complexity. In the Quays’ lucid cinematic dream world, nightmares are populated by dead-eyed dolls placed at the brink of their own demise, forced to confront the human condition, in all its mystery and horrific beauty.

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