Asylum: Inside the Closed World of State Mental Hospitals poses an immediate challenge: what is the audience for a coffee table book about a miserable subject? It is as oxymoronic as a junker limousine or a hairless cat, but contradiction is the essence of this nonetheless earnest book.

Christopher Payne is a photographer who specializes in depicting industrial architecture. His previous book illustrated the substations that power the New York City subway. In Asylum, he continues to publish his photos of unusual and outsized architecture, here with the benefit of a preface written by internationally renowned neurologist Oliver Sacks. Sacks’s personal account of the history of asylums is more than a reciting of the basic facts, although these are also covered. The moral treatment espoused by Victorian doctors was founded on good intentions. At the time, fresh air, exercise, healthy food, and work were considered therapeutic, while highly regimented buildings offered order to those with disordered minds. Sacks himself worked for twenty-five years at a state mental hospital in the Bronx; thus he brings an elegiac tone to his musings. He emphasizes that even in the worst hospitals there were “pockets of human decency” (3). Sacks’s essay movingly sets the scene in this remarkable collective portrait of state mental hospitals: “As Chris Payne’s photographs attest, their ruins, desolate today in a different way, offer a mute and heartbreaking testimony both to the pain of those with severe mental illness and to the once-heroic structures we built to try to assuage that pain” (5).

For historians of psychiatry, Payne’s accompanying essay offers little new information, as it is not based on archival research. It does, however, rely on sound historical texts such as Nancy Tomes’s book on Thomas Story Kirkbride (Philadelphia: University of Pennsylvania Press, 1994) and my book, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007). From Payne, readers learn of the rise and fall of state hospitals as therapeutic places, their civic importance in the nineteenth century, the inhumane crowding that followed, the increasing role of drug-based therapy, and the dumping of mentally ill people into the streets during the last quarter of the twentieth century. In the personal reflections that Payne provides in the afterward, he offers readers a welcome glimpse into his artistic process and persistence.

Asylum contributes vastly to the visual knowledge of state mental hospitals by including contemporary postcards; photographs of the exteriors in their current, usually crumbling, state; and interior views that few outsiders would have ever seen. Payne’s photos do not present a consistent style, which is not to say he does not have a consistent point of view. But a paradox lurks on every page. Although Sacks writes of asylums being a place where a patient could be both mad and safe (5), few of the images evoke safety. Even without the representation of human bodies, their presence is felt and the trespassing of their space is tangible.

Generally, the photographs are stark and unpopulated. The absence of humans from architectural photographs has a long history, but in this case the absence may have emerged from a practical barrier—officials at most psychiatric hospitals request that photographers register their cameras and refrain from taking photos of people. Even though the humans at an abandoned hospital are likely to be repairmen or groundskeepers, the institutions understandably want to protect the identity of anyone who might wander into the frame. I hope to underline here that Payne received permission to explore hospital grounds and record his impressions, adding vast amounts of logistical effort to an already large artistic task; in other words, he did not sneak into these environments hunting for creepy scenes. Strikingly, he captures the monumentality of these buildings without using people for scale.

Scale is among the many challenges posed by Asylum. A mind-bending collection of postcards (some cropped) commands pages 15 through 17, showing the asylums as they wanted to be seen. The administration buildings, some of them five or six stories high, brag of their makers’ optimism: mansard roofs, cupolas, domes, and clock towers all declare the civic importance of these hospitals. Payne’s own photographs capture a sense of architectural grandeur. But flipping through the book, one moves from the colossal to the cramped, from the mammoth to the miniature. In addition to soaring rooftops and endless boiler rooms, there are ephemeral measures of asylum life: bowling shoes in their cubby holes, toothbrushes on their hooks, and an electroshock machine that fits in an attaché case.

The night view of H. H. Richardson’s Buffalo State Hospital (25) is a stand-out. Largely due to the dramatic illumination of the structure, the administration building looms against a gray-black sky. It is an irresistible building. For architectural historians, it is the best-known example of the type. A familiar triangular road sign—“YIELD”—echoes the many gables in the Richardson building’s silhouette. The fame of its architect might make Buffalo State Hospital one of the few structures in Payne’s book to survive for future generations. Buffalo State may not have to yield—to developers or to the wrecking ball.

These evocative photographs work best in series, such as the sequence of views down corridors. The remodeled dormitory ward in the Harlem Valley State Hospital (65) deserves special notice. Although the architectural forms are in fact perpendicular, the slanted shadows make the space appear askew. Though the hallway was apparently decorated recently, the color palette is ghastly. The view down this or any double-loaded corridor has come to symbolize institutions, all institutions. For example, architects in the 1960s, seeking reform in collegiate dormitories, avoided double-loaded corridors, as the corridors themselves were thought to reduce the inhabitants to inmates. But as Payne explains, the ward hallway was the actual center of a patient’s daily life (60).

The day-to-day routine of the asylum farm was also central to the patient’s experience, and the “funny farm” (that indecorous phrase) has never been so lovingly depicted. The vents above a root cellar (138) remind an architectural scholar of Latrobe’s cenotaphs and thus make a visual rhyme with the numbered grave markers that appear elsewhere in Asylum. Payne depends on the viewer’s understanding that the cow stalls, corn cribs, hay lofts, and sauerkraut vats were tended by patients, in the days when work was a key part of the therapy. The court rulings of the 1970s, which “ended patient labor practically overnight and forced closure of the shops and farms,” did much unintended harm to patients (202) who had gained some sense of self from work, even if it was unpaid. And the loss of free labor marked the end of the asylum as a self-sustaining community.

Some of the photographs require the book’s context to carry proper emotional impact. The bathtubs and suitcases are just bathtubs and suitcases, but in the environs of a state mental hospital these objects are solemn: one can hear the echoing screams of patients in cold water baths, and one can feel the sticky polyester street clothes that filled that luggage. A single blue vinyl sandal left on the floor is all that remains of a woman’s life (113). There is a sympathetic voyeurism that pervades many photos.

To return to my opening question about audience: there is a wide audience for this off-putting yet luxurious book. There are historians of medicine and architectural historians who have never burrowed so far into the back rooms of psychiatric hospitals; there are asylum buffs whose pictures populate several websites; there are photographers who will be inspired by Payne’s dogged pursuit; photographic historians, too, may find fertile ground for study, especially given their strong interest in the genres of architectural and medical photography in recent decades. No single asylum campus exists today that offers a complete picture of the state mental hospital. But by bringing together these photographs and combining them into one volume, Payne and Sacks provide a much clearer picture of this closed world.