Asylum – Inside the Closed World of State Mental Hospitals by Christopher Payne – Review



Title: Asylum – Inside the Closed World of State Mental Hospitals

Author: Christopher Payne (with an essay by Oliver Sacks)

Publisher: MIT Press

Published: September 4, 2009

Genre: Non-Fiction, Art, Photography, Mental Health

Pages: 209

Acquired: Borrowed from the library

Links: Goodreads, Amazon, Book Depository

SUMMARY (from Goodreads)

For more than half the nation’s history, vast mental hospitals were a prominent feature of the American landscape. From the mid-nineteenth century to the early twentieth, over 250 institutions for the insane were built throughout the United States; by 1948, they housed more than a half million patients.

The blueprint for these hospitals was set by Pennsylvania hospital superintendent Thomas Story Kirkbride: a central administration building flanked symmetrically by pavilions and surrounded by lavish grounds with pastoral vistas.

Kirkbride and others believed that well-designed buildings and grounds, a peaceful environment, a regimen of fresh air, and places for work, exercise, and cultural activities would heal mental illness. But in the second half of the twentieth century, after the introduction of psychotropic drugs and policy shifts toward community-based care, patient populations declined dramatically, leaving many of these beautiful, massive buildings–and the patients who lived in them–neglected and abandoned.

Architect and photographer Christopher Payne spent six years documenting the decay of state mental hospitals like these, visiting seventy institutions in thirty states. Through his lens we see splendid, palatial exteriors (some designed by such prominent architects as H. H. Richardson and Samuel Sloan) and crumbling interiors–chairs stacked against walls with peeling paint in a grand hallway; brightly colored toothbrushes still hanging on a rack; stacks of suitcases, never packed for the trip home.

Accompanying Payne’s striking and powerful photographs is an essay by Oliver Sacks (who described his own experience working at a state mental hospital in his book Awakenings). Sacks pays tribute to Payne’s photographs and to the lives once lived in these places, “where one could be both mad and safe.”


When adding this to my to-read on Goodreads, I didn’t realize that it is essentially a coffee table book. When I picked it up from the library, I was surprised by its size and heft. But I shrugged and brought it home, interested to see what was inside.

The book begins with an essay by Oliver Sacks, a former employee of 25 years at a state mental hospital in the Bronx. He gives an brief history of state hospitals (formerly called asylums, lunatic asylums, insane asylums, etc.) and some background on how they were designed. In my opinion, the essay wasn’t organized very well and could have flowed a bit better. Ignoring this tiny flaw, it kind of blew my mind!

I had these pre-conceived notions that all people in asylums were there by force of their families or the courts and spent their time sitting miserably in a padded room. This could not be further from the truth! Asylums were very much their namesake – an asylum from the “real” world; a “secure retreat” (Oxford Pocket). Many people experienced pleasant and fulfilling lives in the institutions. In the early 1900s, patients made asylums self-sustaining. Farming crops and raising livestock, maintaining the property, and laundering the clothing and bedding are just a few of the occupations that patients took ownership in. It was good for their minds and provided for the asylums. When they weren’t working, they were enjoying a shave at the barber, knocking down pins at the bowling alley, walking the gardens, etc. Unfortunately, these types of asylums are a thing of the past. Now called state hospitals, patients are not allowed to work, are not afforded the luxuries common so long ago, and are often subjects of neglect or abuse. The essay really shed light on our fall from grace, so to speak.

The rest of the book is a beautiful collection of photos taken by Christopher Payne, a photographer that traveled to and documented some 100 asylums. The photos are stunning. The first few showcase display architecture and attention to detail that can no longer be found in public institutions (and certainly not those for people with mental illness). The next section shows the guts of buildings — crumbling wards, peeling paint, broken windows. I found that the most intriguing photos are those that showed the ghosts of patients past — abandoned suitcases, a mini box of Fruit Loops in a basement bakery, a pile of sneakers outside the gymnasium. According to the saying, a picture is worth a thousand words. This book contains over 100 photos that speak volumes about the rich history of these asylums.

I highly recommend this book to most anyone – art/photography lovers, people interested in mental health, those that like to look to the past to shape the future. If I had a coffee table to speak of, this book would be on it.


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One thought on “Asylum – Inside the Closed World of State Mental Hospitals by Christopher Payne – Review

  1. Pingback: November/#nonficnov Wrap Up | (bargain)bookbliss

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