Asylum: Inside the Closed World of State Mental Hospitals; photographs by Christopher Payne, Essay by Oliver Sacks (MIT Press, £29.95)

Asylum jacketPerhaps the most startling realisation brought about by Christopher Payne’s comprehensive photographic study of disused state asylums in the US is how psychiatry seems to have abandoned its own history. These palatial buildings, designed by leading architects of the day to play a role in the rehabilitation of their inhabitants, once had a very visible place in the discourse of mental health. They appeared to offer not only refuge but also a possible cure, by bestowing light on the incarcerated and by providing sustainable work programmes in their substantial grounds. Presumably, they also provided a kind of reassurance to the public at large, through their sheer scale and solidity, as well as their architectural sophistication.

After the introduction of psychotropic drugs in the 1950s, which in turn enabled a regime of deinstitutionalisation that had mushroomed by the ’80s, the legacy of the asylum was already determined. Heavily barred windows, as Payne’s photographs show, were boarded up altogether, as though rendering these now archaic institutions utterly blind, oblivious to the uncertain destinies of those they once housed. Ironically, many of those who may once have been contained within these thick walls will have merely swapped one institution for another: prison. Many others will have become homeless, semi-spectral figures whose rootless existence carries them peacelessly from stairwell to park to bus depot.

It is these lives that are missing from Asylum. While it is to be sure a serious, scholarly enterprise, born of a desire to document these grand architectural feats and their demise, the unfortunate side effect is that in so doing, the subject has been elided. Empty buildings – or “absence of presence” in photography parlance – is an all too familiar trope in contemporary documentary image-making and, added to this, the propensity of photographers drawn to “mental health issues” could be fairly described as preternaturally high. The symbolism of peeling paint and crumbling interiors ignites every concerned photographer’s ardour and this glut of imagery has come to be perceived as stereotypical. These are, however, unusually accomplished photographs and Payne has captured – in the rows of brightly coloured toothbrushes, or the cupboard overflowing with bedsprings - wounding details. But consider these dignified, static, artfully composed pictures along with this statement: “I was reminded of the pictures of the Nazi concentration camps at Belsen and Buchenwald ... I entered buildings swarming with naked humans herded like cattle and treated with less concern.”

This was the perception of American investigative journalist Albert Deutsch, writing for Time in 1948, after his infamous exposé of mental health institutions. Though a palpable current of sadness courses through Asylum, it bumps up against a bank of nostalgia, which stifles a keener commentary like so many sandbags. The choice of the eminent neurologist and writer Oliver Sacks as the essayist for this project is an apt one. In 1966, Sacks started working at the Bronx State Hospital, where he remained for 25 years, and his rightful position as an elder statesman of psychiatry is certainly not diminished here. Yet, unsettlingly, the combination of Sacks’ soothing writing and Payne’s respectful photographs forms a too-perfect circle, a kind of hermetically sealed utopia that belies centuries of power relations in the (mis)treatment of the mentally ill.

Many images show seemingly endless corridors, the wards positioned at rigid and regular intervals. Though the rooms emit a healing light, such visibility is a trap, more beneficial to the efficient running of the institution than to the needs of an individual, for whom darkness may have offered sanctuary. One photograph shows a red chair, positioned to face a door. Perhaps the door was once flung open, and the sitter’s upturned face bathed by the sun’s restorative rays. Such conjecture is rightly swept away by the unlikely juxtapositioning of a question mark and an arrow, graffitied on to the opposing wall. Payne has a sapient and identifiably American eye for the ecology of signs. “Yield” is the bathetic plea of a triangular traffic sign, overshadowed by the extraordinary edifice that is Buffalo State Hospital, New York. Not a chance.

According to the National Institute of Mental Health, today more than 26 per cent of Americans over the age of 18 have a diagnosable mental disorder. While this book should be applauded for its assiduous commitment to the architecture of madness – it can comfortably be called “definitive” in that sense – I would also welcome a series of photographs that seeks to cast light on what remains hidden in mental health discourse as opposed to that which is already visible.

Buy a copy of Asylum here.