In his eloquent and humane introductory essay, previously published separately in the New York Review of Books (1), Oliver Sacks reviews the good, bad, and ugly of the state hospital era. He lauds Payne as a "visual poet" capturing the beauties and the evolution, and sad devolution, of these enormous enterprises. Payne's photographs see through the deteriorating facades to what was originally intended by the high-minded physicians, nurses, architects, public servants, and citizens who conceptualized moral treatment as the best available method for caring for the mentally ill in the early and mid-19th century. These were interiors of grandeur—large, open, full of light and air and placed in elegant, often palatial, buildings with magnificent grounds, projected to be places of true asylum. So these commanding institutions, in many instances representing top-of-the-line Classic and Victorian architecture, were usually built remotely, purposefully away from large, noisy, and congested urban concentrations, and served as places of actual refuge for countless individuals and their families. They were meant to be fully contained and self-sufficient institutions, and for many decades until well after World War II they were just that: communities that produced virtually all their own consumables, from food to clothing, based on the productive labor of the patients, many of whom found meaning in the work they were expected to contribute to their well being. And these places were huge. At its peak, for example, Pilgrim State Hospital housed about 14,000 patients.