Buffalo State Hospital: A History of the Institution in Light and Shadow is a powerful treatise on mental health care in the Western New York area in the 19th and 20th centuries. The book and its thought-provoking images show an institution in transition. Historic photography shows the building in its bygone splendor as envisioned by prominent American architect, Henry Hobson Richardson, coupled with modern ruins photography by Ian Ference, which allows the viewer a glimpse of the forsaken wasteland that has been locked away, not to be seen. Do not get too distracted by these photographs of waste and destruction for they are only a piece of the story, however with the discovery of this collection of hidden images, we are able to provide the reader with a rare perspective of this once noble institution. Also included in this book are powerful testimonies from key stakeholders from this now shuttered institution, including patients, employees, and neighbors of the facility.