This image taken by Mary Ellen Mark in her Ward 81 series is a landscape black and white photograph. It illustrates a woman kneeling and put her head down on a hospital bed, seems to be in deep struggle. The subject is sitting almost on the edge of the composition, and the picture was taken at a tilted angle, making the whole image looks unbalanced and chaotic. Taking this visual into larger context, which is the fact that this is taken at a mental institution in Oregon, it makes viewers to understand and sympathize the struggle and the pain that these patients endured because of their mental illness. The whole image screams pain and isolation.