This image is a photo collage from the book Tsunehisa Kumura's Visual Scandals by Photomontage, which was published in 1979. That something like this is possible without Photoshop makes my mind whirl.
Tsunehisa Kimura (1928-2008) is a Japanese artist who creates works using photomontage. His montages often contain themes of surreal urban destruction and chaos, or juxtaposition of man-made monuments and natural phenomena.