In recent years our understanding of the history of the mad in Britain has advanced greatly on a broad front. Thanks to Kathleen Jones, Nigel Walker, and Roger Smith, we now have overviews of the making of law, public policy, and administration concerning the insane. 1 The rise of the asylum, its therapeutic order, and of the profession of psychiatrist has been researched and distinctively interpreted by Scull, Mellett, Walton, and others. 2 Bynum and Donnelly have offered important readings of the cognitive foundations and medical standing of psychiatry as it crystallized in the nineteenth century. 3 And, not least, the basic question of the meaning of the rise to public prominence of insanity, the asylum, and psychiatry has been opened up and addressed. Thanks to the critiques of Foucault, Doerner, Sedgwick, and others, we no longer see the growth of psychiatric care and institutions as historically unproblematic. 4 In all this, however, there remains a key absence, a silence at the centre.