Nineteenth-century England witnessed an explosion in the provision of institutionalized care for the insane. The large asylum population was often attributed to the accumulation of chronic patients, who had been admitted with long-established mental illness, the duration of which minimized their chances of recovery. Equally, the poor physical condition of incoming patients had an adverse effect on successful outcomes, and this resulted in pessimism and low expectations amongst the medical staff, particularly in the large county asylums, so that minimal treatment was offered. However, the enduring image of the county asylum as a place of containment and fear has been questioned and efforts made to place the asylum within the broader social context. This has led to considerations of the role of the family in both the incarceration and discharge processes. There has also been increased appreciation of the role of rigid class distinctions in the mental patient experience in both the pauper and private asylum. Official records, whilst valuable, can offer only a limited perspective, so that the reality of the asylum patient experience in the nineteenth century necessarily remains elusive.

By contrasting two geographically close, but ideologically distinct, institutions for the insane in Surrey, Institutionalizing the Insane compares the psychiatric care of men and women within the pauper Brookwood Asylum and the Holloway Sanatorium. The rationale behind their establishment suggests that contemporary class perceptions shaped their existence and management.