The debate surrounding insanity in the nineteenth century contained a profusion of entangled threads that are still being unpicked by historians today. It was regarded – to borrow a phrase from Elaine Showalter – as a primarily female malady. 1 The construction of insanity as female will be explored here in a twofold investigation, to examine the population of a primarily middle- and upper-class asylum through the voices of the doctors using archival patient records and, in doing so, to reconsider the role that doctors played in the construction of insanity as a female malady in the nineteenth century. This will be achieved through the examination of medical records, completed by medical professionals through direct patient–doctor interaction. Nineteenth-century perceptions of female madness are still clearly traceable in the thinking of English society, due largely to the endurance of popular nineteenth-century fiction featuring mentally unstable females. References to the subject conjure up images of wild or uncontrollable women – Charlotte Brontë’s Bertha Rochester or Mary Elizabeth Braddon’s Lady Lucy Audley – or the dark, looming presence of the lunatic asylum, which provided a prison for the insane and those mistaken for the mad alike. The most memorable figure of insanity from nineteenth-century fiction is the ostensibly middle- or upper-class female maniac, as seen in little Miss Flyte in Dickens’s Bleak House (1852–3), Gustave Flaubert’s titular Madame Bovary (1856) and Catherine Earnshaw in Emily Brontë’s Wuthering Heights (1847). Conversely, while the Brontës wrote about mentally unstable females, it was a brother who they had (figuratively) locked away in the attic. It has been suggested that while Branwell Brontë is regarded by some modern scholars as a potentially accomplished artist and author, 2 he also suffered from epilepsy, 3 and following an affair with his employer’s wife, he slipped into depression, exacerbated by drug and alcohol abuse. The female maniac has been explored thoroughly in literary criticism, 4 but fictional representations of the male maniac is more elusive and significantly feminized, problematically blurring gender boundaries and enforcing the representation of insanity as a female ailment. The veracity of this perception has now been extensively challenged through the literary-historical scholarship of Showalter, Janet Oppenheim and Valerie Pedlar, amongst others. This essay will add to this scholarship using a historical perspective.