This paper concerns the story of the nineteenth century lunatic asylum; a unique building type which arose in response to constructions of the perceived problem of madness. Over time, responses both to madness and to the asylum itself have changed, resulting in a new future for the built form of the asylum. The paper takes a historical perspective to draw out the ways in which societal and spatial processes are interconnected, with ideological positions, political interventions, societal attitudes, professional power, spatial contexts, and individual actions all implicated in outcomes. The origin of asylums as containers of the mad is reviewed, and emphasis given to the role of eminent architects in their monumental design. Over time the distinctive built form became symbolic of horror and dread, whilst the next phase of asylum history led to closure and abandonment. However, a changing political and social climate and a renewed appreciation of asylums as heritage has led to possibilities of reconstruction. Three case study examples illustrate the phases of asylum history, including their recent redevelopment for housing, whilst also demonstrating how spatial form has the capacity to embody and represent past and present social practices.