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In the mid-19th century, the Commissioners in Lunacy continued the direction of the earlier reform movements, but depended upon local magistrates for the execution of their ideas. The early development of a single county asylum is described from its beginnings, as are some of the personalities involved.

In psychiatry the relationship between treatment and punishment is variable and ambiguous. It has always been possible to employ physical methods of treatment for punitive ends, against which the introduction of liberal policies is no complete safeguard. Indulging one's personal animosities towards a difficult or violent patient has always been condemned, but the motives of a psychiatrist may be particularly easily misconstrued. These inherent risks in a psychiatrist's situation are illustrated by a case from the 19th century.