The history of madness is populated by mad women and yet, the visual record of madness is bursting with images of madmen alongside the familiar 'Ophelias' and hysterics. This thesis uses patient photographs to examine how patient identities were constructed and represented in the second half of the nineteenth century. It considers the effects of gender, class and medical discourses on how patients were constituted by images. It seeks to explain the effects of patient photography and the ways in which the medical encounter between doctor-photographer and psychiatric patient was visualised. By so doing it sheds light on photographic practices within Victorian institutions, the relationship between photography and medicine, and the various ways in which photography represented gendered mentally ill patients. The thesis draws together histories of madness and photography by exammmg photographs of patients diagnosed with mental conditions, produced from c.1850 to 1910. It is organised according to 'institution' and considers the photographs contained in British textbooks, British and French medical journals and the medical case books from two British asylums. The photographs they contain are analysed in the context of earlier attempts to visualise the insane in the late-eighteenth and early-nineteenth century, and in the light of nonmedical photography practised in commercial studio or family environments. Psychiatric photographs were produced in vast numbers but their style, mode of production and display and, crucially, the patient identities they represent, are far from standardised or indeed predictable. This variety reflects the different priorities of the photographers, the type of patient being photographed and the contemporaneous photographic practices of individual institutions. The visual connections and differences between several types of photograph are discussed, as is their impact on the identity of the subject. It is argued that only by considering images from a variety of sources can the role and effect of photography in this context begin to be understood more fully.