This article seeks, through the medium of a case study of the York Lunatic Asylum scandal of 1813 to 1815, to rethink aspects of the existing historiography of early nineteenth-century asylum reform. By moving away from the normative medical historical focus on ‘madness’ and ‘custody’, it relates the reform of lunatic asylums to the wider social, cultural, and political currents of the early nineteenth century. In particular, it demonstrates how the conflict over the administration of the York Asylum represented a clash between different conceptions of social power and public accountability which were rooted in mutually opposed cultural ideologies. In addition, by bringing more recent work on identity and performance to bear on a classic set of historical issues, it also seeks to investigate how the reform of lunatic asylums, and the cultural shifts which they embodied, impacted upon the social identities of medical practitioners engaged in the charitable care of the sick and mad.