This paper examines the rise of psychiatric thinking and practice and the “disciplinization” of the mind sciences in the Levant. Focusing on the mashreq, the paper situates the birth of psychiatry not in the usual framework of modernization, proselytism or merely the civilizing mission of the late nineteenth century but in a continuous power struggle between diverse local and global actors (including the British, French, Russian, and Ottoman imperial powers as well as different clerical and secular groups). This power struggle amounted to a politics of monopolizing knowledge through the creation and development of “zones of influence” whenever the opportunity arose; from the humanitarian interventions of the 1860s in Mount Lebanon to the Cold War a century later. The foreign powers were not the only self-interested actors in the story; so were the natives who benefited from the productive competition over education and health services. The French historian Jean-Pierre Filiu has called the paradoxical combination of colonial exploitation and cultural proliferation évènement-Janus. In many ways the birth of psychiatry in the mashreq may be considered a Janus event. But it also epitomizes a rationale of imperial power that reflects the banality not only of “evil” (an unjust form of governance with insidious forms of exploitation and violence) but also of “good” (caring for the poor and sick and advancing medical and scientific knowledge). Based on archival documents that span a century, the paper reconstructs how psychiatry emerged as a discipline and how it was sustained by the continuous competition between various actors. One the one side stand the Swiss Quaker missionary who founded one of the first modern psychiatric hospitals in the region (founded in 1896) as well as the American Presbyterian missionaries, the British ambassador, native converts, and an eclectic group of notables from across sects who helped establish the hospital and sustain it over time. On the other side stand the native Franciscan priest who established a competing institution for the care of the mentally ill (1920s) as well as his own supporters (including the French authorities) for whom the former’s project was an attempt by the Protestants (and “Anglo-Saxons” broadly speaking) to expand their influence over a scientific territory of tremendous political, social, and increasingly economic leverage.