The paper explores conceptualizations of insanity and madness in the Levant through the examination of various primary sources from Western travelers and observers of the “Orient” (including medical missionaries) as well as from Eastern insiders, in specific through the medical and scientific writings of the rising intelligentsia of the Nahḍa. The paper focuses on the 19th century, just prior to the establishment of ʿAṣfuriyyeh (or the Lebanon Hospital for the Insane) in 1896 as the first “modern” lunatic asylum in “Bible Lands.” Although the founder (the Swiss missionary Quaker Theophilus Waldmeier) and the renown medical superintendents who supported the endeavor insisted that there was a great need for such a “home” or “refuge” (maljaʾ) to treat the insane and rescue the mad (maʿtūh/majnūn) who were left abandoned—begging on the streets or brutally beaten in “holy caves,” the evidence from the medical literature of the period shows that contrary to common assumptions based on Orientalist literary exegesis (Lamartine, Flaubert, and the like) madness was not prevalent in the Orient. Indeed, the Orient was on the whole incapable of madness because inherently resistant to change and civilization; for the 19th century alienists madness was predominantly a product of civilization. The rising Ottoman Syrian medical elite on the other hand (though on the whole and paradoxically the product of Western education and styles of thinking) had a different take on the causes and interpretations of insanity (more in tune with the missionary ethos of fighting superstition and ignorance) and these will be explored in depth through the key medical and scientific journals and magazines of the period. So was it simply ignorance and the lack of trained clinical gazes that explains the (perceived) low prevalence of insanity in the fin-de-siècle Levant or was it the process of Westernization/civilization/modernization that unveiled the preponderance of these afflictions (maʾsāt)? The paper is an attempt to start charting the anatomical landscape of madness before one is able to answer the question further and explore some of its implications for contemporary psychiatric practices in the Middle East.