Starting with the second half of the nineteenth century, the typical response to insanity underwent a dramatic change. Whereas in the previous centuries only the most violent persons would have been segregated and confined away, in the modern period, the asylum and the doctor were endorsed as the sole officially approved responses to the insane and mental illness. In the nineteenth century, parallel to the re-centralization efforts of the state, coupled with a rising concern with the security and well-being of the population, the insane – like other outcast groups (such as beggars, orphans, vagabonds and the unemployed) – were gradually segregated and found themselves incarcerated in a specialized, state-supported asylum system. A regulation known as Bîmârhânelere Dair Nîzamnâme, which was promulgated in 1876, and which was adapted from 1838 French mental health regulation, in that regard came to play an important role in the officialization of mental health services and monopolization of the confinement and discharge of mental patients, and required a license for one’s incarceration to be given by a doctor for the first time in the Ottoman Empire. The present paper discusses the state’s motivation and the professional agenda in the preparation of the regulation, and investigates the legislative process which culminated in the designation of the insane and as patient by conteztualizing it in the social, political and economic developments of the period.