This paper addresses situations in which Egyptians suffering from mental and physical afflictions found themselves locked out of state mental asylums rather than locked in. It treats the discourses of doctors and patients as coeval, exploring the ways in which both groups coproduced mental maladies, debated etiologies and appropriate treatments (or denial of treatment). The sources for this project are Egyptian government records such as the “Annual Lunacy Division Reports,” “Central Narcotics Intelligence Bureau Annual Reports,” contemporary scientific and medical journals, and other publications produced by both Egyptian and British doctors. During the British occupation of Egypt, the ‘Abbasiyya and Khanka state mental asylums were overcrowded, underfunded, and provided minimal treatment for inmates. Except for individuals considered to be too dangerous and unmanageable, most patients were discharged from the asylums well before they were recovered. Moribund or physically ailing patients, whom doctors assessed as too weak to harm others, were turned over to willing or unwilling relatives in order to create space. Egyptians seeking voluntary admission were frequently turned away. This paper investigates how Egyptians afflicted with mental maladies were managed outside of the asylums, particularly in prisons and hospitals. It shows that doctors made distinctions between diseases that they described as “legitimate” madness and afflictions that they diagnosed as resulting from individual moral failings. These distinctions were deeply influenced by class and gender, and they played significant roles in determining patient treatment or lack thereof. For instance, British and Egyptian doctors described “pellagra insanity” as a disease of poverty from which the fellaheen, described as stoic and uneducated, had minimal defense. But these doctors disagreed amongst themselves and with colonial officials about whether addiction to opioids and cocaine, more prevalent in Cairo and Alexandria, resulted from an individual or societal deficiency. British doctors tended to view this type of addiction as a moral degeneracy, subjecting patients to harsh, painful, and experimental treatments in prisons and hospitals, including immediate withdrawal, injection with their own blood, and blistering. Yet in the case of fellaheen drug addiction, many doctors and colonial officials argued that the painful and impoverished life of the fellaheen was to blame.