The history of mental health and psychiatry in the Middle East in general, and in Egypt in particular, reflects the myriad of ways in which colonial governments and modern nation-states defined both their national projects and relationships with their subjects. The interconnection between health and hegemonic power has been at the center of studies from a variety of fields, from history and political science to healthcare and public policy. This study investigates how mental health in particular has been used as an instrument of state power in nineteenth and early twentieth century Egypt. The study aims to explore the ways in which mental health has been used, invoked, and expanded for diverse colonial interests. Using mental health, or madness, as the lens through which to examine the state’s engagement with various actors, the study also explores how individuals sought to assert their own rights through various means of resistance and negotiation with state institutions. The study offers an expansive history, examining the ‘policing’ of mental illness under British rule and exploring why the management of lunacy assumed such a central role in the British administration’s governance and control of the Egyptian state. It not only highlights interconnections between power and mental health, it also argues that mental health, more than any other area of health and governance, was used as an instrument of state control by the British administration in Egypt. The governance of madness was further ‘securitized’ as asylums were distanced from the city and filled with those deemed criminally insane, thereby jeopardizing the medical nature of the institution. The primacy and centrality of lunacy for the British administration in Egypt was transplanted by more urgent public health priorities in the 1940s; namely rural poverty and health. The significance of lunacy as a means of social control in turn-of-the-century Egypt ceased to exist by the mid-twentieth century. Instead, the British authorities worked actively to establish strategic political and economic links with Egypt in an effort to retain the influence and prestige they had prior to 1922. The study relies on primary archival materials including administrative reports and correspondences from both Dar al-Watha'iq al-Qawmi'yah in Egypt and the National Archives at Kew Gardens in the UK as well as annual Lunacy Division and Department of Public Health reports from the Wellcome Library in the UK.