In 1885, Holloway Sanatorium, an asylum for the 'mentally afflicted of the middle classes' opened in Egham, Surrey, 20 miles outside London. Until 1910, photographs of about a third of the patients--both those 'Certified Lunatic by Inquisition' and the 'Voluntary Boarders' who admitted themselves--were pasted into the asylum's case books. This paper analyses the photographs that were included in the very first of these, when there was a great uncertainty as to how to represent these patients, or whether to represent them at all. The photographs are unlike any other institutional images of the period, and raise critical questions about the imagined incompatibility between documentary photography and personal agency.