This thesis examines historically the negotiated meaning of care at the Friends Asylum for the Insane in early nineteenth century Philadelphia. Using the diaries of the institution's lay superintendents from 1800 through 1850, it explores the interactions among families, staff, and patients as they turned the theoretical idea of "moral treatment" into a form which might best meet their real, day-to-day needs. This thesis argues that the dominant metaphor of the institution as "family," a metaphor typical of most early nineteenth century institutions, provided a compelling rationale for the use of the Asylum by families who committed their relatives their. Yet, in day-to-day practice, such a metaphor proved untenable. To live "normally" as a family within an institution necessitated repression of the inevitable chaos and confusion presented by the behaviors of the insane. But to actively repress such chaos and confusion belied the promise of kind and compassionate care. To resolve such an untenable dilemma, the lay staff at the Friends Asylum actively sought the growing involvement of physicians in the institution's daily life. Their initiatives, more so than just those of physicians to put down the challenge posed by a lay vision of moral treatment, contributed to what has been termed the "medicalization" of care at the Friends Asylum.