Up Top was the name given locally to the Mid Wales Mental Hospital above Talgarth; a double meaning like 'round the bend', which often located asylums elsewhere – out of sight and out of mind. Purcell’s hitherto untold history, based on archives and oral testimony from staff and patients, shows how mentally ill people were treated through the 20th century. At first the ‘lunatic asylums’ relied on a strict regime of fresh air and bromide. Then they became ‘mental hospitals’, trying desperate measures like leucotomy, deep sleep narcosis and electro convulsive therapy. Then the word ‘mental’ was dropped and ‘psychiatric hospitals’ moved into the era of heavy drugs and psychotherapy. Finally, community care took over. The history of the Mid Wales’ was typical of many institutions that lie as ruined monuments to our attempts to help the mentally ill.