In late Victorian and Edwardian Canada, confinement in an asylum was a common fate for many middle-class women who, as a consequence of economic dependency, menopause and other physical realities of their life cycles, or patriarchal inequities, were perceived as burdens to their families or the community. Family members who paid for care often influenced matters of diagnosis, discharge, and even therapeutics. External manipulation created ethical and practical problems for asylum managers who fell victim to it.

Moments of Unreason is the first detailed study of a private asylum in North America: the Homewood Retreat in Guelph, Ontario, established in 1883 as an early Canadian venture into corporate health care. Cheryl Krasnick Warsh studies the careers of its first two medical superintendents, Stephen Lett and Alfred Hobbs, which spanned the evolution of mental health theory from moral management to mental therapeutics and, later, neuro-psychiatry.

This evolution did not make practical management of the Institute less complex: an under-paid, undertrained work force combined with an unruly patient population resulted in instances of neglect, abuse, and over-medication.