The deep process of medicalisation which most developed countries have undergone over the past two centuries has been of central importance in the making of the modern human subject. Psychiatry’s great contribution to this process has been in the production and study of psychologically aberrant selves. This narrative fails, however, to account for the role of the patient in the co-construction of the pathological self. As a small contribution to the ethnography of subjectivity, this article offers a local and limited study of particular instances of the enactment of modern aberrant psychiatric selves through an exploration of a small sample of twentieth-century psychiatric records drawn from two Irish mental hospitals. In this treatment, medical records are considered as inherently multivocal. The case notes are not simply a repository of patients’ stories. Rather, they are a central element in the set of practices and network of associations productive of those stories and also, therefore, productive of psychiatric patients.