The conclusion reiterates the main themes of the book, emphasising what is significant about the book in terms of both historiography and methodology. This study helps us to ‘get out’ of the asylum in our investigation of the history of madness – not because the asylum was unimportant but, rather, because the asylum’s long shadow becomes shorter, and more geographically specific, when one is able to uncover pre-asylum understandings of and responses to madness that continued to thrive long after the asylum’s introduction. This study also helps to establish the importance of civil law in the response to madness over a considerable period of time in a transatlantic context. The conclusion also draws attention to the continuing relevance of the relationship between civil law and the consideration of mental capacity and guardianship as evidenced by the United Nations’ recent declarations about the rights of people of unsound mind.