This paper examines letters from the casebooks of the Valkenberg Lunatic Asylum in the Cape Colony during the South African War. Valkenberg was opened in 1891 in Cape Town, and was the only asylum established exclusively for white patients in the Cape. The South African War took place between 1899 and 1902, and several soldiers serving in the War were treated at Valkenberg during this period. The letters were written by a male patient who used bureaucratic and legal channels to claim his sanity and secure release from the asylum, showcasing a rare example from the archive of a patient’s voice as well as a view into the inner workings of a colonial asylum in South Africa. These letters allow a view into the personal lives of patients and attendants, the medical rules doctors followed, and instances of racism, unexpected solidarity, and loneliness. Analysing these letters reveals the changes taking place in a turbulent South Africa, including the tensions and conflicts of a country at war, the racism and nationalism of early twentieth-century South Africa, and the violence present within the asylum network. By examining letters written directly by a patient, which give voice to a perspective that official institutional records would not ordinarily allow, this paper seeks to contribute to the literature on patient voices in the history of psychiatry.