Asylums were first established to care for the unfortunates of society. It was only later they acquired a negative image. In Kentucky’s First Asylum, author Alma Wynelle Deese explores this issue by dissecting the inner workings of the Eastern Kentucky Asylum, Kentucky’s first asylum and the second state-supported asylum to be established in the United States. She describes the people who were involved in the creation and maintenance of a medical school, law department, and lunatic asylum in Lexington, Kentucky. Using historical data, Deese presents a fictionalized narrative to explore this institution’s history from 1817 to the 1990s-including a chapter dedicated to 1906, a pivotal year for Eastern Kentucky Asylum. That year, four employees were charged in the murder of a patient, and this incident set the stage for the past and present history of this facility. Kentucky’s First Asylum provides a historical understanding of one early asylum that became a state hospital and serves to give broader context for the understanding of the current mental health system. It provides a platform to better comprehend the problems and processes of American psychiatric care.