Examining debates on the link between civilization and insanity in the late nineteenth and early twentieth-century United States, this essay engages the discourse of civilization to discuss the ways in which insanity among Asian immigrants, in particular Chinese and Japanese, was understood, defined and debated. During the period, insanity was regarded as a disease of civilization, which had been increasing due to the struggles of modern life. While Americans witnessed insanity among the “colored” and Asians, they argued that these groups had lower rates of insanity than white Americans and European immigrants because they belonged to lower positions on the civilization scale. Though not explicitly racialist or even racist, the discourse of civilization ordered the international world and drew a clear color line between white westerners and non-white others. At the same time, American missionaries and medical professionals stationed in China and Japan, who were there to see and learn about insanity in Asia, reaffirmed the existing medical understandings of insanity and offered a knowledge base for American psychiatrists who would encounter the Asian insane at their mental institutions. The alleged rarity of mental troubles for Chinese and Japanese was not considered an asset; the insanity debates confirmed the non-white, non-American status of Asian immigrants, rendering them forever foreign. Moreover, their very distance from western civilization explained why Asians in America seemed to have suffered less from mental disturbances and how they could resist the debilitating effects of civilization and migration.