Much of the scholarship of nineteenth and early twentieth century psychiatry in Southern Africa has argued that its discourses, ideology and material practice are an example par excellence of imperial medicine, where mental hospitals were largely sites of state-initiated detention. Drawing on the archival records which detail the legal grounds for the committal of thousands of people to the Pietermaritzburg and Fort Napier Mental Hospitals from 1916 to 1960, it seems however, that in practice in Natal and Zululand, as in the metropole, it was often families rather than medical doctors or state officials who played a decisive role in initiating the process and determining the timing of the committal of patients. This set of records is unique for this region for they detail the committal process of persons from all social, class and ethnic backgrounds. I argue that in order to write a social history of mental illness we need to document how families imagined the role of institutional psychiatric medicine and mental hospitals and their place in the range of therapeutic or custodial options. The paper also raises questions about the changing nature of ‘the family’, mental illness and emotions, in South Africa in the first half of the twentieth century.