Philadelphia’s first insane asylums offer a useful starting point for considering the relationships among theory and practice among a vast constellation of penal, educational, and social-welfare institutions. Each institutional type was created for a very specific regimen of treatment and a specific population, but they shared common architectural forms and a common spatial imagination, or sense of the relationships among people and their environments. The juxtaposition of insane asylums to their relatives in recovery reveals that despite their relatively simple plans and theoretical rationales, these spaces engendered complexities and contradictions that were not evident at first view. Moreover, the same spatial imagination that shaped these familiar institutions also underpinned disparate kinds of spaces that might equally well be called “therapeutic.” Most striking among them was the evangelical camp meeting, a spatial and religious type introduced to the United States at the same time as the insane asylum. Here a spatial imagination similar to the one that shaped formal institutions produced a very different landscape, but one, like the therapeutic institutions, devoted to destroying an older, faulty self and generating a new one.