Between the 1960s and 1980s, many accounts written in English by people who had been inmates in asylums and psychiatric hospitals were republished, or newly commented-upon, creating a canon of English-speaking historical “mad voices”. Insofar as this canon was limited to those who had been institutionalised, it stretched back to the end of the eighteenth century. From at least the 1830s, changes emerged in the justifications given by the authors for writing and publishing these accounts. Before this time they are predominantly published by those who never accept that they are mad and focus on the injustice of their confinement. By the 1960s, there is an established sense that the authenticity of the madness narrated is a key (although ambivalent) part of the value of publication. This chapter focuses on the “paratextual” elements of the various accounts—principally the “acknowledgements”, “preface” and “foreword”—as writing positioned outside the main story, but central to justifying it. The aim is to bring these different justifications to the fore and to argue that we should maintain distance between accounts that are justified in radically different ways, and contain radically different authorial assumptions about their content and potential value.