This article investigates the practice of letter writing from family and friends of patients to doctors at the York Retreat asylum at the end of the nineteenth and beginning of the twentieth century. During this time, letter writing was an important part of asylum practice and a collection of incoming and outgoing letters remain in the Retreat archive. Using mainly incoming correspondence, this article will show how families and friends remained significantly involved in asylum life and patient care. It will investigate the practice of family letter writing, asking questions such as who wrote to the Retreat, how often and why. It will also look at what types of relationships families and friends constructed with doctors, proposing that they regarded them in a variety of ways, ranging from seeing them as employees to treating them as confidants.