What were the demands on a psychiatric clinic in the past, and what are they today regarding the interests and well-being of its patients? How did the stakeholders navigate the changes in psychiatry? The 125th anniversary of the Psychiatric Clinic Breitenau in Schaffhausen provided an opportunity to address these questions from various perspectives. The "Cantonal Asylum" was opened in 1891, even before the cantonal hospital, posing a challenge for the then approximately 38,000 residents of the canton. The ongoing struggle between desires and what is feasible runs like a red thread through the history of the clinic, which has been part of the Schaffhausen hospitals since 2006. However, politics and the public also supported it during financially strained times, and new insights were reflected upon and implemented in Schaffhausen. Ten authors shed light on Breitenau from a local political and architectural historical perspective, addressing therapeutic approaches, the use of coercive measures, nursing education, and patient art. The contributions of individual (chief) physicians are also recognized, including Hans Bertschinger, who was connected as an early psychoanalyst to the Zurich school of Eugen Bleuler and C. G. Jung, and the psychiatrist and psychiatry historian Henri Ellenberger.