Dorothea Dix

If one were to create a short list of those who have had the greatest influence on the history of American psychiatry, Dorthea Lynde Dix (1802-1887) would surely be on it. She was a tireless social activist, who, from the early 1840s to well after the Civil War, drew on the most advanced early nineteenth century ideas about psychiatric treatment to successfully lobby almost every state legislature to create asylums for the insane. Unfortunately for her legacy, these state hospitals grew into enormous “museums of madness” that served as the deserving targets for later reformers’ zeal.

Dix was neither a physician nor a psychiatrist, beginning her career as a reformer before the first American woman graduated from medical school. Legend has it that her discovery of the nether world of madness in 1841 occurred as a sudden revelation. Her road to Damascus, she said, was a brick street in Boston where she overheard two gentlemen loudly denouncing the awful conditions in the Middlesex county jail in East Cambridge. Feeling guilty about her obsessive “improvement of her mind at the expense of her heart,” and bereft of family ties to provide her heart “scope for its affections,” she decided to go to the jail to see if she could be of help to her fellow creatures. There she found a number of insane inmates in disgusting circumstances, which led her to approach the Massachusetts legislature to obtain an official inspection commission.

The story of how Dix came to take an interest in the mentally ill is more complex and more interesting than this legend. Surviving a childhood of abuse and neglect she she became a student of the Unitarian reformer William Ellery Channing[?], and began her career as a teacher and writer. Throughout her life she appears to have turned away from several opportunities to marry. By the mid 1830s she became quite depressed. It is obviously difficult to speculate about the reasons for her declining mood. Being ambitious and having staked so much on her career, it is plausible to see her becoming depressed as she perceived the limited opportunities available as a teacher and writer. In any event, friends arranged to have her sent abroad to recover. In England she spent a year living on the estate of the Rathbone family, eminent Quaker reformers, where she recovered.

She was quick to see the parallel between the circumstances of her recovery and the “moral treatment[?]” practiced at that time in Quaker institutions for the mentally ill, such as the York Retreat[?]. She made an intensive study of this treatment which emphasized the healing power of a family like asylum removed from the pressures of daily life. When she returned to the United states she brought an enthusiasm for this idea with her.

By the early 1840s she began tirelessly visiting alms houses[?] and jails where where the homeless were confined and then lobbying state legislatures to erect asylums to treat the insane according to the precepts of moral treatment.

In Rhode Island, in 1843, for example, she was invited by the humanitarian Thomas G. Hazard to investigate the case of a madman named Abram Simmons who was confined in the Little Compton poorhouse. Simmons, his body twisted, and covered with sores, had been confined in a cage for thirty years. In April 1844, she wrote an account of Simmons in the Providence Journal. In May 1844 she prevailed on several members of the Rhode Island State Assembly to take Simmons case directly to the floor of the legislature. The assembly was shocked into silence, when, following this presentation, the representative from Little Compton announced that Simmons had died. This led to the appointment of a state commission to investigate the condition of all the insane. Dix followed this up by persuading Cyrus Butler, a self-made Providence millionaire and “by all reports a skinflint of the first water” to contribute $30,000 to the construction of a new hospital for the insane.

Although Dix had an occasional failure when she ambitiously overreached herself, she was always astute in dealing with the male power brokers across the country. She developed working relationships with many of the leading psychiatrists of the time. They respected her and occasionally expressed gratitude for what she was doing. The moral force of her campaign came from the image of her as a genteel lady walking through dirty, stinking places and courageously befriending raving lunatics. She understood this and, like Florence Nightingale at the same time in England, she used this image to shame the powerful into action. Not only did she visit alms houses and write reports, but she often spent long periods of time in residence in various state capitals lobbying all male legislatures.

During the Civil War she moved to Washington and attempted to set up a nursing service for soldiers. Due to political infighting and her stubborn determination to do things her way, this was not a completely successful venture. After the war, although she was physically exhausted, she resumed her lobbying for the mentally ill, now by letter more often than in person. The two dozen mental hospitals built between 1865 and 1880 demonstrate the continuing momentum of of her cause. Dix lived, however, not only to see mental hospitals grow in number but also in size. It is poignant to imagine her witnessing the transformation of the hospitals she hoped would provide warm family like care into overcrowded custodial institutions. Outliving her friends and family, she spent her last years living as a guest in the New Jersey State Hospital in Trenton.

For more information on Dix see David Gollaher's Voice for the Mad: The Life of Dorthea Dix, (The Free Press, 1995)