Dorothea Dix

American educator and social reformer

• Born: April 4, 1802
• Birthplace: Hampden, District of Maine, Massachusetts (now in Maine)
• Died: July 17, 1887
• Place of death: Trenton, New Jersey

A crusader for the rights of the mentally ill, Dix devoted her life to establishing psychiatric hospitals to provide proper care for those with mental and emotional problems and set the stage for worldwide reforms in the care and treatment of people with mental disabilities.

Early Life

Dorothea Lynde Dix had a difficult childhood. By his family’s standards, her father married below his station. Because married students were not accepted at Harvard, where he was studying at the time, he was sent to manage family holdings in Maine—nothing less than the frontier during the early nineteenth century. Never a financial success, he did win some notice as a traveling Methodist preacher and a writer of tracts. Thus, Dorothea was often without her father, and unfortunately, her mother was often too ill to give her the attention that young children require.

Dorothea’s happiest memories of her solitary childhood revolved around visits to her paternal grandparents in Boston. Her grandfather, a successful if curmudgeonly physician, and grandmother provided a warm welcome. Dorothea’s first exposure to public service came from watching her grandfather practice medicine. She had few playmates her own age and was four years older than her nearest sibling. At least one biographer believes that isolation from children and involvement with adults led to a high degree of self-interest and blocked the development of personal emotional commitment. In any case, she never married, and most, though not all, of her friendships were with people involved in her charitable endeavors.

When Dix was around the age of twelve and unhappy at home, she began to live permanently with her then-widowed grandmother. To her dismay, her grandmother insisted on both academic and social discipline, and Dorothea’s sense of rejection was actually worsened. After two years, she was sent off to live with a great-aunt, where she finally found a congenial home. Although still a teenager, she was allowed to open a school for small children, which she ran successfully for three years before returning to Boston. Two years later, in 1821, she opened a school for girls. Education for women was unusual—public schools accepted girls only for the few months when many boys were out for agricultural labor—and even more unusual was Dix’s insistence on including natural science in the curriculum. Dorothea Dix proved to be a gifted teacher, and she seemed to have found her life’s work. In a gesture that was a harbinger of her future, she added a program for poor girls who otherwise had no opportunity for schooling.

Ill health—apparently tuberculosis—and the collapse of a romance with her cousin resulted in a new direction for Dix. While recovering her strength during the mid-1820’s, she became interested in Unitarianism and the ideas of William Ellery Channing. This Christian sect’s emphasis on the goodness of humanity and the obligation to serve it would inspire her for the rest of her life. A new attempt to run a school, however, led to her complete collapse in 1836 and her doctor’s orders never to teach again.

Life’s Work

While recuperating, Dorothea Dix visited England. During her two-year stay with the William Rathbone family, she met a variety of intellectuals and reformers. When she returned to the United States, she found that the deaths of her mother and grandmother had left her financially independent. She spent several years seeking some focus for her life. Then, in 1841, she was asked to teach Sunday school for women at the East Cambridge Jail. She found the innocent and guilty, young and old, sane and insane crowded into the same miserable, unheated facility. Those regarded as insane were often chained or otherwise restrained. Her discussions with humanitarians such as George Emerson, who would become a longtime friend, led her to understand that conditions in East Cambridge Jail were, if anything, better than those in most jails. There was virtually no distinction made between mental illness and impairment, and in the entire country there were only about 2,500 beds specifically for those with emotional problems. Dix quickly had a sense that she had come upon something important that needed doing.

Dix’s first move was to demand and get heat for the insane in the East Cambridge Jail. Then, after talking with other reformers, including Samuel Gridley Howe and Charles Sumner (later a radical Republican leader during Reconstruction), she began a survey of facilities for the insane in Massachusetts. Although the McLean Psychiatric Hospital was relatively progressive, most of the mentally ill were kept in local poorhouses, workhouses, and jails. She visited every one. Conditions were horrendous. Patients were often locked in dirty stalls, sometimes for years, and many were chained to the floor. Many were virtually naked, and physical restraint was virtually universal. She also found time to discuss treatment with the best doctors, finding that much more humane treatment was being successfully used in leading hospitals in Europe and a few in the United States. More common in the United States were strong sedatives to induce quiescence and the application of shocks, such as surprise dousings with ice water, to bring individuals back to reality.

After eighteen months, Dix prepared a petition to the Massachusetts legislature. The petition stated psychiatric facilities should provide for physical health and comfort (she would later expand this to prisons) and seek, with kindness and support, to cure diseased minds. When it was published, this document at first produced embarrassment and denial and then attacks upon the author. Her friends—Howe, Sumner, and others—rushed to defend her. She had her first victory when a bill providing for more and better accommodations for the mentally ill was passed. Her career was beginning to take shape.

Dix’s initial investigations had occasionally taken her outside Massachusetts, where she found conditions to be generally worse than in her home state. From the mid-1840’s to the mid-1850’s, she traveled many thousands of miles around the United States and Canada, finding and exposing the suffering of the indigent insane. Although she did not travel to the far West (she did work in Texas), Dix visited almost every one of the thirty-one states of that era.

Dix developed an investigative technique in which, by means of simple persistence and will, she forced her way into every facility where the insane were kept. There followed dramatic revelations of suffering and abuse that shamed all but the most hardened and/or fiscally conservative. Finally, she launched a petition to the legislature for the necessary funds and regulations to ensure improved care. She found the inevitable compromises necessary in any political campaign frustrating, but she settled for whatever state legislatures would fund and began again.

Results varied. New Jersey and Pennsylvania established state psychiatric hospitals as a result of Dix’s efforts. New York, however, rejected her call for six hospitals and only expanded the beds available in an existing facility. In 1845, with the help of Horace Mann and George Emerson, Dix expanded her efforts to prison reform and published a manual on that subject. Proper care for the mentally ill, however, remained her main focus.

From 1845 to 1846, Dix worked in Kentucky, Tennessee, Louisiana, Alabama, Georgia, and Arkansas, and she was working her way up the Mississippi when, in September, she collapsed in Columbus, Ohio. By December, she was sufficiently recovered to resume traveling, and in January, 1847, she presented a petition to the Illinois legislature, which resulted in the passage of a bill creating a psychiatric hospital. Later that year and in the following year, she had similar successes in Tennessee and North Carolina. Her fame was growing enormously, as were the respect and love with which Americans regarded her. One of the greatest marks of the latter came in 1863, when Confederate troops invading Pennsylvania stopped a train on which Dix was riding. A North Carolina officer recognized her, and the train was released to continue on its way. Not even the passions of Civil War could change people’s feelings about Dorothea Dix.

Despite local successes—between 1844 and 1854 Dix persuaded eleven states to open hospitals—Dix recognized by the late 1840’s that only a national effort would resolve the problems of the insane. No more than one-fourth of those needing care got it. She began to push for a federal effort, suggesting that five million acres of public land be committed to set up a fund to provide care for insane, epileptic, and mentally impaired Americans. A bill to this effect was introduced in Congress in 1848. Dix was provided with a small office in Washington from which to lobby. Questions about cost and constitutionality blocked the various versions of the bill until 1854, when, to her joy, it passed both houses. Her exultation was brief, however, for President Franklin Pierce vetoed the bill on the grounds that Congress had no authority to make such grants outside the District of Columbia. It was the final blow—the effort was abandoned.

Exhausted and ill, Dix planned to renew efforts in individual states, but friends and doctors persuaded her to rest. She visited friends in England, and within two weeks she was involved in efforts to reform psychiatric care there. She went so far as to go personally to the home secretary, Sir George Grey, to argue for improvements in Scotland. Before she left, a Royal Commission to investigate the problem was in the works. She also helped to sustain a reform effort in the Channel Islands before touring the Continent, where she visited hospitals, asylums, and jails, exposing problems and demanding change. The force of her personality seems to have made her irresistible; even Pope Pius IX was forced to initiate improvements in the Vatican’s handling of the mentally ill.

Dix’s return to the United States in 1856 brought a large number of requests for aid. She was soon traveling again, seeking various reforms and funding. In the winter of 1859 alone, she asked state legislatures for a third of a million dollars, and in 1860, she got large appropriations for hospitals in South Carolina and Tennessee. The outbreak of the Civil War brought reform work to a halt, and Dix promptly volunteered her services.

After being appointed superintendent of U.S. Army nurses, Dix spent four years of very hard work developing the Medical Bureau from a service set up for an army of ten thousand to one that could handle more than that many casualties from one battle. Unfortunately, she was too straitlaced at the age of sixty to cope with the rough-and-tumble style of the military. Her New England Puritanism showed in her tendency to think that an army doctor who had had a few drinks should be dishonorably discharged. Although her work in ensuring the provision of nurses and medical supplies at the beginning of the war was of great importance, in 1863 her authority was quietly reduced, to her bitter disappointment. After the war, Dix spent another fifteen years traveling as the advocate of the insane. Worn out in 1881, she retired to the hospital (the first created by her efforts) in Trenton, New Jersey, where she lived until her death in 1887.

Significance

Dorothea Dix’s importance can be seen from simple statistics. In 1843, the United States had thirteen institutions for the mentally ill; in 1880, it had 123. Of the latter, 75 were state-owned, and Dix had been a key factor in the founding of 32 of them. She had also been able to get a number of training schools for the mentally impaired established, and specialized training for psychiatric nurses had begun.

More important, the lives of many unfortunate people had been made easier thanks to Dix’s efforts. The idea that the insane, even if poor, deserved humane care and treatment intended to help them recover had been established in the United States. Dix’s efforts began a process that has continued since her death and has left the United States a world leader in the treatment of mental illness.

Bibliography

Brown, Thomas J. Dorothea Dix: New England Reformer. Cambridge, Mass.: Harvard University Press, 1998. This study of Dix provides new insight into her passions and methods.

Dain, Norman. Concepts of Insanity in the United States, 1789-1865. New Brunswick, N.J.: Rutgers University Press, 1964. A useful description of attitudes and problems that Dix had to confront during her career.

Dix, Dorothea. Asylum, Prison, and Poorhouse: The Writings and Reform Work of Dorothea Dix in Illinois. Edited by David L. Lightner. Carbondale: Southern Illinois University Press, 1999. Dix traveled to Illinois in 1846 and 1847 to publicize the need for more humane treatment of prisoners, the insane, and the poor. This book is a collection of her writings during that trip, including a series of newspaper articles about conditions in jails and poorhouses. There also are two memorials she presented to the state legislature: one describes the treatment of inmates at a state penitentiary, and the other urges the establishment of a state insane asylum. Lightner has provided detailed notes and introductions to these documents, and in a concluding essay he assesses the immediate and continuing impact of Dix’s work.

‗‗‗‗‗‗‗. On Behalf of the Insane Poor: Selected Reports. New York: Arno Press, 1971. A valuable source of Dix’s ideas and opinions expressed in her own words. Her eloquence and passion shine through.

Gollaher, David. A Voice for the Mad: A Life of Dorothea Dix. New York: Free Press, 1995. A balanced biography highlighting Dix’s strengths and weaknesses, her efforts in the area of legislative reform, and her second career as head of the Civil War nurses.

Marshall, Helen. Dorothea Dix: Forgotten Samaritan. Chapel Hill: University of North Carolina Press, 1937. Although it is sometimes overly sympathetic to its subject, this is a solid and well-written biography.

Snyder, Charles M., ed. The Lady and the President: The Letters of Dorothea Dix and Millard Fillmore. Lexington: University Press of Kentucky, 1975. Provides interesting insights into one period in Dix’s life.

Tuke, Daniel. The Insane in the United States and Canada. London: M. K. Lewis, 1885. This contemporary description of the problems Dix tried to solve gives a valuable perspective of the situation. It is very useful for modern students trying to achieve an understanding of her work.