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For almost 50 years in the 19th century, a woman waged a successful crusade for the treatment of mental illness. To those of us who worry that psychiatry may be forgotten in the scramble for diminishing dollars in the current health care environment, this story of why and how Dorothea Dix succeeded may provide an inspirational note.
- Dilip Ramchandani. M.D.
History Notes Editor
By Janet Eddy Ordway, M.D.
One of the unsung heroes of the mental health movement that occurred in the middle 1800s was actually a heroine-Dorothea Lynde Dix. She awoke America's conscience to the plight of the mentally ill.
Traveling by coach, train, or riverboat, she had by 1848 covered 80,000 miles and visited more than 9,000 mentally ill and epileptic people in prisons, detention houses, asylums, almshouses, orphanages, and hidden hovels. Documenting all that she saw, she would then write a memorial and present it to a legislator who she knew would introduce it to the legislature in each state she had studied.
Since 1841, when she first visited the East Cambridge jail, she had made possible the enlargement of hospitals in Worcester, Mass., Providence, R.I., and Utica, N.Y. She had helped to establish 13 hospitals in New Jersey, Pennsylvania, Indiana, Illinois, Kentucky, Missouri, Tennessee, Mississippi, Louisiana, North Carolina, and Maryland. She also helped establish a government hospital, which later became St. Elizabeths in Washington, D.C.
Her travels to the states seeking out what was needed for the proper care of mentally ill persons was occurring at the same time that several hospitals were being opened under enlightened conditions, following the establishment by Dr. Thomas Kirkbride of the Pennsylvania Hospital. This was a beautifully designed, airy, attractively decorated hospital on a well-chosen hillside outside Philadelphia. Patients had their own rooms and received excellent care.
How did Dorothea Dix become so intimately involved in the movement to help the mentally ill and improve the often deplorable conditions in which they were housed? Dorothea Dix's grandfather was a prominent doctor in Boston. His son, Dorothea's father, married a woman twice his age after his first year at Harvard. Since Harvard did not permit married students, he was expelled. Unable to support himself, her grandfather sent him to Dixmont, Maine, to manage land tracts he owned. Her father was charged with selling off parcels to people who wanted to settle there. However, he became an itinerant preacher in the surrounding communities, preaching and giving solace to the poor, and would be gone for days at a time.
Meanwhile, Dorothea's sickly mother spent much time in bed, and the household chores fell to Dorothea, the oldest of three children. She acknowledged much later in life that she had never had a childhood. Her father's preaching brought in little or no income, and his problem with alcohol didn't help.
Eventually the family returned to Worcester, which had been her father's birthplace and early home. At the age of 12, being very unhappy in an unhappy home, she went alone by stage coach to Boston and begged her grandmother to allow her to stay in her home.
This was a turning point in her young life. There she had a library at her disposal for her own education. Dorothea, at 14 years, became a successful teacher, educating her young students in a small, vacant house on her grandmother's property. She met many prominent Bostonians, including Dr. Channing, Dr. Sam Howe, and Horace Mann, who would later give her letters of introduction to friends in other states where she would carry out her investigations and introduce her memorials to their legislatures.
In 1841, when she was 39 and temporarily teaching 20 women inmates of the East Cambridge jail, she asked to see how the mentally ill were treated in the jail. She was shown a cold, damp, bare, odoriferous room on whose floor sat some piles of straw. A half dozen poorly clothed people huddled together for warmth and comfort.
This visit changed Dorothea Dix's calling. She journied throughout the United States, Canada, and several European countries (including England, Scotland, France, Austria, Turkey, Russia, Norway, Denmark, Germany, and Belgium) and presented her findings to their governments. Over and over she pointed out that it was not the caretakers of these persons but the cruel and outdated system that she was protesting. Mentally ill people, she declared, belonged in hospitals and needed proper care. She had the support of Dr. Bell of McLean, Dr. Butler of Boston Lunatic, Dr. Woodward of Worcester, and Dr. Tuke in England, all of whom had model hospitals and substantiated her findings.
She retired at the age of 82 years to her apartment in the Trenton Hospital, which was her "firstborn" hospital. Forty-one years of dedication to the mentally ill can be summarized in her own words: "If I am cold, they are cold; if I am weary, they are distressed; if I am alone, they are abandoned."