On Dix and Mental Health


“Monday Musings”
 for Monday June 1, 2015

Volume V. No. 22/230

dix

Saint Dorothea Lynde Dix

By Assad Meymandi, MD, PhD, DLFAPA*

This is not an essay. It is not a column. It is not a “MondayMusings”, it is not a eulogy or encomium. It is a love letter, a love letter to a lady whom I have never met. Yet she has become a central part of my life and career. The lady is Dorothea Lynde Dix, born almost a century and a half before me. I first came across her name “Dix” on a plaque in a hospital ward. It was in the late 50’s. I was a medical student at The George Washington University School of Medicine in Washington DC.  Medical students rotated through Saint Elizabeth Psychiatric Hospital for clinical clerkship in psychiatry. I was assigned to “Dix” Ward which was an acute care admission ward for adults.  Little did I know that I would end up in a place called Dorothea Dix Hospital in Raleigh, NC for my psychiatric residency training. Little did I know that someday I would be living on the grounds of DDH when my three sons were born. Little did I know that someday I will be contributing to turning the beautiful 303 acres of land in the middle of downtown Raleigh into a destination park, Dix Park, that would benefit not only Raleigh but the entire State of North Carolina. It is obvious that North Carolina will benefit from Dix Park as NY has benefited from the Central Park.

A brief Bio:

Dorothea Lynde Dix was born on April 4, 1802 in Hampton, Maine. Her father was a fanatic religious man, almost draconian in discipline, which made the sickly Dorothea’s childhood unpleasant.  At age 12, little Dorothea left home to live with her grandmother in Boston, and then she went to an aunt in Worcester, Massachusetts. From a very early age, Dorothea was interested in helping people. Afflicted with tuberculosis, she was physically weak. But she over compensated her physical weakness with moral strength, devotion to duty and compassion for the poor and the marginalized.

Dorothea travelled to Europe to get help from British doctors to recover from her deadly affliction. In those days tuberculosis was like Ebola virus or AIDS today. It killed a lot of people. In the course of her travels, on a cold morning in March 1841, she was introduced to the female section of the East Cambridge jail which was full of mentally ill patients. The half-naked inmates, some chained, some in restraints with no beddings or cover, were shivering. The treatment was brutal. The place was extremely dirty with human feces and urine strewn about. The jailer/superintendent told the visibly shaken Dorothea that “the insane do not feel heat or cold.” Dorothea Dix was moved by the sight. She obtained permission to go back and began teaching the inmates Sunday School. Most of the inmates responded to her attention and kindness. She began a campaign of changing the name from inmate to patients. Her success in changing the names was only marginal.

Career:

Dorothea Dix began teaching school at age 14. In 1819, she returned to Boston and founded the Dix Mansion, a school for girls, along with a charity school that poor girls could attend for free. She began writing textbooks.  Her most famous book,Conversations on Common Things, published in 1824 is a delight to read. Dorothea was a determined, hardworking and focused person with enormous compassion for the ill, especially for the mentally ill. Tuberculosis had made her weak and often despondent. But she reacted with more vigor and determination to fulfill a mission which she carved for herself, namely improving treatment and living conditions of the mentally ill. In 1848, Dix came to North Carolina to find the condition of care of the mentally ill “despicable”. Through a chance encounter while staying in Raleigh, she met James C. Dobbins of Cumberland County and his wife Louisa. Through her friendship with Louisa, Dorothea persuaded James Dobbins to introduce a bill to create a hospital for the insane, later called Dorothea Dix Hospital. It was her tenacity, discipline, devotion, along with the generosity and thoughtful consideration of NC General Assembly that the land was purchased and the hospital built. Dorothea was a genius in connecting people, identifying and marshalling politicians of influence and persuading them to contribute to her cause. Right in the middle of the Civil War, she lobbied President Lincoln to her cause, creating Saint Elizabeth Hospital in Anacostia, Washington, DC  (1855).

Dorothea knew of Lincoln’s psychiatric history and his proclivity to mood disorder and depression. She also knew of Mrs. Lincoln’s emotional and mental difficulties. Cleverly and adroitly, Dorothea used that knowledge and information to persuade President Lincoln to build Saint Elizabeth Hospital. This was in the middle of the Civil War when resources were sparse.  Nevertheless, she made the President aware of the need for humane treatment of the “insane”. What a miraculous accomplishment. With these efforts, she single-handedly turned the former jails and snake pits that contained the mentally ill into the clean wards of a hospital setting, with good nutrition, comfortable living conditions, protecting the patients form extremes of cold and heat. In the late 1950s and early 60’s, Dorothea Dix Hospital in Raleigh was a national model for cutting edge research and treatment of the mentally ill.

The original tract of land designated for the hospital project was 425 acres. Throughout the years, 122 acres have been given to NC State University, the Farmer’s Market and building of roads leading to those facilities, leaving 303 acres. On May 5, 2015, the city of Raleigh purchased the 303 acres of land from State of North Carolina for 52 million dollars with the expressed purpose of tuning the tract into a destination park. It took 11 years from the conceptual phase of the project (April 2004) to signing of the document (May 5, 2015) to accomplish the feat. Because of the persuasive energy of Dorothea, the wisdom of 1850s North Carolina General Assembly, and the hard work of a group of contemporary Raleigh leaders, we will have a destination park named for Dorothea Dix. It might be helpful to recognize the collective wisdom of the NC General Assembly which in the past has given us the “Horn tooting” Bill in 1932, birthing the distinguished NC Symphony and another bill to create the NC Museum of Art in 1929. We are grateful.

Future

While we rejoice the recent transaction between the Governor and the city of Raleigh to create a 303 acres Dix Park, a destination park, we must not forget the patients who suffer from brain disease and chemical imbalance of the brain (I really believe we know enough neurobiology and brain science related to avoid the stigma laden term of mental illness and use brain disorder instead). Our fellow citizens who suffer from brain disease deserve continued care and compassion. We should support National Association of Mentally Ill (NAMI). It is my hope to change it to the National Association of Brain Disorders (NABD).

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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