“Monday Musings” for Monday February 19, 2018
Volume VIII, No. 8/372
Dorothea Lynde Dix
(Editor’s Note: The author of this paper is a brainy and hardworking teenager, Olivia Ng, the daughter of colleague Peter Ng, and granddaughter of another colleague the distinguished Raleigh surgeon, Fred N. Olivia is completing her frosh year at Davidson College, The paper about Dorothea Dix has brought much deserved honor to Olivia. In addition to the text, there are dozens of notes (33 to be exact), references and footnotes. Frankly, when reading her paper, I had the feeling that I was reading a scientific paper in Nature and Science magazines. The text is presented with such incandescent intensity and persuasive power that makes reading a sheer intellectual and humanistic feat. Olivia has a brilliant future. I am glad to share her paper with our readers)
Olivia Ng Senior Division Historical Paper 2,475 Words
If I am cold, they are cold; if I am weary, they are distressed; if I am alone, they are abandoned.
Dorothea Dix, 1843
Dorothea Dix, born in 1802, was one of the world’s most renowned female activists,educators, and reformers. She was a woman ahead of her time who encountered pressing issues, and despite the odds against her, overcame personal, social, and political obstacles to resolve them. Dix had a profound influence on the mental health field through her courage to explore, encounter, and exchange information through teaching others, spurring the beginning of the revolution of improvements in the mental health field and changing perceptions of the mentally ill.
Dix grew up in an unstable household in Hampden, Maine, where she formed a strong sense of compassion for others by caring for her younger brothers. When she was twelve, after learning to read and write from her alcoholic father, Dix moved to live with her wealthy grandmother, where she demonstrated her compassion and love of teaching by founding a girl’s school when she was fourteen. In 1824, Dix published a popular book of facts, called Conversations on Common Things, which provided basic knowledge to people of different social classes, which helped build her reputation as an educator.
Though Dix enjoyed her work, it was often interrupted with chronic sickness and depression, and she was sent to Europe in 1836 for her health.4 While there, her health improved, and she became acquainted with several influential figures involved in reform, including prison reformer Elizabeth Fry, founder of the York Retreat for the mentally ill, Samuel Tuke, and politician William Rathbone. Exposure to such influential figures helped give Dix a foundation for her ideas and reform work when she returned to America shortly after her grandmother’s death in 1837. Having no financial support from her family, Dix’s grandmother’s death left her an inheritance that allowed her to become more involved in charity and reform work which became extremely important in 1841, when Dix found her calling. That year, Dix was teaching Sunday school at the East Cambridge Jail in Massachusetts, and was shocked by the living conditions. She went to court, secured heat for the prisoners, and began her lifelong journey of visiting various mental asylums and prisons throughout the United States (U.S.) and the world, documenting the brutal conditions she found in each one with exacting detail. Throughout her travels, she presented her findings to various audiences, fighting for the rights of the mentally ill.
Dix created a conversation around mental health that led to the expansion of the field, improvements in conditions for the mentally ill, and furthered social acceptance and understanding of mentally ill people, all issues of significance in society today. Until Dorothea Dix began to explore mental asylum conditions in the 1800s, understanding of the mentally ill was limited, and few were concerned nor cared to understand their plight. The mentally ill were viewed as useless, having no feelings or senses, and as a burden on society. The state felt it had no option other than to put them into asylums, which at that point, was seen as radical, progressive, and liberal. Dix’s decision to investigate the asylums and improve them was seen as outrageous. Few cared about improving asylums, including the private and public financial backers of institutions in progressive states with asylums, whose support was necessary for change. For such reasons, Dix was often opposed by governments and the upper classes because she was viewed as challenging the state’s authority and ideals, posing threats to social order. Dix’s radical ideas also resulted in her being seen as a feminist and as supporting the unpopular women’s suffrage movement, though she did not participate in the suffragette movement. Despite opposition, Dix sought to improve the horrid conditions that she consistently observed that others saw as sufficient, including lack of heat in freezing temperatures, the housing of men and women, and criminals and mentally ill together, frequent rape, the chaining of people to beds, starvation, bad sanitation, and poorly-built buildings.
Dix’s understanding and compassion for the mentally ill was rooted in her childhood when she lived with her mother, who struggled with depression and was rumored to be mentally challenged. Dix struggled with depression as well, but her understanding of the struggles of the mentally ill became clearer when, in 1841, while in Massachusetts, she took action after witnessing the appalling conditions. From then on, Dix was determined to advocate for thementally ill. Throughout her travels in the state, Dix found similar inhumane conditions and presented them to the state government in her Memorial to the Legislature of Massachusetts in1843.13 Through vivid descriptions of unthinkable conditions, Dix petitioned for the expansion of a state insane asylum in Worcester, Massachusetts, which she believed offered curative treatments rather than abuse, for the mentally ill. Other insane asylums she described, however, varied in administration and care, from families keeping insane people in their barns and stables in the freezing cold, to the insane being confined in rooms, denied exercise, being chained to beds, and once in a while, given an opportunity to walk the grounds of facilities in iron collars and leashes. In other cases, they were “treated,” in a tranquilizer chair, invented by Benjamin Rush (see Appendix I). Other forms of cruel treatments for disobedient people, or those who tried to act for themselves, were beatings. A newspaper article published in Oil City, Pennsylvania on March 26, 1880, told the story of John Carroll, a man who, while under a brain fever, was sent to an insane asylum in Pittsburgh, only to return to tell this story:
“When I walked out,” says Carroll, “he knocked me down, and, with three others, kicked and beat me until I was senseless. When I came to my senses I was lying in a cell. I had on a strait-jacket, and was lying on a bare, damp floor. There was no furniture in the room.”
Such was typical of what Dix found as she visited mental asylums around the country; yet the most disturbing thing that Dix encountered was that almost all prisoners were denied a source of heat, most often in the dead of winter in the Northeast, and left blanket-less and alone in tiny stone-walled cells.
When visiting an almshouse in Berkeley, New York, Dix asked a superintendent if an insane person had fire for warmth, and he indignantly replied, “Fire! Fire, indeed! What does a crazy man need of fire? Red-hot iron wants fire as much as he!” Yet, when Dix spoke to the insane, they often spoke of the cold. Another misconception that caregivers had of the insane was that they were incapable of polite interaction. Dix found this to be extremely inaccurate when one “crazy man,” as described by the caretaker, a physician educated at Cambridge, sent her letters of appreciation for books she had given him. An excerpt from one reads, “You express confidence that I have self-control and self-respect. I have, and, were I free and in good circumstances, could command as much as any man.” This letter helps reflect the common stereotype that although many insane were considered to be incapable, helpless people, in many cases that Dix encountered, the insane were capable of self-control and polite interactions.
Through meeting and treating those thought to be insane like normal people, Dix was able to more accurately depict the struggles and needs of the mentally ill and more successfully campaign to meet their needs. Once Dix understood what measures needed to be taken, she continued her work in mental reform, spreading her campaign and influence. Dix traveled around the country, bringing mental health reform into the public and government’s focus. She traveled through Rhode IslandNew Jersey, starting her first hospital for the mentally ill, the Trenton State Hospital, Tennessee, Kentucky, Ohio, Maryland, Pennsylvania, Alabama, Georgia, South Carolina, North Carolina, Mississippi, Texas, Louisiana, and Illinois (see Appendix II for a sketch of the Trenton State Hospital).
In 1848, Dix traveled to Washington, D.C., where she met with Vice President Millard Fillmore. Her evidence, compassion, and conviction led him to give her a grant in 1852 and to draft a land grant bill for mental hospitals. Dix used the $100,000 federal grant to establish Washington, D.C.’s St. Elizabeth’s Hospital. However, the bill, though passed by the Senate, failed to pass in the House of Representatives. Though it remained a topic of discussion, it was later vetoed by President Franklin Pierce in May, 1854 due to budget cuts.24 However, Dix’s ability to create any sort of legislation was a major accomplishment and raised public and federal awareness on her cause for mental health reform.
Dix did not stop campaigning, and she took her influence across the Atlantic to Europe. Starting in 1853, Dix campaigned in Canada, Scotland, Italy, Greece, Turkey, France, Australia, Austria-Hungary, Germany, Russia, Holland, Belgium, Denmark, and Scandinavia. Her widespread campaigning exposed the major problems in the world’s mental health institutions. She was especially successful in Turkey and Greece. Dix even addressed Pope Pius IX in Rome, Italy, and upon further inspection of Dix’s findings, he promised to take action. Dix’s campaign around the world brought the issue of mental health reform to the public’s eye, and made known the problems within mental health institutions and what needed to be done to reform them.
Throughout her campaigns, Dix informed others through speeches to both public and private audiences, demanding improvements of living conditions and treatment of the mentally ill. She emphasized the fact that the insane can feel temperature and emotion and, therefore, needed heat in the winter, and faced horrible stresses from being locked up in rooms for years on end. Additionally, in place of treating the mentally ill by simply locking them away in dark, dank rooms, she addressed the need for medical and emotional treatment. One treatment she found to be extremely successful from personal experience during her tours of facilities was based on the ideology behind “talk-therapy.” First used by Dr. John Galt, a superintendent of the Eastern State Insane Asylum in Virginia, talk-therapy was a method of treatment that involved housing patients with the occasional use of calming medicines, rather than restraints such as chains, and talking to patients about their problems as if they were sane. By explaining the ideology behind talk-therapy, as well as telling stories from her own experiences from visiting them, Dix combined her obvious sense of human compassion and details of horrific conditions of asylums, to stir the hearts and minds with whom she exchanged ideas. Dix’s emotional and humane appeals helped her spread awareness of the importance of mental healthcare around the world, spurring the mental health reform movement, slowly swaying and convincing governments and the public of its importance, founding hospitals, and improving conditions for the mentally ill around the world. Though extremely successful in her mental reform movement, Dix was often not considered to be the activist type. She was extremely quiet, shy, and suffered from severe glossophobia, the fear of public speaking, and agoraphobia, the fear of being in areas where escape is difficult. Not only that, but Dix had no basis for helping the mentally ill besides her sense of compassion; she did not have a medical background, nor did she work in a mental asylum. Yet, she dedicated nearly her entire life to exploring the conditions of the mentally ill and advocating for them. Throughout her life, Dix’s reform movement not only aided the mentally ill, but also helped her grow as a person. By the end of her campaigning, she was no longer quiet and glossophobic, but a sophisticated, well-spoken advocate for the mentally ill.
Yet, unlike many reformers, Dix refused personal credit for her work and was uncomfortable with receiving such recognition. In fact, she refused to allow a new hospital in Raleigh, North Carolina, to be named after herself, and only permitted the hill it was built upon to be named Dix Hill for her father. Given this, it is only a reflection of her lasting impact on the mental health reform of the 19th, 20th, and 21st centuries that many hospitals renamed themselves for Dix after her death.
Dorothea Dix explored new, humane standards for the treatment of the mentally ill, improved and created institutions for their care, and exposed the pressing issues inside asylums that were hidden from public view, while going against the societal expectations of women and the accepted standards of mental health. Through her exchange of ideas, Dix raised awareness of the mentally ill throughout the U.S. and in over ten other countries around the world. Her standards for treatment of the mentally ill have been implemented throughout the world and have significantly improved the lives of millions for over 150 years.
Dix not only helped the mentally ill but also other disadvantaged people by the founding of schools for the feeble-minded, a school for the blind, and several nurse-training facilities. Dix also proved that women can make a difference. She left the “home sphere” far behind, traveling around the country and the world, speaking with people of influence including the Pope. She broke others’ expectations of herself as a woman: the expectation that women and men remain in separate spheres, where women stayed in the home and men worked and involved themselves in public matters. Dix stepped outside of the home sphere, doing what she believed needed to be done for a cause that few saw as important, or relevant at all. She went where few dared to go, for the benefit of others whom had no impact on her life. She encountered pressing issues of mental health, where no one believed there were problems, and worked for almost her entire life to fix them. She improved mental health care and treatment, and she opened the doors for an entire field, which, because of her, is considered a key component of overall health today. She gave the insane a voice, and unlike others, believed they could be helped. She launched a mental health care revolution that has left a mark on mental health institutions for over 150 years following her death. Dix was a woman ahead of her time who fearlessly explored the unknown, encountered major issues, spent her entire life resolving them through advocacy for change, exchanging little-known information with the world, and improving leaving mental health for her time and future generations.
*The editor is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life Fellow, American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He was the 2011 inductee to Raleigh Hall of Fame, and 2016 recipient of the NC Award, Fine Arts.