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.
Until recently it has been difficult to form
a very clear impression of Dix. Older biographies tended to be superficial
and hagiographic. Her conservative views on slavery and her lack of interest
in women’s rights made her an unattractive subject for most recent liberal
historians of psychiatry. At last David Gollaher had given us Voice
for the Mad: The Life of Dorthea Dix, (The Free Press, 1995) a thorough,
balanced and readable biography of Dix. It allows us finally to assess
this unusual and complex nineteenth century reformer as well as glimpse
the ways one nineteenth century woman exerted political power.
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, as Gollaher spells out, 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 her friends arranged to have her sent abroad to
recover. In England she spent a year living on the estate of the Rathbone
family, who were eminent Quaker reformers. Gollaher suggests that the warmth
and kindness of this family contributed to her recovery. Moreover 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.
More on Dix...
Dorothea Dix and her Hospital: mental health care reformer
Dorothea Lynde Dix (1802 ? 1887): Humanitarian Reform and its contribution to the history of psychology. Alison Foley.
