Monday, July 29, 2013

Dorothea Dix - One Woman's Tireless Struggle to Reform the Nation's Attitudes and Public Policy Towards the Mentally Ill

Dorothea Dix was born on April 4, 1802 in Hampden, Maine that was part of the state of Massachusetts at the time.  Her parents were Joseph Dix and Mary Bigelow; she was the eldest of three children.  Joseph Dix was a traveling Methodist minister; he journeyed throughout the New England frontier attempting to make converts to the church.  The family lived in a one-room cabin.  There were a total of 150 people in the town; it was a harsh environment and a hard life in modern terms.  The physical environment consisted of oil-paper windows, dirt floors and few amenities.  The economy of the region supported such industries as the timber trade, trapping of fur-bearing animals and agriculture during the summer months.  In such an austere atmosphere there was little time to be a child and no time to play – everything was geared towards survival. 
Joseph Dix was one of eight children; he was considered to be “delicate” in nature.  His father, Elijah Dix, was an only surviving son; he had six brothers who died prematurely.  Elijah moved his family to Boston in 1795.  Initially, the family had inherited wealth.  Joseph Dix, Dorothea Dix’s father, went to Divinity school but was eventually expelled and also failed in medical school.  He married Mary Bigelow on January 28, 1801.  Mary came from an impoverished family.
When Joseph Dix converted to Methodism, he suffered a serious and irrevocable break with his father who considered this branch of Christianity to be crude and doctrinaire.  This family schism would have a profound effect upon Joseph and his family.
During Dix’s young years, she felt the oppressive impact of her father’s strict and unbending religious beliefs.  As a young child, she was compelled to confess her faith, show repentance for all of her alleged sins and was constantly punished whenever she became obstinate.  Dix was, by nature, a strong-willed and independently-minded individual.  Given these qualities, she needed to escape her father’s oppressive influence and find relief from all the hardship and unhappiness she endured.
Dix remembered the enjoyable time she had with her grandfather, Elijah Dix who taught her about healing herbs and medicine; Elijah, however, was murdered in 1809.  At the age of thirteen she left home and moved to Boston, hoping to live with her paternal and wealthy grandmother in Boston.  Once she was gone, she was never to see her immediate family again.  As a matter of fact, she would often refer to herself as an orphan.  Her father passed away in 1821.
When she arrived unannounced, she pleaded with her grandmother to allow her to stay at Orange Court – a stately mansion; her grandmother relented.   Her new life at Orange Court was dramatically different from her experience growing up.  Her grandmother tutored the young Dix in the ways of society and how to be a “lady.”   Dix found this somewhat irritating, for she was stubborn and headstrong.  Not only was she schooled in the social graces of her time, but she also received an excellent education with accomplished tutors.
In 1821, she opened a charity school at Orange Court with the help of her grandmother.  In that era in New England there was an open intellectual environment with a free exchange of ideas.  The role of women was in a state of flux and the social causes that women became involved in included temperance and the abolition of slavery.  Dix devoted her energies to education and at the age of 22 (1824) she published a manual for teachers entitled, Conversations on Common Things, or a Guide to Knowledge that was published anonymously.  This book actually went into its sixth edition by 1829  
In regards to her spirituality, Dix gravitated towards Unitarianism and frequented sermons delivered by Dr. William Ellery Channing – considered to be the father of Unitarianism.  He gave very moving and charismatic sermons in which he encouraged his parishioners  to help the poor.  Channing   had a marked influence on her thinking.  He became her friend and mentor and she actually lived as a governess in the Channing household (1827). 
In 1831, she started a school dedicated to young women in Boston.  This school existed for five years; until, Dix began to suffer from health problems.  As a consequence of her ill health, Dix decided to find rest through travel – she journeyed to England.   There, she happened to meet and befriend the Rathbone family and was invited to spend a year with them at their mansion in Liverpool - referred to as Greenback. 
The members of the Rathbone family were devoted and practicing Quakers and were deeply immersed in social welfare issues.   In the company of the Rathbones, Dix had an opportunity to meet many progressively-minded reformers who felt that the government should play an active role in issues of social reform.  It should be remembered, that Dix was a contemporary of Charles Dickens, who graphically revealed the extent of social malaise that existed in England at the time.   She also was exposed to the methodology employed to detail the horrific conditions of mental asylums.  The results of some of these investigations were presented as reports to the House of Commons.  The totality of this experience had a marked effect on Dix and would help her choose the path she would take in regards to social reform.
During her lifetime, there was a very influential philosophical movement around Boston that influenced Dix’s thinking and that was Transcendentalism.  It was point of view that emphasized the intellectual and spiritual life.  Its proponents were such notables as Ralph Waldo Emerson, Henry David Thoreau and Margaret Fuller.   She was also influenced by the work of Rev. Henry Furness - a theologian, reformer and abolitionist.   He was responsible to a considerable degree in the establishment of the public school system in Philadelphia.  Dix was also in the midst of the abolitionist movement – the movement to end slavery – typified by the work of William Lloyd Garrison.  Paradoxically, Dix had no interest in the issue of slavery.
After Dix regained her health, she began to investigate the treatment of the mentally ill in earnest.  She began by visiting the UK’s most progressive insane asylum, York Retreat, built in 1796.  It looked like a private residence.   Within its walls, individual patients were treated with dignity and respect for their person.   Dix was struck by the compassionate care provided and realized that patients when treated with care and compassion could recover.  Physical restrains were seldom employed and isolation proved unnecessary.  She returned to Boston in 1837 with a passion for reform.  As a result of an inheritance following her grandfather’s death, Dix received $3000 a year – a substantial amount of money for that time.  With this resource in hand she decided to travel.
She was encouraged to do philanthropic work in Boston.  However, her impassioned belief in the role government should play in tackling the problem of mental illness, inspired her to move to Washington DC .  There, she visited schools, orphanages, almshouses and jails meticulously recording her observations.  When her brother Charles was lost at sea in 1839, she returned to Boston.  The issues that were on the public radar in those days were: a woman’s role in society, abolition of slavery and temperance.   Unlike Jane Addams she did not view slavery as an issue that should occupy her attention – this is somewhat perplexing given her affinity to issues that gravitated around social reform.  She chose instead to focus entirely on the care and support of the mentally ill.  In this regard, she had the support of Senator Charles Summer of Massachusetts, who played a key role in the anti-slavery movement.
Dix continued her travels throughout the New England States gathering information on the care and treatment of the mentally ill.  What she discovered and reported was particularly disturbing.  The institutions that housed the mentally ill often left the patients under their care isolated, often under-nourished and medically unattended.  In the worst cases, individuals were shackled; the sanitary conditions in such abysmal settings were hard to imagine.
Her ability to gain the attention of state legislators and persuade them to make substantial changes in state policy regarding the mentally ill was quite extraordinary.   As an example of the strategy she so successfully employed, in Massachusetts she obtained letters of introduction and credentials from Harvard Medical School with the help of Walter Channing.  In this way, she gained admission to jails and asylums throughout the state.  As a result of her efforts, The Boston Lunatic Hospital was opened in 1839, modeled after the York Retreat in England that had so influenced her thinking.  In 1841, Dix visited the Lowell Almshouse outside Boston and recorded her observations.  In New England an almshouse was house for the poor and indigent supported by the local town.  In many instances, the poor were required to work.  In 1842, she sent the following letter to the Massachusetts State Legislature. 

“About two years since leisure afforded opportunity and duty prompted me to visit several prisons and almshouses in the vicinity of this metropolis. I found, near Boston, in the jails and asylums for the poor, a numerous class brought into unsuitable connection with criminals and the general mass of paupers. I refer to idiots and insane persons, dwelling in circumstances not only adverse to their own physical and moral improvement, but productive of extreme disadvantages to all other persons brought into association with them. I applied myself diligently to trace the causes of these evils, and sought to supply remedies. As one obstacle was surmounted, fresh difficulties appeared. Every new investigation has given depth to the conviction that it is only by decided, prompt, and vigorous legislation the evils to which I refer, and which I shall proceed more fully to illustrate, can be remedied. I shall be obliged to speak with great plainness, and to reveal many things revolting to the taste, and from which my woman's nature shrinks with peculiar sensitiveness. But truth is the highest consideration. I tell what I have seen--painful and shocking as the details often are--that from them you may feel more deeply the imperative obligation which lies upon you to prevent the possibility of a repetition or continuance of such outrages upon humanity. . . .”
In 1843, Horace Mann and Samuel Gridley Howe invited Dix to present a Memorial, petition, to the Massachusetts legislature.  Since, women were not allowed to speak in the legislative chamber, Howe presented it for her.  The following is an excerpt from that petition that graphically illustrates the treatment of the mentally ill and Dix’s passion for reform.

“I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane, and idiotic men and women; of beings sunk to a condition from which the most unconcerned would start with real horror; of beings wretched in our prisons, and more wretched in our almshouses. . . .
“I must confine myself to few examples, but am ready to furnish other and more complete details, if required.
“If my pictures are displeasing, coarse, and severe, my subjects, it must be recollected, offer no tranquil, refined, or composing features. The condition of human beings, reduced to the extremist states of degradation and misery cannot be exhibited in softened language, or adorn a polished page.
“I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience. . . .
“It is the Commonwealth, not its integral parts, that is accountable for most of the abuses which have lately and do still exist. I repeat it, it is defective legislation which perpetuates and multiplies these abuses. In illustration of my subject, I offer the following extracts from my Note-book and Journal:--
“Springfield. In the jail, one lunatic woman, furiously mad, a State pauper, improperly situated, both in regard to the prisoners, the keepers, and herself. It is a case of extreme self-forgetfulness and oblivion to all the decencies of life, to describe which would be to repeat only the grossest scenes. She is much worse since leaving Worcester. In the almshouse of the same town is a woman apparently only needing judicious care, and some well-chosen employment, to make it unnecessary to confine her in solitude, in a dreary unfurnished room. Her appeals for employment and companionship are most touching, but the mistress replied she had no time to attend to her. . . .
“Lincoln. A woman in a cage. Medford. One idiotic subject chained, and one in a close stall for seventeen years. Pepperell. One often doubly chained, hand and foot; another violent; several peaceable now. Brookfield. One man caged, comfortable. Granville. One often closely confined; now losing the use of his limbs from want of exercise. Charlemont. One man caged. Savoy. One man caged. Lenox. Two in the jail, against whose unfit condition there the jailer protests.
“Dedham. The insane disadvantageously placed in the jail. In the almshouse, two females in stalls, situated in the main building; lie in wooden bunks filled with straw; always shut up. One of these subjects is supposed curable. The overseers of the poor have declined giving her a trial at the hospital, as I was informed, on account of expense...
“Besides the above, I have seen many who, part of the year, are chained or caged. The use of cages all but universal. Hardly a town but can refer to some not distant period of using them; chains are less common; negligences frequent; willful abuse less frequent than sufferings proceeding from ignorance, or want of consideration. I encountered during the last three months many poor creatures wandering reckless and unprotected through the country. . . . But I cannot particularize. In traversing the State, I have found hundreds of insane persons in every variety of circumstance and condition, many whose situation could not and need not be improved; a less number, but that very large, whose lives are the saddest pictures of human suffering and degradation.”

Dix’s petition was ultimately successful: the Worcester Asylum received an additional $65,000 – a substantial sum of money in that era.   Invigorated by this kind of success, she traveled throughout New England and New York with her notebooks.  She garnered the support of NY Governor William Seward.   She spent a considerable amount of time and energy in Rhode Island where no facilities existed for the mentally ill.   In 1844, Nicholas Brown, founder of Brown University, left the state of Rhode Island $30,000 upon his death for the establishment of an asylum for the Insane.  Dix encouraged the state legislature to establish a “lunacy commission” in order to review and address the plight of the mentally ill.  Following her persuasive testimony, they did so.   Building considerable momentum, Dix had appreciable success in Tennessee, Kentucky and Pennsylvania as well.

In 1847, Dix took her quest to the federal government in Washington D.C.  There she petitioned the U.S. in 1848 to dedicate 5 million acres of federal land for the exclusive use of asylums for the mentally ill; this would include a parcel of land for each state.  The states, for their part, would be required to build and operate their own facilities.  Dix had the support of Daniel Webster from Massachusetts and Vice President Millard Fillmore.  A bill addressing her petition came out of the Congress – revised bill H.R. 383.  A month earlier, President Zachery Taylor died and was succeeded by Vice President Fillmore.  In 1851, the bill passed in the Senate but was defeated in the House.
Despite this setback, Dix continued her reform efforts  in Canada, especially Nova Scotia, Prince Edward Island and Montreal.    After repeated efforts to pass the bill that she worked so hard for in DC failed, she left for Europe feeling disheartened.   She carried her reform efforts to the U.K., France and even visited Pope Pius IX, distressed by the conditions of mental health institutions in Rome.   She subsequently returned to the US in March of 1857 with James Buchanan as President; civil war looked imminent.  John Brown attacked the arsenal at Harper’s Ferry in West Virginia and attempted to incite a massive slave rebellion.  In 1860, Abraham Lincoln was elected sixteenth President of the US and soon thereafter, the Civil War began. 
In order to assist in the war effort and relieve the suffering of the wounded, Dix enlisted as a nurse for the War Department.  She ultimately became the First Supervisor of women nurses in the US army.  She wished to emulate the selfless service as exemplified by Florence Nightingale’s work as a nurse during the Crimean War between Russia and Turkey.  Louisa May Alcott, famous author of Little House on the Prairie, worked alongside Dix.  By 1872, Dix, at the age of 72, was stricken with malaria.  She recovered from this illness and began her travels once again.  On July of that year, Dix died.

Dix was undoubtedly a remarkable woman who was not dissuaded by the societal constraints placed upon the women of her generation.  She was driven by a singular and consuming passion – addressing the horrific treatment of individuals suffering from mental illness.  She was remarkably eloquent, persuasive and successful.  By the time of her death, Dix helped found 32 state-run mental hospitals and one federal institution, St. Elizabeth’s in DC.  

No comments: