Essay: Tribute to Dorothea Dix: Triumph in Improving Mental Health Conditions for the Mentally Ill



Triumph and Tragedy: Dorothea Dix and Mental Reformation

Dorothea Dix played an important role in the founding or expansion of more than 30 hospitals for the treatment of the mentally ill. She was a leading figure in those national and international movements that challenged the idea that people with mental disturbances could not be cured or helped. She also was a staunch critic of cruel and neglectful practices toward the mentally ill, such as caging, incarceration without clothing, and painful physical restraint. Though the treatment was tragic towards the mentally ill, with Dix’s effort of visiting and evaluating prisons and mental hospitals throughout the world, turned out to be a major triumph in successfully improving the conditions for the mentally ill.

Her experiences with mental health are believed to be the reason behind her mission to improve the conditions and advocate for the mentally ill. Dorothea Lynde Dix was born in Hampden, Maine, in 1802. Dix's childhood was not a happy one; her father was an abusive alcoholic, and her mother struggled with mental illness. Indications suggests she may have been neglected by her parents, and she appeared to have been unhappy at home. She then ran away and moved to Boston in 1814 to live with her wealthy grandmother. Sources report that “Dix had only attended school occasionally while living with her parents,” but in early adulthood, with limited options for women in the professions, Dix became a schoolteacher. She then established elementary school in her grandmother’s home in 1821, which wasn’t easy.  She continued teaching and began a formal school for older children in a cottage on her grandmother's property. The school was named "the Hope" and it served the poor children of Boston whose parents could not afford a formal education. At this time, Dorothea wrote her first book, Conversations on Common Things. This encyclopedia for children was quite popular and sold many copies. Dix often suffered from bouts of illness, including severe cough and fatigue. She began to dwell on the idea of death, and felt overwhelmed by her physical illnesses. Sources suggest that ‘her physical illness took its toll on her mental health, causing her to become depressed,” which eventually took a toll on her and cause her to stop her teaching career. Biographer David Gollaher, the first scholar to have access to all of her papers, has suggested that “she suffered from depression at several times during her life, and that she experienced a type of mental breakdown during this period.” Her mental illness, however, would later become a a driving force in her desire to change mental healthcare in the U.S. for the better. Biographer David Gollaher, the first scholar to have access to all of her papers, has suggested that she suffered from depression at several times during her life, and that she experienced a type of mental breakdown during this period.

  Conceivably Dorothea Dix’s own struggles helped make her a more compassionate advocate for people who had been diagnosed as mentally unstable or insane. Dix returned to Boston in 1837, while she was visiting the Virgin Islands. While caring for her ill grandmother and teaching, Dix became very ill. Though the physicians of the time had no diagnosis or cure for her condition, it is now known that Dorothea suffered from tuberculosis. On the advice of her doctor, Dorothea was forced to quit teaching. The inheritance she received after her grandmother passed, enabled her to support herself fully and devote her time to reform and charitable work. Dix’s physician encouraged her to take a “restorative trip to Europe,” and during her stay, she met prison reformer Samuel Tuke and Elizabeth Fry, founder of the York Retreat for the mentally ill. In 1841, Dix volunteered to teach Sunday school classes to female convicts in East Cambridge Jail. During her visits she saw people with mental illnesses who had been “treated inhumanely and neglectfully,” and she became determined to improve conditions. Dorothea took a tour through the jail what she found changed her outlook on mental health. She saw the mentally ill housed in horrid conditions with no heat, no light, little or no clothing, no furniture, and without sanitary facilities. Her discoveries of how the mentally ill were being housed are,”in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!” The mentally ill were held with criminals, irrespective of their age or sex. Dorothea was appalled by the conditions and treatment of mentally ill and her quest began. She then went on and then toured every facility in Massachusetts and documented the conditions and treatment of the mentally ill. Prisons, jails, almshouses, and private homes were among the facilities that she toured; such as Springfield, Northampton, Williamsburg, Rutland, Sterling, Burlington, Concord, Lincoln, Medford, Pepperell, Brookfield and Granville were mentioned in her memorial, because of their poor conditions for the mentally. She was told, during the Cambridge tour, that the mentally ill “needed no heat because they were unable to feel the extreme temperatures.”  

When Dix was finished touring the facilities the facilities in Massachusetts, she compiled a detailed report and submitted it to the legislature in January 1843. This report was effective in provoking attention, though it was received badly by the people who ran the institutions. This memorial reveals how Dix worked within the conventions of her time to create a role for herself in public life and draw attention to the horrendous treatment of the mentally ill in prisons, almshouses for the poor, and asylums. She began to investigate the mentally ill facilities treatment of the mentally ill and disabled in Massachusetts. These pamphlets were the only means by which a woman could participate in political life in America. “Ideals of femininity characterized women as having a special responsibility to the most vulnerable members of society, and a moral authority superior to men’s. At the same time, women were supposed to be protected from images and experiences of suffering and degradation.” Women were prohibited from voting, could not hold office, and did not present such testimonials themselves before the legislature a male representative had to read the text aloud. Although she had significant political influence and promoted the education of women, “Dix never joined the feminist movement or lent her public support to their cause.” Dix’s memorial didn’t get recognized and was seen as not an important issue. Dix quickly moved on to New York and then to Rhode Island to continue her work on behalf of the mentally ill. In 1845, she addressed the legislatures in New Jersey and Pennsylvania. She moved on to Alabama, Louisiana, Georgia, South Carolina, Mississippi, and Arkansas to view the harsh treatment of the mentally ill.

Dix was able to use her vivid and upsetting descriptions to great effect, reversing the existence of these abuses and shaming political leaders into taking action on her behalf, and on behalf of the “inmates” of these institutions. Yet, her ambitions were not limited to state institutions, in 1848, Dix submitted a bill to Congress that called for “five million acres to be set aside for the use of building mental institutions to care for the ill.” By 1851, the bill had passed the Senate but failed in the House. For the next three years, the bill was passed back and forth. Finally, in 1854, it passed both the Senate and House, but “President Franklin Pierce vetoed the bill. President Millard Fillmore was a supporter of Dorothea Dix and, in 1852, signed an executive order to begin construction of a hospital that would benefit soldiers and veterans.”The model of care that Dix supported, “moral treatment,” was developed for her tireless work and dramatic testimonials highlighted the appalling conditions in existing institutions and promoted the value of compassionate care.

Mental institutions in these times were horrible and brought more damage than healing to the mentally ill. Those who started mental institutions had good intentions but these good intentions eventually were lost. The people who ran mental institutions good intentions were lost because of the increasing population, inadequate staff, and the lack of understanding mental health. Mental institutions had strict rules comparable to prisons. Anyone could have opened a mental institution in this time period. Meaning that many owners of mental institutions had “no prior knowledge on treating the mentally ill.” During these times, American society in general, had a lot fear on anything foreign to them. The general public ignored the problem because of the “placement of the mentally ill in the institutions letting them live in an ignorant society.” They did not see anyone with mental illness in their communities and many of them never returned to share stories about their time there. “Homosexuals were viewed as mentally ill and were put into mental institutions. They were abused and performed harmful treatments on like electroconvulsive therapy (Miner).” Many individuals at the time did not agree with