Dorothea Dix (1802-1887), Champion of the Mentally Ill

Profiles in Nursing

Dorothea Dix (1802-1887), Champion of the Mentally Ill

By Elizabeth Hanink, RN, BSN, PHN
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In 1848, Dorothea Lynde Dix presented the North Carolina General Assembly with a forceful plea for the state to establish a modern, enlightened mental hospital.

Describing the plight of one poor farmer whose mental illness had led him to be confined in the county jail, she wrote, “I cannot tell for how long a time the lone dark dungeon echoed to his moans and cries, nor at what cost the county maintained human life, unaiding its sufferings and necessities.”

In those days before the development of psychotherapy, antipsychotic medications or community mental health centers, such confinement was a common fate for the seriously mentally ill. Misunderstood and frequently mistreated, they were often consigned to crowded jail cells or poorly staffed, unhygienic asylums that were as bad or worse.

Dix made it her mission to change that sorry situation.

The Plight of the Poor  

Dorothea Dix understood all too well how damaging the effects of untreated psychological problems could be. The daughter of an abusive, alcoholic preacher and pamphleteer and a mentally ill mother, Dix was forced to raise her younger brothers until they were rescued by their wealthy grandmother when Dix was 12.

Dix could never quite become the demure, well-bred decoration her grandmother wanted and at the age of 14 began working as a teacher for wealthy young children. (As unpleasant as her upbringing had been, her father had at least taught her to read and write, relatively uncommon skills for poor children at the time).

Young Dorothea railed at the injustice of education being reserved for the rich, so in 1821, she established a separate school for children whose families were unable to pay. She also wrote various textbooks. In 1841, she was asked to take over a Sunday school class for women at Boston’s East Cambridge Jail. The conditions there shocked her: The mentally ill and developmentally disabled were thrown together with common criminals in appalling, inhumane conditions.

Dix knew there was a better way. On an extended trip to England a few years earlier, she had learned about the prison reform movement and a progressive psychiatric facility her host’s grandfather had established in York.

Prisoners and the Mentally Ill

Although Dix had no real medical training, she immediately launched an 18-month tour of poorhouses and jails in about 500 New England towns to assess the extent of the problem. It was worse than she had imagined; seeing people kept in cages or chained naked to walls was the rule, not the exception.

The death of her grandmother in 1837 had left Dix very well off, so rather than return to her work as a teacher, she became a crusader for prisoners and the mentally ill. She enlisted the help of community leaders with status and money (to whom she had access, thanks to her inheritance and family connections), provided them with materials outlining the problem and spoke publicly and passionately to raise awareness and provoke outrage.

Changing the Law

By 1843, she had succeeded in promoting legislation to improve the treatment of the mentally ill in Massachusetts. She moved on to Rhode Island, New York, New Jersey, Pennsylvania, Maryland, Ohio, Kentucky, Tennessee and North Carolina, repeating her Massachusetts strategy with great success. Despite poor health and frequent exhaustion, she traveled more than 10,000 miles while visiting at least 18 state penitentiaries and hundreds of county jails and poor houses.

In 1848, Dix set her sights on Washington, D.C., where she spent six years promoting federal legislation to fund better care for the mentally ill, the deaf and the blind. After a bill she had successfully promoted fell to a presidential veto in 1854, she returned to the United Kingdom and then moved on to Europe, where she even took her crusade to the Vatican.

After the outbreak of the Civil War, she temporarily halted her campaign and became superintendent of Union Army nurses. Although she trained many women for nursing duty, she often clashed with Army surgeons and commanders. She was also unpopular with many Army nurses — particularly, as one doctor put it, those “who failed to do their whole duty.” She was removed from her position in 1863 and returned to her advocacy work.

A Lasting Legacy

By the time Dorothea Dix died in 1887, she had been directly involved in founding 32 mental hospitals and had influenced the foundation of many more in the U.S. and abroad. Although she did not contribute to the understanding of the causes of mental illness, her unwavering patient advocacy played an important role in shifting public perception of mental health problems from the category of moral failing to one of illness.

She was ahead of her time in understanding that with care and support, people with mental health challenges could become productive members of their communities.  

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