Dorothea Lynde Dix (April 4, 1802 – July 17, 1887) was an American activist on behalf of the indigent insane who, through a vigorous program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums. During the Civil War, she served as Superintendent of Army Nurses.
She was the first child of three born to Joseph Dix and Mary Bigelow. She was born in Hampden, Maine on April 4, 1802. Dix’s childhood was far from happy and comfortable. Her mother suffered from mental illness and her father was an itinerant worker and an abusive alcoholic. Despite the adversity, Dix took charge of her family and began to care for her two little brothers. Later in life she acknowledged that she had never had much of a childhood. At age 12, she left her unhappy home and went to Boston to live and study at her grandmother’s place.
About 1821 she opened a school in Boston, which was patronized by the well-to-do families. Soon afterwards she also began teaching poor and neglected children at home. But her health broke down, and from 1824 to 1830 she was chiefly occupied with the writing of books of devotion and stories for children. Her Conversations on Common Things (1824) had reached its sixtieth edition by 1869. In 1831 she established in Boston a model school for girls, and conducted this successfully until 1836, when her health again failed. In hopes of a cure, in 1836 she traveled to England, where she had the good fortune to meet the Rathbone family, who invited her to spend a year as their guest at Greenbank, their ancestral mansion in Liverpool. The Rathbones were Quakers and prominent social reformers, and at Greenbank, Dix met men and women who believed that government should play a direct, active role in social welfare. She was also exposed to the British lunacy reform movement, whose methods involved detailed investigations of madhouses and asylums, the results of which were published in reports to the House of Commons.
After she returned to America, in 1840-41, Dix conducted a statewide investigation of how her home state of Massachusetts cared for the insane poor. In most cases, towns contracted with local individuals to care for people with mental disorders who could not care for themselves, and who lacked family and friends to provide for them. Unregulated and underfunded, this system produced widespread abuse. After her survey, Dix published the results in a fiery report, a Memorial, to the state legislature. “I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.” The outcome of her lobbying was a bill to expand the state’s mental hospital in Worcester.
Henceforth, Dix traveled from New Hampshire to Louisiana, documenting the condition of pauper lunatics, publishing memorials to state legislatures, and devoting enormous personal energy to working with committees to draft the enabling legislation and appropriations bills needed to build asylums. In 1846, Dix traveled to Illinois to study its treatment of mental illness. She became ill and spent the winter of 1846 in Springfield, Illinois recovering, but her report was ready for the January 1847 legislative session, which promptly adopted legislation establishing Illinois’ first state mental hospital. In 1848, Dorothea Dix visited North Carolina and called for reform in the care of mentally ill patients. In 1849, when the North Carolina State Medical Society was formed, the construction of an institution in the capital, Raleigh, for the care of mentally ill patients was authorized. The hospital, named in honor of Dorothea Dix, opened in 1856. The Dorothea Dix Hospital is slated to be closed by the state by 2008. She was instrumental in the founding of the first public mental hospital in Pennsylvania, the Harrisburg State Hospital, and later in establishing its library and reading room in 1853.
The culmination of her work was the Bill for the Benefit of the Indigent Insane, legislation to set aside 12,225,000 acres (49,473 km2) of Federal land (10,000,000 acres for the benefit of the insane and the remainder for the “blind, deaf, and dumb”), with proceeds from its sale distributed to the states to build and maintain asylums. Dix’s land bill passed both houses of Congress, but in 1854 President Franklin Pierce vetoed it, arguing that the federal government should not commit itself to social welfare, which was properly the responsibility of the states. Stung by the defeat of her land bill, in 1854 and 1855 Dix traveled to England and Europe, where she reconnected with the Rathbones and conducted investigations of Scotland’s madhouses that precipitated the Scottish Lunacy Commission.
The Civil War
With the outbreak of the Civil War in 1861, Dix at age 59 offered her services to the Union Army. Although Dix was not formally trained as a nurse, her tenacity and exceptional organizational skills impressed the secretary of war, Simon Cameron, who appointed her as the superintendent of Union Army Nurses. Before the civil war, army nursing duties were done by ambulatory male nurses. Dix convinced the skeptical military officials that women could also do the job perfectly well and recruited 2000 women into the army. Because of her autocratic style, Dix was nicknamed “Dragon Dix,” and she often clashed with the military officials and ignored orders. Yet the army nursing care markedly improved under her supervision. She took good care of the nurses who toiled in the harsh environment, and even went to the extent of obtaining health care supplies from private agencies when the government was not willing to provide them.
Her even-handed caring for Union and Confederate wounded alike, which may not have endeared her to Radical Republicans, assured her memory in the South. Her nurses provided what was often the only care available in the field to Confederate wounded.
After the war, Dix dedicated the rest of her life to improving the lives of the mentally ill, before retiring at the age of 82. Her 41 years of empathy for the mentally ill can be summarized in her own words: “If I am cold, they are cold; if I am weary, they are distressed; if I am alone, they are abandoned.” Dorothea Lynde Dix died in 1887 at the age of 85 and was buried in Mount Auburn Cemetery in Cambridge, Massachusetts.
Dorothea Dix has been described as “the most effective advocate of humanitarian reform in American mental institutions during the nineteenth century” (Goldenson, 1970). However, her achievements are only mentioned in five of the current fifty-three textbooks covering the history of psychology. The reason given for this is that she did not contribute to our understanding of the nature of mental disorders. However, she is only in 10% of today’s general history books. Although this may seem something hard to fathom Dorothea Dix herself would have wanted it this way. In her life, she was inconspicuous with her work to say the least. She did not place her name on most of her publications. She refused to have hospitals named after her. Expressions of praise and gratitude for her work always produced embarrassment. In later years of her retirement she refused to talk about her achievements and wanted them to “rest in silence” (Viney & Zorich, 1982).
4. Viney, W. & Zorich, S. (1982). Contributions to the history of psychology XXIX: Dorothea Dix. Psychological Reports, 50, 211-218.