Dix, Dorothea Lynde (1802–1887)

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Dix, Dorothea Lynde (1802–1887)

American reformer who led the crusade to improve treatment of the mentally ill, built hospitals for the insane, and served as Superintendent of Army Nurses during the Civil War. Born Dorothea Lynde Dix on April 4, 1802, in Hampden, Maine; died in Trenton, New Jersey, on July 18, 1887; daughter of Joseph (a Methodist minister) and Mary (Bigelow) Dix; spent several years at private schools in Boston, but largely self-educated; never married.

At age 14, started her first school (1816); published the first of six books (1824); began work as an advocate for the mentally ill (1841); helped found, design, and expand dozens of hospitals for the mentally ill in the U.S., Europe, and Japan; served as Superintendent of Army Nurses (1861–65).

On a scorching summer day in rural Georgia in the 1840s, Dorothea Dix made her way across a field, approaching a crude log pen. She looked strangely out of place to the small group of farmers that accompanied her. They could tell she was a lady. From her simple but meticulously clean skirt and her crisp New England accent, they could tell she was an educated woman of some means. What possible interest could such a woman have, they wondered, in the wretched sight she was about to behold?

Peering through the wide gaps in the logs, this elegant visitor saw a strange animal chained inside the pen; it was a man, but his naked body was filthy, his hair long and tangled, his eyes vacant. And where his feet should have been, Dix saw only stumps. The man had been left out in the cold too long one winter, a farmer explained, and his feet had been destroyed by frostbite. To prevent that from happening again, a deep pit had been dug at the center of the pen, covered by a sturdy trap door. When cold weather approached, the prisoner was thrown into the pit, shut up "without heat, without light, without pure air" until the next spring, his groans and cries muffled within that muddy dungeon.

Dix was outraged by the sight of this "pining, miserable" creature, but she was not surprised. Over the previous few years, in poor-houses and jails, rural barns and cellars across the country, she had visited thousands of men and women who were treated in much the same way, kept in chains and darkened cells as if they were dangerous beasts. These miserable prisoners were not criminals; they were mentally ill.

Dix had also seen enough of these situations to know that their jailers were usually not cruel and sadistic people who enjoyed torturing those they called "maniacs" or "lunatics." They were mostly well-intentioned people, doing the best they could within their limited means and limited knowledge. Many she had spoken to believed that the people they were caring for were not even human beings at all. When people lost their reason, they thought, they became beasts, without a sense of decency, or even a sense of hot and cold.

I am the Hope of the poor crazed beings who pine in the cells, and stalls, and cages, and waste rooms of your poor houses. I am the Revelation of hundreds of wailing, suffering creatures, hidden in your private dwellings.
—Dorothea Dix

As soon as Dix left that field in Georgia, she recorded what she had seen in her journal, another example added to her mounting inventory of mistreatment of the mentally ill. Before long, she would weave that story into one of her public reports, using these horrifying tales to prick the conscience of legislators and citizens, urging them to correct the abuses by building modern facilities for care and treatment of the insane. For more than 40 years, Dix used this method successfully in almost every state in the nation, as well as in Europe. More than any other person in the 19th century, she was responsible for pioneering more humane treatment for the mentally ill.

Dorothea Dix had a troubled childhood, one that has tempted some biographers to trace her interest in mental illness back to her relationships with her unstable parents. She was born in Hampden, Maine, in 1802, an area that was then a sparsely settled frontier of Massachusetts. Much of the land in that part of Maine was owned by Dorothea's grandfather, Elijah Dix, a successful doctor and land speculator who lived in an impressive Boston mansion. Dr. Dix had sent his son Joseph to live in Maine, ostensibly to help sell the land that would form the new towns of Dixmont and Dixville. But he had another motive as well. Joseph had been enrolled as a divinity student at Harvard when he had fallen in love with and married Mary Bigelow , a woman 18 years his senior and well below his social standing. The family disapproved of the match, as did Harvard, which at the time allowed no married student to attend. In a sense, when Dr. Dix sent his son and his new bride to Maine, he was exiling them from the family.

The stresses of frontier life took their toll on Dorothea's parents. Joseph developed a drinking problem, while Mary collapsed under the strain, taking to her bed most of the time. Ignoring his responsibilities as a land broker and as a farmer, Joseph devoted most of his time to his religious calling, working as an itinerant Methodist preacher. He was a fervent believer and a powerful speaker, but his efforts to bring the gospel to the far flung settlements of northern New England earned him little money and often carried him far from home. As the eldest child, Dorothea was left to care for her invalid mother and her two younger brothers. Years later, she summed up these experiences by saying, "I never knew childhood."

When she was 12, Dorothea ran away from home, making her way to the Dix mansion in Boston. Her grandmother, also named Dorothea, who was by now a widow, reluctantly agreed to take the child in. For the next two years, the older woman worked to mold this uneducated child from the Maine woods into a Boston gentlewoman. As biographer Dorothy Wilson has written, Dorothea's new life was marked by "orgies of admonition," as her grandmother trained her to a life of "industry, inflexible dignity, economy, perfection in manners, spartan discipline, puritanical piety." Dix was an eager student and an avid reader but too stubborn for her elderly grandmother's liking. At age 14, she was sent to a grand aunt's home in Worcester, Massachusetts, for the completion of her education.

While in Worcester, Dix began to exhibit some of the strong will, conscientiousness, and energy that would one day serve her as a reformer. Still only 14, she announced that she would open her own school for young children. Recruiting students from the elite families of Worcester, she taught for several years, presiding over her charges with what one student remembered as "a very stern decided expression." She demanded a great deal of her students, and even more of herself, working late into the night to prepare her lessons.

In 1820, at age 17, Dix returned to live with her grandmother in Boston. She had become a beautiful and polished young woman but took no interest in the balls, tea parties, card games, and other social events enjoyed by most young singles of her social station. To a friend, she confessed, "I look with little envy on those who find enjoyment in such transitory delights." Her delight was education, and she spent much of her time reading and attending lectures, paying particular attention to the religious disputes that were then dividing Boston. She was drawn to the preaching of one of the city's most controversial ministers, William Ellery Channing, the leading speaker of the new Unitarian movement. These

liberal Christians rejected the traditional Calvinist view that people are born sinful and can only be saved through the miraculous interference of God's grace. Channing and his fellow Unitarians thought that this orthodox theology depicted God as an irrational tyrant who had the power to save all, but instead sent many to Hell. Rejecting this view, Channing defended what he called the "dignity of human nature." Sin was not innate and inevitable, he held. People were moral free agents, and if they only used the reason that God had given them, they could drive evil out of their own lives and become champions of "benevolence" in the world. Channing urged his followers to put this theory into practice by devoting themselves to helping those less fortunate.

Dix took Channing's preaching to heart. Not long after she had arrived back in Boston, she received word that her father had died, leaving her mother and brothers without support. To provide for them, she opened a new school in the Dix mansion, serving the children of wealthy families. At the same time, she launched a writing career, working long into the night on a children's encyclopedia that she called Conversations on Common Things. Published in 1824, the book was a great commercial success, with royalties going to support her mother. But, heeding Channing's call to live a life of Christian benevolence, Dix wanted to do more. Ignoring her grandmother's warnings about overworking herself, she opened a second school in the afternoons, providing a free education to children from poor families. Running two schools, and starting on a new book of religious stories for children, Dix told a friend, "what greater bliss than to look back on days spent in usefulness, in doing good to those around you, in fitting young spirits for their native skies!"

While these years in Boston were remarkably productive and exciting for Dix, they were also marked by two sorrows that would haunt her for the rest of her life. Since her earliest years in Worcester, she had been in love with Edward Bangs, a distant cousin many years her senior, who was a successful young lawyer and aspiring politician. As she grew older, their platonic friendship had grown into romantic love, and when Dix was in her early 20s, the two were secretly engaged. But Bangs expected that, after their marriage, Dix would give up teaching, writing, and public service, devoting herself full-time to the job of being his wife. When Dix refused, Bangs broke the engagement. Though she rarely mentioned the incident in later years, her biographers have sensed that the experience left a deep scar that never entirely healed. As Dorothy Wilson put it, "She would burn his letters, try to sublimate human passion in the ardor of useful service, yet never quite succeed." Though numerous men expressed a romantic interest in her through the years, there is no evidence that she ever returned their affections.

Not long after, Dix suffered a second blow, a physical collapse that her doctor described as "rheumatism of the lungs," possibly incipient tuberculosis brought on by her grueling work schedule. She was forced to close the school and head South for the winter to recuperate. The next year, with her health somewhat recovered, she gladly accepted a job as tutor of William Ellery Channing's children. The children both admired and dreaded their new teacher, a beautiful young woman who was so excited about learning, and such a demanding perfectionist. "Fixed as fate," was the way Channing's daughter later remembered her. Dix resumed her writing, publishing a book on botany that was widely admired.

After several years with the Channings, Dorothea once again turned the Dix family mansion into a school, working with paying scholars each morning and poor children in the afternoon. But she ignored her doctor's warnings about her health, pushed herself too hard, and again suffered a physical collapse. "I feel it is very possible I may never again enjoy the fragrancies of spring," she told a friend. She rallied, however, and in 1836 went to England, hoping that a sea voyage would be good for her lungs. In England, she spent more than a year convalescing at the home of William Rathbone, a friend of Channing's and a noted English politician and humanitarian. There, she mingled with some of the most important English and American writers and reformers of her day and developed a lifelong friendship with the entire Rathbone family.

While she was in England, the most important link to her own family was broken. She received word that her grandmother had died. The news was a blow to Dix; the elderly woman had become a close friend and staunch supporter, and the only real family that she had left. Returning to America, Dix found herself at a crossroad. She was now in her mid-30s, well educated and, thanks to an inheritance from her grandmother, financially secure. But she was also alone and without prospects or interest in marriage and family life. She was independent but not sure how to use this freedom. Once again her thoughts turned to Channing's call to devote one's life to Christian benevolence. "Life is not to be expended in vain regrets," she resolved. "There are duties to be performed here."

But she hesitated, not sure just what her new duties should be. In the late 1830s, Boston was experiencing a remarkable intellectual renaissance. Ralph Waldo Emerson, Margaret Fuller , and others were promoting the strange new ideas they called "Transcendentalism," Horace Mann, Mary Peabody Mann , and Elizabeth Palmer Peabody were reforming the public schools, William Lloyd Garrison and Angelina and Sarah Grimké were agitating for the abolition of slavery, and a host of other utopian schemers promoted everything from communal living to cold-water baths as the ultimate cure for society's ills. Dix was eager to play a part, but for women, particularly of her social standing, public debate and social agitation were not considered proper. And there was the persistent problem of her health. Friends urged her to rest, not to overwork herself as she had done in the past. In the back of her mind, she must have wondered if she was sliding into a life of semi-invalidism, much like her mother had done at about the same age.

Then, in 1841, Dix was approached by a Harvard divinity student who had tried to teach Sunday School to the women convicts at the East Cambridge jail, but felt that they would respond better to a woman teacher. He asked her if she knew of a mature woman who could handle this tough assignment. "I will be there next Sunday," she replied. He had not meant for her to take the job, he protested; she was too feeble. But she insisted, and the following Sunday led services for a couple dozen women at the jail.

After services, Dix took a tour of the facilities and was shocked to find a number of mentally ill women locked up there, held without compassion, without treatment and, even worse, without heat. Dressed in filthy rags, these unfortunates were shivering, huddled together for warmth in a corner of their barren cell. When Dix asked the jailer why these women were kept in an unheated cell, she was told that a stove would be unsafe; besides, he insisted, the insane don't feel cold the way normal people do.

Her strong streak of moral righteousness aroused, Dix brought the women proper clothing and demanded that they be provided with a heated cell. When the jailer refused, she took the matter to court, exposing the pitiful conditions that she had seen. Public officials and some newspapers denounced her as a liar, a slanderer, and a woman meddling in public affairs that were none of her business. But, as it would countless times more, persecution only strengthened her resolve. With the help of the reformers Dr. Samuel Gridley Howe and Charles Sumner, who visited the jail themselves and confirmed her story, she won her first victory for the insane. The women were provided with a clean and heated cell.

Sensing that she had at last found her true calling, Dix was anxious to do more. She consulted leading experts in the field of mental illness, and learned that she was not the first to be concerned about the plight of the insane. Following the lead of French and English reformers, a few American physicians were taking a new view of mental illness. Traditionally, insanity was seen as a mysterious calamity, robbing its victims of their humanity. Because many believed it was a punishment from God for past sins, families were often ashamed of members who were ill, and locked them away in back rooms and barns. Those without a family to care for them, the "pauper insane," usually ended up in jail cells or in the poorhouse, where harsh conditions often made their illness worse. But the doctors Dix spoke with had concluded that mental illness was not a spiritual curse but a physical disease, and one that could often be cured with the right approach. They tried administering to the insane by placing them in new asylums, carefully constructed institutions often set in idyllic rural settings. There, under the watchful eye of kindly attendants, patients were released from their chains and treated with a regimen of respect, orderliness, and healthful exercise.

On the cutting edge of these reforms, Massachusetts had built one of these asylums and passed a law requiring towns to send their mentally ill citizens to the new hospital. But, as Dix found out in East Cambridge, many towns ignored the law, often for cost-saving reasons. The state could hardly complain, however, because their new asylum was already filled to capacity.

Consulting with Howe and Sumner, Dix decided that her first step should be to gather more information by conducting a survey of the treatment of the mentally ill in all of the poorhouses and jails in the state. Once the facts were gathered, she would then use them to press the state legislature into making comprehensive changes. This survey was an enormous undertaking, but she approached it with conviction and energy. Ignoring the pain in her lungs, she traveled hundreds of miles by train, coach, and horseback, visiting facilities in every county of the state. More rugged than the physical challenge was the moral one, as she descended into what historian Helen Marshall has called "an inferno of neglect and cruelty." She saw the insane locked into small, filthy stalls, some chained to their beds for decades, others who were beaten into submission, and many who suffered from the same cold and neglect that she had first seen in the East Cambridge jail.

Traveling for more than a year, Dix made a careful record of each case. She summarized the results into a Memorial to the state legislature; this document was a pioneering effort in the gathering of social welfare statistics, and a milestone in the history of American reform. After cataloging the many abuses she had seen, she made an impassioned plea to state lawmakers to expand facilities at the state's hospital for the insane. Only in such asylums, she explained, could the mentally ill escape their cruel conditions and receive the kind of scientific treatment that might cure them of their disease.

Because women were not allowed to address the state legislature, Samuel Howe presented the Memorial on her behalf. The speech set off a storm of controversy. Many local officials challenged her depiction of their poorhouses and jails, while other critics launched more personal attacks. A proper lady, they wrote, would never have exposed herself to such indecencies. But leading doctors and reformers came to her aid, confirming her findings and defending her character. Public opinion swayed to her side, and lawmakers agreed to expand the state asylum.

Dix's faith had moved a mountain of ignorance and apathy, and she now felt that God had chosen her to pursue this "sacred cause." She set out immediately to tour the jails and poorhouses of Rhode Island, then New York, Pennsylvania, New Jersey, and eventually most other states in the nation. Triumphing over physical pains that troubled her for the rest of her life, she traveled more than 60,000 miles in the next few years and visited many thousands of mentally ill patients in dozens of states. In the 1850s, she expanded her mission abroad, promoting better treatment for the insane in Europe, Russia, and Turkey. She even won an audience with the pope, successfully urging him to reform the Vatican's hospitals.

In each place, her method was the same. She started with an exhaustive fact-finding tour, visiting every mentally ill person she could find in an area. While she had no authority to enter and search most of these places, no jailer ever refused her, awed as they were by her forceful personality and her obvious gentility. Concluding her tour, she would then draft an eloquent memorial, which summarized the horrors she had seen, and propose the creation or expansion of hospitals for the mentally ill.

At a time when women were usually barred from public life, Dix became a widely respected, even beloved, figure. Railroads provided her with free passes as she went on her missions of mercy. She mingled freely with men in power, developing close friendships with governors, senators, and even presidents. But she was careful not to push too hard against the limits that society imposed on her because she was a woman. She rarely addressed state legislatures, for example, preferring to let a male ally speak for her in public. When lobbying for a bill, she stayed behind the scenes, quietly but forcefully making her case to male legislators, winning their support without violating the code of gentility expected of a female of her social class. Rather than challenging men for monopolizing political power, she challenged them to use that power for good. When asked how she had won so many converts to her cause, she answered: "By going to people whose duty it is to set things right, assuming that they will do so without disturbance being made, and they generally do so."

For the same reason, Dix shunned all personal publicity, considering it unseemly for a woman to seek public honors. She never allowed her supporters to name a hospital in her honor, and when a reporter asked for an interview, she replied, "Nothing could be undertaken which would give me more pain and serious annoyance, which would so trespass on my personal rights and my perception of fitness and propriety." She avoided any controversy that might distract attention from the plight of the mentally ill. As she traveled, she lent her aid to a number of other reform causes, including penal reform, the building of lifeboats and public drinking fountains, and scholarships for young women. But she avoided the topic of women's rights and, although she hated slavery, never spoke against it publicly, fearing it might jeopardize her considerable influence in the Southern states.

While Dix was quiet about the issue of slavery, when the Civil War broke out she was anxious to do her part for the Union cause. Appointed Superintendent of Army Nurses, she organized women volunteers into a nursing corps. She worked tirelessly at the job, but some of the personal qualities that had served her so well as a reformer—her moral righteousness, her strong will, and her perfectionism—became a liability in her new job as the head of a large government bureaucracy. She often clashed with army doctors, who resented her criticisms of their practices. Even her supporters found her to be an ineffective administrator, too inflexible to compromise and unable to delegate authority. Under extremely difficult conditions, the corps of army nurses did much to alleviate suffering and improve conditions in chaotic and unsanitary army hospitals. But, at the conclusion of the war, Dix was relieved to be able to return to her work for the insane.

Dorothea Dix's single-minded commitment to the mentally ill produced remarkable results, transforming the way they were thought about and cared for in much of the world. Over the course of her 40-year career, she was personally responsible for the creation of 32 asylums in the United States, and the improvement and expansion of many more. Perhaps her favorite of these institutions was the state hospital in Trenton, New Jersey, for which she not only won funding but also helped to locate and design. That place she dubbed her "first born child." A permanent apartment was set aside for her there, and in later years this became the closest thing she knew of a home. She died there in 1887, at the age of 85.