Voice for the Mad: Dorothea Dix – An American Activist

The most effective advocate of humanitarian reform in American mental institutions during the nineteenth century” (Goldenson, 1970)

I wanted to write about Dix because of how she influenced the United State and Congress on social issues, especially when it came to the treatment of mentally ill prisoners.  As the host of Solitary Nation (Metamora Media), I stress the importance of standing up against social injustice, and Dix did just that.


Dorothea Lynde Dix 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.  She was also an author, teacher and reformer. Her efforts on behalf of the mentally ill and prisoners helped create dozens of new institutions across the United States and in Europe and changed people’s perceptions of these populations. Charged during the American Civil War with the administration of military hospitals, Dix also established a reputation as an advocate for the work of female nurses. Her own troubled family background and impoverished youth served as a galvanizing force throughout her career, although she remained silent on her own biographical details for most of her long, productive life.


Dorothea Lynde Dix was born on April 4, 1802 in the town of Hampden in Maine. She was the first child of three born to Joseph Dix and Mary Bigelow Dix. Her father was an itinerant Methodist preacher. Hampden was taken over by the British in the War of 1812, however, the Dix’s took refuge in Vermont shortly before the war began. Her family life can be described as abusive and nonexistent. Her mother was not in good mental health and her father was an abusive alcoholic. Once the family was in Worcester they had two more children, Joseph and Charles. Almost immediately Dorothea began to care for her smaller brothers. Later in life she commented that “I never knew childhood” (Schlaifer, 1991). This was mainly because of her parents unstable household and her role of taking over the raising of her brother’s. Many times when the fighting in her household got out of control she would take refuge at her grandmother’s house, from her father’s side, in Boston.

In 1831, she established a model school for girls in Boston, operating it until 1836, when she had another health breakdown. In hopes of a cure, in 1836 she traveled to England, where she met the Rathbone family. They invited her as a guest to Greenbank, their ancestral mansion in Liverpool. The Rathbones were Quakers and prominent social reformers. At Greenbank, Dix met their circle of men and women who believed that government should play a direct, active role in social welfare. She was also introduced to the reform movement for care of the mentally ill in Great Britain, known as lunacy reform. Its members were making deep investigations of madhouses and asylums, publishing their studies in reports to the House of Commons.


In March 1841, when she was just shy of 40, Dix’s true life’s work suddenly unfolded in front of her. She volunteered to hold a devotional hour for women in the East Cambridge jail and discovered that some of the tattered inmates were chained in a filthy, cold cell simply because they were mentally ill. Dix had confronted the hidden-away fact that most psychiatrically troubled people of the day existed in deplorable circumstances within prisons, poorhouses, reformatories — and even homes. The shy, but incensed witness reported the situation to a local court. Dix’s charges were spurned, but she made the situation public, and efforts were made to improve conditions.


Dix traveled to states around the country, documenting the conditions of the poor and mentally ill and publishing memorials to state legislatures. She devoted enormous personal energy to working with committees to draft the enabling legislation needed to build asylums. Dix was influential in the establishment of Illinois’s first state mental hospital and the construction of a hospital in North Carolina for the care of mentally ill patients, which was named in honor of Dorothea Dix and opened in 1856. She was also 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.

After accomplishing much, she decided to go after her dream in 1848. She sent a document to the United States Congress asking that five million acres be set aside and to be used for the care of the mentally ill. However, with this request she was way ahead of her time by advocating a role for the national government in the care of the disadvantaged mentally ill. In 1854 the bill passed and was approved by both houses but was vetoed by President Franklin Pierce. After her fighting Dorothea was physically worn out by trying to fulfill her dream. She decided to travel to Europe to rest from her thirteen years of work for the mentally ill.

Once she got to Europe she had no time to rest for she began her process of inspecting jails and almshouses there as well. She traveled to England, Scotland, France, Austria, Italy, Greece, Turkey, Russia, Sweden, Denmark, Holland, Belgium and Germany. In a period of 1854 to 1856 she made an effective change in the way Europeans dealt with the mentally ill as she had in the United States. This was a matter of only two years mind you.

Upon her return to the United States in 1854 she continued to travel and investigate many states she had missed before. However at the outbreak of the Civil War she put her energies into being the Superintendent of Union Army Nurses. Although she wasn’t effective in this field, she continued to serve throughout the war. In 1881 the state hospital in Trenton, New Jersey opened. This was the first hospital that was initiated and built through her efforts to be opened. Since her health was failing she admitted herself into this hospital. However, with her decline she remained in the hospital for a period of six years. Her death on July 17, 1887 ended a career that was unique in its singleness of purpose and magnitude of accomplishment.


Following the war, she resumed her crusade to improve the care of prisoners, the disabled, and the mentally ill. Her first step was to review the asylums and prisons in the South to evaluate the war damage to their facilities.

In 1881, Dix moved into the New Jersey State Hospital, Morris Plains. The state legislature had designated a suite for her private use as long as she lived. Although an invalid, she carried on correspondence with people from England, Japan, and elsewhere. Dix died on July 17, 1887. She was buried in Mount Auburn Cemetery in Cambridge, Massachusetts.


Beginning in the 1950s, experts began moving people out of institutions and into communities, and the number of people enrolled in formal institutions dropped dramatically in just a few short years. Unfortunately, communities were slow to adapt to this onslaught of people who needed very intense care. In the 1990s, experts discovered that many people with mental illness entered the criminal justice system, due to a combination of drug use and mandatory sentencing rules.  Administrators of these facilities scrambled to keep up with the demand for services from people who were profoundly ill and unable to get the help they needed on the outside.

Today, at least 400,000 inmates currently behind bars in the United States suffer from some type of mental illness—a population larger than the cities of Cleveland, New Orleans, or St. Louis (National Alliance on Mental Illness).


Metamora Films

Metamora Films

Metamora Films

Unsurprisingly, many prisons are poorly equipped to properly deal with mental illness. Inmates with mental illnesses are more likely than other to be held in solitary confinement, and many are raped, commit suicide, or hurt themselves.  The movement to deinstitutionalize the mentally ill began from a place of humanity, but it hasn’t ended there, at least not yet. The Treatment Advocacy Center report questions how much we’ve really learned about treating the mentally ill in the last 200 years, pointing out that people with mental illness were routinely confined in prisons and jails from 1770 to 1820. “Because this practice was regarded as inhumane and problematic, until 1970, such persons were routinely confined in hospitals. Since 1970, we have returned to the earlier practice of routinely confining such persons in prisons and jails.

A new national survey shows the number of mentally ill prison inmates is growing and the criminal justice system is not prepared to handle the influx.  More than a third of 230 county jails surveyed report that inmates with serious mental illness made up at least 6% or their population. Approximately 17% of the country’s 2.3 million inmates are thought to have serious mental illness. The number of state psychiatric beds decreased by 14% from 2005 to 2010, according to figures from the Treatment Advocacy Center, falling from 50,509 to 43,318 over that period.

“This is something that we should all be ashamed about, and the public needs to be educated about because it’s not moral, it’s not ethical, and it can be addressed,” said Tom Dart, the sheriff of Cook County in Illinois and overseer of Cook County Jail, the largest county facility in the country. The jail houses about 9,000 people daily. An estimated 1 in 3 of them suffers from a mental illness.


These recommendations build on one another in order to achieve truly robust and comprehensive reform. Our plan to stop imprisoning and start treating mentally ill citizens consists of three modest but significant proposals:

We urge expanded training for corrections officers, and mental health, healthcare, and rehabilitative programing staff. Establish an intensive training program for correctional officers, healthcare, mental health, and rehabilitative program staff. Require in-service training that integrates mental health, healthcare, and correctional officer staff.

We urge the construction of mental health treatment facilities and substance abuse treatment facilities. The Governor’s Budget proposes an additional $500 million on top of the $1.2 billion already budgeted for jail construction. This funding needs to be expanded to include construction of mental health treatment facilities and substance abuse treatment facilities.

We urge the guarantee of transitional housing upon release for the mentally ill. Require all mentally ill parolees to be released 90 days early into an intensive transitional housing program.

We urge the creation of a corps of mental health parole officers. Create a specialized caseload for parole agents for mentally ill parolees with a caseload of 1 parole agent
to 20 mentally ill parolees. The mental health parole agent should have a minimum of an Associate’s Degree, at least one year of social casework experience, and training in cognitive behavior treatment and motivational interviewing.

We urge the re-establishment of Parole Out-patient Clinics (POC) as case management offices. As the parole population decreases, the state should change the mission of the Parole Out-Patient Clinic and establish three different levels of case management.


I will leave you with a short gallery of Jenn Ackerman’s work from when she received permission to photograph the Kentucky State Reformatory’s psychiatric unit in 2008.  These are haunting images that can’t be ignored.

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