It has been 170 years since the New England reformer Dorothea Dix (1802-1887) made her plea to government officials in Massachusetts to support the reform of psychiatric care. Dix’s Memorial to the Legislature of Massachusetts1 still makes gripping reading today. In it, she details the neglect and abuse faced at the time by “helpless, forgotten, insane, and idiotic men and women; of beings sunk to a condition from which the most unconcerned would start with real horror; of beings wretched in our prisons, and more wretched in our almshouses . . . of insane person confined within this Commonwealth in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”1
It was in the last 3 months of 1842 that the energetic Dix undertook an ambitious trip, visiting jails and almshouses across the state of Massachusetts, with an eye toward chronicling the plight of the “insane poor.” As biographer Thomas J. Brown2 tells it, at one point, Dix managed to visit 35 towns in the course of 1 week alone. Urged by an acquaintance of hers—State Representative Samuel Gridley Howe—to summarize “the results of your painful and toilsome tour,” Dix wrote up her report during the first weeks of January 1843, submitting it for the legislature’s first meeting on January 19.2
The result is a catalog of disturbing images and stories of mentally ill individuals left to the care of jails, prisons, poorhouses, and foster families. Dix tells of a dilapidated almshouse, in which a handful of insane inmates were forced to share space with some 55 to 60 others in unhygienic conditions. There’s her tale of an agitated woman, kept naked in a closet beneath a cellar staircase by the head of another poorhouse. In another instance, Dix describes a town where one “raging maniac” was, along with the town’s other poor, put up for auction on an annual basis, rented out to the lowest bidder. Throughout, Dix presents a picture of a group of vulnerable, suffering human beings all too often ignored, forgotten, exposed, and mistreated. “Men of Massachusetts,” she concludes, “I beg, I implore, I demand, pity and protection, for these of my suffering, outraged sex! . . . Raise up the fallen; succor the desolate; restore the outcast; defend the helpless; and for your eternal and great reward receive the benediction, ‘Well done, good and faithful servants, become rulers over many things!’”1
The response to Dix’s charge was not altogether positive. Several of the local communities cited by Dix accused her of fevered exaggeration and outright lying. At the same time, Governor Marcus Morton was a proponent of fiscal austerity, making the prospect of comprehensive reform highly unlikely. In the end, however, the legislature did approve enlarging the capacity of the asylum in Worcester from 150 to 400 residents.2
As her biographers have observed, Dix’s Memorial reads like a sermon, and this was intentionally so. A devout Unitarian, Dix’s moral compass and style of expression were inspired by New England preaching and social reformism at the time. As such, Dix’s rhetoric shares much with that of contemporaneous American abolitionists.3 “Cadences and language reminiscent of the evangelical pulpit are everywhere,” notes David Gollaher4:
Dix’s practice of combining personal testimony with overarching moral conclusions were sermonical as well. Since childhood she had been taught that a sermon should use both explication and application, concrete biblical examples and general religious principles, which Christians could use as a guide to life. By the same token, her message carried a two-pronged appeal in which tried to reach her audience both through intellect (“I state cold, severe facts”) and through the affections (“that from them you may feel more deeply the imperative obligation which lies upon you”).
Dix’s Memorial was a plea, as she put it, for “an Asylum for this class, the incurable, where conflicting duties shall not admit of such examples of privations and misery.”1 Impressed by the so-called moral treatment advocated by alienists such as Francis Willis and Samuel Tuke in England, Dix placed great faith in the possibility of curing and ameliorating the maladies affecting the insane poor through thoughtfully managed public facilities. Because she herself had battled with melancholy, she was convinced that the key to recuperation lay in the kind of isolated, domestic-styled caretaking and discipline offered by the 19th-century asylum.
It is this enthusiasm for asylums that is, in retrospect, perhaps most striking about Dix’s Memorial. Within 50 years, of course, the supply of beds in facilities was often being outpaced by demand, and soon, overcrowding became commonplace.5 And over the years 1950-1980, the US—like many other countries—abandoned the model of long-term institutionalization as a failure in favor of outpatient and elderly care.6 Reading Dix now, however, one is reminded that for many during the first half of the 19th century, the asylum appeared to offer an innovative way for society to humanely manage and effectively treat mental illness.
1. Dix DL. Memorial to the Legislature of Massachusetts. Boston: Munroe & Francis; 1843.
2. Brown TJ. Dorothea Dix: New England Reformer. Cambridge, MA: Harvard University Press; 1998.
3. Walters RG. The Anti-Slavery Appeal: American Abolitionism After 1830. Baltimore: Johns Hopkins University Press; 1976.
4. Gollaher D. Voice for the Mad: The Life of Dorothea Dix. New York: Free Press; 1995.
5. Shorter E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, Inc; 1997.
6. Grob GN. From Asylum to Community: Mental Health Policy in Modern America. Princeton, NJ: Princeton University Press; 1991.