Who was responsible for much of the reform of the mental health care system in the 19th century?

Today marks the 218th birthday of Dorothea Lynde Dix, one of the America’s most eminent reformers of the living conditions and treatment of the mentally ill. After first-hand observation of some of the worst “snake pits” that existed in the United States during the mid-19th century, she tirelessly lobbied state legislatures and the U.S. Congress to enact some of the earliest American laws governing mental asylums and psychiatric care.

Dix was born in Hampden, Maine, in 1802, to parents who had descended from members of the original Massachusetts Bay Colony: a mother who was chronically ill, and a father who was an itinerant bookseller and Methodist preacher, and was often financially embarrassed. Both consumed too much alcohol and her father was abusive. At age 12, a deeply unhappy Dix was sent away to live with her wealthy grandmother in Boston.

By age 14, she began work as a teacher at a girls’ school in Worcester, Massachusetts, and developed a novel curriculum that included the natural sciences and ethical conduct. Five years later, in 1821, she established her own school in Boston, which was favored by wealthy families there, including the family a prominent preacher known as “the father of Unitarianism,” William Ellery Channing. Over the next five years, Dix wrote a number of books, including the best-selling 1824 text for schoolteachers, “Conversations on Common Things, or Guide to Knowledge: With Questions,” which, by 1869, was in its 60th printing.

Dix long suffered from both depression and tuberculosis. By 1836, too much work, pain, and bleeding from her lungs forced her to the sick bed. In order to rest and recuperate, she sailed to Liverpool, England, for 18 months where she was the guest of William Rathbone, a friend of the Reverend Channing’s and a prominent social reformer. In England, she met many other do-gooders who were interested in the care and treatment of the mentally ill. They introduced her to the pioneering work of the Parisian alienist Phillipe Pinel who, in 1795, was credited with freeing his insane patients from being chained at the Salpêtrière Hospital. Dix also toured the “madhouses” of Britain and committed herself to a movement that was then known as “lunacy reform.”

Upon returning to the United States in 1840, Dix made similar investigations of the poor houses and prisons where many insane women and men resided. Dix was horrified to find these people treated like criminals, locked up in chains, kept in damp, dark cells with foul air, poor sanitary facilities, and given inadequate nourishment and water.

In 1843, she wrote her now famous “Memorial to the Legislature of Massachusetts,” in which she beseeched the men running the state to do something to relieve the awful plight of the impoverished insane: “I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods and lashed into obedience.”

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Such printed memorials, or pamphlets, was one of the few ways a woman could enter the political discussion of this era, given they did not yet have the right to vote, hold office, or even read their work aloud before a legislative body — a man had to read Dix’s powerful words for her.

By 1845, she had traveled more than 10,000 miles, visiting along the way 19 state prisons, 300 county jails and 500 poor houses on the U.S. Eastern seaboard, in the Midwest and the South, as well as parts of eastern Canada. From 1845 to 1848, Dix lobbied various state legislatures to improve the living conditions of the mentally ill.

After 1848, Dix elevated her reform work to the federal level and asked the United States Congress to reserve a small portion of the profits the government was then raking in from selling public lands to pioneering settlers. She wanted to earmark money to aid the mentally ill, the blind, the deaf and the mute, as well as for abused prison and jail inmates. Between 1848 and 1854, Dix made multiple appeals to Congress, only to be turned down each time. In 1854, the Congress approved her mental health reform bill, but it was vetoed by President Franklin Pierce who worried that such a law might make the federal government financially responsible not only for the “indigent insane” but also “all the poor of the United States.”

From 1854 to 1856, Dix toured the United Kingdom and Europe where she enjoyed far more success in her reform work. When she returned to the U.S. in 1856, she redoubled her efforts and by 1860, a bill was finally passed by both the U.S. House and Senate, as well as signed into law by President James Buchanan, to fund the New Jersey State Lunatic Asylum in Trenton, which Dix founded in 1848. (Though she called the institution her “firstborn child,” the hospital suffered a dark chapter in the early 20th century under the leadership of a doctor who believed surgery could cure mental illness.)

In 1861, the Civil War became the major concern of the federal government and Dix was appointed superintendent of the U.S, Army Nurses. In this role, she distinguished herself by training more than 180 women to care for the wounded. In 1866, Secretary of War Edwin M. Stanton recognized her work in “the Care, Succor, and Relief of the Sick and wounded Soldiers of the United States on the Battlefield, in Camps and Hospitals during the recent war.”

Dix continued to work tirelessly for mental health reform. She retired in Trenton, New Jersey, at age 79 and died five years later on July 17, 1887, at the age of 85. Today, though a figure of the distant past, wherever psychiatric care is delivered in a humane and ethical manner, Dix’s name and work continues to thrive.

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