Dorothea Dix

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Reform movements for treatment of the mentally ill were related in this period to other progressive causes: abolitionism, temperance, and voter reforms. After returning to America, in 1840-41 Dix conducted a statewide investigation of care for the mentally ill poor in Massachusetts. Dorothea's interest for helping out the mentally ill of society started while she was teaching classes to female prisoners in East Cambridge. She saw how these individuals were locked up and whose medical needs weren't being satisfied since only private hospitals would have such provisions. It was during her time at the East Cambridge prison, that she visited the basement where she encountered four mentally ill individuals, whose cells were "dark and bare and the air was stagnant and foul". She also saw how such individuals were labeled as "looney paupers" and were being locked up along with violently deranged criminals and received treatment that was inhumane.

In most cases, towns contracted with local individuals to care for mentally ill people who could not care for themselves and lacked family/friends to do so. Unregulated and underfunded, this system resulted in widespread abuse. 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." Her lobbying resulted in a bill to expand the state's mental hospital in Worcester.

During the year 1844 Dix visited all the counties, jails and almshouses in New Jersey in a similar investigation. She prepared a memorial for the New Jersey Legislature, giving a detailed account of her observations and facts. Dix urgently appealed to the legislature to act and appropriate funds to construct a facility for the care and treatment of the mentally ill. She cited a number of cases to emphasize the importance of the state taking responsibility for this class of unfortunates. Dix's plea was to provide moral treatment for the mentally ill, which consisted of three values: modesty, chastity, and delicacy.

She gave as an example a man formerly respected as a legislator and jurist, who, suffering from mental decline, fell into hard times in old age. Dix discovered him lying on a small bed in a basement room of the county almshouse, bereft of even necessary comforts. She wrote: "This feeble and depressed old man, a pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past—this feeble old man, who was he?" Many members of the legislature knew her pauper jurist. Joseph S. Dodd introduced her report to the Senate on January 23, 1845.

Dodd's resolution to authorize an asylum passed the following day. The first committee made their report February 25, appealing to the New Jersey legislature to act at once. Some politicians secretly opposed it due to taxes needed to support it. Dix continued to lobby for a facility, writing letters and editorials to build support. During the session, she met with legislators and held group meetings in the evening at home. The act of authorization was taken up March 14, 1845, and read for the last time. On March 25, 1845, the bill was passed for the establishment of a state facility.

Dix traveled from New Hampshire to Louisiana, documenting the condition of the poor mentally ill, making reports to state legislatures, and working with committees to draft the enabling legislation and appropriations bills needed. In 1846, Dix traveled to Illinois to study mental illness. While there, she fell ill and spent the winter in Springfield recovering. She submitted a report to the January 1847 legislative session, which adopted legislation to establish Illinois' first state mental hospital.

In 1848, Dix visited North Carolina, where she again called for reform in the care of mentally ill patients. Her first attempt to bring reform to North Carolina was denied. However, after a board member's wife requested, as a dying wish, that Dix's plea be reconsidered, the bill for reform was approved. In 1849, when the (North Carolina) State Medical Society was formed, the legislature authorized construction of an institution in the capital, Raleigh, for the care of mentally ill patients. Dix Hill Asylum, named in honor of Dorothea Dix's father, was eventually opened in 1856. One hundred years later, the Dix Hill Asylum was renamed the Dorothea Dix Hospital, in honor of her legacy. A second state hospital for the mentally ill was authorized in 1875, Broughton State Hospital in Morganton, North Carolina; and ultimately, the Goldsboro Hospital for the Negro Insane was also built in eastern part of the state. Dix had a biased view that mental illness was related to conditions of educated whites, not minorities (Dix, 1847).

She was instrumental in the founding of the first public mental hospital in Pennsylvania, the Harrisburg State Hospital. In 1853, she established its library and reading room.

The high point of her work in Washington 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 (40,000 km2) to be used for the benefit of the mentally ill and the remainder for the "blind, deaf, and dumb". Proceeds from its sale would be distributed to the states to build and maintain asylums. Dix's land bill passed both houses of the United States Congress; but in 1854, President Franklin Pierce vetoed it, arguing that social welfare was the responsibility of the states. Stung by the defeat of her land bill, in 1854 and 1855 Dix traveled to England and Europe. She reconnected with the Rathbone family and, encouraged by British politicians who wished to increase Whitehall's reach into Scotland, conducted investigations of Scotland's madhouses. This work resulted in the formation of the Scottish Lunacy Commission to oversee reforms.

Dix visited the British colony of Nova Scotia in 1853 to study its care of the mentally ill. During her visit, she traveled to Sable Island to investigate reports of mentally ill patients being abandoned there. Such reports were largely unfounded. While on Sable Island, Dix assisted in a shipwreck rescue. Upon her return to Boston, she led a successful campaign to send upgraded life-saving equipment to the island. The day after supplies arrived, a ship was wrecked on the island. Thankfully, because of Dix's work, 180 people were saved.

In 1854, Dix investigated the conditions of mental hospitals in Scotland, and found them to be in similarly poor conditions. In 1857, after years of work and opposition, reform laws were finally passed. Dix took up a similar project in the Channel Islands, finally managing the building of an asylum after thirteen years of agitation. Extending her work throughout Europe, Dix continued on to Rome. Once again finding disrepair and maltreatment, Dix sought an audience with Pope Pius IX. The pope was receptive to Dix's findings and visited the asylums himself, shocked at their conditions. He thanked Dix for her work, saying in a second audience with her that "a woman and a Protestant, had crossed the seas to call his attention to these cruelly ill-treated members of his flock."

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