Dorothea Lynde Dix (1802 – 1887): Humanitarian Reform
and its contribution to the history of psychology
Simon Fraser university
Dorothea Lynde Dix (1802-1887) is a significant figure in the history of psychology. She was one of the most influential individuals of humanitarian reform and change in the treatment of mentally ill individuals in the 19th century. Her efforts were profound and far-reaching, effecting change throughout the world and were felt first hand in Canada. Influenced by other reformers and the humanitarian movement, Dix stepped outside the role expected of a woman of her era and made significant contributions to the social history of psychology. It is important to recognize women like Dorothea Dix in the history of psychology when the tremendous efforts of so many women have been excluded to this point. She may not have contributed theories, diagnostic criteria or experimental research but she strongly advocated for change that would impact all of us in some way and in doing so, contributed greatly to the history of psychology.
Dorothea Lynde Dix was born in Hampden, Maine, April 4, 1802. She rarely spoke of her painful childhood, her abusive or alcoholic father or her frail and semi-invalid mother. Later in her life she claimed that she "never knew childhood" (Viney & Zorich, 1982, p. 211). Overwhelmed by the responsibility of caring for her two younger brothers she left home to live with her affluent paternal grandmother in Boston when she was twelve. Women were not permitted to attend public school at this time and Dix had been self-educated and privately tutored (Stevens & Gardner, 1982). From the age of fourteen to 39 she pursued an educational career. At the age of fourteen she opened a school for young children in Worchester. She later returned to Boston and completed some public and private education courses open to women. At nineteen she opened a "dame school " for young women and published numerous pieces of literature (Viney et al., 1982). Dix was never in good health and at several times in her life she was hospitalized. In 1836 she suffered a complete "nervous and physical collapse" and was not expected to survive. She closed her school and never resumed her educational career, although she did involve herself in educating of another form for the remainder of her life (Stevens, et al., 1982).
In March of 1841 at the age of thirty-nine, Dix volunteered to teach a Sunday school class at the East Cambridge Jail in Massachusetts. This began a journey of reform and significant change to the existing treatment of the mentally ill. Dix was appalled by the conditions at the jail where she observed prostitutes, drunks, criminals, retarded individuals, and the mentally ill all housed together in unheated, unfurnished and foul smelling quarters, huddling together and shivering. Upon inquiring she was told that the insane do not feel heat or cold and that her concerns were pointless. Outraged by this treatment she took the matter to court and won the first in a long line of victories. Heat was provided and the conditions were improved at the East Cambridge Jail (Viney, et al., 1982). Dix then began her crusade, which led her first to the jails, asylums, almshouses, hospitals, and workhouses where she made detailed observation. She later had others confirm and support her findings. She presented her observations and ideas for reform in a memorial to the Massachusetts legislature. She won legislate support and funds were allocated to the expansion of Worchester State Hospital. In all, she played a major role in the development of 32 state mental hospitals, many expansions of existing hospitals, and was instrumental in establishing schools for the "feebleminded", a school for the blind and enhancement of therapeutic programs within hospitals (Viney & Bartsch, 1984, p. 72). Using similar methods, Dix continued her work and reform in the United States and then Europe and Canada. Using her significant political skill and determination she tirelessly sought reform and make humanitarian the treatment of mentally ill people all over the world.
In Canada, Dorothea Dix's efforts were felt in the founding of Nova Scotia’s first mental hospital. In 1844 and 1849, Dix conducted an extensive investigation into the deplorable conditions of the mentally ill in Nova Scotia. At this time Nova Scotia was the only Canadian province which did not have a mental hospital. Efforts to create such an institution were slow to progress. After Dix’s relentless efforts and tactful mentioning of the progress made in other provinces and around the world the provincial government of Nova Scotia approved the plans. The first patient was admitted to the hospital May 26, 1857 and within four weeks 18 more patients were transferred from a Halifax poorhouse (Goldman, 1990).
The "spirit of the times" was very different for women of Dorothea Dix’s era than it is for women today. Deutsch (1949) notes that the work of Dorothea Dix "belonged to a period when social customs made it virtually impossible for women to rise above obscurity" (as cited in Viney, et al., 1982). Women were not typically afforded the right to public education until late in Dix’s life and were not permitted to vote (Marshall, 1967). Women long before Dix’s time such as Mary Wollstonecraft (1759-1797) had opposed such a system. Wollstonecraft had hoped to see universal education, women breaking away from some of their traditional roles and a less negative stereotype of women and their "sensibility" (as cited in Benjafield 1996). Dix seems to have followed in Wollstonecraft’s image. Furomoto (1987) describes women’s experience and work in the 19th century as being relegated to the bottom of the professional hierarchy. Women assumed responsibility for the most "problematic clientele", the sick, weak, young and elderly (as cited in Benjafield, 1996, p. 35). In some capacity, Dix also worked with this population but not in the traditional way women had previously. When other Victorian women rarely stepped out of the domestic sphere Dix was trying to influence a "masculine system from which [she was] excluded". Dix "invaded the system, grasped the levers of government and exercised substantial power" she "forced her countryman to confront one of the nation’s ugliest and most perplexing social problems" (Gollaher, 1995, p. VII).
The message which Dix brought to society came at receptive period when the traditional attitudes towards mental illness were changing (Gollaher, 1995). Early in history mentally ill individuals were thought to suffer possession by evil spirits and society feared contamination. Abnormal behaviour was attributed to divine power or the devil (Marshall, 1967). Mental illness was not to be understood or cured but was believed to be one of the mysterious afflictions that God imposed upon human existence and was to be endured (Lightner, 1999). If the community was small enough and the individual was not a threat to themselves or others they were usually tolerated within the community (Lightner, 1999). In the eighteenth century, the status of the mentally ill began to change due to economic development, population growth and social mobility. The "deranged" were not easily accepted by their neighbours (Lightner, 1999). Society became indifferent to the mentally ill and the main concern of that time was public safety (Marshall, 1967). Such individuals were often chained and kept safely away from all public contact. Next a new humanitarian spirit gave rise to the "asylums" which sought to "harbor rather than cure" the mentally ill. Mental illness was later viewed as a disease to be cured and treatment was aimed at restoration of the individual (Marshall, 1967). It was at this time that Dix’s ideas and reform movement could be received by the governments and the public.
Dix believed that madness was not a crime and that the practice of housing the insane within prisons was an outrage. She emphatically believed that the insane were guilty of nothing "but labouring under disease" (Gollaher, 1995, p.191). Dix viewed the immediate causes of "madness" as often moral and social but the underlying condition in mental disorders was biological malfunctioning of the brain (Gollaher, 1995, p. 191). Her ideas seemed radical at the time. She discussed new and humane treatments for the mentally ill and attempted to show through evidence that the more promptly treatment was provided the more probable the incidence of complete restoration (Marshall, 1967). Dix also distinguished between curable and incurable patients and seeking treatment for those that could benefit and comfort for those that could not (Viney ,et al., 1984). These were commonly held beliefs and practices among most humanitarian reformers.
In North America and Europe the age of enlightenment had created an emphasis on reason and science. This had profound effects on the treatment of and attitudes towards the mentally ill. The belief that "reason" was the essence of being human reinforced the belief that the mentally ill, lacking reason, were sub-human and "beast-like" and they were treated accordingly (Lightner, 1999). On the other hand, the Enlightenment faith in science and the pursuit of progress through reason created the first effective means of "mitigating and even curing mental disease" (Lightner, 1999). The "emergence of therapeutic optimism and the faith in the possibility of a cure… were inspired by the biological view of mental illness and a confidence in science to find an answer" (Aerino, 1989: 69). These beliefs and attitudes influenced the humanitarian movement in Europe and the United States.
Dix was greatly influenced by several significant figures involved with humanitarian reform in Europe and the United States. She was inspired and guided by the physicians who pioneered the humane treatment of the "insane". She read many of their reports, journals and books and saw their work as the "first great triumph of humanity and skill over ferocity and ignorance" (Gollaher, 1995). Of particular significance were the works of Benjamin Rush, Phillipe Pinel and William Tuke.
Benjamin Rush (1745-1713) was a physician who was influenced by the enlightenment faith in science and hope of curing mental illness. He was a prominent figure in the history of the reform movement and also signed the Declaration of Independence (Stevens, et al., 1982). Between 1783 and 1813 Rush worked at the Pennsylvania hospital where he took a particular interest in the mentally ill patients (Lightner, 1999). He took a holistic approach to disease which he applied to mental illness and was the first to describe "madness" as a disease (Jimenez, 1987). His optimistic belief in a cure was combined with a more negative view of the causes of mental illness which he believed to be "vascular tension" and excesses of the body and mind (Jimenez, 1987). Many of his treatments may seem unethical or unusual by today’s standards but he made the first systematic effort to classify patients and improve their behaviour through recreation and humane discipline. His sometimes radical and punishing treatments were only employed when kindness had first been applied. He also engaged in "mental therapy" which entailed talking openly with the patients about their fears (Jimenez, 1987). His efforts foreshadowed the therapeutic improvements to come (Lightner, 1999). This early work in the humanitarian reform in the United States was later improved upon under the influence of Phillipe Pinel’s work and his reform in France.
At the height of the French revolution, Phillipe Pinel (1745-1826) pioneered the "traitement moral" of the mentally ill in Paris (Lightner, 1999). He contributed greatly to the humane treatment of the mentally ill all over the world. Pinel may have been influenced by Rush’s optimism for a cure despite their varying views on its cause (Jimenez, 1987). In 1791, he published his "Treatise on Insanity" and the following year he removed the chains from the mentally ill patients at the Bicetre where he was a physician (Marshall, 1967). A new awareness began as it was realized that mental patients could be helped rather than hidden. Pinel’s primary interest was not the cause of mental illness but rather its treatment. He believed that mentally ill patients could be "restored to reason through kindness, regular routines and work" (Jimenez, 1987, p. 75). He believed that there was an innate goodness in the insane which allowed them to respond to gentleness and kindness (Jimenez, 1987). Pinel was committed to the inductive method of understanding and the idea that observations proceed theory, and he recorded daily observations of his patients. In 1806, Pinel’s "Treatise on Insanity" became available in English and it became the rational and foundation for the humanitarian movement and treatment for the mentally ill in the United States (Jimenez, 1987).
While Pinel’s work laid the groundwork for the humane treatment of the mentally ill in the United States, William Tuke (1732-1822) was the most influential figure in the building of early asylums (Jimenez, 1987). Tuke encouraged new procedures and attitudes in England in the 1820’s through the operation of his asylum, the York Retreat (Stevens, et al., 1982). Many asylums in the United States were modeled after Tuke’s and were based upon his conviction that the mentally ill were curable (Jimenez, 1987). Other asylums, which Dix opposed, did not follow Tuke’s prototype. William Tuke was a Quaker merchant who sought to instill the virtues of "quietness and solitude…in a place where the unhappy may find refuge" (Gollaher, 1995, p. 110). He had a "gentle, respectful attitude towards the insane in the asylum". He firmly believed that if treatment was implemented as soon as the disease was apparent that mentally ill individuals could be saved from a life of insanity and that they deserved this treatment (Jimenez, 1987). The famous York Retreat was heralded all over the world for its progressive treatment of the mentally ill and was later operated by Samuel Tuke, William’s grandson, and then William’s great-grandson, Daniel Tuke. As fate would have it, York Retreat was where Dorothea Dix recovered from her "collapse" in 1836 (Gollaher, 1995). Having personally experienced humane treatment and benefited from its therapeutic effects she was later able to "save others as she herself had been saved" (Lightner, 1999, p.11).
Rush, Pinel and Tuke all had profound effects on the development of humane treatment of the mentally ill and directly and indirectly provided Dix with impetus for her reform. The moral treatment proposed was not "moral treatment" referring to morality but came to be referred to as that based upon the incorrect translation of Pinel’s "traitement moral". The correct French translation would be, "well-being" or "morale" (Lightner, 1999). Despite the differences in their beliefs or practices all "moral treatments" contained the same basic components. All removed the insane from their environments that drove then insane. Patients received discipline and direction in hopes of changing their behaviour and eventually their thought processes. Each treatment provided counselling, recreation, physical labour and religion. Patients were separated into groups based on the severity and nature of their illness and as the patients improved they were given more freedom and responsibility. The hope was that through this mode of treatment the patient’s mental health would be restored and they could then return to society (Lightner, 1999). It was her belief in this model upon which Dorothea Dix based her reform and quest for change.
Through her political involvement and crusade for reform in the treatment of the mentally ill, Dorothea Lynde Dix did not directly contribute to the intellectual history of psychology but instead contributed significantly to the social history of psychology. Psychology is a uniquely "pluralistic discipline" with roots in both the natural and social sciences and applied traditions (Viney, et al., 1982). The intellectual history of psychology is best understood and complimented by the social history. The reform movement provides an example of how the social history interacts with the intellectual history. Dix’s contributions are important to the social history of psychopathology and treatment of the mentally ill and represent a turning point in the history of treatment (Viney, et al., 1982). It can be argued that her work and the increased exposure and sensitivity to the struggle of mentally ill contributed to subsequent theories of mental illness and treatment.
Before Dix, women such as Mary Wollstonecraft belonged to the "Utopia tradition" seeking to improve their well-being and the well-being of others by "changing the nature of the society in which they lived" (Benjafield, 1996, p. 36). Dix sought social betterment through knowledge and belonged to this tradition. The social activism of many 20th century psychologists followed the lead of women like Dix and Wollstonecraft as well as other reformers and psychologists (Benjafield, 1996). With knowledge comes the power to affect change. This is a fact of which Dorothea Dix and many other reformers were keenly aware.
Dix provides a powerful model for anyone who wishes to use his or her psychological knowledge to affect social change (Viney, et al. 1982). The practice of many psychologists today never involves direct contact with the client or patient. Many psychologists conduct research with the sole purpose of providing information. This research can then be used to change or influence existing social or therapeutic practices. The determination and skill which Dix used to further her ideas and beliefs, provides inspiration and a model for anyone wanting to use their knowledge to make change. Psychology is a discipline inevitably concerned with public opinion, allocation of funds and legislative decisions. The future success of psychological practice may rest on the ability to represent our skills and services to the public and to government bodies (Viney, et al., 1982). Dorothea Dix was an expert in influencing lawmakers and public opinion and through her knowledge, dedication and persistence created change (Viney, et al., 1982). She provides a model and inspiration for those of us who must do the same.
Primarily due to the efforts of Dix, for the first time, the general public and lawmakers were made to be aware of and to identify with the plight of the mentally ill (Viney & Bartsch, 1984). Dix wanted convey the belief that the mentally ill did not lose their "humanness" or "human rights" because of their illness. One of the most important human rights of mentally ill individuals was the right to treatment. With public acceptance of such beliefs came change in public opinion, which inevitably led to reform (Stevens, et al. 1982).
Rehabilitation and treatment of the mentally ill, which is an integral component of applied psychology have roots in the beginnings of humanitarian treatment in the 19th century (Lamb, 1994). Community and Clinical Psychology practices are based on the dedication to treatment and the well being of the mentally ill. These are ideals that Dorothea Dix and other humanitarian reformers advocated. Her careful and systematic measurement, her "participant-observer" model and consideration of inter-rater reliability have become important methods in applied and experimental psychology today (Stevens, et al., 1982).
Dix was not active in the feminist movement but she also accomplished a great deal for women’s rights. She demonstrated that a women could be "assertive, autonomous and effective in political matters" (Viney, et al., 1982. p. 216). Through her achievements she bettered the conditions for women and provided inspiration for the next generation of humanitarian women and possibly female psychologists.
We as a society and as psychologists have come a long way in our understanding and treatment of the mentally ill. The many mental hospitals for which Dix was indirectly or directly responsible are not the ideal by today’s standards but at the time they were a significant improvement to the existing conditions (Lamb, 1994). As Roberts (1967) summarizes we "have seen an exhilarating leap forward in our treatment of the mentally ill…if we are to advance further, the lessons of the past should be well studied" (p. 12). One of Dorothea Dix’s greatest contribution to psychology is an important "lesson of the past". She fought tirelessly with fierce determination to create change and betterment in the society in which she lived. In doing so, she brought public and government attention to the treatment of the mentally ill and the possibility for cure and rehabilitation. Her ideas may have been radical at the time but they have become a significant component of psychological practice today. She did not contribute theoretical knowledge but her work and the work of other humanitarian reformers foreshadow the practice and nature of psychology, as we know it today. Personally, I feel that the most important contribution that psychology can make to individuals is to educate and to extent compassion, caring, empathy and hope to those facing illness, instability or crisis. I feel that Dix and I share this belief and it is in this commonality that I find much respect for her.
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