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Dorothea Dix

Dorothea Dix Dorothea Lynde Dix (April 4, 1802-July 18, 1887), in her early career a teacher and author of children's books, was, in her unique and international role as an advocate for improvements in the treatment of patients suffering from mental and emotional disorders, the most visible humanitarian reformer of the 19th century. During the Civil War she served as Superintendent of United States Army Nurses.

Dorothea (as a child called Dolly) was born in Hampden, Maine, the first of three children of Joseph and Mary (Bigelow) Dix. Her mother was listless and self-absorbed. Her father was a book dealer and an active Methodist, perhaps a lay minister. As a distributor of religious tracts promoting a hellfire and brimstone theology, he continually moved his family from place to place. As a child Dorothea was required to stitch and paste tracts, a task she deeply resented. The unhappy child felt neglected and abused. At age 12 she ran away. She lived briefly with her Grandmother Dix in Boston and, by 1816, with an aunt in Worcester, Massachusetts.

Unusually mature and intellectually gifted at age 14, Dix opened a private school in Worcester. Her pedagogical techniques were demanding and rigid, as they were expected in that day to be, and her school was successful. By 1821, she was again residing with her grandmother in Boston. There she opened a private school which was also open to young girls. Believing the work of a teacher must include community service, she ran a free evening school for poor children, one of the first in the nation. She wrote a number of books for children and parents. Her best known, Conversations on Common Things, published in 1824 and much reprinted, was designed to help parents answer their children's questions such as: "Why do we call this day Monday? Why do we call this month January? What is tin? Does cinnamon grow on trees?" The answers given demonstrated Dix's extensive knowledge of the natural world. She also published American Moral Tales for Young Persons, 1832, The Garland of Flora, 1829, and Meditations for Private Hours, 1828.

Though Dix received little formal education, her appetite for knowledge was insatiable. She attended public lectures, read widely, and made a point of keeping company with knowledgeable people. She studied literature, history and the natural sciences with a special emphasis on botany and astronomy. As a teacher she did her intellectual homework before embarking on any project, a practice she continued and developed with originality in her later work as a reformer.

Although Dix's work was driven by deeply felt moral sensitivities, for a time she struggled to find an appropriate religious context. She attended her grandmother's Congregational church in Boston, but found there as little spiritual satisfaction as she had earlier in the Methodism of her father. Doubting the many "necessities of belief," she could not doubt the importance of salutary action to promote positive social and personal growth.

By the early 1820s Dix had found her religious home among Unitarians. She appreciated the Unitarian emphasis on the goodness of God, purity of heart, openness to new knowledge and responsibility for the good of all society. A close friend of William Ellery Channing, the famous pastor of the Federal Street Church in Boston, she served from time to time as governess for the Channing children and sometimes accompanied the family on vacations. She read many printed Unitarian sermons appreciatively and critically.

Dix established an extensive network of friends in the Boston Unitarian community. Anne Heath, a member of the Federal Street Church, became a lifelong friend and confidant. Heath, like Dix, would never marry, but unlike Dix, had grown up in a stable extended family and found contentment in domestic activities. Their extensive correspondence, spanning a period of over 50 years until Heath's death in 1878, provides a window into Dix's inner world. This world was filled with deep appreciation for poetry, literature, history, and nature, but marred by loneliness, alienation, and self-deprecation.

In many of her letters and communications, especially those to children, Dix resorted to the language of her earlier Christian conservatism. At the same time, Dix had a deep suspicion of doctrines and creeds. She didn't like the abstractions of theology and was a pragmatist in the good sense of that word. She felt nearest to God when she was involved in specific actions that resulted in measurable good effects.

Dix's work as a teacher was interrupted from time to time by a recurring and severe upper respiratory ailment, aggravated by a work schedule that afforded too little sleep. In 1836 she was forced to take an extended rest. With a letter of introduction from Channing, Dix moved to Liverpool, England where she stayed in the home of a Unitarian philanthropist, William Rathbone. The Rathbones took a great liking to Dorothea and treated her with more affection than she had ever known in her own family. She remained with them for about a year and gradually regained strength.

In 1837, following the death of her grandmother, Dix returned to the United States. Still not strong enough to resume teaching, she supported herself during a period of recuperation and limited travel with funds from the Dix estate and her savings and royalties from the sale of her books.

In March, 1841, a ministerial student, frustrated with his efforts to teach a Sunday class for women incarcerated in the East Cambridge jail, thought that a woman might better do the task. He approached Dix for advice. She decided to teach the class herself. What she encountered in the jail shocked her and changed her life. The jail was unheated. Those incarcerated were not segregated; hardened criminals, feeble-minded children and the mentally ill all occupied the same quarters. Dix secured a court order to provide heat and to make other improvements.

Her experience in the East Cambridge jail made Dix wonder about conditions in jails and almshouses in less populated areas of Massachusetts. She was particularly distressed to learn that the mentally ill were commonly housed with felons. She prepared herself to embark upon a mission of reform, to call for decent accommodations for those suffering from mental and emotional disease. She read all the available literature on mental illness and treatment facilities. She interviewed physicians about the diagnosis and treatment of mental illness. She acquainted herself with the work of reformers Philipe Pinel, Benjamin Rush and William Tuke. Some informative accounts of Pinel's work are found in Dix's published work. Her knowledge of mental disorders soon compared favorably with that of leading hospital superintendents of her day.

As her knowledge expanded, Dix developed a bold and remarkable plan to provide further intellectual foundation for her reforms. To investigate accommodations for the mentally ill, she would personally visit many jails and almshouses. This at a time when women seldom traveled alone or attempted to influence legislation, funding, or the regulation of public institutions.

Dix was soon visiting jails and almshouses all over Massachusetts to conduct one of the earliest social research projects in the United States. She collected data on the number of occupants in overcrowded facilities and kept careful notes on conditions, which were far worse than she had anticipated. She found the mentally ill chained in cellars, living in accumulations of their own excrement and often suffering from the cold. Most jails and almshouses were poorly ventilated. They seldom provided proper nutrition or exercise. She was often so nauseated by the smells that she had to go outside for a bit to recover her composure.

Though jailers and proprietors of almshouses often tried to prevent Dix from seeing their worst cases, she demanded and usually got full access. "I cannot adopt description of the condition of the insane secondarily; what I assert for fact, I must see for myself."

Based on her observations, she crafted a powerful memorial which was presented in 1843 to the Massachusetts legislature by Dr. Samuel Gridley Howe, Director of the Perkins School for the Blind and himself a strong advocate for the mentally ill. The memorial first met with criticism and denial, but independent observations soon supported the truth of her claims. The legislature allocated funds for a large expansion of the State Mental Hospital at Worcester. A major victory for Dix and for the insane poor of Massachusetts, the act was also a stimulus for wider efforts.

Even before completion of her work in Massachusetts, Dix had begun investigating conditions in the jails and almshouses of other states. In 1844 she presented a memorial to the New York State legislature, and in 1845 two more to New Jersey and Pennsylvania lawmakers. Her pattern in each state was the same. She traveled extensively to collect data, and then prepared a memorial bearing her carefully documented findings, to be delivered by a friendly and well-known political figure, pleading for funding for better accommodations for the mentally ill. For over a decade her memorials were presented in state after state, often with gratifying results. Hospital after hospital was erected, along with additions and improvements made to existing facilities. Deeply attuned to the latest in architectural design, Dix insisted on a therapeutic setting for the curable insane and a humanely comfortable setting for those regarded as incurable.

By the late 1840s Dix was formulating a creative and ambitious plan to assure proper facilities and treatment for the insane poor in the long term. She proposed that a federal land-grant of 12,500,000 acres be set aside as a public endowment, the income to be used for the benefit of the blind, deaf, mute and insane. From 1848-54 she lobbied for her plan and secured passage from both the Senate and the House of Representatives. President Millard Fillmore favored the act, but it did not reach his desk before his term was over. Defeating Dix's hopes for secure financial resources for the disadvantaged, President Franklin Pierce vetoed the bill.

Discouraged, Dix traveled to Europe in 1854 to rest. But once there, she soon learned of the great disparity between private hospitals for the wealthy and miserable public facilities for the insane poor in Europe. Again, she set out to investigate and to agitate for reform. From 1854-56 she traveled in 14 countries and instigated many changes. For example, upon finding deplorable hospital conditions in Rome, Dix managed to get an audience with Pope Pius IX. Having verified the accuracy of her reports, the Pope undertook a series of improvements. He expressed his appreciation for her work and compared her to Saint Theresa.

Back in the United States in 1856, Dix resumed her reform work, but now the country was torn over the slavery issue. In 1861, as the Civil War began, Dix volunteered her services and was named Superintendent of United States Army Nurses. Her tasks were to organize first aid stations, recruit nurses, purchase supplies and help to set up training facilities and field hospitals. Although Dix did muster the resolve and stamina required to pursue these enormous tasks throughout the war, she lacked the social skills of an effective administrator. In her reform efforts she had worked autonomously and was thus poorly prepared for the bureaucracy she encountered in a military establishment. She was often at odds with doctors over their drinking habits and their neglect of sanitation. Wounded soldiers called her an "angel of mercy," but the nurses thought her rigid and imperious. But she stayed the course even after the war, helping to trace missing soldiers, writing letters to families concerning the status of their sons and helping soldiers secure their pensions.

When Dix again took up work for the mentally ill, she found prospects for success now dimmed by massive immigration, a swelling population of the insane poor and much depleted state treasuries. Hospitals earlier built were now overcrowded, understaffed and in disrepair, well on the way to becoming as poor as the jails and almshouses they had replaced. By the middle of the 20th century some writers unjustly blamed Dix for the custodialism of the hospitals she had helped found. In fact, she hated custodialism and had argued strongly that the mentally ill should be provided therapy, books, music, recreation and, above all, meaningful work. She had embraced a holistic approach to care and treatment.

Dix finally retired at age 79. Depressed by deteriorating accommodations and programs for the insane, she did not talk about her work; nor would she cooperate with those who inquired about her life and career. She died in 1887 and was buried in Mount Auburn Cemetery in Cambridge, Massachusetts.

The primary archival repository for Dix's unpublished works, including her letters, is in the Houghton Library at Harvard University in Cambridge, Massachusetts. There are also Dix letters at the Menninger Foundation in Topeka, Kansas. Some letters are published in Charles M. Snyder, The Lady and the President: The Letters of Dorothea Dix and Millard Fillmore (1975). Her reports, including "Memorial to the Legislature of Massachusetts" and "Memorial Soliciting a State Hospital for the Insane," are reprinted in David J. Rothman, ed., On Behalf of the Insane Poor (1971).

The major biographies are Francis Tiffany, Life of Dorothea Lynde Dix (1890); Helen E. Marshall, Dorothea Dix: Forgotten Samaritan (1937); David Gollaher, Voice for the Mad: The Life of Dorothea Dix (1995); and Thomas J. Brown, Dorothea Dix: New England Reformer (1998). Among many article-length pieces on Dix are Wayne Viney and K. Bartsch, "Dorothea Lynde Dix: Positive or Negative Influence on the Development of Treatment for the Mentally Ill," The Social Science Journal, (1984) and Wayne Viney, "Dorothea Dix: An Intellectual Conscience for Psychology," in Gregory A. Kimble, C. Alan Boneau, and Michael Wertheimer, eds., Portraits of Pioneers in Psychology, vol. 2 (1996). See also Norman Dain, Concepts of Insanity in the United States, 1789-1865 (1964) and Wayne Viney and D. Brett King, A History of Psychology: Ideas and Context (2002).

Article by Wayne Viney - posted January 3, 2003


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