E • I • G • H • T

Dorothea Lynde Dix: Privilege, Passion, and Reform

Barbara Ann Caldwell

U.S. postage stamp issued in 1983 honoring Dorothea Lynde Dix.

To the General Assembly of the State of North Carolina (1848):

Dorothea Lynde Dix (1802–1887) was born into an upper-class, highly educated, intelligent, and politically connected Bostonian family. These opportunities provided the foundation necessary to propel her into a leadership role as national and international advocate for the most vulnerable groups in the mid-1800s. She utilized her Methodist father’s background to augment the teachings of her adopted religious calling, Unitarianism, which promises salvation through leading a pure and directed life. As we explore her leadership role in this period of American history, it is easy to see how her family background, pursuit of education, personality, and religious commitment to humanitarianism enabled her to confront seemingly insurmountable obstacles to implement national and international reform of care for psychiatrically disabled and imprisoned populations.

SETTING THE STAGE: THE INFLUENCE OF FAMILY

A short background regarding Dorothea Dix’s life provides an understanding of the underlying religious, social, and philosophical tenets that emerged during her shortened and neglected childhood. Her appreciation for acquiring knowledge at an early age set the stage for her beginning role as a teacher. Teachers can become the lifeline of displaced individuals, assisting in providing a vision and dream to which any student can aspire. In her role as a young teacher, Dorothea brought to her students a sense of purpose and direction based on Christian principles.

During the 1790s, Dorothea’s grandfather, Elijah Dix, was a wealthy doctor who had taken advantage of the economic opportunities of the Revolutionary War. He and his wife, Dorothy Lynde, settled in Worcester, Massachusetts, with the entire family clan, including a network of doctors, lawyers, and municipal officials. Her grandfather’s life was an inspiration to Dorothea to make the most of the evolving economic and social life in Boston. In 1795, the family moved to Boston with other prominent families.

Her grandfather became an influential importer of European pharmaceutical products, chemicals, and appliances, which created the family fortune. As an entrepreneur, he developed local merchant institutions and diversified his investments. The Dix family mansion, built on Orange Street in Boston with its tailored botanical gardens, bespoke of the standards of the aristocratic community. Elijah Dix also transformed State Street into a city enterprise and erected chemical factories in South Boston.

Elijah and Dorothy Dix’s rising influence was enhanced by their oldest son’s graduation from Harvard Medical School under the tutelage of John Warren, the most prominent physician in Boston. Their daughter married a Harvard graduate who became a well-respected Methodist pastor in Dorchester. Their second son and Dorothea’s father, Joseph, also attended Harvard, but as a result of erratic attendance, partying, and abuse of alcohol, was unable to apply himself to academic studies. In 1800, he married Mary Biglow, who, according to his father, Elijah Dix, was a step backward for the family’s reputation compared to his daughter’s choice of partner. As Elijah Dix’s prestige and wealth grew, he invested in real estate, purchasing vast acreage in western Maine and developing a commercial center known as Dixmont, Maine. Because Joseph had not graduated from Harvard and made a place for himself in Boston, his father provided the couple with land in Hampden, Maine.

Dorothea was born in the small village of Hampden on April 4, 1802. Because of political events in 1807, an embargo halted the New England sea merchant trade and Elijah Dix’s businesses failed. Shortly after, Elijah Dix died, leaving a small inheritance to his oldest surviving son and Dolly (Dorothea), his 5-year-old granddaughter.

Dorothea experienced an isolating and lonely childhood as a result of her mother’s poor health during her pregnancies and her father’s difficult temperament and alcoholic tendencies. In 1915, they then moved to Worcester, Massachusetts (Lightner, 1999). The birth of her brother was a difficult experience for Dorothea, aged 10, because it forced her into being the older sister, losing her role as an only child. Her parents began to rely on her to be more independent and self-sufficient, working with her father in his bookbindery business.

Her father was a fervent Methodist; Methodism, at the time, was practiced mainly by farmers and rural artisans. A new and more refined religious movement that attracted Dorothea was Unitarianism, a sect that evolved at a time when other religious movements were occurring. As an adolescent, Dorothea rejected Methodist teaching and embraced Unitarianism with fervor.

Dorothea’s discontent with her place in her nuclear family, her mother’s chronic illnesses, and her feelings of being abandoned by her parents, prompted her to leave home, seeking sanctuary with her grandmother in the Boston mansion. Her grandmother sent her home after 2 weeks. By the time she was 14, she again returned to her grandmother’s home, but this time, her grandmother made arrangements for her to live in Worcester with the family of Sarah Fiske, whose husband was a prominent physician and a close friend and supporter of Dorothea’s grandfather’s initiatives.

In the early 1800s, age 14 marked the end of Dorothea’s childhood and the beginning of early adulthood and independence for this adolescent girl. Her early family experiences of feeling abandoned and alone shaped Dorothea’s attitudes, personality, and future. She had a strained relationship with her grandmother, who had a similarly dominant personality; neither could easily relent under pressure. Dorothea desperately sought to find a replacement maternal figure. Seeking respectability for herself, she turned to older women in the community to serve as mentors and confidants.

Anne Heath, 5 years older than Dorothea, was able to fill this role as an older sister. Ann was one of six sisters and a devout Unitarian. The Heath family lived in Brookline, and this provided an active social environment for Dorothea. They often entertained recently ordained Unitarian ministers from Harvard Divinity School, thus affording Dorothea opportunities to meet eligible male companions. Dorothea, however, was not inclined to actively participate in Boston society. She was highly regarded as beautiful and articulate, but most of all, intelligent and resourceful, important qualities associated with an aspiring leader.

ENACTING NONTRADITIONAL FEMALE ROLES: EDUCATOR AND WRITER

Dorothea began to develop more fully as a nontraditional, independent woman. She was exposed to innovative ways of thinking about education and how change could be achieved. Dorothea was able to develop a self-reflective and goal-directed approach to daily life and began to ingrain these qualities in her students. She shared her talents and ideas through her published books. This, in turn, enhanced her social status. These actions set her apart from other women, but she continued to struggle to find an appropriate career path.

The traditional role of women in the 1850s was one of domesticity, benevolence, and education. Teaching became the exclusive profession available to single, respectable women who wanted to distinguish themselves in public life. Dorothea’s moral compass was embedded in her new religious attraction to the teachings of Unitarianism in the churches of Boston. This attitude supported her ambitions to open a school. She believed that the poor and unfortunate were also entitled to be educated. So, at age 14, she convinced her grandmother to allow her to use a small portion of their home for her new school.

Dorothea, tall and elegant, projected confidence in her new role as a teacher. Contrary to the more traditional activities of needlework and sewing for women, as schoolmistress, her philosophy was that education should focus on developing ethical and religious foundations. She inculcated in her students a sense of self-control, perseverance, and goal directedness. Dorothea supplemented her own knowledge by attending lectures and classes at local schools, learning about horticulture, botany, and the sciences.

Dorothea Dix’s reputation as a young educator grew in the Boston community. She was asked to lead an innovative educational initiative, developed by an English educator named Joseph Lancaster, dividing schools into smaller groups with older children teaching younger children. Initially refraining from accepting a position at the prestigious Boston Female Monitorial School because the focus was on needlework, she realized that she could influence more children through advocating her philosophy of moral teachings. The school’s headmaster, William Bentley Fowle, introduced significant innovations into education by transforming the focus from discipline to learning, by using blackboards, maps, and written lessons. The school’s prominence and innovative style enabled the development of an educational program designed to prepare women as teachers.

Dorothea was developing many new ideas about education and introducing change in large educational systems. In May 1824, at age 22, she published her first book, Conversations on Common Things: Or Guide to Knowledge (Dix, 1824), which was, ironically, a dialogue between a mother and her daughter on everyday knowledge and lessons on life. Publication was a major accomplishment for a woman at that time, and this greatly strengthened Dorothea’s stature as an educator.

Traditionally, a young woman’s role was to find a suitable husband, without which a woman would have to care for herself and make her own way in the world. In her early 20s, Dorothea’s social life allowed her the hope of finding a young suitor in Ezra Stiles Gannett, a college friend of Ralph Waldo Emerson. Gannett was a graduate of Harvard Divinity School and Dorothea often attended his sermons. Gannett became interested in another Boston woman, Elizabeth Davis, but she married Daniel Webster’s law partner. Dorothea’s interest in Gannett faded as she became more convinced that she wanted to lead a productive and singular life. She also experienced a change in her relationship with Ann Heath.

The Heath family endured a significant tragedy with the death of Anne’s 21-year-old younger sister, Mary. This tragedy brought the Heath family together and Dorothea’s place in the family began to erode. Mary’s death acted was a reminder to Dorothea of the unresolved loss in her life, activating her deep and hidden fears of abandonment, which she had never faced. She was beginning to come to terms with her fate in life as a single woman. As with most single women of her day, she moved into a boarding house in Beacon Hill.

FINDING MENTORS: RELIGIOUS AND EDUCATIONAL COMMITMENT

Dorothea continued her transformation with another mentor, William Ellery Channing, who translated his religious views into an action-oriented humanitarian program. Her time with the Channing family allowed Dorothea the opportunity to more fully expand her literary work. This was the time period of the American Literary Renaissance, which enabled expanded educational opportunities for women. Although Dorothea continued to be burdened by her difficult childhood, her quest for a moral imperative was coming into focus.

Mentors are a critical component in the development of exemplary leadership practices and behaviors. Mentors provide others with a role model to emulate. They do this not only in behavioral ways but also by providing opportunities for reflection on a potential leader’s philosophical approach and career path. An important event in Dorothea’s life was her meeting William Ellery Channing, who was considered one of the leading religious and literary leaders in the United States. His philosophy was known as Christian Humanism, which conflicted the prevailing Calvinist teachings of predestination (Howe, 2007). A Harvard classmate of Joseph Dix, Dorothea’s father, and pastor of the Federal Street Church, William Ellery Channing was considered a very important intellectual and moral leader of his community (Howe, 2007). He requested that Dorothea lead a Sunday school class for his congregation.

As a result of her newest book, Evening Hours (Dix, 1825), Dorothea’s reputation continued to expand in Boston. The book used a question-and-answer format for children to gain insight into the New Testament. Dorothea’s compulsive work habits of taking on more than she could physically produce created health issues for her. She suffered from lung inflammation and chronic exhaustion as a result of her daily schedule (Brown, 1998). Because of ongoing health issues, she was forced to engage in intellectual pursuits rather than the more strenuous physical demands of teaching. She wrote another children’s storybook series, American Moral Tales for Young Persons (Dix, 1832). In this book, she blended principles of Unitarianism with her own personal experiences to create moral-minded characters of poor and orphaned children. Around this time William Ellery Channing and his wife, Ruth, invited her to join their family in Newport, Rhode Island, and to take responsibility of their two children. Dorothea used this opportunity to network with other influential individuals, such as Sarah Gibbs, whose father had made his fortune in Newport. Like many wealthy people of the day, Dorothea decided to travel south to spend the winter in Pennsylvania (Brown, 1998). She stayed with Sarah Gibbs but found herself lonely and searching for emotional support. She subsequently reconnected with Anne Heath, who communicated with her by letters for the rest of her life.

Dorothea’s moral underpinnings of Christian piety were further highlighted in another book, Meditations for Private Hours (Dix, 1828), a manual of daily devotional practices. Her religious perspective and continued involvement with Unitarianism was at odds with the more orthodox sects prevalent at that time in Boston. Her religious beliefs, which were founded on the Gospels, provided direction, she believed, for every good word and deed. Dorothea believed that for individuals, action, constant action, is life’s true calling, not just the mere enjoyment of life. She felt strongly that women have a special place in society because women have a superior piety, benevolence, and morality.

Merging her religious commitment and literary talents earned Dorothea a reputation as an accomplished teacher and professional author. While in Philadelphia in 1828, she became the editor of a children’s holiday book, The Pearl or Affection’s Gift: A Christmas and New Year’s Present (Dix, 1829). Such books were becoming popular as gifts in a prospering America. In this book, Dorothea told stories involving moral lessons for children. She also began to exercise her political thinking on topics such as the forced relocation of Native American Indian tribes and to support replacing jails and almshouses with new institutions for the insane.

Dorothea Dix’s talents and reputation as an educator continued to grow, but her dogmatic religious principles and rigid thinking as an educational leader foreshadowed problems she would encounter as head of nursing during the Civil War. Boston was in the initial phase of an educational transformation for women. George B. Emerson, a headmaster of a leading private school for girls, believed that educated women “give a permanent impulse to the onward movement of the race” (Emerson, 1831, p. 25). Dorothea’s mentors, besides Emerson, were Catherine Beecher who was headmistress at the Hartford Female Seminary, and Mary Lyon, who started the New England Female Seminary for Teachers, a project that founded Mount Holyoke College. Dorothea Dix proceeded to open a school for the wealthy families of Boston, requesting fees of $80 per 12-week quarter, not including room and board. This was considered expensive for the time, but allowed her the funds to support herself and finance the growth of more diverse academic programs offered at the school.

Her curriculum was innovative and included Unitarian religious services and bringing consultants in to teach French and the sciences. Dorothea’s reputation continued to grow but, owing to her disciplinary rules and because of her continued strong-mindedness, students found the atmosphere of the school too rigid. By 1834, the conflict between her pupils and her rules continued. Many promising young, wealthy students left. Although stressed by these issues, she continued her commitment to teach and care for the young students. Nonetheless, she distracted herself with additional commitments, such as the development of charity schools for poor children, which were supervised by Nathaniel Hall.

Dorothea’s inability to come to terms with her difficult childhood continued to haunt her. She was unable to clearly reflect and manage her life within normal boundaries. Working without giving any consideration to her own health, she soon became seriously ill. Dorothea was counseled by George B. Emerson to close her school. She was offered the opportunity to sail to Liverpool with the support of the Channing’s friends, the Rathbones, a wealthy and influential British family. The Rathbones were responsible for launching the success of John James Audubon; they encouraged many Bostonian families to visit London. Because of her continued health problems and the death of her grandmother, Dorothea decided to stay in England for several years. The turning point for Dorothea came when she returned to Boston. Her quest for a higher calling was revealed in a visit to the Middlesex County Jail and Boston Lunatic Hospital.

POLITICAL LEADERSHIP AND THE MORAL MOVEMENT

The 19th century was a period of rapid change in the United States, fueled by new and innovative ideas from Europe. The insane asylum reform movement, supported in England by the Religious Society of Friends, the Quakers, sought a gentle, patient, self-controlled approach to insanity. Thus, began the “moral movement” and institutional reform. Dorothea had arrived at the intersection of her religious beliefs and roles as educator and moral advocate. She was inspired by the fate of the most vulnerable, the mentally ill and imprisoned, and began her quest to understand the problems faced by the insane and to persuade others that they have a responsibility to support a new way of caring for this population. Her talent to enable others to act continued to expand. She understood, possibly by self-reflection, that collaborating and networking with political individuals who shared her vision required essential leadership skills and behaviors. She began to hone her talents in lobbying and partnering with superintendents of mental hospitals in order to bring her reform legislation forward. She began comprehensive data collection of the state’s insane institutions in order to present the most accurate information.

In 1842, Dorothea Dix’s interest in the most vulnerable was influenced by the writings of Edward Jarvis, a young physician who published Insanity and Insane Asylums (Jarvis, 1841). This book advocated for self-control versus violent coercion and was based on a philosophy from the European movement in France and England, known as the “moral treatment” approach. The word “asylum” means “haven,” and, to Dorothea, a homelike place of calm and focused treatment. The “moral treatment” approach to the insane recommended a therapeutic milieu, a normal homelike environment where the insane would have a daily work schedule. Intellectual and social stimulation would be incorporated into the treatment setting. Dorothea, understanding best practices for the mentally ill, visited sites using this innovative method such as the Worcester State Lunatic Hospital, Boston Lunatic Hospital, and McLean Asylum of the Massachusetts General Hospital. She began to integrate the “moral treatment” model of care with her closely held religious doctrines, which would become the basis of her own reform doctrine.

Women had begun to participate in the presidential campaign in 1840 (Howe, 2007). In 1842, the Whig party, whose foundational cause was based on redemptive reform and positive government, had interests similar to Dorothea’s mission (Howe, 2007). The Whigs encouraged women to participate in political areas in an indirect manner by exerting influence on their husbands. Seeking political connections, Dorothea understood that in order to successfully achieve her goals for the mentally ill, she needed to keep her agenda free of issues involving women’s rights and slavery. In addition, she needed to engage others in her vision.

Samuel Gridley Howe, a friend of Horace Mann, secretary of education in Massachusetts, was a major reformer for the blind. Dorothea Dix collaborated with him to launch efforts to expose the conditions of the jails and almshouses in eastern and southern Massachusetts. They also persuaded the editor of the North American Review to publish a commentary on the deplorable conditions of the insane, promoting the innovative “moral treatment” movement. She began to collect data all across the state on all the town and county institutions housing the insane. When Howe won the election as a Whig member in the Massachusetts’ House of Representatives, he had Dorothea complete her report to be presented at the opening session of the legislature.

Dorothea learned early that she needed to challenge the system in order to accomplish her moral mission. Her report, Memorial to the Legislature of Massachusetts, 1843, a 32-page comprehensive account, was considered one of the most outstanding reports of the century. The report contained elements of political rhetoric, religious commitment, and eye-witness accounts of the “cages, closets, cellars, stalls, pens that the insane are kept in” as well as “the chained, naked, beaten with rods and lashed into obedience conditions found.” This was her moment of awareness: This endeavor, uncovering the horrible treatment of the insane and jailed, was to be her life’s work, her vocation, and would require her to enter public life, not a traditional life for a 19th-century single woman.

She believed that the existing conditions were so horrific that only new facilities could provide humane conditions. Dorothea did not focus on the causes of insanity but rather on the duty that society had to respect, protect, and care for those who could not care for themselves. Her views reflected those of her early pastor and mentor, William Ellery Channing, who preached that kindness was an essential part of human interactions and the path to a more divine place. She appealed to the legislature’s sense of civil obligation to exercise its power and authority to take immediate corrective action.

Dorothea proved to be a successful lobbyist. The Memorial report, not unsurprising, was met with mixed reviews. Dorothea was not to be dissuaded. She used her capacity to network on behalf of the reform she was seeking by soliciting letters from all of the superintendents of the mental hospitals in New England in support of the construction of a new facility. She became politically active by attending legislative debates and engaging legislators in her cause. As in all things political, a compromise funding bill was adopted to enlarge the Worcester asylum to accommodate 150 more patients. With passage came the public acknowledgment that the government had a responsibility to care for the insane.

DEVELOPING LEADERSHIP EXPERTISE AND CAMPAIGNING FOR CHANGE

Dorothea embraced reform, continuing to expand her leadership base by collaborating with the superintendents of the various psychiatric hospitals and with politicians and ensuring that all reform legislation had the support of a board-based constituency. Using a team approach and sharing her vision in leading this transformation enabled her to garner support and enable others to act. She demonstrated her capacity to share her hard-earned power base with other prominent individuals by keeping her writings humble and direct, not filled with religious rhetoric. The important leadership strategies Dorothea used were her persuasive language skills and her ability to be available to meet and converse with powerful politicians and prominent professionals involved in the passage of much-needed reform legislation.

Dorothea Dix was a deliberate and intelligent woman who learned from her past experiences to enhance her new initiatives. Based on limited personal writings available, she concluded that the rehabilitation of the insane could be improved if the newly committed were separated from the more chronically afflicted, but ensuring separation would require new facilities. Even today, this model is the current evidence-based treatment strategy for individuals newly diagnosed with schizophrenia (Harder, Koester, Valbak, & Rosenbaum, 2014; Norman, Manchanda, & Windell, 2014). Individuals experiencing their first episode of psychosis are maintained in community settings with a treatment team and psychosocial interventions are delivered in day programs.

Dorothea Dix transformed herself into a reformer and advocate for the insane by continuing her visits to public insane institutions, almshouses, jails, and hospitals in Vermont, New Hampshire, Rhode Island, and Canada. She also widely distributed copies of her report Memorial to the Legislature of Massachusetts. Dorothea Dix’s society background enabled her to network with wealthy donors who would be willing to support the reform movement for the insane. An example of the effectiveness of her social standing was her successful funding of an asylum in Rhode Island in collaboration with Nicholas Brown, Jr., the namesake of Brown University.

In the early months of 1848, Dorothea focused her energies on New York by engaging in a 10-week tour of all 60 counties to examine their almshouses, poorhouses, and insane asylums. The data she gathered was incorporated into a report similar to the one she had presented in Massachusetts. She delivered her new report to the New York legislature, seeking support from the former governor, William H. Seward, a strong supporter for a state asylum. Having learned from her previous experiences in Massachusetts, she deleted religious fervor from her text in favor of a strictly dispassionate, statistical account and objective evaluation of each facility she had visited. Her clear, straightforward narrative outlined a nonmedical model of care based on an approach used at Antwerp Hospital in the Belgium town of Geel. This outraged the medical community. As a result, in 1848, the Association of the Medical Superintendents of American Institutions for the Insane argued that all institutions should be controlled by physicians. Her “Memorial to the Honorable Legislature of New York” was rejected in New York (Dix, 1844; Wilson, 1975). Having met with failure, she learned an important lesson: Make sure that all the stakeholders are on board with any initiative and all opposition is neutralized.

With steadfast persistence, resilience, and a more refined sense of political savvy, Dorothea traveled to New Jersey and Pennsylvania. She traversed both states collecting copious amounts of data and field notes. She traveled by overnight stagecoaches so she could work during the day. Once again, she adapted to the resistance that had undermined her previous reports by placing the prevailing medical views in the forefront of her reports. She also incorporated a discussion of the cause of insanity as a condition of the brain rather than demons of the mind as had been championed by Philippe Pineal, reform advocate of the moral movement in Europe. She realized that in order to motivate others to join her cause, she needed to infuse the reports with concepts that physicians were willing to support: Prompt therapy cured most insanity; and the economics of building new hospitals administered by physicians would repay taxpayer investment by removing the newly cured from public assistance. This awareness is a perfect example of her ability to garner support and enable others to act by supporting her reform cause and legislative acts.

Her political acumen was demonstrated in her ability to exercise her leadership skills with the legislatures in New Jersey and Pennsylvania. Dorothea engaged the legislators in open dialogue concerning the dimensions of the moral treatment by infusing the meetings with her persuasive arguments. She met frequently with legislators, shuttling between Trenton and Harrisburg. In 1845, the passage of legislative funding allowed for the construction of state mental hospitals in both New Jersey and Pennsylvania.

Dorothea’s fame in these extraordinary endeavors spread to other states. She was asked by William M. Awl, superintendent of the Ohio Lunatic Asylum, to support his efforts in launching a political campaign to fund a state asylum. At the same time, however, New Jersey and Pennsylvania officials requested that she act as design consultant to oversee the construction of their new state hospitals. Because Dorothea could not be in two places at the same time, she focused her energies on New Jersey and the construction of the first state psychiatric hospital in Trenton. Mindful of the necessity of establishing the best model for the new hospital, she visited the treatment facilities in Massachusetts, which were considered the premier national mental institutions employing the moral treatment model.

PRISONERS’ LETTERS AND EXPANSION OF LEADERSHIP

Dix’s reform successes for the insane expanded to prisoners. In her book, Fifth Letter to Convicts in State Prisons and Houses of Correction or County Penitentiaries, published for the prisoners, she states:

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