A society neglecting it’s most vulnerable population is indeed wholly poor in virtue.
“The righteous care about justice for the poor, but the wicked have no such concern.“
Proverbs 29:7 NIV.
As a child, Dorothea Lynde Dix (1802-1887) was a pseudo-pauper, for although her paternal grandparents were fairly well-off, her father and mother were rather underfunded, as neither maintained steady employment. Dorothea’s parents, Joseph and Mary Dix, and the family lived on a tract of land owned by Joseph’s father, Elijah Dix, in Hampden, Maine.
Dorothea’s father was known for his fanatical flights of religious fervor equal only to his propensity for strong drink. A Methodist lay pastor by trade, Joseph traveled and distributed tracts of sermons he wrote preaching hellfire and damnation.
Dorothea’s mother suffered from some sort of mental infirmity; the accepted speculations favoring depression, but whatever it was that ailed Dorothea’s mother, she felt it was personal business and never shared the details with anyone. It can be sure the mental infirmities suffered by her mother made a grave impression on the young girl.
There was more than a little bit of mystery and tragedy slapping against the face of Dorothea Lynde Dix’s childhood. By the time she was twelve she grew tired of pasting and sewing her father’s religious tracts together for him and spending all of her remaining time seeing to the household duties her parents neglected in favor of their various oddities, conditions, and pursuits.
One day in 1814, Dorothea appeared on her paternal grandmother’s doorstep in Boston Massachusetts, having had enough of what biographer Francis Tiffany termed as Dorothea’s “immediate parents’ lacking in energetic fibre.” Though her grandmother was a strict disciplinarian, Dorothea preferred the sewing, cooking, and knitting lessons of her grandmother to the arrant disregard of her parents and especially the endless drudgery of the gluing and stitching of her father’s tracts. When Dorothea went to her grandmother’s, her brother, Joseph, was 2 years old, and Mary Dix was expecting a third child.
Without any formal schooling herself, other than having been taught to read by her father, Dorothea began teaching school at the age of 14. She moved in with her great-aunt, Sarah Lynde Duncan, in Worcester and discovered her knack for storytelling, which her cousins deeply enjoyed. Dorothea set up her dame school over the bookstore on Main Street and began teaching the three R’s to any child who would pay the small fee. To the delight of her students, it was with her own favored stories that she taught science to the children as well as devotions and tales with a moral lesson. The school was very successful because even though Dorothea executed fair and strong discipline, she was also gentle and kind.
When she was 17, Dorothea moved back to Boston into her grandmother’s mansion, bringing her little brother Joseph along. Her second brother, Charles Wesley, remained at home. Here she not only continued teaching, but also set up a second school so that poor children could have access to moral training. Dix wrote eight books between 1824 and 1829, including hymns for children, short stories, meditations, and botany. Two examples of the books she wrote are Conversations on Common Things, (reprinted 60 times by 1869) and The Trials of a School Girl,
Raising her brother Joseph, and now her other brother, Charles, as well as caring for her mother, along with teaching at two schools, preparing her own texts, and looking after her aging grandmother, all made for a heavy work load which took a toll on Dix. After about fifteen years of it, all told, she had a nervous breakdown. To recuperate, she quit teaching and took to traveling and visiting friends. In 1836 Dix’s mother and grandmother passed away and left her a legacy which, combined with her own savings and the money she earned from her books published a few years prior, provided funds enough to live on as she recuperated from her malady, which some speculate to have been associated with some form of depressive disorder.
Despite her feeble health, on March 28, 1841, Dix volunteered to teach Sunday school to some twenty female convicts in the East Cambridge jail for a pastor friend of hers. This was where she saw the fate of society’s indigent insane, which propelled her into the political/social-welfare arena. When Dix found the bowels of the East Cambridge jail were over crowded not only with criminals, but also the indigent insane, as well as the mentally and physically handicapped, all herded together in filthy and freezing conditions, her first political act undertaken on behalf of these innocent persons was to present a proposal to the court which won heat to warm the prisoners’ jail cells.
Certain that conditions should be improved for those less fortunate souls, Dix spent the next two years traveling with a notebook to every almshouse and jail from Berkshire to Cape Cod, noting the conditions of each institution along the way. With her notes, she wrote a memorial (report) addressed to the state legislature with the hope of gaining humane living conditions for the innocents who were neglected and abused. In the memorial, Dix wrote:
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. Lincoln. A woman in a cage. Medford. One idiotic subject chained and, and one in a close stall for seventeen years. Peppernell. One often doubly chained, hand and foot; another violent.
The local newspapers cried that the memorial written by Dix was pure fiction, that there were no almshouses keeping the poor citizens of Massachusetts as prisoners, behind bars, with iron chains around their necks! “Incredible” the citizens argued. “Sensational and scandalous lies!” But Dix would not be discouraged. She garnered the support of politicians and respected statesmen, and after many weeks of heated debate, finally convinced the state legislature to expand the size of the state hospital in Worcester in order to accommodate more patients and provide better care, such as the gentle and therapeutic moral treatment she’d learned from Elizabeth Fry, Samuel, Tuke, and William Rathbone in her travels.
Spurred on by her empathy for so many poor people suffering in jails and almshouses in other states, in three years’ time, Dix traveled over 30,000 miles, visiting institutions all over the United States and lobbying for improved conditions for the poor mentally ill. In New York, New Jersey, Pennsylvania. From the Canadian border to the Gulf of Mexico, the Atlantic to the Mississippi, contracting sicknesses, and sometimes bedding with rats and cockroaches. Her practice in each state was the same; she visited every jail and almshouse she could, collected data, prepared a memorial using her meticulously documented research, all to be presented by an affable and well-known politician pressing for better facilities for the indigent insane. The tireless woman carried on this process for ten years, pleading with state after state to provide humane conditions, moral treatment, for the weak-minded who could not afford the care provided in the private hospitals of the wealthy. The moral treatment contended that environmental factors such as beauty in architecture, landscaping, interior design, etc, and pursuits such as reading and enjoying company, all played a significant role on the way to recovery.
One after another, the states began building adequate mental hospitals. In 1845 Dix published a treaty, Remarks on Prisons and Prison Discipline in the United States, which advocated for separating prisoners according to the crimes they’d committed and for educating them in the hopes that the acquisition of knowledge would improve their lives. Throughout the 1850’s Dix advocated for mental health institutions and for the incorporation of moral treatment on an international basis, and her pleas were heard all throughout Europe, Canada, Russia, and Japan. Her intercessions for active reform were building momentum.
With the building of mental institutions all across the United States and even internationally, and on the heels of the failing of a land grant bill she’d spent six years (1848-54) lobbying for, Dix took a much deserved vacation in Europe. She soon discovered a great inequality between the private hospital care provided for the wealthy and the public care facilities relegated to the poor. She managed to get an appointment with Pope Pius IX who verified the research in her statements and set out to make changes in Italy’s system. Upon her return home, Dix again took up the cause of seeing to the needs of the mentally infirm and began to ask the state governments for larger appropriations and more hospitals suited to provide efficient and effective moral treatment.
In 1861, at the age of 59, Dix volunteered her services in the Civil War and was appointed Superintendent of Nurses for the Union Army. This was, as had been all of her previous official activities, an unpaid position. She was responsible for recruiting and training over 2,000 women as nurses, and organizing and procuring all necessities for the Union Army hospitals. Dix was the first woman in such a high federal position. She found herself often confronting doctors about their drinking habits and lack of sanitation and the nurses complained of her severity, but the soldiers called her an angel of mercy. Obviously, she was not politically motivated, as making friends with the drunkard doctors and seemingly uncaring nurses was not in par with getting the needs of the patients met.
After the Civil War, Dix returned to her role as a representative for the impoverished mentally ill. She examined hospitals and tested proposed sites for water purity. She ate the food being served to the residents, inspected the heating systems, looked over the finances; she thoroughly examined all aspects of the asylums that she helped to create. Before her death in 1887 she would help establish 32 of the 110 new mental institutions built in her lifetime. The first institution that Dix helped set up was built in Trenton New Jersey. That institution is where she retired to in 1881 and is the one institution dedicated in her name, for Dix was forever and always the humble empath, proven by the fact that she rarely put a name to any of her endeavors in her lifetime. Even many of her books are void of her name.
In the same year as Dix’s death, the journalist Nellie Bly undertook an assignment for the editor of the New York World Newspaper as investigative reporter. Bly was born Elizabeth Jane Cochran in 1864 in Cochran’s Mills, Pennsylvania, a town began by her father, Michael Cochran, a successful miller, store owner, postmaster, and associate judge. Though her father passed away when she was only six, Bly managed to acquire some college education at the Indiana Normal School in Indiana Pennsylvania before financial restraints sent her to help her mother manage a boarding house in Pittsburgh. In 1882, Bly fired off a hot missive to the editor of the Pittsburgh Dispatch rallying against Erasmus Wilson’s recent editorial which stated women who work outside the home were a “monstrosity.” The editor, George Madden, immediately offered her a position at the paper.
By 1885, Bly was becoming increasingly bored at the Dispatch where the editor assigned her to the women’s page and ever further away from a chance for writing exciting journalistic endeavors. Two years later, she managed to move to New York and land a gig with the New York World newspaper. One of her first assignments was to enter, undercover, the Women’s Lunatic Asylum on Blackwell’s Island (now Roosevelt’s Island), an institution for the indigent insane in New York. She was to report on everything she saw there, be it good or upsetting, happy or sad, whatever she experienced, heard, felt, because the editor wanted to know if the reports he’d heard about concerning the asylum’s brutality and neglect were true.
After getting herself committed, which was a clever bit of acting itself as she feigned the demeanor of a person who did not know where she was or whence she came, it wasn’t long before Bly found herself on Blackwell’s Island. The ten days of her incarceration were the first immersion journalist actions ever recorded in an American newspaper. The conditions exposed were far from Dix’s practical philosophy of moral treatment. In the Women’s Lunatic Asylum, Bly witnessed horrid abuses of the women, many who were taken to the closet and beaten by the caretakers and verbally teased into fits of rage or tears. She suffered through eating wretched food, bathing in a cold water dorm-successive tub, forced silence, freezing conditions in thin clothing as the heat was not allowed until October (Bly’s subterfuge took place in September), and witnessing patient’s fingers getting twisted and their faces slapped by the nurses.
With the publication of the two part series of Bly’s report on the women’s asylum, the New York World not only introduced immersion journalism to the reading public, but due to the exposure of the conditions inside, New York City awarded $100,000 in additional funding toward the care of the insane. Bly was proud of her accomplishment in aiding the penniless mentally ill.
Unfortunately, moral treatment for the institutionalized insane who were underfunded was not to make a comeback, as for the first three quarters of the 20th century, state institutions crowded more and more patients into their quarters, anesthetized and sometimes euthanized their souls with medications, straightjackets, frontal or medical lobotomy, shock treatments, wet towel treatments, cold water treatments, foul food, and kept them under observation for experimental purposes.
By 1977 the number of patients housed in institutions fell to 160,000 from 1963’s 600,000, a result of President Kennedy’s enacting of the Community Mental Health Centers Act, an act hoping to afford a more humane treatment to those in need. Those remaining institutionalized tended to be heavily medicated mental hospital patients suffering from dystonia (painful muscle spasms), tardive dyskinesia (stiff, jerky, uncontrollable movements of face and hands), and suicidal tendencies; many test subjects having signed no informed consent form.
The community-state model of moral treatment expanded in the last decades of the 20th century, affording for a meaningful and fruitful life for some. The many advances in medications prescribed by doctors combined with local outreach nonprofits as well as government funded programs and services, became a more attractive treatment resolution to the states.
By the turn of the 21st century, the buildings once toured by curious admirers of impressive architecture reminiscent of castles and cathedrals, manicured landscapes, and the relative order of moral treatment, were lauded as exciting haunted asylum tours. However, without enough spaces available in the underfunded, understaffed, and undertrained care facilities intended to care for the many who needed help, the prison population exploded with mentally ill persons falling through the cracks (Federal prisons: 78,800, state prisons: 705,600, local jails: 479,000. (2006 Bureau of Justice Statistics, BJS) and the streets increasingly became homes for the insane who could not afford private care. Recently, I saw a statistic that a full 33% of the homeless people we see huddling on the sides of roads, cowering near bushes, and curling under plastic tarps suffer from mental illness.
Certainly, there is not one simple and easy answer for the current problem of homeless people who wander aimlessly through the streets, but the original answer wasn’t easy for Ms. Dix as she parried and wrestled with bureaucrats until she tore through their hardened prejudices to expose their humanity. Because the federal government no longer provides funds for long term mental health care and the states can’t afford to provide it for them, are we going to, collectively – as a strong, thriving, robust nation, – ignore those poor souls who’ve lost their connection to their own community?
Who among us will rise from the circumstances dealt us, only to turn around and sleep among rats and cockroaches, heroin needles and feces, in order to secure a dignified future for those we don’t even know, who likely wouldn’t even know us or thank us for our troubles? While the buildings of Ms. Dix’s creations are being dismantled brick by brick, or turned into museums, where will all the people go?
The stresses of Dix’s ideals were to engage with the patients, provide them therapy, music, books, recreation, and meaningful work. Where were the Dorothea Lynde Dix’s in the 20st century? Where were the Nellie Bly’s to expose the perfidy? Where was the humanity? If “a nation’s greatness is measured by how it treats its weakest members” (Mahatma Gandhi), the United States’ lack of moral treatment toward the indigent insane in the 20th century may display the nation under a less than favorable light. It is yet to be seen if we will redeem ourselves in the 21st, a century which, through the lens of modern history, given that we’re confirmed navel gazing screen swipers, looks to have spawned more sloths than doers and more ailments than caregivers.