Today, we have a lot of help when it comes to health. Science has advanced, new discoveries have been made, and institutions have been established to help the less fortunate. When it comes to mental health, there have also been many changes and discoveries, but have you ever wondered how this came to be? Dorothea Dix, born in the state of Maine on April 4, 1802, was the woman who was in charge of helping people with mental health problems.¹ Her journey was not easy, but she was responsible for the huge change that has ended up helping many generations, even to this day. Her immense passion for helping those who were mistreated all these years is something extremely inspiring and important that changed the medical field. In this article, we will go through the journey of Dorothea Dix’s reform of mental institutions. She got to see many inhumane treatments firsthand at the House of Corrections at East Cambridge. This event made her wonder if this is how mentally ill people were being treated at other institutions as well. This inspired her to start a survey and travel to various states to gather information for many years to change the system. 

Dorothea Dix was a very intelligent but stubborn woman. Her career began at the age of twelve when she decided to run away from home and live with her grandmother in Massachusetts. She had a difficult youth. Her mother suffered from a mental illness and her father was an alcoholic.² After living with her grandmother for a while, she was sent to live with her aunt, Sarah Duncan. It was there that she had the idea of ​​starting her own school to earn money to pay her aunt to live with her. She opened her school when she was fourteen years old, in 1816, and in order to appear older, she changed her appearance. In those days, there were not many opportunities to have an education. To enter school, children already had to know how to read and write. So, Dorothea got to work and became a very popular teacher, known for her strict and disciplined way of teaching. Dorothea did this for three years and then went back to her grandmother where she established another school in 1821. The following year, her father died, leaving her responsible for her mother and siblings. She used her teaching career to support her family after her father’s death. She loved teaching and that is what made all her schools so successful. But her illness made her work difficult. She had constant problems with her lungs and was also losing her voice. This caused her to retire in 1835. In her retirement, she went to Europe for two years, and when she returned to America, she found herself in better health but without any purpose.³ She was looking for this purpose for four years until she decided to teach on Sundays at a women’s prison.⁴

This prison was called The House of Corrections in East Cambridge. When she started teaching, she noticed that people who were mentally ill were in places with no heating. This was especially concerning in the cold seasons. Seeing this, Dorothea was astonished, and this moment marked the beginning of her life’s work with the mentally ill. After teaching her classes, Dorothea liked to walk and talk with the inmates, and in doing so, she saw that some people with mental illnesses were mingled with criminal inmates, and were not being given the proper care for their conditions. This was because in the past people associated their behaviors with witchcraft or demonic possession. Those people who began to have symptoms of illness were sent to prisons, asylums, or hospitals for the insane. In these establishments, since there was not enough information about what caused these illnesses, they were mistreated and abused.⁵ Upon seeing this prison, Dix decided to consult with her friend Dr. Howe, who later visited the establishment and published an article in the Boston “Daily Advertiser” on September 8, 1841.⁶  Dr. Howe then reached out to Charles Sumner, who also visited The House of Corrections at East Cambridge in order to corroborate Howe’s findings. He said that unfortunately, the things that were mentioned in the Article were a sad reality. After the article was published, Dorothea Dix wondered if this was happening in other establishments.

Dorothea Dix set to work and began visiting more places throughout the state of Massachusetts, and made a survey of how the mentally ill were being treated. “Notebook in hand, she started out on her voyage of exploration, visiting every jail and Al’s house from Berkshire on the west to Cape Cod on the east.”⁷ In these places, she saw people in cages, and closets, naked and chained.² Having all this information she began to make a report that she took to the state government asking for adequate asylums where these people would be treated professionally, taking them out of prisons.⁴

Her report had to have many examples and descriptions of what she had seen, so that the state government could see the seriousness of the situation. One of her examples included a visit to a place called “The Home.” There they saw a young woman in a very serious condition. She was in a bed, her hair disheveled and her skin unwashed. She had many irritations on her skin caused by dirt. The irritation was so bad that the young woman was tearing her skin off. Her face and body were disfigured because she did this so constantly. Dix was scared and horrified at the sight and screamed, to which the lady who was showing them around explained that they could not do anything about it because she eats her own skin⁴ Other examples included making it clear to the government that these people, with proper care, could be capable of living a normal life. They, like us, are people who need help from time to time. The example Dix gave was that of a young woman who lived in Sandisfield and was physically controlled and abused. Every year they held an auction with economically disadvantaged people and this young woman participated. From among the people, a man appeared who decided to take care of her along with his wife. They groomed her, bathed her, fed her, and gave her her own room. After living with her for a while she began to act non-violently and did not swear. This young woman felt comfortable and loved. She now called the people who were taking care of her father and mother.

Besides these examples, there are many more that Dorothea Dix saw, and despite everything she said, the state government did not want to believe. They told Dorothea it was a bunch of lies.¹¹  “Incredible, incredible! Sensational and slanderous lies!”¹² Part of the reason why they didn’t believe Dorothea was because she was a woman: “Women were not expected to take on a leadership role, and certainly not expected to confront large systems; the men were usually in charge of these systems.”⁴ Usually, women then were expected to work in factories or were housewives, so it was very unusual to see a woman being a leader. “There are some and Miss Dix may be one of them, who are always on tiptoe, looking forward for something more marvelous than is to be discovered in real life…”¹² After continuing to fight against these sentiments, and looking for more people to support her cause, the legislature voted to expand the institutions already established by adding approximately 150 beds.⁴ This was a success in the sense that more and more people became informed of these problems and were able to expand the institutions. But Dorothea Dix wanted to do more. She wanted to establish new institutions, like asylums, so that people with mental problems could be treated properly. This became a feat that needed to be accomplished.

She did not give up. From the time she visited the prison in Massachusetts until the beginning of the Civil War, it was a 25-year struggle. But this time, she traveled all over the United States, documenting the states of other establishments and how they treated people with mental illness.⁴ “The more she advanced in her investigations, the more vast and broad she discovered that it was an evil that had to be confronted.”¹⁷ She also began to make connections with businessmen who could make donations, and with legislators who would support her.⁴ It took a lot of effort, time, and dedication to make this happen. There were many people against it and she had to “design a bill through the legislature.”¹⁹ So she took it upon herself to work together with professional men who were sincerely interested and aware of any strategies against her project. 

After many years of work, Dorothea was able to get a bill passed that established the New Jersey State Hospital in Trenton. This was the first of 32 asylums built in 15 states.⁴ In 1845, Dix said that she had “visited eighteen state penitentiaries, three hundred county jails and houses of correction, more than five hundred almshouses … besides hospitals and houses of refuge. I have been so happy as to promote and secure the establishment of six hospitals for the insane, several county poorhouses, and several jails on a reformed plan.”⁴ She often referred to this institution as her first-born child. This was a great achievement for her because she made this possible at a time when women could not yet vote. 

After this project was successful, in 1850, she decided to give the federal government a certain amount of land to build new asylums. This process also took a long time, but she used the same strategies as before, so she had high hopes that this would be possible. As we can see, she was a constant fighter for the rights of the mentally ill. She was always looking for something to do to improve their situation. For this reason, she was recognized as “Dragon Six.” We now have the Extra Mile plaque that was established in Washington DC in 2005.⁴