Tag Archives: Dorothea Dix

And the Living Wasn’t Easy

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

When reformers first began to champion the use of insane asylums in the 1830s, these institutions really did tend to operate as the havens they were meant to be. Life was harsh everywhere for most people: there were few protections for workers, public aid for the weak or disabled scarcely existed, and bodily comfort might mean no more than a slice of bread and a straw-filled sack to sleep on.

It was an age when a professor at the Paris Faculty of Medicine could safely state: “The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it . . . Knife and pain are two words in surgery that must forever be associated in the consciousness of the patient.”

When surgeons scoffed at the idea of easing pain for (presumably) paying patients, what comfort could lunatics–who supposedly did not feel pain, cold, or hunger–expect? When Dorothea Dix began her crusade to provide compassionate care to the insane, she wrote graphically about the filth and misery she found in jails and outbuildings where the mentally ill were held as prisoners. Once asylums were established, however, these patients could expect decent food, clean bedding, warmth and ventilation, and human attention.

Reformer Dorothea Dix

Newspaper Article from April 14, 1940

Conditions deteriorated quickly as families filled asylums with relatives they either did not want or could not handle. Some asylums became little better than the dark and filthy jails they had replaced, and certainly did not help their patients to recover. Coming full circle, reformers again began to agitate on behalf of the insane–to release or “de-institutionalize” them.

Undefended and Alone

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Dorothea Dix

Compassion for the insane has been in short supply through most of history, particularly since the general public (until fairly recently) felt that somehow madness was the victim’s own fault. Accommodations for the insane have never been more than merely comfortable, and even that was not often the case until the mid-1800s. When reformer Dorothea Dix began her survey of the insane in Massachusetts, she saw victims of mental illness in horrific conditions. In her Memorial to the Massachusetts legislature, she wrote that in Groton:

“A few rods removed from the poorhouse is a wooden building upon the roadside…it contains one room, unfurnished, except so far as a bundle of straw constitutes furnishing.” The room had no window except for a small slit covered with a board shutter. A young man was confined inside.

Worcester County Almshouse, 1908, African-American Building, courtesy Maryland State Archives

“He can move a measured distance in his prison; that is, so far as a strong, heavy chain, depending from an iron collar which invests his neck permits.” Dix mentioned that on the particular day she saw him, the weather was pleasant and the door open so the man could see outside. However, she pointed out that in New England, “the portion of the year which allows of open doors is not the chiefest part.” She asked her audience what it must be like for that young man to sit in a dark room, chained and alone for months, with nothing to do and no one to talk to.

Dix Discussed Her Findings in This Memorial to the Legislature of Massachusetts

Dix witnessed similar situations wherever she went. Reformers often stressed how unfair it was that victims of insanity–who had committed no crime–often wound up in jails, punished for life.

Training for Nurses

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Civil War Nurse

Just as war in the Crimea led the way for women’s involvement in nursing for Great Britain, the Civil War led to similar breakthroughs in the U.S. Dorothea Dix led the effort to get women into the hospitals. She wanted her nurses to be old and plain so that decorum would not be upset, but eventually accepted women outside those parameters because of the great need. The inroads females made in overcoming the exclusivity of male nursing care during the war helped them retain their place in hospitals afterward.

Doctors particularly saw the need for nurses in insane asylums, because of the often long-term nature of patient care. In 1880, the McLean Hospital for the Insane began to give instruction to attendants in the “manipulations of nursing,” and introduced the term “nurses” for attendants and “patients” for boarders.

In 1883, the Buffalo State Asylum began instruction for female attendants. Some of the questions included:

What are the physical conditions of acute melancholia; detail the care such patients need.

What are the characteristics of a fit?

Give method of applying moist heat–a turpentine stupe fomentation–poultices–a mustard plaster.

What is a deodorizer; an antiseptic; and a disinfectant?

Give apothecary’s weights; dose of powdered opium; tincture of opium, morphine; symptoms and treatment of opium poisoning?

McLean Asylum for the Insane

Buffalo State Asylum

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A New Kind of Superintendent

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Dr. Peter Bryce

Dr. Peter Bryce (1834-1892) was a young man of 26 when he was elected superintendent (on the recommendation of Dorothea Dix–see posts for 5/13 and 5/16) of the newly built Alabama Insane Hospital in 1860. The first patient was admitted in 1861, and Bryce insisted from the start that his attendants display courtesy and kindness to anyone admitted.

He also instituted a system of work (farming, sewing) that helped the institution make ends meet and provided a sort of occupational therapy for patients; his program provided amusements as well, including music, that also benefited patients. His practices were very successful, and by 1882 he was able to institute a policy of “absolute non-restraint.”

Bryce died in 1892 and the hospital was renamed Alabama Bryce Insane Hospital in his honor.

Postcard of Bryce Hospital (circa 1900)

Bryce Hospital Laundry

A Female Crusader, Part Two

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After Dorothea Dix visited a jail in 1841 and discovered the appalling conditions that mentally ill people suffered there, she began to gather information to present to legislators. She visited every jail and poorhouse in Massachusetts (her home state) and compiled a graphic report. Dix described a woman who was tearing her skin off, bit by bit, with no one to stop her. She had seen a man confined to an outbuilding (presumably at a hospital) next to the “dead room” so that he saw only corpses. Others she had seen were locked into rooms without heat, daylight or fresh air.

She was immediately called a liar, but newspapers reprinted excerpts of her report. She persuaded a group of men to take up her cause, and they were able to persuade the legislature to appropriate more money for the state hospital for the insane.

During her lifetime, Dix played a direct role in founding 32 mental hospitals. One in particular, the Government Hospital for the Insane, (later named St. Elizabeths) provided “the most humane care and enlightened curative treatment of the insane of the Army, Navy, and the District of Columbia.”

From 43rd Congress, First Session, courtesy Library of Congress

One of St. Elizabeths’ doctors became superintendent of the Canton Asylum for Insane Indians.

Men Working in Broom Factory at Oak Forest, IL Poorhouse, circa 1915, courtesy Library of Congress

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Indians, Insanity, and American History Blog

Asylums And Insanity Treatments 1800 – 1935

Tag Archives: Dorothea Dix

And the Living Wasn’t Easy

Undefended and Alone

Training for Nurses

A New Kind of Superintendent

A Female Crusader, Part Two