Dix’s campaign illustrates two important shifts in social attitudes in antebellum America. First, women began to take on more active roles in reforming society. In the colonial period, women had not been permitted to participate in political matters, and men initiated social reform campaigns. But in the early nineteenth century, people began to argue that women were more moral than men, and that their unique talents and insights suited them to improving and reforming society.
During the late eighteenth century, Americans also began to feel — and ask for — more sympathy for the less fortunate. Social rank and position had once been thought to reflect the will of God; now, it seemed a result of birth, education, and effort, something that could be changed. Reformers inspired people with emotional pleas. Abolitionists used sentimental and sensational stories of slavery to inspire pity and sympathy for the enslaved. Temperance workers, who wanted to abolish drinking, published sensational stories about the plight of women and children who were impoverished because of their husband’s or father’s drinking. Here, Dix uses the same approach to stir up her readers’ emotions and inspire them to feel sympathy, rather than repulsion, for the mentally ill.
The nineteenth century witnessed the birth of psychiatric care. In earlier periods, people had simply been locked away, as Dix describes. In some cases, people were put into hospitals in New York, Philadelphia, and Richmond, but these hospitals served only to confine people, not to treat them. With feelings of sympathy for the less-fortunate and the urge to reform society, people began to argue as Dix does here, that mentally ill people could be reformed if they were given proper guidance. Much of the work that went on in the new hospitals was focused on changing patients’ behavior, giving them moral instruction, and providing them with basic skills. Although the causes of mental illness were still not understood, these facilities were much like mental hospitals today, in which people are given medication and counseling.
Women were still unable to hold public office, and it was socially unacceptable for women to publicly debate topics such as business and government. But social and moral issues — such as campaigns to end prostitution, prohibit drinking, and abolish slavery — were deemed socially acceptable topics for women to address. Care of the mentally ill would also have been seen as a natural extension of a woman’s “natural” role as a nurturer and caregiver. Just as women were to guide their children and influence their husbands to act morally, women could help change society so that all men, women, and children lived in a more safe, virtuous, world.
Dix’s campaign also marked a great change in the way Americans viewed the mentally ill. In previous centuries, mental illness had not been recognized as an illness at all. Mentally ill persons might be viewed as as having deliberately abandoned themselves to sin or as being possessed by demons. Beginning in the eighteenth centuries, some doctors began to argue that such people needed treatment, not punishment.
In this excerpt from her “memorial” to the North Carolina General Assembly, Dorothea Dix lays out her arguments for building a state hospital for the mentally ill.
[Insane persons kept in jails or poorhouses]
I admit that public peace and security are seriously endangered by the non-restraint of the maniacal insane. I consider it in the highest degree improper that they should be allowed to range the towns and country without care or guidance; but this does not justify the public in any State or community, under any circumstances or conditions, in committing the insane to prisons; in a majority of cases the rich may be, or are sent to Hospitals; the poor under the pressure of this calamity, have the same just claim upon the public treasury, as the rich have upon the private purse of their family as they have the need, so have they the right to share the benefits of Hospital treatment. Urgent cases at all times, demand, unusual and ready expenditures in every community.
If County Jails must be resorted to for security against the dangerous propensities of madmen, let such use of prison-rooms and dungeons be but temporary. It is not long since I noticed in a Newspaper, published near the borders or this State, the following paragraph: "It is our fate," writes the Editor, "to be located opposite the County Jail, in which are now confined four miserable creatures bereft of the God-like attribute of reason: two of them females; and our feelings are daily excited by sounds of woe, that would harrow up the hardest soul. It is horrible that for the sake of a few thousand dollars the wailings of the wretched should be suffered to issue from the gloomy walls of our jails without pity and without relief. Were our law-makers doomed to listen for a single hour each day to the clanking of chains, and the piercing shrieks of these forlorn wretches, relief would surely follow, and the character of our State would be rescued from the foul blot that now dishonors it." In nearly every jail in North Carolina, have the insane at different times, and in periods varying in duration, been grievous sufferers. In Halifax County, several years since, a maniac was confined in the jail; shut in the dungeon, and chained there. The jail was set on fire by other prisoners: the keeper, as he told me, heard frantic shrieks and cries of the madman, and "might have saved him as well as not, but his noise was a common thing he was used to it, and thought nothing out of the way was the case." The alarm of fire was finally spread; the jailer hastened to the prison: it was now too late; every effort, (and no exertions were spared,) to save the agonized creature, was unavailing. He perished in agony, and amidst tortures no pen can describe....
In illustration of the blessing and benefit of Hospital care in cases long and most cruelly neglected, I adduce the following examples recorded by Dr. Hill, and corresponding with many cases under my own immediate observation since 1840. "Two patients," writes the Dr. "were brought to me in 1836, who had been confined in a poor-house between eighteen and twenty years. During this period they had not known liberty. They had been chained day and night to their bedsteads, and kept in a state so filthy that it was sickening to go near them. -- They were usually restrained by the strait-waistcoat, and with collars round their necks, the collars being fastened with chains or straps to the upper part of the bedstead, to prevent, it was said their tearing their clothes. The feet were fastened with iron leg-locks and chains. One poor creature was so wholly disabled by this confinement, that it was necessary for the attendants to bear her in their arms from place to place after she was brought to the Hospital; she shortly acquired good habits, and was long usefully employed in the sewing-room. The other was more difficult of management but soon gained cleanly habits, and now occupies herself in knitting and sewing, and that, after having been treated for years like the lowest brute. Another case was brought in chains, highly excited; five persons attended her; in six days all restraints were removed; and she walked with her nurse, in the patients' gallery. In June, she was discharged from the wards quite cured, and engaged as assistant in the kitchen....
Iredell jail, is isolated and had just passed into the charge of a newly appointed officer, it would hardly be just to remark severely upon very dirty and neglected condition. The County poor-house, a few miles from Statesville, is situated in a singularly secluded spot, remote from supervision and often observation, and is a model of neatness, comfort, and good order: having a most efficient master and mistress, especially the latter, upon whose cares in these institutions by far the most is dependent. All in all, this was in much the best condition of any poor-house I have seen in North Carolina, neat, plain, and decent, it would do credit to any State; but it is no fit place for the insane. Since I was there, in September, a highly respected citizen writes me that a young woman has been sent to the poor-house so violently insane, that it is quite unfit she should remain there. Also a man has in that County, very recently become so violently mad as to be quite unmanageable, and having no Hospital in the State, they have confined him, with, chains and manacles, hand and feet, and do as best they can. A subscription paper has been circulated for the purpose of raising funds to send him to Columbia, S. C. Other painful cases exist in this, as in the counties which I have visited, and from which I have heard; most of which I do not feel at liberty, through their domestic and social position, to designate; but they plead in heart-reaching language for the early establishment of a State Hospital....
[Insane persons kept at home]
Of the few examples of many which exist, to which I shall now refer in private families, the following have quite recently come under my observation: A poor but industrious farmer in the western part of this State, the father of a numerous family, became insane; it was in vain to control him in his own dwelling, he was furious and he was conveyed to the County jail here his sufferings were aggravated and his malady exasperated: I can not tell for how long a time the lone dark dungeon echoed to his moans and cries, nor at what cost the county maintained human life, unaiding its sufferings and necessities. In process of time the paroxysms of violence subsided, and finally he was transferred to the humble log cabin of his aged widowed mother, a lone woman dwelling upon the mountains. There I found the infirm, afflicted mother, and the insane son. Amidst tears and sighs she recounted to me her troubles, and as she wept she said, "the Lord above only knows my troubles, and what a heap of sorrow I have had in my day, and none to give me help. There he lay, in the jail, cold and distressed, mightily misused; if I could have got money to send him off to where they care such spells, for they do say crazy folks can be cured, I should have had him in my old age to take care of me, but I am poor and always was, and there is no help here. Ah well, many and many is the long night I am up with him and no sleep or rest, anyhow; this cant last always; I shall die, and I dont know what is to come of him then."... Had there been in North Carolina, a State Hospital, timely care might have secured a permanent cure. It is almost too late to assure this now, but instead of restoration is life-long expense and life-long suffering.
In Lincoln County, near a public road, stands a decent dwelling; near by is a log cabin, strongly built, and about ten feet square, and about seven or eight feet high; no windows to admit light the square logs are compactly laid; no chimney indicates that a fire can be kindled within, and the small low door is securely locked and barred. Two apertures at right angles, ten inches long by four wide, are the sole avenues by which light and air are admitted within this dreary cabin, so closely secured, and so cautiously guarded. You need not ask to what uses it is appropriated: the shrill cries and tempestuous vociferations of an incarcerated maniac will arrest you on the way, and if you alight, and so far as the light received as before described will allow, examine the interior of this prison, you will discern a ferocious, filthy unshorn, half-clad creature, wallowing in foul, noisome straw, and craving for liberty. The horrors of this place may not be more definitely described; they can hardly be imagined: the state of the maniac is revolting in the extreme. This creature, is a man -- insane for more than thirteen years -- for a long time suffered to range the country far and wide, addicted to mischief and disposed to violent acts. For assuring public and private safety, his family have adopted the only alternative of confining him upon their own farm, rather than seeing him thrown into the dungeon of the County jail. Of these two evil conditions, I confess, I see no choice. The family though enjoying the means of decent livelihood, when unburthened by extra expenses, have not the means of sending him to a distant Hospital. The rich may partake the benefits such institutions afford: the poor must suffer, agonize, and bear heavily out, by slow-killing tortures, their unblessed life! Are there no pitying hearts, and open hands that can be moved by these miseries?...
[Treatment of the insane]
Moral treatment of the insane with a view to induce habits of self-control, is of the first importance. Uniform firmness and kindness towards the patient are of absolute obligation. The most exact observance of truth should be preserved in all intercourse with the insane. They rarely violate a promise, and are singularly sensitive to truthfulness and fidelity in others. They rarely forgive an injury and as seldom betray insensibility to kindness and indulgence. Once deceived by a nurse or attendant they never a second time bestow their confidence upon the same individual.
Moderate employment, moderate exercise, as much freedom as is consistent with the safety of the patient, and as little apparent anxious watchfulness with cheerful society should be sought. The condition of the patients must determine the number of nurses in a ward. The general opinion is holden that all patients do better without special nurses, wholly devoted to their care.
"The proper mental and physical employment of the insane," says Dr. Kirkbride, "is of so much importance that the full treatment of this subject would be to give at once a treatise on the insane and on insanity. Whatever it maybe, it must embrace utility, and it is well to combine both physical and mental occupation. Active exercise in the open air, moderate labor in the gardens, pleasure grounds, or upon the farm, afford good results. Short excursions, resort to the work shops, carpentering, joining turning, the use of a good library&c.,&c., are aids in advancing the cure of the patient." Sedentary employments are not in general favorable to health. The operations of agriculture seem liable to the least objection. There is a limit to be observed in the use of labor as a moral means; for there are always some patients to whom it is decidedly injurious. This effect is manifested oftenest in recent cases.
Dr. Ray says that it is an error to suppose that the insane can labor as productively and as uniformly as the sane man. The working hours of a patient should seldom exceed six or seven per-diem, and not seldom work is altogether intermitted.
The manner in which labor exerts a beneficial influence upon the insane mind differs no doubt in different forms of the disease. In highly excited patients the surplus nervous energy will be consumed, if no other way is provided, in mischief and noise; but let it be expended in useful labor, and although the work may not always be perfectly well done yet the patient thinks it is, and experiences the gratification of having done what he believes is a good thing, and consequently, so far as it goes it is beneficial.
This sentiment of satisfaction in being useful, the guardian of the insane cannot too carefully watch over and foster, since it conducts to self-control and self-respect. Incurables who are able and willing to work, are much more contented and enjoy better health when employed. Even some of the most demented and idiots are found capable or doing something. A young man became a raving maniac, and in three months was conveyed to the hospital, but was already declining into idiocy; soon complete imbecility supervened. He was classed with the idiots in the institution; and considered as past hope of benefit or cure. One day he was observed to amuse himself with some rude coloring and odd figures upon the walls of his room. He was supplied with colours, brushes, and canvass, and soon commenced a portrait: he was now roused, and eager to accomplish his new and attractive work. He was encouraged to renew and repeat his attempts, and finally his mind was restored to its early and rational condition. Thus, careful attention to the daily state of the patient, suggested a method or treatment which resulted in a decided cure. The diseased organs were suffered to rest and their recuperative energies recovered action.
The physician of the hospital at Staunton, in a report of his institution, says, that during the past year, the men patients were chiefly employed in cultivating the farm, working the garden, improving the grounds constructing fences, cutting wood. and attending to stock. The women were engaged in sewing, knitting, spinning, and assisting in various departments of house-work, and other occupations and recreations suited to their sex.
"A patient, insane for more than ton [sic] years, and beyond hope of recovery, considered dangerous to the public safety, and therefore detained at a hospital, converses incoherently and raves wildly, yet finds constant and profitable employment upon the farm; has charge of a stock of cattle and hogs and is scrupulously faithful in the discharge of his duties. Instead of confinement in a county jail, from whence he was removed to the Hospital, in a most filthy, and abject condition. at a cost of little less than three hundred dollars per annum he is here a genteel, orderly, and industrious individual, cheerful, happy, and useful: his labor more than pays all his expenses and supplies him with sufficient indulgencies."