Friday August 10, 2018

What about Dorothea Dix?

Last night five dear friends came over for dinner. We laughed; we told stories. We talked politics and kids in alternating breaths. We ran through summer plans, college drop-offs and future adventures and before we knew it, midnight struck. It was an evening filled with joy created by the strength of connection and community.

Dorothea Dix would have approved. And I wish I could have invited her to join us, but she would be 216 years old if she were alive today. A mental health reformer in the US in the mid 1800’s, Dorothea Dix was passionate about creating more community and connection for people with serious mental illness who were otherwise being incarcerated or neglected. Dix was a pioneer well ahead of her time.

Calvin Acker, one of our 2018 Summer Interns, learned a lot about Dorothea Dix as he conducted background research for one of his mentors. Here are some highlights:

1.

Putting an end to incarceration of individuals with mental illness. This is a problem today. It was a problem 200 years ago. In the mid-1800’s, Dix documented the abysmal living conditions for individuals with mental illness. They were incarcerated along with criminals regardless of age or sex. Along with the danger of their living situation, many individuals were kept isolated, restrained, and in complete darkness. They were frequently held naked and exposed to the elements, with no heating or sanitary amenities. Dix was a lone voice advocating for the human rights of individuals with mental illness.  Around the world today, we still have a long way to go in terms of ending human rights violations and promoting community and connection for individuals with mental illness.

2.

Championing the asylum as a place of safe refuge. Dorothea Dix was committed to advancing “moral treatment” for individuals with mental illness. In contrast to torturous interventions like ice baths and spinning chairs, improved mental health care was to be found in opportunities for meaningful work and leisure activities, provided in a quiet and peaceful setting. Thus, the growth of the asylum in the bucolic countryside as the place for mental health and recovery.

3.

Building a new model of care. Through her passion and political influence, Dix pushed to created facilities to house those with mental illness with moral treatment as the foundation. She inspired new legislation in fifteen US states and in Canada. She travelled all over Europe documenting and presenting on the conditions of those with mental illness, and even persuaded Pope Pius IX to see personally what she had uncovered. By the time she died, her efforts directly impacted the building of 32 new institutions in the United States, and the reorganization and re-staffing of many more.

4.

The rocky road of asylums. Dorothea Dix was motivated to redress the inhumane living conditions for individuals with serious mental illness, and her efforts resulted in dramatic improvements over the incarnation that preceded her. But reform lagged and asylums replicated many of the egregious mistakes of earlier institutional settings. Beginning about 5o years ago, community mental health and recovery movements disavowed institutions for those living with mental illness, and around the world these institutions have been closing their doors. Tragically, the shuttering of institutions has not been met with commensurate community services. In an ironic déja vu of Dix’s time, once again, many individuals know a life characterized by inadequate mental health care, homelessness and incarceration.

5.

Reimagining what asylum looks like today. The word asylum comes from the Greek asulon meaning ‘refuge’. We have yet to find a system that truly and fully achieves a safe place in society for people living with mental illness. Dorothea Dix was revolutionary in her thinking and her efforts to humanize treatment for individuals with mental illness, and the asylum movement, dramatically improved conditions. Temporarily. But today we find ourselves, yet again, facing serious human rights violations for individuals with mental illness around the world. Today, yet again, we need to lay bare the failures of current systems of care. Today, we need a 21st century Dorothea Dix – or more likely many such champions – to persevere in shaping communities that defend human rights and provide humane and safe refuge for individuals living with mental illness.

 

What Calvin learned during his summer internship is that Dorothea Dix’s life mission of ensuring community and connection for individuals with serious mental illness is as relevant today as it was in the 1800’s. I wish she could have joined our conversation around the dinner table last night.

Kathleen M. Pike, PhD
is a Professor of Psychiatry and Epidemiology & Director of the Global Mental Health WHO Collaborating Centre at Columbia University
[email protected]