Tag Archives: Dorothea Dix

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William Tuke

William Tuke

William Tuke and Philippe Pinel are generally credited with revolutionizing the care of the insane in England and France, respectively. These men substituted compassionate care for patients (at the York Retreat and the Bicêtre) for the typical imprisonment and harsh punishment the insane received before that time. But . . .

Before either of these men were even born, the Religious Society of Friends in Philadelphia were concerned about the sick and insane living in the new continent of America. Around 1709, they expressed this concern in one of their monthly meetings, and took steps to establish the Pennsylvania Hospital for both these groups in 1751, and later the Friends’ Asylum for the Relief of Persons Deprived of the Use of Their Reason solely for the insane in 1813. The asylum (which actually began to receive patients in 1817) had as one of its stated goals, to be a place where “the insane might see that they were regarded as men and brethren.” The York Retreat predated the Friends’ Asylum by a few years, but the idea for the American asylum had come much earlier and was probably delayed for many reasons, possibly including the political unrest going on in the colonies.

Friends' Asylum for the Insane

Friends’ Asylum for the Insane

When the asylum first opened, it was only for fellow Friends, but in 1834 the religious affiliation was dropped and the institution opened its doors to all patients. From its beginning, all efforts were directed toward helping patients without resorting to restraints or cruelty. The annual report from 1853 states that “a chain was never used for the confinement of a patient.” The  founders also wrote into the rules the injunction: “Come what may, the law of kindness must at all times prevail.”

Friends' Asylum History

Friends’ Asylum History

The Asylum was a far cry from the conditions Dorothea Dix met in Little Compton, Rhode Island (see last post), which were barbaric to the point of torture.

 

Why Asylums?

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New Pennsylvania Hospital for the Insane Under Construction, circa 1859, courtesy Library of Congress

New Pennsylvania Hospital for the Insane Under Construction, circa 1859, courtesy Library of Congress

Just the word “asylum” conjures up negative associations for most people–we have learned so much about the conditions and abuses in these institutions that it is hard to believe anyone thought they could be a good idea. We may understand that this deterioration was never anticipated by the original asylum advocates, but we still ask the question: couldn’t they have guessed what would happen?

Perhaps not. Here is a description of a lunatic’s dwelling in Little Compton, Rhode Island circa 1845: “The place, when closed, had no source of light or of ventilation. It was about seven feet by seven, and six and a half high. All, even the roof, was of stone. An iron frame interlaced with rope, was the sole furniture. The place was filthy, damp, and noisome.

“. . . –there he stood [the insane man] near the door . . . his tangled hair fell about his shoulders; his bare feet pressed the filthy, wet stone floor; he was emaciated to a shadow. . . . In moving a little forward I struck against something which returned a sharp metallic sound; it was a length of ox-chain, connected to an iron ring which encircled a leg of the insane man.”

Seated Portrait of Dorothea Dix, circa 1849

Seated Portrait of Dorothea Dix, circa 1849

The writer, Dorothea Dix, discovered that the man had been in this little cell for three years, with no heat in the winter. Before that, he was kept in a cage. Dix’s outrage and compassion for the unfortunate men and women held in these conditions spurred her life’s work of urging states to build asylums with decent conditions and amenities.

One Result of Dix's Concern Was the Butler Hospital

One Result of Dix’s Concern Was the Butler Hospital

When Dix saw the day-and-night difference in new asylums and the type of private care she described above, she undoubtedly believed that conditions could never be so bad in an institution as they had been under the haphazard system that spurred her reforms. And though asylum conditions did go downhill, they were never tolerated by society at large the way earlier abuses  had been.

Preparing for Idiots, Lunatics, and Insane Persons

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Commericial Hospital Began Ambulance Service in 1865, courtesy National Library of Medicine

Commercial Hospital Began Ambulance Service in 1865, courtesy National Library of Medicine

Ohio became a state in 1803 and quickly realized the need for an insane asylum; its initial institution was established as The Commercial Hospital and Lunatic Asylum of Ohio in Cincinnati. Built without delay, in January, 1824, the hospital’s trustees were able to put a notice in the Liberty Hall and Cincinnati Gazette: “. . . the undersigned trustees hereby give notice . . . that they are prepared to receive idiots, lunatics and insane persons.”

Though it was a gentle enough invitation, these unprotected guests of the state may not have enjoyed their stay. Built before reformer Dorothea Dix’s campaign to treat the mentally ill with kindness and understanding, the asylum was as much a prison as a place of healing.  In 1831, the state legislature even asked the question as to “whether the cells and apartments of the lunatic asylum are sufficiently separated from each other by thick walls to prevent the inmates from communicating with each other.” Was solitary confinement their goal?

Longview Asylum, 1860

Longview Asylum, 1860

Though stumbling a bit at inception, the hospital was the starting point for an orphan asylum, the city infirmary, the Cincinnati Hospital, and Longview Asylum. A description (from 1916) of patients’ rooms at Longview shows a dramatic upswing in comfort from what must have been dismal quarters at the original Commercial Hospital:

1910 Article Shows That Asylum Was Fallible

1910 Article Shows That Asylum Was Fallible

“The walls are covered with photographs of the best pictures of the world . . . . Everywhere throughout the house are inlaid tables and unusual pieces of fancy furniture, fancy needlework, flowers, singing birds, bric-a-brac, etc. which is seldom roughly handled or destroyed by patients. In each ward is a tastily furnished cozy corner, fitted up with book shelves, easy chairs, etc., where patients who will not abuse the privilege are allowed.”

 

 

 

A Special Veterans Hospital

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An Early View of the Government Hospital for the Insane

An Early View of the Government Hospital for the Insane

Though Armistice Day (November 11) was renamed Veterans Day only in 1954, veterans with mental health issues did have a special facility to meet their needs quite early on. Though crusader Dorothea Dix had pushed unsuccessfully for federal funding to help pay for America’s (civilian) mentally ill, she and other supporters did manage to get approval for a hospital for the insane of the army, navy, and District of Columbia. On January 15, 1855, the Government Hospital for the Insane received its first patient, Thomas Sessford.

Dr. Charles Nichols was the facility’s first superintendent, and he helped design one of the campus’s earliest buildings, the Center Building. One interesting feature was that the wards used different species of wood for their interiors: the Beech Ward installed woodwork from beeches, and the Cherry and Poplar Wards installed their interior woodwork from like-named trees. The patients had lovely views of the Anacostia River and farmland, and the grounds had extensive trees, shrubs, and flowers to give it a rural feeling of peace.

St. Elizabeths, 1917, courtesy Library of Congress

St. Elizabeths, 1917, courtesy Library of Congress

Allison Building's Sleeping Porches, 1910, courtesy National Archives and Records Administration

Allison Building’s Sleeping Porches, 1910, courtesy National Archives and Records Administration

The Government Hospital for the Insane became known during the Civil War as St. Elizabeths. Sick soldiers quartered in the hospital were embarrassed to write home from an insane asylum and simply substituted the historic name of the land patent on which the hospital stood. The name was made official in 1916.

My next two posts will discuss early care at St. Elizabeths, and its Civil War operation.