An alcoholic father, a physically and possibly mentally troubled mother, a rigid grandmother, years spent with an aunt learning to become a lady, and a very early career as a private school teacher all came together in Dorothea Dix’s life the day she went to teach a Sunday School class of women in the East Cambridge Prison.
It was 1841. The conditions of all the prisoners appalled her. No matter what their reason for removal from the streets, all the inmates lived together: young, old, violent and mild.
In the basement where the mentally ill stayed, provisions especially fell below par. Dix saw a woman caged and bound, with little clothing and no fire. No fire to fight the cold of winter, no furniture to give comfort and no soap to fight the smells.
Shocked, Dix investigated and documented the almhouses and jails housing the insane. She wrote to the Massachusetts state legislature: “I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”
And thus began Dorothea’s campaign to improve the living conditions and provisions for the insane nationally and worldwide. She wanted them housed separately from the criminals. She wanted the institutions to offer libraries, music, civilized living conditions to provide humane conditions.
From that initial encounter, for the next 15 years, until the Civil War began, Dix studied conditions in the states east of the Mississippi River and lobbied avidly for changes.
Dix duplicated her successful Massachusetts campaign in 14 other states and saw the building of, or improvement of, 32 asylums for the mentally ill. Her actions also influenced changes in all of the states.
Dorothea Dix maintained a deep concern for the physical care and living conditions of the mentally ill. She did not profess to understand what caused the individual’s illness or proclaim to have a cure. Dix simply considered that even the most fringe person of society needed humane living conditions. She worked tirelessly in the United States and later in Europe to bring the living conditions of the indigent mentally ill to the attention of the people who could change things.
That was then. This is now.
This is 40 years past the 1970s when across the nation, state legislators voted to cut back funding for state mental hospitals. Facilities closed their doors one after another as the discovery of new medications improved the mental state of many patients and emptied the wards.
Ideally the patients who benefitted from the new medications would check in with their community mental health center and receive ongoing outpatient care. The ideal conflicted with the reality of the bottom line of state budgets and the cost of the centers. Those in need slipped through the cracks, lost contact with reality, caught the attention of the local authorities and landed in jail.
Over the past 40-50 years the mentally ill once again found themselves housed with criminals and under the supervision of guards who did not necessarily have the resources (medication, training or time) to deal with the unique needs of the severely mentally ill.
Even with the best of medications for mental illness some will always need housing, care and supervision.
In 2015 we again face the dilemma that Dorothea Dix faced in the mid 1830s: the use of penal institutions designed for the correction of criminals employed as housing for the seriously mentally ill.
The Arkansas Constitution says that “the General Assembly shall provide by law for the support of the institutions for the treatment of the insane.” Seven years ago, Judge G. Thomas Eisele of the United States District Court, Eastern District of Arkansas, declared that “our local and regional jails should not become our mental hospitals by default;” and “that it is up to the General Assembly to address needs for services and mental health treatment facilities.”
Arkansas’ severely mentally ill and their families are still waiting to see a long overdue resolution to this discrepancy.
(Joan Hershberger is a staff writer at the News-Times. Email her at joanh@everybody.org)