Dorothea Dix: APA’s First Posthumous Fellow

I read with great interest Aaron Levin’s article “Behind the Legend of Dorothea Dix Rests a Woman ‘Famous but Unknown’ ” in the April 5 issue. I thought it worthwhile to add that in 2005, Dorothea Dix was made an honorary fellow of APA, the first such fellowship awarded posthumously (Psychiatric Services, April 2005) in recognition of her advocacy for humane care and development of people with mental illness and her central role in the development of psychiatry as a medical specialty and in honor of St. Elizabeths’ Hospital’s 150th anniversary in 2005.

Dorothea Dix was personally responsible for obtaining funding and land from the U.S. Senate to construct “The Government Hospital for the Insane,” as St. Elizabeths was originally called. St. Elizabeths was the first and only federal psychiatric hospital from 1855 to 1987, when the District of Columbia took over its administration and operation. Dix was also responsible for the founding and establishment of 32 asylums, which she considered her “children.”

Dix was also responsible for the appointment of St. Elizabeths’ first superintendent, Dr. Charles Nichols—as she was for almost all superintendent appointments through the latter half of the 19th century. Photographs taken of APA’s precursor organization, the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), often show Dix standing with many of the founding members and presidents. Nevertheless, being a woman and not being a superintendent of an asylum, she was never an AMSAII member.

To this day, Dix’s central social mission—to provide “the most humane care and enlightened curative treatment of the insane”—who in the mid-19th century were impoverished, homeless, or incarcerated—remains an elusive goal. Today, more than 150 years since Dix began her social reform activism, we have the same number of (or fewer) inpatient beds available for those with serious mental illness as were available at the start of the 19th century asylum movement. The problems of providing humane care to impoverished individuals with mental illness, many of whom are again living on the streets or incarcerated in jails and prisons, remain unsolved.

Liza H. Gold, M.D.

Washington, D.C. ■