1847 | Tennessee

Civilization and Its Discontents

Dorothea Dix pleads for the creation of a new institution.

To the Honorable, the General Assembly of the State of Tennessee

Gentlemen: I ask to lay before you, briefly and distinctly, the necessities and claims of a numerous and unfortunately increasing class of your fellow citizens—I refer to the insane of this state, the various distresses of whose various conditions can be fully appreciated only by those who have witnessed their miseries. Pining in cells and dungeons, pent in log cabins, bound with ropes, restrained by leather throngs, burdened with chains—now wandering at large, alone and neglected, endangering the security of property, often inimical to human life; and now thrust into cells, into pens, or wretched cabins, excluded from the fair light of heaven, from social and healing influences—cast out, cast off, like the pariah of the Hindoos, from comfort, hope, and happiness: such is the present actual condition of a large number of your fellow citizens—useless and helpless, life is at once grievous to themselves, and a source of immeasurable sorrow to all beside.

There is less insanity in the southern, than in the northern states, proportioned to the inhabitants of each; for this disparity several causes may be assigned: there is, in the former, comparatively but a small influx of foreigners, while they throng every district of the latter … But a more obvious cause is found in the fact of the much more numerous colored population here than there. The negro and the Indian rarely become subject to the malady of insanity, as neither do the uncivilized tribes and clans of European Russia and Asia. Insanity is the malady of civilized and cultivated life, and of sections and communities whose nervous energies are most roused and nourished.

Insanity requires a peculiar and appropriate treatment, which cannot be rendered while the patients remain at their own homes, or by even skillful physicians in general practice. I confide in hospital care for remedial treatment, and in no other care.

It is not safe, nor is it humane, to leave the insane, whether curable or incurable, to roam at large or abide in families unguarded, unguided, and uncontrolled. For their own sake, for that of their friends, for that of the community, they should be rendered to the kind, skillful, intelligent, judicious watch of hospital protection.


Dorothea Dix

From a letter to the legislators of Tennessee. In 1841 Dix went to the East Cambridge House of Correction in Massachusetts to teach Sunday school. Shocked by the filthy underground chambers in which the “insane” were kept along with criminals, she began her lifelong campaign to create hospitals for the mentally ill. Over a span of forty years, Dix helped to establish thirty-two institutions, fifteen of which were state-run.