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  Q: Were Dorothea’s family relationships as estranged as you have portrayed them here?

  A: Her biographers refer to her mother as “unavailable.” I wondered if this distance was possibly a result of postpartum depression or mental illness. Whatever the reason, Dorothea referred to herself in her letters as an orphan even while both her parents still lived. Her efforts to adopt Marianna Cutter were thwarted much as I conveyed in this story. Her close friendship with Anne Heath, which eventually became estranged, was an important relationship in her life. She was closer to her brother Charles than to her brother Joseph, who indeed never paid back any of his loans. She adored William Ellery Channing and George Emerson and saw them as father figures. She did have a close relationship with Millard Fillmore as well and his family, and letters kept by him from her suggest that there might have been a promise of more than friendship. But Fillmore married a wealthy young widow in 1858, and Dorothea appears to have rejoiced with him. Her former students were her closest allies, as were Elizabeth and William Rathbone, who truly rescued her from what appears to be depression and likely death by tuberculosis when she first came to them at Greenbank. Dorothea maintained correspondence with more than seven hundred individuals, so she had an active writing life, yet none of those did she claim as family. I think the mentally ill were her family.

  Q: Dorothea was a successful teacher at fifteen and a royalty-earning author at twenty. Why wasn’t that enough?

  A: You’d think it would be! She attributes her calling to the day at East Cambridge prison. That she was able to bring heat into those cells, she wrote, was one of her greatest accomplishments. She also wrote that convincing Cyrus Butler to establish the fund for the hospital named for him (which still stands in Rhode Island) was one of the great successes of her life. She sought a life of purpose, and I think she didn’t find it until that day in East Cambridge. She was rarely ill after that, despite long hours, difficult travel, and persevering in the halls of Congress, nor even later when she worked as a nurse during the Civil War.

  Q: What surprised you about Dorothea during your research?

  A: Her generosity. She performed all the state surveys at her own expense, for example. She funded a rescue fleet for the Sable Islands of Nova Scotia. She had a water fountain for horses commissioned for the city of Boston. When she died, she left five hundred dollars to the Humane Society, yet we have no evidence that she ever owned a pet. She did indeed buy a life insurance policy with the New Jersey State Hospital at Trenton as the beneficiary. She gave hundreds of music boxes to jails and asylums and really did find prints that she had framed and sent to asylums for patients’ rooms. She spent hundreds of dollars on bandages and medicines during the Civil War. Her royalties and frugal life, along with what her grandmother left her from the sale of Orange Court, sustained her. She gave much of it away.

  I was also surprised to learn that she spent the latter part of her life as a resident in the apartment in the Trenton hospital. A small museum is maintained in her honor there, and a yew tree she planted to commemorate the poet Thomas Gray still flourishes. She died in that third-floor apartment on July 17, 1887, at the age of eighty-two. She is buried in Mount Auburn Cemetery in Cambridge, Massachusetts.

  It also surprised me that she spurned public attention, though it shouldn’t have, given the limitations placed on women of her time. She turned down possible book reviews and articles that might have expanded her cause because the articles would be about her as well. She rejected a bronze bust planned by supporters in Tennessee. She started but never finished an autobiography. I think she never accepted herself as worthy, still the young child who ran away from home, hoping to protect her brother and failing. As with many passionate true believers, her failures weighed more heavily on her than all her successes.

  Q: What’s happening in mental health today? Would Dorothea recognize the system of care?

  A: According to the World Health Organization, 450 million people suffer from mental disorders; many more have mental problems that interfere with their daily lives. Mental health is defined as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.”

  In 2008, the most recent year for which comprehensive statistics are available from the Centers for Disease Control and Prevention, it’s estimated that 58.7 percent of adults in the United States received mental health treatment, mostly in outpatient settings with medication. A smaller percentage was served in institutional settings. The most recent Department of Justice’s Survey of Inmates in State and Federal Correctional Facilities and Survey of Inmates in Local Jails also indicate that fewer than half of inmates who have mental health issues have ever received treatment for their problem. A third or fewer received mental health treatment after admission. Currently it’s estimated that one-quarter to one-third of those without insurance suffer from mental or substance abuse disorders. A fractured care system leaves many people needing treatment but unable to find it. Many of these people make poor choices that result in their incarceration. Dorothea located mentally ill persons in the debtors’ prisons or almshouses. Today, we don’t have such institutions, but we do incarcerate people at a significant rate, and many of those people desperately need mental health services. Today, most services are provided in overburdened community mental health programs rather than public or private institutions.

  Crazy: A Father’s Search Through America’s Mental Health Madness is a must read. Written by award-winning journalist Pete Earley, it not only looks at contemporary mental health–system needs but is also a compassionate account of a family’s struggle with a son who is mentally ill. Dorothea would have loved to know that there is a National Alliance on Mental Illness (www.nami.org) where families support each other and work together with professionals to bring about needed changes within the mental health care system.

  Dorothea hoped that by placing people in institutions, better treatment would reach them and they would be protected from the insults of society. She was not concerned with the cause but rather the care. Her work drew many from the cellars and back rooms out into a life richer than they had ever known. She was compelled to this work by her faith and her belief that what we do for the least of these, we do for our Lord.

  Her concerns about how to fund and sustain institutions continue in our contemporary world. Privacy and rights laws often affect access to treatment for individuals, unless they are dangerous to themselves or others. Medication can improve functioning, but it can also lead patients to feel no need for treatment, and without good follow-up support, individuals often stop taking medication. This aspect of treatment creates chronic chaos for patients, their families, and treatment providers, as well as for law enforcement. These issues continue to dominate the discussion among mental health and correctional programs today. New voices, new reformers like Dorothea Dix, are needed, as are volunteers across all settings. Dorothea, I think, would urge people to contact a local mental health clinic and offer to volunteer or be willing to share with state and federal legislators their own experiences of when they needed help and how they got it.

  Q: What do you hope readers will take away from this story?

  A: I hope readers will see how significant one person can be in relieving the suffering of many. I hope Dorothea’s story inspires other present-day reformers. I also think Dorothea had a difficult time believing that she was enough. I know so many hard-working people who are compassionate. They give to their community. They are motivated by family and faith. And I consider them all remarkable for all they do. Yet many of them do not see that in themselves. For them, I hope reading Dorothea’s story will remind them to accept the open arms of those who cherish all they do, even when their grand idea or glorious ambition does not bring about t
heir desired hopes. I also hope that readers might see the wisdom in Dorothea’s belief that relieving the suffering of others helped to relieve her own.

  Acknowledgments

  My thanks to WaterBrook Multnomah Publishing Group from their president, Steve Cobb, to editorial and especially editors Shannon Marchese, Ed Curtis, and Laura Wright, to the marketing, publicity, and sales staff, for their professionalism and care in allowing me to tell these stories and place them in the hands of readers; agent Joyce Hart of Hartline Literary for standing beside me all these years; my family, especially Jerry who puts up with my angst; and my many friends, prayer partners. I also thank readers, who tell me they await my next book and the discovery of yet another fascinating story of remarkable women stepping from one generation to our own to teach us and touch us with their lives. And thanks to all the mental health mentors I’ve had in my life—professors, staff, and patients—who chose to make a difference and showed me how I might do that too. Thank you for being a part of this story.

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