Chapter 4 - Reform

Dorothea Dix was a reformer from Massachusetts who made it her special cause to improve care for persons suffering from mental health challenges. She toured states to make note of the often deplorable conditions in which the “insane” were held. In North Carolina, her travels took her to county poor houses, where she found people incapacitated by mental suffering lodged together with the poor in 11 of 36 sites visited. (Brown, p.65) She found wide variance in levels of care, but argued that even the best poorhouse was “no fit place for the insane.” (Dix, p.17) The lack of special care frequently resulted in their simply being isolated and restrained. Her report included an observation of facilities in Mecklenburg County:

Mecklenburg Jail is remarkably well planned and well built, but less well kept than are most County prisons in North Carolina, as respects cleanliness. The county poor-house several miles from Charlotte, was nearly deserted in October, having but two of the County poor; a partially insane woman and a paralytic man. (Dix, pp.19-20)

“Much do we trust to her enlightened zeal,” said the Lincoln Courier about Dorothea Dix. (December 16, 1848, p.2) In the wake of her report, North Carolina built two state psychiatric hospitals and began to take some of the burden off counties for the care of this class of patient. Even so, “county homes,” as the old poor houses came to be called, continued to house persons judged insane well into the twentieth century. The need for places exceeded the capacity of state hospitals, and so the counties had to take the remainder.