BOOK REVIEW / BIOGRAPHY : A Life Devoted to Helping the Insane : VOICE FOR THE MAD: The Life of Dorothea Dix <i> by David Gollaher</i> , Free Press, $28, 538 pages

In 1841, schoolteacher Dorothea Dix looked around her Boston neighborhood and for a host of reasons stemming from her religious upbringing and dysfunctional family, found a calling that offered her “unlimited moral opportunity.” In an era of social fervor during which causes ranging from antivivisection to missionary work attracted support, Dix discovered a constituency that had no other defender: the homeless insane.

When Dix embarked upon what became a lifelong crusade, she was 39 and single with only a small income. This did not discourage her from methodically scouting the whole state of Massachusetts, county by county, counting noses and documenting the conditions of the insane. In 1843 she published her conclusions in a “Memorial to the Massachusetts Legislature,” 30 pages filled with graphic descriptions of mentally ill people confined in cages, closets, stalls and pens, some chained naked and beaten with rods, all within the commonwealth.

Dix did not know much about the nature of mental illness, nor did anyone else in the 1840s. The idea that madness was a treatable condition began to seep into medicine after mid-century when a generation of doctors armed with microscopes began to examine autopsied brains for visible clues. Common sense, however, and compassion suggested to Dix that whatever the cause, gentleness, cleanliness, and some kind of discipline, along with the separation of the mad from convicted criminals, could improve their lives and occasionally effect cures or rehabilitation.

After successfully wooing the Massachusetts Legislature into funding asylums, Dix took her crusade to the rest of the country. She traveled relentlessly, surveying facilities wherever she went, and in her wake left an architectural trail of large, public, state-funded institutions. Then in 1854 she reached Washington, where she lobbied for a bill that would have set aside public land in every state for lunatic asylums.

From there Dix crossed the Atlantic to survey the treatment of the mad in Britain and the continent. In Rome she met Pope Pius IX (who, unknown to her, had suffered from severe depression as a young man) and in Constantinople visited hospices where she marveled that the mad were soothed with music.

Dix’s access to people in power would have been remarkable anywhere and any time, but it was extraordinary for a single middle-class white woman in the mid-19th Century. Yet where her contemporaries Clara Barton and Florence Nightingale have secure positions in the pantheon of Victorian heroines, Dix is scarcely recalled.

In “Voice for the Mad,” David Gollaher, president of the California Health Care Institute, explains that Dix has been overlooked and underappreciated for two reasons. The first is the fact that her great innovation--the insane asylum--has become an anachronism and is on its way to oblivion. The second reason has little to do with mental health and everything to do with contemporary politics. While Dix’s voice rang strong for the mentally ill, it was silent in defense of abolition and the rights of women. She was singularly lacking in compassion for the slaves she saw as a young woman visiting the Danish colony of St. Croix, or traveling through antebellum Kentucky, Mississippi and Louisiana.

Gollaher describes Dix as a victim of poverty and of a devout father who beat her faithfully, following the “spare the rod” precept of his day. Abused or simply miserable, Dix ran away from her parents when she was 13 and found refuge with her paternal grandmother in Boston. Whether or not she spent the rest of her life looking for a home, she did seek, and usually found, the friendship of strong, rich and often famous men.

The story of Dorothea Dix’s career illuminates the importance of separating the actions from the actor. Dix’s contribution to acknowledging madness as an illness was the crucial first step toward treatment. That she happened to be a snobbish hypocrite who was blind to the other injustices of her day ought not to obliterate her accomplishments. The public she braved a century and a half ago opposed paying taxes to alleviate homelessness or to care for the mentally ill, declaring these the domain of private charity. Dix insisted that care and treatment were a right.

President Franklin Pierce vetoed Dix’s public asylum bill in 1854 on principle. “If the general government takes responsibility for the insane poor,” he said, “someone would be bound to argue that it should also take responsibility for the poor who are not insane.” Dorothea Dix started us down the slippery slope toward a humane society. Pierce’s philosophical heirs are doing their best to ensure that we do not get there by opening the public purse.