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Dorothea Dix

Born in 1802 in Hampden, Maine, Dorothea Lynde Dix became a fierce advocate for the poor and the mentally ill, who worked to create the first mental asylums in the United States.

Dix was raised partly by her wealthy grandmother in Worcester, Massachusetts – there, Dorothea became a teacher, and spent time teaching the poor children of her city. She travelled extensively and witnessed the common solution for dealing with the mentally ill at the time – putting them in prisons alongside violent criminals.

Through the later half of the 19th century, Dix worked to expand care for the mentally ill beyond, “the present state of Insane Persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.” (Memorial to the Legislature of Massachusetts, 1843)

Dorothea Dix’s work helped build a system of institutions across the country – in what was seen at the time as a move for the better.

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Institutional Bias

Institutional Bias

It is easy to assume that institutions are the right place for people with significant needs – in an institution, the assumption is that we can keep them “safe”, provide all the care they need in one place, and people with disabilities can live with “people like them”. These assumptions were worked into the policies and laws until the systems and the biases were intertwined and interchangeable.

Despite the evidence that institutions do not provide better care, a more stimulating environment, or less expensive treatment options than the community, our systems still reflect the historical assumptions that built them. When asked if people would like to live in the community they sign a waiver from their right to an institution.  The “institutional bias” is imbedded within the current waiver system – how most people with developmental disabilities access services – makes getting good and services in the community harder.  For that matter, the “institutional bias” includes an unwritten value statement that people with developmental disability do not have a natural place within the community.  But is that true?  Doesn’t everyone have a place?

More troubling still, many organizations are beginning to look towards building new institutions, using very similar language to that of the early 1900’s. They point towards the failures of the community system as proof that we need large congregate settings for people with developmental disabilities.

What are the assumptions here?