the simple matter of moral righteousness that she considered it, the treatment of the insane she favored was only one of the possible alternatives.
Dix's moral appeals on behalf of the insane underpinned her particular view that institutions provided the best treatment, that the state and the national government should assume responsibility for matters of individual welfare, that the treatment of the mentally ill rightly fell to the medical establishment, and that asylums could provide the benefits of a well-ordered family. The persuasiveness of her appeals, the extensiveness of her own fieldwork, and the tirelessness of her lobbying efforts made a huge impact on the direction of mental health reform. The securing of funds from the state would have been met with much fiercer resistance had not Dix disarmed the opposition with her stature, argument, and unassailable moral stance. Above all, perhaps, her life was devoted to defining decent treatment of troubled individuals as a moral issue; indecent treatment that later emerged in many contexts, including in the asylum, did so in spite of her efforts.
In sum, Dorothea Dix helped usher in a major shift in public opinion that designated insanity as the special province of asylum superintendents and doctors, a discrete condition requiring special and humane treatment, and an affliction best treated in institutions apart from society. Her shortcomings and those of the movement for mental health reform lay in the belief that their plans for change needed to entail a wholesale rejection of earlier customs as well as their failure to distinguish colonial custom from early national practice.
Dix and fellow reformers were blind to the possibly devastating effects of the larger movement toward incarceration even of the nonviolent insane, the subsequent expansion of the population considered insane, the invasion of the psychological realm necessitated by the new institutions and treatment, and the replacement of individual, family, and community obligations with governmental and institutional responsibility. Unquestioning faith in the new forms and a certain righteous impatience helped complete a revolution in the way Americans thought about madness. Thus were buried the best along with the worst customs of long past generations--to the detriment of future ones.