Dorothea Lynde Dix

“Wanted: spinsters between the ages of 35 and 50. Must be unattractive and willing to perform difficult and dangerous work for free. Only brown or black dresses to be worn while on duty, with no jewelry or cosmetics allowed. Can be fired at will and without cause. Catholic Germans and Irish need not apply.”

Dorothea Lynde Dix was born in April 1802 in (what is now) Maine, and spent her formative years at the home of her wealthy maternal grandmother in Boston. Dix had fled there at the age of 12 to escape her alcoholic and abusive father. As a young adult, she became a teacher, twice opening private schools and tutoring in her own home, and twice having to cease working because of unspecified ill health, possibly neurasthenia. After spending time in England with socially active Quakers, Dix returned to the U.S. in 1840 and began a crusade to expose abuses of the mentally ill in prisons, state hospitals, and almshouses throughout this country. She was unable to get legislation passed on the federal level, but had much greater success lobbying state houses for support for better conditions for the mentally ill. For example, Dix’s visit to North Carolina in 1848 resulted, eight years later, in the opening of the public psychiatric hospital which bore her name until it was finally closed in 2011, a run of 157 years.

Though without any formal medical training herself, Dix was appointed as Superintendent of Army Nurses during the American Civil War; she wanted only plain single women to serve as nurses “for their own protection,” and actively prevented the service of German and Irish nuns, as she found them to be coldly aloof and unsympathetic toward the ill and injured. She was more charitable toward Confederate wounded, earning the ire of the radical Republicans of the day. And inexplicably, she lobbied (successfully) against military pensions being awarded to army nurses after the war!

'Fountain for Thirsty Horses,' another Dix initiative, for the Mass SPCA (courtesy Boston Historical Society)

‘Fountain for Thirsty Horses,’ another Dix initiative, for the Mass SPCA (courtesy Boston Historical Society)

Shortcomings aside, Dix raised public awareness of the rampant maltreatment of the mentally ill in the era. For this alone she deserves our thanks.

Dorothea Dix died on this very night, 126 years ago, on the grounds of the New Jersey State Lunatic Asylum, where she kept a private apartment. She was 85 years old.

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Shrink (shrĭngk) vb. Shrank (shrăngk) or shrunk (shrŭngk) past tense vb. Shrunken (shrŭng’kən) adj. 1. to become constricted from heat, moisture, or cold; contract. 2. to become reduced in amount or value; dwindle. 3. to draw back; recoil. 4. to be reluctant to do or say something. 5. the act of shrinking. 6. slang, a psychiatrist or psychoanalyst (American Heritage Dictionary, Houghton-Mifflin, Boston, 1985).

When asked my profession, I often refer to myself as a ‘shrink.’ I do this for several reasons. First, I am not a fan of people – even accomplished and educated types – taking themselves too seriously. Second, I enjoy others’ reactions to such a self-description; it almost always ‘breaks the ice.’ Finally, in the clinical setting, if I’m with a patient who professes, say, severe depression, and I’m just not certain if the neurovegetative profile supports such a diagnosis, I’ll look for a way to throw into the interview a comment such as this to see how she reacts – while not proof positive, a patient’s response to unexpected humor is very telling re: mental status and degree of social connectedness.

I’ve been using the term for years now, and I wasn’t entirely certain from where it came. So I thought I’d share with my readers what I’ve since learned.

Apparently the term has not been in common usage for very long. The first reference to a ‘headshrinker’ that I can find comes from 1926, and at that point referred not to psychiatrists, but rather to members of the Jivaro tribe in deep Ecuadorian and Peruvian Amazonia who collected the severed heads of enemies killed in battle as trophies, called tsantsas. The public’s fascination with these macabre tchotchkes was fanned by 1939’s Five Came Back, its later remake entitled Back From Eternity, and 1954’s Jivaro, all Hollywood’s attempts to portray the bad ends that might befall someone who became lost in the Amazon and fell into the clutches of these savages.

It didn’t take long before this term for South American primitives was extrapolated to my professional brethren as ‘headshrinker,’ and then just ‘shrink.’ There’s no agreement as to why ‘shrink’ was attached to psychiatry per se. I suppose that it was a form of gallows humor at a time rife with latent suspicion toward mental health and ‘getting inside your head’ in general, and during which seeing a psychiatrist remained a dirty little secret.

This earliest found print usage of this secondary meaning dates only from 1950; in an article in Time in November of that year, an editor added a footnote explaining that ‘headshrinker’ was a term used in Hollywood for a decade or more to denote a person’s psychiatrist. The moniker was then used in James Dean’s opus, Rebel Without A Cause, in 1955, and in Time For The Stars, in 1956. By the time the label turned up in Broadway’s West Side Story in 1957 and Thomas Pynchon’s The Crying of Lot 49 in 1965, it had apparently entered the general lexicon, where it remains to this day as a term for a mental health caregiver that is almost universally understood if not employed.

But what of the original headshrinkers?

The Jivaro, to my knowledge, are the only native people of the New World who successfully resisted all attempts by the Spanish colonial empire to seize control of their lands. Not only that, but they had earlier repulsed the mighty Incan empire from the south. More than one hapless ‘governor’ who was appointed on paper to rule over the Jivaro met grisly ends: having molten gold poured down the throat was one such form of execution for non-combatants.

In no small part, the fear of having molten gold poured down your throat (or of becoming a tsantsa if you were a combatant) might have kept more than a few outside interlopers at bay.

Immediately after a battle, the heads of the fallen enemy were collected by Jivaro warriors. No matter how thoroughly the enemy had been vanquished, a Jivaro community would consider the victory incomplete unless heads were brought back from which tsantsa could be created to serve as centerpieces at the subsequent celebratory banquets.

Tsantsa (courtesy Pitt Rivers Museum, UK)

Tsantsa (courtesy Pitt Rivers Museum, UK)

Tsantsa were felt to embody magical powers. It was believed that the creation of a tsantsa locked the enemy’s spirit within the new trophy, preventing that spirit from escaping and exacting revenge, as well as imparting to its new owners the strength of the fallen enemy.

Oddly, it wasn’t always necessary to have an actual human head to make a tsantsa, though this was preferred. In those cases in which heads couldn’t be severed and spirited away before the enemy counterattacked, substitute heads – from sloths, monkey, or goats – would be taken back to the village, and they apparently worked just as well. Even gourds would suffice if some of the fallen enemy’s hair could be attached to this vegetable ‘scalp’ during preparation.

And equally oddly, once the tsantsa was made and celebrated, it wasn’t necessary to even keep it. Many of these trophies were casually discarded or given away.

And this is how they came to the attention of white traders.

As Europeans made gradual and cautious inroads on the borders of Jivaro lands in the 19th century, they saw their first tsantsa and decided they would make interesting souvenirs. The Jivaro weren’t all that attached to the tsantsa, and were happy to trade them to the whites – for firearms with which to kill their enemies more efficiently. Local governments soon realized that the tourist trade in tsantsa was only encouraging the natives to kill each other for raw materials. Thus, laws were passed in South America prior to WWII imposing stiff penalties on the sale or trade of tsantsa, and other countries – the U.S. and U.K. amongst them – banned their importation.

A final word in case you might sometime need bling for your own dinner party: how does one even make a tsantsa? It requires about three days, so plan ahead. Take the head, make an incision from the base of the skull over the occiput, and peel the skin off the skull, which is then removed along with the brain. The skin is soaked in hot water (not boiling yet) to make it pliable and to loosen remaining fat and connective tissue, which is then scraped off. The skin is then placed over a smaller wooden object, similar to a milliner’s block, to help it keep its shape. The top of the head is pierced to allow for the later addition of a suspension cord, and the incision in the back is stitched up. The eyelids are sewn shut with coarse cotton string, and the mouth is likewise sealed with pins made from chonta palm. The head is then boiled in water infused with special herbs, spices, and tannins; each boiling requires a slightly smaller wooden block be used so that the skin can wither but retain its general morphology as it reduces in size. Then, after the series of boilings, the head is packed with hot rocks and sand for further desiccation. Finally, the work product, now the size of a large man’s clenched fist, is coated with charcoal ash (to seal the spirit inside). Add a suspension cord and decorative beads and feathers, and you’re good to go!

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[Copyright 2013 @ The Alienist’s Compendium]

The Pendle Hill Cat, and Apotropaia

Occasionally, those restoring old buildings stumble across the remains of unfortunate animals inadvertently trapped inside crawlspaces or crevices sealed by opposing walls and ceiling. At first, the unfamiliar might suspect that these hapless creatures had become suddenly confined within, and had expired of starvation and dehydration shortly thereafter. A natural ‘oven effect’ inside the wall might then have resulted, desiccating the corpse and turning it in to a mummy.

A lamentable accident indeed.


As those familiar with Poe’s Cask of Amontillado know, there is sometimes much more to the story of such finds.

In one of the most famous ‘animal mummy’ cases in the recent past, engineers undertaking restoration work last year at a reservoir near Pendle Hill in Lancashire, England, found what appeared to be the remains of a buried and long-forgotten 17th century house. They called archaeologists, who dug further into the grassy knoll and uncovered the entire building, it having collapsed on itself, and which included an internal wall in which a cat had been entombed.

The dig site was in the same immediate area in which occurred the Pendle witch trials. For those unfamiliar with the Pendle witches, twelve people – ten women and two men from the Demdike and Chattox families – were accused of causing the unexpected deaths of several neighbors, along with other nefarious roguery including sexual licentiousness with Lucifer, Beelzebub, Mephistopheles, and the usual cast of netherworld suspects. All of the defendants were swiftly convicted and sentenced to be hung, drawn, and quartered (though only eleven met that end, one dying conveniently in her cell the night prior, on 19 August 1612). This represented one of the largest mass-executions of 17th century witches in UK history.

Trial Narrative

In the hysteria that predictably resulted from the then-widely accepted belief that Lancashire witches were everywhere, it is likely that the unfortunate feline was intentionally immured in the structure by superstitious locals to ward off these endemic evil spirits. Period folklore held that the presence of a cat – alive or in spirit form – was effective in blocking curses and other undesired visitations upon a home and its occupants.

And despite America’s own Puritan witch-hunt history, I cannot find any sources that point to similar finds in the United States. Thus, this sacrifice appears to be one of the few period witch-cats still extant.

The Pendle Hill cat has gone to a nearby museum to live out her retirement in climate controlled comfort.

But what I find a bit more disquieting is that if one Googles ‘mummified cat’ and ‘Etsy,’ there will appear a number of sale listings complete with photos. Not 17th century witch-cats (though that cannot be far behind.) Not Egyptian god-cats preserved like Tutankhamen. But real live (?) feral barn cats which expired when trapped between bales of hay and dried out in the not-distant past.

No joke… look for yourself.

Almost nothing of the macabre disturbs me, but that’s just plain gross!

~ ~ ~ ~ ~ ~ ~ ~

In my original post, The Pendle Hill Cat, above, I offered that, the Lancashire discovery notwithstanding, there are no examples of purposeful immurements of cats inside walls on this side of the Atlantic of which I knew.

Sharp readers set me straight on this point, for which I send thanks. And I learned a great new Scrabble word in the process.

Firstly, I refer the reader to ‘The Material Culture of Household Apotropaia in the Eastern United States,’ by M.C. Manning, presented at the annual meeting of the Society for Historical Archaeology in Baltimore last year. It’s a good read, and you can see it here:

[and there’s that Scrabble word: ‘apotropaia,’ which references talismans that can avert evil]

Apparently there have been a number of such inurnments in the U.S. associated with both domestic and public structures. Relatively common finds include boots, clothing, hats, and gloves; glassware; toys; horseshoes; knives; and printed ephemera, especially Bibles. But mummified cats – and even one horse’s skull, in Massachusetts – have been found as well.

Sometimes the dried cats are found in poses, such as leaping at small mummified mice and rats that are entombed along with them.

Secondly, I spoke this week with staff at the Museum of the Middle Appalachians in Saltville, Virginia, about an exhibit that was curated several years ago entitled, ‘Concealed Objects.’ Saltville, a small village in the rural southwestern part of the state, was in the 19th century the site of the Holston Salt and Plaster Company, which was then purchased by the Anglo-Irish Mathieson Alkali Works in 1893. Mathieson turned Saltville into a company town, owning all of the buildings, running the general store, and paying the police force. It seems that Mathieson also supplied many of its own workers, most of whom were themselves from the British Isles and brought with them some of their folk ways.

An old log home on the former DeBusk farm, in unincorporated Beaver Creek not far from the Mathieson site, was found recently to have a mummified cat entombed between the lathe and logs. Although this feline’s story is now lost, she was a centerpiece of the museum’s exhibit, though I’ve not been able to find photos yet.

The cat has since been returned to the property owner, her fate unknown.

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[Copyright 2013 @ The Alienist’s Compendium]

Thomas Story Kirkbride, MD

The young Quaker from Morrisville, Pennsylvania, decided early in life on a career in medicine. He began his studies under the tutelage of a Dr Nicholas Belleville in Trenton, New Jersey, when the former was not yet eighteen years of age. Once the basics had been mastered, he matriculated at the University of Pennsylvania and received a medical degree in 1832. Graduation was followed by a number of years of successful private medical practice.

His name, Thomas Story Kirkbride, is little known today outside of historical, psychiatric, and architectural circles. It is unlikely that his mentor Dr Belleville, or the professors at the university, could have predicted the degree to which their student would later contribute to medicine and psychiatry, or the manner in which he would influence the care of patients in the United States during the 19th and 20th centuries.

T.S. Kirkbride (courtesy of

In 1840, Kirkbride left his private practice to assume the superintendency of the Pennsylvania Asylum for the Insane (PAI). The hospital complex consisted of two large buildings and a garden, known as the ‘pleasure ground,’ on a campus that stretched from 45th to 49th Streets along the north side of Market Street in Philadelphia. Additional building construction and improvements to the physical plant were almost finished when Kirkbride arrived, and though PAI was considered progressive for the day, Kirkbride probably realized quickly that further advances were needed.

Asylums in the United States in the first half of the 19th century, and even PAI to a degree, were still managing patients in ways that shock most 21st century professional sensibilities. Crowding and unsanitary conditions to varying extents were widespread. Punishment was often employed as much as actual treatment, and violent forced feedings, forced hydrations, and the use of seclusion, restraints, and icy baths were not uncommon.

Patient 'care' in the 19th century (courtesy of

Patient ‘care’ in the 19th century (courtesy of

Kirkbride, largely because of his upbringing, was familiar with the Quaker’s York Retreat in England and its theory of ‘moral treatment’ of patients. Moral treatment emphasized a calm, respectful, and collaborative approach to care. Based on the principles of moral treatment and his own clinical experiences, Kirkbride began to refine the guidelines for humane and effective care of the insane at PAI; this approach included features such as less or no punishment, more recreational time, the availability of private patient rooms, more fresh air and sunshine, and cleaner and more attractive physical surroundings. Kirkbride finally published these beliefs in his seminal work of 1854, On the Construction, Organization, and General Arrangements of Hospitals for the Insane, with Some Remarks on Insanity and its Treatment. The theories came to be known as the ‘Kirkbride Plan,’ and hospitals designed with his guidelines in mind as ‘Kirkbride hospitals.’

Typical Kirkbride floorplan (courtesy of

Typical Kirkbride floorplan (courtesy of

Kirkbride’s recommendations were controversial in his day, and agreement was far from universal. Some felt that there was nothing wrong with the longstanding quasi-punitive manner in which patients were widely managed up to that point. And then there were those advocates who suggested that Kirkbride’s moral treatment didn’t go far enough.

A number of Kirkbride hospitals were built in the United States in the second half of the 19th century. Amongst them were the New Jersey Asylum for the Insane (the first entirely Kirkbride-influenced facility, opened in 1848), Bryce Hospital in Alabama (1859), the Trans-Allegheny Lunatic Asylum in West Virginia (1863), Danville State Hospital in Pennsylvania (1869), the Athens Lunatic Asylum in Ohio (1874), Broughton Hospital in North Carolina (1875), Clarinda State Hospital in Iowa (1884), and Sheppard-Pratt in Maryland (1891) to name just a few.

Kirkbride went on to become a founding member of the Association of Medical Superintendents of American Institutions for the Insane, the precursor organization of today’s American Psychiatric Association. He also remained the superintendent of PAI for the remainder of his career. And in a sign of how mores have changed since the 19th century, Kirkbride later married a former asylum patient after his first wife’s death, and lived with his extended family in a residence on the grounds of the asylum, where he died at the age of 74.

Kirkbride’s moral treatment? With modern refinements it lives on. But the Kirkbride hospitals? As most were large imposing Victorian buildings on vast swaths of land, they proved too expensive to run and maintain, especially in the age of deinstitutionalization. A very small number are still used for patient care, but others have been torn down, abandoned, or converted to commercial, other public sector, and residential uses.

Thomas Kirkbride was born 204 years ago this month (31 July 1809).

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