Dorothea Dix Oval Frame

Maine’s Dorothea Dix created inclusive communities for the mentally ill in the 19th c.

As Dix Hill becomes Raleigh’s Central Park, we must stop to remember that this was once a place where mentally healthy and mentally ill lived together in community, much like the vaunted and admired communities of L’Arche.


The communities of L’Arche have always intrigued and humbled us. In these homes where able-minded and learning-disabled share life together, the intellectually challenged “least of these” are treated as peer – even teacher – to their “normal” housemates, including philosopher Jean Vanier, who founded the first household.

The nearest L’Arche is 150 miles away, but in Wake County we can still listen to the men and women who lived together on Dix Hill.

The last Dix Hill reunion drew together more than 800 people to remember a way of life many of us can hardly imagine. The former residents of Dix Hill describe a world where psychiatric patients dropped in at a doctor’s house for a cup of coffee and some cookies. They recall a community where patients were afforded not just vocational rehabilitation with a coach to prevent assumed errors but a real job essential to the community in which they lived. They remember a world where an adult patient could ask a staff
member’s child when her mother’s next baby was due.

Dix Hill had vegetable gardens that supported its kitchens, dairy and beef cattle, a laundry, a warehouse. Different kinds of housing supported different patients and staff: a fully confined unit for those who had committed crimes under the influence of their illnesses; small cottages for those able to live all but independently.

The world of Dix Hill was not ideal. As a child, one person remembers telling classmates she lived “near Boylan Heights … because Boylan Heights was a nice place to live and you wouldn’t want to say you lived at the mental hospital.” Off the grounds, stigma was real. On the grounds, people were people.

Off the grounds, stigma was real.
On the grounds, people were people.

As Dix Hill becomes Raleigh Central Park, these kinds of relationships are what must never be forgotten.

Before access to medications turned people with mental illness into patients to be locked away – before mental health reform turned people with mental illness into patients to be hidden in tiny group homes with inadequate community supports – there once was a time when people with mental illness and people who were mentally healthy lived together in a large and thriving community on Dix Hill.

Santayana said that those who do not know history are doomed to repeat it. Our fear is that because we do not know our history, we are doomed to haphazardly recreate the worst elements of past care models in place of a quality care system we once had.
Studies showed that people in long-term care failed to “get better.” This became the rationale for the mental health reform that has repopulated our parks and bridge abutments with homeless and created a revolving door between hospital ERs and the too few group homes that provide inadequate care on their too small fund base.

The problem is that people with chronic illnesses don’t always “get better.” Dix Hill provided a continuum of care that allowed people with chronic illness to move between more highly and less highly supervised environments according to their needs. Within that continuum, they interacted with a wide range of people, from cooks to children. Life wasn’t characterized by the “Thorazine shuffle” or a sadistic “Nurse Ratched.” In North Carolina, people with mental illness lived, not in a “cuckoo’s nest,” but with friends and caregivers on Dix Hill.

We must never forget. The new Raleigh Central Park must include not just a few buildings that were once part of Dorothea Dix Hospital but a museum that allows this history of vibrant community life for people with mental illness to be seen. Perhaps then it can become again a model for quality care in the 21st century.

Co-author Gail Benson Barefoot’s father supervised the warehouse at Dorothea Dix Hospital. Like many children of Dix staff, she works in a helping profession, serving in a Raleigh psychiatric practice. Carlene Hill Byron is a Cary-based writer who has been a mental health family educator. Originally published in the News & Observer, Raleigh, NC: The Way They Lived on Dix Hill