The Unlettered Women Who Changed Mental Health Care Forever

Before I start, I’d like to thank Linda, for inviting us to help in kicking off XX in Health Week, an initiative of Rock Health, whose function, in its own words, is to “connect. . .and empower. . female visionaries to drive change in healthcare.”

I can’t say I’m a visionary, and I’m not particularly looking to be empowered—but, after 40 years of going through the system, I do believe we could afford some changes in healthcare. So if this post accomplishes any small piece of that. . .well, all the more power to me!

Were you to research the history of mental health—say on Google–your search would turn up a number of names of people who indeed made important differences.  You’d be sure to find names like Sigmund Freud, B.F. Skinner, Alfred Adler, and Erik Erikson, right off the bat.

But the perceptive among you would notice a void amongst all these great thinkers:  Women.  To find some, in this hypothetical search, you’d have to keep on looking.

Regular sites that might pop up in your hypothetical search, say, “10 Most Influential Psychologists: A Look at Eminent Thinkers in Psychology,” or “Top 10 Most Influential Psychiatrists,” list precisely zero females.

While these men were indeed accomplishing much and making their names great, all the while there were women–perhaps without MDs, maybe lacking PhDs–who nevertheless changed the world of mental health treatment forever.


Let’s take a step back to the birth period of “modern” psychiatry.  Call it psychiatry or psychology or social work or what you will–in the 19th century, mental health professionals were trained to work in the asylums, places, I assure you, that were not great to visit—and you’d most certainly not want to live there. Asylums were where families placed difficult mentally ill members to live when the they  could no longer handle the patients.

“Treatment” was cruel and abuses abounded.  Even the best-intentioned asylums found themselves resorting to more brutal and less therapeutic tactics as the numbers of inmates grew out of all proportion.

Take Danvers State Hospital, for example, in Massachusetts, which had over 2,300 patients at its height.  Danvers is famous for having innovated the lobotomy—a surgical procedure where the doctor severs the nerve pathways in the brain’s frontal lobes from pathways in other areas. By losing this connection, the patient becomes permanently sedate.  Gone, too, is the patient’s personality, motivation, really their inner essence.  But the patient, a shadow, of himself, make no more trouble.

Lobotomies at Danvers aside, patients in asylums had other horrors to look forward to—physical restraint (often in straight jackets), cold wet packs (patients were wrapped in ice cold, wet sheets as a means of restraint), water boarding, bleeding (i.e. draining the ‘bad blood’ from the patient to heal him/her), and ‘shock therapy’ ( with electric shocks given to patients while a rubber piece was shoved in their mouths to—kindly—prevent them from biting off their tongues when the convulsions began).


But two women—without letters after their names–would change the face of the asylums, and with it the treatment of the mentally ill.

First meet Dorothea Dix, born in 1802, with the pivotal event of her life occurring in 1841, when she began teaching Sunday school at a women’s prison.  Dix was appalled at the treatment of the prisoners and further distressed by finding the mentally ill mixed in with the criminals.

The inmates were provided no heat, often left unclothed in darkness, and frequently chained and beaten. An appalled Dix went to court on the prisoners’ behalfs.  There she procured a court order promising heat for the prisoners—and thus began her decades-long crusade to improve conditions among prisons, poorhouses, and, ultimately, insane asylums.

Dix had found her calling. For the next 40 years she pushed and lobbied to establish 32 state hospitals for the mentally ill, founded on principles of moral treatment and humane care, where prisoners would be restraint- and shackle-free.

Despite Dix’s best efforts, even as she was winding down her career, there was much left to accomplish.

And then one Nellie Bly, a committed reporter, without a single mental health credential, got in on the act.  She pretended she was crazy convincingly enough to get herself committed to an asylum known as Blackwell’s Island.  Bly carefully observed her surroundings, and when she was discharged (a fate considered too good for most of the inmates), she wrote in great detail of the abuses she had seen.  

In 1879 she published an article in no less a paper than The New York Times, which described how difficult simply getting out of an asylum was.  The place, she wrote, is “a human rat-trap. It is easy to get in, but once there it is impossible to get out.”  

Her writings would become a best-selling book—and, for Bly, the experience would help launch her as an investigative reporter. But she never forgot that her main goal was to bring about asylum reform. Once she told the reading public about “coarse, massive” orderlies who “choked, beat and harassed” patients, about rancid food, dirty linens, no warm clothing and the ice-cold baths that preceded water boarding (wrote Bly, “My teeth chattered and my limbs were goose-fleshed and blue with cold. Suddenly I got, one after the other, three buckets of water over my head – ice-cold water, too – into my eyes, my ears, my nose and my mouth. I think I experienced the sensation of a drowning person as they dragged me, gasping, shivering and quaking, from the tub.”),  she made a difference–and often that means ponying up, which is just what happened.

Seemingly solely based on Bly’s tale, the Congressional appropriations committee provided $1,000,000 more than it had ever given for the benefit of the insane, New York city increased its budget for asylums, and, in addition to the money, a month later, a grand jury panel accompanied Bly back to Blackwell. Bly noted with satisfaction that most of most grave abuses had already been fixed. “The institution was on exhibition, and no fault could be found,” she wrote.


Practically on the other side of the moon of mental health, a mother and daughter team were changing the way we understand people at all.

Testing people to assess their personality dates back as far as the 18th century–but it was a bit, well, unscientific, shall we say.  Testers assessed the patients through measuring their skulls or feeling their faces.  Fortunately by the 20th century some more practical–and less invasive–ways, at arriving at theories about a person’s personality and potential were in the works.

Enter Isabel Briggs Myers.

Both she and her mother, Katharine Cook Briggs, had long been engaged by Jung’s theory of psychological types, wanting to put his theory to practical use.  Then World War II was upon them. Both women realized that, at the war’s end, hundreds of thousands of people would return to the working world. The two women believed that if people could better understand themselves, they could choose occupations more suited to their personalities, and thus lead happier—and even healthier–lives.

Briggs began work on the what would become the Myers-Briggs Type Indicator personality inventory in the 40s, and continued to research and develop it for the next four decades, publishing successive versions, until she died in 1980.

But, like all of the women you’ll read about today, neither Briggs nor her mother were formally educated in the field of psychology–nor did they have any credentials in psychological testing.  So Briggs’ mother apprenticed herself to a successful businessman, from whom she learned how to construct and score and test, and how to interpret statistics.

The lack of degree hardly held them back–and certainly didn’t put a dent in the quality of the testing the women created.  The Center for Applications and Psychological Type calls the test “the most widely used and highly respected personality inventory of all time.” It has been translated into 16 languages and is currently taken by over two million people every year.


And even in the present day, the ‘uncredentialed’ moved worlds. Anyone involved in the field of mental health has heard of NAMI, the National Alliance on Mental Illness.  NAMI  is the “nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.”

It has loudly and effectively advocated for mental health rights, made mental illness an acceptable topic of conversation–and helped scores of individuals, in countless ways. It has branches in every state and more than 1,000 local NAMI affiliates in communities across the country and in Puerto Rico.

Surely, we think, such an organization must have been started by some big honcho, highly credentialed.

We think wrong. Meet Harriet Shetler, born in 1917 in Pennsylvania. Shetler attended Monmouth College–where she most certainly didn’t major in psychology or anything close–and went on to work for over 30 years as a newspaper reporter and magazine editor. I mention her marriage–to Charles William Shetler, in 1943–because it’s a crucial part of the story.  Without him, it seems pretty certain she wouldn’t have had the two children she did–and her life would have taken a most different path.

For in 1977, Harriet’s son Charles was diagnosed with with schizophrenia.

Although most parents feel a sense of loss upon learning that their child has a serious mental illness, Harriet used that loss to galvanize herself into action.  Minus an MD, a PhD, or any other degree in mental health, she simply arranged a lunch date with her friend Beverly Young [who belongs on this post, if only we had world enough and time], to sympathize (Ms. Young’s son had schizophrenia, as well), but also to set up a group for people like them, so they could all support each other in their struggles. Planning ahead, Ms. Shetler suggested the group be called the Alliance for the Mentally Ill, partly, she claimed, because the acronym AMI meant ‘friend’ in French. (The name was changed as the group quickly became a national organization.)

Within 6 months they had 25 members. But they didn’t let it go at that.  Rather,  the two women began to organize a national conference.  Given what they knew about mental illness and stigma, they kept their expectations low, planning for 35 attendees. 250 people came.  And by the meeting’s end, there was a national group, with a name, a purpose, and initial financial backing.

Ms. Shetler, who had never taken a course in medical school, and who knew nothing of psychometrics, was, with a close friend, almost single-handedly responsible for what Dr. Steven Hyman, former director of the National Institute of Mental Health, would call “the greatest single advocacy force in mental health.”


To change the life of suffering humans, one needs neither a degree nor formal training. In fact, to truly shake up the world one may have to be an outsider, with a different perspective. In such a case, it helps to be a woman.

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