Suffering Veterans - The American Civil War and PTSD

By Emma Walton

Much has been written about the lives and deeds of Civil War soldiers, but little has been said about their mental state. This is in part because the practice of psychiatry was not established by the cessation of hostilities, and attitudes to mental illness were then very different to those we hold today. However, there is significant evidence of disturbed behavior from Civil War veterans to support a theory that many were irreversibly damaged by their experiences during the war. Many undoubtedly suffered from what is today referred to as 'Post-Traumatic Stress Disorder'

The History of PTSD

Post-Traumatic Stress Disorder (PTSD) is a term covering a range of symptoms and behaviors which can be traced back to mental and emotional damage caused by traumatic experiences. These symptoms include, but are not limited to, an increase in aggression, an inability to connect with the world, flashbacks to the traumatic events, sudden and seemingly unprovoked violence, panic attacks, hallucinations, great stress, depression, shaking, ‘hysterical’ physical symptoms (i.e. apparent bodily problems induced by the mind rather than any more physical cause), substance abuse, mood swings, and suicide. The condition was first properly recognized during the First World War, when hundreds if not thousands of soldiers suffered irreparable emotional damage by what was then termed ‘shell shock’. However, it has almost certainly existed ever since human consciousness first developed – and has featured in the battle accounts of many ancient cultures. Ancient Egyptian hieroglyphs have been found which depict the stories of soldiers suffering from battle-induced mental trauma, while the Ancient Greek historian Heroditus eloquently records the tales of several fighters which most modern medical professionals would not hesitate to diagnose with PTSD. In one, a young man is afflicted with blindness for which there is no apparent physical cause after witnessing his fellow soldier shot down by an arrow next to him. In another, a soldier is withdrawn from the front lines due to incessant trembling. He leads a listless, haunted life – which he ultimately takes. Clearly, therefore, PTSD has been affecting humans for millennia, making it a fairly certain bet that many of those who participated in the American Civil War would have been affected in like manner.

Haunted By Their Experiences

PTSD can be brought on by any traumatic event – childhood abuse is a common cause – but its strongest causative correlation comes with wartime events. Given that civil wars are among the most mentally and emotionally distressing of combat situations, it should come as little surprise to find that a great many accounts record ex-soldiers who were thoroughly unable to reintegrate with peaceful life. Many found that they simply could not cope with civilian existence and opted out of society. The years following the Civil War saw an increase in vagrancy, with veterans making up the vast majority of these new wanderers. Some attributed this to a lack of economic opportunity for ex-soldiers, but others acknowledged that most of these people had been rendered mentally and emotionally incapable of taking any opportunities offered to them. In his book ‘To Appomattox and Beyond’, Larry Logue speaks of a veteran named ‘Len’. Len took up a nomadic lifestyle, drifting from place to place, and completely unable to speak of his experiences. When taken in by the police, he seemed unable to remember any personal details – but perusal of his effects and a little detective work revealed that this apparently deranged hobo had once been a prosperous man, happily settled into family life and with a contracted lawyer to boot. His experiences during the war had damaged him beyond repair. If he ever returned to his family, he swiftly absented himself from them, driven to the roads by the horrors within his own head. Many others did likewise.

Inadequate Treatment

Those who did return to their families often fared little better. It takes a strong and loving family indeed to cope with a PTSD sufferer. Logue tells of Polly McColley, who wrote letters about her son, whom she described as ‘Out of his mind’ when he returned from the war. Many recognized that their loved ones were ill, and called in the professionals – but with little effect. Post-Traumatic Stress Disorder would not be recognized as a condition for several decades, and treatments would take even longer to arrive. Nowadays, although there is still no definitive ‘cure’ for the condition, avenues do exist which can be of great help to sufferers. Treatment centers like The Refuge have a much greater understanding of the condition and how to treat those suffering from it. Not so after the Civil War. Those who seemed depressed were diagnosed with ‘melancholy’ or ‘nostalgia’, and their families were advised to raise their spirits. Others were simply passed as physically sound and told they needed to ‘pull their socks up’. The protests of wives and parents that their sons and husbands were ‘not themselves’ or ‘being strange’ were considered too nebulous to act upon, and frequently dismissed as feminine silliness or oversensitivity. Besides which, the violence which commonly accompanies PTSD was rarely spoken of in a domestic context – and not considered a great problem even when it was. Where behavior was clearly disturbed, disturbing, or dangerous, sufferers would be throw into lunatic asylums - where they received treatment which was often brutal and very rarely (if ever) effective. Those who evaded this often acquired lengthy criminal records, and many ended up in jail.

The 'Old Soldier' Problem

Old soldiers have always been something of an awkwardness for peacetime society – which frequently wishes to brush the horrors and atrocities of wartime beneath the carpet and forget about them. Veterans expecting a hero’s welcome when they return home after the cessation of hostilities are thus more often than not disappointed. A pervasive disillusionment has been observed to take hold of many veteran populations after major armed conflicts – and this phenomenon was attributed to the general surliness, disengagement, and ‘oddness’ of many post-Civil War veterans. However, the behavior of many would now be recognized as far too extreme to stem from simple discontentment with society. That they had experienced wartime horrors, and been mentally scarred by them, seems a near certainty. While the war brought out a great deal of heroism and produced legends which would last generations, it also continued to deal out human suffering long after the killing had ended. The mental torment of those soldiers who returned with PTSD should not be forgotten. The condition continues to affect combatants to this day – although, thankfully, diagnostic procedures now exist to spot and attempt to remedy it in vulnerable soldiers.

From: nycivilwar.us

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History of PTSD in Veterans: Civil War to DSM-5

By Matthew J. Friedman, MD, PhD, Senior Advisor and former Executive Director, National Center for PTSD

Exposure to traumatic experiences has always been a part of the human condition. Attacks by saber tooth tigers or twenty-first century terrorists have likely led to similar psychological responses in survivors of such violence. Literary accounts offer the first descriptions of what we now call posttraumatic stress disorder (PTSD). For example, authors including Homer (The Iliad), William Shakespeare (Henry IV), and Charles Dickens (A Tale of Two Cities) wrote about traumatic experiences and the symptoms that followed such events.

The PTSD diagnosis has filled an important gap in psychiatry in that its cause was the result of an event the individual suffered, rather than a personal weakness. PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. War takes a physical and emotional toll on Servicemembers, families, and their communities. So, the history of what is now known as PTSD often references combat history.

Early attempts at a medical diagnosis
Accounts of psychological symptoms following military trauma date back to ancient times. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions.

Nostalgia, Soldier's Heart, and Railway Spine
Prior to U.S. military efforts, Austrian physician Josef Leopold (1761) wrote about "nostalgia" among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.

A second model of this condition suggested a physical injury as the cause of symptoms. "Soldier's heart" or "irritable heart" was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these "cardiac" symptoms and described it as overstimulation of the heart's nervous system, or "Da Costa's Syndrome." Soldiers were often returned to battle after receiving drugs to control symptoms.

The thought that physical injury led to PTSD-like symptoms was supported by European reports of "railway spine." As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.

Shell Shock
In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. At that time, some symptoms of present-day PTSD were known as "shell shock" because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Thinking changed when more soldiers who had not been near explosions had similar symptoms. "War neuroses" was also a name given to the condition during this time.

During World War I, treatment was varied. Soldiers often received only a few days' rest before returning to the war zone. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. In European hospitals, "hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis.
Battle Fatigue or Combat Stress Reaction (CSR)

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as "battle fatigue." With long surges common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe "battle fatigue" was real. A good account of CSR can be found in Stephen Crane's Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery.

Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using "PIE" (Proximity, Immediacy, Expectancy) principles. PIE required treating casualties without delay and making sure sufferers expected complete recovery so that they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

Development of the PTSD diagnosis
In 1952, the American Psychiatric Association (APA) produced the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which included "gross stress reaction." This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.

Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM (1968). DSM-II included "adjustment reaction to adult life" which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome (marked by incorrect answers to questions) in prisoners who face a death sentence.

In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.

The DSM-III criteria for PTSD were revised in DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), and DSM-5 (2013) to reflect continuing research. One important finding, which was not clear at first, is that PTSD is relatively common. Recent data shows about 4 of every 100 American men (or 4%) and 10 out every 100 American women (or 10%) will be diagnosed with PTSD in their lifetime.

An important change in DSM-5, is that PTSD is no longer an Anxiety Disorder. PTSD is sometimes associated with other mood states (for example, depression) and with angry or reckless behavior rather than anxiety. So, PTSD is now in a new category, Trauma- and Stressor-Related Disorders. PTSD includes four different types of symptoms: reliving the traumatic event (also called re-experiencing or intrusion); avoiding situations that are reminders of the event; negative changes in beliefs and feelings; and feeling keyed up (also called hyperarousal or over-reactive to situations). Most people experience some of these symptoms after a traumatic event, so PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning.

Today VA operates more than 200 specialized programs for the treatment of PTSD. In Fiscal Year (FY) 2013, more than a half million Veterans diagnosed with PTSD received treatment at VA medical centers and clinics.

VA is committed to provide the most effective, evidence-based care for PTSD. It has created programs to ensure VA clinicians receive training in state-of-the-art treatments for PTSD. At of the end of FY 2013, VA had trained more than 5000 of its clinicians to use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), which are cited by the Institute of Medicine Committee on Treatment of PTSD as proven to be effective treatments for PTSD.

VA's National Center for PTSD was created in 1989 by an act of Congress, and celebrated its 25th anniversary on August 29, 2014. We continue to be at the forefront of progress in the scientific understanding and treatment of PTSD. In addition to improving upon existing treatments, we are researching effective new treatments. We are also developing new educational products such as our What is PTSD? whiteboard video. For more information on the National Center for PTSD, please visit our About Us section of the website.

Sources
Portions of this fact sheet originally appeared in a Veterans Day observance post on VA's blog, VAntage Point (November 7, 2013). For more information about the history of the PTSD diagnosis, see PTSD History and Overview in the "Professional Section" of our website.

From: ptsd.va.gov

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The Hardening Effect from Combat on Civil War Soldiers

By Chris, 5-2-11

The process of “hardening” (via the experience of battle over a period of time) has been analyzed by historians and interpreted in several different ways. James M. McPherson saw the stress (combat fatigue) of combat as a breaking down of the soldier’s senses (“the nerve to endure”) thus subduing the awareness to suffering. That though they saw horrible things, they could rise above it and McPherson stressed the importance of courage and motivation as major contributions to a soldier’s constitution. (1) Of course Gerald R. Linderman saw the impact of hardening as a form of “disillusionment” for the soldier and evidence that the ideological fabric of their Victorian values were breaking down, if not completely diminished. (2) However, Earl J. Hess probably does the best job with his analysis of the “hardening” that soldiers experienced. The process of “learning of war” involved what Hess called “crossing over,” which was the process where they “acclimate their senses and emotions” by crossing over an emotional “gulf” that separated soldiers from their civilian sensitivities (3). This process does not mean that they became any less patriotic or that their value systems had broken down.

A horrific yet poignant depiction of this “hardening” nature of a combat soldier can be seen in Forty-six months with the Fourth R. I. volunteers, by Corp. George H. Allen. Specifically a passage where he describes in detail his understanding of the “heart-hardened” solider.

"By these minor details are shown the beauties of siege life, and it will be seen to what severe and dangerous duties we were at all times subject. We had lost, up to this time, twenty-five men killed or wounded in twenty days; and all around us other regiments were suffering in like manner. By being accustomed to sights which would make other men’s hearts sick to behold, our men soon became heart-hardened, and sometimes scarcely gave a pitying thought to those who were unfortunate enough to get hit. Men can get accustomed to everything; and the daily sight of blood and mangled bodies so blunted their finer sensibilities as almost to blot out all love, all sympathy from the heart, and to bring more into prominence the baser qualities of man, selfishness, greed, and revenge.

"As an illustration of this condition I cite one case that came within my own observation.

"One afternoon, two of the stretcher bearers brought out of the covered ways a man who had been fatally wounded, and setting down their stretcher near a small group of mounds, just above our camp on the hill, they began to dig his grave. From their actions I perceived the man was not yet dead, and went up to watch them. After digging a hole about a foot deep, they lit their pipes and sat down to smoke and talk over matters, and wait for him to die.

"They betrayed not the least sense of emotion or feeling for the poor wretch who lay there before them, gasping in the agonies of death, and when he had breathed his last, roughly tipped him over into the hole, and covering him with a few shovelsful of earth, picked up their stretcher and went back into the pits for the next one.

"Such scenes were common, and few there were that were killed here that got more than a blanket for a coffin, or as much as a prayer over their burial. And yet all this lack of sympathy was without malice, and but the result of living night and day within the 'valley of the shadow of death.'"

Notes
——–
1 -James McPherson, For Cause and Comrades, Why Men Fought in the Civil War (New York: Oxford Press, 1997) 43-45, 163-169.
2 – Gerald E. Linderman, Embattled Courage The Experience of Combat in the American Civil War (New York: Free Press, 1987), 240-241.
3- Earl J. Hess, The Union Soldier in Battle (U of Kansas Press, 1997), 4-9.

From: soldierstudies.org

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Occupational Medicine in the Civil War

From: med.navy.mil

The new technology of iron and steam in the Civil War introduced brand-new hazards—exploding boilers, scalding with live steam, burn injuries, and primary and secondary wounds resulting from large caliber, rifled naval guns. Ironclad vessels also introduced environmental and occupational concerns for sailors aggravated by badly ventilated and hell-hot engine rooms. It is estimated that a typical low ranking coal heaver aboard a poorly ventilated ironclad routinely endured temperatures approaching 130 degrees F. In fact, aboard Monitor in summer, temperatures of 125 degrees were recorded on the berth deck and 150 degrees in the galley. One cannot underestimate the utility of awnings in deflecting the sun from ironclads decks.

THE SILENT KILLER

Even the fuel that fired an ironclad’s boilers was a threat. Coal, while not a new fuel used by the Navy, had the potential of becoming a silent killer. Fossil fuels require proper ventilation and this concept was not yet adequately understood by Civil War engineers. Untold casualties, some fatal, occurred when crewmen either loaded wet bituminous coal in below-deck bunkers or bilge water contaminated the fuel. Both the Mississippi Squadron and the South Atlantic Blockading Squadron reported a number of cases of sailors being discovered either dead or unconscious below deck. The more fortunate were revived when exposed to the fresh air. Besides unconsciousness, surgeons described their patients as being cyanotic—blueness of the skin caused by oxygen starvation with foreheads and eyelids markedly swollen.

IRONCLAD FIGHTING

There were many differences between wounds sustained in battle on the old wooden ships and those encountered aboard ironclads. Shots striking wooden vessels tended to throw about splinters which, as secondary projectiles, caused many of the wounds. Burns were uncommon. In yardarm engagements and during the hand-to-hand fighting resulting from boarding an enemy’s vessel, many wounds were caused by small arms, cutlasses, bayonets, and pikes. In ironclad fighting, splinters might be fewer, but burns and fragment wounds became commonplace. The so-called protected environment an ironclad warship provided was illusory. If anything, it offered fatal hazards the crew of a wooden ship rarely experienced. Take the example of the monitor Nahant. Engaged in Samuel Du Pont’s attack on the Charleston forts in April 1863, shellfire from the forts slammed against her pilot house and turret with such velocity that broken bolts ricocheted about her pilot house like bullets, killing one man and injuring two others, including her captain.

HEARING LOSS ABOARD SHIPS

Iron shot weighing over 150 pounds were now common, making the 24- and 32-pound size thrown by earlier guns seem quite puny in comparison. What’s more, a newer generation of rifled guns that could pulverize masonry forts could do worse to those enclosed within an iron-sheathed hull. What resulted was the “garbage can” effect. Imagine yourself encased in a typical galvanized steel garbage pail or a 55-gallon steel oil drum, ears unprotected, and then having your antagonists hurling 50-pound cement blocks against your cocoon, one per second. With blood dripping from nose and ears, crewmen were sometimes driven mad under the barrage of both rifled and unrifled artillery impacting against iron armor. And if not driven mad, many Sailors had their eardrums ruptured or, at very least, suffered temporary or permanent deafness. Civil War Sailors frequently described ringing in the ears or tinnitus. With noise levels aboard Civil War ironclads routinely exceeding 130 decibels, one can only conjecture what kind of hearing damage resulted among these warriors.

PSYCHOLOGICAL HEALTH

Needless to say, under these conditions, the psychological health of Sailors was often in question. “Give me a discharge and let me go home,” a distraught coal-heaver begged his skipper after months of duty outside of Charleston. “I am a poor, weak, miserable, nervous, half-crazy boy. Everything jarred upon my delicate nerves.” In the Civil War we begin seeing terms “nostalgia,” “melancholia,” and “irritable heart” masking conditions that would in future years be called “shell shock,” “combat fatigue” and “PTSD.”

Image: "Coal Heaver" by Alfred Waud

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Did Civil War Soldiers Have PTSD?

By Tony Horwitz, January 2015

One hundred and fifty years later, historians are discovering some of the earliest known cases of post-traumatic stress disorder.

In the summer of 1862, John Hildt lost a limb. Then he lost his mind.

The 25-year-old corporal from Michigan saw combat for the first time at the Seven Days Battle in Virginia, where he was shot in the right arm. Doctors amputated his shattered limb close to the shoulder, causing a severe hemorrhage. Hildt survived his physical wound but was transferred to the Government Hospital for the Insane in Washington D.C., suffering from “acute mania.”

Hildt, a laborer who’d risen quickly in the ranks, had no prior history of mental illness, and his siblings wrote to the asylum expressing surprise that “his mind could not be restored to its original state.” But months and then years passed, without improvement. Hildt remained withdrawn, apathetic, and at times so “excited and disturbed” that he hit other patients at the asylum. He finally died there in 1911—casualty of a war he’d volunteered to fight a half-century before.

The Civil War killed and injured over a million Americans, roughly a third of all those who served. This grim tally, however, doesn’t include the conflict’s psychic wounds. Military and medical officials in the 1860s had little grasp of how war can scar minds as well as bodies. Mental ills were also a source of shame, especially for soldiers bred on Victorian notions of manliness and courage. For the most part, the stories of veterans like Hildt have languished in archives and asylum files for over a century, neglected by both historians and descendants.

This veil is now lifting, in dramatic fashion, amid growing awareness of conditions like post-traumatic stress disorder. A year ago, the National Museum of Civil War Medicine mounted its first exhibit on mental health, including displays on PTSD and suicide in the 1860s. Historians and clinicians are sifting through diaries, letters, hospital and pension files and putting Billy Yank and Johnny Reb on the couch as never before. Genealogists have joined in, rediscovering forgotten ancestors and visiting their graves in asylum cemeteries.

“We’ve tended to see soldiers in the 1860s as stoic and heroic—monuments to duty, honor and sacrifice,” says Lesley Gordon, editor of Civil War History, a leading academic journal that recently devoted a special issue to wartime trauma. “It’s taken a long time to recognize all the soldiers who came home broken by war, just as men and women do today.”

Counting these casualties and diagnosing their afflictions, however, present considerable challenges. The Civil War occurred in an era when modern psychiatric terms and understanding didn’t yet exist. Men who exhibited what today would be termed war-related anxieties were thought to have character flaws or underlying physical problems. For instance, constricted breath and palpitations—a condition called “soldier’s heart” or “irritable heart”—was blamed on exertion or knapsack straps drawn too tightly across soldiers’ chests. In asylum records, one frequently listed “cause” of mental breakdown is “masturbation.”

Also, while all wars are scarring, the circumstances of each can wound psyches in different ways. The relentless trench warfare and artillery bombardments of World War I gave rise to “shell shock” as well as “gas hysteria,” a panic prompted by fear of poison gas attacks. Long campaigns in later conflicts brought recognition that all soldiers have a breaking point, causing “combat fatigue” and “old sergeant’s syndrome.” In Vietnam, the line between civilians and combatants blurred, drug abuse was rampant and veterans returned home to an often-hostile public. In Iraq and Afghanistan, improvised explosive devices put soldiers and support personnel at constant risk of death, dismemberment and traumatic brain injury away from the front.

Civil War combat, by comparison, was concentrated and personal, featuring large-scale battles in which bullets rather than bombs or missiles caused over 90 percent of the carnage. Most troops fought on foot, marching in tight formation and firing at relatively close range, as they had in Napoleonic times. But by the 1860s, they wielded newly accurate and deadly rifles, as well as improved cannons. As a result, units were often cut down en masse, showering survivors with the blood, brains and body parts of their comrades.

Many soldiers regarded the aftermath of battle as even more horrific, describing landscapes so body-strewn that one could cross them without touching the ground. When over 5,000 Confederates fell in a failed assault at Malvern Hill in Virginia, a Union colonel wrote: “A third of them were dead or dying, but enough were alive to give the field a singularly crawling effect.”

Wounded men who survived combat were subject to pre-modern medicine, including tens of thousands of amputations with unsterilized instruments. Contrary to stereotype, soldiers didn’t often bite on bullets as doctors sawed off arms and legs. Opiates were widely available and generously dispensed for pain and other ills, causing another problem: drug addiction.

Nor were bullets and shells the only or greatest threat to Civil War soldiers. Disease killed twice as many men as combat. During long stretches in crowded and unsanitary camps, men were haunted by the prospect of agonizing and inglorious death away from the battlefield; diarrhea was among the most common killers.

Though geographically less distant from home than soldiers in foreign wars, most Civil War servicemen were farm boys, in their teens or early 20s, who had rarely if ever traveled far from family and familiar surrounds. Enlistments typically lasted three years and in contrast to today, soldiers couldn’t phone or Skype with loved ones.

These conditions contributed to what Civil War doctors called “nostalgia,” a centuries-old term for despair and homesickness so severe that soldiers became listless and emaciated and sometimes died. Military and medical officials recognized nostalgia as a serious “camp disease,” but generally blamed it on “feeble will,” “moral turpitude” and inactivity in camp. Few sufferers were discharged or granted furloughs, and the recommended treatment was drilling and shaming of “nostalgic” soldiers—or, better yet, “the excitement of an active campaign,” meaning combat.

At war’s end, the emotional toll on returning soldiers was often compounded by physical wounds and lingering ailments such as rheumatism, malaria and chronic diarrhea. While it’s impossible to put a number on this suffering, historian Lesley Gordon followed the men of a single unit, the 16th Connecticut regiment, from home to war and back again and found “the war had a very long and devastating reach.”

The men of the 16th had only just been mustered in 1862, and barely trained, when they were ordered into battle at Antietam, the bloodiest day of combat in U.S. history. The raw recruits rushed straight into a Confederate crossfire and then broke and ran, suffering 25 percent casualties within minutes. “We were murdered,” one soldier wrote.

In a later battle, almost all the men of the 16th were captured and sent to the notorious Confederate prison at Andersonville, where a third of them died from disease, exposure and starvation. Upon returning home, many of the survivors became invalids, emotionally numb, or abusive of family. Alfred Avery, traumatized at Antietam, was described as “more or less irrational as long as he lived.” William Hancock, who had gone off to war “a strong young man,” his sister wrote, returned so “broken in body and mind” that he didn’t know his own name. Wallace Woodford flailed in his sleep, dreaming that he was still searching for food at Andersonville. He perished at age 22, and was buried beneath a headstone that reads: “8 months a sufferer in Rebel prison; He came home to die.”

Others carried on for years before killing themselves or being committed to insane asylums. Gordon was also struck by how often the veterans of the 16th returned in their diaries and letters to the twin horrors of Antietam and Andersonville. “They’re haunted by what happened until the end of their lives,” she says.

Gordon’s new book on the 16th, A Broken Regiment, is but one of many recent studies that underscore the war’s toll on soldiers. In another, Living Hell: The Dark Side of the Civil War, historian Michael Adams states on the first page that his book describes “the vicious nature of combat, the terrible infliction of physical and mental wounds, the misery of soldiers living amid corpses, filth, and flies.”

Not all scholars applaud this trend, which includes new scholarship on subjects such as rape, torture and guerrilla atrocities. “All these dark elements describe the margins not the mainstream of Civil War experience,” says Gary Gallagher, a historian at the University of Virginia who has authored and edited over 30 books on the war. While he welcomes the fresh research, he worries that readers may come away with a distorted perception of the overall conflict. The vast majority of soldiers, he adds, weren’t traumatized and went on to have productive postwar lives.

Image: The wounded soldiers were photographed at a hospital in Fredericksburg, Virginia, between 1861 and 1865. (Library of Congress, Prints and Photographs division)

From: smithsonianmag.com

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The Civil War and P.T.S.D.

By Dillon Carroll, 5-21-14

Edson Bemis was a hard man to kill. Rebel soldiers tried three times, and three times they failed. At the Battle of Antietam, a musket ball ripped through his left arm. Two years later, in the horrible fighting in the Wilderness, he was shot in the abdomen, just above the groin. The ball was never extracted, remaining in his body until the day he died.

The Confederates came the closest to killing Bemis in February 1865. At Hatcher’s Run, Va., a Minié ball struck him in the head. He lay near death for several days, his skull cracked and leaking brain matter. Most passed him off for dead. Dr. Albert VanDevour, however, did not, and instead performed a risky surgery to remove the bullet from his skull. Bemis improved immediately, eventually recovering, much to the shock of everyone.

The war was finally over for Bemis. He moved to Suffield, Conn., with his wife, Jane, where they hoped to start a new life. He began working for W.W. Cooper’s, a local merchant house, but very quickly it became clear to everyone that Bemis was not right. One of his colleagues at W.W. Cooper’s, George N. Kendall, described his health as “never very good,” and Bemis began to suffer from “spells of vertigo” or “something that afflicted his head” so much so that he frequently could not work.

Kendall noticed that Edson was also “very forgetful.” He had wild mood swings, and Kendall wrote “any little thing irritates him.” He was increasingly subject to memory loss. Sometimes, for several hours each day, he had no memory of where he had been or what he had done. Eventually he had to stop working at W.W. Cooper’s because of his condition.

In 1890, Bemis suffered what appeared to be a stroke, and his condition, which was already bad, got exponentially worse. A pension official came to Suffield to interview the Bemis family and friends, and immediately noticed that although Bemis was only 55 in 1895, he walked “like a man of 80!” His wife had to assist him in dressing, she had to “cut his meat and wash his potatoes” and she described him as being “like a child.” The pension official wrote that Bemis’s only job each day was to go to the post office “right below here for the mail and to a few houses above for a pail of milk every day this is all he can do.”

In 1900, Jane had apparently had enough, and Bemis was examined and institutionalized in Westboro Insane Hospital in Westboro, Mass. By this time, his condition had spiraled even further. A doctor at Westboro, Lewis Bryant, wrote that Bemis believed he was “thirty years old” but he could not recall the present “year month or day of the week.” Bemis believed that “the civil war is still going on” and, occasionally, would “see dogs in the room.” Bryant described him as “silly, emotional, crying and laughing without apparent cause” and having “little memory confusing the present with the past…soils his clothing has had delusions and false sights, and at times requires the care and attentions usually given a child.”

Celestia Bemis, his sister, who coincidentally married a man with the last name Bemis, came to Westboro and took charge of Edson, taking him to her farm in North Brookfield. Celestia and Jane did not get along, and their feud spilled over into the notes of the pension official who occasionally checked up on Bemis. Jane claimed that Celestia ordered her to stay away from him, because her presence excited him too much, while Celestia claimed that Jane had never once tried to visit Bemis, and was content to keep cashing his pension checks without ever seeing him. Jane last saw her husband in August of 1900; he died two months later. She continued collecting a pension until her death in 1917.

Bemis’s story was not an uncommon one among Civil War veterans. Historians are beginning to uncover what was a virtual epidemic of emotional, psychological and neurological trauma that afflicted soldiers after the war. Veterans labored under emotional and psychological stress in ways that are disturbingly similar to the present. Alcoholism was rampant, as was unemployment. Suicide was endemic. Civil War veterans dotted the wards of insane asylums across the country.

Modern science would most likely have given Bemis a diagnosis of traumatic brain injury, caused by a blow to the head or a penetrating injury of the skull. Such injuries are all too common among veterans of Iraq and Afghanistan today. Symptoms of T.B.I. range from headaches, confusion, lightheadedness and dizziness to fatigue, mood changes, depression, changes in sleep patterns, restlessness and agitation. That seems to be consistent with Bemis’s litany of postwar complaints.

If so many Civil War veterans were troubled with emotional and psychological trauma, why has it taken us so long to discover them? Veterans were loath to admit they were traumatized. In the 19th century, mental illness carried a tremendous stigma, and most veterans fought a private battle rather than disclose their trauma.

Additionally, most families preferred to care for mentally ill loved ones at home. Bemis’s care as his mental health declined became a community project. Jane certainly performed the lion’s share of the work. She dressed him, fed him, and sometimes had to help him in the bathroom. But she could not watch him all the time. A.P. Sherwin, a local doctor, later testified that everyone “in town knows soldier to be mentally afflicted” and all the people in Suffield near the Bemis household “watch him closely.” Jane Bemis testified that she did not watch him “on the street” because “everybody knows him” and that he only “goes a short way from home.”

Finally, the relationship between warfare and psychological trauma has only recently become better understood. War trauma has distressed veterans in nearly every war, but the whispers of shell shock and combat fatigue never really entered the public consciousness. It was not until after Vietnam that veterans’ groups successfully lobbied the American Psychiatric Association to include post-traumatic stress disorder in the Diagnostic and Statistics Manual of Mental Disorders. Since then, our understanding and empathy for veterans afflicted with psychological trauma has grown rapidly. Bemis’s life demonstrates that combat has been damaging to the human brain and the human psyche long before we were willing and able to give the maladies a name.

Follow Disunion at twitter.com/NYTcivilwar or join us on Facebook.

Sources: Soldier’s Certificate No. 59,267, Cpl. Edson D. Bemis, Company K, 20th Massachusetts Volunteer Infantry, National Archives; Case Files of Approved Pension Applications of Veterans Who Served in the Army and Navy Mainly in the Civil War and the War with Spain, 1861-1934, National Archives; Steven T. DeKosky, “Traumatic Brain Injury: Football, Warfare, and Long-Term Effects,” in the New England Journal of Medicine 363, No. 14 (Sept. 30, 2010); Rebecca J. Anderson, “Shell Shock: An Old Injury with New Weapons,” Molecular Interventions 8, No. 5 (Oct. 2008); Emily Singer, “Brain Trauma in Iraq,” Technology Review 111, No. 3 (May–June 2008); Jeanne Marie Laskas, “Game Brain,” GQ, Oct. 2009; Ben McGrath, “Does Football Have a Future?” New Yorker, Jan. 31, 2011.

Dillon Carroll is a graduate student in history at the University of Georgia.

From: opinionator.blog.nytimes.com

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Study: Mental Trauma Led to Illness in Civil War Troops

From: npr.org

Mental trauma led to physical disease among American Civil War veterans, according to a study appearing in the current issue of the "Archives of General Psychiatry" magazine. Scientists found that younger and more traumatized soldiers had much higher rates of illness later in life. Michelle Trudeau reports on the study, and how the findings could apply to today's veterans.

ALEX CHADWICK, host:
This is DAY TO DAY.
Now a story that never ends, that of the American Civil War. There's a new study about it appearing in the current issue of the Archives of General Psychiatry. It finds that the Civil War had affects on the physical and mental health of veterans throughout their lifetimes. Michelle Trudeau reports.

MICHELLE TRUDEAU reporting:
General William Tecumseh Sherman seems to have predicted the findings of this study when he famously declared, War is hell. Now research psychologist Roxanne Cohen Silver has investigated whether the degree of hellish trauma that a soldier experienced can be linked to increased health problems. She examined the military records of over 15,000 union soldiers, records which give details as to whether a soldier had been wounded or had been a prisoner of war, also the number of deaths in each combat company. During the Civil War many company members came from the same town or even family, and so tabulating deaths in each company indicates the amount of intimate violence that a soldier may have been exposed to, says Silver.

Dr. ROXANNE COHEN SILVER (Professor, UC Irvine): It would represent the numbers of dead bodies that he witnessed, dismembered bodies and dying individuals. And it also represented undoubtedly the degree of loss or bereavement that they had encountered in the war.

TRUDEAU: These 15,000 military records are kept by the National Archives, which also has each soldier's medical records.

Dr. SILVER: We obtained the medical records from the time that they discharged until they died.

TRUDEAU: Available thanks to the life-long relationship between Civil War vets and the federal government.

Dr. SILVER: In order to receive a pension after the Civil War, the veterans would have to go to pension board physicians which were military physicians. And in order to be classified as having a particular ailment, three physicians had to agree on a diagnosis. So these records are remarkably complete, remarkably thorough, and remarkably reliable.

TRUDEAU: When the researchers from the University of California Irvine matched a soldier's military record with his life-long medical records, some strong connections emerged.

Dr. SILVER: The more traumatic the experiences that the soldier encountered in the war, the more likely he was to have physical health ailments and mental health ailments.

TRUDEAU: A 50 percent greater chance of cardiovascular disease, or gastrointestinal problems, and a similar increase in mental health problems, such as depression. The horrors of war, though, had the most brutal impact on young soldiers, enlistees as young as nine years old.

Dr. SILVER: Those who were youngest when they were enlisted had a 93 percent increased risk of developing signs of physical and mental health problems.

TRUDEAU: And these youngest vets also died at a significantly younger age than vets who had been older when they enlisted. Roger Pitman, a research psychiatrist at Harvard Medical School, says he's intrigued by this finding because we know, he says, that youngsters have immature nervous systems.

Professor ROGER PITMAN (Research Psychiatrist, Harvard Medical School): Adolescents or even children who have incomplete brain development might not be able to handle the emotional stress of combat as well as persons past their adolescence where their brains are more-or-less completely developed.

TRUDEAU: The bottom line, Pitman adds, is that war has extracted similar costs from veterans of every era.

For NPR News, I'm Michelle Trudeau.

Image: Indiana Hospital for the Insane, Indianapolis, Indiana

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Suffering in Silence: Psychological Disorders and Soldiers in the American Civil War

By Sarah A.M. Ford
Kutztown University of Pennsylvania

Did soldiers of the American Civil War suffer from post-traumatic stress disorder and other psychological disorders? It has only been several decades since mental illness attributed to war conditions was clinically recognized. Recent research has shown a strong positive correlation between war time events such as witnessing the death of comrades, friendly fire or IED explosions and post-traumatic stress disorder.

With a conflict as devastating as the American Civil War, it would be logical to hypothesize that Civil War soldiers were subjected to events that put them at risk similar to today’s soldiers. There is a strong relationship between attributing events during the Civil War and psychological affects; for instance revolutionary weaponry developments, medical procedures, psychological warfare, and hand to hand combat could have invoked psychological ailments. Data compiled from diaries and letters will affirm the presence of psychological disorders in soldiers who fought in the war. From this body of evidence, it is clear that soldiers of the American Civil War did indeed suffer from post-traumatic stress disorder and other psychological disorders.

The most common disorder that results from exposure to combat is called post-traumatic stress disorder or more commonly known as PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders, there are several categories of symptoms for PTSD. The symptoms include the experience of actual harm or threats to be harmed physically and or emotionally, intrusive symptoms that include flashbacks, disturbing dreams or memories, negative changes in cognition, the avoidance of stimuli associated with the event and changes in arousal levels. In order for there to be a diagnosis, symptoms must be present for over a month and the level of stress has to be significant enough where everyday activities are negatively affected.

Another common and relatively novel disorder is Traumatic Brain Injury (TBI). This is a neurological disorder that inhibits cognitive functioning as a result of an injury to the head. Symptoms include moderate to severe amnesia, headaches, changes in personality and accumulating more sleep than normal.3 This disorder is becoming widely recognized and diagnosed more frequently in veterans today. Over 30 percent of all casualties in Operation Iraqi Freedom (OIF) and Enduring Freedom (EF) were associated with the head or neck area.

As many as ten to twenty percent of OIF/EF veterans have been diagnosed with TBI. It is plausible to assume that Civil War soldiers, who were not provided helmets, would have suffered from TBI if they experienced in injury to the head or neck region. General Anxiety Disorder and Depression are both common psychological disorders that plague many veterans today. Soldiers who experience traumatic events, such as the death of a comrade or innocent civilians, may experience depression as a result. It is logical that countless men of the Civil War era may have suffered from depression or general anxiety disorder.

The first mentions of symptoms correlated with PTSD dates back three thousand years ago; four thousand years before it would be clinically recognized. Ancient Egyptian Hieroglyphics depicted the emotions and fears soldiers felt while in combat. The Greek historian Herodotus wrote, in 480 B.C, of a Spartan soldier who was taken off the front lines due to his trembling and later took his own life in shame.

In the seventeenth century any disorder associated with depression or changes in personality was termed melancholy or nostalgia. Symptoms similar to PTSD were called Soldier’s Heart and Da Costa Syndrome during the mid and late nineteenth century.

The catalyst for the recognition of PTSD was the outbreak of World War One. The Great War had some of the worst casualties in human history as a result of revolutionary weaponry that redefined warfare. The psychological effects of this war were often seen in the returning veterans as many experienced involuntary ticks and shook unaccountably. This later would be termed Shell Shock.

While not to the extent of the First World War, The Civil War had revolutionary weapon and technological developments that negatively affected soldiers physically and mentally. This included the Minie Ball, a cylinder shape bullet that was more aerodynamic, making it more precise and effective. Instead of a round bullet that would break the bone, the Minie Ball would completely shatter it.

Another technological development that changed the world as well as warfare was the railroad. For the first time in human history, mankind would not have to rely on horses or their own two feet to transport them. This drastically changed warfare by allowing supplies and troops to move into the most remote areas at record speeds. This meant that more soldiers were exposed to significantly more carnage than past wars. A soldier was no longer confined to a specific geographical location allowing them to fight in more battles. Witnessing this novel amount of gore would have been a severe trauma that could have produced anxiety and other psychological symptoms associated with PTSD.

The Civil War is unique in that it took place during a time of great weaponry and technological developments but it was only decades shy of medical advancements that could have saved countless lives. Disease rather than bullets proved to be a significant factor in the death toll of the Civil War. For every one death in combat, there were two deaths caused by disease. The lifesaving technique of sterilization was a foreign concept to Civil War physicians and as a result thousands of soldiers succumbed to infections.

The omnipresence of decay and death of thousands of sick men only added to the carnage witnessed not only by soldiers but nurses and doctors. On a daily basis, medical teams witnessed horrific wounds, ghastly amputations and men succumbing to their injuries and illnesses. Procedures and surgeries performed by army surgeons and physicians also left Civil War veterans literally scarred for life. The survival rate for a man going into surgery was roughly eighty percent depending on the location of the wound. The fatality rate was directly related to the proximity of the injury to the core of the body.

Anesthetics, like ether and chloroform, were used for many surgeries which made the procedures much more humane.Though the fear of having to endure surgery invoked great anxiety, the fear of life after surgery was an even greater anxiety to face.

In a society that relied on physical labor for maintaining a livelihood, living without a limb meant a lifetime of unemployment. Farmers, mill workers, railroad workers or dock workers were all required to be physically able to complete the tasks required of them. An amputee could not continue working in the physical labor market. To make matters worse, majority of the men who fought in the Civil War were from lower economic classes. The socioeconomic status of an amputee would have been lowest amongst the ranks partly because there would be very few jobs that could accommodate their special needs. The anticipation of failure to provide for themselves and their families conjured major stress and anxiety.

The biological needs of humans are crucial for both physical and mental health. If humans are bereaved of biological necessities then they are at greater risk of psychological ailments. In war, especially the American Civil War, even the most basic of human essentials, such as food, water and shelter, are unavailable to soldiers putting them at an elevated risk of psychological danger.

Food supplies were frequently limited and insufficient for the amount of calories a soldier would expel. The water was often contaminated with germs making soldiers sick. Septic water is especially dangerous because it carries many diseases like cholera and dysentery. A diary entry by Union soldier Henry Tisdale implies that he got sick from drinking the water at his camp “Unwell today for diarrhea, causing me to feel weak. Think it caused by drinking too much of the aqueduct water we have here.”

Not only were the soldiers on alert for enemy attacks but also had to worry if their next drink or meal was going to make them ill. Due to the insufficient and inadequate food and water, many soldiers did not have the caloric intake needed to support straining activities. Union soldier Cornelius Platter wrote “3 mile to our right and went into camp 8 mile South East of Jonesboro at 8 oclock -- This has been the hardest days march we have had. Distance marched 22 mile.”

A malnourished soldier would have had difficulties executing long endurance orders like this and would have been pushed to the brink of exhaustion. On top of malnutrition, each soldier was subjected to the weather and its unforgiving nature. Evolutionary instinct would be to seek shelter from the elements, but this cannot be done in war. Joseph Waddell from the Indiana Volunteer Division wrote “Off early and marched to Black River a hard rain late in the evening two men killed on the road with lightning.”

Soldiers had very little protection, which would have affected their sense of safety. With unavailable resources and basic needs going unmet, these men were at an elevated risk of developing psychological disorders.

Arguably one of the most intense contributing factors to psychological effects and disorders were the prisoner of war (P.O.W) camps. Some of the most detestable incidences in the war occurred inside these camps. Psychologically, people are put in situations with numerous traumas, such as ubiquitous death, fighting and abuse, making P.O.W camps a minefield for psychological disorders.

Camps like Salisbury, Libby, Douglas and the most notorious Andersonville were overpopulated and did not have proper supplies for the number of prisoners it contained. At one point, Andersonville detained thirty-two thousand men but the original capacity was for only ten thousand men. When Sherman’s soldiers liberated Andersonville, they found some prisoners completely emaciated. At the end of the war when supplies were scarce, rations were withheld. “No rations issued yesterday to any of the prisoners and a third of all here are on the very point of starvation...”

Prisoners would fight, even kill, other prisoners for whatever they might have in their possession that could aid in their survival. “Have just seen a big fight among the prisoners; just like so many snarly dogs, cross and peevish.”

The fight to survive in hellish places like Andersonville, Libby, Salisbury and Douglas was exceedingly stressful. Witnessing the intense trauma of death on a daily basis was more than enough to produce PTSD.

A unique factor of the Civil War was that units were very often created by geographical location. A town’s entire male population, brothers, friends and neighbors, would fight together. A Union soldier from Michigan found the body of his best friend who was shot and killed. During the chaos of battle, the soldier kneeled down to clear the blood off his friend’s face, while bullets and shells exploded around him. He had lost his sense of urgency and experienced heightened arousal level, which put him in physical danger. This is an example of a soldier’s psychological state putting them at physical risk.

This psychological state would be even more compromised when a soldier fought their own kin. The famous motto of the Civil War was Brothers Fighting Brothers. Families were torn apart by this war as brothers would often fight on opposing sides. James and Alex Campbell were two brothers who fought on opposing side. When war broke out, James went to the Confederate Army with the Union Light Infantry also called the 42nd Highlanders and Alex went to the Union 79th Highlander Regiment. At the Battle of Secessionville in eighteen sixty-two, the two brothers were fighting against each other. Not only would losing the support system of a family member be stressful but the thought of intentionally killing a relative would be a severe psychological trauma that could generate PTSD.

Psychological warfare has been a vital part of combat for thousands of years. Biblical writings of Gideon portrayed of soldiers blowing horns, let out a fierce cry and breaking objects as a result the Mindianite soldiers were so beside themselves with fear that they committed suicide. (Judges 7:1-22) The Civil War was no stranger to these psychological tactics.

The phrase “Rebel Yell” originates from the Civil War and was a weapon used to instill fear in the Union soldiers. Similar to the battle cries of the Native Americans, Confederate soldiers would yell, shout or chant certain phrases or noises to invoke fear in their enemies and many times it did its job. The sounds were described anywhere from Indian whooping noises to the shrieks of a wild animal and these yells implored great fear into the Federal soldiers. “....the Union troops were startled by the most hideous of modern war cries, known as the ‘rebel yell’…This was the first time the Vermont boys had heard that fiendish sound, and it is not too much to say that they were appalled by it for a moment, and thought their time had come to be ‘wiped out.” Fear is a great weapon in combat; unfortunately this great weapon is lethal to a soldier’s psyche.

Witnessing an event is just as catastrophic to the psyche as being a victim of a trauma. Many soldiers did not have to experience combat to receive the full effect of war. Thomas Smiley, a confederate soldier, described the horrifying event that he witnessed at the Battle of Chancellorsville to his aunt. “The large brick house at Chancellorsville took fire and burnt up with about two hundred wounded Yankees who were so badly hurt that they could not move and their own soldiers did not help them any. Later in the day the woods took fire and a great many more helpless men perished.”

At the battle of Seven Pines, a Confederate soldier was horrified not by fighting but from what he heard on that day. The soldier, lying wounded on the ground, described the cries and screams for help from the Union soldiers as they lay in the ditches too wounded to move. A heavy rain came and the water had accumulated in the ditches and the wounded men were slowly starting to drown.

Stories like this would find their way back to the small towns and cities, terrifying the men who were eligible for enlistment or conscription. Joseph Waddell wrote of a young man who was sobbing because he was called up by the draft. “I heard a sound of lamentation.... A negro woman informed me that it was a soldier crying because he had to go to the war!... Several men and women stood in the street, some laughing and others denouncing the recruit”.

Severe anxiety plagued the prospective soldiers as the news of the bloodshed and atrocious fighting trickled from the battlefield to home.

The amount of hand to hand combat in the Civil War left soldiers particularly vulnerable to PTSD, depression or any battery of psychological illnesses. This is the last major American war and one of the last major wars in the world to significantly utilize hand to hand combat. After the twentieth century, the technologies gained in World War One, such as planes, bombs and machine guns, did most of the heavy labor. While linear warfare was the fighting style of choice in the Civil War, almost every battle had some form of hand to hand combat . Union Naval Officer William Ferguson testified to Major-General Hurlbut as to what he witnessed when he arrived at Fort Pillow after the massacre “[There were] Bodies with gaping wounds, some bayoneted through the eyes, some with skulls beaten through, others with hideous wounds as if their bowels had been ripped open with bowie-knives…”

This archaic style of fighting is tremendously personal and has exceedingly negative effects on a person’s psyche. To defeat the enemy, one must look into their eyes and take their life. Hand to hand combat is arguably one of the leading causes in the development of PTSD.

The evidence of psychological effects and disorders as a result of combat is clearly illustrated in the suicides of the soldiers. Numerous soldiers took their own lives rather than live to see another fight. Many men wrote home telling their loved ones about the unfortunate souls that would rather die by their own hand then fight for a chance of survival. Jacob Stouffer wrote about his friend Absolam Shetter saying, “he had been in trouble and at times in a State of despondency-this with the troubles and Excitements around us-deranged his mind and on yesterday morning ended his existence by hanging.”

Newell Gleason, a lieutenant colonel, was described as a fearless leader but had experienced nervousness and anxiety after the Atlanta Campaign. Gleason had difficulty sleeping and battled with depression. In eighteen eighty-six, Gleason committed suicide as a result of his time spent in the Union Army. A majority of the suicide victims were Confederate veterans. Besides the fact that they lost the war, the South lost twenty percent of its population. Families were torn apart by this war. Fathers and mothers lost sons, brothers lost brothers and wives lost husbands. The men that were lucky enough returned from war found their homes and lands destroyed. They lost everything. The war and its surrounding events could have thrown the soldiers into a depressive state leading to psychological ailments.

Understanding events and conditions that contribute to PTSD and psychological disorders help to create a mental picture of the soldier’s experiences. These events are correlated to psychological disorders but neither confirm or deny a conclusion. Examining individual soldiers provides insight into the effects of the war. It also makes the connection personal and the event feel real instead of words on a paper. The next three case studies are the smoking gun evidence that there were indeed psychological disorders as a result of the Civil War. More importantly, they were all real people who were once very much alive and they were all victims of something far greater than themselves.

Albert Frank was a soldier in the Union Army. At the Battle of Bermuda Hundred near Richmond, Frank was off the front line and sitting on top of a trench. He offered a drink from his canteen to a fellow soldier sitting next to him. While the soldier was taking his drink, a shell exploded and decapitated the man, covering Frank with blood and pieces of brain. Frank experienced a complete loss of cognitive functioning being unable to speak, communicate or understand his fellow soldiers. He was later found on the floor shaking and making bomb noises. The only thing he would say was “Frank is killed.”

He was taken to the Government Hospital for the Insane in Washington D.C and declared mentally insane. Witnessing such an intense trauma had affected Frank greatly. He was re-experiencing and reenacting the event and he associated himself to the trauma in a negative way saying he was the one killed. These are indicators of post-traumatic stress disorder.

Angelo Crapsey from Potter County, Pennsylvania eagerly enlisted in the Union army in 1861. Early in his military career, a sergeant in his unit committed suicide by placing his rifle between his knees and putting the muzzle in his mouth. This event would have a profound impact on Crapsey. As Crapsey started to engage in combat, his glorified perception of war began to fade away. “Rebels charged on us & we had to run, run for [our] lives…through an open field & we had showers of bullets sent after us.”

Crapsey became more withdrawn and the radiant spirit he possessed prior to the war disappeared. At the Battle of Fredericksburg Crapsey was taken prisoner and he spent time in at Libby Prison. While contained, Crapsey developed a case of lice infestation and frequently tried to rid himself of the pest even after they had subsided. After his release he fought at the bloodiest battle of the Civil War, Gettysburg. Upon his discharged, he returned back home to Pennsylvania were he experienced illusions, involuntary ticks and violent fits. On August 4, 1864, Crapsey said he was going out to hunt but instead stuck a gun in his mouth and shot himself; the same way the sergeant had done three years prior.

Major General Thomas Kane said that he “loved no one of his men more than Angelo. He came up to his ideal of the youthful patriot, a heroic American soldier.” Crapsey embodied the image of the ideal soldier and possessed a luminous spirit that was contagious. Unfortunately, he lost himself in the tremendous force that was the Civil War.

Just like the soldiers in the Great War, Angelo had experienced involuntary ticks and violent fits. World War One soldier’s ticks and fit were attributed to constant bombardment at battles like Verdun and Somme. Angelo fought at Gettysburg, the sight of the largest artillery bombardment in North American History. While the bombs never physically harmed him, they drove him to insanity. Angelo experienced a change in personality, diminished personal relationships, a loss of previous interest, flashbacks, disturbing memories, negative emotions and he associated the negative trauma to himself which created a sense of self hatred. It got to the point where Angelo could not find a way out of his own prison and the only solution was death. Angelo displayed numerous symptoms of post-traumatic stress disorder.

Dr. William Chester Minor was a surgeon in the Union Army for several years. Minor served at various battles including the Battle of the Wilderness, one of the most gruesome conflicts of the entire war. As a surgeon, Dr. Minor had seen the worst that war had to offer. He had experienced delusions and paranoid fits after the war and as a result Minor was diagnosed with soldier’s heart, an early form of PTSD.

In August of eighteen seventy-two, Minor shot and killed a man in the streets of London, England. According to his testimony, Minor claimed he had been experiencing a delusion where he was back on the battlefield and the man was an enemy soldier trying to kill him. The courts found him not guilty by reason of insanity and he was sent to Broadmoor Hospital, a notorious insane asylum in Crownthrone, England. Arguably one the most intrusive symptoms of PTSD are flashbacks. The person is experiencing an illusion or vision of the past trauma. They are essentially re-living the event allowing them to experience it all over again. Minor may have truly believed he was back on that battlefield and was fighting to preserve his life. William Minor’s incident could have been a result of post-traumatic stress disorder from his combat experience.

Did soldiers in the American Civil War suffer from psychological effects and disorders? Through revolutionary weaponry developments, horrific medical procedures, psychological warfare, and the great deal of ferocious hand to hand combat, there appears to be a great deal of evidence for psychological effects in civil war soldiers. The Crapsey, Minor and Frank case studies provide significant evidence of psychological disorders as a result of Civil War combat. With this body of evidence the question can be definitively answered; psychological disorders are present in soldiers of the Civil War as a result of combat and or its attributing factors. Without a shadow of a doubt the Civil War psychologically scarred and damaged its soldiers. Those brave men put their “sacrifices upon the altar of freedom” and endured a fate worse than death by living their lives in silent suffering. The presence of psychological effects and disorders are evident in the soldiers of the American Civil War.

Image: Government Hospital for Insane, Nurses Home, [Washington, D.C.]

From: armstrong.edu

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"Haunted Minds: The Impact of Combat Exposure on the Mental and Physical Health of Civil War Veterans" and "Years of Suffering and Change: Modern Perspectives on Civil War Medicine"

Book Reviews

By Captain Rea Andrew Redd

Haunted Minds: The Impact of Combat Exposure on the Mental and Physical Health of Civil War Veterans, Judith Andersen [143-158 with notes] and Years of Suffering and Change: Modern Perspectives on Civil War Medicine, James M. Schmidt and Guy R. Hasegawa (editors), Edinborough Press, 2009, $29.95 (hardcover), $13.95 (paper).

Judith Anderson introduces her understanding of post-traumatic stress syndrome in Civil War combat veterans with discussion of the disintegration of a veteran's marriage and family. Frank Lang, native German, active duty infantryman, hospital attendant waded through suffering and death while serving in Company K, 7th Michigan in the Army of the Potomac from 1861 to 1865. By 1871, his wife went before a Minnesota judge and testified to the emotional and physical abuse, neglect and abandonment that she and her children suffered at the hands of her husband, Frank Lang. After the divorce was granted Frank Lang disappeared.

Anderson states that from ancient to modern times, whenever humans suffer an extended period of exhaustion, hunger, hard campaigning, and combat, all at the mercy of nature's elements, the likely outcome is psychiatric disorders. Showing no visible wounds but carrying memories that would leave him cross, morose, reclusive, violent and quite willing to bring about the destitution of his wife and family, Frank Lang had changed during the course of the war. The family's neighbors confirmed the wife's testimony to the judge.

Physicians in the Civil war noted that stress reactions included partial paralysis, muteness, intermittent screaming and weeping. Nightmares, flashbacks, anxiety, agitation, irritability, nervousness, unexplained headaches and nausea with no apparent organic orgin stymied doctors understanding. Often, the diagnosis was hysteria and nostalgia. The disorders of paranoia, psychosis, hallucinations, illusions, insomnia, confusion, memory problem's, delusions and spontaneous violence were classified as nervous disorders without known cures. 'Irritable heart' and 'cardiac muscular exhaustion' were the official diagnosis. Malingering was an official medical condition during this era.

In 1862 to settle pension issues the government had to distinguish between the malingering soldier from the soldier with an organic disease the symptoms of which were malingering. In order to avoid paying pensions to soldier feigning illness, pension bards set procedures for investigating claims. A government examiner whose first criteria as the record of physical wounding. If a wound was not present, then affidavits from clergy, relatives and neighbors had to be submitted. These affidavits recounted the soldiers behavior before and after military service. If a significant change was discovered then the possibility of a pension was considered. Examining physicians were named to objectively interview the veteran. Multiple examinations were sometimes needed to form a consensus by the examining board of doctors.

The heritage of Civil War medicine is the reliance on objective evidence for a diagnosis of a nervous disease and the development of a process to collect medical records. The chief advances as they relate to the diagnosis of mental illness were few but essential for the growth of psychiatric medicine.

From: civilwarlibrarian.blogspot.com

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One Too Many: Civil War Suicide Estimates

By David Silbey, chronicle.com
 

Christopher Frueh and Jeffrey Smith recently attempted to estimate the military suicide rate during the American Civil War. They did this, in part, because the current military suicide rate has been going up rapidly during the last decade of constant war, and there is little historical data to which to compare it:

Suicide rates and post-traumatic psychopathology among U.S. military personnel have risen dramatically since 2001. We have little understanding of historical context to indicate whether this is a typical outcome of war, apart from Durkheim’s (1951) conclusion from 1897 that suicide rates tend to decline during the active phases of war. Data gathered by the U.S. Government during the Civil War provide a conservative estimated suicide rate among active-duty Union Forces of 8.74–14.54 per 100,000 among white troops during the war. In the year after the Civil War ended, the suicide rate for the small percentage (17.6%) of white forces that remained on active-duty climbed to 30.4, though it is unknown how representative these troops were to the larger group that had been discharged from military duty….In the final year of the war, when casualties were the highest, the suicide rate for white and black troops combined was 10.35. This is comparable to the rate of 11 among U.S. forces in 2001 at the start of the wars in Afghanistan and Iraq, although quite a bit lower than the current rate of roughly 20.

The conclusion: Thus, any way we view it, current suicide rates in the U.S. military are probably two to three times higher than those documented during the Civil War.

The authors acknowledge a few data problems, including collection issues and a 19th century naivete about depression and suicide, but miss a few other problems. For example, when they talk about racial differences in suicide rates– “Among black troops the suicide rate in their first year of official duty (1863–1864) was 17.7, dropping to 0 in the next and final year of the war” –the authors show no sense that it is quite likely that black suicides were tracked and recorded at a much lower rate than white suicides because of racism. Instead, they argue that it fits with “Durkheim’s (1951) conclusion that whites generally had much higher rates of suicide than blacks during the Nineteenth Century.” Possibly, but a suicide rate of zero for black troops in 1865 seems highly unlikely. The other issue is that the Civil War lasted a much shorter time than have the wars in Iraq and Afghanistan, with shorter enlistments (add in the difference between the current long-service force and the Civil War’s mix of volunteers and conscripts), and many of the Civil War soldiers may have been out of the service when they committed suicide and thus were not caught in the official tally that Frueh and Smith used.

Having said all that, however, even if the Civil War rate was substantially higher than Frueh and Smith have found and might even have been near the current rate, it’s not good news that American soldiers, sailors, and marines are killing themselves at such massively high levels. Wars aren’t limited to battlefields, and casualties aren’t, either.

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A Burden Too Heavy to Bear: PTSD, Suicide, and the Civil War

From: opinionator.blogs.nytimes.com

By Diane Miller Sommerville

In late December 1861 Northern newspapers buzzed with rumors about a high-ranking Confederate officer who had committed suicide. Within days the victim was identified as Philip St. George Cocke, one of Virginia’s wealthiest and largest planters. Cocke, a West Point graduate, had been appointed commander of Virginia’s state forces by Governor John Letcher in the earliest days of hostilities. He lost his coveted rank of brigadier general, however, when Southern state militias were folded into the Confederate Army.

Although he received a promotion to brigadier general after the First Battle of Bull Run, Cocke never recovered from being demoted to colonel and felt that his battlefield successes were not sufficiently acknowledged. The perceived slights, on top of the strain of war, combined to take a huge toll on Cocke’s psychological and physical health. He retreated to his plantation a broken man, and on the day after Christmas 1861, he shot himself in the head with a pistol.

Cocke may well have been the highest-ranking Confederate soldier to die by his own hands during the Civil War, but he was not alone. The historical record is peppered with cases of soldiers, Northern and Southern, taking their own lives. While most suicides likely occurred as a consequence of what was then called “battle shock,” quite a few took place in camp, even before being shipped off to the front.

The Richmond Dispatch, for example, reported that a soldier identified only as E. White committed suicide while in camp near Savannah, Ga., in October 1861. The grandson of Kentucky Senator John Crittenden, a 26-year-old private named Coleman, who was attached to the 1st Florida Regiment, cut his throat in late August 1861 while stationed near Pensacola. No explanation was offered other than he had been “under a state of mental derangement.” A prominent lawyer from Mobile, Ala., had enlisted in one of the volunteer companies formed in that city in early summer 1861; he, too, slit his throat while making his way to the front.

None of these Confederate soldiers left a suicide note, so it is impossible to know with certainty what drove each to commit such a rash act. While it is entirely possible that non-war related factors – pre-existing conditions or an unstable home life, for instance – contributed significantly to their deaths, war and one’s looming participation in it, the common thread in all these suicides, almost certainly proved the decisive factor. But the question remains: why were so many of them Southern? Was there something about Southern society that, combined with the stress of war, made suicide more likely? And what effect did so many suicides have on a society that before the war had roundly, even punitively, condemned the act?

Each suicide is a thing unto itself, but we can offer a few conjectures. Importantly, men, especially white men in the South, well understood the expectations Victorian society demanded of them in wartime. Honor and duty required their martial participation. So in the wake of the firing on Fort Sumter and Lincoln’s call for troops, Southern white men heeded their new nation’s call to arms and flocked to recruiting stations.

The “Boys of ’61” were pulled into military service by rage militaire a sense of adventure, but they were also pushed into service by patriotic womenfolk who, despite reservations, implored their husbands and sons to enlist. To resist would raise questions about one’s manhood as well as commitment to nation. Consequently, thousands reflexively rushed off to war without much deliberation or contemplation.

As Southern recruits mustered in camps, the reality of what they faced set in. While many a green soldier longed to “see the elephant” – a colloquial term referring to engaging in battle – eagerness often gave way to anxiety and a plethora of fears: of dying, of killing, of failure, of the unknown. If any of those fears were made manifest, a soldier’s courage would be called into question, as appears to have been the case with Charles Robinson, a member of the newly constituted Independent Scouts of Mobile that was mustering in June 1861. When fellow recruits accused him of being a coward, Robinson retorted that he would show them how a Roman could die, then plunged a knife into the carotid artery in his neck.

While most new soldiers punched through that initial reservation and persevered, some became emotionally paralyzed in battle and ultimately unable or unwilling to fight. Take the case of Capt. Christopher Fisher of the newly formed Petersburg Cavalry, a “man of high social position at home.” Fisher first began to show signs that he was “laboring under mental aberration” as his company faced battle near Pig Point, Va., in the early weeks of hostilities. According to a newspaper account, Fisher had become “depressed in spirit” after recognizing that this company was about to be “cut to pieces by the enemy.”

Sympathetic officers and enlisted men, apprehending his weakened state of mind, persuaded him to leave his post and return home. Fisher complied, but en route he drew a pistol, shot himself and sustained an injury that felled him from his horse. He stumbled, ran a short distance, then shot himself again, through the head, dying a few minutes later. Suicide permitted the young captain to escape the taint of cowardice that surely would have followed him had he lived, just as it spared him the pain of facing loved ones as a man who had failed the battlefield test.

Suicide in the antebellum South, as in the rest of the nation, was roundly condemned in moral and religious terms. Protestant and Catholic theology decried suicide as a mortal sin, while laypeople often equated the act with cowardice and selfishness. Ministers railed against the act as an encroachment on God’s authority. Preachers admonished parishioners to follow the example of the long-suffering Job, who patiently endured endless personal suffering. And while the legal remedies to punish suicide victims had largely disappeared from American practice – namely, forfeiture of the suicide victim’s inheritance to the state – the stigma surrounding suicide steadfastly remained at the outbreak of the Civil War.

Indeed, the war stands as an important turning point in the way Southerners came to view suicide and helped usher in a more tolerant, sympathetic attitude toward those who died by their own hands. Consider the newspaper coverage of the death of Captain Fisher. We learn that Fisher “was greatly beloved by his company,” members of whom believed he was a brave man. Excessive concern for his company, not fear or shame, the newspaper explained, had caused Fisher to end his own life.

General Cocke, too, had been eulogized in similar fashion. The Richmond Enquirer even equated Cocke’s suicide with a battlefield death by proclaiming him a “martyr to his patriotism as if he had fallen in the field of battle.” Readers were assured that his “heart and soul were thoroughly enlisted in the noble cause of Confederate independence.” The Richmond paper further vindicated Cocke by denying he bore blame for the self-murder, explaining that he had shot himself while “under the impulsion of a mental aberration that extinguished all responsibility.”

Sympathetic responses extended to enlisted Confederate soldiers as well as officers. On Dec. 14, 1861, for example, the Richmond Daily Dispatch, reported on yet another soldier suicide, this one from the 9thSouth Carolina Regiment. While friends were at a loss to explain why Burgess killed himself, the newspaper surmised that he was “tired of life and had concluded to try the realities of another world.” Noting that this was the second such suicide in a few days, the newspaper abhorred “such deplorable waste of life.” The piece further opined that “men in war become more reckless of their lives and attempt, through a mistaken notion, to relieve themselves of a burden too heavy to bear.”

Another measure of changing attitudes toward Civil War victims of suicide can be seen in the public sympathy victims received after their deaths. The lawyer from Mobile who cut his throat en route with his company to the front was accorded considerable respect following his suicide. Two companies escorted his coffin to the cemetery for burial, where he received military honors. The Knoxville Register reported that “a large number of our citizens” attended the funeral, which was presided over by a minister, suggesting at least some religious rituals were observed. Similarly, a military detachment accompanied the remains of Thomas Stringham, a 22-year-old German Virginia man who killed himself while encamped near Norfolk with his company in October 1861. In a display of community reverence, members of the Norfolk Tailors Society appeared at burial-site services.

If some Southerners expressed compassion and support for soldiers who died by their own hands, others failed to make the connection between suicidal behavior and wartime experiences. Modern observers, many of whom witnessed American soldiers returning from Vietnam, Iraq and Afghanistan, are keenly aware of the possible contribution of trauma experienced in war to mental illness. But 19th-century Americans had no such understanding that exposure to battle sometimes resulted in psychiatric breakdown or debilitation.

Consequently, when a soldier (or, after the war, a veteran) developed severe signs of mental distress including suicidal tendencies, the causal connection to his military duty eluded many people, even family members and professional caretakers. As was common before the field of psychiatry matured, social pathologies like alcoholism were confused as a cause, not a symptom, of mental illness. Consequently, bystanders trying to explain why “a poor unfortunate soldier” attempted suicide in June 1862 said he had been made “delirious from liquor.” Likewise, masturbation was to blame for Joseph Henderson’s violent threats to himself and others, not his stint as a soldier in “Price’s Army” in Missouri or the “many fatigues” he had undergone there.

The stories of Confederate soldiers who attempted or committed suicide get us closer to a full accounting of the personal costs of the Civil War. Losses in dead, wounded and treasure have been well-documented; individual suffering, less so. And while suicides occurred among Union soldiers, there is evidence to suggest suicides occurred more frequently in the South during the war and following the defeat and collapse of the Confederacy, as broken soldiers returned home burdened with combat stress as well as the herculean task of rebuilding themselves, their families and the region.

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