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Invisible Wounds: PTSD, the Civil War and Those Who "Remained and Suffered"

Editor’s Note: WSKG has asked faculty and graduate students in the History Department at Binghamton University to explore the history behind PBS’s new drama Mercy Street. In today’s blog post, graduate student Jonathan Jones discusses how historians are just beginning to understand how PTSD may have affected Civil War veterans.

Invisible Wounds: PTSD and the Civil War

The Civil War was the greatest health crisis in American history. Some 750,000 soldiers died, and another 500,000 were wounded or maimed. From violent bullet and bayonet wounds, results of poor medical care like gangrene and infection, or debilitating illnesses like dysentery and malaria, the bodies and minds of those who survived the Civil War were scarred in a myriad of ways.

For decades after the war’s end, thousands of survivors carried reminders of their wartime experiences with them in the form of amputations. These visible scars came to symbolize wartime service in the American imagination. However, equally as present and potent for Civil War survivors were the invisible wounds they carried home. 

The Case of Tom Fairfax and "the War"

In Mercy StreetTom Fairfax, a Confederate soldier being treated at Mansion House, embodies these invisible wounds. Tom appears physically unwounded, but suffers from severe hallucinations, forcing Dr. Foster to treat him with opium. As Tom's case shows, psychological wounds related to combat debilitated many soldiers long after the adrenaline of battle left their bodies and their physical wounds healed.In episode one, Tom tells his friend Emma Green, “[the doctors] don’t understand what’s wrong with me.” The moment pointedly reminds us that these mental wounds were often misunderstood.

Like Tom, many who survived the Civil War suffered profound mental wounds from what they saw, felt, and heard. Civil War-era doctors tended to interpret symptoms like Tom’s as signs of “cowardice.” This often lead to the stigmatization of those afflicted with mental illnesses as a result of their wartime service.Other healthcare providers, without the benefit of modern psychiatry, struggled to describe what they suspected was connected to wartime suffering. Names like “combat fatigue,” “sunstroke,” “mania,” “melancholy,” “neuralgia,” "soldier’s heart,” and “irritable heart” recorded in hospital records bear witness to doctors’ attempts to diagnose and treat the hallucinations, flashbacks, and other symptoms of their patients.In the decades after the war, physicians at some asylums used an even more compelling descriptor to name this invisible illness, calling it simply — “the War.” 

A New Understanding

In recent years, historians have paid increasing attention to cases like Tom’s. Influenced by contemporary events like the wars in Afghanistan and Iraq, the historical and medical communities now better understand the psychological toll of combat upon the brain and mind. Historians are increasingly convinced that many who lived through the Civil War suffered what was once thought to be a modern condition – post-traumatic stress disorder (PTSD).Civil War combat caused traumatic mental illnesses in many survivors after the war. What historian Drew Gilpin Faust has called the “work of death” had the potential to impact anyone who witnessed Civil War carnage. Because American civilians had never witnessed a war of the scale and magnitude of the Civil War, they had never faced the psychological consequences of such widespread destruction. Americans at the time were not prepared to cope with veterans afflicted with PTSD.As the war went on, however, many realized that the soldiers, nurses, and civilians who survived battles, hospitals, and prison camps suffered in non-physical ways. Healthcare networks at the family, state, and federal levels struggled to cope with the high numbers and intense nature of trauma-related mental illness among veterans.

Historians who study post-Civil War era healthcare have documented widespread symptoms that indicate PTSD was on the rise after the war. The postwar North and South saw spikes in suicides and divorce rates. In addition, asylums and soldiers’ homes were overwhelmed with surging admissions.As depicted in Mercy Street, many doctors tried to treat their patients with opium and morphine, resulting in widespread addiction among veterans in the decades after the war. Doctors and nurses at the time noted these trends, but struggled to understand their causes and meaning.

Challenges for Historians

By analyzing the records of hospitals and institutions, historians now understand that some Civil War soldiers suffered from PTSD and that the health crisis of the war was more profound than previously thought.Still, several challenges remain as historians try to realign the history of the Civil War to account for its psychological consequences. For one, privacy laws in some states make it difficult for historians to access the Civil War-era medical records needed to pursue further research on PTSD.Nineteenth-century soldiers, their relatives, and physicians also lacked a single descriptor for the symptoms of PTSD; as a result, historians have to decipher outdated language in hospital and pension records, letters, and memoirs.Lastly, as today’s controversies over veterans’ healthcare remind us, mental healthcare providers still struggle to detect and effectively treat PTSD among combat veterans. As a better clinical definition of PTSD emerges, historians continue to revaluate areas of the Civil War that were once thought to be settled in the history books.

Civil War combat is often romanticized in popular accounts of the war, causing its darker side to be overlooked. This makes Tom Fairfax an especially striking and important example in popular culture of how survivors fared mentally after the smoke of the Civil War faded.His struggle to heal was the struggle of many who, as Walt Whitman described, “remained and suffered.”  Read our previous blog posts about Mercy Street.

Sources:Michael C. C. Adams, Living Hell : The Dark Side of the Civil War. 2014. Johns Hopkins University Press, 2014.Dennis W. Brandt, Pathway to Hell : A Tragedy of the American Civil War. Lehigh University Press, 2008.David T. Courtwright, “Opiate Addiction as a Consequence of the Civil War,” Civil War History 24, no. 2 (June 1978): 307-438.Eric T. Dean, Jr., Shook Over Hell : Post-Traumatic Stress, Vietnam, and the Civil War. Harvard University Press, 1999.Drew Gilpin Faust, This Republic of Suffering : Death and the American Civil War. Alfred A. Knopf, 2008.Brian Matthew Jordan, Marching Home : Union Veterans and Their Unending Civil War. Liveright Publishing Corporation, 2014.James Marten, Sing Not War : The Lives of Union and Confederate Veterans in Gilded Age America, University of North Carolina Press, 2011.Jeffrey W. McClurken, Take Care of the Living : Reconstructing Confederate Veteran Families in Virginia. University of Virginia Press, 2009.Matthew Warshauer and Michael Sturges, “Difficult Hunting: Accessing Connecticut Patient Records to Learn about Post-Traumatic Stress Disorder during the Civil War.” Civil War History 59, no. 4 (2013): 419-52.

Jonathan Jones is a first year Ph.D. student at Binghamton University. He studies 19th century U.S. History and the history of medicine and the body. His current research project is an attempt to quantify how widespread combat-related mental illness was after the Civil War in the National Home for Disabled Volunteer Soldiers (NHDVS).  The NHDVS was a major effort by the Federal Government to support Union veterans after the war and a precursor to the VA’s healthcare system.