In the last ten or so years there have been a nice handful of books written about the immediate and lingering effects of illness, wounding, and trauma on the men who fought in the Civil War. Dillon J. Carroll has written an excellent addition to this group with his Invisible Wounds: Mental Illness and Civil War Soldiers. As each new book on this subject is published, the information becomes more accurate, and Carroll’s book offers further information about Post Traumatic Stress Disorder. PTSD should not be seen as a “catch-all” diagnosis for any condition possibly resulting from combat. Instead, it has specific criteria for diagnosis and can result from experiencing any life-threatening situation. Because it is almost impossible to gather specific information from long-dead soldiers, author Carrol has carefully chosen his examples of letters and diaries. Only those referring to PTSD–identified experiences (dreams and flashbacks that are specifically event-related, suicidal ideation, attempted self-medication with drugs or alcohol, and a personality change defined by episodes of anger or irritability) indicate PTSD.
Invisible Wounds examines possible causes for Civil War veterans to be referred to a mental health facility such as St. Elizabeth’s in Washington or the Milledgeville Insane Asylum in Georgia. These include reasons that cannot be classified as PTSD, such as chronic alcoholism. The opportunities for soldiers to drink were both medicinal and social. Apparently, many who did not have any alcohol habits before the war soon developed them. Morphine and alcohol were used in hospitals as pain medication, and many men left the service with well-developed dependencies on both drugs and alcohol. Another issue was venereal disease. Syphilitic dementia was a problem difficult to diagnose. Soldiers were not forthcoming about whether they were infected or not, and until 1943, the disease was incurable.*
The primary reason for a veteran of the Civil War to be sent to a mental hospital was the veteran’s inability to conduct himself within society. If he could not keep a job, his family was often indigent. It might be possible for relatives to offer a home to a wife and children, but not necessarily to a veteran who had difficulty controlling himself. There was often physical abuse within the family. Also, veterans who had no family were sometimes seen as a dangerous nuisance to a community. Because of this, they were often committed. Many came from soldiers’ homes created at the state level to house and care for Civil War veterans who could no longer live within those confines for various reasons.
All in all, author Carroll presents a sad condition for these fellows. It was worse for Confederate veterans, who did not always have access to pensions, homes, or caregiving facilities. The reasons for fighting in the first place are also discussed as part of the contribution to mental illness. Dillon Carroll does an excellent job of “threading the needle” when he shows, from letters, diaries, and recorded conversations, that losing the war and returning home to poverty and despair was a factor in the mental illnesses of many Confederates. By contrast, Union men came home able to declare themselves winners. The things they had fought for were seen as being on the correct side of history. Their coping mechanisms were supported by the resources offered to them by their families and communities; more jobs, more education, and more opportunities awaited their return.
One of the most compelling parts of Invisible Wounds is Carroll’s analysis of African American veterans and mental illness. Rarely did a person of color end up in any care facility before the 20th century. Even today, there is a resistance to seeking out available mental health resources within those same communities. Few veterans of the U. S. Colored Troops ever entered any mental hospital. If Federal soldiers saw themselves as winners, Carroll asks readers to see the mental status of black soldiers as even more “winning.” Not only were they on the successful side of the war, but they also gained their freedom. Offered as “a principal reason” for the low numbers of black veterans who became mentally ill after the war is:
…the war was a far less ambiguous experience than for their white comrades in arms. While the results of the war during Reconstruction and beyond were far from perfect, these men had been instrumental in the destruction of slavery and the brief flowering of racial liberty in the South. Despite the challenges they faced–such as pay discrimination and racism in the ranks–African Americans often relished their role as soldiers of freedom.
Invisible Wounds: Mental Illness and Civil War Soldiers takes its place among such volumes as Aberration of Mind: Suicide and Suffering in the Civil War-Era South (Sommerville), Pathway to Hell: A Tragedy of the American Civil War (Brandt), Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War (Dean, Jr.), and Nature’s Civil War: Common Soldiers and the Environment in 1862 (Shively). As progress is made in the mental health field, the information in these books continues to change, building upon each previous offering. If this trend continues, we will finally begin to understand what military veterans, including those of the American Civil War, endured.
*In 1943, penicillin was introduced as a treatment for syphilis by John Mahoney, Richard Arnold, and AD Harris of the US Marine Hospital, Staten Island.