Did Civil War Veterans have PTSD?: Part I
Did Civil War veterans suffer with PTSD in the years following Appomattox? The short answer: probably. For the long answer, I'm writing two blog posts. The first will argue against Civil War veterans having PTSD. The second will argue for Civil War veterans having PTSD. I leave it up to readers to ponder the evidence and make their own conclusions.
First, what is PTSD? Post-Traumatic Stress Disorder was an anxiety disorder—now a traumatic disorder—first added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. The DSM is the bible for psychiatrists, an inventory of two hundred named mental disorders categorized based on shared features. Today PTSD is a cluster of symptoms that can follow in the wake of a traumatic experience “outside the range of normal human experience.” These experiences can include accidents, natural disasters, rape, and war. Sufferers of PTSD experience essentially four sets of symptoms. The first set of symptoms is hyper vigilance and hyper arousal. Those afflicted with PTSD are often on high alert to stressors that trigger the feelings, memories or thoughts of the original trauma. Moreover, they are prone to extreme arousal, such as perceiving danger in otherwise normal situations, mood changes, unusual anger and aggression, and sleep disturbances. The second symptom is avoidance of stimuli that might trigger those feelings, memories or thoughts of the trauma. To do this, those afflicted with PTSD will often suppress thoughts, isolate themselves, or turn to alcohol or drugs to self-medicate. The third symptom is emotional numbing. Those with PTSD feel dead to the world, like they care for nothing anymore. They experience a decreased interest in activities that they previously enjoyed, and they often have extremely negative thoughts and feelings. And finally, and most importantly, PTSD affects time and how its victims experience time. Sufferers are prone to intrusive nightmares, flashbacks and hallucinations of the traumatic event, in crystal clear clarity. In his new memoir, In the Evil Hours, David Morris describes PTSD essentially as a disease of time. This is the defining experience of PTSD, what sets it apart from other disorders. Most people experience time as linear. PTSD distorts the linear progression of time, trapping victims in an almost hallucinogenic circular experience of time. PTSD forces people to compulsively return to a traumatic moment, through nightmares, flashbacks and hallucinations.
Scattered evidence of soldiers suffering with psychological problems in the wake of combat exists as far back as the Peloponnesian War, but the twentieth century proved to be a sea change for the awareness of combat related disorders. The World Wars witnessed unprecedented mass mobilization of millions of soldiers, as well as mechanized, industrial slaughter on a level that was previously barely even imaginable. An estimated 10 million soldiers would die in WWI (the casualties of the Battle of Verdun in 1916 exceeded the casualties of the entire American Civil War). The level of artillery fire gave rise to "shell shock," a condition that physicians then believed was due to the concussive blasts on the spine and nervous system which could result in frightening psychiatric symptoms. Once home, many soldiers re-experienced terrifying memories through nightmares, such as British soldier Siegfried Sassoon, who wrote while convalescing in a hospital: “And when the lights are out…then the horrors come creeping across the floor: the floor is littered with parcels of dead flesh and bones. Yet I found no bloodstains there this morning.” British veteran Robert Graves recalled when he returned home he “was still mentally and nervously organized for War. Shells used to come bursting on my bed at midnight, even though Nancy shared it with me; strangers in the daytime would assume the faces of friends who had been killed.”
An estimated 50 million died in WWII. Instead of shell shock, psychiatric trauma during WWII was frequently diagnosed as “combat exhaustion” or “combat fatigue.” American G.I. E.B. Sledge remembered watching men who were evacuated with psychiatric trauma fighting the Japanese in the Pacific. Sledge found these cases “distressing” and noted that their reactions ranged from “dull detachment” and “quiet sobbing” to “wild screaming and shouting.” 314,500 men were discharged due to psychiatric symptoms in WWII, which constituted 43 percent of all men discharged for medical reasons. The psychological effects of war on the “greatest generation” are shrouded in secrecy, because as writer Karl Shapiro wrote, it was also a “generation of silence.” The WWII generation went to war on the heels of the Great Depression, imbued with a social milieu that stressed stoic silence. People had little tolerance for those who complained, especially about emotional or mental problems. So the GI’s who came home from Berlin or Tokyo stayed quiet about the effects of war on their minds. The emotional toll of the war remained shrouded in secrecy. “I believe, as I’ve never believed in anything else before,” wrote J.D. Salinger in one of his early stories, “that it’s the moral duty of all men who have fought and will fight in this war to keep our mouths shut, once it’s over, never again to mention it in any way.”
In 1974, the Council on Research and Development of the American Psychiatric Association (APA) began the early work on a third edition of the DSM. A sympathetic group of veterans, psychiatrists, writers and family, lobbied the APA to include a task force on “Vietnam Syndrome.” This "syndrome" affected a distressing number of veterans of America's war in Vietnam, who came home noticeably angry and agitated, suffering with high rates of insomnia, substance abuse, and intrusive nightmares of combat. In 1979, the American Psychiatric Association approved the final draft of what became the DSM-III. Included in the new edition, was Post-Traumatic Stress Disorder.
Part of trauma's attraction, argues writer David Morris, is its mystery. There is still much we don't know about PTSD. Why for instance, does one veteran develop PTSD, while another member of his/her unit who saw and survived the same experiences never develop the disorder? And while PTSD is the most current iteration of a long line of combat related disorders, we simply don't know how medicine and psychiatry will change and evolve in the future. It could be (and likely will be) that there are mysteries of trauma and PTSD that future scientists and psychiatrists will uncover. In ten or fifteen years, we will likely understand PTSD much differently than we do at this moment today. It could be (though I believe unlikely) that we are totally wrong altogether.
That being said, PTSD is (I believe) a real condition and can affect combat veterans, as well as survivors of rape, natural disasters, and violent accidents. But is PTSD timeless? Did it affect Patriots and Loyalists, Billy Reb and Johnny Yank, American Doughboys and G.I. Joe's in the same way it can affect contemporary American veterans? One thing I believe for sure, medicine and psychiatry are not timeless. They are intimately intertwined with the times, the culture and the society in which they exist. People understand their mind and body, in part, socially and culturally, as well as medically. And in the Civil War Era, the social and cultural landscape was perhaps not conducive for the belief and acceptance of PTSD.
Soldiers who volunteered for the war in 1861 came from a completely different world than ours. Their world was harsh, and they were a hard generation, tempered by the constant presence of death. As scholars such as Mark Schantz have argued, the horrors of war were perhaps not as shocking to the Civil War generation because their experiences and their world view steeled them against the depravities of war. Consequently, Civil War veterans were less likely to have suffered with PTSD. Civil War soldiers came from a world where death was always close at hand. Most of the major medical advancements—Joseph Lister’s discovery of antiseptic surgery and Robert Koch’s discovery of bacteria—were years in the future.
Consequently, childbirth and childhood were still very risky and mortality was high. Every parent had a dead son or daughter, every child a dead brother or sister. Moreover, epidemics erupted in major American cities on an almost annual basis. Residents of such cities as Philadelphia, Charleston, and New Orleans lived in almost annual fear of yellow fever. Citizens remembered particularly bad epidemics, when jaundiced victims lay piled in the streets and the gutters were awash in black vomit. Cholera, once thought to be only an Asiatic disease, struck American cities with terrible fury in 1832 and again in 1848, claiming thousands of victims in New York, St. Louis, and Cincinnati. Additionally, Americans had an almost routine relationship with tuberculosis, which wasted away thousands every year. The prospect of death, then, was less shocking for nineteenth-century Americans than today.
Additionally, nineteenth-century Americans could face death with “resignation and even joy” because they “carried in their hearts and heads a comforting and compelling vision” of life after death. A majority of Americans fervently believed that for those who were faithful, resurrection and eternal life awaited. In their minds, heaven offered bodily resurrection, a family reunion, and a place without strife or bloodshed. This vision led many to triumphantly march off to their potential deaths convinced that they would be reunited with relative—living and dead—in the Kingdom of Heaven. “If I should fall, my dear, grieve not for me,” wrote Shepherd Pryor to his wife Penelope. “Be assured that I die in the faith and hope of a crown of glory that awaits me above where there will be no more wars or trouble of any kind. I want you to meet me there, and there be no parting there, where all will be peace and happiness beyond the human mind to comprehend.”
Americans were familiar with the classics of the ancient world, and they were regular subscribers to the western notion of the citizen-soldier. As Edward Ayers observed, Americans “knew the stories of the ancient world, of the Spartan soldiers and their women. People knew how they were supposed to act in times of war and crisis. People followed the scripts and took great pleasure in speaking the lines they already knew.” Americans’ could recite Pericles funeral oration, or tell the story of the deaths of Leonidas and his three hundred Spartans at Thermopylae. They believed that for a man to achieve full citizenship he must be willing to lay down his life for the state. And for those who did make the ultimate sacrifice on the altar of their nation, eternal glory awaited. “I am determined to fight if there is any done, as I had rather die on the battlefield than live and see my country needing my services,” Tom Dowtin wrote to his sister. “I am ready and willing to devote my all to my country.”
On top of all of this, the Civil War generation held different notions of trauma. They did not generally believe that warfare could psychologically damage its participants. Indeed, as Allan Young has argued, the notion of a traumatic memory—the foundation of modern combat related anxieties—did not exist until the late nineteenth century. Psychological professionals of the period sometimes actually believed that combat could be a balm for mental illness. Writing to the trustees of the Maine Insane Hospital in 1863, the Superintendent of the institution marveled at how few admissions there had been since the war began. “There were fewer admissions to the Maine Hospital in 1862 and 1863 than during any equal period for ten years previous,” he wrote. The Superintendent argued that Maine citizens had found a distraction from mental illness “in the new and unusual occupation which has so thoroughly possessed the American mind since 1861” and in the awakening of “that wholesome principle in man, the love of country.” They simply did not know that fighting in combat could be mentally destructive to soldiers.
Soldiers of the American Civil War were socially and culturally much more prepared for war, violence and death than twentieth and twenty-first century soldiers. That is not to say that contemporary soldiers and veterans are weaker than their nineteenth century forebears. Simpy put, for nineteenth century Americans, death was an inescapable reality. People thought about death, prepared for it, memorized the rituals and rites to be performed. They saw dead bodies, washed them, took daguerreotypes of them, buried them. Consequently, the death and destruction of the war was less shocking for them. Nineteenth century Americans held more fervent and unquestioned beliefs about the afterlife, and most believed not only in spiritual resurrection, but also that God controlled all events on Earth. They also held different notions of citizenship. Like Cincinnatus of Roman times, men were required to defend their country even if it claimed their life. And medically, Americans were bombarded with a variety of ideas about the relationship of trauma and mental health. Most believed that trauma was purely physical, not mental. This social and cultural landscape helped many Civil War soldiers cope with the grim realities of soldiering.
Part II will argue why Civil War veterans may have indeed suffered with PTSD.
 Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington: American Psychiatric Association, 2013), 271-280.
 Rupert Hart-Davis, ed., Siegfried Sassoon Diaries, 1915-1918 (London: Faber and Faber, 1983), 161.
 Robert Graves, Goodbye to All That (New York: Vintage Press, 1958), 288.
 William C. Menninger, “Psychiatry and the War,” Atlantic Monthly 176 (November 1945): 110-114; Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997), 154-181; Kenneth D. Rose, Myth and the Greatest Generation: A Social History of Americans in World War II (New York: Routledge, 2008), 30-34.
 E.B. Sledge, With the Old Breed: At Peleliu and Okinawa (New York: Oxford University Press, 1990), 264.
 Kenneth Slawenski, J.D. Salinger: A Life (New York: Random House, 2012), 185.
 Paul Fussell, Wartime: Understanding and Behavior in the Second World War (New York: Oxford University Press, 1989), 134
 Mark S. Schantz, Awaiting the Heavenly Country: The Civil War and America’s Culture of Death (Ithaca: Cornell University Press, 2008), 2-9; Christoph Gradmann, Laboratory Disease: Robert Koch’s Medical Bacteriology (Baltimore: The John Hopkins University Press, 2009), 1-7.
 J. Worth Estes, “Introduction: The Yellow Fever Syndrome and Its Treatment in Philadelphia, 1793,” in J. Worth Estes and Billy G. Smith, eds., A Melancholy Scene of Devastation: The Public Response to the 1793 Philadelphia Yellow Fever Epidemic (Philadelphia: College of Physicians of Philadelphia and the Library Company of Philadelphia, 1997), 1-7; Jo Anne Carrigan, “Yellow Fever: Scourge of the South,” in Todd L. Savit, ed., Disease and Distinctiveness in the American South (Knoxville: The University of Tennessee Press, 1988), 55-60; Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, 1987), 1-8; Nicholas Marshall, “The Great Exaggeration: Death and the Civil War,” The Journal of the Civil War Era, 4 (March 2014): 3-27.
 Schantz, Awaiting the Heavenly Country, 38; Jason Phillips, Diehard Rebels: The Confederate Culture of Invincibility (Athens: The University of Georgia Press, 2007), 9-21; Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (New York: Alfred A. Knopf, 2008), 6-9; Shepherd Pryor to Penelope Pryor, August 17, 1861, Shepherd Green Pryor Papers, Hargrett Rare Book and Manuscript Library, University of Georgia, Athens.
 Edward L. Ayers, In the Presence of Mine Enemies: War in the Heart of America, 1859-1863 (New York: W.W. Norton & Company, 2003), 150-151; Tom Dowtin to his Sister, April 30, 1861, Civil War Collection, 1860-1865, Box 3, Folder 10, Manuscript, Archives, and Rare Book Library, Emory University.
 Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton: Princeton University Press, 1995), 4-6; Carol Reardon, “Lost in Jomini’s Silence: The Human Factor in War,” in Carol Reardon, With a Sword in One Hand & Jomini in the Other: The Problem of Military Thought in the Civil War North (Chapel Hill: University of North Carolina Press, 2012), 13-14; Gerald N. Grob, The Mad Among Us: A History of the Care of America’s Mentally Ill (New York: The Free Press, 1994), 58-65; “Report of the Trustees of the Maine Insane Hospital,” American Journal of Insanity 2 (October 1864), 229.