Haunted Minds: The Impact of Combat Exposure on the Mental and Physical Health of Civil War Veterans, Judith Andersen [143-158 with notes] in 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.