Invisible Wounds

Reviewed by: Invisible Wounds: Mental Illness and Civil War Soldiers by Dillon J. Carroll Frances M. Clarke (bio) Invisible Wounds: Mental Illness and Civil War Soldiers. By Dillon J. Carroll. (Baton Rouge: Louisiana State University Press, 2021. Pp. 368. Cloth $45.00.) In Invisible Wounds, Dillon Carroll provides a judicious, interesting study of the trauma resulting from America's Civil War. He starts out by acknowledging that severe psychological breakdown among soldiers was not the norm. Enlistees employed a variety of successful strategies for coping with the exhausting marches, epidemic disease, and terrors of battle that ranged from religious beliefs and self-care to straggling, humor, and camaraderie, while Black Union troops' role in destroying slavery helped to prevent them from giving way to despair. Nonetheless, a war as vast as this one was bound to generate much anguish, some of which replayed in participants' minds long into the future. Part intellectual and institutional history and part social history, Invisible Wounds tracks changing understandings and treatment of insanity across the second half of the nineteenth century alongside a discussion of the fluctuating conditions faced by soldiers and their families during and after the Civil War. While the first half of the book deals with wartime [End Page 408] experiences, the second half examines the postwar era. As Carroll notes, asylum superintendents and physicians in the mid-nineteenth century typically located the cause of insanity in physical or moral forces—phenomena that attacked the body and brain, such as disease, extreme weather, and head injury, or practices that supposedly signaled a lack of self-control, such as masturbation, intemperance, and expressions of intense emotion. Heredity, they believed, could also play a role, with sufferers passing a weakened system on to their offspring. Four years of war did not immediately alter these diagnoses, although they did give rise to a volume and range of conditions that fascinated some medical men and formed the basis for new thinking in the years that followed. In a chapter on the rise of neurology, Carroll examines the work at Turner's Lane Hospital of Silas Weir Mitchell and William Keen, who treated nerve-damaged soldiers during and after the war. Mitchell famously went on in the late nineteenth century to develop the diagnosis of neurasthenia—a condition of weakened nerves associated with the emotional stresses of modern living—and to join the growing criticism of asylum medicine. By the turn of the century, critics of asylum medicine included psychologists who had begun delving into the workings of the human mind. Both neurology and psychology rejected moral therapy, which tended to blame sufferers for their own plight, in favor of examining either the nervous system or patients' memories and emotions. Yet, as Carroll notes, it was actually the families of Civil War veterans who first linked war memories and mental illness: having watched self-assured or level-headed loved ones march off to war, they were best placed to recognize the behavioral changes resulting from war trauma. Some of the book's most interesting evidence relates to Black soldiers, very few of whom either ended up in mental institutions or left behind evidence of the war's long-term psychological toll. In explaining this fact, Carroll points not only to the way emancipation gave meaning to wartime suffering but also to the myriad effects of racism. Black veterans knew that white Americans would attribute failure or weakness to race rather than situation, seeing in their insanity evidence that they were unfit for freedom. Their emotional breakdowns therefore had implications for their communities as well as for themselves, adding social pressure to conceal emotional distress. Fewer Black soldiers fought in the first place, as well, while those who did so were disproportionately assigned to noncombat roles. In addition, institutional racism undoubtedly affected the ability of suffering Black veterans to access treatment: asylums in the former Confederate states tended to treat only white patients while those in the North, such as St. Elizabeth's, had limited space and prohibitive fees. [End Page 409] When it comes to changing conceptions of mental illness, veterans' treatment and emotional experiences, their postwar struggles, and the long-term consequences of war, Invisible Wounds

Ancient history · Anguish · Battle · Body politic · Criminology · Insanity · Mainstream · Mental health · Mental illness · Political science · Politics · Psychiatry · Sociology · Spanish Civil War · Diverse Historical and Scientific Studies · Historical Psychiatry and Medical Practices · History · History of Science and Medicine · Law · Philosophy · Psychology