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PTSD - Battlefields and Beyond

Discussion in 'Medical Care of the Civil War' started by amweiner, Mar 10, 2017.

  1. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    Over the past twenty years, a solid body of research has emerged regarding Post-Traumatic Stress Disorder (PTSD) in the Civil War[1]. Rather than looking at prevalence or debating the application of modern diagnostic criteria to the past, I think it’s useful to consider some of the following associated dynamics/concerns:
    1. How is PTSD different from combat stress reaction, why does it matter, and how did this impact the soldiers?
    2. How were women impacted by trauma?
    3. What were some of the traumas children experienced, and how were these different from those of adults?
    4. How did trauma shape the experience of returning veterans?

    The increased attention to and awareness of PTSD has resulted in most people having a basic understanding of it. In short, PTSD is a chronic, pervasive response to traumatic events. It can be marked by flashbacks or nightmares of the trauma, increased startle response to sounds, avoiding situations that remind a person of the traumatic event, and difficulty concentrating or thinking. The flashbacks aren’t simply remembering the event, they are a re-experiencing of it, where the individual feels she/he is there reliving that moment. Because of this, PTSD is thought of as a cyclical condition in which the brain is essentially trapped, repeatedly reliving the moment and trying to figure out a way to change the outcome. Often overlooked is the fact that a witness to traumatic events can be traumatized as well.

    This is similar to, but somewhat different from, a combat stress reaction (CSR) or sometimes known as “battle fatigue”. There can be a range of symptoms, including fatigue, irritability, slower response times, and trouble concentrating. Generally, these symptoms appear in combat soldiers and result in a general decrease in the mental and physical functioning of a soldier. These symptoms often don’t last for long, especially when they are treated effectively. CSR can develop in response to a distinct traumatic event, or from prolonged emotional/physical tension (e.g., occupying a forward position for an extended period without rest). With repeated trauma, CSR can develop into PTSD, but this isn’t always the case and depends on a number of individual and situational factors.

    During the Civil War, it’s likely that there were tens of thousands of men impacted by combat stress reactions[2]. First-person accounts of the emotional and physical toll of battle are commonplace and unusually poignant. Letters, diaries, and memoirs give us a unique insight into a sudden explosion of combat stress that hadn’t been seen before. For example:

    “…And in my sleep I see nightly the gastly [sic] upturned faces of the dead and hear the groaning of the mangled and dying, the hissing of the shot and shell, the shouts and curses of the victorious and the shrill whistles of the musket ball, as it wings its flight of death.”

    John McGrath, 13th Louisiana



    “I never expect to be fully believed when I tell what I saw of the horrors of Spottsylvania, because I should be loth to believe it myself, were the case reversed…”

    Thomas Hyde, 6th Corps

    Other accounts hint at experiencing or witnessing things too horrible to recount, but it is clear that these events had a lasting impact on those that survived.[3]

    A consideration of the effects of CSR sheds some light on a frequently posed question related to Civil War combat: why didn’t the victorious army pursue the defeated one? The question was posed with considerable frustration by President Lincoln during the War, and by generations of historians since. Considering that the traumatic impact of combat and witnessing combat can lead to increased heart rate, fatigue, and confusion (and add to those factors woolen uniforms and extended physical exertion), it makes more sense that soldiers were rarely in any condition – mental or physical – to pursue a beaten enemy.

    The impact of trauma on women during the war took different forms. For women who volunteered as nurses, the exposure to wounded and dying soldiers could have been a source of repeated trauma. On the home fronts, women, particularly in the Confederacy, were exposed to multiple forms of trauma, including combat (e.g., Siege of Vicksburg), robbery and economic losses during the 1864 Shenandoah Campaign and Sherman’s March[4], and rape (at least 335 documented cases are known)[5]. The extended deployment of men meant that women were often thrust into multiple highly demanding roles – breadwinner, sole parent, farmer, and others. While these are not necessarily traumatic, the sudden changes women faced could have placed them at risk for more severe stress reactions. Certainly the loss of husbands, fathers, brothers, and sons would only have heightened the stress for women, who were also challenging social, political, and economic norms of the 19th century.

    Reliable figures were hard to find, but common estimates indicate that approximately 20% of the combat soldiers in the Civil War were under 18 years of age. This does not include children who were allowed to enlist as musicians or in other noncombatant roles. While children and teenagers were exposed to the same traumatic events that adult soldiers were, it’s necessary to consider that children will experience and interpret these events differently from adults. Children are definitely resilient, meaning they can often “bounce back” from traumas more easily than some adults, even without treatment. Depending on the child, the severity of the trauma, and the frequency with which they are exposed, they may not recover easily. Children repeatedly exposed to severe traumatic events (including witnessing these events) can develop auditory hallucinations, have sleep difficulty, bowel/bladder problems, and mood swings. Their understanding of the trauma may be more limited, especially for younger children who tend to blame themselves for being traumatized. One can only imagine that children, separated from family and far from home, witnessing multiple battles, were impacted in ways that we may never know of.

    Civil War veterans returning to their homes had few, if any, resources available to help them process the ordeal they survived. While many veterans were able to resume their prewar lives, countless men were suffering from the long-term impact of PTSD and unable to cope. Flashbacks, nightmares, and difficulty thinking would have devastated surviving veterans, and without an understanding of these symptoms or outpatient treatment, alcohol abuse was a common method for keeping symptoms under some control. A striking testament to the increase in PTSD is in the number of individuals committed to mental institutions: in 1861, there were approximately 8,500 people institutionalized. By 1866 the number had doubled, and continued to double every ten years for the next fifty years[6]. Hospitalization reportedly was effective in the short term, but apparently didn’t last long when men were discharged. Many veterans were hospitalized repeatedly or incarcerated, and were often perceived as dangerous. Fortunately, treatment options improved at the end of the 19th century, and for Union veterans, military pensions provided some measure of economic support for disabled men. No such support system was available for Confederate veterans, unfortunately, resulting in some men becoming homeless.[7]

    What can we learn from all of this? One of the clear conclusions is that trauma left thousands of unseen casualties in its path. Men who were legitimately traumatized may have been seen as weak, cowards, or unpatriotic. Those exposed to repeated trauma, typically men who served for extended periods, often had the worst outcomes, or at least this is suggested by modern research and anecdotal data. Women and children were also exposed to multiple forms of trauma unrecognized by history’s focus on battles and leaders. Understanding how the War impacted soldiers and civilians requires us to consider the invisible, but very real, wounds inflicted by trauma.




    [1] Clarke, D. (1996). Post-Traumatic Stress Disorder and the American Civil War: A Reappraisal. Accessed March 9, 2017. http://www.academia.edu/5812575/Pos...rder_and_the_American_Civil_War_A_Reappraisal.

    [2] Talbott, J. (1996). Combat Trauma in the American Civil War. History Today, 46 (3).

    [3] Alexander, E. (2013). Life of the Civil War Soldier in Battle. Accessed March 9, 2017. http://www.civilwar.org/hallowed-gr...013/life-of-the-civil-war-soldier-battle.html

    [4] Ransom, R. (2001). Economics of the Civil War. Accessed March 9, 2017. URL http://eh.net/encyclopedia/the-economics-of-the-civil-war/

    [5] Stutzman, M. (2009). Rape in the American Civil War: Race, Class, and Gender in the Case of Harriet McKinley and Perry Pierson. Accessed March 9, 2017. http://www.albany.edu/womensstudies/journal/2009/stutzman.html.

    [6] Clarke, D. (1996)

    [7] Ibid.
     

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  3. Cavalry Charger

    Cavalry Charger First Sergeant

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    This is a very important topic to reflect on, in light of our greater understanding of such things today. It is impossible for most of us to imagine the level of trauma those who experienced the Civil War first hand were exposed to, and I am glad to see you have included civilians, especially women and children. Returning to 'normal' life afterwards would have required enormous effort, and the bonds formed by Veterans no doubt lasted a lifetime. Who else could possibly understand what they had been through? I hope to follow up on some of the references you have included. More recently, I have been reading a book called "Aftermath of Battle: Burial of the Civil War Dead". The trauma didn't end when the battle was over...
     
  4. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    Thanks @Cavalry Charger! I saw any number of articles debating whether PTSD existed among CW soldiers at all, then read some of the letters and diaries and felt very strongly that it had to. So much hurt, and a lot of untold stories.
     
  5. Gladys Hodge Sherrer

    Gladys Hodge Sherrer Corporal

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    Interesting topic. In my upcoming Civil War novel, I created a soldier who clearly has PTSD, and as a former registered nurse, I pulled from my memory bank and recent research to attribute the poor man with his symptoms. PTSD behavior in past wars was virtually ignored, until tragedy struck.
     
  6. Burning Billy

    Burning Billy Corporal

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    http://www.civilwarmed.org/suicide1/
     
  7. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    That sounds really interesting, Gladys. Hope to read this when it's ready!

    I hear you - as a psychologist, I found a lot of familiar themes in the letters and diaries of the soldiers that matched what I've seen in my work with traumatized children. While there's a lot of focus on PTSD as it relates to soldiers, I didn't want people to forget about the pain noncombatants endured as well.

    Adam
     
  8. gunny

    gunny First Sergeant

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    If I remember correctly we have had posts regarding this before in the past. During the Civil War it was known as sunstroke and then morphed into several different names including shell shock, combat fatigue, ptsd and others. You might be able to search the forum to find it.
     
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  9. Legion Para

    Legion Para Brigadier General Moderator Forum Host

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    http://civilwartalk.com/threads/neuropsychiatric-casualties.118345/#post-1211408

    http://civilwartalk.com/threads/did-civil-war-soldiers-have-ptsd.107363/

    http://civilwartalk.com/threads/moral-injury-and-the-civil-war-soldier.128575/

    http://civilwartalk.com/threads/post-traumatic-stress-disorder-and-the-civil-war.103106/

    http://civilwartalk.com/threads/mental-health-in-from-the-civil-war.110456/
     
    Last edited: Mar 10, 2017
  10. rpkennedy

    rpkennedy Major

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    I would recommend Brian Matthew Jordan's Marching Home: Union Veterans and Their Unending Civil War. Jordan discusses how Union veterans coped with their wartime traumas, both physical and mental, and also how society in general dealt with it (spoiler alert: not well).

    Ryan
     
    Last edited: Mar 10, 2017
  11. rpkennedy

    rpkennedy Major

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    double post
     
  12. Burning Billy

    Burning Billy Corporal

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  13. Legion Para

    Legion Para Brigadier General Moderator Forum Host

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    I also highly recommend.

    511z0s-KDqL._SX331_BO1,204,203,200_.jpg
     
  14. lelliott19

    lelliott19 2nd Lieutenant Forum Host Trivia Game Winner

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    Thank you so much for posting your article here @amweiner

    We appreciate your contributions to Civil War Talk and the Medical Care forum! You address some very interesting questions. Great to have a psychologist weigh in on the topic. Thanks again!
     
  15. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    Hi Gunny,
    Yes, I did take note of these and reviewed them earlier. My interest in posting was certainly not to simply revisit a topic that had been covered before, but to differentiate between combat stress reaction and PTSD, as well as highlight the impact trauma could have on noncombatants. I may not have read every post in all of the threads, but saw nothing that might have addressed these important considerations.

    Please forgive me if I sound in any way snarky about it, but the posts I read seemed to lump every soldier's response to trauma as PTSD, which I feel is highly inaccurate. Treating combat stress/combat fatigue/acute stress is markedly different from treating PTSD, so from my perspective it was comparing apples to cinderblocks.

    Please know as well that I'm open to feedback and not thin-skinned about this, just have the same insistence on clarity and understanding that any professional has about their field.

    Thanks for your response!
    Adam
     
  16. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    Thank you lelliott19! I do appreciate any and all feedback on the post, and the different perspectives.

    Adam
     
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  17. JPK Huson 1863

    JPK Huson 1863 Colonel Forum Host

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    Holy gee whiz. No one does that, differentiate Combat PTSD from others, and thank you! Goodness. I also suspect, not to jump in the deep end here, a hugely troubled household would be one where a Combat PTSD veteran and a Complex PTSD survivor of multiple trauma were trying to find peace post war. So much pain.

    You're a professional. Reading of women's experiences in the war, it's so hugely varied- but goodness, some certainly came away with redirected circuits. Marie Tepe shared the front lines with troops. Her post war life was a shambles- she died a suicide. Nurses? There's book after book with nurses writing of their time spent gluing shattered men together or watching them die horribly or cleaning maggots from wounds.

    Some of those nurses became nurses because an army showed up in their town one day and had a war. Their homes became blood soaked hospitals-poof-within hours. My grgrgrandmother was one. Her small children were there, watching. It would take a more minute research of so many, many lives like hers and women of Gettysburg but how could they not, especially so unprepared? We're not made, as human animals to absorb that. Short term PTSD is caused by a car accident, one- touching war, in your house, is 100 of them. Or 1,000. Oh! Terrific example would be Elizabeth Thorn, of Gettysburg, only read her journal, not the hoo-ha written of her. If any female came away from 1863 with PTSD, it's Elizabeth Thorn.

    Children? Ouch. There are books written post war by then-grown witnesses to awful carnage and shocking events. Did they? As a non-professional, I do not see how they could not. How could our children growing up enslaved not be Complex PTSD sufferers? Opinion only- I feel traumas from this war reached a few generations post war.

    There are still a huge misunderstandings on PTSD- that it's purely a mental illness. In my opinion this is deliberate, our society not dealing well, however unfairly with mental illness. Money must be spent, on victims of PTSD- can't have that.
    It's a physical, hand's-on, broken, shredded neurological system you could see, if someone looked. You can't put a plaster cast on neurons or pleasantly ask them to please go back where they're supposed to.

    Sorry so long a reply. You hit a vacationing nerve.
     
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  18. Gladys Hodge Sherrer

    Gladys Hodge Sherrer Corporal

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    Adam, I will be on this Forum when the book releases in October, and will make public its launch. It's to be sold on Amazon. Currently, I'm working with an editor to fine tune. Yesterday, this ex-military-man-turned-editor called me, virtually in tears, having read my manuscript's ending. This came after he had told me (when I had a male character misty-eyed), "Change this wording. Men don't shed tears." NOT! How can anyone experience the tragedy of war, and stuff inside their emotions? Of course, men try to do what is expected, and humanly impossible, and break down mentally.
     
  19. gunny

    gunny First Sergeant

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    Forgive me if I sounded like I was tired of this topic - I'm not. I just didn't know if you had seen the others.

    I had a GGGrandfather that was in the war and suffered from something. Call it what you will, but he would go to sleep in the bed and wake up on the floor just about every night. His son's wife's father was too old to participate in the war, but had a traumatic experience, as did his son.

    I found this while researching the Sixteenth Tennessee infantry regiment. A young man named John Harman Nichols wrote a book called "Proof of the Pudding" that was published in 1913. In that autobiography, he mentioned my GGGrandfather. Daniel Grizzell lived near Gassaway, Tennessee (once know as Clear Fork). There was an infamous Federal guerrilla that became sheriff of Cannon County named Captain Hathaway.

    At some point Captain Hathaway shot my GGGrandfather's fifteen year old son in the stomach (he recovered somehow) and pistol whipped my GGGrandfather so badly that he had horrific scars on his head for the rest of his life. I had always heard a folklore story that was similar to this, but never could verify it until I read this book to my surprise.

    Imagine the trauma suffered by the three of them. One, being a combat veteran that served the entire war and was (at least) twice wounded in a unit that suffered extreme casualties. Second, a father that watched his son be shot in the stomach by a renegade and was pistol whipped only because the attacker ran out of ammunition. Third, a fifteen year old boy that was shot by a grown man - but survived.

    The pain, physical and mental that all three had to experience must have been maddening.
     
  20. gunny

    gunny First Sergeant

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    Regarding the Battle of Perryville, one member of the regiment stated, "I had no hope of getting out alive. Such trials as that has a tendency to temporarily derange the minds of some, at least it was the case with me."
     
  21. amweiner

    amweiner First Sergeant Trivia Game Winner Member of the Month

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    Not at all @JPK Huson 1863 ! Thank you for your thoughtful response! Reading about this topic makes me more aware that there are thousands of untold stories of untold harm because of the War. Sadly, it's true of every conflict, I imagine. It feels that some of that is masked, both by time and by the Victorian era sentimentality with which some soldiers wrote about it, and I think that what makes it more poignant for the Civil War is that it broke open the floodgates on people who simply were not ready to comprehend large scale slaughter.

    Interesting you mentioned Elizabeth Thorn - I thought about her, too! Can you imagine? One aspect I didn't address in the OP was just a theory about community trauma, or the idea that there was something of a collective trauma to a town deeply impacted by a battle (such as Gettysburg) or by a community who, for example, might have lost dozens of their young men in a certain battle. Just a thought to bounce around.

    I agree with you 100% that the trauma from this War filtered down through many generations, and is one piece of the puzzle to think about when we wonder why we're still talking so passionately about it.

    Thanks for your observations!!
    Adam
     
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