Hickey on Carroll, 'Invisible Wounds: Mental Illness and Civil War Soldiers'

Dillon J. Carroll. Invisible Wounds: Mental Illness and Civil War Soldiers. Conflicting Worlds: New Dimensions of the American Civil War Series. Baton Rouge: Louisiana State University Press, 2021. 342 pp. $45.00 (cloth), ISBN 978-0-8071-6966-7.

Reviewed by Donald Hickey (University of California at Santa Cruz) Published on H-CivWar (February, 2023) Commissioned by G. David Schieffler (Crowder College)

Printable Version: https://www.h-net.org/reviews/showpdf.php?id=58304

While scholars have examined the military aspects of the American Civil War in great detail, there is much less understanding of the psychological costs of the war, both by the Civil War generation that incurred them and the historians who study them. Dillon J. Carroll’s timely Invisible Wounds: Mental Illness and Civil War Soldiers investigates the experiences of Civil War soldiers who paid a psychological price for their wartime service, the doctors who treated them, and the families and communities who cared for mentally ill veterans. Carroll draws on insights from modern psychiatry to frame how nineteenth-century professionals understood, diagnosed, and treated mental illness. Invisible Wounds is thus as much a story about mentally ill veterans as it is about the nineteenth-century mental health practitioners, or the “alienists,” who treated “alienated” (mentally ill) patients in asylums during and after the Civil War (p. 2). Although deploying the concepts of modern psychiatry in his analysis, Carroll is careful not to directly apply modern psychiatric evaluations upon historical subjects that understood mental illness radically differently than we do today. Ultimately, Invisible Wounds answers the question of how the Civil War damaged the minds of its direct participants.

Following Eric T. Dean’s pioneering study of veterans in Shook Over Hell (1997), which first advanced the argument that Civil War veterans suffered from post-traumatic stress disorder (PTSD), Invisible Wounds fits into the “darker turn” of Civil War historiography that questions an older, triumphalist narrative by revealing the conflict’s darker and more unsettling aspects. Invisible Wounds is in conversation with recent scholarship on veterans, including James Alan Marten’s Sing Not War: The Lives of Union and Confederate Veterans in Gilded Age America (2011), Matthew Brian Jordan’s Marching Home: Union Veterans and their Unending Civil War (2014), and Paul A. Cimbala’s Veterans North and South: The Transition from Soldier to Civilian after the American Civil War (2015).

Carroll organizes Invisible Wounds as a series of well-researched case studies of veterans suffering from mental illness, supported by other pertinent examples found in the archival record. The first two chapters explore how Civil War soldiers’ experiences dealing with limited food, loneliness, boredom, disease, marching, and the terror and violence of combat contributed to the emotional and psychological breakdown that many veterans experienced during and after the war, and how these variables affected the distinctive experiences of Black veterans. Chapters 3 and 4 investigate the wartime work of mental health professionals by drawing from the extensive records of the Government Hospital of the Insane (later renamed St. Elizabeth’s) and the coping mechanisms veterans employed to process wartime trauma. In chapter 5, Carroll argues that many Union veterans’ postwar lives were more ambiguous than victorious, which helps explain, in part, their higher rates of poverty, lower rates of employment, and higher rates of institutionalization. In chapters 6 and 7, Invisible Wounds compares and contrasts the experiences of white and Black Civil War soldiers who suffered psychological breakdowns, while chapter 8 examines the postwar lives of Confederate veterans who shared important commonalities with their Union counterparts but received far less institutional support.

In the book’s final two chapters, Carroll brings into focus the impact of veterans’ mental illness on their families while tracing asylum doctors’ slowly shifting understanding of mental illness as the result of “character flaws” in personal morality. He also examines neurologists’ novel explanations of mental illness deriving from nerve damage and traumatic memories lurking in the human psyche (p. 9). Through each of these discussions, Carroll threads the argument that military discipline, disease, exhaustion, and combat threatened the emotional and psychological health of a significant (though ultimately indeterminable) number of Civil War veterans. Although scholars cannot precisely diagnose illnesses of the past, Invisible Wounds makes the case that the cumulative stresses of the war weighed upon, and in some cases broke, the minds of fighting men in important ways that historians are only beginning to understand (p. 34).

Invisible Wounds ably renders the culture, attitudes, and beliefs of nineteenth-century psychiatrists in part by borrowing explanatory language from modern psychiatrists who treat similar phenomena. As Carroll argues, the ways that Civil War-era doctors and soldiers treated and experienced wartime injuries reveal a great deal about historical understandings of masculinity and manhood in an age when soldiers and veterans remained under enormous pressure to “rise above” physical and mental suffering. For example, Northern soldiers who refused to complain about physical suffering and showed patience for the recovery process were believed to have demonstrated physical and moral fortitude as well as an unflinching commitment to the Union cause (p. 64). Carroll insists that veterans were not always passive victims of the war’s trauma and urges historians to investigate how many of them successfully coped with the challenges of trauma and transitioned into healthy and well-adjusted civilians.

Historians are especially interested in people’s transitions from civilian to soldier and then back to civilian, and the effects these changes wrought on culture. Invisible Wounds analyzes soldiers’ letters and the candid discussions they had with family members regarding mental illness, even if precise descriptive language often escaped them. Carroll makes the case that the cessation of fighting did not always bring peace to Civil War veterans trapped in a liminal state between soldier and civilian. Changes in the postwar economy and society further agitated some afflicted veterans. With each of his case studies, Carroll contends that lessons in modern medicine can suggest what veterans with mental illness endured (p. 139).

Invisible Wounds also shows how race and class differences shaped veterans experiences, noting lower rates of mental illness and a much lower rate of institutionalization for Black veterans. According to Carroll, Black veterans’ experiences in the war were “less ambiguous” than their white counterparts’, and, as a result, they were less likely to seek treatment for mental illness. Moreover, African Americans’ experiences with discrimination and abuse shaped their long distrust of medical institutions and professionals (p. 164). Invisible Wounds argues that limited institutional support for Confederate veterans may have contributed to their comparatively higher rates of suicide, violence, and substance abuse (p. 178). In each of these chapters, Invisible Wounds tracks how living with a mentally ill veteran in the nineteenth century was often associated with poverty or shame, especially for those veterans and their families who suffered before the advent of modern psychiatry and the social-welfare state (p. 203). Finally, Invisible Wounds shows how veterans lived through (and helped fuel) a paradigm shift in psychiatry in the late nineteenth century when mental health diagnoses moved away from poor “moral decisions” of sufferers to those of strictly somatic origins, and how this shift was built upon the bodies of Civil War veterans.

Invisible Wounds calls on scholars to investigate how the American Civil War’s “panoply of trauma” affected veterans decades after Appomattox and was much more far-reaching than historians have realized (p. 242). Amply supported by research and clearly written, Invisible Wounds benefits historians of the Civil War and its veterans, as well as those interested in histories of nineteenth-century psychiatry and masculinity. The book would work well for upper-level undergraduate or graduate-level Civil War and Reconstruction or Gilded Age history courses. Most broadly, this is an important book for any student of human conflict and its cost on the psyche. “We should look at potential conflicts with clear eyes,” Carroll argues, “understanding completely what war makes before we make it” (p. 252).

Citation: Donald Hickey. Review of Carroll, Dillon J., Invisible Wounds: Mental Illness and Civil War Soldiers. H-CivWar, H-Net Reviews. February, 2023. URL: https://www.h-net.org/reviews/showrev.php?id=58304