By Graham Warder, Ph.D., Keene State College
Few Americans in 1861 recognized the potential psychic costs of large-scale warfare. Diagnoses like shell shock, combat fatigue, and post-traumatic stress disorder are twentieth-century concepts. Nineteenth-century psychiatrists, largely the group of men who superintended a growing number of specialized asylums, spoke a very different language about the causes of what they called insanity. In the pages of their Journal of Insanity, some even argued that the war, by giving people purpose and common cause, would reduce the incidence of insanity. Not surprisingly, though, the Union Army was forced to respond to the large number of its soldiers who did experience psychiatric disorders, especially after horrific battles like Fredericksburg, Gettysburg, and Cold Harbor. The first line of defense was another institution, the Government Hospital for Insane Soldiers in southeast Washington, D.C., and Civil War soldiers, and later veterans, were sent there in large numbers.
Opened in 1855, the Government Hospital, now St. Elizabeths Hospital, expanded rapidly during the war. During the Civil War, the institution was the nation’s only federal mental health care facility. (Antebellum asylums, many created or expanded through the lobbying efforts of Dorothea Dix, tended to be either state or private institutions.) The Government Hospital was founded upon the principles of moral treatment, the idea that people with psychiatric disabilities could be nurtured back to psychic health by being cared for in home-like settings with spacious, parklike grounds. Dr. Pliny Earle, originally from Leominster, Massachusetts, and one of the most prominent psychiatrists of the nineteenth century, served there during the war.
Soldiers who exhibited signs of psychiatric disorders were often suspected by their officers of being “malingerers.” Such attitudes persisted after the war, and veterans with psychiatric disabilities found it far more difficult to obtain a pension than, for example, an amputee. Dr. Earle, on the other hand, treated soldiers who were admitted to the Government Hospital as truly needing help.
As the war went on, the need grew. The Hospital admitted 212 patients in 1862 and 357 in the 1863. According to Earle, the staff was overwhelmed. By the spring of 1864, the Government Hospital for the Insane held 569 patients, far beyond its capacity. Such overcrowding must have rendered moral treatment’s aspirations for a homelike environment impossible.
After the war, the Government Hospital for the Insane continued to care for Civil War veterans with psychiatric disabilities. In 1882, Congress authorized that those insane veterans housed in the branches of the National Home for Disabled Volunteer Soldiers be transferred there. Many were chronic cases, and hundreds of Civil War veterans with psychiatric disabilities are today buried on the hospital grounds. The optimistic expectations that institutions would cure insanity proved to be unrealistic.
Carroll, Dillon. Invisible Wounds: Mental Illness and Civil War Soldiers. Baton Rouge: Lousiana State University Press, 2021.
Dean, Eric T., Jr. Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. Cambridge, MA: Harvard University Press, 1997.
Logue, Larry M., and Peter Blanck. Heavy Laden: Union Veterans, Psychological Illness, and Suicide. Cambridge: Cambridge University Press, 2018.
Sanborn, F.B. Memoirs of Pliny Earle, M.D., with Extracts from His Diary and Letters (1830-1892) and Selections from His Professional Writings (1839-1891). Boston: Damrell & Upham, 1898. https://archive.org/details/memoirsofplinyea00sanb.