Psychiatry, Military

The Civil War to World War I

Although historians have identified examples of psychiatric collapse in the most ancient of wars, the field of military psychiatry is decidedly modern. Its antecedents are first recognizable in the Civil War, when physicians began to notice Union soldiers exhibiting a wide range of abnormal behaviors. Frequently labeled as “nostalgia” or “nervousness,” symptoms of psychiatric collapse included emotional and physical fatigue, general insanity, and a debilitating longing for home. Military surgeons also diagnosed thousands of men, many of whom showed no signs of physical injury, as suffering from paralysis, tremors, or “soldier's heart” (severe cardiac palpitations).

Military leaders often viewed such men as cowards, lacking the stamina and “manly character” necessary for combat. Civilian neurologists, on the other hand, tended to have a different view. Schooled in 18th-and 19th-century theories of biological psychiatry, which attributed abnormal behavior to damage in the brain or nervous system, they sought to establish a physiological explanation for soldiers' symptoms. With the help of citizens of the northern states, who viewed mentally ill servicemen as a threat to public safety, doctors urged the Union Army to end its practice of mustering out psychiatric casualties, and leaving them to fend for themselves or wander the countryside. By 1863, the U.S. government had founded St. Elizabeth's Hospital in Washington, D.C., the first American institution exclusively for mentally ill soldiers; that same year Union forces initiated the world's first psychiatric screening program of potential recruits. Such measures, however, did little to treat the most severe psychiatric casualties, and many traumatized soldiers were institutionalized or left impoverished at the war's conclusion.

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