January 21, 2000

Psychiatry During the U.S. Civil War


Psychiatry appeared to have little involvement in the military world of the Civil War (1861-1865). The American Journal of Insanity (predecessor of the American Journal of Psychiatry) mentions, mainly in passing, bits of information relating to the war that so shook the nation. The annual meeting of the Medical Superintendents of American Institutions for the Insane (predecessor of the American Psychiatric Association) was to be held in Providence, R.I., in 1861 but was cancelled " on account of the troubled state of the country." The next year, the meeting was held in Providence.

During the war years, no superintendent from a Confederate state attended the annual meeting. Dr. Chipley, of the Eastern State Hospital in Kentucky, wrote that his absence from the 1862 meeting was due to the need to attend the wounded of the southwest army. Dr. McFarland of Jacksonville, Ill., explained his absence for the same reason: " the late battles in the southwest (left) a large number of wounded from his state." At that meeting, Dr. Tyler of the McLean Hospital in Massachusetts said, " The military camp is a crucible in which our men have been placed, a small percentage cannot endure, but the great majority have provided good metal. . .and benefit by the hardy manner of life."

In May 1864 the annual meeting was held in Washington, D.C., and the superintendents who called upon President Lincoln were " cordially received." Dr. Nichols, superintendent of the Government Hospital for the Insane (now St. Elizabeths Hospital in Washington, D.C.), was appointed to meet with the Army surgeon general to offer the assistance of the Association to care for the wounded in Fredericksburg, Va. The written reply gave thanks, but " until a more urgent necessity makes it advisable," help was not then needed.

At the 1864 meeting Dr. Van Deusen of Michigan stated that insane soldiers were being discharged without provision for their care. Dr. Gray of Utica, N.Y., pointed out that a War Department General Order had made such provision but was not being carried out. A letter was sent to the surgeon general, and in November 1864 a reply was received that insane soldiers were to be sent to the nearest asylum pending transfer to the Government Hospital for the Insane at government expense.

No articles dealing with military psychiatry were published in the Journal of Insanity during or after the war years. An annual report from the Government Hospital for the Insane in 1864 noted 207 Army and 12 Navy personnel had been admitted in the past year. The long report noted that not more than 2 percent of the 493 total admissions from the Army and Navy during wartime had an origin due to active military hostilities. Homesickness was evident. A depression of the " vital forces" due to physical illness often caused by the privations, exposures, and fatigue of active service impairs the strength and tone of the nervous system and may lead to mental manifestations, the report said. Contrary to expectations that the upheaval of society by war might lead to an increase in insanity, fewer civil cases were admitted to the hospital.

The return of southern superintendents to the annual meeting came in 1869. Among the hospitals represented were those in Williamsburg, Va., Jackson, Miss., Raleigh, N.C., and Austin, Tex. The meeting was held in Staunton, Va.

Dorothea Dix, nationally and internationally known for her success in the establishment of many mental hospitals, offered her services to the War Department during the Civil War. In 1861 she received a commission as superintendent of U.S. Army nurses, a post she retained throughout the war. She was responsible for the selection of nurses (plain-looking women over the age of 30) and procurement of hospital supplies. She resigned her position after the assassination of President Lincoln.

Military psychiatry was to await the efforts of Dr. Thomas Salmon, medical director of the National Committee for Mental Hygiene, who began the study and practice of military psychiatry during World War I.