Shook Over Hell

A new book arrived today!

Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War by Eric T. Dean Jr.

James M. McPherson wrote a wonderful review of this book and that led me to purchase it. Below is a portion of of his review in the Atlantic Online, March 1998 :

EVEN though Dean discusses the possibility that PTSD is "a grab-bag of symptoms" rather than "a distinct psychiatric disorder," the core of this book is an application of the PTSD concept to Civil War soldiers. Part of the myth of the scorned and troubled Vietnam veteran is the implied contrast between his postwar treatment by a hostile or indifferent society and the hero's welcome given veterans of other wars. Although many studies of Civil War soldiers have appeared in recent years, they have focused mainly on the wartime experiences of these men; their postwar history has been relatively neglected. Union veterans returned home as victors, celebrated by parades and official receptions. Confederate veterans did not have this solace, but the romanticization of their heroic courage and pure devotion to a sanctified though doomed Lost Cause fulfilled the same cathartic function. Dean writes, "A re-examination of the Civil War veteran through the lens of the Vietnam experience promises new perspectives and challenges, regarding ... the assumption that Civil War veterans readjusted well after their war."

The combat experience of Civil War soldiers was more intensive and prolonged than that of American soldiers in Vietnam. The actual number of American soldiers was the same in both wars: three million. This represented nearly 10 percent of the U.S. population in 1861, as against 1.5 percent of the population in 1970. The number of American dead in the Civil War was 620,000; in Vietnam it was 58,000. In proportion to the population, the death rate was sixty-nine times as great in the Civil War as it was in Vietnam. The ratio of combat to support troops in Vietnam was one to seven; it was almost the reverse in the Civil War. Some 35 percent of Civil War soldiers were killed or wounded, as compared with 5.5 percent of U.S. soldiers in Vietnam. There was no helicopter evacuation of the wounded and no antibiotics or antiseptic medicines in the Civil War. The physical hardships endured by Civil War soldiers would have been almost inconceivable to an American in Vietnam.

In view of these facts, Dean is quite right to hypothesize a high incidence of psychiatric casualties during the Civil War and of what we now call PTSD afterward. The problem in identifying these phenomena is that Civil War medicine had no term or concept to describe them. But observations by surgeons, officers, and soldiers themselves make clear the frequency of psychiatric casualties, which were all too often officially regarded as cowardice or malingering. Nevertheless, diagnoses of "insanity," "homesickness," "melancholy," "acute mania," "dementia," "nostalgia," "irritable heart," and even "sunstroke" offer hints of an effort to identify and understand these casualties.

Dean also presents evidence of a higher post-Civil War crime rate among veterans than among non-veterans, of nightmares and flashback recollections, of disorderly behavior, and of suicide (though data to compare veteran and non-veteran suicide rates do not exist).

Dean's research in Civil War letters and memoirs, postwar newspapers, and pension files was thorough and exhaustive. It has yielded more information about the mental health of Union veterans than historians had previously realized was available. (Comparable sources for Confederate veterans are much thinner or nonexistent.) The most original and important feature of this book is Dean's analysis of 291 case studies of Civil War veterans committed to the Indiana Hospital for the Insane. Most of them exhibited symptoms that would today be diagnosed as PTSD. The inquest record for one such inmate, Jason Roberts, supplied the title for this book:

Says he has been shook over hell.... Sometimes he is raving and excited, at others melancholy ... Very peculiar and eccentric, flying from one Subject to another, and talking incoherently on all Subjects, ... The subject of religion and his experiences in the army being paramount in his mind ... [he] thinks all his enemies should be in hell.

The amount of effort and patience required to match these asylum inmates with their combat experiences is awe-inspiring. Yet a caveat is in order. Does Dean ask the right questions about this sample?

Is the Indiana Sample of 291 men representative of Civil War veterans in Indiana or elsewhere? Can the problems of the men in this sample be generalized to a significant proportion of the approximately 180,000 [actually 135,000] Indiana veterans or the 1.9 million Union veterans?
The answers would seem to be obvious: men committed to a hospital for the insane are by definition not representative, and their problems cannot be generalized.

Having put so many hundreds of hours of research into this sample, however, Dean wants it to bear more weight than it possibly can. He acknowledges that the regiments to which these 291 men belonged had higher than average casualties from both disease and combat, but "the most salient point about the Indiana Sample is how close to average it seems in so many other respects." He continues, "One is tempted therefore to think that the problems of the Indiana Sample could not have been atypical." This is sloppy thinking. The question is not whether these men and the units to which they belonged were representative in a variety of objective criteria -- age, occupation, ethnicity, length and theater of service, number of battles, and so forth -- but whether their psychiatric problems were typical or representative of the personalities of the more than 99 percent of Civil War veterans who were never committed to an asylum. To suggest otherwise exposes Dean to the same charge of inflating the psychiatric casualties and PTSD of Civil War veterans that he has so effectively proved against superficial students of Vietnam veterans.

Despite this caveat, the Indiana Sample in combination with other evidence sustains Dean's conclusion that historians have overlooked a significant incidence of PTSD among Civil War veterans -- probably greater than that among Vietnam veterans. Of this book it can truly be said, as it is all too often falsely said of other historical studies, that it breaks new ground.

James M. McPherson is the George Henry Davis Professor of American History at Princeton University. He won the 1989 Pulitzer Prize in history for Battle Cry of Freedom. McPherson's most recent book is For Cause and Comrades: Why Men Fought in the Civil War(1997).