Vets, PTSD and suicide: An age-old problem?
July observances are more about patriotism and independence than soldiering, but the two are never far apart. This past Independence Day, you may have seen the two concepts dovetail on yard signs notifying revelers that “A COMBAT VETERAN LIVES HERE — PLEASE BE COURTEOUS WITH FIREWORKS.” These signs have engendered a lively debate about veterans’ mental health and the public’s proper response, but what is less debatable (and what is assumed by the signs) is that veterans are a class apart. They are men and women whose exploits are at once admirable and unfathomable, especially when it comes to the psychological wounds of war.
Scholars have done their best to demystify soldiers’ and veterans’ experience, but they have found psychological traumas especially intractable. Post-traumatic stress disorder (PTSD) is among the “signature casualties” of conflicts from the Vietnam War onward. However, the condition’s relationship to earlier conflicts and warfare in general is less clear. Is PTSD a genuine product of today’s extraordinarily lethal technology, or is it a new name for an age-old response to the horrors of combat?
Both sides in this dispute have marshaled evidence. Advocates of PTSD’s timelessness point to the occurrence of its symptoms — flashbacks, irritable behavior, depression, and the like — as far back as the Civil War. Their critics point to the specificity with which those who coined PTSD invoked the Vietnam War, and to warnings against “retroactive diagnosis.”
Our recent book investigates assertions about the Civil War’s psychological damage. Our principal source is military and pension records for approximately 72,000 Union army soldiers, digitized by the Center for Population Economics at the University of Chicago. When they examined applicants for federal pensions, physicians reported signs of mental illness (mania, dementia, hysteria and the like) in approximately 5 percent of white veterans. This incidence is close to the proportion of 21st-century veterans who develop PTSD, but the similarity masks the perils of comparison across centuries. While the Union army diagnoses were recorded by physicians, the 21st-century occurrence of PTSD comes primarily from self-reports. The earlier information also reflects the prejudices of physicians who ignored most instances of mental illness in black veterans.
Yet there is something tantalizing in the story of Joseph Shipley. A former sergeant in the U.S. Colored Troops, Shipley still “imagined himself in the army.” He “would walk up and down the street shooting with [a] stick,” shouting “Grant says blow ’em up.” If not PTSD, what should we call Shipley’s condition?
A promising answer comes from the history of tuberculosis. Countless individuals were diagnosed with “consumption” prior to the late 19th century, a diagnosis that has since been superseded by tuberculosis. What appears to be simply a replacement for an archaic label, however, is not straightforward. The cause, course, and treatment of consumption were understood differently from what would become the characteristics of tuberculosis; an apparent matter of semantics reflects a genuine historical change.
So it is with Joseph Shipley and PTSD. As hauntingly familiar as Shipley’s behavior is, a different society interpreted it differently: Shipley was declared insane and committed to a series of asylums. Insisting that Shipley’s symptoms were PTSD flattens historical context into a prelude to an enlightened present.
Does respect for the past obviate putting today’s PTSD in perspective? One especially noteworthy feature of service-connected trauma is its association with suicide. Veterans are more prone to suicidal behavior than are civilians, and those with PTSD are even more susceptible. A recent study found that veterans with PTSD were more than four times as likely to have suicidal thoughts than were those without the condition. Though suicide has become a more private act than in the late 19th century, its meaning (or its mystery) remains largely the same.
Death records allow a test of the claim that today’s psychological toll on servicemembers is unprecedented. Massachusetts had exceptionally complete death records for the late 19th century, and suicides from that period can be compared with those of 2014. Though veterans’ suicides were more common than among civilians at both times, the Union army rate was highest of all, surpassing both the rate for veterans in contemporary Massachusetts and those reported nationally.
We needn’t take sides in the dispute over PTSD’s timelessness. Severe psychological damage, severe enough to drive an extraordinary number of veterans to suicide, extended at least as far back as the post-Civil War era. Unlike PTSD, however, the earlier trauma acquired no meaningful name, and pleas for public recognition — of the kind evinced in those July 4th yard signs — went unheeded. If the recognition of PTSD has become a burden employed to stereotype returned soldiers, yesterday’s silence may have been still more burdensome.
Larry M. Logue is a senior fellow at the Burton Blatt Institute (BBI) at Syracuse University. Peter Blanck is a Syracuse University professor and BBI chairman. They are co-authors of “Heavy Laden: Union Veterans, Psychological Illness, and Suicide.”