Tag Archives: melancholia

Nostalgia and Insanity

Thomas Nast's Picture of a Homesick Soldier

Thomas Nast’s Picture of a Homesick Soldier

America’s Civil War left many soldiers with lingering mental ailments that degraded their quality of life or disrupted it so violently they were considered insane. Today we would likely call these problems post-traumatic stress disorder, but in the 19th century it would have been called soldier’s heart or irritable heart.

Another syndrome that affected soldiers during the war was called nostalgia. Men (and boys) who had never traveled far from home were suddenly in a strange place away from family and friends. Many were so homesick that they fell into depression and despair, stopped responding to the people and stimuli around them, and sometimes became so lethargic and apathetic that they died.

John Clem, a 12-Year-Old Union Drummer Boy, Would Surely Have Had a Hard Time Coping With Homesickness

John Clem, a 12-Year-Old Union Drummer Boy, Would Surely Have Had a Hard Time Coping With Homesickness

Nostalgia was recognized in the 1863 Manual of Instructions for Enlisting and Discharging Soldiers. The manual said: “Nostalgia is a form of mental disease which comes more frequently under the observation of the military surgeon… it belongs to the class Melancholia.”

The typical camp treatment for nostalgia was to shame soldiers for it, increase their drilling and other training, or push them into combat to stimulate them. Letting them take leave, or furlough, was also an option, but camp physicians had little use for it. Many were more concerned about the physically ill and wounded–whose symptoms could not be faked–than they were with uninjured soldiers who had symptoms that could.

It Would Have Been Impossible to Treat Nostalgia in a Civil War Hospital Like This

It Would Have Been Impossible to Treat Nostalgia in a Civil War Hospital Like This

This cold attitude was driven more by the wartime situation than the prevailing attitude of the era. Moral treatment, with its kinder outlook and sympathetic treatment of the mentally ill still dominated treatment in asylums. Unfortunately, the Civil War demanded soldiers so relentlessly that physicians found it hard to justify releasing a relatively able-bodied soldier from the army, for any reason.

Nostalgia was a very old term for the illness it represented, and the Civil War was the last war in which Americans used it as a diagnosis.

What Price for Care?

In the 1800s Families Could Be as Medically Informed as Most Doctors

In the 1800s Families Could Be as Medically Informed as Most Doctors

The public originally supported insane asylums because they offered genuine hope. Typical at-home care provided little focused psychological expertise for patients, so recoveries within this family system had been few and far between. (One exception might be for conditions  like “melancholia” that could perhaps be treated by a change of scenery.) However, when professionally staffed asylums gave patients the time and attention they needed, recoveries did occur, and the former life-sentence of insanity seemed to have lifted.

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

John and Thomas Bailey, Father and Son Admitted Simultaneously to an Asylum for Melancholia, courtesy Museum of the Mind

Asylums were imposing, beautifully constructed, and reassuring. Superintendents who had actually been trained in the treatment of insanity–unlike family doctors who may have read a book or two on the topic–added to that reassurance. Families lost their reluctance to send loved ones to asylums and many times were rewarded for their faith. Even those who knew a family member would never recover could at least have the physical and psychological burdens of care lifted from their own shoulders.

Bloomingdale Asylum Presented a Lovely and Imposing Picture

Bloomingdale Asylum Presented a Lovely and Imposing Picture

That first wave of care paved the way for successive waves of continually poorer care as more and more families took advantage of asylums and stretched their resources too thin. At that point, money made all the difference. My next post(s) will discuss some of the differences money made in the quality of care for the insane.