Thursday, August 18, 2011

Medical Department #41 - Soldier Suicides During the Civil War

The following tragic headline was carried in many of the nation's newspapers in the past couple of weeks:


This extract from an article in the Washington Post (full article here) explains the epidemic:

"The U.S. Army suffered a record 32 suicides in July, the most since it began releasing monthly figures in 2009. The high number of deaths represents a setback for the Army, which has put a heavy focus on reducing suicides in recent years. The number includes 22 active duty soldiers and 10 reservists. The previous record was 31, from June 2010. Army officials cautioned that investigations are still underway in most of the deaths to confirm the exact cause...In recent years, the Army’s suicide rate has surpassed the rate for the overall population. Comparing suicide rates among soldiers is difficult because the latest national suicide statistics, which are compiled by the Centers for Disease Control and Prevention, are about three years old."

It's an unfortunate - but all-the-more timely - coincidence that my most recent "Medical Department" column for The Civil War News deals with soldier suicide in the Civil War. (I had already submitted the article to editor at CWN before these recent headlines).

I usually introduce a column by stating "Enjoy!"...that's not appropriate in this case...see the end of the column for a more appropriate sentiment: a call to action.

By James M. Schmidt
Civil War News

“Medical Department” – September 2011

At the end of the third part of Robert Penn Warren’s poem, “The Day Dr. Knox Did It,” a Confederate veteran tries his best to answer his grandson’s question why a neighbor had killed himself:

“But what made him do it?” I said, again.
Then wished I hadn’t, for he stared at me.
He stared at me as though I weren’t there,
Or as though I were dead, or had never been born

Darker than shade, his mouth opened then.
Spit was pink on his lips,
I saw the tongue move beyond the old teeth,
in the dark of his head.

It moved in that dark.
Then, “Son -” the tongue said

“for some folks the world gets too much,” it said.

The grandfather came as close as anyone can to explaining the tragedy of suicide. Indeed, a report from the Department of Defense recently (2010) concluded “After decades of research, there is still much that is not understood about the causes of suicide and effective approaches to prevent it.”

That the DOD would have to contemplate the issue at all is the more recent tragedy: In the five years from 2005 to 2009, over 1,100 service members have committed suicide; a rate of a suicide every 36 hours. The past year alone has seen the publication of dozens of papers in the medical literature commenting on the crisis and methods to identify the risk of suicide among active-duty personnel and in the ranks of veterans.

Not surprisingly, the phenomenon was also a social concern in the mid-19th century, and is the subject of Col. R. Gregory Lande’s recent and interesting article, “Felo De Se: Soldier Suicides in America’s Civil War” (Military Medicine, Vol. 176, May 2011, pp. 531-36.). (Full abstract here).

Dr. Lande (MC, USA, Ret.) was mostly recently attached to Psychiatry Continuity Service at Walter Reed Army Medical Center. He is the author of more than thirty papers on military psychiatry in the professional medical literature and several books, including Madness, Malingering & Malfeasance: The Transformation of Psychiatry and the Law in the Civil War Era (Potomac Books, 2003).

In the article, Dr. Lande examines several aspects of suicide in the 1860s and 1870s, including record-keeping by states and municipalities; competing views of suicide among the public, the legal system, and the medical profession; factors that were thought to contribute to suicide; statistics on suicide among soldiers during the Civil War by year, by season, and troop strength; a discussion of conclusions drawn from those statistics; and the recognition that the “stressors of war” are timeless.

The term “felo de se” is a term meaning “a felon on himself.” Although it seems counter-intuitive, in fact suicide was considered a crime – legal and moral - deserving of punishment in the 1800s. Unfortunately, it was the families of the victim who actually suffered as Dr. Lande notes that the consequences could involve forfeiture of the victim’s property to the state or Crown. In the United States, life insurance policies were generally written to deny benefits to the families when deaths occurred due to suicide.

Official medical records kept during the Civil War indicate that there were no les than 268 suicides in the 51 months between June 1861 and August 1865, or 5.25 suicides per month. Dr. Lande found that the second year of the war produced the most suicides. He also examined the number of suicides by season and found that they reliably peaked every spring, but did not make a guess as to why that would be so.

The article also included reports – drawn from period newspapers – of specific suicides. Using leads from Dr. Lande’s paper – as well as my own research – below are some examples. Though one always has to be careful with simple anecdotal evidence, in fact each of the cases illustrates one or more of the social and personal factors that Dr. Lande identified as reasons for suicide, including “financial reversals, troubled relationships, the pernicious impact of certain literature, aggravating influence of education…poor health, insanity, and temperament.”

While Dr. Lande necessarily confined himself to reports of soldier suicides during the war for the purposes of the article, I’ve also included some reports of suicide of a war widow and veterans of two wars:

“Alonzo Coy…shot himself through the brain at these headquarters…A few days since his business led him to Washington, where he lost or had stolen from his pocket promissory notes to the amount of nearly $1,000 since which time he had appeared unusually depressed. Yesterday he was quite ill, and his illness, together with his loss, doubtless overruled his customary firmness, and to some degree unsettled his mind…About noon, Major Tripp…passed the door of his tent and entered a house standing near, the deceased saluting and speaking in a cheerful tone as he passed...immediately afterward heard the report of a pistol...The Major…rushed into the tent and found his friend lying…with the blood flowing from both temples. The pistol, a heavy revolver, lay upon the floor, having fallen from his grasp... his death has east a gloom upon the spirits of all who knew him.”New York Times, September 26, 1862.

“W. B. Carter, a returned soldier, committed suicide on Wednesday, by taking strychnine…he left a note, saying he was tired of life, and stating where his pension certificate could be found, desiring it to be returned to his wife.” - Daily Evening Bulletin (Philadelphia), June 4, 1869.

“A homeless and hopeless soldier committed suicide in the streets of New York last week.”The Press (Philadelphia), May 19, 1865.

“A soldier’s widow in Muncy became so depressed in consequence of the returning home of soldiers, that she committed suicide by drowning herself in a well.”The Mariettian (PA), June 24, 1865.

An Old Veteran Commits Suicide Rather Than Go to the Poor House – An old man named Andrew Klotz…committed suicide one day last week by hanging himself. He was an old soldier of the war of 1812 and had become quite poor. He was to have been removed to the Poor House the day after the commission of the deed.”Lancaster Intelligencer (PA), September 18, 1867.

Dr. Lande concluded his article with a well-worded call to action:

“The shock of suicide often leads to a correspondingly intense inquiry. After a time, interest seems to dwindle until the next ‘unexpected’ suicide. The goal for policy makers and clinicians is to remain vigilant, ever on guard for the possibility of suicide. Even with the best practices, suicide prevention is hampered by the mysteries surrounding the motives. After all, the real answer is lost forever when the person dies. Nonetheless, prudent risk management strategies enforce alertness, ensure the appropriate interventions are quickly accessible, and demonstrate the military’s resolve to combat the dark emotional forces that lead to suicide.”

Let us never forget that casualties of the Civil War extended beyond the battlefield and – heeding Dr. Lande’s call – let us also remain vigilant and alert and do our part in supporting the needs of our men and women in uniform and returning veterans so that, for them, the world does not get “too much.”

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