Understanding the Early Mental Health Challenges of Veterans: From the Civil War to the Jim Crow Era

During the Civil War, the U.S. military was quickly overwhelmed by the need to care for hundreds of thousands of wounded and disabled soldiers. These wounds included mental illness, sometimes a result of war experiences or preexisting conditions complicated by injury or disability.

At first, Veterans relied on family or community support for their disabilities. However, as time passed, demand for institutional care surged. The U.S. Sanitary Commission, led by figures like Dorothea Dix and inspired by Florence Nightingale’s reforms, recruited and trained thousands of nurses and set up hospitals and temporary homes for Veterans. After the war, most of these homes were dissolved, but the enormous scale of injuries drove activists like Delphine Baker to push for a permanent national system to care for the disabled. This led to the founding of the National Home for Disabled Volunteer Soldiers (National Home) in 1865, with initial branches in Maine, Ohio, and Wisconsin. The National Home would eventually grow to 11 branches across the country, with a peak of 35,854 residents in 1906.

For most of history, societies have tried to explain mental illness, often blaming supernatural forces, bodily imbalances, or moral failings. At the same time, Veteran populations have statistically been more prone to suffering from these ailments. Mental disorders were first officially classified into categories like melancholy, mania, and dementia, but physicians also created diagnoses that reinforced social control and justified the oppression of women and the enslaved. Before the mid-19^th century, most people with mental illness were hidden at home or institutionalized, often facing brutal conditions. As medical approaches advanced over time, figures like Dr. Benjamin Rush rejected supernatural explanations and insisted that mental illness was a medical condition.  They advocated for more humane care, and “insane asylums” grew throughout the 1800s, though they were often authoritarian and sought to “reform” behavior rather than treat the underlying causes.

 Post-Traumatic Stress Disorder (often called Soldier’s Heart during this period) and other significant mental illnesses were not uncommon at National Homes. According to Brian Matthew Jordan, some National Home campuses maintained “insane wards” for Veterans, holding them or sometimes transferring the “hopelessly insane” to state lunatic asylums or to the Government Hospital for the Insane in Washington, D.C. Depression and suicide among Veterans at the National Homes were also frequently reported.[1]

In an era that was only beginning to recognize mental illness as something other than a personal weakness, mental health care for Black Veterans was even more limited. Black Veterans, who made up about 10 percent of the Union Army, were nominally entitled to the same benefits and were sometimes housed in the National Homes alongside White Veterans, albeit in small numbers. Yet, segregation and social hostility limited their access and led to calls for separate facilities, especially as the country moved into the Jim Crow era. In the Hampton, Virginia branch, ostensibly built for the benefit of Black Veterans, the population never rose above 8 percent of total residents.

While marginalized groups had inconsistent access to mental health care, Black Americans faced segregation and worse conditions in asylums than White patients. Racist interpretations of census data in 1840 were used to argue that freedom caused insanity among Black people, reinforcing discriminatory attitudes and policies. Even as reform took hold, systemic inequalities persisted in early American mental health care.

Even though Veterans were not provided with specific mental health treatment at the National Homes, holistically, the conditions of the home may have been quite therapeutic to those with psychiatric symptoms. Campuses contained beautiful buildings set among bucolic landscapes in mostly rural environments. Coupled with a structured but modest daily schedule, where residents worked to their abilities among people with similar experiences, the National Homes created a nurturing domestic environment focused on rehabilitation.

By the late 1800s, new formally trained neurologists began to challenge traditional asylum doctors, arguing that asylums had become overcrowded and custodial, and that new treatments and outpatient settings were needed for proper care. World War I brought even more attention to psychological trauma, leading to a surge in the need for new neuropsychiatric facilities. During the early years of the Veterans Bureau (VB), neuropsychiatric hospitals were established and some National Homes, such as the Marion, Indiana, and Hampton, Virginia, branches, were turned into neuropsychiatric facilities.

However, for Black Veterans, access to such hospitals became quite limited. Under pressure from segregationists who did not want Black Veterans in VB hospitals, the Tuskegee Veterans Hospital was built to serve solely Black Veterans. It was able to offer some mental health care, but only to those who could get to Alabama. Other Veteran hospitals rarely admitted Black Veterans until the 1950s, when facilities were officially desegregated.

Sources

Jordan, Brian Matthew. Marching Home: Union Veterans and Their Unending Civil War. New York: Liveright Publishing Corporation, 2015.