Nerve injury during the Civil War was an all-encompassing rubric for a variety of ills and symptoms ranging from burning neuralgia to phantom limb pain to depressed or resistant behavior. Thus nerve injuries became the perfect vehicle for both literal and metaphoric discussions of the physical and psychological wounds of war. They were chronic and invisible. They flamed up and subsided at will. Most important, they foregrounded the tenuous distinction between “feeling” like oneself and enduring a growing sense of alienation from one’s injured body and from one’s self at war. The Civil War world Mitchell describes for his patients is a world viewed aslant, either numbly perceived through thick, insensitive skin or felt excessively and painfully through hyperaesthetic nerves. Thus Mitchell presents nerve injury both as an etiology and as a powerful cultural trope, one that would continue to accrue significance as the nineteenth century wore on.
Scholars have come to know Mitchell mainly through Charlotte Perkins Gilman’s The Yellow Wall-Paper (1892) and Jane Addams’s Twenty Years at Hull-House (1910), where he is revealed as the abusive inventor and implementor of the “rest cure,” a therapy designed to relieve primarily upper-class female neurasthenics of a myriad of symptoms by enforcing stereotypically feminine behavior. Both contemporary praise and criticism of Mitchell focus on the mature, self-assured public figure he had carefully constructed by the 1880s when his expertise with nervous cases was highly sought. As his medical biographer, Richard Walter, writes, “Apocryphal stories continue to circulate, his name designates lectureships and prize papers, and his works are cited as references in the clinical game of roundmanship”—honors accumulated, however, relatively late in Mitchell’s career. Recent articles in The American Journal of Psychiatry and The New York State Journal of Medicine celebrate the versatility of this poet-physician and invoke him as the beloved patriarch of modern neurology and even of American psychology. The preoccupation with Mitchell’s late-century activities has commonly led most scholars to only two of his many medical texts: Fat and Blood (1877) and Doctor and Patient (1888). It is widely accepted that he formulated the rest cure in these two books.3
What is less well known about Mitchell’s medical praxis but is equally significant is that the elements of the rest cure were developed for the treatment of Civil War soldiers suffering from nerve injuries. It was in Gunshot Wounds and Other Injuries of Nerves (1864) that he began to order “tonics, porter and liberal diet” for his patients, along with “shampooing [i.e., massage] and passive movement vigorously carried out” and electrical stimulus.4 It is also here that we see the doctor’s increasing resolve to carry out painful treatments despite the soldiers’ “prayers and protestations” (Gunshot 25). Thus the foundations of Mitchell’s later fame—the therapeutic aids of bed rest, forced feeding, massage, and electric therapy, as well as the vexed doctor-patient dynamic—were laid in the 1860s. Whereas women were to be returned to femininity through the therapy, these injured soldiers were to be rehabilitated into vigorous masculinity, ready to reenter their regiments and submit themselves to military rule. In both cases, patients suffering from symptoms that did not fit into existing categories or were unresponsive to known remedies were labeled “hysterical.”
The distrust, even contempt, Mitchell felt toward his female patients was also apparent in his attitude towards Civil War soldiers; in all cases of hysteria Mitchell was hypervigilant, for he believed some patients feigned illness out of laziness or greed. Thus an important component of Mitchell’s therapeutic protocol during both periods was distinguishing the real sufferers from the imaginary malingerers. In his own disease, Mitchell revealed the tenuous authority of the doctor and the medical knowledge at his disposal, admitting that doctors too are often malingerers feigning their roles. As a necessary correlative of the amorphous nerve injury, the concept of malingering became a trope in post-bellum America for the ontological uncertainty of Americans who could no longer gauge how they felt. It also applied to those burgeoning professionals—such as Mitchell—who took upon themselves the task of deciding how Americans should feel.
Although designing a “system of therapeutics” was ostensibly his only goal in his medical texts, Mitchell was clearly embarking on an even more crucial project—one of hermeneutics (Gunshot 11). Civil War soldiers suffered from injuries that had never been recorded in medical history, presenting phenomena to Mitchell and his colleagues that were “naturally foreign to the observation even of those surgeons whose experience was the most extensive and complete” (Gunshot 10). In the introduction to Gunshot Wounds Mitchell explains that “never before in medical history has there been collected for study and treatment so remarkable a series of nerve injuries” (Gunshot 11). Again and again Mitchell expresses the difficulty of describing in “ordinary terms” bodies that are so extraordinarily diseased. Extant etiological vocabularies were simply unequal to the task of representing something that seemed to be inarticulable. He emphasized that this was not the “normal” pain found in civil practice, suggesting that what was suffered in the context of the Civil War was appreciably different—was felt differently, endured differently—from the pain of previous generations. Since feeling is subjective, we simply have no way of knowing if people had never felt in the ways they felt during the war, but because, as David Morris explains, “we experience our pain as it is interpreted, enfolded within formal or informal systems of thought that endow it with a time-bound meaning,” we can assume Mitchell’s patients endured, as he puts it, “a form of suffering as yet undescribed” (Gunshot 101).5 Part of the Civil War doctor’s task, then, was to create a system of meaning with which the doctors and patients could interpret their illnesses and their respective roles in the rehabilitative process.
Although Mitchell appointed himself the “historian” of the aftermath of modern warfare, his anxiety about the possibility of a valid history based on the narratives of diseased individuals and the observations of uncertain doctors is evident in both his medical and fictional work (Gunshot 69). The case history method evolving during this time explicitly linked medical and historical endeavors. Indeed, Mitchell makes history corporeal, siting specific psychic moments and historical events in bodily wounds—the scars of memory attested to the reality of corporeal experiences and of events long gone. Yet his efforts to substantiate truth-claims in the body proved untenable as his work on nerve injury proceeded. Viewed through the lens of nerve injury, the body itself became a mutable, even spiritual, medium. Even when an injury was visible, the true nature of another’s feelings could only be a matter of faith. One’s own body became uninterpretable when proximate to nerve injury as healer. In his late-century historical fiction especially, Mitchell continued to wrestle with the inadequacy of corporeal knowledge, an uncertainty he consistently expressed through the trope of the Civil War.
Finally, the malingering inherent in nerve injury signaled a change of consciousness Mitchell valiantly resisted. We can see him stretching to make the uncommon and incomprehensible—bizarre injuries; seemingly recalcitrant, even depressed, patients—fit into his medical prognoses, to make amorphous ills treatable. He reassures his reader, “Phenomena which one day seemed rare and curious, were seen anew in other cases the next day, and grew commonplace as our patients became numerous” (Gunshot 2). Mitchell crafts a bodily logic contingent on a vast quantity of diseased bodies. The considerable number of nerve injuries and the doctors’ increasing familiarity with the “rare and curious” promised the possibility