These tests were not foolproof, however; Mitchell and his colleagues desperately tried to create rhetorical control of the issue, removing nerve injury from the realm of medicine to that of law and morality by entering the “medical jury box,” as they put it. The doctor was overtly transformed into a prosecutor armed not only with medical knowledge, but also with “ingenuity” (“Malingering” 371). Mitchell suggests that he should be aided by “detectives” who should “zealously follow [suspected malingerers] everywhere unseen … when they least suspect it … to see how they act when off their guard” (371). The doctors even recommend a “malingerer’s brigade” as a punishment, made up of convicted malingerers marked visibly with a “peculiar dress” who are compelled to do the “hardest and filthiest duty” till they return to the battlefield as “honest men” (“Malingering” 369). Like Brody, who claims “a physician creates illness just as a lawmaker creates crime,” Mitchell suggests that tracing the etiology of nerve disease relies as much upon the legal rhetoric that distinguishes criminals from innocents as it does upon physical exams and scientific observations.30 Still the disease remained ambiguous. Malingerers managed to slip through the fingers of the law, unable to be court-martialed, for “it is yet impossible to swear to it, and even when it can be sworn to, it is often difficult to advance such evidence as will convince a court of non-professional men” of subterfuge (“Malingering” 369). Medical science ultimately failed the doctors in their case against malingering, for bodies did not provide adequate evidence for such purposes, and punishment and treatment remained elided.
Perhaps most surprising about the essay “On Malingering” is that doctors also became a subject of examination. They might also be malingerers, the authors suggest, employing desperate means to substantiate the diagnoses of these invisible nerve diseases and maintain control of the hospital. In trying to explain how doctors are qualified to make the important decisions between illness and criminality outlined in the work, Mitchell submits that he uses “his own sense, his habits of observation, and that peculiar tact in detecting imposters, which, whilst it seems an instinct with some, may be acquired” (“Malingering” 371). Ironically, the nerve doctor must rely upon his own senses, which—the doctors maintain throughout their medical literature—are always suspect during the Civil War era. In their effort to fix identity, the doctors became actors—or malingerers—playing their own parts in the elaborate game of one-upmanship. When approaching the potential cauterization of a suspected malingerer, the doctors “purposely, in his hearing, to the ward-master in the tone of a stage ‘aside’” torture the patient with graphic descriptions of the “treatment” to come (“Malingering” 391). The authors themselves simulated various seizure types to see which signs could be mimicked and which were “involuntary.” Finally, in some cases the doctors conspired to manufacture illness for the malingerer: “His body was perfectly free from disease, but we thought we would work a little on his imagination,” Mitchell boasts as he begins to describe the painful examination to come.31
In “The Case of George Dedlow” Mitchell exploits the doctor’s debility, for the patient is a doctor so spectacularly injured that he is unable to gauge the world around him, never mind assessing and treating patients. The doctor is the one who wastes away, who is incurable, and who eventually loses all sense of himself. George’s case might be read as Mitchell’s effort to tell the story of his own wartime illness.32 Much had happened to Mitchell between the 1864 publication of his emphatic medical texts and the 1866 appearance of his anonymous foray into fiction. He had become a patient himself, forced by ill health to resign his nerve hospital, as he wrote to his colleague, William Keen. He would later explain curtly that he “broke down” in 1864. Mitchell complains to Keen that his winter of illness has been a “great hiatus full of aches and nausiaus [sic] doses—mustard plasters, slow, long, lazy days of convalescence and lots of not work done [sic].”33 Most interesting is Mitchell’s comment that after this long convalescence he was “just beginning to feel that [he] shall ever be [him]self again.” Like George Dedlow, Mitchell lost something of himself in the war, but unlike his fictional character, Mitchell was confident that he could pull himself back together again. Still, although Mitchell went on to be fabulously successful, it is clear that his own wartime disease continued to cause him pain (Fig. 2). He would abruptly abort his novel about how the news of Fort Sumter had been received in Philadelphia with the phrase “incomplete—too painful for both sides.” Even in 1905, commenting on the number and variety of injuries he saw during the war, Mitchell remarks tersely, “I sometimes wonder how we stood it.”34
Figure 2. S. Weir Mitchell in Canada around 1870, possibly on a camp cure. Mitchell is sitting on a chair, fourth from the left. Courtesy of the College of Physicians of Philadelphia.
As we’ve seen, Mitchell’s Civil War-era responses to the ambiguity of medical factuality and individual coherence varied widely, as widely as his ability to cure his suffering patients. Though Mitchell would later go as far as alienating the influential William James in proclaiming spiritualism bunk, the young, stunned George Dedlow finds it the only way to reconcile the scientific facts that rule his professional identity with the distinctly unscientific reality of his experience. Mitchell can only imagine full therapeutic relief from George’s physical amputation and his psychic difficulty.35 Even in his medical writings, Mitchell invokes the language of miracles and spiritualism in describing the recovery of his patients. For example, in some cases, Mitchell notes, nerve damage literally causes a person’s body to disappear: the “muscles waste,” “tissue shrinks,” and “vessels fade” until “nothing is left but bone and degenerated areolar structures, covered with skin” (Gunshot 70). The nerve damage eats away the individual’s physical being. Mitchell’s role, then, was to bring these “motionless, emaciated” sufferers back to life, so to speak, through his treatments (Gunshot 23). He wrote to his sister of the pleasure he felt conducting his “splendid Hospital work,” for he was able to treat men who “have drifted hopeless and helpless from Hosp. to Hospital” by reenlisting their “dead limbs” and “moveless” lower torsos.36 Mitchell then figures himself as a spiritual medium, bringing life back to the dead, manufacturing new, strong muscle and tissue out of thin air. He waxes poetic on the tearful thanks of men who identify him as their savior. Yet one senses that Mitchell feels little control over his healing abilities; the role the doctor plays in these miraculous rehabilitations is as suspect as that of a spiritualist.
Indeed, the sorts of bodies upon which Mitchell’s medical knowledge is founded apparently reside in a spiritual plane. George Dedlow demonstrates that very little of the body is necessary to sustain sentience; he emphasizes that he has lost approximately four-fifths of his weight, that he sleeps and eats less, and that his heartbeat has slowed (“Dedlow” 7). His healthy limbs had connected George to the outer world in familiar ways and had provided the firm foundation of his individuality. But nerve injuries—and phantom limb pain in particular—proved the body’s functionality beyond the grave; though impalpable, the body still registered feeling. Thus it is no surprise that George is compelled by the spiritualist follower who explains that nothing dies, that the soul “merely changes form” (“Dedlow” 9). Whether healthy and visible or amputated and invisible, George’s body parts serve as mediums of communication, conveying feelings that were never completely translatable. Indeed, we might see phantom limb pain as another way of linking memory and corporeality, even when the latter has been compromised. “This pain keeps the brain ever mindful of the missing part,” Mitchell writes, for it communicates the existence of that which one no longer sees but feels only in memory (“Dedlow” 6). The often observed “deformity” of the phantom limb indicates the imprecision of memory; the mutability of the phantom’s presence represents history’s evasiveness. George’s reunion with his limbs at the end of the story imagines that corporeality can