Can medical data from the U.S. Civil War help us better understand military suicides?
Your recent Time cover story in the July 23 issue detailed the tragic facts that suicide rates among active-duty U.S. military personnel rose dramatically over the past decade. Military suicide rates doubled between 2001 and 2006, while remaining flat in the general population, with more military fatalities attributed to suicide than to actual combat in Afghanistan during that period.
To make matters worse, we do not understand why. Stressors related to military training, overseas deployment, transition back to civilian life, and combat are widely believed to be major driving factors. However, 31% of soldiers who committed suicide had never been deployed to a war zone. Furthermore, suicide rates in British military forces have also increased recently, though to a lesser degree, and do not exceed the rate of the general population.
Is there a lack of historical context?
Compounding our inability to understand this current phenomenon is the lack of adequate historical data to provide context on whether high suicide rates were typical of prior wars. Review of archival records from past wars might help shed some light on the current military suicide epidemic.
In a recent study (Frueh & Smith, 2012) we reviewed historical medical records on suicide deaths among Union forces during the U.S. Civil War (1861-1865), a brutal war that many consider the first modern one, and for the year immediately after the war to estimate the suicide rate among its Union combatants. We also reviewed these same historical records for data on rates of alcohol abuse and other probable psychiatric illnesses.
White active-duty Union military personnel suicide rates ranged from 8.74 – 14.54 per 100,000 during the Civil War, and surged to 30.4 the year after the war. For black Union troops, rates ranged from 17.7 in the first year of their entry into the war (1863), to 0 in their second year, and 1.8 in the year after the war.
For comparison, the current rate of U.S. military suicides is just over 20 per 100,000 troops. To further put these figures into current context, there were more military suicides in 2010 (total suicides = 295), than during the entire four years of the Civil War, for which we found 278 documented Union suicides, and forces were of comparable size.
Thus, current suicide rates in the U.S. military are probably two to three times higher than those documented during the Civil War. Rates for other available psychological domains, including chronic alcoholism, “nostalgia,” and insanity, were extremely low (< 1.0%) by modern day standards during the Civil War.
Of course, we should interpret data from the U.S. Civil War cautiously, not simply because of its age, but because medicine and society in the 1860s were psychologically naïve. There was almost no awareness or understanding of mental illness then. Posttraumatic stress disorder (PTSD), now understood to be a common post-combat reaction did not exist in the medical literature at the time. Moreover, it is possible (but by no means certain) that the stigma of suicide and psychological problems may have biased against reporting.
What about combat intensity?
As noted by preeminent Harvard psychologist, Richard J. McNally (2012), these Civil War findings occurred within the context of extremely intense combat operations. In reviewing historical data on rates of killed in action, he notes that the death rate for Union forces during the Civil War was 48 times higher than for modern U.S. troops serving in Iraq and Afghanistan. And yet, emotional problems and disability (from many different causes) has risen dramatically among U.S. military personnel and veterans, even since the Vietnam war.
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