Combat Effects on Mental Health:  The More Things Change, the More They Remain the Same

In this issue, Pizarro and colleagues¹ add a particular kind of archaeological perspective on the American Civil War.² From a painstaking archival examination of the military and medical records of 15 027 US Civil War veterans, they produced insights into the mental health consequences of that war, which should lay to rest the notion that there was something psychiatrically unique about the Vietnam Conflict or about what used to be called “post-Vietnam syndrome.” Their central findings strikingly echo the results of research into the mental health status of Vietnam veterans, including posttraumatic stress disorder (PTSD).^3- 4 For example, these authors' findings included the following: (1) psychological trauma, as measured by serving in a Civil War company in which more soldiers were killed, conferred a greater risk of developing signs of physical (cardiac and gastrointestinal) disease and comorbid physical and nervous disease; (2) being wounded was associated with an increased risk of nervous disease alone and comorbid nervous and physical disease; (3) being a prisoner of war predicted signs of comorbid physical and nervous disease and even mortality; and (4) younger soldiers had an increased risk of comorbid physical and nervous disease and even of earlier death if they witnessed more death during the war.