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Chapter 1

Doctors’ Bodies: Dr. S. Weir Mitchell and Patient Malingering

I like a look of Agony,Because I know it’s true—Men do not sham Convulsion,Nor simulate, a Throe—

—Emily Dickinson, # 241

In 1863, Dr. Silas Weir Mitchell wrote to his sister of his increasing passion for the research he was pursuing in between his more mundane duties in a Civil War hospital. “I so much dread to find increasing practice or other cause removing from me,” the young Philadelphian wrote, “the time or power to search for the new truths that lie about me so thick.”¹ The “new truths” to which Mitchell alludes occupied his medical research and his fiction over the course of his long life. At Mitchell’s death at age 84 his friend and fellow doctor, Owen Wister, summarized these interests: “Four years of mutilated soldiers and fifty of hysteria, neurosis, insanity and drug mania, unrolled for him a hideous panorama of the flesh, the mind and the soul.”² It is precisely the interstices between flesh, mind, and that amorphous essence called soul that characterize Mitchell’s imagination and distinguish his work. These issues coalesced early in Mitchell’s career in his once celebrated but now forgotten war-era texts. During the Civil War Mitchell defined the new medical phenomenon that would shape the way he—and his whole generation—viewed the proper behavior of patients, the forms in which their stories could be told, and the role of the doctor: nerve injury.

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 of knowledge and rehabilitation. It is through the meticulous layering of case history upon case history that individual bodies would become recognizable and, ultimately, treatable as they were amalgamated into a theoretical composite. Even if not properly cured, the idea that such diseases would become “commonplace” assured rehabilitation, for habituation to disease makes it normative. What remains unspoken is that insensibility could become the norm.

Most of Mitchell’s significant medical work on nerve injury and malingering was written during his two-year stint as head army surgeon at Turner J. Lane Hospital, an institution created by his friend Surgeon General William A. Hammond to explore the increasing number of puzzling maladies produced by the war.⁶ Gunshot Wounds and Other Injuries of Nerves, the first product of his war-era medical research, has been dubbed the major treatise of the nineteenth century on nerve damage. In the words of one recent critic, it was so “truly revolutionary” that it remained the definitive work on nerve damage for at least a generation, resurfacing in Paris hospitals during World War I.⁷ Mitchell’s pamphlet “On Malingering, Especially in Regard to Simulation of Diseases of the Nervous System,” also published in 1864, was, like Gunshot Wounds, coauthored by Mitchell and his Turner J. Lane colleagues, Drs. Keen and Morehouse. This formidable trio confronts the difficulties of assessing personal character as a necessary aspect of medical practice, perhaps unwittingly presenting the doctor as an object of assessment as well.⁸ Finally, in his anonymously published short story “The Case of George Dedlow” Mitchell’s main character, who is both doctor and patient, confronts the psychic cost of wartime service.⁹ Readers of the Atlantic Monthly were moved by the story of army surgeon George Dedlow, who after losing more than 80 percent of his body mass through the amputation of all of his arms and legs, experiences a short-lived spiritual reembodiment of his limbs at a seance. The imaginative resolution of Mitchell’s story implies that rhetorical rehabilitations offered the only hope of recovery.

Two decades later, Mitchell’s fictional imagination was still trained upon the Civil War. His first novel, In War Time, was serialized in the Atlantic Monthly in 1884 and subsequently appeared in book form. In it Mitchell returns to the Civil War hospitals and home fronts of his early career, places he revisited again and again in his fiction. It is in those historical and psychic spaces, as one of his characters proclaims, that men discovered “[what is true of] disease is true of war. It ruins some men morally, and some it makes nobler.”¹⁰ Perhaps not surprisingly, it is not the patients’ demoralization or nobility that are the main focus of In War Time but, rather, the Civil War doctor’s. Mitchell’s Dr. Ezra Wendell clearly suffers from nerve disease, and the novel charts his incompetence and the mortal danger he poses to his patients. Mitchell’s Civil War medical texts demonstrate that he was deeply invested in the emergence of a postbellum medical culture based on the practitioners’ objectivity and the superiority of scientific methodology with its tenet of repeatable results. His fatally flawed fictional doctors often struggle with the disabling expectations this new medicine demanded. Wendell is rendered professionally and psychologically impotent by his inability to control his own senses and, then, consistently and fully rehabilitate his patients’ bodies. Put another way, Mitchell’s Civil War fiction demonstrates the futility of employing a method premised on producing objective results apart from the human beings who also embody those results. Doctors are always patients as well, subject to the science that they practice.

Thus Mitchell’s Civil War texts provide a multifaceted picture of the convolutions of medicine, of narrative, of bodies, and of self that are completely integrated in the trope of the Civil War. This is not to say that his medical texts are primarily imaginative pieces or that they may be taken figuratively because the medical treatment and political views they espouse are largely outmoded. First and foremost, they must be read as serious efforts on the part of the medical community to cope with the very real injuries of Civil War soldiers and the doctors’ abilities to serve their patients. Yet Mitchell himself seems aware that his texts not only attempt to heal patients but that they also construct crucial cultural narratives of body and selfhood. In particular, this chapter on Mitchell’s war work reveals the psychological labor entailed in both the patient’s recovery and the doctor’s profession. The Civil War era, with its masses of diseased participants, established that all postbellum survivors would be long-suffering malingerers.

“When the Sensation Lenses … Become Destroyed”

In his war-era science and fiction Mitchell portrays patients at odds with their bodies, distanced, even alienated, from their unfamiliar, painful, and ultimately grotesque physical manifestations. In short, Mitchell explores how patients and doctors cope when “the sensation lenses” and the bodies that express them “become destroyed,” as his George Dedlow puts it (“Dedlow” 8). Yet patients classified as nerve injured were impaired in an astounding variety of ways. In the most straightforward cases, the men described feeling detached, numb, and out of sync with normal body functions. The patients were fully conscious of what was happening to them, yet they did not feel at all, or felt partially or incorrectly. Mitchell focuses on men such as “Lieutenant G” who felt no pain when he was shot in his leg but eventually felt pain in the other leg (Gunshot 15). Another man could discriminate compass points equally well on injured and healthy tissue, “but when his eyes were covered, a large needle could be run nearly through the palm without pricking” (Gunshot 128). Their pains do not correspond to presumed physical sources and thus suggest that bodily damage does not hold as an originary source for nerve injury. There is not a necessary correspondence between the visible wound and the interior pain, as medical wisdom of the time would have it. What is clear is that these men do not feel the way they did before their war injuries.

Although some patients maintained a conflicted and alienating attachment to their pain and the corporeal or phantom body parts that expressed the pain, others were so overloaded with pain that they were overwhelmed by it. Mitchell describes patients to whom “touch is interpreted or felt as pain … the sense of tact not lost but practically defective, by the overwhelming influence of the pain” (Gunshot 95). These patients feel so much that it hurts; the faculty of touch is “constantly exercised” and obliterates all other types of sensation. The symptom of “too much sense” or hyperaesthesia may also be interpreted as an inability to feel. A patient’s hypersensitivity to pain can cause one, in medical parlance of the time, to become “hysterical.” As Morris phrases it, “Prolonged chronic pain threatens to unravel the self,” ushering in not death, but insanity.¹¹ In Gunshot Wounds one patient is “nervous and hysterical to such a degree that his relatives suppose him to be partially insane” (89): “The temper changes and grows irritable, the face becomes anxious and has a look of weariness and suffering … at last the patient grows hysterical, if we may use the only term which covers the facts. He walks carefully, carries the limb tenderly with the sound hand, is tremulous, nervous, and has all kinds of expedients for lessening his pain” (Gunshot 103). Hysteria had not, of course, in 1864 attained the cultural significance that it would enjoy later in the century as a catchall for ills of the body and spirit plaguing modern Americans.¹² Yet this patient’s hysterical body has come to be his entire sphere of existence, swallowing up all other concerns and perceptions. As Mitchell explains it, the diagnosis of hysteria is the only chance of “cover [ing] the facts” of this man’s case, by organizing his disorder and offering the possibility of rehabilitation.

In describing such cases as hysterical, Mitchell contends that the body’s uncontrollable susceptibility to sensation spills directly into social behavior. Mitchell wishes to rehabilitate the patient’s body not only by measuring and standardizing how he feels but also by bringing him to his senses, restoring him to acceptable patterns of behavior. The seeds of a modern understanding of selfhood, in which the bodily economy is interpreted as out of control and in constant need of rehabilitation, were sown in Civil War hospitals. Not surprisingly, then, Mitchell concentrates on bringing the will to bear on the patient’s body so that he will avoid becoming demoralized. Mitchell defers to martial law in his description of one patient, arguing, “Had he been abandoned to his own wishes, he certainly would have remained a helpless cripple; but it is quite sure that nowhere, except under military rule, could he have been relieved” (Gunshot 27). Self-discipline becomes a key component of the patient’s physical rehabilitation. Because nerve injuries were so poorly understood, patients were often excoriated for lacking the will to overcome their physical maladies. Even today, when doctors do not have an organic understanding of a patient’s disease, they may blame the patient for his or her inability to behave in expected ways. As Howard Brody persuasively argues, “There is a proper way to be sick … a proper way to carry out the role.…”¹³ Since these injuries were being defined during a state of war, the military discourse helped to determine what was socially acceptable, even for the patient’s muscles. Mitchell summons one patient’s legs, insisting that an effort of will is “demanded to call them into action” (Gunshot 98). However, too many individuals failed in this effort during the Civil War for nerve injury to remain solely a matter of character. Mitchell and eminent colleagues, such as psychologist William James, spent the rest of the century grappling with the complicated relationship between the patient’s bodily symptoms and his or her moral fiber.

As one might expect given this apparent crisis in character, patients who exhibited mental fortitude in disassociating themselves from their physical weaknesses were celebrated by physicians. Mitchell proudly recounts how “wounded men who are not weakened by loss of blood or excessive shock have a very natural curiosity as to the condition of the wounded part, and are apt almost immediately to handle it, and try to move it” (Gunshot 20). In this scenario, the injured body part—“it”—is rhetorically, and perhaps psychically separated from the individual. Early in Gunshot Wounds, the injuries are described rather mildly as “foreign” oddities; at a later point Mitchell comments upon the monkey-like appearance of a patient’s atrophied hand, bestializing the injury; finally, the injuries are strongly described as “grotesque deformity” (10, 24, 70). The progression of Mitchell’s imagery through the text signals his increasing frustration with the disease’s resistance to treatment and the patient’s inability to maintain corporeal integrity. As patients continue to suffer from their injuries, their humanity is systematically stripped away; likening their psychic realities to their atrophying limbs, Mitchell de-evolves the patients until they are no longer even animal-like, but monstrous. Although patients and doctors used this rhetoric for purposes of self-preservation, certainly one could not use such debasing language without imputing the individual.

Mitchell’s stories of patients who do not feel pain and who exhibit courageous fortitude served an additional social function, that is, in Morris’s words to persuade his audience “that they had nothing to fear from pain, at least when they suffered in a great cause.”¹⁴ This self-alienation was a necessary coping mechanism for a soldier who might be horrifyingly mutilated, let alone faced with the amputation of some body part. It gave the patient the illusion of an essential self that was protected from the ills that afflicted the self’s shell. In its own way, this strategy combated midcentury physiological views of the reliable correspondence between the body and the mind. Certainly, their wounded bodies did not represent the physical self-portrait to which injured soldiers had been accustomed before the war. In many cases patients preferred amputation to deformity, perhaps believing that in excising the offensive, dehumanizing marks of war, they would be able to regain some semblance of their antebellum selves. Mitchell relates how he was “again and again urged by patients to amputate the suffering limb” as if it were apart from the patient’s economy, a distantly suffering relation of whom the patient was fond but wished to put out of his or her misery (Gunshot 105). In addition, the amputated body, it was hoped, could provide a more accurate and healthy representation of the inner self than a whole but deformed body.

In “The Case of George Dedlow” Mitchell imaginatively explores the whole range of ontological states accompanying the physical undoing he encounters in Gunshot Wounds. Here Mitchell demonstrates the psychic and metaphoric death that can eventually accompany drastic changes in a person’s physical experience of him- or herself or, as George phrases it, “how much a man might lose and yet live” (“Dedlow” 8). This is no conventional war story; we get only the sketchiest details of George’s battlefield exploits. Rather, Mitchell concentrates on the “metaphysical discoveries” related to injury and loss of selfhood, presenting the gory details in order to “possess [the audience] with the facts in regard to the relation of the mind to the body” (“Dedlow” 1, 5). At the beginning of the story George describes his first injury in much the same terms Mitchell initially used in Gunshot Wounds. George is able to detach himself from his body, to look at his hand hanging loosely from his shattered arm and remark, “The hand might as well have been that of a dead man.” He then proceeds to relate a thorough examination during which he determines the extent of the injury (“Dedlow” 2). However, sensation eventually does return, and the story illustrates that the feeling that persists after an injury is often reduced to pain when initiated through the gauntlet of the Civil War. The injured limb is “alive only to pain” and so is “dead” in every other sense (“Dedlow” 3). George begins to refer to his arm as if he were watching his own corpse, detaching from it and yet still feeling its miseries.

Initially Mitchell is eager to make George’s pain meaningful. When George explains to a pastor that he feels fine “except this hand which is dead except to pain,” Mitchell refers to nerve injury as a state not unlike purgatory or hell. The pastor makes that connection explicit when he warns, “Such you will be if you die in your sins; you will go where only pain can be felt. For all eternity, all of you will be as that hand,—knowing pain only” (“Dedlow” 3). Mitchell also suggests that George suffers for the sins of the Union; the doctor treating him in a prisoner-of-war camp is unable to relieve his pain with morphia because, he reminds George, “You don’t allow it to pass through the lines” (“Dedlow” 3). Whether or not the pain is a divine or martial punishment, both the pastor’s and the doctor’s explanations make sense of George’s pain, giving it a rationale and a predictable moral or spiritual meaning. The amputation of that arm functions not only as sanity-preserving detachment but also as expiation. Afterwards, George is calmly able to look at his amputated limb across the room and comment, “There is the pain, and here I am. How queer!” (“Dedlow” 3). The arm is no longer a body part; indeed, it is not even corporeal but instead signifies pure sensation for George. Who would not wish to rid one’s body of pain? It is only through excision that his identity can be maintained.

Yet none of these solutions suffice, for George’s body is endlessly vulnerable in the story. The continual pain does not transfigure Mitchell’s patients or his fictional George or make their suffering meaningful; instead, it reinforces the fragile continuity between the previous and presumably coherent self and the new body consciousness.¹⁵ Linking war, disease, and the (im)possibility of representation, George’s eventual amputations and phantom pain suggest that re-membering war is either an absence of feeling—a death, a gap—or unremitting, excruciating pain. Once all of George’s limbs are amputated, the pain does not end. In addition to throbbing or burning, George’s phantom limbs now have the additional effect of keeping “the brain ever mindful of the missing part, and, imperfectly at least, preserv[ing] to the man a consciousness of possessing that which he has not” (“Dedlow” 6). Throughout his subsequent amputations, George’s body-consciousness registers the dynamics of self and cultural history; he endures a pain that does not express the reality of his body or of the events he witnessed but only makes him aware of that which cannot be re-membered.

Consequently, when he awakes from the etherized sleep of the surgery during which his legs are amputated and “[gets] hold of [his] own identity,” as he puts it, he claims he is “suddenly aware of a sharp-cramp in [his] left leg” (“Dedlow” 5). George is horrified to discover that his awareness is a false one as his amused neighbor informs him he “aint [sic] got nary leg.” The longer he survives without his limbs, the more George feels his identity slipping away. “I found to my horror,” he writes, “that at times I was less conscious of my own existence, than used to be the case. I felt like asking some one constantly if I were really George Dedlow or not” (“Dedlow” 8). Life is theorized as more than simply physical existence in Mitchell’s writings; it is sentience, physical situatedness, a sense of individuality. Though George survives his injuries physically, psychologically he has been irreversibly lessened: “At the time the conviction of my want of being myself was overwhelming, and most painful. It was, as well as I can describe it, a deficiency in the egoistic sentiment of individuality. About one half of the sensitive surface of my skin was gone, and thus much of my relation to the world destroyed” (“Dedlow” 8).

He insists, as one medical ethicist has argued, “that life is not mere biological life … and human death is not, pure and simple, its biological termination.”¹⁶ Mitchell formulates a dynamic rather than static definition of the individual. As George explains, “A man is not his brain, or any one part of it, but all of his economy, and that to lose any part must lessen this sense of his own existence” (“Dedlow” 8). The body becomes the medium through which the world and the individual correspond along the course of “nerve threads”—as the body is diminished, communication lessens and so does one’s sense of self (“Dedlow” 6). Without adequate materiality, this story theorizes, a human is no longer able to impress himself or herself upon the world or to be impressed by it. Indeed, George is unable to impress himself upon himself; he writes, “Often at night I would try with one lost hand to grope for the other” (“Dedlow” 7). In this story, Mitchell thus insists upon simultaneous correspondences and slippages between the body and the mind. George’s corporeality must hold, no matter how imprecisely, the place for his identity, and, as the story’s ending suggests, his ontological troubles can be healed by re-membering his body. But rehabilitation is achieved only in the realm of fiction. George’s body is an incomplete signifier, and so George is a self unbounded—signification without substance or form.

As such, George’s self seeps away, lacking the material sounding board, the friction through which he had been discernible. By the time he has lost all of his limbs, not only has George lost his identity, but he is also struggling to maintain his humanity. Rather than transcending his body, George becomes primarily identified through its absence. He is a “useless torso, more like some strange larval creature than anything of human shape. Of my anguish and horror of myself I dare not speak” (“Dedlow” 5).¹⁷ He is unable to escape his decimated body—a body that makes visible the dehumanizing nature of war. His “useless” torso, shorn of its limbs by another human being, demands that we see the barbarity of war and the insensible self it ushered in.

Ultimately, Mitchell’s medical rhetoric was unequal to the task of rehabilitating strange and debilitating nerve injuries like George’s wrought by Civil War combat. His hermeneutical project was continually thwarted by his inability to read his patients and fit their symptoms into preexisting categories. The greatest test of the Civil War doctor’s ability was the endless task of accurately and precisely taxonomizing nerve injury, because “it assumed all kinds of forms, from the burning, which we have yet fully to describe, through the whole catalogue of terms vainly used to convey some idea of variety in torture” (Gunshot 101). Further, the “causes are indeed so numerous and so perplexing related in individual cases that it is not always easy to assign to each its share in the production of defects of motility” (Gunshot 119). Mitchell sums up his frustration in despairing of describing seizures, for they have such a great variety of symptoms that they “know no law” (“Malingering” 384). As George’s dissolution demonstrates, these diseases unbound and unfixed the idea of a stable corporeality that was central to any notion of rehabilitation. Nerve diseases were particularly insidious; they could extend from the site of the injury to affect other parts of the body, to transfer “pathological changes from a wounded nerve to unwounded nerves.” The very unpredictability of this malady, its ability to strike seemingly healthy and unaffected parts of the body, suggested not only the instability of life on the battlefield but also the war’s ability to affect even those seemingly insulated from its brutality.

The vagaries of the nerves insinuated themselves into Mitchell’s composing processes as well. Some of Mitchell’s frustration stemmed from the phenomenal transformations taking place in medical practice at the time. It is important to keep in mind that medical writing of the 1860s was quite different from that of our own time. Yet Mitchell’s Civil War work was part of a larger shift in medical praxis, as the “healing art” practiced by doctors such as Benjamin Rush was being transformed into a science. One medical historian explains that mid-nineteenth-century scientific writing was more leisurely, personal, and genteel than it was in subsequent decades: “With less editorial pressure, papers were frequently longer, more idiosyncratic and often autobiographical.”¹⁸ In a passage from his unpublished autobiography, Mitchell likens the writing of his medical articles to the mysterious process that overtakes him when writing fiction or poetry, where you “wait watching the succession of ideas that come when you keep an open mind”:

I seem to be dealing with ideas which come from what I call my mind, but as to the mechanism of the process, beyond a certain point it is absolutely mystery. I say, “I will think this over. How does it look? To what does it lead?” Then comes to me from some inward somewhere criticisms, suggestions, in a word, ideas, about the ultimate origins of which I know nothing.¹⁹

Though I would not argue that Mitchell’s scientific work is wholly fictional, the close connection in his mind between scientific and literary inspiration illustrates the transitional nature of his scientific work and the persistent difficulties of creating a precision between narrative and bodily experience. Debra Journet suggests that in “The Case of George Dedlow” “fictional techniques enable Mitchell to explore a phenomenon that he could not fully articulate within the scientific paradigms of his time.”²⁰ Yet the etiology of nerve injury suggests that accounting for the idiosyncrasies of the human body is always a theoretical endeavor.

Most significant about Mitchell’s self-reflexive passage on his medical composing process is that he cannot locate the “ultimate origins” of the theories he produces in his medical texts. Although one would guess, given the tenets of scientific praxis Mitchell advocated, that his patients’ bodies would serve as the foundation and original material for Mitchell’s texts, this candid passage suggests that the origins of his body theory emerged from the individual subconscious. Indeed, in “The Case of George Dedlow”—the work that most clearly muddies both the artistic and scientific intentions that animate Mitchell’s writing—George metaphorically links bodily inscription and textual production. In recounting the story of his last injury in battle, George explains that the events of that day are “burned into my memory with every least detail” and reiterates “no other scene in my life is thus scarred, if I may say so, into my memory” (“Dedlow” 4, emphasis added). He uses the language of corporeal branding to express the permanent alteration his psyche sustained along with his body. Continuing his description, George also says that the moment of injury is “printed on my recollection” (“Dedlow” 4). Using the terms burned, scarred and printed interchangeably in this passage to express how injury impresses itself on bodies, psyches, and texts, Mitchell inextricably links the moment of bodily injury, the genesis of textual production, and the ability to access the past. The body literally is inscribed by historical events—each wound marks their reality. Yet the body’s inability to re-member—indeed, its volatility and substantial immateriality—indicates its lack of originative integrity for narratives of medicine and history.

The generic confusion “The Case of George Dedlow” provoked among its readers speaks not only to the amorphousness of medical authority at the time but also to the public’s fears and desires about the authenticity of nerve injuries. In the opening paragraphs of the story, Mitchell purposefully exploits his readers, explaining that this story had “been declined on various pretexts by every medical journal to which I have offered” it (“Dedlow” 1). Thus he alerts readers immediately that the world of peer-reviewed scientific medicine denies the validity of the case history to come. However, he goes on to explain that although the story may not have any “scientific value,” it has led him to new “metaphysical discoveries” that some readers have found valuable (“Dedlow” 1). Thus the text is supramedical; this introduction might have proven attractive to readers who found the medical community and their narratives of health inadequate and unable to account for the spiritual realms of experience so appealing to a country in mourning. The fact that Mitchell laces his story with accounts of actual battles and references to real regiments and hospitals also lends the story its veracity. Of equal importance, George Dedlow is a doctor, a professional identity that increasingly connoted authority.

Finally, though the narrator eschews the institutional world of medical science, he employs the scientific tropes of experimentation and repetition. George constantly situates his experiences in a larger context. For example, after describing his thoughts and sensations during his first amputation, George writes, “At a subsequent period I saw a number of cases similar to mine in a hospital in Philadelphia” (“Dedlow” 4). And later, “There were collected in this place [“the Stump Hospital”] hundreds of these cases [nerve injuries]” (“Dedlow” 5). The instantaneous accretion of diseased Civil War bodies that Mitchell invokes validates the etiological explanations George subsequently proffers and ensures that the diseases he charts are genuine. Indeed, the most remarkable aspect of Mitchell’s Civil War medical experience was that there were so many extraordinarily diseased people gathered together. In the hospitals surrounding Philadelphia alone there were 26,000 beds for the sick and wounded, and Turner J. Lane eventually housed 400 patients, all of whom suffered from some form of epilepsy, chorea, palsy, stump, or nerve disorder.²¹ Medical historians are impressed by the meticulous case histories taken by Mitchell and his colleagues, thousands of pages detailing the stories of the men and their wounds.²² The more material gathered, the more likely that one would be able to discern patterns. The apparently lawless diseases appear again and again, providing ample opportunity for experimentation, generalization, and finally rehabilitation.

Yet Mitchell later marveled that his readers had been so taken by his story. As he explained in his unpublished autobiography, “The unfortunate George Dedlow’s sad accounting of himself proved so convincing that people raised money to help and visited the Stump Hospital to see him. If I may judge it by one of its effects, George Dedlow must have seemed very real.”²³ By responding in such immediate and visceral ways, Mitchell’s readers insisted that narrative treatments of bodily trauma were barred from the realms of fiction. Denied a generic classification or an author, readers assumed that the story conveyed new truths of the sort that Mitchell himself had wondered at day after day in the Civil War hospitals. In a way, the story became a phantom limb; Mitchell’s subsequent statements would make it into a fraudulent version of reality, but his readers’ responses suggested that it conveyed new and troubling information about postbellum bodies and identity. Indeed, the apparently seamless generic switch and bait suggests that all case histories are equally (un) able to communicate the reality of bodily experience.

The story Mitchell would later tell of how “The Case of George Dedlow” was produced and published echoes the mystical tone of his description of his medical composing process; it also smacks slightly of disingenuousness. He claims that he wrote the story on a dare: “A friend came in one evening and in our talk said, ‘How much of a man would have to be lost in order that he would lose any portion of his sense of individuality?’ This odd remark haunted me, and after he left I sat up most of the night manufacturing my first story, ‘The Case of George Dedlow, related by himself.’”²⁴ For some unexplained reason, he then left the tale in the hands of a “delightful lady, Mrs. Caspar Wistar.” When Mrs. Wistar’s father, “Dr. Furness, a Unitarian minister,” got his hands on the manuscript, he sent it to the editor of the Atlantic Monthly merely because he was “much amused.” Mitchell then writes, “To my surprise, I received about three months afterwards a proof and a welcome cheque for Eighty-five Dollars.” Thus the story’s transference from nearly supernatural inception (the story “haunted” him) to anonymous publication to unforeseen compensation seems apocryphal itself. It is as if the story passed effortlessly—one might say divinely—from thought to print, unmediated by the mundane problems of composition, editing, and publication. Mitchell reveals that his medical and fictional narratives materialized from the “mystery” of “some inward somewhere,” the “haunting” of bodily conundrums not far removed from those he saw in the Civil War hospital.

At the same time, Mitchell was keenly aware that empirical science was becoming the professional creed of American doctors.²⁵ Trained in this new milieu, Mitchell certainly felt pressure to present his new truths as persuasively as possible. Despite the amorphous nature of his composing process, the triumph of Mitchell’s medical work lay in his ability to obtain objective detail by “ocular and microscopic examinations” and to posit a taxonomy of what paralysis “looks like, how it manifests itself in the skin” (Gunshot 36, 77). However, his patients’ bodies and invisible symptoms continually subverted this scientific project. Mitchell had to vouch not only for the reliability of his observations but also for the authenticity of his patients’ stories and the symptoms they presented. Again and again he attempts to convince his readers, and perhaps himself, of the veracity of the amazing bodily phenomena he witnesses. He argues passionately that one patient could not possibly be faking, for “he had never been in a hospital before” (Gunshot 104). The true difficulty of these types of injuries was that the body was an unreliable indicator of its own status—it gave even well-meaning patients false and unreadable symptoms, defied the known laws of physiology, healed itself seemingly without reason. A doctor could not establish nerve injury when patients knowingly or unwittingly presented falsified texts to the doctor. For both doctor and patient, then, these nervous maladies opened a fault or fissure in their worlds. Mitchell’s desire to write a taxonomy of nerve injury contributed to the alienation of both physician and patient by providing physicians with new tools to systematize, objectify, and finally to appropriate not only the disease but also “the human experience and particular meaning the disease holds for the patient.”²⁶ Doctors began to assume an adversarial relation to their patients, insisting that their diseases conform to the narratives of illness the medical establishment provided.

In Gunshot Wounds Mitchell briefly touches upon the issue of patient authenticity, an issue that grows to obsessive proportions in his pamphlet “On Malingering.” In this correlative text, Mitchell and his colleagues put both doctor and patient on trial, outlining the various ways physicians can poke, prod, burn, faradize, cut, etherize and generally survey their patients in order to ferret out the dreaded malingerer.²⁷ What is most disturbing to the doctors is that malingerers purposely blurred the boundaries of illness, health, and self-representation that were already so fuzzy in medical discourse of the period. The notion of a “true self” at stake in this article becomes bound at points to contemporaneous anxiety about the disappearance of social distinction. For example, Mitchell writes that he is not alarmed that the otherwise “endur[ing] and tenac[ious]” malingerer would “pretend disease” but, rather, that he would carry on the double game of “an assumed character” (“Malingering” 371). Karen Halttunen has argued persuasively that the emergence of confidence men at midcentury resulted from an increasingly uncertain social system where, it was feared, men and women could pretend to a social status that they did not hold.²⁸ In pursuing malingerers, Mitchell believed that he would force patients to reveal an essential self that was, if not physically diseased, at least morally corrupted. For example, in etherizing a suspected malingerer in order to ascertain who is hidden beneath the hysterical exterior of one patient, “The tongue let out the thoughts, and the brain forgot to hold the eyes convergent, and then remembered it again with a sort of betrayed look most curious to see” (“Malingering” 391). Mitchell crows with success at his ability in this case to unveil the poser.²⁹ His rehabilitative work both returns health to the ill and stabilizes the identities of those who dare to feel something they should not given the way that social norms dictated bodily performances at the time. Mitchell’s early experience with Civil War malingerers may have confirmed his suspicion of lazy inferiors, be they working-class men or upper-class women, which manifested itself most disturbingly in his domineering treatment of late nineteenth-century female neurasthenics.

On the whole, it was not malingerers themselves but the possibility of malingering that threatened the carefully constructed system of scientific diagnosis doctors were building at the time. Like the neurasthenia that would spread later in the century, the malingerer could infect others with his illness: “So long as one man succeeds … so long will ten others continue to imitate him” (“Malingering” 369). The doctors were loathe to admit that in cases of nerve injury only the patient possessed the “power of telling where exactly he has been touched” (Gunshot 115). In the face of such unflagging uncertainty and disempowerment, doctors desperately tried to regain control of the illness experience, initially devising a list of procedures and tests to be performed upon the patient to determine his health. When their tests revealed no organic condition, the doctors still cured the patients, though it was through the torture of “dry galvanism, actual cautery, setons and blisters” used normally to relieve neuralgic pain, as well as unnecessary anesthetics, that the malingerer was forced to reveal his true character (“Malingering” 371). Emily Dickinson’s famous lines “I like a look of agony / Because I know it’s true” cut only one way for these doctors. Whereas the pain their patients manifested as a result of their invisible wounds was always suspect, pain carefully administered by the physician and perceived “normally” by the patient could be an authentic indicator of their ability to feel. Mitchell advocates “faradizing” the skin with “a bundle of thin wires,” for it is “the most intense and painful local excitant known to medicine, while yet it has not power to injure the part it thus violently irritates” (Gunshot 137, 141). Shocking his patients proved one of the Civil War doctor’s most successful therapeutic strategies; malingerers treated in this way were immediately rehabilitated.

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 be communicated and that memory and the pursuit of history are consequently legitimate—that one can recapture and literally feel the existence of long-gone bodies and events. Thus the story grounds the possibility of personal memory and medical case history in the promise of corporeal rehabilitation.

Yet at war’s end nerve injuries were still incurable, the soldiers unrehabilitated. Mitchell’s final prognosis in the conclusion of Gunshot Wounds is that “the neural lesion may have been long well, and the ill it did live after it” (144). Mitchell’s only real power lay in restoring some semblance of normality to the surface appearance of the body while coercing appropriate, obedient behavior. The disciplined, healed body seals the wound inside; the ghostly presence of long-gone limbs channels a corporeal reality that, Mitchell suspects, was never sure-footed. As he claims, “It would be in vain to amputate a member while the scar lies beyond it” (Gunshot 106). Though the injury had been metaphorically excised from the patient’s body and mind through Mitchell’s course of treatment, in reality the wounds of war remained in the patient in some unlocatable place.

“What Is True of Disease Is True of War”

After Mitchell’s brief rest cure and the cessation of hostilities, he took up the compelling research he had begun in the nerve hospital; however, he found it impossible to make a living from this work. On July 11, 1868, Mitchell wrote to his sister Elizabeth that “the laboratory does not flourish,” joking that his “cerebrum is softening.” By July 1870 he admits defeatedly, “This year indeed every year now makes physiological research harder for those who cannot give their whole time to it.”³⁷ At the same time, Mitchell discovered that he was consulted more and more about treating nervous maladies; Gunshot Wounds had gained prominence in its field and was expanded and re-issued in 1871 to wide acclaim. Capitalizing on the situation, Mitchell adapted his wartime therapies to treat upper-class female patients, consequently making a name for himself—and a lucrative living—as the world-renowned, charismatic “rest cure” doctor. Eventually, he gave up not only his research but also his general practice, focusing exclusively on cases of nervous disease. But despite his great success, he was still drawn inexorably to his war-era stints at Philadelphia’s hospitals and to the professional and personal crises that first became evident during his tenures there.

Although Mitchell had published anonymous poems and short stories throughout the 1860s and 1870s, by the 1880s he was willing to claim his profession as part-time author, a self-described “literary physician who still remained loyal to medicine.” In War Time was given a prominent position when it ran in the Atlantic Monthly during 1884; reviews and subsequent book sales were favorable according to Mitchell’s biographer, Joseph Lovering. In this novel, Mitchell fully articulated the interconnections between medical narratives, fiction, and the Civil War that were evident in his earlier work. In particular, the affinity between his experimental medical texts and realistic fictions continued to animate his writing. Mitchell bragged that a therapeutic ethos pervaded his fiction; as he notably remarked, “There is a clinic” in every one of his books. He reveals to one correspondent that In War Time contains a “description of a case of locomotion ataxia,” one that “conceal[s] the knowledge which a dr. has of these cases & … use [s] only enough to interest without disgusting.”³⁸ He assures his intimate thus that his fictions are built upon the presumably firm foundation of medical science. Those “in the know” would surely recognize his characters’ symptoms and be able to diagnose their diseases. Yet he confuses the work of the author, the doctor, and the medium or confidence man in this description as well, for he writes that he conceals the mechanisms by which he maintains the “interest” and credibility of his audience.

The congruence between his medical and fictional hermeneutics caused Mitchell a great deal of anxiety, which he expresses again and again in his private correspondence. In a letter to his great supporter, William Dean Howells, Mitchell explains, “I am twins and one is an amateur literateur in summer and goes to sleep in winter while the other attends to the literature of prescription.”³⁹ Here Mitchell invents a professional schizophrenia to account for his dual interests and attempts to make them distinct from each other. Yet the fact that the “literateur” merely hibernates when the prescriptive writer takes over does not separate the two personae, for surely the dreams of the sleeper intrude upon the conscious self. Further, Mitchell twins his work, making the two “literature[s]” if not identical, at least fraternal. Mitchell’s pride in his literary success clearly struggles with his need to downplay that success, for he senses that the plausibility of his fictional “clinics” might cast suspicion on the authority of his scientific work. In his autobiography, Mitchell writes that In War Time “had a large success, and trusting the good sense of the American people to know whether I was any the less a good doctor because I could write a novel, I continued to thus amuse myself.”⁴⁰ Working in a still fledgling profession, Mitchell was keenly aware that he might be perceived as a dilettante for dabbling in the arts. He also implies that his facility with language and his ability to create credible characters and situations might undermine his medical authority. In transferring the language of medical narratives to literary ones and vise versa, the novels might confuse the distinctions between art and science, fact and fiction. As we have seen, lay readers perceived no difference between Mitchell’s case histories and his stories. And because In War Time depicts in particular the duplicity and murderous mistakes of a very bad doctor, it seems logical that Mitchell might have worried that patients would turn from a practitioner who seemed to know the thoughts and motivations of a bad doctor so very intimately. Dr. Ezra Wendell might be read as the omnipresent nightmare of the waking doctor.

However, admirers chalked up Mitchell’s detailed knowledge of the incompetent Dr. Wendell to his superior medical skills, his ability to discern the thoughts and motivations of his neurasthenic patients. Howells speaks for many when he claims, “There has seldom been a man in fiction so perfectly divined as Wendell,” implying that Mitchell had merely fathomed the inferior Wendell’s thoughts in godlike fashion.⁴¹ According to Eugenia Kaledin, Mitchell delineated such diseased characters in order to “help his literary patients perceive the good life.” In his journal Mitchell conflated disease and culture, writing that “good manners” could be “contagious.”⁴² Much in the same way that his war-era medical texts were meant to redress the demoralization of nerve patients, his novels of manners were prescribed as antidotes to what he perceived as an increasingly undisciplined citizenry. Dr. Wendell is a case in point. Though of supposedly good Anglo-Saxon stock, he is a weak, immoral spendthrift. His behavior is contrasted to that of the characters who make up his wartime community: his sister Ann, a Puritanical, unintellectual spinster; Alice Westerly, a strong, principled woman who is attracted by Wendell’s dreaminess, but who is ultimately deceived by him; and Edward Morton, the man who suffers from the aforementioned “locomotion ataxia,” but who bravely battles his illness and sacrifices his love in order to ensure his brother’s happiness. These are just a few of the many characters who enact this very convoluted plot of love and betrayal, honor and disgrace, death and redemption. Yet Wendell unfailingly appears the weaker by comparison.

Perhaps what is most distinctive about Mitchell’s diverse oeuvre, and what makes it a fit starting point for this project, is that his work imagines the Civil War as the primary site for explorations of the disruptions of the flesh and soul. Mitchell’s son testified that in his deathbed delirium Mitchell ordered treatments for the suffering soldiers streaming in after the Battle of Gettysburg, and it is at this same martial crossroads that Mitchell began his first novel. As In War Time’s action begins, Dr. Wendell is attending to the wounded and dying in a long-gone Civil War hospital. Yet the narrative voice soothingly notes of those makeshift outfits: “The rest of the vast camps of the sick, which added in those days to the city population some twenty-five thousand of the maimed and ill … ha[ve] been lost, in the healing changes with which civilizing progress, no less quickly than forgiving nature, is apt to cover the traces of war” (War Time 1). One might argue that Mitchell implies Civil War rehabilitations are complete. At the very least, he rhetorically rehabilitates, stating that the “healing changes” of “progress” “cover the traces of war.” To return to the etymology of habile, the wounds of war have been covered over, re-clothed. Yet significantly, Mitchell writes that the “maimed and ill” have been “lost,” not erased or obliterated. The lost may linger; like neural lesions, they persist despite their inability to be located. Further, the “camps of the sick” may be gone, but their former citizens have not been exterminated, rather “heal[ed]” and redistributed during peacetime. Thus only the density of disease has been dispersed as that makeshift city’s members were sent home. Indeed, Mitchell’s story of war only briefly concerns itself with battles, soldiers, and hospitals; it moves immediately behind the lines, zooming past the hospital into the home of a Civil War doctor, and then into the homes of the doctor’s civilian patients and acquaintances. Mitchell’s novel flees farther and farther from the front lines, and yet disease, demoralization, and uncertainty pursue and infect all of the characters’ doings.

In War Time was composed during the heyday of female hysteria and at the height of Mitchell’s popularity; yet it is his fictional men who are permanently enervated, either by their wartime service or by their inability to serve in the war fully. Edward Morton, the invalid son of one of Wendell’s hospital patients, claims, “All the man in me is going to shrivel up by degrees,” for he has no opportunity to “die man-like in some wild rush of battle” (War Time 98). Conventionally, Mitchell initially posits that although both disease and battle diminish a man’s body, disease emasculates that body, whereas battle lends potency to the body’s impending dissolution. Prohibited from joining the army, Edward immerses himself in what Theodore Roosevelt termed the “strenuous life” to restore his manhood. In contrast to the “infantilazation and enforced debilitation” imposed upon female neurasthenics, men were sent to “hike in the Alps,” engage in the sporting life at resort spas, or take “rough-riding camp cures,” preferably “out West” somewhere.⁴³ Mitchell had prescribed such cures for neurasthenic friends and engaged in them himself. Yet Edward’s exertions in Texas leave him permanently diminished, “unnaturally sensitive and nervous” (War Time 225). The masculine camaraderie and primitive conditions of such Western excursions were meant to replicate the invigorating deprivations of camp life at war. However, Mitchell reveals that the injuries that result from war are not ennobling or transforming either; rather they reduce men to hyperaesthesia. Edward’s father, Major Morton, who has been manfully injured in battle, “can’t think, for torment. [He] can only feel” (War Time 10). The long-term drain of his grave wound accentuates “all that was worst in Morton”: he is increasingly “irritable and nervous” and ultimately undergoes the “moral degradation,” as Mitchell calls it, that so often accompanies chronic illness (War Time 85).

Mitchell’s most extended portrait of nervous disease is that of his main character, Dr. Wendell. Wendell is overemotional, one of the “unhappy people who are made sore for days by petty annoyances” (War Time 8). He is also hyperaesthetic, “exquisitely alive to the little annoyances of social life”; with eyes like “microscopes” and ears like “audiophones,” his life is “one long misery” (War Time 89). And he is morbidly self-absorbed, using his “considerable intelligence” and imagination as funds for “self-torment” rather than as means of improving himself. Finally, he is violently moody. Mitchell claims that the shifting climate of Wendell’s mind left him “without much steady capacity for resistance, and [he] yielded with a not incurious attention to his humors,—being either too weak or too indifferent to battle with their influence” (War Time 16). His “frequent changes of opinion” in diagnosis and treatment not only lose him clients, bur they also reveal Wendell’s “mental unstableness” (War Time 235). Thus the doctor who suffers from the nerve injury he seeks to treat is bound to spread disease rather than cure it.

Most damning is Wendell’s inconstancy, which costs his patients their lives. In the opening episode of the novel, one of Wendell’s patients, a young officer, dies abruptly. Mitchell tells us that Wendell vaguely perceives that his moody impatience that day had prevented him from offering sufficient advice that might have made the young man more careful (War Time 17). Although he at first excoriates himself for his laziness, the realization that none of his colleagues notice his malpractice encourages Wendell to abandon his uncomfortable self-scrutiny. Thus Wendell’s neurasthenic self-indulgence goes unchecked, and his negligence continues to kill people. Near the end of the book Wendell’s hysterical self-involvement leads him to hastily administer the wrong medication to Edward Morton, killing him instantly. Wendell is dimly aware of the way that his nervousness skews his world view, aware enough to notice with a dawning sense of “disturbing horror” that the “material importance of his favorite pipe,” which he breaks, is “as important as the young officer’s life” (War Time 18). The broken pipe also serves as a convenient and conventional metaphor for the compromised state of white masculinity.

Interestingly, given Mitchell’s own vexed relationship to his literary work, he attributes Wendell’s egomania to his aesthetic sensibilities: “The poets who live in a harem of sentiments are very apt to lose the wholesome sense of relation in life, so that in their egotism small things become large…. They call to their aid and comfort whatever power of casuistry they possess to support their feelings, and thus by degrees habitually weaken their sense of moral perspective” (War Time 18). In distinguishing poets who are seduced by the erotic and exotic headiness of a “harem of sentiments,” Mitchell implies that there are literary types who are not weak and self-indulgent. Yet in making Wendell both a doctor and a poet, Mitchell explicitly links the literary and medical temperament. Mitchell’s fascinating harem of sentiments even evokes the nature of his 1880s practice, when the famous rest cure doctor spent his time in the bedrooms of many women, attending to their overwrought sensibilities and vulnerable bodies. Regardless of the character of that temptation, Mitchell posits that not only a nervous injury but also a literary proclivity can reduce one’s relation to the world and skew one’s feelings. The afflicted poet/doctor has no “wholesome” sense of the world, but rather a partial or exaggerated relationship to it.

In describing the therapeutic protocol that Mitchell employed with his nervous patients—and that we might use to discover the source of Wendell’s “moral measles”—David Rien suggests Mitchell’s affinity for Freud’s notion of the subconscious (although Mitchell would later publicly denounce Freud’s theories as immoral).⁴⁴ In Wendell’s case, the secret ailment that both typifies and triggers his nervousness is an early show of battlefield cowardice. When serving on the front lines in West Virginia, Wendell’s regiment had come under heavy fire. “Dr. Wendell very soon showed signs of uneasiness, and at last left his post,” abandoning hundreds of injured men; Wendell is lucky that he is permitted to leave the army quietly (War Time 303). This brief but key incident contrasts sharply with George Dedlow’s thoughtless heroics, while illustrating that battlefield scenes provided concise, resonant shorthand for late-century audiences. The legitimacy of self-concern is relative; what is an instinct for self-preservation under normal circumstances is understood as pathological in wartime. The Civil War becomes the source of subsequent diseases for Wendell. He frames his second immoral act—lying about the cause of Edward’s death—in terms of his previous “failure to meet professional obligations” on the battlefield (War Time 393). The discovery of his moral wounds, and the necessity of exposing them to the view of those he loves, eventually destroys Wendell. We last see him in an opium daze, shunned by his former society and proclaiming his imminent death.

Yet In War Time does not allow itself to be resolved in a neat way. Critics who see Mitchell’s fictions as prescriptions for a morally corrupted culture contend that he “gave his stories happy endings because he saw them as cases he refused to let suffer, situations he had rescued from reality.”⁴⁵ In War Time insists that Civil War disease resists both medical and literary therapeutics. Indeed, the novel’s most notable malingerer is the Civil War doctor. It is perhaps understandable that the young, unknown Mitchell who worked in Civil War hospitals would have revealed Wendell’s disease, just as he had exposed army surgeon George Dedlow’s foibles in 1866. One critic locates neurasthenia precisely “at the intersection of personal insecurity about a career and the unsettled and transitional status of the professions open” to young men of Mitchell’s generation.⁴⁶ Mitchell’s authorial aside on the great number of “hapless persons” who were “more or less competent” and glad enough to extend their “feeble tentacula” to grasp the eighty dollars a month offered them as contract surgeons indicates that the tremendous number of casualties sustained during medical treatment may have been due to a compromised medical corps (War Time 3). And according to Mitchell, the exigencies of wartime medicine only encouraged laxity. “It is difficult not to become despotic,” Wendell reflects, for when “no keen critic followed him, or could follow him, through the little errors of unthoughtful work” he is happily free to continue his “slipshod” technique (War Time 363, 45). Recall that Mitchell had called for detectives to help him discover the dreaded malingerers in his hospitals. His description of Wendell’s inability to police himself suggests that perhaps doctors were the ones in need of constant surveillance.

But by the 1880s, Mitchell was an internationally renowned neurologist, seemingly secure in his rest cure and his profession. Presumably he had conquered his war-era ghosts. And yet they intrude upon his psyche, invading his fictional worlds. Perhaps Mitchell suspected what an 1892 survey of wounded veterans would confirm: an army of neurasthenic, insomniac victims denied his curative powers. The erratic success rate of nineteenth-century doctors, their susceptibility to mood swings that might affect their work—in short, their humanity—is interpreted by Mitchell as the disease still plaguing modern Americans. Mitchell’s professional reputation rested upon the forcefulness of his character, the certainty of his diagnosis, and the rigidity of his cures. However, in 1884 as he composed In War Time, he had been treating neurasthenia for two decades with, at best, mixed and, at worst, disastrous results.⁴⁷ Scholars of neurasthenia note that doctors themselves were frequent sufferers of the disease. Mitchell wrote often of his own erratic nature to intimate correspondents. In one letter he confesses to his young son John: “I have on me my Sunday mood which is grim enough & has been so for years—Yet why I can hardly tell—since on the whole life ought to satisfy me—but does not—Indeed I have had great luck to have had to work always for otherwise the sensitive side of me would have so grown that I might have come to be a morbid sort of man.”⁴⁸ Though neurasthenia would remain a viable diagnosis well into the 1920s, in the 1880s scientists searched in vain for the organic source of neurasthenic symptoms and behaviors.

Certainly, Mitchell’s fictional alter-ego, Wendell, engages Mitchell’s personal demons and professional ambivalence. Yet Wendell’s incompetence, his halfhearted efforts at doctoring, relieves him of the responsibility of curing his patients and ultimately explains his failures. Ironically, although the doctors’ disease makes rehabilitation impossible, it also makes rehabilitation possible. To clarify, in this circle of logic, rehabilitated Civil War doctors could act with an objective, robotic precision and potentially effect their patients’ rehabilitations—which would then ensure the patient/doctors’ cure, and so on. Thus the Civil War can represent both the potential for sure corporeal knowledge and the tragedy of lost chances. Mitchell’s fictional doctors admit that watching the sick leaves “vague but lasting mental impressions which may wear out with time, or be deepened by future circumstance and which are, as it were, memorial ghosts that trouble us despite our unbeliefs in their reality” (War Time 53). The bodies of their unrehabilitated patients—the reflections of their own inherently diseased subjectivities—linger around the doctors like amputated appendages. The experience of the Civil War hospital becomes representative of the persistence and inadequacies of medicine and of memory itself. Though time may rub away the sharp edges of trauma, they continue to “trouble,” generating a surreal, interior world of half-truths and self-doubts. Even scientific pursuits reiterate this new lawlessness. When Wendell looks in his microscope searching for cures and answers, he sees

a wild world of strange creatures; possibly, as to numbers, a goodly town full of marvelous beasts, attacking, defending, eating, or being eaten: some, merely tiny dots, oscillating to and fro; some, vibratile rods; and among them, an amazing menagerie of larger creatures, whirled hither and thither by active cilia too swift in their motions to be seen. (War Time 165)

Mitchell suggests that medical research only confirms that the “invisible” worlds that he knew defined Civil War disease reflected, and more important, naturalized, the frenetic, combative nature of wartime and postbellum worlds. Like ghosts, these microscopic beings are alien, “strange” and “beast[ly]” “creatures” that come and go at will. Their constant, chaotic motion reinforces the idea of a reality too impalpable and elusive, always slipping away before one can get a fix on it.

The brief episode concerning Wendell’s hysterical confederate patient, Captain Gray, dramatizes the war’s incessant, ghostly return. Gray is brought to the Union hospital as a prisoner-of-war. As an officer, he is treated with respect and housed with a Union officer, Major Morton. Although Gray’s prognosis is initially bright, he soon becomes convinced that he will not pull through. He explains to Wendell that he has a “queer sensation of confusion in my head, and—then I can’t change my ideas at will. They stick like burrs, and—I can’t get rid of them” (War Time 31). Frances Gosling notes that men’s hysteria was most often characterized by such “obsessions or ‘fixed ideas.’”⁴⁹ Those relentless thoughts eventually begin to eat away at Gray. After a conversation between the rebel and his Northern roommate about the battle at which they were both injured, Gray becomes convinced that Morton is the very man who shot him. At first, Gray claims that he is comforted by the fact that it is a “gentleman” who has been the cause of his misfortune. However, a new disturbing idea takes hold of him, a “brain echo” that, like a “silent song[,] comes and goes a thousand times” (War Time 41). The inarticulable pain of Civil War injury became an endless repetition—not the repetition of scientific cure, but the recurrence of Civil War trauma. Mitchell’s Civil War texts return to the site of failure, where the only thing consistently produced is disease. The doctors insist that only Gray’s silence will cure him; but Gray continues charging, “He shot me!, he shot me!” Unable to quiet the voices, dispel the ghosts, or stop the continuous loop of his moment of injury, Gray develops a fever that ultimately kills him. Like Shakespeare’s Macbeth, who utters the phrase Gray repeats in his final delirium—“To-morrow, and to-morrow, and tomorrow”—Gray has “supped full of horrors,” too glutted to move on to the future.⁵⁰

The Civil War was a lifelong obsession for Mitchell, a gnawing wound, a persistent ghost, an incurable disease. In January 1914, the year Mitchell died, a colleague wrote of his life’s work after the war, “Whatever his thoughts henceforth deep down was that memory perpetual. His tales and poems, no matter what be their subjects, all come from a spirit over which has passed the great vision; every drop of ink is tinctured with the blood of the Civil War.”⁵¹ Mitchell’s work illustrates what becomes apparent in the work of others—that the Civil War is itself “memory perpetual”: it is not necessarily a one-time, fixed event, but rather a trope that embodies the notion of memory as a constantly reoccurring but unpredictable presence. Writing itself for Mitchell and his contemporaries becomes Civil War writing—a rewriting, a constant return, an obsession with the corporeal. The bodies of war and text mingle here in the bloody ink that inscribes Mitchell’s texts. That those bodies proved as tenacious and ephemeral as the memories they summoned and the texts meant to account for them is the legacy of the trope of the Civil War.