Recovering from PTSD

The DO Book Club, Nov. 2024: ‘Night Watch’

Tim Barreiro, DO, reviews this engrossing and thought-provoking historical read about ConaLee and her mother as they become institutionalized in an asylum shortly after the Civil War.

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Despite receiving a negative review from The New York Times, “Night Watch” by Jayne Ann Phillips is a National Book Award nominee and a Pulitzer Prize winner. The book is a work of historical fiction set during the Civil War and its Reconstruction aftermath, showcasing numerous themes that make this novel a definite recommendation—trauma and war, PTSD and mental health, the role of healer and physician, family, asylums and treatment can all be found in this book.

Trigger warning: This book review includes references to rape, abuse and trauma.

Set largely in the 1870s, most states were still recovering from the horrors of the Civil War. ConaLee and her mother, Eliza, are alone on their family farm that is tucked into the Appalachians. ConaLee’s father, a sharpshooter who had gone off to fight for the Union, is missing.

ConaLee and Eliza are both victimized by a roving Southern veteran/deserter, “Papa,” who survives by pillaging. Despite staying vigilant, Eliza is caught and spirals into his web of violence, abuse and murder, becoming increasingly withdrawn and mute. ConaLee does her best to care for her mother and her half-siblings until Papa sends the other children away and institutionalizes Eliza and ConaLee in a West Virginia asylum in 1874.

Using false identities, they make a home for themselves in the security of the asylum. Eliza and her daughter, now disguised as a servant for a proper lady, gradually return to health. Readers should be aware that security and feelings of normalcy rarely last in this novel.

Dark themes are eased by lighter undertones

The writer and her work are engrossing and thought-provoking. The violence, rape and murder found in this novel may have readers pondering the trauma of war and its impact on the individual psyche. Expecting additional horror and misery in an asylum, readers might be surprised to find more of a sense of order and morality. The fog of war, mental illness and conjuring by a neighbor are all contrasted with kindness, compassion and care in the institution, demonstrated with potted palms.

One aspect of “Night Watch” I appreciated was the different and diverse characters who were healers. There was a folk healer and herbalist (almost shaman-like) in Dearbhla, who offered not just concoctions and tinctures, but also counsel and care. There was a Civil War surgeon, Dr. O’Shea, whose careful assessment and exam, followed by dressings, bandages and therapy, was curative for the lost husband, a sharpshooter who barely survives the Wilderness campaign.

“… dry wood and leaf, forcing the men back even as the enemy, seeing their advantage, fired, cutting men down through the flames as they turned to flee,” the book describes. “A bedlam of Federal soldiers poured in from adjacent lines. Fires lit throughout the Wilderness and pinnacles of flame shot skyward.” (p. 56)

The medical director for the asylum, Thomas Story Kirkbride, a Quaker physician from Philadelphia who is a real historical figure, continues the legacy of his mentor, providing progressive treatment and therapy for the patients. (p. 160)

Finally, there was the night watchman, a patient with a traumatic brain injury who assumes his doctor’s name, providing care for others in a Civil War hospital and a asylum. All healers make “Night Watch” a worthy read for health care workers.

The book remains a sign of its time

Several aspects of the novel were distractions. The dialogue lacks quotation marks, so reading the text and understanding character speech takes initial effort. However, the story is engrossing and the initial effort to understand dialogue quickly fades. The story is not told chronologically either, so understanding the timeline and context is required. Shifting points of view, where diverse characters recall the same event, will require effort on the part of the reader; however, the literary device gives readers a deeper, more complex and developed story. 

The device may even help readers capture the fugue, mystery and fog of PTSD and other mental illnesses. As a historical novel, I appreciated the book’s references to Civil War battles, such as the Wilderness campaign; Thomas Story Kirkbride, the 19th-century physician reformer; and the Trans-Allegheny Lunatic Asylum, the West Virginia asylum where much of the book is set.

However, the lack of accuracy on several details was concerning. The photo of former President Abraham Lincoln in his coffin, not published until after its discovery in the 1950s, could not have been kept by the Southern sympathizer Papa from a period news account, as the book claims.

“I didn’t remember Lincoln myself, only that Papa swore oaths to cheer the murder and kept a newsprint photo of Lincoln laid out in his casket,” the book describes. “I feared Papa and so believed Lincoln was good.” (p.160)

The asylum gardens could not have been blooming with witch hazel and other plants simultaneously because those plants don’t bloom at the same time. Even the description of the asylum and Civil War hospital seems too genteel, given the historical record.

“We walked past the fountain on the paved walk beside the flower beds,” the book claims. “Low boxwood borders, bluebells, azaleas. Spidery yellow witch hazel that I knew from Dearbhla’s garden.” (p. 163)

These inaccuracies in a work of historical fiction reminded me of Shakespearian anachronisms—like chimney tops in Julius Caesar’s Rome, more than a millennia before their invention and use.

Overall, I found the author to be a master storyteller. I was impressed with her use of prose and language to illustrate the effects of historical events on human suffering and resilience. The glimpses of history, such as 19th-century pioneers and advocates for humane mental health treatment and the Trans-Allegheny Lunatic Asylum in West Virginia, offer readers enough framework and credibility that a ponderer is captured by the tale. The novel’s relevance for physicians, residents and medical students is not missed by this reader.

December’s book

For December, The DO’s Book Club column authors and staff are compiling their favorite winter reads to head into the New Year on a positive and encouraging note. We encourage all who are interested to reach out to us to share their own! The column will include the following:

  • “Between Two Kingdoms” by Suleika Jaouad
  • “Rearranged” by Kathleen Watt
  • “Outer Order, Inner Calm” by Gretchen Rubin
  • “Friends, Lovers, and the Big Terrible Thing” by Matthew Perry

If you read “Night Watch” or any previous Book Club selection and want to share your reflections, please leave a comment below or email [email protected].

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

The DO Book Club, Sept. 2024: ‘The Covenant of Water’

The DO Book Club, Aug. 2024: ‘One Flew Over the Cuckoo’s Nest’

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