Rep. Ilhan Omar, D-Minn., a civil war survivor and refugee, recently acknowledged that talk of war between the United States and Iran had made her "ill" and "stricken with PTSD." Rep. Jim Banks, R-Ind., denigrated her statement as "a disgrace and offensive." Veterans, he insinuated, were the real and, presumably, only group entitled to lay claim to the post-traumatic stress disorder (PTSD) diagnosis.

Not only was his comment insensitive and ignorant about PTSD, which can have many causes unrelated to war, but the history of the U.S. Civil War and the attendant traumas it inflicted on civilians show just how very wrong Banks is about the connection between war and PTSD. And remembering this history should help us understand the horrors of war for both combatants and civilians - and extend empathy to them.

It's true that the PTSD diagnosis originated after Vietnam War veterans returned home with debilitating psychological ailments.

Yet the modern psychiatric disorder we know as PTSD had roots in the American Civil War. Soldiers during and after the war exhibited symptoms - hallucinations, depression, flashbacks, nightmares, suicidal ideation and startle reflexes - that we now associate with war trauma, even though 19th century Americans had no understanding that war-related experiences could affect the mind.

Noncombatants, including women, also suffered psychologically, especially white Southern women whose homes and families stood in the path of rival armies - and who left detailed documentation of their plights. Unsurprisingly, they encountered myriad war-generated stressors that taxed the emotional stamina of many on the home front. Signs of mental stress brought on by war dot the diaries and letters of Southern women. They suffered from insomnia, depression, nervousness, migraines and suicidal thoughts. Virginia resident Mary Greenhow Lee confessed, for example, that she had become "completely unhinged" and broken down mentally.

With men gone, Southern women acquired new roles and tasks for which they had little training or experience, such as running a business or farm. These added responsibilities also stretched their physical and mental capacities taut and at times pushed women to the brink. Emily Harris, the wife of a South Carolina farmer who joined the Confederate army and was unaccustomed to making decisions about harvesting crops and butchering hogs, felt overwhelmed and "crazy," as she wrote.

In addition to the unfamiliar work as farmer and single parent, Harris worried about the well-being of her husband, a common preoccupation of Confederate women who agonized about the safety of male relatives at the front.

Consider, for example, the sad tale of 21-year-old Elizabeth Shockley, who lost three brothers to disease as well as her father, who traveled to care for them. The four deaths put her in a Georgia insane asylum. There, caregivers noted that this trauma contributed materially to the "disorder of her mind" and that she was "in Hell and suffering all the torments of the damned."

Although caregivers at such institutions rarely made the causal connection between mental illness (they would have used the term "insanity") and the pressures of war, examining wartime admissions records allows us to see the effect of the war on civilians. Occasionally, patient intake forms identify the purported cause of insanity as related to civil war generally, as in the case of North Carolina teen Ida Murchison, whose mental distress was attributed to "fright" and "war news." Or as grief following the news of a husband killed in battle, as was thought to have been the cause of 22-year-old Martha Harbin's psychiatric instability and subsequent institutionalization.

Compounding grief, the deaths of male relatives left families with little or no means of support. Confederate women struggled to feed their children and pay bills amid scarcity and economic hardship.

Southern women and their children whose residences sat in the path of an invading army often relocated. Uprooted, on the run, fearful of an enemy and unsure of the support they'd receive at their destinations, they were very much like the people displaced by wars today. The uncertainty of war's outcome and the increasing likelihood of defeat gnawed at Confederate women such as Virginian Catherine Barbara Broun, who confessed, "We all feel distressed. The suspense is terrible."

To be sure, civilians' emotional suffering differed from that of soldiers, who witnessed horrifying scenes of carnage and struggled with fear, an emotion that would have been denounced as cowardice. At the front, they fought disease, the elements and homesickness.

But those left on the home front experienced a different form of trauma. Want, fear, starvation, loss, deprivation, dislocation, grief, uncertainty, the threat of violence - all these weighed heavily on civilians living in a war zone. Widespread mental distress among those on the home front is documented not only in the historical record but also in contemporary studies on the effect of war on civilians today that show pervasive and long-term psychological problems. In some war-torn societies, two-thirds of the population exhibited symptoms of depression while nearly 90 percent experienced PTSD.

Not since the Civil War have large numbers of American civilians experienced life in a war zone on U.S. soil. Its lessons therefore continue to resonate. War - regardless of time and place - claims casualties on both fronts, home and battle. Its costs include the psychological well-being of civilians and soldiers alike. Its toll is long-lasting. The message of our own Civil War should be to take seriously the emotional pain of those who have suffered similarly.

We should listen to the stories of Americans today who have experienced war as civilians - the thousands of refugees and people from places unsettled by wars who have found haven in the United States, such as Omar. She has something important to tell us about war.

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Diane Miller Sommerville is professor of history at Binghamton University, SUNY and author of "Aberration of Mind: Suicide and Suffering in the Civil War-Era South," a Lincoln Prize finalist and recipient of the Willie Lee Rose Prize for the best book in Southern history.

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