Census-takers in the last quarter of the nineteenth century found fewer cases of “insanity” among Civil War veterans than their civilian peers. Adding pension records, however, produces an estimated insanity rate more than double that of civilians. Two ex-soldier physicians called attention to this phenomenon, which one labeled “chronic post bellum neurokinesis,” but their advocacy achieved little influence. Suicides underscore the gravity of delayed casualties: Massachusetts ex-soldiers took their own lives in much higher proportions than did non-veterans of comparable ages. Substance abuse was common in early middle age: veterans had nearly twice civilians’ proportion of suicides attributed to intemperance before 1890. Afterward, deteriorating health became the leading apparent motive for both groups. An elevated risk of suicide among veterans pensioned for wartime disabilities, and the high rate for all veterans compared to civilian men, are our clearest evidence of the Civil War’s deep reach into the lives of ex-soldiers.