Head trauma linked to Hemingway’s suicide
LITERARY TITAN SUFFERED NINE BLOWS TO HEAD: STUDY
Ernest Hemingway’s depression and psychosis were a t extbook case of chronic traumatic encephalopathy, the brain disease caused by repeated blows to the head, according to an American forensic psychiatrist who has written what he calls the “first comprehensive and accurate accounting of the psychiatric diagnoses” that led to the Nobel l aureate’s f amous shotgun suicide in Ketchum, Idaho, in 1961.
In his new book Hemingway’s Brain, Andrew Farah, chief of psychiatry at High Point Regional Health System at the University of North Carolina in Chapel Hill, refutes earlier theori es that Hemingway was suffering from bipolar disorder, manic depression or even an excess accumulation of iron known as hemochromatosis.
By reviewing medical records, memoirs, biographies and even Hemingway’s changing writing s t yl e, Farah focused on nine major head traumas, the first of which was sustained in Italy during the First World War, when a shell landed three feet from Hemingway, knocking him out, killing a soldier right beside him and blowing the legs off another. Years later in Paris, he accidentally pulled a skylight cord too hard, thinking it was the toilet flusher, and the whole fixture fell on his head, leading his friend Ezra Pound to write him: “Haow the hellsufferin tomcats did you git drunk enough to fall upwards thru the blithering skylight!!!!!!!"
Other concussions came in a London car crash during the Blitz blackout, from a fall on a fishing boat and from a plane crash in East Africa, all symptomatic of the 61- yearold author’s swashbuckling lifestyle. The result was, as Farah describes it, “an illness whose cruelest trick was to incapacitate the mind, yet all the while preserve insight into the sufferer’s plight.”
Contrary to t he common s t ory t hat modern psychiatry failed America’s greatest living writer in his moment of need, Farah concludes that Hemingway in fact received the best care known to medical science at the time. But it was for the wrong illness, based on a false diagnosis.
Shortly before he shot himself, Hemingway had received two courses of electroconvulsive therapy, which should have had a 90 per cent chance of improving his presumed illness of depression and related psychosis. But Hemingway got worse, and quickly, because while electroshock improves depression, for those suffering organic brain disease it acts as a stressor on a vulnerable nervous system, accelerating the patient’s decline.
In his research, Farah said he saw this decline in Hemingway’s handwriting and could discern the changes in his writing, some of which became a bland imitation of his former self, in line with the old joke that nobody imitates Hemingway like Hemingway.
Farah describes, for example, the writing of the posthumously published Paris memoir A Moveable Feast, which stalled to the point that Hemingway basically cancelled it. He contrasts this anguished experience with the writing in 1927 of Hills Like White Elephants, perhaps Hemingway’s greatest short story with its elegant dialogue between a man and a woman obliquely discussing abortion, and how the prose was refined over and over again in a process that required a cognitive capacity that over time was lost to him.
“We all think of the Hemingway persona, but what the CTE did, later in life, was it simply solidified and locked in the very worst aspects of that persona. It made him irritable, volatile, difficult, challenging, all that,” Farah said in an interview. “People talk about how, psychologically, he was trapped by the persona like a spy out too long, believing his own cover, or acting that way because people expected it of him. I think he was biologically incapable of breaking free from the nastier aspects of that persona, simply because of the CTE.”
CTE was once known as dementia pugilistica, for the “punch- drunk” boxers who exhibited it, but it was largely unknown in Hemingway’s time and its symptoms were often dismissed or misdiagnosed. One effect is to make a person less able to tolerate alcohol, which also figures in Hemingway’s various diagnoses. But Farah sees his alcoholism as a part of a larger puzzle, a secondary consideration rather than the primary problem.
Farah is not the first to doubt the depression diagnosis. Others have diagnosed bipolar disorder, such that it gets frequently repeated as true, but Farah points out Hemingway never had a manic episode, and his depressive episodes were situational. Another theory was hemochromatosis — an excess accumulation of iron — and doctors even considered a liver biopsy to be sure, but Hemingway’s normal blood iron levels argued strongly against it.
Many other accounts of his mental state have been psychoanalytical, complicated by the fact that, as Farah puts it, “our subject is not interested in helping us.”
Farah’s CTE theory is of course unprovable. Hemingway’s brain was never imaged, and his suicide physically destroyed it, preventing anything like the posthumous studies that were done on Einstein’s brain, for example.
“They wouldn’ t have known what they were seeing anyway,” Farah said. “In fact, in 1961, the year he was getting his shock therapy, there was an article in the British Journal of Psychiatry, and it described postconcussive syndrome after motor vehicle accidents, but it was called ‘ accident neurosis,’ in which the author argued these were people just seeking attention, and they were not really sick in an organic way. And now we know that just poisoned the well and made people look for years at these people as malingerers.”
WE ALL THINK OF THE HEMINGWAY PERSONA, BUT WHAT THE (BRAIN DISEASE) DID ... WAS IT SIMPLY SOLIDIFIED AND LOCKED IN THE VERY WORST ASPECTS OF THAT PERSONA. IT MADE HIM IRRITABLE, VOLATILE, DIFFICULT, CHALLENGING, ALL THAT. — ANDREW FARAH, PSYCHIATRIST