Hemingway's Brain

Andrew Farah

• Publisher: University of South Carolina Press
• Year: 2017
• ISBN:
  9781611177435
• Topic: Literature
• Subtopic: Literary Biographies
• Index: Literature

A forensic psychiatrist's second opinion on the conditions that led to Ernest Hemingway's suicide, "mixing biography, literature and medical analysis" ( The Washington Post ). Hemingway's Brain is an innovative biography and the first forensic psychiatric examination of Nobel Prize–winning author Ernest Hemingway. After seventeen years researching Hemingway's life and medical history, Andrew Farah, a forensic psychiatrist, has concluded that the writer's diagnoses were incorrect. Contrary to the commonly accepted diagnoses of bipolar disorder and alcoholism, he provides a comprehensive explanation of the medical conditions that led to Hemingway's suicide. Hemingway received state-of-the-art psychiatric treatment at one of the nation's finest medical institutes, but according to Farah it was for the wrong illness, and his death was not the result of medical mismanagement but medical misunderstanding. Farah argues that despite popular mythology Hemingway was not manic-depressive and his alcohol abuse and characteristic narcissism were simply pieces of a much larger puzzle. Through a thorough examination of biographies, letters, memoirs of friends and family, and even Hemingway's FBI file, combined with recent insights on the effects of trauma on the brain, Farah pieces together this compelling alternative narrative of Hemingway's illness, one missing from the scholarship for too long. Though Hemingway's life has been researched extensively and many biographies written, those authors relied on the original diagnoses and turned to psychoanalysis and conjecture regarding Hemingway's mental state. Farah has sought to understand why Hemingway's decline accelerated after two courses of electroconvulsive therapy, and in this volume explains which current options might benefit a similar patient today. Hemingway's Brain provides a full and accurate accounting of this psychiatric diagnosis by exploring the genetic influences, traumatic brain injuries, and neurological and psychological forces that resulted in what many have described as his tortured final years. It aims to eliminate the confusion and define for all future scholarship the specifics of the mental illnesses that shaped legendary literary works and destroyed the life of a master.

Chapter 1

Inheritance

Mental illnesses can certainly pass down from generation to generation, but there was no hint of the trouble to come from the very sober and productive life of Anson Tyler Hemingway, Ernest Hemingway’s paternal grandfather. He was born in Plymouth, Connecticut, in 1844, but Connecticut would not be the home of his descendants. He traveled with his family at the age of ten, making the nine-hundred-mile journey to Norwood Park, Illinois, when such travel was more than a little dangerous. He grew from youth to adulthood there, only eight miles from where he and, later, his son, Clarence Edmonds Hemingway, would die—in Oak Park.

Anson Hemingway volunteered to serve under the command of Ulysses Grant at the battle of Vicksburg, a city that President Jefferson Davis ordered held “at all costs.” In February 1862 Forts Henry and Donelson, in Tennessee, fell, and New Orleans was in Union hands by April. If Vicksburg followed, then the Mississippi River would be completely under Union control, cutting the Confederacy in half. Lincoln also understood Vicksburg’s strategic importance, labeling it the “key to victory.” Capturing the city was so critical that during the campaign he even sent a spy to camp with instructions to monitor Grant’s alcohol intake.¹

Yet Vicksburg was more of a siege than a single battle, lasting just under fifty days. And Anson Hemingway would survive the abysmal conditions in the swamplands around Vicksburg. Malaria, smallpox, and dysentery claimed the lives of enough of his comrades to fill a mile-long trench of graves. And Hemingway proved especially useful to Grant, a proponent of enlisting the escaped and newly liberated slaves as Union soldiers, as he placed Officer Hemingway in command of many of these new troops. Grant also understood that this helped to solve the problem of exactly what to do with the hundreds of refugees who were descending on his camps in desperate need of food and shelter. In time Grant would win the protracted and muddy chess match and solidify his reputation. Anson would follow his General down into Natchez, Mississippi, where his duties involved more occupying than fighting, but by the time he retired from military service he had risen to the rank of first lieutenant. He was also an educated young man, thus a rare commodity in his day—a veteran who also possessed a college degree.

During his studies at Wheaton College in Illinois, he would meet and eventually marry his fellow student Adelaide Edmonds, and the young couple would settle in the Oak Park community, just ten miles from Chicago. Anson Hemingway would become a respected real estate broker with the reputation of being a deeply religious man. He served as a deacon in the First Congregational Church of Oak Park, and his opinion was valued when it came to local business or political matters. He also expected each of his children to receive a proper education, and all six would attend Oberlin College. His second child, Clarence Edmonds Hemingway, born September 4, 1871, would study medicine at the prestigious Rush Medical College, in Chicago, and settle into a general practice, a career he would one day encourage his son, Ernest, to follow. He specialized in obstetrics, and Ernest would pick up a level of medical understanding from his father’s practice and discussions that would be evident in works such as In Our Time and A Farewell to Arms.

Dr. Hemingway’s daughter (and Ernest’s older sister), Marcelline, wrote in her memoirs that her father sketched the design for special forceps to be used in spinal surgery while sitting on the banks of the Des Plaines River (the procedure would eventually be termed a laminectomy). The idea “flashed in his mind,” and he quickly drew the instrument design on the back of an envelope. He eventually took to sketch to Sharp and Smith, instrument manufacturers in Chicago, for further development.² This anecdote accurately sums up the public understanding of “Ed” Hemingway as a medical man, but also an avid outdoorsman, whose sprightly and brilliant mind never rested.

The medical volume on Dr. Hemingway’s shelf titled Nervous and Mental Diseases, published when his son, Ernest, was twenty and a veteran of World War I, devotes only nineteen pages to “Mental Disease,” twenty pages to the topic of “Psychoneuroses of the War,” and just five to “Other Psychoneuroses.” The majority of the text deals with epilepsy, movement disorders, meningitis, brain trauma, and various illnesses of the peripheral nerves. There are tips for discerning hysterical paralysis from the real thing (the hysterical being “caused by suggestion and cured by psychotherapy,” often in one sitting) and a description of a new study detailing the mental deficiencies of a sample of Newport News prostitutes. There is also a new psychoanalytic theory on the origins of kleptomania that suggests that it is driven by the “instinctive desire to secure sexual excitation … by the stimulus furnished by the emotions of fear and anxiety that necessarily accompany the perpetuation of theft.” But depression is not mentioned, nor is it mentioned in the index; neurasthenia (a nineteenth-century precursor to dysthymia, a form of low-grade depression, and chronic fatigue syndrome), though the fashionable diagnosis just three decades prior, gets only a passing nod.³

Despite the prominence of Freud’s work, psychiatry had yet to be fully carved out from the hardware of the nervous system. Thus, when Dr. Hemingway began suffering from depression, there was little in his professional training or library to direct him in any attempt to heal himself. If he opened this volume at all in 1919, he was most likely reading about the brain injuries of contusion and “commotion” caused by the explosive detonations of war, as his son had experienced and written about from a Milan hospital the prior year. (Ernest’s letter home, of July 21, 1918, detailed his traumas, which involved a mortar blast, concussion, and slugs in his leg. Under “Love Ernie” he had drawn a cartoon of himself lying flat, titled “Me drawn From life” and shouting “gimme a drink!” His stick-figured leg was bandaged from hip to toe, and a label read “227 wounds.”)⁴

Like those of many patients with major depression, Clarence Hemingway’s case was brought about by a stressful situation: he worried about his own health (he suffered from chest pains [angina pectoris] and diabetes). Neither were fatal illnesses at the time, but he also anguished over finances and his real estate investments. He and Grace had mortgaged their home (which was paid for in full at the time) in order to buy Florida real estate, taking part in the great Florida real estate boom of the early twentieth century. He had hoped this investment would secure his family’s future. His brother George had encouraged the purchases, but the lots were not appreciating as they had been expected to. George then advised his brother to sell off some of them to stem the losses, but Dr. Hemingway balked, hoping for a future recovery rather than locking in the lower values and financial loss.

Psychiatrists would eventually view depression as an illness similar to many others in psychiatry: caused by a possible underlying genetic vulnerability compounded by some social stress and an excessive amount of anxiety that conspire to create the clinical disease. Patients describe an overall sadness, difficulty with sleep and energy (perhaps sleeping too much or too little, worrying into the night), anxiety, irritability, and appetite changes; everything seems a struggle, and even the activities of daily living are an effort. The longer a depressive disorder is left untreated, the harder it is to cure—even with modern therapies. For Dr. Hemingway, depression was a known symptom in the patient with manic-depressive illness or perhaps the hysterical patient and of course the emotionally weak, but not a topic to be found in the contents of his medical books. Though it had always existed, major depression was a black hole for Dr. Hemingway and his colleagues. With regard to recognizing and treating depression as a disorder, he and his profession were not in denial; they were simply in the dark. This particular science was unknown to them.

Biographers agree that Dr. Hemingway’s situation was not as dire as he perceived—his house was still valued at more than he owed, three of his children (including Ernest) were financially secure, and he could practice medicine not only in Illinois but also in Florida, having obtained a Florida medical license. He even hoped to retire there in the near future. But depression often brings a catastrophic form of thinking to the sufferer, a type of “cognitive distortion” in which the patient sees things through a distorted prism as being much worse than they truly are—all negative situations and stressors, however minor, grow to catastrophes in the mind’s eye. The patient may further see no hope for change. Indeed, hopelessness is viewed as one of the most problematic harbingers of suicidality in a depressed patient.

There is also evidence that Clarence’s depression, like Ernest’s, was tinged with paranoia. He had written to his wife in 1909 and again in 1920, detailing financial provisions he had made for his family in case of “his death under suspicious circumstances,” even elaborating (in 1909) on how to create a “consistent and convincing story for a coroner’s hearing.” The 1920 letter anticipated his trip to Lake Walloon, in northern Michigan, to close up the family cabin, Windemere, for the season. The trip was also an excuse to rest his nerves and, he hoped it would permit him to return to his family in Oak Park less stressed and much less irritable. This letter also included a check for $1,000 and safe-deposit-box keys “in case of some unforeseen accident I should not return.”⁵ These were unusual concerns for a man who had no suspicious dealings or acquaintances and whose day-to-day life had certainly achieved the wholesomeness he strived for.

As his medical problems flared, he ignored his wife’s advice. She insisted he visit a colleague when he woke with severe foot pain, but Clarence refused, no doubt fearing vascular complications from diabetes. His mind no doubt was ruminating on the worst of circumstances—neuropathy, injury, infection, and eventual amputation. He also refused to let his son Leicester (or any other family member) ride in his black Ford with him (by then he had graduated from horse-and-buggy house calls), fearing an angina attack would result in an accident and endanger others as well as himself. But Dr. Hemingway would never see himself as a patient who needed treatment, let alone analysis. These thoughts were not dismissed; they were simply never considered.

His oldest daughter wrote eloquently of her father’s descent in her memoirs: “my father changed from his high-strung, active, determined, cheerful self—the self with a twinkle in his eye—to an irritable, suspicious person. He was quick to take offense, almost unable to let himself believe in the honesty of other people’s motives. He began to spend long hours alone in his office with the doors closed. He kept his bureau drawers and his clothes closet locked. It was agony for my mother, who shared the bedroom with him, to think he must be distrusting her.”⁶

His depression was noted in his own letters early as 1903, and he required a “rest cure” (when Ernest was just four).⁷ Yet documentation from his professional career indicates that when he was at his “healthy” baseline, he handled stress masterfully. “Grace under pressure” will always be attributed to Ernest, but when, during the birth of Dr. Hemingway’s first child, Marcelline (January 15, 1898), the attending physician suffered a heart attack, Dr. Hemingway was summoned and immediately returned home in a snowstorm. He not only cared for the critically ill doctor but continued to administer anesthetics to his wife and safely delivered his child, a complicated birth that required forceps.

Dr. Hemingway was regarded as one of the most skilled obstetricians of his time. Learning of the pregnancy of Pauline, Ernest’s second wife, he wrote, “If you want to have me attend your wife at the Oak Park Hospital, I am glad to offer you my services.” He was clearly looking forward to the opportunity, writing, in June, “We are anxious to hear what you are planning.” Later in the month, he informed the couple that he was deferring plans to go to Windemere “until I hear from you.”⁸ Yet one of the last pieces of correspondence he ever received from Ernest noted that he and Pauline had chosen to have their son delivered in Kansas City and that thus, without directly stating it, they were declining Dr. Hemingway’s offer to deliver his next grandchild. Perhaps it was their last meeting, in October 1928, that had convinced Ernest that his father was not the man for the job. When he and Grace visited Key West, Dr. Hemingway was anxious, tired, and possibly irritable. He had also gauged the value of his Florida real estate on the trip, a major source of his stress.

If this news hurt Dr. Hemingway, it was never documented that he expressed as much to anyone. Surely it was some bruise to his ego. Still, his professional composure and skills never seemed compromised as a result of his depression. He carried on silently as long as he could and eventually reached that strange point of no return and singular focus. On a day that his foot pain flared severely and caused him to ruminate once again on the worst of medical outcomes, he came home around lunchtime and asked how his son Leicester was doing, as he had been ill with a cold. He was better, his wife informed, but asleep. After burning some personal papers in the basement furnace, later thought to be financial records, he went to his bedroom, shut the door, and used his father’s revolver, the very one carried by Anson in the Civil War, to end his life. He was fifty-seven years old. Uncharacteristically, he had left his checkbook unbalanced and bills unpaid for months. His fears were certainly exaggerated, as even in the week of his death he could have most likely sold the Florida property for a small profit—though the lots had declined from their peak prices, his original investment was still intact.

The medical report was stark and to the point: “The bullet pierced the brain looping under the skin, after shattering the bone of the skull in the left temple 5 cm. above and 7 cm. posterior to the external auditory meatus. There were powder burns at the point of entrance of the bullet. Blood was oozing out of the bullet wound.”⁹

The young Leicester not only found his father’s body but was the sole family member to speak to the coroner the next day at the inquest. Grace was too distraught and grief stricken and had to be heavily sedated. The thirteen-year-old had the sad and scarring duty of speaking in her stead. The eldest son, Ernest, was on a train from New York to Florida with his own son, Jack, when he received a telegram at the Trenton stop. It was from his sister, Carol, informing him of the grim news. He was already an established writer and halfway to the fullness of his stardom, working out his revisions of A Farewell to Arms at this point in time. In a letter to Ezra Pound, Hemingway would register his callous annoyance at his father’s death: “I would have been glad to pay my esteemed father a good sum or give him a share in the profits to postpone shooting himself until the book was completed—Such things have a tendency to distract a man.”¹⁰

His remark to Marcelline at the funeral, essentially that suicides are not welcomed into heaven,¹¹ reflected more than callousness. It grew primarily from the desire (unknown to Ernest consciously) to reject the new mantle of family patriarch. That would put him in the same struggle for power, the same losing battle with his mother, that had killed his father. Much easier to stay the rebellious son.

Leicester, the young teen who no doubt was traumatized by his discovery of his father on the bed expiring and making “hoarse breathing noises” and who then had to relive the experience at the coroner’s interview, was instructed by his famous older brother: “At the funeral, I want no crying. You understand, kid?”¹² Leicester would also one day suffer from diabetes. His illness also resulted in vascular complications of the legs and, later, in peripheral neuropathy, a form of chronic pain from nerve damage. When tissue death occurs, many diabetics require amputations. And when Leicester was faced with the probability of more extensive surgery than he had already required, he too shot himself, like his father with a handgun. He was sixty-seven when he took his life.

To what extent a predisposition to suicide is inherited has been explored in many ways, from reviews of basic family history to the search for specific genetic markers. Suicides do run in families. A commonly reproduced Hemingway family photo from 1906 shows young Ernest wearing his page-boy haircut and looking to the left of the camera with a halfhearted attempt at a smile. Dr. Hemingway looks every bit the patriarch, with a stern demeanor but a gentle hold on his youngest, Madelaine (“Sunny”), balanced on his knee. The other two daughters, Ursula and Marcelline, are lovely, and Grace exudes maternal warmth. Yet the most remarkable aspect of this photo is that four of the six Hemingways pictured would eventually commit suicide. The exceptions were Hemingway’s mother, Grace Hall Hemingway, and Sunny, who died at the age of ...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Illustrations
• Acknowledgments
• Introduction
• 1. Inheritance
• 2. Trauma Artist
• 3. Giant Killer
• 4. Dementia, Disinhibition, and Delusion
• 5. Free Fall
• 6. Stigma
• 7. Mayo
• 8. The Body Electric
• 9. Working Man
• 10. A Moveable Feast
• 11. Alone
• 12. Modern Times
• Epilogue
• Notes
• Bibliography
• Index