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  Hemingway’s Brain

  Hemingway’s

  Brain

  Andrew Farah

  THE UNIVERSITY OF SOUTH CAROLINA PRESS

  © 2017 University of South Carolina

  Published by the University of South Carolina Press

  Columbia, South Carolina 29208

  www.sc.edu/uscpress

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  Library of Congress Cataloging-in-Publication Data

  can be found at http://catalog.loc.gov/

  ISBN 978-1-61117-742-8 (cloth)

  ISBN 978-1-61117-743-5 (ebook)

  Front cover photograph: Ernest Hemingway on the steps of his house, Cuba, 1954, by Tore Johnson/Magnum Photos.

  For Priscilla Farah

  It is perfectly true, as the philosophers say, that life must be understood backwards. But they forget the other proposition, that it must be lived forwards.

  Søren Kierkegaard, Journals (1843)

  This may be wrong and I would be glad to have anyone disprove the theory as what we want is knowledge, not the pride of proving something to be true.

  Ernest Hemingway, “Out in the Stream: A Cuban Letter” (1934)

  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

  Illustrations

  following page 70

  The newborn Ernest Miller Hemingway

  Hemingway family photo from 1906

  Hemingway, pictured in his Milan hospital bed

  Wedding photo, Elizabeth Hadley Richardson

  Artistic nude of Hadley

  Pauline, Hemingway’s second wife

  Hadley and Pauline, likely in Schruns

  Hemingway, scarred from his skylight accident

  Hemingway with an unknown woman, likely Debba

  Ernest on safari in 1954, “going native”

  Hemingway, Robert Capa, and their driver

  Ernest photographed by Yousuf Karsh

  The first of two African plane crashes

  Hemingway recovering after his Africa plane crashes

  Mary Hemingway and Castro during 1977

  Gianfranco and Adriana Ivancich pictured in Cuba

  Ernest and Adriana in a lighthearted moment

  The Farm, by Joan Miró

  Acknowledgments

  My thanks go to Cambridge University Press for permission to reprint passages from Rose Marie Burwell’s Hemingway: The Postwar Years and the Posthumous Novels (Cambridge University Press, 1996); to Simon and Schuster and Penguin Random House UK for permission to reprint passages from A Movable Feast (Scribner’s, 1964), Across the River and into the Trees (Scribner’s, 1950), The Complete Short Stories of Ernest Hemingway (Scribner’s, 1987), In Our Time (Scribner’s, 1930), Carlos Baker’s Ernest Hemingway: Selected Letters, 1917–1961 (Scribner’s 1981), and Carlos Baker’s Ernest Hemingway: A Life Story (Scribner’s, 1969); to Dover Publications for permission to reprint from Wassily Kandinsky’s Concerning the Spiritual in Art (Dover, 1977); to W. W. Norton for permission to reprint from Bernice Kert’s The Hemingway Women (W. W. Norton, 1983); to the Hemingway Society for permission to use excerpts from an unpublished letter; to Roxann Livingston for permission to use a photograph by Earl Theisen; to the National Gallery of Art, Washington, D.C., for access to information regarding The Farm by Joan Miró that led me to the Artists Rights Society, which granted permission to use the art; and to the dedicated and kind staff of the John F. Kennedy Presidential Library and Museum for access to letters, documents, and images in the Ernest Hemingway Collection.

  Introduction

  On July 2, 1961, Ernest Miller Hemingway rose quietly so as not to disturb his wife. He put on his bathrobe and slippers, walked down to the basement of his Idaho home, and unlocked his gun case. He climbed the steps to his foyer, placed his favorite shotgun to the roof of his mouth, and blew the top of his head off.

  Many of those who have never read a Hemingway novel or biography still know the details of this tragedy. His suicide may even be the most famous in American history, competing with those of Marilyn Monroe and Robin Williams for this tragic distinction. He shot himself only six days after his discharge from the Mayo Clinic, where he had been hospitalized twice. The primary goal of his treatment at Mayo for severe depression and psychosis was to prevent this exact scenario. Yet his death was the result not of medical mismanagement but of medical misunderstanding. Hemingway received state-of-the-art psychiatric treatment in 1960 and 1961, but for the wrong illness.

  This book is the first comprehensive and accurate accounting of the psychiatric diagnoses that led to the demise of Ernest Miller Hemingway. Thus, Hemingway’s Brain is a forensic psychiatric examination of his very brain cells—the stressors, traumas, chemical insults, and biological changes—that killed a world-famous literary genius. The method of the forensic psychiatrist is to carefully review all medical records, study any other relevant information available (usually in the form of depositions), and, if possible, interview the subject himself. Even though the subject is America’s quintessential writer, the medical chart is still closed and confidential. When his Mayo psychiatrist, Dr. Howard Rome, was approached at professional meetings by colleagues who asked, “Weren’t you Hemingway’s doctor?,” Dr. Rome was known to always lift an index finger to his lips, indicating that they were forever sealed. He was an ethical clinician who maintained patient confidentiality for the rest of his life

  Fortunately for this study, there is no shortage of collateral information. We have numerous biographies, Hemingway’s extensive catalogue of personal letters, the memoirs of friends and family, and even an FBI file on our patient. With all of this data, it is possible to piece together a narrative of neurological and psychiatric illnesses that were progressing for years. This specific analysis has been missing from the scholarship for too long. Indeed, no scholarship can be complete without integrating these insights, as Hemingway’s illnesses informed his relationships, his day-today life, and the last two decades of his creative output. One theme that will become apparent as the reader progresses through Hemingway’s Brain is that marvelous literature was still possible despite Hemingway’s cognitive decline, his anxieties, and even his psychosis. His late-life struggle was made particularly difficult by his acute awareness of his declining mental capacities. His sensitivity and his ability to “notice everything,” which were key to his creative genius, were by then fueling his torment.

  His neurological and psychiatric conditions began years before the iconic sixty-one-year-old stood at his worktable shuffling papers, unable to write just the one sentence asked of him. It was for a volume of wellwishes to be presented to President Kennedy. He had been delighted to receive the telegram inviting him to the inauguration but declined for the very health reasons that left him frustrated and frozen as he stared at the blank pages. The illness began with specific inherited vulnerabilities, genes from both sides of his family, was developing as the young ambulance driver lay unconscious in the mud of
the Italian front during World War I, and continued to germinate with the slow poison of thousands of cocktails. His pathology was the result of the coalescing of genetic codes with trauma, untreated hypertension, diabetes, and numerous lifestyle choices. And when his psychiatric illness was fully manifest, it eluded the finest doctors of his day.

  Modern scans and testing would leave no doubt regarding the specifics of his diagnosis, and there are numerous treatment options available now that were not even theoretical in 1960. Even if he had received the correct diagnosis, there were few therapies available—but still, there were a few.

  Though many excellent biographies of Hemingway have been written and his life has been extensively researched, no biographer to date has been able to make an accurate diagnosis, nor could one be expected to, without training and experience in the practice in neurology and psychiatry. What scholars instead have turned to, by default and out of sheer fascination, is psychoanalysis. Thus, there is no shortage of conjecture along psychoanalytical lines regarding Hemingway’s mental state, with his fiction and many of his utterances, indeed, his very predictions of his demise, serving as a diffuse array of suicide notes to be mined for nuggets. Even as a young newlywed on the way to Paris with his bride he contemplated jumping into the wake of the steamer somewhere in the middle of the Atlantic, leaving behind only the mystery of his disappearance. His first major work, In Our Time, published when he was in his twenty-sixth year, is the usual starting point for psychoanalysis of his life through his fiction.

  In the story “Indian Camp” (1924), he wrote of a country doctor modeled on his own physician father and of his young son, obviously a reflection of the young Ernest, as they are summoned to a difficult delivery. A Native American has been in labor for two days when they arrive. Hemingway writes of her screams as the doctor busies himself with a jack-knife Caesarean, necessary to save the breech baby, while his son, Nick, sort of looks on. Nick asks his father, “Oh, Daddy, can’t you give her something to make her stop screaming?,” only to be told the woman’s screams “are not important. I don’t hear them because they are not important.” She has to be held still during the operation by “Uncle George” and three Indian men, and after she bites Nick’s uncle on the arm, amusing one of three Indians, George curses her as a “Damn squaw bitch!”

  When the procedure is a success and the newborn safe, the doctor boasts of his skills: “That’s one for the medical journal, George,” he announces. Yet his self-satisfaction is short-lived. With typical Hemingway sleight of hand, the obstetrical procedure has temporarily concealed the morbid punch line. The newborn’s father was unable to leave his wife’s delivery, as was the custom, because of an injury he had sustained days before from an axe—so he lay hidden on the top bunk while the screaming and drama unfolded beneath him. “Ought to have a look at the proud father. They’re usually the worst sufferers in these little affairs,” the doctor says. “He pulled back the blanket from the Indian’s head. His hand came away wet. He mounted on the edge of the lower bunk with the lamp in one hand and looked in. The Indian lay with his face toward the wall. His throat had been cut from ear to ear. The blood had flowed down into a pool where his body sagged the bunk.… The open razor lay, edge up, in the blankets.”1

  “Why did he kill himself, Daddy?” Nick asks his father. “I don’t know, Nick. He couldn’t stand things, I guess.” The doctor’s answer is as satisfactory as any and remains applicable to any other case of suicide (real or fictional) since.

  In an even more prescient story than “Indian Camp,” Nick encounters Ad Francis in “The Battler.” Ad is an ex-prizefighter who carries the scars and disfigurement of his past days, but not only physical ones—he also suffers from dementia pugilistica. He is not only grotesque but paranoid, volatile in mood and behavior and capable of violence with no provocation. Like Ad, Hemingway would one day find his brain forever changed in such a way and yet still somewhat insightful: “Listen, the little man said. I’m not quite right.… I’m crazy.… Listen, you ever been crazy? No, Nick said. How does it get you? I don’t know, Ad said. When you got it you don’t know about it.” Ad’s paranoia soon emerges, and his volatility erupts. He screams at Nick and threatens him. But in short order Nick is saved from harm when Ad is knocked unconscious by his companion and caretaker, Bugs, with his handy blackjack, carried for just such episodes.

  Ad is “crazy” not only from the poundings he has taken in the ring, but also from an odd psychological trauma—the unpleasantness that followed from having married his sister. We learn, in Bug’s explanation to Nick, that, though Ad and his wife are not really siblings, “there was a lot of people didn’t like it either way and they commenced to have disagreements, and one day she just went off and never come back.”2

  A lifetime of such fiction is more than ripe for psychoanalysis and in perfect harmony with Hemingway’s biography. Consider Ad’s marital situation in light of a 1950 letter in which Hemingway elaborated: “When I came home after the first war, [my sister Ursula] always used to wait, sleeping, on the stairway of the third floor stair-case to my room.… She would drink something light with me until I went to sleep and then she would sleep with me so I would not be lonely in the night. We always slept with the light on except she would sometimes turn it off if she saw I was asleep.”3 In the unfinished story “The Last Good Country” Hemingway would revisit the theme of sibling partners. The teenage Nick escapes deep into the woods with his younger sister, Littless, to elude a vengeful game warden and the “down-state man” on his trail but also to elude their family (“the others”). “His sister was tanned brown and she had dark brown eyes and dark brown hair with yellow streaks in it from the sun. She and Nick loved each other and they did not love the others.”

  They sleep like any intimate couple, her head on his shoulder. When she sits on his lap, she asks, “Can I kiss you while you’re making supper?” Hemingway even pounds us over the head with his symbolism: “We’ll eat a couple of apples.” Littless also brings another recurring Hemingway theme to the forefront after she crops her hair: “Now I’m your sister but I’m a boy, too.” 4

  Sibling love and cross-gender themes are just the tip of the iceberg. The life and the fiction both contain seemingly infinite Freudian and Jungian facets. Perhaps there is no other literary life in which so much autobiographical information is wrapped into the fiction and so much fictional content appears as if in a crystal ball, eerily predicting the author’s future. This is no ordinary two-way street; this is a multilane highway traveled for a lifetime. Fascinating as they are, none of these explorations can lead to the correct diagnosis—any analytical insight can exist only as theory. However, an examination of Hemingway’s psychiatric case and a review of the extensive forensic data point to the very cells of Hemingway’s brain. The deterioration of his central nervous system as the result of a collection of factors and the subsequent loss of his mental capacities and his sense of self—all with the demoralizing awareness of these losses—is ultimately to blame for his death. Though not the complete picture, the fiction and the memoirs serve their purpose too; their contents are the daily manifestations of a life in decline and a working man growing less competent. In short, they help to confirm the diagnosis.

  This book grew out of two questions asked by Bill Smallwood, the coauthor of The Idaho Hemingway: why did Hemingway’s mental illness get worse, not better, after two courses of electroconvulsive therapy? And what would modern psychiatry offer him today? The answer to the first is the subject of this book: patients who worsen after a course of ECT have organic brain disease. For them the ECT is not curative but a form of stress on the vulnerable nervous system that accelerates their decline. The following chapters elaborate on the exact nature of Hemingway’s brain illness, a dementia caused by several factors, which was still progressing at the time of his death. The answer to the second is detailed in chapter 12.

  As for Hemingway’s profession, the last ten years of his life still involved in
ternational travel and a writing production that was at times as beautiful as ever, yet at others a bad imitation of his earlier work. And he was often paralyzed by anxiety, with writing a seemingly hopeless struggle that further compounded his anxieties.

  In the last ten years of his life, he displayed a grandiosity of almost delusional proportions, moments of tenderness and humility, paranoia with specific and elaborate delusions, excessive alcohol intake with brief periods of self-control, volatility and abusiveness toward the ones he loved the most, frequent irritability, near-constant socializing, romantic infatuations, petty and grand disputes, and an acute self-awareness of his own magnitude—a puffing out of the chest and an endless display of a man all too full of himself, the expert on everything, all because of the spotlight. He enlisted a celebrity entourage before it was fashionable. He repeatedly threatened his suicide, predicted his suicide, and even demonstrated (on more than one occasion) his “technique of hara-kiri with a gun” for dinner guests at his Cuban home. According to his friend Dr. José Herrera, Ernest would “sit in his chair, barefoot, and place the butt of his Mannlicher .256 on the fiber rug of the living room between his legs … leaning forward, he would rest the mouth of the gun barrel against the roof of his mouth. He would press the trigger with his big toe and we would hear the click of the gun.”5

  Until that July morning in 1961 when he loaded the gun, he was only performing. As Dr. Herrera further informs us, Ernest would lift his head off the gun barrel, “grinning.” The precise reason why he was so compelled to perform is that by this point in his life he was trapped by his own legend. He was living out the “Hemingway role” because it was expected of him, or perhaps because he actually believed it, or, more likely, because at some point there was no difference.