An Interview With Andrew Farah, MD, Author of Hemingway’s Brain
In Dr. Andrew Farah’s new biography of Ernest Hemingway, Hemingway’s Brain, he details the neuropsychiatric demise of a great literary mind. Dr. Farah argues that Hemingway suffered from chronic traumatic encephalopathy (CTE) as the result of numerous severe concussions during his life, and this ultimate dementia was complicated by alcoholism as well as untreated diabetes and hypertension, possibly contributing a vascular component. He believes this condition not only informed Hemingway’s day-to-day life, interactions, and relationships, but the later literary works as well.
Ms. Smith: Dr. Farah, your book is a wonderful contribution, not only to Hemingway scholarship but to medicine in general. What interested you in Hemingway’s mental demise?
Dr. Farah: Shortly out of residency, I met with a Hemingway biographer. He had seen some of my research on ECT, and he wanted to know why Hemingway declined and committed suicide after receiving ECT, rather than improving. He had read that 90% of patients who receive ECT achieved the cure they were hoping for. I mentioned that in my experience, the patients who deteriorate after ECT generally have some undiagnosed organic brain disease, and the ECT is a biological stressor that serves to unmask that disease.
He wanted to know what that disease could have been for Hemingway, so I began reading this author’s biography of Hemingway and all the other biographies I could find—all the memoirs, letters, and so forth. I had been a fan of Hemingway’s fictional work for a long time. I made a couple of trips to the Hemingway Collection and archives at the John F. Kennedy Library in Boston and was able to put the pieces together.
Ms. Smith: Your thesis centers on the numerous concussions Hemingway suffered, starting in World War I, correct?
Dr. Farah: Yes, you are referencing Hemingway’s first major concussion. During World War I, while in Italy, a 5-gallon Austrian mortar exploded fairly close to him. The report of the Department of Military Affairs indicates that it exploded just 3 feet from him, so his first major head injury was a blast-type concussion. His best friend at the time, and fellow reporter and ambulance driver, Ted Brumback, wrote to Hemingway’s father from Milan that “an enormous trench mortar bomb lit within a few feet of Ernest.” It killed a soldier standing between him and the blast, blew the legs off another, and blew Hemingway several feet and covered him in earth. He was so blood-soaked from the dead soldier he attempted to carry once he roused himself that a Florentine priest administered last rites to Hemingway at the dressing station nearby.
That first major concussion was followed by an accident in Paris in 1928, after he had been out drinking with friends and came home late. Rather than pulling the cord for the commode, he accidentally grabbed the cord that was attached to a cracked skylight, which caused the skylight to fall on the left frontal area of his head, resulting in another major concussion and a famous scar.
More accidents followed. There was a fall from the flybridge of his fishing boat while off the coast of Cuba, then a serious car accident in London during the blitz. His head hit the windshield, and he required 57 stitches in the frontal area. There were 3 more concussions during World War II. A German antitank round blew him off a motorbike while he and Robert Capa were on an ill-advised adventure. He struck his head on a boulder as he landed. That incident involved a blast injury as well as blunt trauma. There was another motor vehicle accident in Cuba with his fourth wife and, finally, he and his fourth wife survived 2 plane crashes in Africa during the 1954 safari. The second crash prompted his friends to comment on his cognitive decline.
Ms. Smith is UNC-Regional Neuropsychiatry Research Fellow, University of North Carolina, Greensboro.
Dr. Farah is Chief of Psychiatry, High Point Division of the University of North Carolina. He maintains inpatient, consultation, and forensic practices, and spent 17 years researching the neuropsychiatric demise of Ernest Hemingway. His forthcoming book, Diagnosing Ezra, is a similar study of the writer Ezra Pound.