Neurological Disorders in Famous Artists - Part 3

J. Bogousslavsky, M. G. Hennerici, H. Bäzner, C. Bassetti

• Publisher: S. Karger
• Year: 2010
• ISBN:
  9783805593311
• Topic: Medicine
• Subtopic: Neurosurgery

The third part of Neurological Disorders in Famous Artists presents painters, musicians, and writers who had to fight against an acute or chronic neurological disease. Sometimes this fight was without success (e.g. Shostakovich, Schumann, Wolf, Pascal), but often a dynamic and paradoxical creativity of the clinical disorder was integrated into their artistic production (e.g. Klee, Ramuz). Occasionally, some even wrote the first report of a medical condition they observed in themselves, like Stendhal who made a detailed report of aphasic transient ischemic attacks before dying of stroke shortly thereafter. In rarer instances, a neurological disease was inaccurately attributed to an artist in order to explain certain features of his work (de Chirico, Schiele). Some chapters in this publication focus on neurological conditions reported in artistic work, including descriptions by Shakespeare and Dumas. Bringing new light to both artists and neurological conditions, this book serves as a valuable and entertaining read for neurologists, psychiatrists, physicians, and anybody interested in arts, literature and music.

Bogousslavsky J, Hennerici MG, Bäzner H, Bassetti C (eds): Neurological Disorders in Famous
Artists – Part 3. Front Neurol Neurosci. Basel, Karger, 2010, vol 27, pp 174–206

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‘A Man Can Be Destroyed but Not Defeated’: Ernest Hemingway’s Near-Death Experience and Declining Health

Sebastian Dieguez

Laboratory of Cognitive Neuroscience, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland

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Abstract

Ernest Hemingway is one of the most popular and widely acclaimed American writers of the 20th century. His works and life epitomize the image of the hyper-masculine hero, facing the cruelties of life with ‘grace under pressure’. Most of his writings have a quasi-autobiographical quality, which allowed many commentators to draw comparisons between his personality and his art. Here, we examine the psychological and physical burdens that hindered Hemingway’s life and contributed to his suicide. We first take a look at his early years, and review his psychopathology as an adult. A number of authors have postulated specific diagnoses to explain Hemingway’s behavior: borderline personality disorder, bipolar disorder, major depression, multiple head trauma, and alcoholism. The presence of hemochromatosis, an inherited metabolic disorder, has also been suggested. We describe the circumstances of his suicide at 61 as the outcome of accumulated physical deterioration, emotional distress and cognitive decline. Special attention is paid to the war wound he suffered in 1918, which seemed to involve a peculiar altered state of consciousness sometimes called ‘near-death experience’. The out-of-body experience, paradoxical analgesia and conviction that dying is ‘the easiest thing’ seemed to influence his future work. The constant presence of danger, death, and violence in his works, as well as the emphasis on the typical Hemingway ‘code hero’, can all be traced to particular psychological and neurological disorders, as well as his early brush with death.

Copyright © 2010 S. Karger AG, Basel

A man can be destroyed but not defeated

Ernest Hemingway

The Old Man and the Sea (1952)

Ernest Miller Hemingway was born on July 21, 1899, in Oak Park (Illinois). He is one of the most popular American writers of the 20th century. When released in 1952, ‘The Old Man and the Sea’ sold 5,300,000 copies in 2 days. The novel earned him the Pulitzer Prize in 1953, and the Nobel Prize the following year. He is also celebrated for his short stories, a genre in which he excelled his works as a journalist, a movie on the Spanish Civil War, his poetry and the prolific correspondence he left [Gurko, 1952].

Hemingway was a larger-than-life figure, not only a celebrated author, but also a real celebrity: ‘His name was a synonym for an approach to life characterized by action, courage, physical prowess, stamina, violence, independence, and above all “grace under pressure” (…) He was, in short, the heroic model of an age’ [Yalom and Yalom, 1971, p 485]. He was indeed ‘a man living life to the hilt – deriving maximum value from experience – while achieving lasting work’ [Bruccoli, 1986, p x], who filled his life and works with overtly masculine themes such as war, bravery, hunting, fishing, safari, sports, drinking, bullfights, and of course women. His constant bragging, machismo, and sense of competition became legendary¹ A charitable view might be that: ‘while aggrandizing himself, he aggrandized the practice of reading and writing’ [Bruccoli, 1986, p xii]. However, we will see that psychologically inclined critics perceived his overt behavior more like a defense to ward off his inner demons. His overt behavior and immense success, indeed, stand in sharp contrast to his very sad ending, when crippled by health and mental problems he committed suicide. This act might have been surprising to the general public and his readers, but it ultimately revealed the very deep insults that kept growing throughout his life inside his body and mind.

What made him such a famous author? Hemingway brought a revolution in style and was a keen observer of the contemporary world and human nature. At odds with most of his preceding and contemporary writers, he perceived the value of economy in writing. He was perhaps the first American author to write as a journalist, opting for grade school-like grammar, simple words and short descriptions. This might seem like a self-defeating approach for a novelist, but it nevertheless left its mark. There is even a joke about 20th century American writers that says that they can all be categorized in two groups: those trying to write like Hemingway and those trying not to. Through its deliberate simplicity, use of short declarative sentences, and urge to eliminate the superfluous, Hemingway’s style magnified the art of the dialogue and mastered the use of the understatement (e.g. in ‘For Whom the Bell Tolls’, we find this famous line: ‘He was dead, and that was all’). For him, quite simply, ‘the job of a writer is to tell what happened and how he feels about it’ [Goldberg, 1997].

His style is encapsulated in what he called his ‘iceberg theory’, which he explained in ‘Death in the Afternoon’ (1932): ‘If a writer of prose knows enough about what he is writing about he may omit things that he knows and the reader, if the writer is writing truly enough, will have a feeling of those things as strongly as though the writer had stated them. The dignity of movement of an iceberg is due to only one-eighth of it being above water’ [Burhans, 1960, p 446]. The effect was to ‘make people feel something more than they understood’ [Young, 1975, p 39].

Hemingway knew how to tell a story and capture the imagination of millions of readers. The basic pattern of his stories is ‘to expose a character to violence, to physical or psychological shock, or severe trial, and then to focus on the consequences’ [Young, 1975, p 32].

It has been noted that all his male heroes are basically the same man [Gurko, 1952, p 373]. This is the ‘code hero’ (a term coined by Young [1966]), a character that exemplifies principles of honor, courage, and stamina in the face of adversity. There are rules for the Hemingway code hero: no self-analysis, no self-retreat, no sentimentality, no rationalizations or excuses, no apologies, no cowardice, no deceptive flourishes or fakery. The code hero is true only to himself, remains stoic in the face of adversity, and does not care about other’s opinions. It is not enough for the Hemingway character to have integrity, virility and courage, he has to show and demonstrate it repeatedly, and of course under the toughest circumstances. He thus needs to pass through a number of tests in which he can display ‘grace under pressure’ (a phrase Hemingway seems to have coined himself [Parker, 1929]). Once the tests are passed, most of the time the hero dies [Gurko, 1952, p 374].

The writer himself seemed to have adopted this philosophy of life. His outlook was nonetheless quite pessimistic. As one critic wrote, for Hemingway ‘life is one crisis after another. The naïveté which believes otherwise only produces disappointment, heartbreak, and, eventually, fruitless despair’ [Gurko, 1952, p 373]. Vitality and action were his antidotes against the cruelties of life, which perhaps explains why Hemingway ‘has sought out the death pattern wherever it appeared, on the battlefield, in the bullring, in the African jungle, in the individual consciousness, [as] only there could the full capacity of man’s powers of survival be fully tested’ [Gurko, 1952, p 375].

Of course, such a credo can quickly degenerate into ridicule and self-parody, as well as put oneself needlessly at risk and jeopardize one’s valuable relationships. Indeed, the stakes Hemingway put for his heroes and himself were exceedingly high, nothing short of an attempt at immortality, as if men were mortal, but heroes immortal [Bocaz, 1971, p 53]. There were numerous obstacles to his idealized view of life and literature. One of which he was deeply aware of was celebrity: ‘fame came welcomingly early, burgeoned, blossomed and finally bloated into a demanding burden’ [Monteiro, 1978, p 287]. Other problems, however, were much more worrisome. This chapter first examines the psychological and physical burdens that hindered Hemingway’s life and ultimately lead to his suicide. Special attention is paid to a particular event he experienced while he was a young volunteer engaged in the World War I, in which he suffered a wound that nearly killed him and, apparently, involved a peculiar altered state of consciousness sometimes called a ‘near-death experience’. We then discuss the effects these pathobiographical features might have had on his works.

Psychological and Psychiatric Assessment

We do not have a medical assessment of Hemingway. Although he was formally examined during his stay at the Mayo Clinic shortly before his suicide, his doctor, Howard P. Rome, held to his promise to keep his files secret [Yalom and Yalom, 1971; Craig, 1995]. We thus have to rely primarily on the information that has been gathered by biographers, accounts by friends and relatives, as well as interviews, his vast correspondence and of course his published works (below we will return on the extent to which Hemingway’s writings should be considered autobiographical or not).

Psychology

Hemingway’s early years seem relevant to understand the emergence of such a complex individual (for a summary of psychological approaches to Hemingway, see table 1). At age three, baby Ernest reportedly claimed “fraid of nothing!’, which aptly introduces the basic psyche of the man to come. His father was a medical doctor who imposed a very strict education on his children, and whose mood was highly unstable. Dr. Clarence Hemingway frequently displayed angry outbursts, sometimes beating his son, interspersed with profound depressive episodes, and often needed ‘rest cures’ away from his family [Martin, 2006]. In 1928, deeply depressed by financial problems, burdened by diabetes and angina, he committed suicide with a collectible Civil War pistol. Hemingway’s mother was also described as being inconsistent. Although we might never know exactly why the writer came to hate her so much, we know that Grace Hemingway was very controlling and dominated her more passive husband. For unclear reasons, Hemingway would eventually blame her for his father’s suicide. Grace had an unstable mood and health, and suffered from headaches and insomnia. Most intriguingly, she went to some lengths to raise her son, and present him publicly, as a girl. Grace seemed to find some comfort in seeing Ernest as the twin of Marcelline, his sister. Both were dressed alike, but at the same time the mother encouraged her boy to display masculinity in sports, hunting and fishing. As one can imagine, much has been made of this anecdote from psychodynamic perspectives. Regardless of the alleged profound consequences for Hemingway’s gender identity, he seemed to react with a combative attitude, crying out loud in his heart: ‘Damn it, I’m male’ [Young, 1975, p 44]. His youth was marked by feelings of anger and guilt, a taste for displaying courage, and an interest for violent imagery, firearms, and death. It seems plausible that the ‘quest for masculinity’ so emblematic of Hemingway’s life and work had something to do with these early years [Martin, 2006, p 356]. His parents, it should be said, never encouraged or even accepted their son’s writing [Fuchs, 1965, pp 433-434]. In fact, all they could make of it was that it was ‘filth’.

Table 1. Psychological portrait of Hemingway, derived from various sources, as outlined by Craig [1995, pp 1076-1077]

Hypothesis	Description
Neurosis emanating from parental dynamics	Father had mood disorders and was strict and violent Mother was dominant and sent mixed messages about gender identity and self-worth Confusing identification processes
Latent homosexuality	Excessive displays of masculinity (overcompensation) Scornful attitude towards homosexuals
Castration anxiety and unresolved oedipal conflict	Projective behaviors through hunting, fighting and interest for bullfight Defensive attitude towards women
Weak self-image	Public and idealized self-images were to be constantly and strenuously strived for and defended Need for power

Hemingway’s psychological profile as an adult has been described by Hardy and Cull [1988] and summarized by Craig [1995, pp 1074-1076]. The writer emerges as a competitive and ambitious man of fierce independence, who frequently lied, exaggerated, and behaved childishly and egocentrically on many occasions. He required constant adulation and was prompt to destroy relationships when he found himself on egalitarian grounds or dominated by others. He often acted out of impulses to display his panache and could go to quite some lengths to make a point to an annoying interlocutor. The same authors have noted feelings of inadequacy and self-dissatisfaction, unstable masculine identity, tense relationships with his father (even after he committed suicide), hatred of his mother, need for extreme levels of stimulation, a deeply ingrained depression and suicidal tendencies present throughout his life. The key to understand Hemingway’s behavior, it is concluded, is his need for overcompensating these flaws.

Hemingway’s life and work interplay so closely that it has often been remarked that the author seemed to play one of his fictional characters in real life² Yalom and Yalom [1971, p 487] argued that most of Hemingway’s persona was in fact an ‘image’ he carefully built through the years to hide his deeper angst, and they questioned his authenticity by wondering ‘whether a man firmly convinced of his identity would channel such a considerable proportion of his life energy into a search for masculine fulfillment’ and highlighted his ‘need to assert again and again a brute virility’.

Certainly his need for action and danger were signs of a deeper personality trait. Perhaps Hemingway was anhedonic, and needed an inordinate amount of stimulation to experience pleasure. He had difficulties in being alone and constantly sought to fill his life with excitement and travels [Yalom and Yalom, 1971, p 487; Brian, 1988], to the point of complaining after the 2nd World War ‘of the emptiness and meaninglessness of his life without war’.

Hemingway’s ego appeared disproportionally big, and he was extremely sensitive to any critique, bearing extraordinary grudges against everyone who dared question his talent and courage. As his idealized self-image and general expectations were clearly unrealistic, he inevitably ‘fell short of his idealized goals’ [Yalom and Yalom, 1971, p 490]. It has been argued that this discrepancy lead to disappointments, and ultimately to self-hatred and self-destructive tendencies.

Not surprisingly, a number of authors have written about Hemingway’s alleged Oedipal issues, and speculated about repressed factors such as the ‘death instinct’, a fear of castration and impotence, guilt over his father’s suicide, and even lat...