April 20, 2017


LIZ MURPHY:  Good evening, I'm Liz Murphy, Forum Producer here at the John F.

Kennedy Presidential Library and Museum. On behalf of all of my Library and Foundation colleagues, thank you for coming this evening. And for those of us watching on webcast, welcome to you as well.

 I would like to acknowledge the generous support of our underwriters at the Kennedy Library Forums: lead sponsor Bank of America, the Lowell Institute; and our media sponsors, the Boston Globe, Xfinity, and WBUR. 

After tonight's conversation and question-and-answer period, Dr. Farah, whose work we're honored to feature tonight, will be signing copies of his new book in the lobby right outside the doors. And our bookstore does have copies available for sale if you're interested. 

It is a tremendous pleasure to introduce Dr. Farah this evening. Dr. Andrew Farah is the author, as you know, of Hemingway's Brain. He serves as the chief of psychiatry at the High Point Division of the University of North Carolina Healthcare System. He is a native of Charleston, South Carolina, and a graduate of Clemson University and the

Medical University of South Carolina. He completed his residency at Wake Forest University, and in 2014 he was named a distinguished fellow of the American Psychiatric Association. 

Andy, on behalf of everybody at the Library and Foundation, welcome. Thank you for making the trip up north to discuss your work with us. We're so excited to have you here.

It's also my privilege to introduce this evening's interlocutor and moderator, Dr Linda Patterson Miller. She is Distinguished Professor of English at Penn State Abington, where she has taught American literature since 1984. She is the author of the forthcoming book, Reading Hemingway: In Our Time, as well as The Book of American Diaries and Letters from the Lost Generation: Gerald and Sara Murphy and Friends, as well as numerous scholarly articles. She's presently completing another book on the American expatriate artists in France. She is a longtime board member of the Ernest Hemingway Foundation, and she chairs the editorial advisory board for The Cambridge Edition of The Letters of Ernest Hemingway.

Linda, thank you so much for agreeing to moderate tonight's Forum. We're really looking forward to the conversation. Welcome to you both. [applause] 

LINDA MILLER:  Thank you, everyone. It's a delight to be here. I'm always thrilled to talk about Hemingway. I guess as a woman it's not popular to say that I'm in love with Papa, but it's been a long career where increasingly Hemingway has taken over my own scholarship. I'm always thrilled to see new works that come out, and works keep coming out endlessly. There's no end of fascination with Hemingway. 

It's a thrill for me to be here today to be with Andrew Farah to discuss his wonderful new book, Hemingway's Brain

Ernest Hemingway, as we know, is a complicated man, and an even more complex writer. No wonder that people remain endlessly fascinated with his life and his art. He was designated early on as the father of modern American prose, and he became an overnight session and an iconic figure in American life. 

Recognized for his innovative prose, what Ezra Pound would call the shock of the new, he was also known by the persona that would both define and then entrap him. Scholars have long deliberated over Hemingway's personal complexities and his mental demons that led to increasingly erratic and even abusive behavior. And they have puzzled over the nuances of his writing as his style began to shift and change over time.

Hemingway knew from a young age that he wanted to write. And when he began to recognize that his memory would fail him, he became morose and even suicidal. If he could no longer write, he told A.E. Hotchner, he no longer wanted to live. 

Scholars and many an armchair psychologist have speculated about Hemingway's mental state, only to arrive at a variety of conclusions, many of them now suspect. Fortunately, we now have a legitimate and first-rate psychiatrist here with Andrew Farah, who has taken on Hemingway and dared to diagnose in definitive terms the intricate workings of his brain. 

Andrew Farah draws convincingly upon the latest scientific studies to help us appreciate the multiple factors that culminated in Hemingway's suicide in the summer of 1961. Andrew and I serendipitously met in New Orleans a couple of weeks ago. I think it was divinely inspired that we were both there at the same time, and we had a wonderful time talking about Hemingway, and went on for a couple of hours and could have gone longer. So stand forewarned. [laughter] 

I'm going to be just feeding some questions to Andrew and allow him to really move forward and talk about his incredible book. I asked Andrew when I first met him, I was intrigued by this. Here we've got a psychiatrist who's not a typical Hemingway scholar in terms of a literary scholar in the academic world. And here's a psychiatrist who's taken on the study of Hemingway. And I asked him, first thing, what led you to this study of Hemingway?

ANDREW FARAH:  Thank you for that lovely introduction. We were in New Orleans, and we were both there for different meetings. But we were having such a good time I was ignoring my cell phone going off, and by the time I picked it up, I was ten minutes late for my own lecture. [laughter] We had talked so long.

LINDA MILLER:  Was that a lecture you were giving that you were late for?

ANDREW FARAH:  I didn't share that, but yeah. So I ran out and left her with the bill, but I made it.

But yes, I, of course, was a fan of the fictional works for a long time, and I remember being in middle school being assigned For Whom the Bell Tolls and thinking it was just beyond me. I remember going to my father and saying, "Can you explain to me the Spanish Civil War?" Which is like my little boy coming to me now and saying, "What's going on in Syria?" I don't know how to explain that.

So I actually put him aside and focused on Joyce. Can you imagine that? Finding Joyce simpler than Hemingway. But years later, right out of residency, I met with a nice gentleman named William Smallwood. He had helped Tillie Arnold write her memoirs of Hemingway, The Idaho Hemingway. And he was passing through the Triad, and he knew of me through– as a resident, I did research on ECT, shock therapy, what Hemingway received, and he wanted to meet someone who knew about shock therapy. And he had two questions:

He said, "Why did Hemingway decline and deteriorate after his shock therapy and commit suicide?" He had always read that 90% of people get a cure. And he said, "And secondly, what would you do for him today?" And I said, "Well, the patients that we treat with electroconvulsive therapy who decline, what we learned from that decline is that they had some undiagnosed organic brain disease that we had yet to see prior. The treatment was the biological stressor that allowed it to manifest." And he said, "Well, what was that for Hemingway?" And I said, "I don't know, let me read your book." And I started reading all of the biographies. And as you know, it's quite addicting. The biographies are just fascinating at so many levels. 

And that's when I came to the conclusion. I was kind of amazed that no one had put the dots together before. I think that people had repeated the myths so often, that he was bipolar or that alcohol explained everything, and it was just too easy to repeat the myths and not do the tough work.

LINDA MILLER:  So what is your diagnosis?

ANDREW FARAH:  Yes, he had dementia, but a specific kind of dementia. It was predominantly chronic traumatic encephalopathy, like we read about with football players or boxers. Now, this was not unknown at the time because people had described dementia pugilistica, which is what boxers get. And he had written beautifully in "The Battler," Ad Francis, who was a boxer modeled on two other boxers, Ad Wolgast, I think, and Oscar Nielsen, who were known for their ring-induced trauma, chronic trauma.

However, medical science had not caught up with Hemingway, even in 1961 when Hemingway himself was being treated. The current thinking about post-concussive syndrome was that it was a form of neurosis, that it was psychogenic; it was not an organic illness. In fact, a pivotal article was titled, "Accident Neurosis," saying these people in car wrecks claim that they have these concussive injuries, they're just looking for attention or something. 

But Hemingway himself suffered at least nine major concussions during his life. Now, he boxed throughout his young life. He played football in high school, and he described that a little bit in his writing. But the first major concussion was, of course, in World War I, the five-gallon Austrian mortar. He's up in northern Veneto. This mortar explodes and throws him several feet, buries him in earth, kills a man between him and the bomb, blows the legs off, kills another man. He lays unconscious for a while.

But what's important about that is that it was a wave blast injury. So there's multiple ways you can get a concussion, but we divide them in terms of that energy wave of a blast and the direct blow. And his first major one was that energy wave. We know that 20% of returning veterans from Afghanistan and Iraq suffer those types of injuries. It's estimated that 2% of the population lives with some type of chronic disability from a head injury.

So this is not unknown science. At the time, it was fairly unknown. 

But that was the first major concussion, and a very important one. And of course, it had multiple effects for his life and for his writing career, and so forth, and his persona.

But then we zoom ahead of the Paris years. He's with Pauline, second wife, I think 1928. Comes home after drinking all night with Archie MacLeish. He goes in the bathroom at two in the morning and he goes to flush the commode and grabs the wrong cord; the cords got mixed up, so he pulls the chain or the cord on the skylight. Pulls the skylight onto his head. Gives himself another major concussion. And you see that famous horseshoe-shaped scar over the left frontal area. 

So now we fast forward, goodness, where to stop with the next concussion, during the Blitz in London. It was blacked out and he's partying with Robert Capa, the famous photographer. They were buddies, of course, in the Spanish Civil War and World War II. Capa was celebrating his girlfriend's birthday. Her name was Pinky. And they were partying into the night, but Hemingway is in the passenger seat of a car. The driver was chosen to drive because he was described as "no drunker than Hemingway." [laughter]

Imagine being at a party: "you're no drunker than I am, so you get to drive."

Well of course, it's blacked out during the Blitz and they plow into this water tower at Leicester Square. And of course, Hemingway goes into the windshield, requires 57 stitches, again in the frontal area. Now he's supposed to cover Normandy, the D-Day landing. He's finding after this concussion it's very difficult to climb in and out of the boat, the Higgins craft, and so forth. 

During World War II he's sort of running around getting into trouble. He's with Robert Capa again. Hemingway's in the sidecar of a motorbike. They're really on an ill-advised mission. They come around a corner and they run into some Germans, and an anti-tank round blows up ten feet from Hemingway, is what Capa said. Hemingway thought it was three feet. Who knows?

It blew him out of the sidecar and he hit his head on a boulder. So now in that instant we have the wave blast injury and the direct blow injury. Now within a few months we're in Cuba. He falls off his fishing boat, that famous incident. This is the funny one where, I guess it's the gaff or whatever holds the clamps on the edge of the ship, hit his head and busted it down to the skull. And the surgeon said, "Being thick skulled saved your life." And he says, "That's a form of literary criticism, calling me thick skulled." At any rate, he gets sewn up there.

But of course, now after the two plane crashes in Africa – this is the famous story where they're on the 1954 safari and Mary is wanting to photograph Murchison Falls and a flock of ibis cuts in front of the aircraft, so they dodge, they hit some telegraph wires. The plane crashes. But it wasn't that serious a crash, but of course this is when the commercial airliner spots it, radios back that there are no survivors and they begin writing his obituaries, which he was fascinated with, and he would stay up at night, reading his own obituaries. And Mary Hemingway would say, "Turn off the light, go to bed, you can't read your obituaries all night."

But there's a plane looking for them that finds them, a twin-engine de Havilland, and unfortunately it landed in what was not so much a runway but a badly plowed field. And so, the pilot taking off crashes on takeoff. So this crash is more fiery, more violent. 

The pilot kicks out the front window. The cockpit's filling with smoke. He climbs out. His name was Cartwright, Reginald Cartwright. He pulls Mary out, but Hemingway's too big to get out the window. The door is jammed. He's injured his shoulder from the other crash. So he chooses very unwisely to bust open the door with his head, giving himself a skull fracture and another concussion.

So it was after the second plane crash where his cognition was not the same. His memory was worse. His headaches were persistent. At that point, the post-concussive syndrome had taken hold. 

And in his own letters– I was, just before coming up here, I remember thumbing through the collected letters, or selected letters rather. And I put a little sticky note every time he himself used the word concussion in a letter or described post-concussive symptoms. It was just like about seven in there. So he himself knew what was going on. 

So that's really the diagnosis, that we have a man who had multiple head injures. And he had a form of dementia that was predominantly from a concussive injury. But there were other contributors, which of course would be heavy drinking and would also probably have a vascular component. He had untreated prediabetes to diabetes and untreated hypertension for most of his adult life – actually, past 1940. And that would put you at risk for very small strokes in the brain. Not enough to make your arm paralyzed, but enough to do cumulative damage. And we call that vascular-type dementia.

The reason I throw that in is because the risk factors were there, but also the specific kinds of delusions he had later in life seemed to indicate a vascular. That's just sort of what I see with patients with vascular dementia.

LINDA MILLER:  Really, it's more the cumulative effect of these incredibly numerous concussions he suffered.

ANDREW FARAH:  Absolutely. Now, not everyone who has a concussion has postconcussive syndrome, but about 20% of people have persistent deficits that just can last a lifetime. I emphasized the blast injury because after the wave energy type concussion, you can have chronic traumatic encephalopathy with just one of those injuries, where it usually takes multiple blows to develop. But it is a cumulative type damage.

There's also evidence that you can have multiple sub-concussive blows, like the boxer who never has the concussion but has multiple sub-concussive blows. That can have the same effect.

So again, it's an accumulation of damage.

LINDA MILLER:  It's interesting. Scholars have made such a big deal over Hemingway's war wounding. Maybe excessively so. And attribute all of Hemingway's portrayals of wounded warriors, of psychologically depressed characters. And they attribute it, again with Philip Young–

ANDREW FARAH:  The trauma artist, right.

LINDA MILLER:  –his book, Hemingway: A Reconsideration. Do you think that had Hemingway just had that one injury in the war, that it would have led to what we see?

ANDREW FARAH:  It's probably not to the degree - it probably would not have reached the threshold of such a decline that we would write this book. But it would have changed his life, because I think the concussive blow was that serious. I think when we were earlier speaking, I remember a phrase, I don't know if it was your phrase or mine, but I think he got all of the war trauma he could have hoped for, but more than he bargained for. 

So he comes back with this great war story, the wounds, the crutches, the really cool cape, and he's the hero. But the seeds of the damage were already planted, sort of like a time bomb. And of course, there was the psychological impact.

LINDA MILLER:  It's interesting, because I think in talking about this war wound, scholars have tended to focus on the leg injuries, the shrapnel that seriously damaged his legs and that he almost lost one leg as a consequence. And I don't recall anyone really talking about the head wound. So that's very interesting to me. And that caused me to go back and look into A Farewell to Arms, where Hemingway writes, of course, ten years later about his war experience. 

I'm going to read a little passage from here that describes Hemingway's war wounds through the framework of Frederic Henry. And I notice that it culminates in a kind of very direct description that he was indeed hit, his head. And that was maybe a more major factor in his wounding than the other. But I'm sure many of you have read A Farewell to Arms, but here is Frederic Henry describing his wounding:

Interesting that he's wounded while eating cheese. How mundane. They're discussing philosophically the war and then the hits come.

I ate the end of my piece of cheese and took a swallow of wine. Through the other noise I heard a cough, then came the chuh-chuhchuh-chuh. Then there was a flash, as when a blast-furnace door is swung open, and a roar that started white and went red and on and on in a rushing wind. I tried to breathe but my breath would not come and I felt myself rush bodily out of myself and out and out and out and all the time bodily in the wind. I went out swiftly, all of myself, and I knew I was dead and that it had all been a mistake to think you just died. Then I floated, and instead of going on I felt myself slide back. I breathed and I was back. The ground was torn up and in front of my head there was a splintered beam of wood. In the jolt of my head I heard somebody crying. 

I sat up straight and as I did so something inside my head moved like the weights on a doll's eyes and it hit me inside in back of my eyeballs. I knew that I was hit... 

I thought that was really an incredible description of actually the concussion had ruined. And is that kind of what you see in your patients, that description of where he talks about not only the kind of out-of-body experience, but also something moving inside his head "like the weights on a doll's eyes, and it hit me behind my eyeballs," that kind of almost detachment from yourself; you have to catch up, almost.

ANDREW FARAH:  You're absolutely right. Those are common findings, this idea that there's this disconnect between your eye movements and the rest of your head. In fact, the medical term of doll eyes indicates a severe injury, where as you turn a doll and its eyes move separately than you would expect.

And the out-of-body experience is fascinating because it shows up here. It shows up in "Now I Lay Me." So it's something that he processed. We know that that can occur with concussive injury, but exclusively it seems with the wave type injury. Now, you don't meet a lot of psychiatrists who talk about–

LINDA MILLER:  What is the wave?

ANDREW FARAH:  The energy wave of a blast. Rather than the direct blow of getting hit on the head. So the concussive wave energy of an explosion versus the direct blow. 

But you don't meet a lot of psychiatrists who want to talk about it because the paranormal people kind of want to encroach on that. But we do, when people do report that sort of out-of-body sensation with head injury, we seem to localize it to the temporal parietal area on the right side, temporal parietal area of the brain. And that kind of makes sense because parietal area is how you keep track of space, and temporal area, time. Who knows.  As a neuropsychiatrist, we can point to a place in the brain where this can happen and we tend to put the stamp of approval on it, and we take it away from the paranormal people. 

But it informed him. He wrote in October of that year to his family, "I have seen death and I'm not afraid," this very heroic language. He said, "I've pretty much proved conclusively that nothing can bump me off." 

So I think that out-of-body sensation almost validated his sort of adolescent sense of daredevil invincibility that he carried with him the rest of his life. But it also gave him that insight of that crossing over. 

Your friend Robert Gajdusek writes beautifully about Joyce and Hemingway, both being concerned with this breaking down the dichotomy of the spirit/matter world, in crossing over. And Ulysses, for goodness sake, goes to the underworld. Finnegans Wake, the premise is a wake, and Across the River and Into the Trees is crossing. It's about the last

24 hours of a man's life based on the words of Stonewall Jackson on his deathbed. The Snows of Kilimanjaro is about a slow death.

So I think that it informed the literature in that way, but it also something he could process. But I think it kind of made him feel a little special, that he was a bit invincible. 

But to get back to your earlier point, you're absolutely right. He was pretty good at describing bodily sensation like that, which most of your patients just report being dazed and confused. But you're talking about a genius who was acutely aware and, in his own words, noticed everything. And that included himself.

LINDA MILLER:  What's interesting, he was a very young guy when he was wounded. 

ANDREW FARAH:  17/18, yeah.

LINDA MILLER:  18 just turning 19. He was only there for a month when he was wounded. He was delivering chocolate to the – he was in the ambulance car and delivering chocolate and cigarettes to the troops. 

After his wounding, in his letters, you mentioned, to his family, there's sort of a gee-whiz quality to them. When he was going over to the front he wrote his friends back in Kansas City, "I'm going to the front tomorrow. Wow!" But that juvenile gee-whiz quality seemed to belie the reality that something more happened to him with that wounding than we realize. And I think it does translate, as you're talking about, into his artistic vision, that something happened to him with that out-of-body experience and he traveled – I like the way you describe it – to this other sphere. 

He would revisit that in some of his stories about Nick Adams, where Nick Adams in the story, "Now I Lay Me," based on the old childhood prayer, which heaven forbid you should never tell your children, as I did my son, "Now I lay me down to sleep, I pray the Lord my soul to keep. If I should die before I wake, I pray the Lord my soul to take." And what a terrifying thing for a child.

And Hemingway would have Nick Adams write about that. After his wounding, he was afraid to go to sleep because he feared he could die; his soul would be taken. And I think it plays in to this, whatever journey he took mentally. I find it really fascinating. I think it is significant for him.

You mention in your book that Hemingway's second concussion with the skylight coming down on his head and that huge gash. Archibald MacLeish wrote about that later and how the blood was just literally gushing, and Archibald MacLeish had to come to the apartment and drove him to the hospital.

But you talk about how that almost seemed to trigger a freer flow of his artistic energy that led into his writing of A Farewell to Arms

ANDREW FARAH:  It did. And MacLeish talked about his giddy ramblings in the cab.

He was in a post-concussive state where he was confused in delirium and just rambling. But he remembered what his blood tasted like, his own blood. It reminded him of being in the mud in Italy and what that blood tasted like. And that just unleashed this force. What was a short story going nowhere just blossomed into A Farewell to Arms. And I think he wrote to Scribner's, I think he wrote to Perkins and said, "My wife is going to see that I'm bled as often as possible the way it's been going." The trauma really was somehow freeing. Who knows?

I also wrote about the horseshoe-shaped scar that he wore around, kind of proud of it, that it was like every day was Ash Wednesday, here's my outward symbol of inward change.

LINDA MILLER:  Archibald MacLeish said it changed the configuration of his face forever after. 

ANDREW FARAH:  Yeah. Well, the scar stayed with him.

LINDA MILLER:  It did. It was sewn up pretty primitively, apparently. Going back just to some other factors that you talk about in your book, besides the concussions, the depression. That's kind of what many scholars have attributed to Hemingway, but you say he probably wasn't clinically depressed. 

ANDREW FARAH:  He certainly had depressive symptoms and depressive episodes. His father was certainly depressed; his father committed suicide, which we can talk about. But a careful reading indicates that his depressive episodes weren't random; they were after incidents. Like when he had the car wreck out west in Montana or something, he just couldn't work. There were these lulls after he finished a book, where he physically couldn't write or had run out of ideas and he felt he wasn't going to work. That was always his advice to Scott Fitzgerald, after the crackup, "Don't pity yourself, go out and work. Work is your therapy. This is what we're meant to do." 

So to me, they were more what we'd call situational depressions. And I've had people argue with me and say, no, no, he was prone to chronic depression. Certainly he had the genetic risk factor for it. But I think that as he, in the last five years, certainly in his downward slide, yes, there was depression, but it was, again, through the awareness of the cognitive decline, I think the awareness that he couldn't work, that his memory had been erased, his mind was no longer. I think that's, again, more of a situational depressive impulse from the situation, rather an endogenous– he's not the patient who comes, "I don't know why I've been depressed my whole life," he's not like that.

LINDA MILLER:  And the suicides in terms of family history. What do you make of all of that?

ANDREW FARAH:  Talk about genetic loading. The genetics of suicide are becoming clearer, but what's fascinating is that when we do find genetic markers for selfdestruction, they seem to be passed on independent of mental illness, which is very paradoxical. Certainly people who are depressed or prone to suicide, 15% of bipolar patients commit suicide, 5-10% of schizophrenics commit suicide. But the specific genetic marker can be passed without the trait for mental illness. So kind of a funny way to think about it, but that travels on its own path. 

His father, of course, committed suicide with a Colt pistol carried by his father in the Civil War. And I show the family photo and talk about how every– it was Hemingway and his dad and his mom and sisters, and so forth, and even the two hearts unborn, the brother and the sister to come. Everyone in that photo committed suicide except two people. Amazing genetic loading. 

Many people he knew committed suicide. Adriana, his Italian muse, hung herself on her family farm. Harry Crosby. Jules Pascin. The list of the people that die this way– I think Pascin outdid everybody by, I think he cut his wrists and wrote the name of his mistress in blood on the wall before he hung himself or something; he got the prize for drama.

But the genetics are certainly there. And in fact, he wrote to his future mother-in-law, I guess Pauline's mother at the time, Pauline Pfeiffer, that he was delighted to have the Pfeiffer in his family to breed out some of the suicidal streak. 

And the wonderful, well not wonderful story; it's an interesting story about Grandfather Hall; so, his mother's father, who was living with young Clarence and Grace, his father and mother, they were in his home. But Grandfather Hall was dying of Bright's disease, which is an old term for inflamed kidneys, very painful. And he was going to shoot himself, but Clarence, Hemingway's father, took the bullets out of the gun. And so he pulled the trigger and of course nothing happened. But it's probably apocryphal because Hemingway was just five years old and he was writing this letter in his forties. 

But the point is that he believed himself to be the descendant of suicidal men on both sides of the family. And that's why he predicted his suicide, rehearsed his suicide. He even would, for friends in Cuba, would show them what he called hari-kari with a gun. And he would put the shotgun on the floor and put his big toe in the trigger and put it in the roof of his mouth and it would go "click." And then he would grin. Why he needed to do that is a whole 'nother book. But again, I think he believed that that was within him. 

So yes, the genetics were there. But I think that when it comes to his suicide, people blamed the ECT; they talk about the depression and so forth. I think the ECT itself – we have a compromised brain. The shock therapy itself was a biological stressor on that brain that it could not handle, neither from a physiological standpoint or psychological.

LINDA MILLER:  Describe to the audience in case they don't know what happened in the last year of Hemingway's life in terms of being taken to the Mayo Clinic.

ANDREW FARAH:  Of course, he was very delusional, very paranoid and was suicidal. He needed treatment, and it was recommended he go to Menninger Clinic, but they knew he would never go into a hospital known for psychiatric care, so the excuse became "your high blood pressure, go to Mayo Clinic," that will be the excuse. And there's evidence that was even hidden from him, that he was taken there to be treated for blood pressure and suddenly he's on a locked psychiatric ward.

Now, when you have psychosis and depression and you're suicidal in 1960 or 1961, you get shock therapy, you get ECT. And we can talk about how the movies have treated that procedure. But he received probably 10 to 15 treatments during the first round, but came home and was not much better. In fact, between admissions, he had become suicidal again. Mary had caught him basically writing a suicide note, got Dr. Saviers there, his family doctor; they got him to the hospital there in Sun Valley, the Ketchum area. And they were waiting for a break in the weather to fly back to Mayo.

So the day before, he's ready to go, they're going to his house to gather some things. And he runs in and grabs a shotgun and gets shells in it before it's wrestled away from him by a nurse and another individual who was accompanying him, Don Anderson. So he's intensely suicidal.

There is a story that on the second trip back, that they stop at, I guess, is it Rapid City, I think, but they were stopping to refuel the plane and he was rummaging around for a gun, or he was going to walk into the propeller of another plane. That's not true. That's been one of those myths that's been repeated. Saviers, who was there, said this did not happen.

But at any rate, he goes in for another round of ECT, and he comes home, and within two days of being home has shot himself. Many people blame Mary because she left the keys to the gun case where it was clearly visible. Rose Marie Burwell thinks that Mary – in her book she talks about how she felt that that was a way out for Mary, that she didn't plan it, but she allowed it to happen. 

But at any rate, the shock therapy itself; again, you have a compromised brain and he felt after that that he couldn't work. And psychologically he was ruined. I think the last piece of professional writing he did was that line about Moveable Feast: "This book comes from the remises of my memory and of my heart; one doesn't exist, the other's been tampered with." 

Now, you could read it both ways – my memory's gone, my mind is gone and my heart doesn't exist. Or, my mind doesn't exist, my heart is long gone. Or something like that. So typical Hemingway ambiguity, you can read him multiple ways. But he believed he was "out of business." And so, that's what led to the demise.

But sure he was depressed, but again it as propelled by the situation and the understanding that he was ruined. 

LINDA MILLER:  The whole role of memory for a writer, particularly Hemingway, is huge. And to feel that you're losing your memory, you've lost everything. I pulled out this letter from– I'm a part of the whole huge project now, publishing all of Hemingway's letters. It's based at Penn State. And we're coming out with a fourth volume in the fall. And believe it or not, there'll be 17 volumes of Hemingway letters, probably more Hemingway letters than anyone ever wants to read. But it's been very exciting to discover all these letters, many of them not published before, and see a new view of Hemingway actually emerging, similar to what you're doing, kind of resurrecting him from some of the myths that have developed around his very predominant persona. 

But in the early letters, as he's thinking about writing and heading off to Paris, he writes to one of his friends from the war, Bill Horne. This letter was written on July 17, 1923. And he's reminiscing about Michigan, the country where Hemingway grew up and the country that informed the In Our Time stories and the beautiful Nick Adams stories. And Hemingway writes this:

We can't ever go back to old things or try and get the "old kick" out of something or find things the way we remembered them. We have them as we remember them and they are fine and wonderful and we have to go on and have other things because the old things are nowhere except in our minds now.

And as a writer, Hemingway knew that he had to step into memory. When you read Moveable Feast, where he talks about writing In Our Time stories, he's actually in the story and moving in it as he writes. And that's a tricky thing. How do you step into memory? And for the artist, this is crucial. So when he's beginning to recognize that he's losing his memory, it's just absolutely tragic.

ANDREW FARAH:  It is. And the encephalopathy he had, the form of chronic traumatic encephalopathy, the form of dementia he had from these blows, it didn't help his craft at all. In fact, I write a lot about the posthumous works and the decline and the skill. And as you said beautifully, no one could imitate Hemingway like Hemingway. And he had enough skill that he could create forgeries, but the memories, the older-held memories stick around, even in more– you can see a patient with dementia and say, "What'd you have for breakfast," and they don't know. But say, "What'd you do in World War II?" and they'll tell you.

So the older-held memories are more– and so, that's why writing Moveable Feast was a little bit easier for him because he was going back to those well-engrained things. Now, the skill, it took a lot of editing to get the work we know. 

And I think that you've taken issue with how the chapters have been arranged. You're very right to do that, because he himself arranged them to get a Proustian effect; imagine that, using Proust and Hemingway in the same sentence, that must horrify some people.

LINDA MILLER:  No, it's wonderful because Proust is all about memory. And talk about, how do you step into memory. It's very sensory, you can't plan it or predict it, and he writes about dipping the madeleine into the tea and suddenly he's there with his grandfather at the farm. So Hemingway and Proust are very aligned.

ANDREW FARAH:  Yeah, two sides of the same coin. The other wonderful phrase

about them both I like is that they're experts at the articulation of perception. I love it.

But you're absolutely right, that the memory was preserved better for the older days. But as far as the kind of skills he needed to do his craft, they were deteriorating. He was a working man. And if you take something like "Hills Like White Elephants" – four beautiful words, we all know what it means, we've all written essays about it – that started as 83 words and several paragraphs, and he distilled it and distilled it. That's poetry, to distill those concepts down to just those four words. The ability to do that was lost at some point. And that's why he would just stand at his desk shuffling papers in the last year and felt he could never finish the Paris book. We saw an exaggeration of some of the paranoia and the traits, that he thought he'd be sued by all sorts of folks. I think that would explain why he so scapegoated Dos Passos in Moveable Feast. Because he was dead, unlike Murphy, who he should have scapegoated, as you say. 

And you've written beautifully about in The Garden of Eden, it's about writing. And he's reliving the lost valet case of Paris and rewriting the stories from memory. The only two stories to survive were "Up in Michigan" and "My Old Man." And that was it. He had to reconstruct everything. And like Ezra Pound said, if the form was good, you'll be able to recreate it from memory. But if it wasn't any good, the story wasn't worth keeping in your head. 

But you're right, in The Garden of Eden, we all get distracted by the sexual content, but it's a book about writing.

LINDA MILLER:  It's absolutely about writing. And The Garden of Eden is a book he was working on in the last–

ANDREW FARAH:  The last 15 years, off and on.

LINDA MILLER:  –years of his life. And he was trying to recapture the garden that a man has lost. And crucial to that is not only the reconfiguring of all the personal stuff with the women, the two women and the lost manuscripts that get metaphorically presented in The Garden of Eden where Catherine burns his manuscripts, David Bourne's manuscripts. And David Bourne, who wants only to write, has to recover those. It really parallels the lost manuscripts of Hemingway when Hadley left the suitcase on the train.

Think of that, to have all your work up to that point, or almost all your work just–

ANDREW FARAH:  Disappear.

LINDA MILLER:  –disappear. And most writers would right there kill themselves. How do you get that ability to go back and face it down again? And Hemingway did. And I think it's what you describe in his last years, the strength of determination of his confronting his awareness of his declining abilities, and yet he kept going at it, and kept going at it, and kept going at it. There's something very triumphant in that. 

And in those last manuscripts, there's some really good stuff there. As you describe it, wow, it's all there, but it had to be kind of– someone else had to come along and pull out and pull out and pull out. I talked with Tom Jenks, actually, he was the guy at Scribner who edited The Garden of Eden. And many scholars kind of abandoned work with that manuscript because it was huge and very complicated. And finally Tom Jenks, who was with Scribner, took it on. And he said to me, it was a bold edit, but he didn't change a word that Hemingway had written. He just took out and took out and took out. And so, what's left there is I think quite extraordinary.

ANDREW FARAH:  It's funny how Catherine Bourne takes on the role of the critics, because she says, "You're writing these silly stories about when you were a kid and about your father." It's funny how he's just hypercritical and I think he projected the critics onto her. And you're right, I think it is the story of a man trying to recapture that ability to write. 

The other side of that, when people asked Hemingway if he would see a therapist, he'd say, "Well, my typewriter is my therapist." Now, what he meant was that "the act of working was all I needed for mental health." But what we know now is that it was the processing. The content was much more valuable, and that's how he did his own therapy.

If you think of Fathers and Sons, which is probably the most Joycean of his works, it's got the stream of consciousness and the internal dialogue, it's got the overt sexuality. It was about a father and a son, and he's writing about his father. It has more corrections and typeovers than any other manuscript. It's right after the suicide of his father and right after he's learned of the death of his first little honey, his little girlfriend when he's a teenager, Prudy Bolton, who's committed suicide. Another suicide.

So he's processing this. And there's so much of Hemingway scholarship where we look backwards and say, aha, these are the people in Sun Also Rises that correlate with this part of his life. But I think the next phase is to look forward and say, okay, here's the man doing the work of therapy through this writing. Now, how does it inform the life going forward? And now we have that as it goes on, the other layer of the dementia going on.

LINDA MILLER:  He clearly was deeply troubled by his father's suicide. He said he wasn't going to write about his father or people in Oak Park. But he did write about his father, but it was really much of it after the suicide, in Fathers and Sons where he directly goes into describing his father's death and the way the undertaker had to really reconfigure his face, really feeling angry as conveyed in that story that his father betrayed him and betrayed others. And in The Garden of Eden, this core story there, that David Bourne is working on a book about his father and trying to get at the heart of his father and the whole issue of betrayal. 

So the suicide thing is an underline, it's a huge dimension there that hangs in all of

Hemingway's art. When I teach Hemingway to my students, they always tell me, they

feel a kind of underlying darkness and sadness that's just under the surface of his very minimalist prose, to be sure. 

ANDREW FARAH:  Yeah, there's the thread that's always there. Even a simple story like A Clean, Well-Lighted Place. The premise of the story is that an old man has attempted suicide. He's not been successful, and now his very presence is annoying people. And that's the story in a nutshell. So you're right, it's a thread that just goes right through.

LINDA MILLER:  What about this idea, we talked about it a bit, and people are often intrigued with the idea of creativity and geniuses and the writers and artists who seem to be sometimes a little, can I say crazy – is that acceptable today –

ANDREW FARAH:  Sure, absolutely.

LINDA MILLER:  –than others. Or are functioning in a different dimension. You say in your book, and I love this line about the brain: The brain's complex design argues for our transcendental nature, that there is in the creative individual maybe something more there.

ANDREW FARAH:  Right, and that's a good place to start. When I talk about head injury and the axonal shearing and what happens to nerve cells, we're talking about hardware; we're not talking about the software. And I think our mistake is to assume that the Mozart is coming from the radio. Well, no, the radio is the tool whereby we hear the Mozart. The Mozart's coming from somewhere else. I think my profession has gotten so into the neurotransmitter and into what Locke called the science of mind and matter– I'm sorry, matter and motion, that we've forgotten the science of the mind. And I think it's good to remember that transcendent nature of what we're talking about.

And also will go on record saying that Hemingway did not have a monopoly on mental illness when it came to the Lost Generation. Joyce, of course, drank heavily, his daughter was schizophrenic, and her illness tormented him, just to watch a daughter suffer like that. TS Eliot was so neurotic that he couldn't pass a military exam because his heart rate was so high, but he married a girl that was thought to be psychotic. I have a lot of feelings about Vivienne Eliot. I think if you're a histrionic young lady in the 1920s and someone gives you bromide, you're going to hallucinate. And that's sort of what they did then, like Evelyn Waugh hallucinated on bromide. Let's see, Zelda Fitzgerald, her psychosis is well known. Scott's drinking is well known. Ezra Pound spent pretty much his entire adult life as an untreated manic individual. 

Poets are more prone to depression, sure. Bipolar folks are more prone to creativity. But the important point is that when they're in the grip of the illness, they're not working; they can't work. There's a recent biography of Robert Lowell. Here's a contemporary artist who was a wonderful poet, and certainly the bipolar illness informed his most striking and most critically acclaimed poetry, but he couldn't do it when he was acutely manic. When he was acutely manic, he was standing in the streets of New York trying to stop traffic and thought he was a reincarnation of the Holy Ghost.

Yes, it may fuel the fires, but acute illness is not conducive to work. And it's a heck of a price to pay. I think we hear about the mentally ill artist because the stories are so dramatic, but I think there are many other artists who do wonderful work without that tragedy in their lives. Would we have a van Gogh paintings if he wasn't so tortured? I don't know. Would they look different? I don't know.

LINDA MILLER:  That gets to a level of speculation again which we can maybe go. Well, we've talked about some comparisons of different artists. Andrew and I both recognized our fascination with the painter Willem de Kooning, who was doing abstract expressionist art in New York in the 1950s. And you write about him in your book.

ANDREW FARAH:  You're right, we both made that connection, not with the content of the work between Hemingway and de Kooning, because that's kind of impossible to do, but the fact that when you're looking at a de Kooning you see this sort of cartoon woman; it's sort of just a superficial distraction. Just like a lot of Hemingway's surface– if you read him on the surface, well, it's a fine story, but that's just the surface. What's really happening is underneath. And the layering and the complexity and the beauty of de Kooning is much like the layering and complexity and beauty of Hemingway. It's not there at first, it's not obvious at first. In fact, de Kooning looks simple, but he's not.

But he was important to talk about because he's another artist who had a form of dementia. And his dementia, he was a heavy smoke, and his dementia was the vascular type, and probably a bit of Alzheimer's, because when you do diagnose somebody with vascular dementia, multiple strokes over time, small strokes usually, over 70% do have a component of Alzheimer's.

But he still worked. And in the 1980s, he was cranking out the work. And his work became even simpler. He used primary colors, ribbons of floating colors. Now, he was called a factory before Andy Warhol was even called a factory. So what was amazing was that even though he could not recognize the people around him, and would have volatility, like any demented patient, they would put the palette in front of him and he would do this incredible work. And he would only work with primary colors. And if they put other colors, he would push them aside. Which is fascinating in the context of dementia, because a demented patient will hang on to things they learned as a very young child – they'll know their colors, they'll able to finger name; things you learned in kindergarten stay with you, even when you're severely demented.

But the importance is that his craft could still, whatever he was doing, the act of painting, the action painter, they were using the basal ganglia. This is learned memory. They're not using the cortical structures that have the dementia. So whatever his impulse was an abstract expressionist was still conveyed. Whereas for Hemingway, he needed the cortical structures to do his craft. And I think that in the latter works, you see the archetypal impulses still trying to come through, trying to break through. But he just can't get it down.

But I thought it was an interesting parallel, the two types of artists and the two types of dementia, and how it affected their works.

LINDA MILLER:  There are definitely parallels between the two in terms of their attempt to get to the interior. I remember being absolutely intrigued by de Kooning's Woman paintings, which you describe as cartoonish. He would slash at these paintings and work at them for over a year and kept – I don't know if you're familiar with those paintings, but they're very distorted and rugged and jagged and harsh colors. And I was intrigued when I first saw them as a young college student, realizing that – to me, what de Kooning was doing was not betraying women or demeaning women, but trying to get to the reality of the woman inside. And I thought it was really beautiful.

And I think that's what Hemingway was about. He wanted to write the way that painters painted to find a way to get– as Picasso said, he painted what he could not see with his eyes. And how do you get into that interior world. 

And so, the parallels between someone like de Kooning and Hemingway I think are very interesting. And it's interesting what you're saying about de Kooning's ability to maybe pull it off in the end better than Hemingway was able to at the end. 

ANDREW FARAH:  And I think de Kooning, was he a drinker, too? I think he was a bit of a heavy drinker.

LINDA MILLER:  Probably. [laughter] 

ANDREW FARAH:  Don't want to defame him. I know Jackson Pollock was. 

LINDA MILLER:  Is there anything more you want to say definitively? 

ANDREW FARAH:  Boy, you're so kind. I think it's good to set the record straight. I think that so many people have repeated the cliché that he was bipolar and that explains everything, or he was a narcissist, that explains everything. And you and I talked a lot about the Hemingway persona. And to me, it's interesting from an autobiographical standpoint, working in this way to the work and so forth, and it's interesting from a psychological standpoint. But I think as his dementia progressed, some of the hallmark symptoms of post-concussive syndrome, developing a chronic traumatic encephalopathy are mood swings, volatility, irritability. So the worst aspects of the persona were almost solidified by this illness.

I think Gajdusek talks about the persona as he was like a spy out too long who kind of believes his own cover. But I think at some point he was psychologically and physiologically incapable of retreating from those behaviors and that persona. Sadly. 

And I think a lot of people want to blame the alcohol for a lot. And I think it's worth noting that, as Scott Donaldson said, he was a functional alcoholic for many, many years before the drinking took more of a toll. But the concussive injuries mean you tolerate alcohol less well. I always think Hemingway's like a Churchill when he says that, "I have taken more out of alcohol than alcohol's taken out of me." I think that's kind of classic for both of them.

But I think we've got it right, knock on wood. And your words have been very kind. The reception's been very, very kind from real Hemingway scholars and people who really know what they're talking about.

LINDA MILLER:  Hemingway scholars, I think, were initially a little skeptical.

ANDREW FARAH:  Oh, weren't they? Who is this guy? Another one of those, "Hemingway's this, Hemingway's that."

LINDA MILLER:  Because there have been psychologists who have analyzed Hemingway and there have been a lot of wacky assessments and some ideas that have been perpetuated, as you say, and become engrained in stone, and really need to be challenged. So we really appreciate your showing the reality of his actual mental/physical condition and the way it affected his life, and then ultimately for us his art.

I thought this was an interesting little poem maybe I'd end with. You talk about the life that informs the art forwards. When Hemingway killed himself, and it was in the newspapers, and initially Mary Hemingway tried to pretend that it was an accident, that Hemingway had been cleaning his gun. Of course nobody believed that. But Archibald MacLeish, who was a friend of Hemingway's from Paris, and was there when the skylight came down, when he read in the newspapers about Hemingway's suicide and Mary's statement, "in some inexplicable way an accident," she was quoted as saying, Archibald MacLeish wrote this pithy little poem on Hemingway, and I think it kind of really summarizes really everything that you've been saying. 

Oh, not inexplicable. Death explains, that kind of death: rewinds remembrance backward like a film track till the laughing man among the lilacs, peeling the green stem, waits for the gunshot where the play began;

rewinds those Africas and Idahos and Spains to find the table at the Closerie des Lilas, sticky with syrup, where the flash of joy flamed into blackness like that flash of steel.

The gun between the teeth explains.

The shattered mouth foretells the singing boy.

Very powerful.

ANDREW FARAH:  It's very powerful stuff, yeah.

LINDA MILLER:  We'd like to open it up to you, our great audience, for questions and further discussion. It's hard to see, I've got this blinding light here. Questions? Come forward to the mic.

Q:  I just had two very brief questions regarding athletes, football players or soccer players that get concussions. Many times they're told to sit out for about a week or so. And I was told that's because the blood vessels have expanded, and if they get hit again they could burst, I guess. Is there some truth to that? 

And the other thing is on helmets. Some of the helmets are very expensive and very big. And yet, at the same time I'm told that the helmet may protect the skull, but it won't protect the brain, so you can still get a concussion. So is that a false sense of security with these very nice helmets.

ANDREW FARAH:  You bring up a great point, because the brain is floating in a fluid sac. And of course, at some point it does get, with these kinds of hits, it gets sloshed around and hits the bony structures, gets contusions and so forth. So you're right, the better helmets, as you see they have that sort of cutout frontal area where it basically lessens the impact, but at some point there's not much you can do with some of these hits. 

And you're absolutely right about what you're describing in your first question is second impact syndrome. Because there are cases of people that might even have a mild concussion sent back in a game. In the literature, it's only about 44 cases, but a second concussion within minutes to hours, sometimes even days after a first concussion can, in this situation, disrupt the blood vessels of the brain and their ability to have their integrity and the fluid will seep out of them and the brain swelling is very rapid. And there have been deaths. And those who have not died have had permanent injury. So you're right, the resting of the player is to prevent second impact syndrome.

Now, we live in an age where, to say a concussion protocol, well, it's very different from team to team, sport to sport, sideline to sideline. It really doesn't have one singular meaning. Locally, we have a set of things we do. The first question is, how long do they rest; should they rest for a certain period of time or not. And there are certain agents that you can take to lessen the damage. We've based ours on the military's protocol with some additional factors. 

Those are great questions, thank you.

Q:  Thank you.

Q:  Alex Cardoni, Hartford, Connecticut. I'm a psychopharmacologist at the Institute of Living. I've been following Hemingway and his medical issues since 1988. First of all, I want to thank you for a wonderful review of this topic. It's very difficult. 

My interest is focused on Hemingway's drug use while he was live, obviously. The fact that he took drugs like Ritalin and other psychoactive drugs, barbiturates, probably to control his moods, bring himself down when he was too high, lift himself up when he was too low. And of course, his admission to Mayo and the way they handled him at Mayo I have great concern about, the fact they didn't try available medications at the time. I know in your book you mentioned there were two medications available. There were probably more than two psychotropics available during that time – the MAO inhibitors were available; tricyclic antidepressants; and Thorazine and Mellaril, thioridazine, which is a low level antipsychotic drug, which is sometimes used in, quote, mild schizophrenia.

It seems to me they should have given him a trial of medication first, early on, before ECT, to see what would work. In 1961, lithium was available as an investigational drug in this country. And I have a feeling that he should have been given a trial of lithium as well.

ANDREW FARAH:  You bring up a lot of great points. And you're right, through the '50s, he was known to take Ritalin. He went to his Cuban doctor, said, "I fall asleep after lunch." He didn't ask him how much he was drinking during lunch. He said, "I can't work." But he gave him Ritalin. And he also took Seconal at times at night. And it was the Seconal and the alcohol together that would make him fall asleep in front of guests and so forth.

Reserpine was used for his blood pressure, which unfortunately depletes serotonin, makes people more depressed. So at Mayo, they did take away the reserpine. A very common antihypertensive, but it also makes people depressed who are more prone to depression, like he would have been. He took testosterone in shot form. And he took high doses of Vitamin A because he thought it would be good for his eyesight, high doses of Vitamin E because he thought it would help his libido.

But from what I could gather, nothing was ever that consistent. It was sporadic as far as the use of those compounds. You're right, there was amitriptyline and I guess imipramine at the time. So there were two tricyclic antidepressants. I guess there was Nardil as well.

And of course, thioridazine.

But at the same time, 1960, I didn't– of course, I didn't talk to Howard Rome. I talked to one of his colleagues and kind of asked him the same thing. And I talked to a medical student who was there at the time. Their thinking was that this is such an acute situation, let's go ahead and do the ECT. 

They also were mindful– the side effects with tricyclic antidepressants are short-term memory deficits, decreased libido, weight gain, sluggishness. So they were kind of weighing that out. And really, the psychopharmacology, we really hadn't broken away from insulin coma, shock therapy. In fact, poor, old Zelda Fitzgerald; she not only had shock therapy, she had insulin coma. Her doctor was a very unusual practitioner who would inject the spinal fluid of his patients with placental blood or with honey. I mean, just bizarre sorts of things. It's a wonder they survived. 

Q:  Just a postscript. Mary Hemingway visited the Institute of Living in June of 1961, to look at the campus. She wanted him transferred from Mayo. And of course, he would never go. Against his will you can't transport patients across state lines. And secondly, he wanted to be admitted under an alias, again, which they would not do at the IoL. 

Thank you very much.

ANDREW FARAH:  Great questions. 

Q:  First of all, I'd like to thank the panel for speaking so clearly on rather complex matters. One of the issues that was not mentioned, I think, or at least not extensively in the discussion had to do with the alleged attempt on the part of Hemingway's mother to present him as a female when he was very young. I'm curious even if we accept the notion that it's the concussive injuries that really underlies much in Hemingway all the way through, and perhaps accounts for his inability to write later, if there is somehow a very, very powerful strain that is not describable in physical terms as you've done so, but has a lot to do with that condition of the mother's relationship with Hemingway.

My sense of Hemingway, and I'm eager to hear reaction, is that Hemingway was a man who needed to be a human being without restraint. He did physical exercise that was excessive. He married four times. He drank to excess. He took drugs to excess. He somehow seemed to need to tempt, to risk death in order to find out what was the truth about death in order for him to grasp beyond the norms that normal life provided.

And I'm curious if you could somehow assess this strain of macho, unrestrained behavior in relation to the concussive course of his life in determining what really made Hemingway Hemingway ultimately as an artist.

ANDREW FARAH:  You bring up the twinning of his sister Marcelline and Ernest. At a young age, his mother twinned them and dressed them the same, and so forth. And that was sort of a quaint Victorian holdover, to have the little boys in gowns for a period of time. And the twinning went both ways. Unfortunately, it was Marcelline who suffered worse because her hair got cropped off as a teenager and it looked like a boy's. She held her back so she and Ernest could be in the same grade. So I think both genders suffered from it.

But I think he had no real recollection. That happened at such a young age. But I think a lot of people have made a lot of psychological hay over the fact that you have this macho overcompensation from being twinned as a girl. And certainly, gender bending and gender switches show up a lot in his short stories – little girls saying, "I'm your sister but I'm a boy, too," kind of thing. In "Last Good Country," that shows up very prominently.

And of course, Catherine Bourne. 

I think he processed that. But I think, to getting more to your point of the daredevil, the macho overcompensation, I think that how it relates to the chronic concussions is I think that the concussive injuries tended, like I said, to solidify the worst aspects of the persona, which would be the bluster and the braggadocio and the loquaciousness and the irritability. I think that's where it had its organic solidification.

But you're right, there's a lot of people who've written about that, and they've noticed the same thing you have. And he did hate his mother; he absolutely hated her. And like his friend Buck Lanham said, "A lot of people say they have their mother, but I think Hemingway's the only person who really hated his mother." [laughter] 

Q:  Could I just ask a small thing in relation to what you just said? Would you also say that his attacks on other people, particularly friends, seems to fall also within this unrestrained ethos that characterizes his life and behavior?

ANDREW FARAH:  I think it's all under that umbrella. There's a part of him that is they adolescent boy that was displeasing Mom and Dad; there's a part of that that never changed. And I think the last marriage, to Mary Hemingway, they played this very pathological ballet. He was the naughty, contrite little boy, he misbehaved again and she would scold him, maternally. It was the same relationship he had with his mother and they acted it out beautifully for the rest of their lives. Very complex.

LINDA MILLER:  You talk in your book at a kind of regression into a childlike behavior. Do you think that is a result of the–

ANDREW FARAH:  Of the injuries, yeah, I think so.

Q:  Thank you so much.

ANDREW FARAH:  Thank you. Great questions. 

Q:  In all of the pictures we've seen of Hemingway, he's either a young man or a very old man. I was just wondering if there's anything about concussions or mental illness that just ages the hell out of you?

ANDREW FARAH:  It does. It actually does. And the drinking didn't help. And I think as a young man, he certainly had the Hollywood looks. But by the late 40s, he was really letting himself go. But in the latter photos, you can see the neurological damage. Certainly the scar is still there, but you see the ptosis, the drooping of the eyelid on the left side, which is a sign of dementia or brain injury. And you see the slight exotropia of the eyes; they were not quite as focused in the same point. So that's what we call soft neurological signs. 

So I think you're right, I think the hard living, the repeated blows, the hard drinking, being blown up a few times, that took its toll, absolutely.

Q:  Andrew, as yet I haven't read your book, and perhaps you covered it. But did you get into the research about the appearance of hemochromatosis in the blood line?

ANDREW FARAH:  That's a great question. An article came out in 1990; it was such an original contribution because somebody was really thinking outside the box. They said, look, he had all the symptoms of hemochromatosis, which is a hereditary illness. So this author argued that his father had it as well. It leads to skin pigmentation. It's basically a disease of iron storage. So iron will abnormally build up in the liver and the skin and so forth, but it has multiple brain manifestations to look like depression, mood swings, dementia.

So it was a lovely explanation, so I did look into that. And there's this notation from his internist at the Mayo Clinic where he says, "I just don't think a liver biopsy– it's a possibility, but I don't think a liver biopsy is worth the exploration." Liver biopsies are dangerous now; they were dangerous in 1960.

But I was able to learn from that med student that iron levels were part of the routine blood work. The reason his doctor said "let's not bother with a liver biopsy" is because in the presence of a normal iron level, a liver biopsy would just be too– the chances of having that illness in the presence of a normal iron level are nil.

So it was a great idea, but it turned out to be a dead-end. But it sort of took hold, too. And you'll read articles, "aha, he had this." But I was just fortunate enough to meet somebody who remembered. I guess if my patient were Hemingway, I would remember everything about that chart, too.

Q:  Thank you again for a great conversation. This is less academic probably than some of the other questions, but there's been a fairly recent movie, Hemingway in Cuba, or Papa Hemingway in Cuba, if you want to comment on that. Is that a movie that, for the general public, says anything about Hemingway?

ANDREW FARAH:  I have not seen that.

Q:  And then I have one other question. You talked about the genetics of suicide in the family. Have there been other suicides after his, in his children or other relatives?

ANDREW FARAH:  Yeah, the granddaughter Margaux is the famous one. His son,

Gregory, he truly did have bipolar and had the most tortured life. He received multiple ECT treatments and sadly died in a jail cell in Miami of a heart arrhythmia because they were unaware that he needed heart medication when he was arrested. So he had the most tortured and saddest life. But yes, and Margaux of course is the famous. 

I have not seen the movie, in Cuba. That's always been sort of a– have you seen that?

LINDA MILLER:  I haven't seen that particular– I tend to kind of resist seeing some of these movies because it worries my husband because I get so upset and storm out of the theater. Because the reality is, and it's what we've been talking about here, you've got this artist with this incredible persona, the myth of Hemingway, Papa, Hemingway, the macho guy. And the reality is, is he was very complex, and actually very tender, very sensitive. And movies that have tried to capture Hemingway, Fitzgerald, any of those characters, they're larger than life and they come across as kind of just silly-looking characters.

The only movie that I think has really done it well actually is a movie that was intended as a parody, and it was Woody Allen's Midnight in Paris. Which I actually liked. And they were kind of caricatures of these writers. 

But just a further note on that, in respect to not being able to capture the reality of Hemingway, and it's something that he fought, too. He was trapped in that persona. I was a consultant on a series that was planned for American Playhouse several years back. It was going to be on Hemingway and the whole Lost Generation group, centered around Gerald and Sara Murphy at Villa America. And Sara and Gerald's daughter, Honoria, loved Hemingway. She said he was the most tender man she had ever met.

There was a scene they were trying to film that Honoria told the story of Hemingway taking her out fishing on the lake, on Saranac Lake, where her brother Patrick had been taken for his tuberculosis. And Honoria catches a fish, and it's sort of the stereotypical woman, "Ah, now what?!" And the fish is flopping around in the boat, still on the line. And Hemingway said, "Now, daughter, you have to take it off the line." So he said, "I'll show you." And he took the fish in his big hand and took it off the hook, and then he got out his fishing knife. And he slit open the fish and flayed it open. And Honoria told me, she said, "In the morning sun, on the lake, the insides of that fish glistened like jewels because what Hemingway did then, "Now, daughter, I want you to see this fish," and he pointed out and named every part of the interior of the fish.

To me, that's a wonderful metaphor for Hemingway's art, that you have to get inside. But the reality is, how do you photograph that? They tried to photograph that scene about ten times. And what do you get? Hemingway, the macho guy, with a young girl, taking his knife out and slitting a fish open in front of her, and the blood and, you know. 

So you can't bring him to film. So I tend to resist. But I have had colleagues who said that the Cuban movie was not very good. [laughter] But it gives you some good scenes from Cuba.

Q:  It does, yeah.

Q:  Just a clarification. In your book you mentioned that Carol Hemingway committed suicide. In 1999, my wife and met with Carol Hemingway in Western Massachusetts. She lived in Shelburne Falls; her husband had passed away. She was 88. Now, could you clarify that statement, that she committed suicide?

ANDREW FARAH:  Let's see. I'll have to get back to you.

Q:  Could you have been thinking of Marcelline? Because there's been some speculation that Marcelline–

ANDREW FARAH:  Yeah, I think that was a typo that's corrected in the next printing.

The sisters got reversed.

LINDA MILLER:  You've been marvelous, a delight. [applause] And I hope you'll all rush out and buy Andrew's book and have him sign it. It's an extraordinary book. And I say that as a Hemingway scholar who's a tough judge. It's really new and really very well done. He's done his research in the Hemingway scholarly world, and he certainly has his vast knowledge as a doctor. 


LINDA MILLER:  Thank you so much.

ANDREW FARAH:  Thank you, it was great. Thank you.