Ruminations

Head Trauma : Serial Concussion

"[Hemingway fell victim to] an illness whose cruelest trick was to incapacitate the mind, yet all the while preserve insight into the sufferer's plight."
"We all think of the Hemingway persona, but what the CTE [chronic traumatic encephalopathy brain disease] did, later in life, was it simply solidified and locked in the very worst aspects of that persona. It made him irritable, volatile, difficult, challenging, all that."
"People talk about how, psychologically, he was trapped by the persona like a spy out too long, believing his own cover, or acting that way because people expected it of him. I think he was biologically incapable of breaking free from the nastier aspects of that persona, simply because of the CTE."
"They [scientists involved in posthumous studies] wouldn't have known what they were seeing anyway. In fact, in 1961, the year he was getting his shock therapy, there was an article in the British Journal of Psychiatry, and it described post-concussive syndrome after motor vehicle accidents, but it was called 'accident neurosis', in which the author argued these were people just seeking attention, and they were not really sick in an organic way. And now we know that just poisoned the well and made people look for years at these people as malingerers."
Andrew Farah, chief of psychiatry, High Point Regional Health System, University of North Carolina, Chapel Hill

It has only been in the last decade that research has been done in depth on concussions and their post-accident impact on the lives of those who had sustained serious head injuries where the brain was injured through being badly jolted. Stories of sport figures involved in physically strenuous and violent extreme sports like rugby, football, hockey, boxing, snowboarding, skiing, sustaining concussions and grimly carrying on regardless until the end of the game. Sometimes never seeking medical help. Often going on to play another game, and sustaining injury on injury.

The author of the newly published book Hemingway's Brain, Andrew Farah, is well credentialed as a health professional. As such he is intimately aware of all the most recent literature in brain injuries and the ubiquitous nature of concussions and how those injuries make life extremely difficult for many people struggling through long and sometimes complex recoveries. These people now have professional help in their recoveries. There is a recognition in the health community of concussion impact on the brain.

In Ernest Hemingway's time, such was not the case, even though it was well recognized that boxers in particular, suffered perceptibly the injurious after-effects of repeated and violent blows to the head through their popularized sport. Dr. Farah writes his professional opinion that the adventure- and action-seeking Ernest Hemingway was often in harm's way. He elaborates in his book, on the number and frequency of Hemingway's brushes with violence that left him repeatedly concussed.

File photo Ernest Hemingway helps a soldier unjam his rifle during the Spanish Civil War at the Battle of Teruel between December 1937 and February 1938.

From the first event when he sustained a serious head trauma during the First World War in Italy as a result of a shell landing mere feet from him, to a later event in Paris when he inadvertently pulled a skylight down on himself, to a London car crash during the Second World War, then a fall on a fishing boat, and finally a plane crash in East Africa, all impacting on Hemingway's skull and brain. Dr. Farah notes that medicine did its best to serve America's most famed novelist, in the framework of what it knew at the time.

But it was felt by medical professionals that Hemingway was suffering from depression and related psychosis, psychiatric illnesses without an organic component. He had been subjected to electroconvulsive therapy which, had he really been bipolar disorder or manic depression, might have helped him. But since it was instead the then-unrecognized condition of chronic traumatic encephalopathy that tormented the writer, exposure to electroshocks stressed his vulnerable nervous system toward further decline.

One recognized symptom of CTE is the growing intolerance to alcohol. And Hemingway was famously alcoholic. And suffered as well from high blood pressure. Dr. Farah's theory makes sense, but it will always remain a theory. When Hemingway committed suicide, he shot out his brain, leaving nothing for medical science to study as is often done on the posthumous brains of people considered in the popular realm to be of genius mettle.