The old man, washed away by the sea

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By Diane Grimard Wilson

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When you think of Ernest Hemingway you may visualize the iconic photo of the man in the turtleneck captured by photographer Yousuf Karsh in 1957. Karsh described Hemingway as "the shyest person I ever photographed."

What happened to transform a brash, fearless world traveler and adventurer into a shy and paranoid man as he approached 60 and died at 61? After 17 years of meticulous research, forensic psychiatrist Andrew Farah addresses this question in his recent book, Hemingway's Brain.

Farah views the details of Hemingway's life through the lens of modern medicine to offer a new mental diagnosis and contemporary treatment.  

The inheritance

Hemingway's genetic inheritance skewed heavily to depression and self-destruction. It came from both sides of his family. Ernest, three siblings, and his father all ended their lives by suicide. 

Hemingway's affinity for alcohol was legendary. 

"I have drunk since I was 15 and few things have given me more pleasure," he famously said. 

Farah considered Hemingway a "functional alcoholic" as alcohol played a medicinal role in his daily life. Over the years, however, it became another poison in the mix as his body deteriorated. 

Popular wisdom is that Hemingway was bipolar. Farah disagrees and notes his alcohol addiction caused alterations in mood and behavior. Also at play was an ongoing struggle with his two worst fears: that he could not write and that he had nothing to say. Hemingway ruminated between projects and was buoyant when writing again.

He lettered in football at Oak Park and River Forest High School. He also took up boxing as a testament to his manhood and boxed throughout adulthood. But Farah found no evidence of concussion from either sport. 

He does, however, chronicle a series of concussions and serious blows to the head that Hemingway suffered during the Spanish Civil War, World Wars I and II, plus car accidents and plane crashes. 

Like our football heroes

Farah's new and convincing primary diagnosis is Chronic Traumatic Encephalopathy (CTE). "His injuries and head traumas were frequent, random, and damaging," Farah writes. "The repeated concussive blows did cumulative damage so that by the time he was 50, his very brain cells were irreparably changed."

Hemingway's dementia developed along with delusional paranoia, both evidence of CTE. Other symptoms include depression, cognitive decline, mood swings, irritability, headaches, dizziness and impaired judgment. 

Farah likens Hemingway to the retired football National Football League players in the movie Concussion who have taken too many hits. While CTE doesn't explain everything, it's the biggest piece of the puzzle. 

Misdiagnosed, Hemingway was treated for depression with electroshock therapy at the Mayo Clinic in 1960. Considered then to be state-of-the-art, he received 25 treatments in two separate stays. 

The seizures from the shock therapy didn't serve to reset Hemingway's system. Instead, they washed away the fragile structures of a mind with CTE. He was no longer able to write — an ability that had stayed with him well into his illness. 

After the second set of shock treatments he went home and shortly afterward took his own life the same way his father did: a gun to the head. 

Contemporary treatments

Chapter 12 of Hemingway's Brain describes a treatment plan modern psychiatry would offer Ernest if alive today. It will interest anyone concerned with dementia, depression or the brain. For example, Farah discusses new data revealing B vitamin deficiencies as a root cause of depression.

What's missing from Farah's protocol is neurofeedback, which is increasingly used for retired football players, others with traumatic brain injury, and even Olympic athletes seeking peak performance. 

Neurofeedback trains brain waves to function optimally and is used in conjunction with QEEG (Quantitative Electroencephalograph), a brain scan to identify injury. Dr. Lucas Koberda, a neurologist for the NFL Concussion Settlement Program, based on his research and practice, says these are invaluable tools. Other research shows neurofeedback aids recovery from challenges Hemingway faced, including trauma, substance abuse, anxiety, and depression.

Psychiatrist Bessel Van de Kolk, author of the popular book, The Body Keeps the Score, discusses the crucial role neurofeedback plays in rewiring the brain after trauma — a hallmark of Papa's life.

Overall, Hemingway's Brain provides a new and unique perspective. It's compassionate while shedding scientific light on the factors that transformed a beloved icon and led to his demise. The book will appeal to both literary devotees and to a public increasingly fascinated with the brain. 

Diane Wilson, LCPC, BCN, is a coach, counselor and board-certified neurofeedback specialist in Chicago. An Oak Park resident, she has written about her own concussion and recovery for Wednesday Journal: "Traumatic brain injury: All in your head?" (http://www.oakpark.com/News/Articles/7-22-2014/Traumatic-brain-injury:-All-in-your-head%3F-)

Other links:

"Concussion" movie (http://www.oakpark.com/News/Articles/2-2-2016/This-film's-title-describes-its-impact)

Lucas Koberda, PhD, MD (https://www.researchgate.net/profile/Jaroslaw_Koberda/publications and http://tallahasseeneurobalancecenter.com/AboutUs/TheTeam.aspx)

Koberda JL, Moses A, Koberda P, Koberda L., "Clinical advantages of quantitative electroencephalogram (QEEG)-electrical neuroimaging application in general neurology practice" (https://www.ncbi.nlm.nih.gov/pubmed/23536380)

Neurofeedback Research: Trauma, Substance abuse, Anxiety and Depression, Bessell Van der Kolk, "The Body Keeps the Score" (https://www.youtube.com/watch?v=EKjBM6MxTKg)

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