Psychiatry 69(4) Winter 2006 351

Ernest Hemingway:A Psychological Autopsy of a Suicide

Christopher D. Martin

Much has been written about Ernest Hemingway, including discussion of hiswell-documented mood disorder, alcoholism, and suicide. However, a thoroughbiopsychosocial approach capable of integrating the various threads of the au-thor's complex psychiatric picture has yet to be applied. Application of such a psy-chiatric view to the case of Ernest Hemingway in an effort toward betterunderstanding of the author's experience with illness and the tragic outcome is theaim of this investigation. Thus, Hemingway's life is examined through a reviewand discussion of biographies, psychiatric hterature, personal correspondence,photography, and medical records. Significant evidence exists to support the diag-noses of bipolar disorder, alcohol dependence, traumatic brain injury, and proba-ble borderline and narcissistic personality traits. Late in life, Hemingway alsodeveloped symptoms of psychosis likely related to his underlying affective illnessand superimposed alcoholism and traumatic brain injury. Hemingway utilized avariety of defense mechanisms, including self-medication with alcohol, a lifestyleof aggressive, risk-taking sportsmanship, and writing, in order to cope with thesuffering caused by the complex comorbidity of his interrelated psychiatric disor-ders. Ultimately, Hemingway's defense mechanisms failed, overwhelmed by theburden of his complex comorbid illness, resulting in his suicide. However, despitesuffering from multiple psychiatric disorders, Hemingway was able to live avibrant life until the age of 61 and within that time contribute immortal works offiction to the literary canon.

Ernest Hemingway is one of the mostrecognizable figures of the twentieth century,known to the world as a literary genius whoalso became a near mythic representation ofAmerican hypermasculinity, a hard-drinkingwomanizer, big game hunter, deep sea fisher-man, aficionado of the bullfight, and a boxerwith quick-tempered fists both in and out ofthe ring. A critic called him "the outstanding

author since the death of Shakespeare"(O'Hara, 1950, p. 200) while on other occa-sions the critical voice has been less compli-mentary (Mellow, 1991). However, there islittle question regarding the inestimable sig-nificance of his role in American literature. Inaddition to possessing a rich talent, Heming-way was heir to a biological predispositionfor mood disorders and alcoholism and also

Christopher D. Martin, MD, is Instructor and Staff Psychiatrist at the Menninger Department ofPsychiatry and Behavioral Sciences at Baylor College of Medicine, The Menninger Clinic, in Houston,Texas.

The author would like to thank Glen O. Gabbard, MD, for his invaluable mentorship and generouseditorial assistance with the preparation of this work.

Address correspondence to Christopher D. Martin, MD, The Menninger Clinic, COMPAS Unit,P.O. Box 809045, 2801 Gessner Drive, Houston, TX 77280; E-mail: cmartin@menninger.edu.

352 Hemingway: A Psychological Autopsy

suffered the characterological fallout of achildhood spent under the care of parentswith their own unpredictable mood swingsand disorienting inconsistencies. The resultwas a deeply troubled, though resilientoffspring.

Hemingway's public life was so rich inexperience, his inner world so complex, andboth so well documented that it is easy to be-come disoriented while navigating throughhis past. Thus, integrating the various ele-ments that influenced his mental life becomesa challenging task. Hemingway biographerMichael Reynolds wrote, "If you get too fix-ated on Hemingway, you lose the ability tounderstand him. He's hke a deep well: you fallin and you may never come out" (Allen,1999). Multiple authors have attempted tocharacterize the psychiatric illness from whichHemingway suffered, an important task giventhe manner in which psychiatric disease af-fected the writer's life and informed his work,his writings being both products shaped inpart by his painful internal mental states anddefenses against them. However, none haveutilized a biopsychosocial approach to formu-late an understanding of the interrelation ofthe complex psychiatric comorbiditiesinvolved.

This type of integrated approach is ex-pressly indicated in the case of Ernest Heming-way. Careful reading of Hemingway's majorbiographies and his personal and public writ-ings reveals evidence suggesting the presenceof the following conditions during his lifetime:bipolar disorder, alcohol dependence, trau-matic brain injury, and probable borderlineand narcissistic personality traits. Given thisdegree of complex comorbidity, anyreductionism, or an approach that is dispro-portionately biological or psychological, islikely to produce only a partial explanation ofthe author's experience with psychiatric ill-ness, limiting any effort to understand him.Certainly, any undertaking that seeks to con-vey an understanding of Hemingway mustalso address the particular society into whichhe was born as well as the culture he con-structed about himself. Thus, only an inte-grated biopsychosocial approach can begin to

fully assess the psychiatric aspects of Heming-way's life. Before undertaking such an effort,however, important caveats must be ad-dressed. In no way is this investigation meantto offer a comprehensive analysis of Heming-way's life or work or an explanation of his ar-tistic genius. Such a chnical undertaking couldnever convey the depth of character in theman. Rather, the goal is to present a plausiblestatement about Hemingway's complex psy-chiatric picture. Additionally, an explorationof Hemingway's experience with illnessshould not detract from the memory of thisman who was beloved by friends and family,many still living who knew him and otherswho will never have the good fortune to knowhim in life. Finally, as with all similarpsychobiographical efforts, this study has themethodological limitations inherent in theabsence of a clinical evaluation of the subject.One must speculate based on fragments of thesubject's writings, other surviving documents,and biography.

Several major biographies produced inthe years since Hemingway's death have re-corded his life in extensive detail and to vary-ing degrees have attempted to provide an un-derstanding of the psychiatric difficultieswhich befell him. Baker (1969), Hemingway'searhest major biographer, clearly documentedthe writer's dramatic mood swings, even ap-plying the term "manic-depressive" (Baker,1969, p. viii). He noted Hemingway's recur-rent references to suicide in conversation andpersonal correspondence. Baker also docu-mented Hemingway's unpredictable person-ality, troubled interpersonal relationships,and alcoholism. Lynn (1987) and Mellow(1992) each produced enriched accounts ofHemingway's life, expanding on Baker'swork. Lynn particularly explored Heming-way's early years and contributed to a deeperunderstanding of Hemingway's family of ori-gin, his mother's inconsistent messages aboutmasculinity and femininity, and his father'sunpredictable temper and strictdisciplinarianism. Lynn also notably com-mented on the presence of a history ofmanic-depressive illness in the Hemingwayfamily. Reynolds (1999) offered perhaps the

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most comprehensive biographical explora-tion of Hemingway's life and contributed adetailed depiction of factors around Heming-way's decline into illness and death. Yalomand Yalom (1971) explored potentialpsychodynamic conflicts and focused on thewriter's traumatic experiences on the Italianfront in World War I.

A logical starting point for a psychiatricperspective on Hemingway's life is with hisfamily of origin. In the memoir A MoveableFeast, Hemingway wrote, "Families havemany ways of being dangerous" (Heming-way, 1964, p. 108), and his own family wasdangerous to him in varied ways, not the leastof which was the genetic heritage they be-queathed to him. Ernest Miller Hemingwaywas born on July 21, 1899, to Dr. and Mrs.Clarence Edmonds Hemingway (Reynolds,1986). Ernest's father, a physician, sufferedfrom unpredictable and dramatic moodswings characterized by episodes of depres-sion and irritability (Reynolds, 1986). TheHemingway children complained of the stresstheir father's "nervous condition" placed onthem, and Dr. Hemingway required repeatedretreats away from the family for "rest cures"(Lynn, 1987; Reynolds, 1986). In 1903 andagain in 1908, Dr. Hemingway traveled aloneto New Orleans to isolate himself as aself-prescribed intervention for depression(Reynolds, 1986). In December of 1928, in anepisode of depression, feeling burdened by fi-nancial concerns and with diabetes and an-gina threatening his physical health. Dr. Hem-ingway took his life with a gunshot to the head(Mellow, 1992). Multiple scholars have retro-spectively diagnosed Dr. Hemingway with abipolar mood disorder (Jamison, 1993; Lynn,1987). Grace Hemingway, the author'smother, suffered from episodes of insomnia,headaches, and "nerves" (Reynolds, 1986, p.86). Similar conditions have been identified inGrace's brother, Leicester, and Clarence'sbrother, Alfred (Reynolds, 1986). Ernest, oneof six siblings, was preceded in birth by his sis-ter Marcelline and followed by Ursula,Madelaine, Carol, and his brother, Leicester(Burgess, 1978). Ursula and Leicester bothdied by suicide (Reynolds, 1986). Marcelline

suffered from periods of depression, andthough her death in 1963 was ruled due tonatural causes, the family suspected suicide(Reynolds, 1986).

In the third generation, Ernest's youn-gest son, Gregory, himself a physician, was di-agnosed with bipolar disorder, making himthe third in a line of male Hemingways to suf-fer from the illness. Gregory also struggledwith substance dependence and lost his medi-cal license as a result. His comorbid condi-tions led to multiple psychiatric hospitaliza-tions and arrests for bizarre behavior.Gregory, whose transvestic fetishism drove awedge between father and son, underwentsexual reassignment surgery before his deathin 2001. He died of natural causes in a jail cellin Miami where he was incarcerated after be-ing found in public in a state of undress(Schoenberg, 2001). Margaux Hemingway,the daughter of Ernest's eldest son. Jack, suf-fered from a seizure disorder, depression,bulimia nervosa, and alcoholism. The Los An-geles coroner's office ruled her 1996 death asuicide due to "acute phenobarbital intoxica-tion" (Marano, 1996). As Marano noted,family and friends of the beloved actress andmodel did not accept the ruling. Margaux'sdeath would mark the fifth or sixth suicidewithin four generations of Hemingways.Thus, the Hemingway family has a long his-tory of affective disturbance, substance-re-lated disorders, and suicide that preceded Er-nest's birth, claimed at least three of the sixsiblings in his generation, and has continuedon through two further generations.

Hemingway himself warrants a closerlook. Hemingway's personal correspondenceis replete with examples of abnormal moodstates that befell him. He wrote to hismother-in-law in 1936, "Had never had thereal old melanchoha before and am glad tohave had it so I know what people go through.It makes me more tolerant of what happenedto my father" (Hemingway, 1981, p. 436).Here, Hemingway seems to report he was suf-fering from a depressive episode. A letter toJohn Dos Passos describes in more detailHemingway's experience of depression, "I feltthat gigantic bloody emptiness and nothing-

354 Hemingway: A Psychological Autopsy

ness. Like couldn't ever fuck, fight, write, andwas all for death" (Lynn, 1987, p. 427). Hem-ingway sets down virtual diagnostic criteriafor a major depressive episode, suggesting lossof interest and pleasure, feelings of emptiness,decreased libido, and thoughts of death andsuicide.

Depression was not the only abnormalmood state that Hemingway experienced.Hemingway's first major biographer, a manwho knew him in life, referred to him as a"temperamental manic depressive" (Baker,1969, p. viii) and wrote that "the pendulum inhis nervous system swung periodicallythrough the full arc from megalomania tomelancholy" (Baker, 1969, p. 291). Later, an-other wrote, "his mood swung so fast fromlow to high and back down again that onecould almost say he was simultaneously exhil-arated and depressed" (Lynn, 1987, p. 135).His biographies contain numerous examplesof episodes in which Hemingway experiencedunusually elevated moods and periods of ex-cessive energy. As a youth, he was prone tostay awake into the early morning, drinkingwine and reading aloud from volumes of po-etry. On one such occasion, his companionsfell asleep, awakening hours later to findHemingway "still at it, looking fresh as adaisy" (Baker, 1969, p. 37). It may have beena manic high that kept the young writer up allnight excitedly reading and drinking. Duringone period in 1924, Hemingway's first wife,Hadley, found her husband "sky high, emo-tionally intense, and ready to explode"(Reynolds, 1989, p. 194). His company wasso difficult to tolerate that she sent him off ona trip alone. The episodic irritability thatdrove his father away from his own familywas also manifested in the son. For the youn-ger Hemingway, however, the associated en-ergy could be channeled into creative output.During the 1924 episode, Hemingway rapidlyproduced seven short stories. In 1934, he ex-perienced another "immense accession of en-ergy," which he described as "juice" andfound to be "bad as a disease" (Baker, 1969,p. 268). It drove him to complete several sto-ries and articles in rapid succession. Then, onNovember 20,1934, he fired off a letter to his

editor. Maxwell Perkins. He was in a state ofmind to boast that the work contained thebest writing he had ever produced and was a"super-value" for the reader's money. In ad-dition, the writing had been a difficult task,"like painting a Cezanne," and he was the"the only bastard right now" who couldaccomplish such an achievement (Baker,1969, p. 268). Apparently, the energetic andirritable Hemingway could also be agrandiose Hemingway.

There was an additional abnormalmood state, which Hemingway described tothe mother of his second wife, when he wrotein 1936:

I've been working hard. Had a spell where Iwas pretty gloomy . . . and didn't sleep forabout three weeks. Took to getting up abouttwo or so in the morning and going out to thelittle house to work until daylight becausewhen you're writing on a book and can'tsleep your brain races at night and you writeall the stuff in your head and in the morningit is gone and you are pooped. (Hemingway,1981, pp. 435-436)

Given the context of the other mood ep-isodes he experienced, it is probable that thisperiod represented a mixed episode. This his-tory suggests that Hemingway sufferedthroughout his adult life from a bipolar affec-tive disorder. Given the family history, itseems likely that he had inherited a geneticpredisposition for mood disorders. He alsosuffered from another condition that sciencehas shown to be, at least in part, hereditary.

In 1957, Mary Hemingway wrote to afriend that during her husband's depressedmoods, "the protagonist" was "his poor,long-suffering liver" (Baker, 1969, p. 537).There can be little doubt that Hemingway, alife-long drinker, suffered from alcohol de-pendence. He likely first drank alcohol in ado-lescence (Lynn, 1987, p. 60). He was probablyfirst exposed to liquor in 1917 Italy where hedrank Scotch and Irish whiskey with hisfriends and comrades (Lynn, 1987, p. 122).After he was wounded, the hospital stafffound cognac bottles hidden in his World War

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I hospital room (Lynn, 1987, p. 87). Dailydrinking started for Hemingway in the early1920s as his first marriage failed and escalatedwith the deterioration of his relationship withhis mother and his father's suicide (Lynn,1987, pp. 122, 337). Then, in 1937, he pre-sented to a physician complaining of abdomi-nal pain, was found to have hepatic damage,and was told to abstain from alcohol (Lynn,1987, p. 474). However, he was unable tocomply with the recommendation.

In 1944, while covering World War IIin England, Hemingway was in a car accidenton the way home from a party thrown by pho-tographer Robert Capa. Hemingway was apassenger, and it is likely that everyone in thecar was intoxicated. Hemingway sustained aconcussion and was hospitalized. He wasagain warned by doctors to abstain, but hecontinued to drink. When his wife, MarthaGellhorn, found empty liquor bottles underthe hospital bed, the death knell sounded forhis third marriage (Lynn, 1987, p. 509). Manytimes, Hemingway was urged by loved onesand physicians to stop his drinking. Perhapsno request was more succinct or more poi-gnant than that of physician A.J. Monnier inhis 1957 letter to Hemingway. "My dearErnie, you must stop drinking alcohol. This isdefinitely of the utmost importance, and Ishall never, never insist too much" (Monnier,1957). For years, Hemingway had worriedabout his drinking and had tried to limit it, de-veloping numerous rules to regulate his alco-hol intake, yet he was never able to heed thewarnings or achieve any sustained period ofsobriety (Lynn, 1987). The toxin must havewrought damage on the brain, where it hkelydestabilized Hemingway's bipolar disorder,making him more susceptible to moodepisodes and perhaps eventually encouragingpsychosis to kindle and catch flame.

As illustrated by the accident afterCapa's party, one consequence of Heming-way's drinking was a propensity for injury.He was remarkably accident prone through-out his life, and the most notable of Heming-way's injuries were the numerous blows to thehead. In 1928, while living in Paris with hissecond wife, Hemingway arose from bed one

night and walked to the bathroom. In a men-tal state altered perhaps by alcohol, hemistook the skylight cord for the toilet'sflushbox chain. When he jerked the cord, theheavy pane of glass came down on his head.The laceration in his scalp required ninestitches, and the scar was visible on his fore-head for the remainder of his life (Lynn, 1987,p. 370). The drunken 1944 car accident senthis head through the windshield and caused aconcussion as well as a scalp laceration thatrequired 57 stitches; he nursed both with alco-hol (Lynn, 1987, pp. 508-509). Less thanthree months later, Hemingway was thrownfrom a motorcycle as he and several compan-ions, including Capa, attempted to evade Ger-man fire in Normandy (Lynn, 1987, p. 512).Hemingway experienced headaches, tinnitus,diplopia, slowed speech, and memory difficul-ties for several months (Lynn, 1987, p. 513).In June of 1945, he was behind the wheel inCuba when his vehicle went into a skid andstruck an embankment. Hemingway's fore-head was lacerated by the rearview mirror(Lynn, 1987, p. 528). Then, in 1950, whiledrinking onboard his boat, the Pilar, heslipped and fell, striking the deck with hishead and receiving what he later described as"a concussion of about force 5 (Beaufortscale)" (Lynn, 1987, p. 528).

The fall on the Pilar made perhaps thefifth traumatic brain injury of his life, but theworst was yet to come. On January 23,1954,while on his second safari to Africa, Heming-way's plane from the Nairobi airport struckan abandoned telegraph wire and crashed(Reynolds, 1999, pp. 272-273). Hemingwaysprained his back, his right arm, and his rightshoulder. No one was seriously injured, andthe party was rescued. They boarded a secondplane which, shortly after leaving the ground,also crashed and began to burn (Reynolds,1999, p. 273). Hemingway attempted to es-cape through the plane's door by battering itwith his head. He sustained two fierce blowsto his head, lacerating his scalp and fracturinghis skull, so that cerebrospinal fluid leakedfrom his ear. The crash left him again withdiplopia, temporary deafness, and significantinjuries to his liver, spleen, and kidney. He

356 Hemingway: A Psychological Autopsy

was, in fact, in danger of death (Reynolds,1999, p. 274). The repetitive injuries mayhave served to destabilize the course of Hem-ingway's mood disorder and predispose to thesevere psychotic episodes he developed later inlife, as well as to the possibility of cognitivedecline.

Hemingway suffered psychologicalwounds during his childhood that predated bymany years the traumatic experiences he en-countered in World Wars I and II and all hissubsequent injuries. Dr. Clarence Hemingwaywas a strict, vicious disciplinarian whospanked his son and beat him at times with arazor strop (Lynn, 1987, p. 35). The youngHemingway developed such rage that headopted a ritual in which he played out an as-sassination fantasy against his abusive father.At the age of 18, Ernest would hide in a back-yard shed and draw a bead on the doctor'shead with a loaded shotgun (Lynn, 1987, p.63). With regard to his mother, Hemingwaythroughout his life described her as a selfishand controlling figure whose personalitydominated that of his more reserved and pas-sive father. Hemingway stated to friends,"She had to rule everything" (Lynn, 1987, p.395). When Clarence Hemingway committedsuicide, Ernest openly blamed his mother andseemingly held firm to that position for the re-mainder of his life. He wrote to his friend andpublisher, Charles Scribner, in 1949, "I hateher guts and she hates mine. She forced myfather to suicide" (Hemingway, 1981, p. 670).

The fact that Hemingway held hismother responsible for his father's death maybe interpreted as a potential source for hisdeep anger toward his mother, anger so fierceit prompted his friend, John Dos Passos, to re-fer to the writer as "the only man I ever knewwho really hated his mother" (Lynn, 1987, p.395). Friend Charles Lanham also wrote, "healways referred to his mother as 'that bitch.'He must have told me a thousand times howmuch he hated her and in how many ways"(Lynn, 1987, p. 27). However, this hatredmay have had its origin in Hemingway's earlychildhood, long before Clarence's death.Hemingway's deep and longstanding rage to-ward his mother may have shaped his concep-

tualization of his father's suicide so that his fa-ther's death became his mother's fault. A po-tential source for this early rage is identifiable.Grace Hemingway insisted that the boy Er-nest be dressed as a girl. Though the Victoriancustom of the day did call for young boys towear dresses, the clothes that Grace selectedfor Ernest were more feminine than thoseworn by other male children of the era. He re-mained in this style of dress for several yearsbeyond the span most boys spent in dresses,and his hair was cut in a fashion more com-mon for female children (Lynn, 1987, pp.38-40). Grace even attempted to pass her sonoff as the twin of his older sister, Marcelline,persisting despite their differential sizes(Lynn, 1987, pp. 40-41). On the back of aphotograph of young Ernest wearing a dressdecorated in lace, his hair grown long under ahat covered in flowers, Grace wrote the words"summer girl" (Lynn, 1987, p. 41). Grace alsopraised her son at times for his expression ofmasculine traits, such as his prowess at hunt-ing and fishing, activities he enjoyed at thefamily's vacation home in the Michiganwoods. In this rural setting, he wore ruggedoutdoor clothes, and the feminized boy wasnot to be seen. Grace's inconsistency regard-ing gender may have been confusing and diffi-cult for the young boy to reconcile, possiblyinfluencing him toward overt masculine pur-suits later in adult life. Hemingway neverspoke or wrote about this piece of his child-hood experience. However, the preservedwords of his infant tongue give a clue to thefeelings he may have harbored. Grace had acustom of referring to the femininely garbedErnest as "Dutch dolly," and Ernest called hismother "Fweetee." At the age of two, in re-sponse to his mother's application of the nick-name, Ernest told her, "I not a Dutch dolly . . .Bang, I shoot Fweetee" (Baker, 1961, p. 5).Thus, in childhood, Hemingway haddeveloped enough anger toward his parents toshoot them both to death in fantasy.

When Clarence Hemingway actuallydid die from a gunshot to the head, Ernestmight easily have felt guilt. He had wished hisfather dead and had pointed a loaded gun athis head. Thus, blaming his mother may have

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served a defensive role; he could absolve him-self of his guilt by projecting it onto her. Cer-tainly, such guilt could have contributed tothe author's depression and suicidality. Ernestwas powerfully affected by his father's sui-cide, and in the aftermath of Clarence's death,Ernest confided to his friend and mentorOwen Wister, "My life was more or less shotout from under me and I was drinking muchtoo much entirely through my own fault"(Lynn, 1987, p. 337). It felt to him as thoughnot only his father's life was shot away but hisown as well. The repetition of violent imageryand references to firearms is startling, seemingto foreshadow the son's own eventual suicide.

The reservoir of anger that may havehad its origins in his early childhood seemed tohave a tendency to spill over throughout hislife. Baker pointed out that Hemingway was aman of many contradictions who was capableof alternately appearing shy or conceited, sen-sitive or aggressive, warm and generous, orruthless and overbearing (Baker, 1969, p.viii). It may have been that certain borderlinepersonality traits caused him to appear erraticand dramatic. Part of his apparent inconsis-tency may have arisen from a lack of a cohe-sive, stable identity, a problem which mighthave readily followed in the wake of hismother's inconsistent parenting. Heming-way's conceptualizations of others may nothave been so stable or sufficiently nuanced ei-ther. Baker suggested that Hemingway had atendency toward splitting, "He divided all theworld into good guys and jerks" (Baker,1969, p. viii). In addition to the issues of iden-tity disturbance and splitting, that difficultieswith recurrent suicidal ideation, anger,impulsivity, affective instability, and unstableinterpersonal relationships that characterizeborderline personality traits seem identifiablein Hemingway's life story. His relationshipsseemed plagued by conflict and instability.His parents became mental targets for assassi-nation, and his mentors could becomeenemies. His marriages were beset byextramarital affairs, and three of four endedin divorce (Lynn, 1987).

Hemingway had tendencies towardnarcissism that also interfered with his inter-

personal relationships. Friends noticed that hecould be vicious and cruel and might easilyturn against those who had been kind to him(Mellow, 1992, p. 133). Such kindnessesmight be seen as narcissistic injuries once theywere no longer immediately necessary or help-ful. Friend and mentor Sherwood Andersonsaid of the younger author's capacity forself-interest that Hemingway's "absorptionin his ideas" had "affected his capacity forfriendship" (Baker, 1961, p. 181). Heming-way's fierce competitiveness also got in theway of his friendships. In childhood, a merehike through the woods or tennis match mighttrigger spiteful feelings and cause him to initi-ate quarrels (Lynn, 1987, pp. 115-116). As anolder man, he was capable of spoiling huntingtrips with envy and sullen behavior whensomeone surpassed him with a bigger kill(Mellow, 1992, pp. 427, 433). Hemingwaywas also ferociously competitive when it cameto academics and letters. He heaped derisionon those men who had been graduated fromuniversity, as he had not, and when intoxi-cated, he boasted of having attended Prince-ton (Baker, 1969, p. 222; Lynn, 1987, p. 248).When William Faulkner, who won the NobelPrize before Hemingway, failed to respond toa cable of acknowledgement from Heming-way, the injured writer wrote these words ofanger and perhaps projection to a friend:"You see what happens with Bill Faulkner isthat as long as I am alive he has to drink to feelgood about having the Nobel Prize. He doesnot realize that I have no respect for that insti-tution and was truly happy for him when hegot it" (Mellow, 1992, p. 588). Throughouthis life, Hemingway's vanity prevented himfrom wearing glasses in public despite eyesightso poor that it has been hypothesized as a fac-tor contributing to his tendency toward acci-dents (Lynn, 1987, p. 73). Near the end of hislife, he lashed out viciously at a dear friendwho inadvertently bumped the back of hishead, displacing his hair, which had been me-ticulously combed forward to conceal hisbaldness (Lynn, 1987, pp. 578-579). Hisgrandiosity reached such proportions that heonce admitted he would have liked to havebeen a king (Baker, 1969, p. viii), and when he

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finally prepared to die by his own hand, heselected from his wardrobe a cherishedgarment he had affectionately named his"emperor's robe" (Baker, 1969, p. 563).

At 7:00 AM on Sunday, July 2, 1961,Hemingway died of a self-inflicted wound tothe head from the double barrels of one of hisshotguns (Lynn, 1987, p. 592). Although was61 when he took his life, his mind had beenhaunted by suicide from a very young age. Hisearliest fictional stories, written years beforehis father took his own life, contained themesof violence and suicide (Baker, 1969, pp. 23,25). After his father's death, his mature fictioncontinued to address these themes and beganto deal with fathers' suicides. His personalcorrespondence revealed a lifelong obsessionwith suicide. In 1923, he wrote to GertrudeStein, "I understood for the first time howmen can commit suicide simply because of toomany things in business piling up ahead ofthem that they can't get through" (Baker,1969, p. 119). The perhaps partially con-scious attempts at minimization in these linesdo not now hide the significance of whatHemingway communicated. The trouble isthat Hemingway felt the need to discuss sui-cide in his letters to his friends at all. The fol-lowing year, he made a related reference toEzra Pound, "I still claim that anybody thatwants to can do it. Things are looking betterand I look forward to not giving a demonstra-tion of my theory for some time" (Lynn, 1987,p. 267). Then, 12 years later, Hemingwaywrote to Archibald MacLeish, "Me I like lifevery much. So much it will be a big disgustwhen have to shoot myself. Maybe prettysoon I guess although will arrange to be shotin order not to have bad effect on kids" (Hem-ingway, 1981, p. 453). It seems, a quarter cen-tury before his death, that Hemingway hadaccepted that he would die by a self-inflictedgunshot. By the time he wrote these words in1936, he had survived his father's suicide, andone can infer from these lines that it had in-deed wounded him deeply. His thought was todisguise his own suicide, so that his childrenwould not have to suffer as he had, knowingthat their father had taken his life.

Hemingway put his plan of arranging

his death into action, seeking out danger in hispersonal and professional life, and he gavefate plenty of opportunity to do first what heeventually did himself. He pursued warsacross the globe. After his service in WorldWar I, he served as a correspondent for theSpanish Civil War and World War II, and herepeatedly put himself into combat. He wasnot content to be an aficionado of the bull-fight; he needed to be a participant, physicallyat risk of the horns and hooves of the bulls.There was also a sense of recklessness abouthis hunting and fishing, hinting that he wasperhaps arranging to be killed. He neverseemed quite satisfied unless his quarry almostkilled him first. As outlined by Lynn, in acancelled passage from the manuscript ofGreen Hills of Africa (1935), Hemingway'sfictionalized hunting memoir, the authorwrote of the feeling that danger broughthim—"Now, truly, in actual danger, I felt aclean feeling as in a shower" (Lynn, 1987, p.415)—and he contrasted this feeling with hisfather's suicide, which he conceptualized ascowardly. Hemingway might have felt cleanbecause he could tell himself he was arranginghis death in a more noble fashion than hisfather had done.

Hemingway marshaled about him a va-riety of mechanisms for defending against hisabnormal moods and suicidal impulses. Hisuse of alcohol was in one sense a defenseagainst his suffering, which he used perhaps tofight off his depression and self-destructivethoughts. Hemingway told his friendArchibald MacLeish, "Trouble was all my lifewhen things were really bad I could alwaystake a drink and right away they were muchbetter" (Lynn, 1987, p. 122). This defense wasless than adaptive; drinking complicated hislife through the usual interpersonal pitfalls ofalcoholism as well as possibly worsened hismood disorder, perhaps actually speeding upthe ultimate tragic outcome.

His obsession with hunting and fishingmay have served a defensive function againsthis aggressive and suicidal impulses. Heming-way explained to Ava Gardner in 1954, "Eventhough I am not a believer in the Analysis, Ispend a hell of a lot of time killing animals and

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fish so I won't kill myself" (Hotchner, 1966,p. 139). He hinted at some degree of accep-tance of a psychodynamic interpretation ofhis interest in killing. As a boy, he had fanta-sized about shooting his parents; later, he de-veloped chronic thoughts of doing the same tohimself. The reservoir of anger that drovethese impulses could, he perhaps found, beemptied somewhat by turning guns onanimals and by catching and killing fish.

Hemingway's writing can be seen as anadaptive defensive strategy for dealing withpainful moods and suicidal impulses. Bakerwrote that for Hemingway, "the story achedto be told" (Baker, 1969, p. 190). Hemingwaymay have told certain stories in order to easethe aches that life started inside him. In AFarewell to Arms (1929), he tells the fictionalstory of Fredrick Henry, a young Americanman who is wounded in the leg while servingin World War I Italy and then falls in love withan American Red Cross nurse while recuper-ating. Henry is wounded in the same mannerand in the same geographical location as wasHemingway while he served as an ambulancedriver on the Italian front (Hemingway, 1929,54-55). Hemingway too fell in love with anAmerican nurse, and the two entered into alove affair. Hemingway and his nurse likelynever consummated their relationship, andthough he hoped to marry her, she ultimatelyrejected him in a letter after his return home toChicago (Baker, 1969, pp. 56, 59). However,when Hemingway wrote his novel, he alteredthe tale such that the affair between the soldierand nurse was fully consummated and wasended by her death in childbirth as she at-tempted to deliver his child. Hints of fantasiesof wish fulfillment and revenge are decipher-able in the fictional alterations he made to theevents he had experienced. Hemingway car-ried physical and emotional wounds homewith him from World War I Italy; telling thestory of those wounds and applying twists offantasy may have served a defensive role forthe author. Hemingway's use of writing as adefense mechanism is suggested by his ownwords in response to reading F. Scott Fitzger-ald's article, "The Crack Up," which told thetale of its author's own struggle with depres-

sion. Hemingway thought Fitzgerald ought torealize "work was the thing that would savehim if he would only 'bite on the nail' and getdown to it, honest work with honest fiction, aparagraph at a time" (Baker, 1969, p. 283).Hemingway was unwilling to accept the treat-ment available to him during his lifetime. Per-haps he feared social stigma against mental ill-ness. Thus, the only aids available to him werea set of defenses of his own construction, som efrankly maladaptive and others only partiallyeffective measures against the persistentonslaught of his comorbid conditions.

In 1960, Hemingway began to lose hisbattle with depression and suicide. He wroteto his friend A.E. Hotchner, "I'll tell you,Hotch, it is like being in a Kafka nightmare. Iact cheerful like always but am not. I'm bonetired and very beat up emotionally" (Lynn,1987, p. 581). He began to worry that hisfriends were plotting to kill him and that theFBI was monitoring him (Lynn, 1987, pp.581, 583). These paranoid delusions mayhave been due to a psychotic depression re-lated to his bipolar illness, complicated as itlikely was by chronic alcoholism and multipletraumatic brain injuries. In addition, Heming-way began to speak more and more of suicide(Lynn, 1987, p. 583). His physician urged himto undergo hospitalization at the MenningerClinic in Topeka, Kansas. Hemingway re-fused, insisting, "They'll say I'm losing mymarbles" (Lynn, 1987, p. 583). However, heagreed to be treated at the Mayo Clinic, underthe guise of an admission for treatment of hishypertension (Lynn, 1987, p. 584). He didsuffer from hypertension, and the medicationprescribed, reserpine, might also have causean adverse effect of depression. For insomnia,he was taking secobarbital, another potentialdepressant (Reynolds, 1999, p. 293). Hem-ingway was seen by Mayo Clinic psychiatristDr. Howard P. Rome, who treated the authorwith electroconvulsive therapy (Lynn, 1987,p. 584). After a seven-week hospitalization, hewas discharged home, entering a period of rel-ative wellness (Lynn, 1987, p. 584). Duringthese weeks he ate and slept well and limitedhis drinking. He also maintained a strict writ-ing regimen and was, in his own words.

360 Hemingway: A Psychological Autopsy

"working hard again" (Lynn, 1987, p. 585)on what would become the memoir of hisyouth in Paris, A Moveable Feast (1964). Ashe wrote, he revisited those years spent withhis first wife as he achieved his first great liter-ary successes. Lynn theorized that these mem-ories might have been therapeutic toHemingway and that his work during thisperiod may have served to keep him well(Lynn, 1987, p. 585).

Eventually, Hemingway's depressionreturned. He lost the ability to write, breakingdown in tears when he could not summonwords. It may have been that the years of alco-hol abuse and cumulative traumatic brain in-jury led to cognitive impairment that, com-bined with depression, robbed him of his skillin writing. Regardless of the precise etiology,"That one gift which had meant everythinghad now deserted him" (Lynn, 1987, p. 589).In April of 1961, Mary came upon him as hewas beginning to load a shotgun. He was hos-pitalized near his Ketchum, Idaho, home(Lynn, 1987, pp. 589-590). Soon, he asked toreturn to his home to retrieve some items.While escorted home by hospital staff, he ranfrom his chaperones, picked up a shotgun,and turned it against himself. The hospitalstaff members caught up with him and physi-cally struggled to disarm him and thwart theattempt (Lynn, 1987, p. 590). He was trans-ferred to the Mayo Clinic for a second admis-sion, but as the plane stopped to refuel inSouth Dakota, Hemingway, bent on suicide,began to walk quickly toward a plane's spin-ning propeller, stopping when the pilot cut theengine (Lynn, 1987, pp. 590). This was thethird serious suicide attempt within four days.Hemingway was hospitalized at Mayo fortwo months. He underwent further treatmentwith electroconvulsive therapy and was dis-charged on June 26, 1961. Mary feared thather clever husband had "charmed and de-ceived Dr. Rome to the conclusion that he wassane" (Lynn, 1987, p. 591). The day after thecouple arrived home in Ketchum, they dinedout, and Hemingway told his wife that pa-trons in the restaurant were actually FBIagents there to monitor him (Lynn, 1987, p.591). He was by no means well. The next

morning, Hemingway awoke before his wifeand took his hfe while she slept.

It was an overwhelming interaction ofbiological and psychosocial forces that over-came Hemingway's defenses and left him vul-nerable to suicide on that early July morningin 1961. The accumulated factors contribut-ing to his burden of illness at the end of his lifeare staggering. The bipolar mood disorder heinherited from his family had plagued him allof his life with painful, abnormal mood states.His chronic alcoholism put him at greater riskof depression even as he struggled in vain touse this toxic drug to treat himself. The reser-pine and secobarbital may have further con-tributed to his depression. Repetitive trau-matic brain injuries also likely destabilized hismood disorder and worked alongside the al-cohol to damage neuronal networks, loweringhis ability to control his mood and spurring onthe development of a psychotic illness. Such aprocess would also have worked to rob him ofone of his most adaptive defenses, his abilityto write. Each of these biological factorswould have contributed to Hemingway'schronic suicidality and downward course ofillness. He also bore the psychological burdenof childhood abuse. From early childhood, heheld a reservoir of rage against both his par-ents, a father who had viciously beaten himand a mother who had provided him with dis-orienting messages regarding gender andself-worth. One result may have been a re-treat into a defensive facade ofhypermasculinity and self-sufficiency. Hischildhood experience seems also to have lefthim with a personality structure that tendedtoward narcissistic and borderline traits. Hisuncertainties about his identity, difficultieswith interpersonal relationships, tendency to-ward anger, vulnerability to narcissistic in-jury, and chronic suicidality complicated hispersonal life and may have served to preventhim from forming deep, meaningful, sustain-able relationships, the types of relationshipsthat might have provided sorely needed socialsupports to this man who was not willing toturn to treatment for the assistance he needed.He also lived in a time when treatment optionswere quite limited. In addition, he lived with

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his father's example, a constant reminder thatsuicide is a readily available option. It is likelythat he carried powerful feelings of guilt andanger about his father's death, and these mayhave been driving factors behind his own sui-cide. Certainly, this man who nicknamedhimself "Papa" also felt love that matched hisrage at his father, and he may haveexperienced a drive to be reunited with him,leading him to choose a parallel means oftaking his life.

When these interrelated factors are con-sidered together, it becomes clear that Hem-ingway suffered from an enormous burden of

psychiatric comorbidities and risk factors forsuicide. Clearly, he possessed enormousstrength and resilience to live such an extraor-dinarily rich and full life, ultimately achievingimmortality through his contributions to theliterary canon. Given this achievement, Hem-ingway's life can be considered not only atragedy, but also a story of triumph. Heming-way wrote these fitting words of conclusion inThe Old Man and the Sea (1952): "But man isnot made for defeat . . . A man can be de-stroyed but not defeated" (Hemingway,1952, p. 114). Hemingway was destroyed,even by his own hand, but not defeated.

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Hemingway, E. M. (1935). Green Hills of Af-rica. New York: Charles Scribner's Sons.

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