The same brain disease battering the NFL may have killed Ernest Hemingway – Washington Post

In one of Ernest Hemingwaysfirst publishedstories, a mangoes into the woods andmeetsa disfigured prizefighter insightful, thoughprone tofits of paranoia and violence.

Youre all right,says the visitorafter theyve chatted a while.

No, Im not. Im crazy, the fighter says. Listen, you ever been crazy?

No. How does it get you?

I dont know. When you got it you dont know about it.

Nearly a century after The Battlerwas written, psychiatrist Andrew Farah contends,we wouldrecognize that the prizefighter suffered fromchronic traumatic encephalopathy or CTE the same concussion-induced brain diseasenow infamous insports, particularly professional football.

And theprizefighters renownedauthor had CTE, too, Farahargues inhis new book,Hemingways Brain.

The psychiatrist from High Point Universityin North Carolina writes of nine serious blows to Hemingwayshead from explosions to a plane crash that were a prelude tohis declineintoabusive rages,paranoia with specific and elaborate delusionsand the final violence of his suicide in 1961.

Hemingwaysbizarre behavior in his latteryears (he rehearsed his death by gunshotin front of dinner guests, for example) has been blamed on iron deficiency, bipolar disorder, attention-seeking and any number of other problems.

After researching the writersletters, books and hospital visits, Farah is convinced that Hemingway haddementia made worseby alcoholism and other maladies, but dominatedby CTE, the improper treatment of which likelyhastened his death.

[In stunning admission, NFL official affirms link between football and CTE]

He truly is a textbook case, Farah told The Washington Post. His biography makes perfect sense to me in the context of multiple brain injuries.

Farah isnot the onlypersonto make thelink. A shorter discussion of head traumain Paul Hendricksonsbiography, Hemingways Boat,convinced a reviewerthat the famous writer was probably suffering from organic brain damage.

But Farahs book goes deeper, mixing biography, literature and medical analysis in what he writes isa forensic psychiatric examination of his very brain cells the stressors, traumas, chemical insults, and biological changes that killed a world-famous literary genius.

Farahdates Hemingwaysfirst knownconcussion to World War I, several years before hewrote his short story, The Battler.

A bombexplodedabout three feet from his teenage frame.

Another likelyconcussion came in 1928, when Hemingway yanked what he thought was a toilet chain and brought a skylight crashing down on him causingwhat Farah describes asgiddy concussive ramblings about his own bloods smell and taste.

Then came a car accident in London then more injuries as a reporter duringWorld War II, when aGerman antitank gun blew Hemingwayinto a ditch.

The psychiatrist describes his reported symptoms: double vision, memory trouble, slowed thought. And headaches thatused to come in flashes like battery fire, Hemingway wrote in a letter.

There was a main permanent one all the time. I nicknamed it the MLR 2 (main line of resistance) and just accepted that I had it.

[The quiet tragedy of Ernest Hemingway]

These wereclassic and typical symptoms of head trauma, Farah writes.

And not the last Hemingway wouldsuffer.

After the war: another car accident. Then a fallon hisboat Pilar, two yearsbefore he published The Old Man and the Sea, which a book reviewercalled Hemingwayslast generally admired book.

Farah did not include in his list of concussionsHemingways flirtations with boxing, or accounts of head injuries he could not verify or which he suspected were the authors tall tales.

Butby the time Hemingway survivedtwo consecutiveplane crashes on a 1954 safari trip escaping the second wreck by batter[ing] open the jammed door with his head, Farah writes his remarkable brain was beyond repair.

The injuries from earlier blows resolved, but, with additional assaults, his brain developed CTE, Farah writes.

Often though not always caused by concussions, chronic traumatic encephalopathy is a degenerative brain disease that can manifest as memory loss,anger, dementia and suicidal behavior usually decades after the head blow, according to the Centers for Disease Control.

This video from the CDC illustrates and explains the science behind a concussion and the importance of recovery time for the human brain. (CDC via YouTube)

Unknown in Hemingways day, ithas been found in the brains of at least 17 dead athletes, and researchers will look for it in the brain of Aaron Hernandez, a former NFL star who killed himself in prison last week while serving a murder sentence.

While Farah cant autopsy Hemingway, much of his book is spent detailingthe writers many symptoms.

For example: an episode two years before his death, when Hemingway drove past a bank in his Idaho town, noticed the lights were on after dark, and became convincedthat the FBI must be rooting through hisaccount.

Less bizarre but perhaps moredevastating to the author: his deterioratingability to arrange words.

The genius who had written masterpieces such as A Farewell to Arms and The Snows of Kilimanjaro was now paralyzed, fully in the grip of a severe mental illness as he struggled to assemblesimple sentences for his memoirs in 1961, Farah writes.

Farah, who is the chief of psychiatry at the High Point Division of University of North Carolina Healthcare, was remindedof a man who once approached him after he gave a lecture on CTE complaining of his problems after a traffic accident.

He has headaches. He cant get his stuff written, Farah said.This is just like Hemingway saying: Ive shuffled paper, the words wont come, I cant finish this damn, beautiful book.

Smithsonian Magazine contacted Kevin Bieniek, a research fellow who studies CTE at the Mayo Clinic, where Hemingway was eventually hospitalized.

Bieniek agreedthat Hemingway sustained traumatic brain injuries andthat his paranoia and other symptoms tracked the accounts of confirmed CTE cases. But without an autopsy on Hemingways brain now impossible hecalled Farahs theorylargely speculative.

Only an autopsy can put the 100 percent stamp of approval on a diagnosis, Farah acknowledged to The Post.But he didnt back down from his conclusions in the book. The symptoms are just so obvious, he said.

CTE accounted forabout three-quarters of Hemingwaysdementia, Farahsaid.The concussions, alcohol, hypertension, and pre-diabetes all contributed to the changes in Hemingways brain, he writes in his book.

And a longhistory of suicide in Hemingwaysfamily couldnt have helped the authorcope with his condition, Farah said.

But he is sure that by the end of his life, Hemingway had concussion-driven dementia, not psychotic depression as his doctors believed to tragicconsequences, he writes.

[Hemingways Boat: Everything He Loved in Life and Lost, 1934-1961, by Paul Hendrickson]

At the end of The Battler, the prizefighter falls into one of his sudden rages and threatens his visitor.

Thefighters friend intervenes with a makeshift treatment for such episodes: He knocks the fighterunconsciouswith a blackjack.

I have to do it to change him when he gets that way, the friendexplains.

Hemingways doctors tried to change him with electroshocktherapy. It was considered an effective treatment for depressionin the last year of his life, 1961, and still is.

But depression was not Hemingways main problem, Farah argues. The traumas and resulting CTEhad physically changed his brain demented and weakened it.

His neuronal pathways, the bridges of connection in his mind, were rickety and collapsing, Farah writes.Electroshockwas the storm that covered them with floodwaters.

After a round of shock treatments in early 1961, Farah writes, Hemingway grew more and more abusive to his wife, berating her because of his paranoia.

She and somefriends had to physically restrain Hemingwayfromshooting himself that April.

Hewent back to the hospital for more shock treatments.

A few days after being discharged a second time, on July 2, 1961, Hemingway woke before sunrise. He fetched hisshotgun from the basement, this time with no one to stop him.

All his vulnerabilities coalesced in one final instant, as Farah puts it.

Had he livedin the 21st century, Farah writes, Hemingwaywould have had an MRI scan, which mighthave revealed his much-abused brain was shrinking.

He would have been sent to a therapist, and told to stop drinking, to focus on his health, and remind himself he is safe.

He likely would have been prescribedantidepressants and vitamin B pills, and kept clear of stresses such aselectric current.

Modern medicine couldhave saved Hemingwayslife, Farah said.

Even if not: We would have at least understood him.

Hemingways Brain by Andrew Farah was published in April 2017bythe University of South Carolina Press.

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The same brain disease battering the NFL may have killed Ernest Hemingway - Washington Post