Hemingway's Brain by Andrew Farah

Abstract

Reviewed by: Hemingway's Brain by Andrew Farah Susan F. Beegel Hemingway's Brain. By Andrew Farah. Columbia, SC: U of South Carolina P, 2017. 194 pp. Cloth $24.99. Hemingway studies has waited a long time for the right physician to take an interest in the tragic central problem of Hemingway's life—his progressive mental unraveling, begun early and accelerating in the 1950s, and his final descent into severe depression and psychosis, culminating in one of the most famous suicides of the twentieth century. At last, the doctor is in. Andrew Farah is a Neuropsychiatrist, Chief of Psychiatry at the High Point Division of the University of North Carolina Healthcare System, and a Distinguished Fellow of the American Psychiatric Association. His arrival is timely. Neuroscience, bolstered by technologies such as the PET scan, which uses radioactive tracers to show problems at the cellular level, is a rapidly advancing field with many new things to tell us. Farah's interest in Hemingway is not casual; his neuropsychiatric study is based on comprehensive research into the primary and secondary materials of Hemingway biography. The result, Hemingway's Brain, offers a "forensic psychiatric examination of his very brain cells—the stressors, traumas, chemical insults, and biological changes—that killed a world-famous literary genius" (1). [End Page 122] Farah's opening chapter, "Inheritance," reviews the well-known multigenerational history of depression and suicide in the Hemingway family. To this, he adds a valuable discussion about the stand-alone heritability of suicidal behavior (see pages 14-15). Identical twins sharing the same DNA are seventeen times more likely than fraternal twins to make a serious attempt at suicide if a co-twin has also done so at any time in his or her life. Adoptive studies of siblings separated and raised by different parents in different homes show that a genetic code for suicide operates independently of environment; the rate of suicide among biological siblings of adoptees who commit suicide is six times higher than the rate among siblings of non-suicidal adoptees. "The genetic risk of a suicidal tendency can be transmitted completely independent of the genes for mental illness," Farah tells us. "The predetermined vulnerability for self-destruction is… independent of the genetic risk for depression, bipolar illness, substance abuse, or any other psychiatric disorder." In other words, Hemingway may have carried a genetic code for suicidal behavior, "its own potential time bomb." We do not need to seek a mental illness that explains not only his suicide, but those of his father, two siblings, and granddaughter. Instead, Farah's extremely convincing diagnosis of Hemingway's mental decline is "dementia, mixed etiology" with recurrent depression, and psychosis secondary to both (159). That "mixed etiology" includes three major contributors. Farah looks first at Hemingway's history of at least nine serious concussions, from the blast of that Austrian mortar in a World War I trench to the final African plane crash, with every falling skylight, car accident, and slip-and-fall from Pilar's flying bridge in between. Farah then offers a detailed discussion of chronic traumatic encephalopathy, or CTE (see pages 38-40). While some patients recover fully from a concussion, or continue with minor impairment, others develop CTE, a form of progressive brain degeneration that can result from major concussive injuries or from multiple minor or "sub-threshold" brain traumas. First known as dementia pugilistica, the syndrome of the "punch-drunk" boxer (Ad Francis in Hemingway's short story "The Battler" is a fine example), CTE garnered headlines during the NFL's 2013 "Concussion Crisis," when the organization awarded $765 million to former players with head injuries. Farah offers a devastating list of how CTE causes progressive dementia and other neurological problems—damage to the blood-brain barrier that protects the brain from neurotoxins, damage to the blood vessels supplying the brain, disruption of brain cell membranes blocking the entry of cell-destroying calcium, atrophy of brain structures, inflammation, the release [End Page 123] of chemical messengers called cytokines, and a phenomenon known as "apoptosis," a form of DNA damage that can actually reprogram brain cells for premature death. Add alcoholism and stir. For instance, Hemingway, in a World...