Ernest Hemingway Psychological Case Study

Running head: PSY303: FINAL PAPER 1 Ernest Hemingway Case Study John Metts PSY303: Abnormal Psychology Instructor: Peggy Olsen January 16, 2016

PSY303: FINAL PAPER 2 Week 5 Final Paper – Psychological Case Study Psychological Report I. Identifying Information: (Wagner-Martin, 1999). Name: Ernest Miller Hemingway Age: Born – 07/21/1899 Died – 07/02/1961 at age 61 Gender: Male Race: Caucasian Occupation: Writer/Novelist, Nobel and Pulitzer Prize Winner Sexual Orientation: Heterosexual Birthplace: Chicago, Illinois USA II. Chief Complaint/Presenting Problem: (Martin, 2006, Walsh, 2011, Bio. Editors, 2014, Meyers, 2016, 1985, Reynolds, 1985 2016, et.al).  Patient has a number of complaints indicative of both a biophysical health conditions and psychological instability. Among his chief complaints, are widespread pain, fatigue, irritability stomach pain, insomnia and decreased libido.  Mr. Hemingway suffers from physical illness associated with long term degenerative diabetes, angina, liver dysfunction and a wide range of effects likely associated with many severe injuries including traumatic brain injuries sustained through a series of violent accidents.  Mr. Hemingway also has a number of concerning complains related to Psychological issues that have begun to prove problematic in his life and interpersonal relationships. What he describes as 'malaise,' 'melancholy,' and irritable mood changes have become more exaggerated and frequent. III. Symptoms: (Martin, 2006, Dömötör, 2013, Walsh, 2011, Bio. Editors., 2014, Meyers,

PSY303: FINAL PAPER 3 1985, Reynolds, 1985, et. al).  Symptoms of major manic-depressive disorder, mood swings affecting his relationships, general distress, irritability and co-morbidity associated with widespread pain and clear indications of possible borderline and narcissistic personality traits.  Complains of severe episodes of widespread pain and displays clear signs of alcohol dependency related to his tendency to self-medicate with continued frequent use of alcohol. His problems sleeping and the resulting fatigue add to his state of overall failing health. His presenting symptoms indicate a connection between his known physical illnesses and a concerning deterioration of his mental stability. IV. Personal History: (Martin, 2006, Dömötör, 2013, Walsh, 2011, Bio. Editors., 2014, Meyers, 1984 - !985, Reynolds, 2016, Meyers, 2010, James D. Brasch & Sigman, 1981 et. al). Earnest Hemingway grew up in Oak Park Illinois and spent his childhood years living a family home built by his Grandfather Earnest Hall Hemingway. Throughout his childhood, Ernest was raised by his parents Clarence and Grace Hemingway. His Father was very strict, enforcing conservative values common throughout upper-middle class towns in the mid-west. He was taught that hard work, determination, a strong devotion to religion and keeping physically fit were the keys to a man’s success. His Father instilled in him an appreciation for nature that included hunting, fishing and spending time at the family’s summer home on Walloon Lake in northern Michigan. The house was called Windemere. Although not particularly inclined with musical talent, he learned music appreciation from his mother Grace. For a time during his early childhood, his Mother made a strange attempt to raise Ernest as a girl, pairing him with his older sister Marcelline and treating them as

PSY303: FINAL PAPER 4 twins. She even went so far as too keep his sister back in school so they would be in the same class. This period came to an end around the age of eight and throughout his schooling in the Oak Park public school system, Hemingway did very well academically. He was quite popular, taking part in sports such as football and swimming, as well as serving as a manager for the track team. He found more satisfaction writing for the school newspaper and spending time among nature. Rather than going on to college, Hemingway took a job as a Jr. reporter for the Kansas City Star shortly after his graduation in 1917. Hemingway was very well read and well-traveled, having spent significant time in Italy, serving in the Red Cross as allied support during World War I. where a mortar shell detonated close by, severely injuring him. This marked the first of a long line of injuries Hemingway suffered throughout the rest of his life which likely played a significant role in his degenerating health and psychological wellbeing (Meyers, 1984 – 2010). While in Paris, Hemingway made a point of associating with many among the Avant guard of his time, often referred to as “the Lost Generation,” maintaining long term relationships with the likes of artist Pablo Picasso, authors F. Scott Fitzgerald, Gertrude Stein, Alice B. Toklas, James Joyce, Ezra Pound, Max Perkins, later during his time in Cuba he even became acquainted with Fidel Castro. During his time in Paris, Hemingway began to become quite an accomplished writer. In 1928, while still in Paris working on a novel entitled A Farewell to Arms, Hemingway received the news of his father’s suicide by a self-inflicted gunshot to the head. In many ways, this could be seen as a major event contributing to Hemingway’s more dramatic psychological downward spiral. His drinking increased, as he also began to display an unusual propensity toward accidents and injuries (Martin, 2006).

PSY303: FINAL PAPER 5 Although quite popular among most of the people who knew him, the patient’s interpersonal and romantic relationships often suffered as a result of his unpleasant mood swings, drinking and unpredictable behavior. As Martin points out, Hemingway was quite an egotistic womanizer, having a number of mistresses, but over the course of his life he had four wives; Elizabeth H. Richardson, who bore his first son John (Jack) Nicanor in 1923, Pauline M. Pfeiffer, mother of his other two sons, Patrick in 1928 and Gregory Hemingway in 1931, before marrying Martha Gellhorn and later Mary Welsh (Martin, 2006). His numerous biographies emphasize episodes of highly elevated moods and manic periods of hyper activity. As a youth, he would stay up all night and obsessively read poetry out loud. One such occasion, his companions fell asleep, awakening hours later to find Hemingway 'still at it, looking fresh as a daisy' (Baker, 1969, p. 37). During one period in 1924, Hemingway's first wife, Hadley, found her husband 'sky high, emotionally intense, and ready to explode' (Reynolds, 1989, p. 194). His wife remembered her husband being so difficult to tolerate that she sent him away by himself. The irritable states that drove his father away from his own family had begun to have the same effect on Ernest. For Hemingway the writer, the periods of heightened energy provided a means to increase his productivity. In 1934, he experienced another 'immense accession of energy,' which he described as 'juice' and found to be 'bad as a disease' (Baker, 1969, p. 268). His almost unnatural ability to produce significant volumes of literary works, was a contributing factor to his success. In the 1930s, he was commissioned as an American correspondent, traveling to Spain in support of the Republic where he wrote the legendary book, For Whom the Bell Tolls. Maxwell Perkins, one of Hemingway's closest friends, reported that, ' He was in a state of mind to boast that the work contained the best writing he had ever produced and was a 'super-value' for the reader's money.'

PSY303: FINAL PAPER 6 He went on to say that the writing had been a difficult task, 'like painting a Cezanne,' and he was the 'the only bastard right now' who could accomplish such an achievement' (Baker, 1969, p. 268). Hemingway certainly displayed a flair for the dramatic, once writing to his second wife Pauline Pfeifer's mother in 1936, 'I've been working hard. Had a spell where I was pretty gloomy and didn't sleep for about three weeks. Took to getting up about two or so in the morning and going out to the little house to work until daylight because when you're writing on a book and can't sleep your brain races at night and you write all the stuff in your head and in the morning it is gone and you are pooped' (Hemingway, 1981, pp. 435-436). Given the context of the other mood episodes he experienced, it is probable that this period represented an episode of mixed feelings. This history suggests that Hemingway suffered throughout his adult life from affective bipolar disorder and other comorbid mental conditions. In 1944, Hemingway traveled to England where he wrote for Collier’s Magazine for a time, submitting his writings about the exploits of the British Royal Air Force. Eager to be close to the action, he joined the allied fleets during the invasion of Normandy and later spent time among General Patton’s famous armored tank division. He had a tendency to embellish stories of his experiences while witnessing historic events at the Ardennes and the Battle of the Bulge, as his legendary status continued to grow (Meyers, 1984 – 2010, Martin, 2006, Wagner-Martin, 1999, Bio. Editors., 2014, et.al). Following the war, Hemingway sought retirement, traveling frequently between Cuba and his home in Key West Florida. His book, The Old Man and the Sea was published in 1955 and for his work he was awarded the Nobel Prize for Literature, but was unable to attend the ceremony due to his failing health. At the banquet, H.S. Nyberg, Member of the Swedish Academy, made the following comment: “Another deep regret is that the winner of this year's

PSY303: FINAL PAPER 7 Nobel Prize in Literature, Mr. Ernest Hemingway, on account of ill health has to be absent from our celebration. We wish to express our admiration for the eagle eye with which he has observed, and for the accuracy with which he has interpreted the human existence of our turbulent times; also for the admirable restraint with which he has described their naked struggle. The human problems which he has treated are relevant to all of us, living as we do in the confused conditions of modern life; and few authors have exercised such a wide influence on contemporary literature in all countries. It is our sincere hope that he will soon recover health and strength in pursuit of his life-work” (Nyberg, 1954). In his phoned in Nobel Prize acceptance speech, Hemingway recorded the following comments: “Having no facility for speech-making and no command of oratory nor any domination of rhetoric, I wish to thank the administrators of the generosity of Alfred Nobel for this Prize. No writer who knows the great writers who did not receive the Prize can accept it other than with humility. There is no need to list these writers. Everyone here may make his own list according to his knowledge and his conscience. It would be impossible for me to ask the Ambassador of my country to read a speech in which a writer said all of the things which are in his heart. Things may not be immediately discernible in what a man writes, and in this sometimes he is fortunate; but eventually they are quite clear and by these and the degree of alchemy that he possesses he will endure or be forgotten. Writing, at its best, is a lonely life. Organizations for writers palliate the writer's loneliness but I doubt if they improve his writing. He grows in public stature as he sheds his loneliness and often his work deteriorates. For he does his work alone and if he is a good enough writer he must face eternity, or the lack of it, each day. For a true writer each book should be a new beginning where he tries again for something that is beyond attainment. He should always try for something that has never been done or that others have tried and failed. Then sometimes, with great luck, he will succeed. How simple the

PSY303: FINAL PAPER 8 writing of literature would be if it were only necessary to write in another way what has been well written. It is because we have had such great writers in the past that a writer is driven far out past where he can go, out to where no one can help him.” “I have spoken too long for a writer. A writer should write what he has to say and not speak it. Again I thank you” (Hemingway, 1954). An avid adventurer, hunter and fisherman, he enjoyed traveling to Africa on hunting safari’s. In 1954, during a trip to the Belgian Congo, he and his wife Mary were involved in a tragic series of events which resulted in some of Hemingway’s most serious, even life threatening injuries. The trouble started when their plane took off from Nairobi, but crashed before reaching its destination. The stranded party was rescued, but the rescue plane burst into flames on the runway during takeoff. Hemingway used his head to batter open the jammed door. His actions resulting in a number of injuries including a fractured skull, lacerated scalp, spinal fluid seeping from his ear, temporary vision-loss in the right eye, deafness in left ear, partial paralysis, first degree burns on face, arms and head. He was also diagnosed at the hospital in Nairobi with a sprains to his arm, shoulder and leg, crushed vertebra and ruptures of his liver, spleen and kidney. Following the accident, Hemingway’s health and overall physical condition never seemed to improve (Martin, 2006). In 1960, Hemingway and his wife moved to a home they had purchased in Idaho. He enjoyed the natural beauty of the surrounding countryside, but his illness had reached such severe levels that he was forced to seek medical attention. As chronicled in Hemingway: A Psychological Autopsy of Suicide, Lynn (1987) reports that Hemingway was seen by Mayo Clinic Psychiatrist Dr. Howard P. Rome, who treated the author with electroconvulsive therapy (Lynn, 1987, p. 584). After a seven-week hospitalization, he was discharged home, entering a

PSY303: FINAL PAPER 9 period of relative wellness (Lynn, 1987, p. 584). During these weeks he ate and slept well and limited his drinking. He also maintained a strict writing regimen and was, in his own words, 'working hard again' (Lynn, 1987, p. 585) on what would become the memoir of his youth in Paris, A Moveable Feast (1964). As Hemingway's depression slowly returned, Martin (2006), citing accounts by Lynn (1987) of ow it began to take hold of the doomed Hemingway. He lost the ability to write, breaking down in tears when he could not summon words. It may have been that the years of alcohol abuse and cumulative traumatic brain injury led to cognitive impairment that, combined with depression, robbed him of his skill in writing. Regardless of the precise causes, 'That one gift which had meant everything had now deserted him' (Lynn, 1987, p. 589). In April of 1961, Mary came upon him as he was beginning to load a shotgun. He was hospitalized near his Ketchum, Idaho, home (Lynn, 1987, pp. 589-590). Soon, he asked to return to his home to retrieve some items. While escorted home by hospital staff, he ran from his chaperones, picked up a shotgun, and turned it against himself. The hospital staff members caught up with him and physically struggled to disarm him and thwart the attempt (Lynn, 1987, p. 590). He was transferred to the Mayo Clinic for a second admission, but as the plane stopped to refuel in South Dakota, Hemingway, bent on suicide, began to walk quickly toward a plane's spinning propeller, stopping when the pilot cut the engine (Lynn, 1987, pp. 590). This was the third serious suicide attempt within four days. Hemingway was hospitalized at the Mayo Clinic for two months. He underwent further treatment with electroconvulsive therapy and was discharged on June 26, 1961. Mary feared that her clever husband had 'charmed and deceived Dr. Rome to the conclusion that he was sane' (Lynn, 1987, p. 591). The day after the couple arrived home in Ketchum, they dined out, and Hemingway told his wife that patrons in the restaurant were actually FBI agents there to monitor him (Lynn, 1987, p. 591). He was by no

PSY303: FINAL PAPER 10 means well. On the morning of July 2, 1961, Hemingway awoke early before his wife, retrieved a double barrel shotgun from a downstairs storage closet, and while Mary slept peacefully in an upstairs bedroom, Ernest Hemingway loaded the gun, placed the barrels into his mouth and ended his own life with a self-inflicted shotgun blast that finally brought his suffering to an abrupt and tragic end (Martin, 2006). V. Family History: (Martin, 2006, Reynolds, 1995, Meyers, 1999, Biography, 2017, et. al.). Ernest Hemingway was raised by his parents, Dr. Clarence and Grace Hemingway. His father was born on September 4, 1871 and his mother was born June 15, 1872. Hemingway had five siblings. One brother named Leicester and four sisters, Ursula, Marcelline, Madelaine and Carol. Growing up, Earnest was a devoted son and brother despite the somewhat odd and strained relationships between them. Later in life, especially in the years that followed his father’s 1928 suicide, Hemingway became completely disconnected from his mother, even refusing to attend her funeral and had very little contact with his siblings. This was due, in part, to the nature of his lifestyle and frequent travels, but likely relates to the family’s history of poor health erratic behaviors, which included anxiety, bi-polar mood disorder, along with various other symptoms of comorbidity that he himself had suffered from for the majority of his adult life. Hemingway’s alcohol abuse coupled with the inordinate number of quite serious injuries he had sustained throughout his life, particularly to the head, in a disturbing string of freak accidents, did little to help his deteriorating condition. In fact, as Martin (2006) pointed out, these circumstances and Hemingway’s stubborn reluctance to seek proper treatment were undoubtedly main factors in the unfortunate, untimely death that fate dealt him. In the end, it ultimately became somewhat apparent that his instability seemed to relate to some hereditary trait that had yet to be determined (Martin, 2006). All the while, even

PSY303: FINAL PAPER 11 though it was becoming more and more likely that an unknown biological, possibly hereditary condition which had alluded his doctors for decades, was likely playing some contributing role in his continually deteriorating, comorbid health and psychological conditions. Particularly concerns arose concerning the frequency of suicide that continued to rise among members of the Hemingway family. A situation that those who have studied Hemingway’s life in detail, such as Biographers, Martin, Meyers, the Editors of Biography, Lynn, Reynolds, Shoenberg, Walsh & Mirkin MD. (et. al., 1984-2017) could clearly recognize, even though the Doctors at the Mayo Clinic among others, responsible for Hemingway’s treatment late in life failed to address at all. As mentioned in the above entry regarding the patient’s personal history, Hemingway's father was very strict, enforcing conservative values common throughout upper-middle class towns in the mid-west. There is a notably disturbing history of suicide among other members of the Hemingway family. Ernest, his father Clarence, and his first son Jack all took their own lives, along with siblings Ursula and Leicester and in 1996 while making a family documentary, Ernest’s granddaughter Margaux took her own life. Ernest’s youngest son Gregory, who underwent gender reassignment surgery and went by the name of Gloria, was found dead in a jail cell at a Miami-Dade Women’s detention center at the age of 69 after being arrested for indecent exposure in Key Biscayne Florida (Meyers, 1999). VI. Therapy History: Personal Physician – Dr. George Saviers treated Hemingway’s physical and mental conditions over the years, including diabetes, high blood pressure, liver disease, angina and various mood disorders thought to be associated with alcoholism, a troubled childhood and the pressures of celebrity. His Doctor often pleading with Hemingway to quell his drinking habit. He was prescribed reserpine and secobarbital, along with other medications for treating his known

PSY303: FINAL PAPER 12 illnesses that were common for the time. Mayo Clinic medical team, led by Psychiatrist Dr. Howard P. Rome initially diagnosed Hemingway with high blood pressure, major depressive disorder as well as comorbid conditions attributed to his excessive alcohol use and the long term effects of many serious injuries, head trauma in particular. His course of treatment while at the Mayo Clinic involved a reported 11 to 15 rounds of Electroconvulsive therapy (ECT), commonly known as “shock treatment.” The treatments were not successful and by all accounts made Hemingway’s condition worse. He began to experience progressing states of depression, psychosis, paranoia memory loss and other symptoms often related to the side effects of ECT. Continuing his regimen of reserpine and secobarbital, he was somewhat stabilized before returning to his home in Ketchum, Idaho where his condition improved for a short time, but feelings of inadequacy and his inability to function in the manner to which he was accustomed. His depression and lack of control began to undermine his will, resulting in increasing displays of disturbing behaviors. VII. Medical Conditions: (Martin, 2006, Meyers, 1999, Donaldson, 1995, Reynolds, 1985, Cobb, 2016, Olson, 2013, Mirkin, 2013 et. al.)  Hemingway had a history of physical illness related to high blood pressure, liver dysfunction and angina. Hemingway had a long, well documented history of mood swings, manic states associated with bi-polar depression, uncontrollable outbursts and other unpredictable behaviors for much of his life, quite possible related to hereditary conditions that seem to be inherent among many other family members.  A series of violent accidents resulting in a number of serious injuries, including multiple head traumas, the worst of which were suffered during two consecutive plane crashes in Africa. In

PSY303: FINAL PAPER 13 the years that followed these traumatic injuries, Hemingway never seemed to fully recover. VIII. Substance Abuse: (Martin, 2006, Meyers, 1999, Ernest Hemingway was a heavy drinker for most of his adult life, turning to alcohol in addition to prescription drugs as a way of self-medicating in a desperate attempt to cope with the many distressing problems he faced. IX. Collateral Information: Ernest Hemingway His ego could be described as narcissistic and self-destructive by many accounts reflecting the deeply troubling internal conflict he almost never expressed regarding sexuality and masculinity. Much of those underlying issues likely had to do with his early childhood experiences and his tendency to overcompensate was apparent to many who knew him best. An invaluable resource, rich with details from a wide range of sources directly relating to Ernest Hemingway the man, as well as Hemingway the writer, can be found in a 2006 publication of Psychiatry, entitled Hemingway: A Psychological Autopsy of a Suicide. This comprehensive look into the life of Hemingway provides a great deal of priceless collateral information. Author Christopher Martin, brings together one of the finest collections I've found, skillfully weaving his own perspectives alongside citations from the works of a number of writers who made their names writing about the life of Hemingway. In setting the foundation of this brilliant expose, Martin states, 'there is little question regarding the inestimable significance of his role in American literature. In addition to possessing a rich talent, Hemingway was heir to a biological predisposition for mood disorders and alcoholism (and) also suffered the characterological fallout of a childhood spent under the care of parents with their own unpredictable mood swings and disorienting inconsistencies. The result was a deeply troubled, though resilient offspring' (Martin, 2006).

PSY303: FINAL PAPER 14 Martin (2006) provides further insight from the works of Baker (1969) and Lynn (1987): Hemingway's first major biographer, a man who knew him in life, referred to him as a 'temperamental manic depressive' (Baker, 1969, p. viii) and wrote that 'the pendulum in his nervous system swung periodically through the full arc from megalomania to melancholy' (Baker, 1969, p. 291). He noted Hemingway's recurrent references to suicide in conversation and personal correspondence. Baker also documented Hemingway's unpredictable personality, troubled interpersonal relationships, and alcoholism. Many times, Hemingway was urged by his loved one’s friends and doctors to stop drinking, as Martin (2006) records. In a letter to Hemingway in 1957, A.J. Monnier wrote, 'My dear Ernie, you must stop drinking alcohol. This is definitely of the utmost importance, and I shall never, never insist too much' (Monnier, 1957). Lynn (1987) and Mellow (1992) each produced enriched accounts of Hemingway's life, expanding on Baker's work. Lynn particularly explored Hemingway's early years and contributed to a deeper understanding of Hemingway's family of origin, his mother's inconsistent messages about masculinity and femininity, and his father's unpredictable temper and strict disciplinarian attitudes toward parenting. Lynn also notably commented on the presence of a history of manic- depressive illness in the Hemingway family (Martin, 2006). In characterizing Hemingway, Lynn (1987) wrote that, 'his mood swung so fast from low to high and back down again that one could almost say he was simultaneously exhilarated and depressed' (Lynn, 1987, p. 135). Baker pointed out that Hemingway was 'a man of many contradictions who was capable of alternately appearing shy or conceited, sensitive or aggressive, warm and generous, or ruthless and overbearing' (Baker, 1969, p. viii). 'It may have been that certain borderline personality traits caused him to appear erratic and dramatic. Part of his apparent inconsistency

PSY303: FINAL PAPER 15 may have arisen from a lack of a cohesive, stable identity, a problem which might have readily followed in the wake of his mother's inconsistent parenting' (Martin, 2006). Martin continues with a piece from Baker, that Friend and mentor Sherwood Anderson spoke of Hemingway's capacity for self-interest, stating, 'absorption in his ideas' had 'affected his capacity for friendship' (Baker, 1961, p. 181). 'Although he was 61 when he took his life, his mind had been haunted by suicide from a very young age. His earliest fictional stories, written years before his father took his own life, contained themes of violence and suicide' (Baker, 1969, pp. 23, 25); included excerpt from (Martin, 2006). In 2014, A&E Television Networks produced a series of short biographical films addressing specific aspects of Hemingway's life through the first-hand accounts of some of his closest friends and loved ones. These rare interviews provide an intriguing glimpse at the complex nature of the man himself, revealing a number of quite unique motivating factors that drove his enigmatic personality. These compelling, often vivid descriptions of Hemingway’s life-long quest for adventure fueled fantastic, often embellished tales of his exploits as seen from the perspective of those who knew him. It was these ego-driven activities, and his ceaseless dedication to writing, along with increasingly unpredictable interludes involving unpleasant mood changes and instability reflective of his deteriorating mental health condition, that came to characterize the difficulties that plagued his interpersonal relationships (Bio. 2014). In 1957, Mary Hemingway wrote to a friend that during her husband's depressed moods, 'the protagonist' was 'his poor, long-suffering liver” (Baker, 1969, p. 537) as cited by (Martin, 2006). In Part II of the A & E series, a segment entitled Ernest Hemingway - Macho Macho Man, Clara Spiegel, a close friend of Hemmingway, very passionately talks about the man behind the

PSY303: FINAL PAPER 16 image: 'His image had some relationship to him, he was big, he was burley, he did drink, he was a boxer, he was an outdoorsman, he was about as well rounded a man as I've ever known' (Bio., 2017). Writer, Editor and playwright, A.E. Hotchner, a longtime friend of Hemingway describes his friend, 'He was established, in the world and in his own world. Ernest knew who he was and how he wanted to be' (Bio., 2017). Hemmingway's son Gregory, before his untimely death, expresses his view of his father's image when he says, 'He developed a masculine image, for several generations to emulate. This image of super masculinity, was just an overcompensation for his insecurities about his masculinity. I can remember hundreds, thousands of times of him saying, 'being a man is a hard trade; it's hard to be a good man' this phrase repeated, just over and over and over in different situations ad I... I didn't know what he meant' (Bio., 2017). Memoirs written by those close to Hemingway convey different impressions of his suicide. In a heartbreaking article appearing in Today in Literature, entitled The Hemingway's' and Suicide. Mary Hemingway does not refuse the idea that it was a noble, destroyed-but-not- defeated act, but she stresses the sure fact that her husband was mentally ill, and getting worse. Brother Leicester chooses the heroic interpretation: 'Like a samurai who felt dishonored by the word or deed of another, Ernest felt his own body had betrayed him.' Having hunted with his big brother, and heard him talk about giving animals 'the gift of death,' Leicester believes that Hemingway chose to give it to himself. Greg categorizes his father's death as 'semi-voluntary,' an act born of lifelong defiance and momentary delusion. (King, 2016). Impressions: Any research into the behaviors of such a complex personality as Ernest Hemingway,

PSY303: FINAL PAPER 17 particularly those areas involving collateral source material, would be incomplete without a significant amount of exploration into his romantic pursuits. Hemmingway had four wives and relationships with several other women over the course of his life. Many have characterized him and rightly so, as a womanizer, pointing to a number of instances when he would take a bride, only to fall right into another relationship. Hemingway had a charisma that attracted women wherever he went and his inability to resist the temptation to explore many of these opportunities, made him a less than desirable husband for the women who loved him. Hemingway married his first wife, Hadley Richardson in 1921 and the two remained together until 1927, but after a long standing affair with Pauline Pfeiffer finally led to their divorce, Hemingway and Pauline were married in Paris on May 10th, 1927, just four months later. Hadley was the mother of Hemmingway's first son Jack, and Pauline was the mother of his other two sons, Patrick and Gregory (Hemingway Home, 2016). Hemingway Biographer, Jeffery Meyers tells the story of how Martha replaced Pauline, seemingly on a romantic whim. As the story goes, Hemingway was at Sloppy Joe's pub in Key West Florida, when he was suddenly taken aback by the attractive Martha Gellhorn. The bold Hemingway, soon introduced himself to Martha and later that same day to his wife Pauline. Although the situation was tenuous, Martha came to visit at Ernest and Pauline's Key West home. One evening, after dinner, Ernest and Martha had stepped out to lounge on the veranda together. Hemingway affectionately called Martha 'daughter.' A peculiar nick name for a young woman for whom you have shown a clear romantic attraction. As he filled her glass, Hemingway asked Martha if she had 'ever been to a bull fight.' When she said she hadn't, an inspired Hemingway declared, 'then we'll go.' After Ernest had stepped inside for a few moments, Martha found herself sitting out on the veranda of the grand house alone and feeling a

PSY303: FINAL PAPER 18 bit out of place. Suddenly he returned and addressed her, 'penny for your thoughts?' Martha responded, 'oh, I was just thinking about life, about never knowing what's around the corner, who you might meet.' Hemingway responded with conviction, 'I knew when I first saw you, on that day you arrived with your mother and your brother, that you were the woman I had been waiting for, the woman I had to marry.' After expressing her doubts about Hemingway's sincerity and a brief romantic interlude, Martha asked about the book on the table. Hemingway replied, 'Death in the Afternoon. I've signed it for you, it's for you.' When Martha opened the book, she saw the words, 'For the woman I am going to marry. Ernest. Key West, 1937.' Martha insisted that he come away with her to Spain and expressed her deep concerns about the war there. Ernest agreed that he would get the details worked out and would go. As he walked her back to the nearby hotel where she was staying, Ernest kissed her again saying, 'goodnight daughter.' Martha lay in bed contemplating the events of the evening and the reality of what lie ahead in Spain. She concluded that Ernest had been sincere about marrying her and as she dozed off to sleep, she realized that she wanted that too. Soon after, Ernest joined Martha in Spain where they covered the civil war together. During his time in Spain, his marriage to Pauline faded, finally ending in divorce in November of 1940. Ernest married Martha just 16 days later, on the 21st, in Cheyenne, Wyoming. A short while later they made a home in Cuba together (Meyers, 1984). It was there, while he and Martha were apart for a time, Ernest met another female journalist named Mary Welsh from Minnesota. Mary was nothing like Martha, small, with short blonde hair and a somewhat boyish look. She had an unflattering style of dress, reflecting a look of a common, middle-class girl. Jeffrey Myers described her as 'not particularly good looking, but cute, with a good figure.' Something about Mary immediately attracted Hemingway. Mary, was a woman who enjoyed

PSY303: FINAL PAPER 19 the 'good life,' which included the company of men and was already somewhat of a fan of Hemingway's. Then in May, 1944 and when he was hospitalized with a head wound sustained in a car crash. She arrived carrying daffodils, which seemed to please Ernest very much. Before she departed, Hemmingway said, “I’ll be back at the Dortch in a day or two, come and see me.' The encounter was unabashedly flirtatious (Meyers, 1984). An article entitled, Hemingway in love: four found letters, provides some intimate details in characterizing the questionable motives behind Hemingway's relationship with Jigee Vierrtel, wife of screenwriter Peter Viertel. 'Peter believed that Mary mistakenly attributed Hemingway's seductive advances to Jigee, who was not independently wealthy and could not have supported him in equine luxury. He was as curious as Mary about Jigee's relations with Hemingway, but did not realize that Mary was extremely upset about their budding love affair' (Meyers, 2010). Peter expresses, 'I was becoming more and more conscious of Papa's special attentions to Jigee,' he noted, 'which Mary seemed quite willing to overlook. Jigee assured me whenever we found ourselves alone, that I had no reason to be jealous, as Papa's devotion to her was purely platonic and he needed to be 'a tiny bit in love with someone in order to feel more alive.' She admitted that she enjoyed his adoration of her, but said it was absurd for me to be jealous (Meyers, 2010). A notable observation from Hemingway in love: four found letters, was when F. Scott Fitzgerald once observed, 'I have a theory that Ernest needs a new woman for each big book. There was one for The Sun Also Rises. Now there's Pauline. A Farewell to Arms is a big book. If there's another big book I think we'll find Ernest has another wife.' The Piece continues; Sure enough, he married Martha Gellhorn for For Whom the Bell Tolls and Mary Welsh for Across the River.” Hemingway, indeed, was intensely romantic. During his forties and fifties, which

PSY303: FINAL PAPER 20 proved to be the last two full decades of his life, he compensated for his disappointing marriage to Mary by falling in love with several attractive and much younger women: not only Jigee, but also Jane Mason, the wife of the Pan Am manager in Havana; Nancy (Slim) Hawks, the wife of the director Howard Hawks; the Venetian aristocrat Adriana Ivancich, who both preceded and succeeded Jigee, and was the model for the heroine of Across the River; and, later on, his Irish secretary, Valerie Danby-Smith. As he grew older and more anxious, fearful about his health and his creativity, he needed to be 'a tiny bit in love with someone' (Meyers, 2010). Hemingway in his own words: Maxwell Perkins, perhaps one of Hemingway's most significant acquaintances in terms of literary influence and collaboration assessed that, 'He was in a state of mind to boast that the work contained the best writing he had ever produced and was a 'super-value' for the reader's money.' In addition, the writing had been a difficult task, 'like painting a Cezanne,' and he was the 'the only bastard right now' who could accomplish such an achievement' (Baker, 1969, p. 268). There was an additional extraordinary mood state, which Hemingway described to the mother of his second wife Pauline, when in 1936 he wrote: 'I've been working hard. Had a spell where I was pretty gloomy . . . and didn't sleep for about three weeks. Took to getting up about two or so in the morning and going out to the little house to work until daylight because when you're writing on a book and can't sleep your brain races at night and you write all the stuff in your head and in the morning it is gone and you are pooped' (Hemingway, 1981, pp. 435-436). Given the context of the other mood episodes he experienced, it is probable that this period represented a mixed characterization in the mind of Hemingway. This history suggests that Hemingway suffered throughout his adult life from a bipolar affective disorder. In the personal accounts of Hemmingway's time in Paris, Malcolm Cowley, a prominent

PSY303: FINAL PAPER 21 writer in the 1920's, played a role in the construction of the Hemingway legend, contributing the introduction to Portable Hemingway (1944) and the publication of an article in Life magazine entitled, A portrait of Mister Papa, in 1949. Cowley seems to have held Hemingway in high regard, telling exaggerated tales of his exploits as a war correspondent and 'submarine hunting commando.' Although Hemmingway's ego must have fed upon these depictions, he maintained an outwardly humble approach in discussing them. In 1950, Cowley presented a disclaimer in the publication of the work in McCaffery's critical anthology (1950), which half-heartedly read, 'He asked me to state that he is not responsible for any inaccuracies or legendary accomplishments of any sort which may have been attributed to him.' Hemingway must have felt compelled to downplay Cowley's work in an attempt to portray himself as more of a humble hero. This may have been his way of concealing his own tendency to incorporate a healthy dose of fantasy in the glorification of his experiences. In another attempt to distance himself from Cowley's fantastic depictions, he approached his friend Buck Lanham saying, “Can you imagine anyone going around Hurtgen with a canteen of gin and one of vermouth? There wasn’t any good vermouth, even in Paris and who the hell would give vermouth canteen space in a war, that was just one of those old chestnuts from Malcolm’s Life piece.” This is a great example of the calculated and clever ways that Hemingway would portray himself one way, while the real motivation was always his secret obsession with creating his own legend (Meyers, 1984). As Martin (2006) records, Hemingway wrote to his mother-in-law in 1936, 'Had never had the real old melancholia before and am glad to have had it so I know what people go through. It makes me more tolerant of what happened to my father' (Hemingway, 1981, p. 436). Here, Hemingway seems to report he was suffering from a depressive episode. A letter to John

PSY303: FINAL PAPER 22 Dos Passos describes in more detail Hemingway's experience of depression, 'I felt that gigantic bloody emptiness and nothingness. Like couldn't ever fuck, fight, write, and was all for death' (Lynn, 1987, p. 427). Hemingway sets down virtual diagnostic criteria for a major depressive episode, suggesting loss of interest and pleasure, feelings of emptiness, decreased libido, and thoughts of death and suicide (Martin, 2006). His personal correspondence revealed a lifelong obsession with suicide. In 1923, he wrote to Gertrude Stein, 'I understood for the first time how men can commit suicide simply because of too many things in business piling up ahead of them that they can't get through' (Baker, 1969, p. 119). Hemingway wrote to Archibald MacLeish, 'Me I like life very much. So much it will be a big disgust when have to shoot myself. Maybe pretty soon I guess although I will arrange to be shot in order not to have bad effect on kids' (Hemingway, 1981, p. 453). It seems, a quarter century before his death, that Hemingway had accepted that he would die by a self-inflicted gunshot. By the time he wrote these words in 1936, he had survived his father's suicide, and one can infer from these lines that it had indeed wounded him deeply. His thought was to disguise his own suicide, so that his children would not have to suffer as he had, knowing that their father had taken his life (Martin, 2006). Hemingway told MacLeish, 'Trouble was all my life when things were really bad I could always take a drink and right away they were much better' (Lynn, 1987, p. 122). In another account, Martin (2006) includes an entry from Hotchner (1996) when in 1954, Hemingway explained to Ava Gardner, 'Even though I am not a believer in the Analysis, I spend a hell of a lot of time killing animals and fish so I won't kill myself' (Hotchner, 1966, p. 139). In 1960, Hemingway began to lose his battle with depression and suicide. He wrote to

PSY303: FINAL PAPER 23 his friend A.E. Hotchner, 'I'll tell you, Hotch, it is like being in a Kafka nightmare. I act cheerful like always but am not. I'm bone tired and very beat up emotionally' (Lynn, 1987, p. 581). He began to worry that his friends were plotting to kill him and that the FBI was monitoring him. Lynn (1987) furthers the notion that 'these paranoid delusions may have been due to a psychotic depression related to his bipolar illness, complicated as it likely was by chronic alcoholism and multiple traumatic brain injuries, pointing out that Hemingway had begun to speak more and more of suicide (Martin, 2006). An entry from Hemingway and Suicide, as reported by Scott Donaldson (1995), may lend an added insight into Hemingway's attitudes regarding suicide, particularly in the case of his father. Hemingway stated, 'We are the generation whose fathers shot themselves. It is a very American thing to do and it is done, usually, when they lose their money, although their wives are almost always a contributing cause' (Hemingway, 1935). As much as he wanted to blame his father's fate on his mother, in a declaration of condemnation, Hemingway once wrote, 'My father was a coward.' in an unpublished passage from Green Hills of Africa (1935). 'He shot himself without necessity.' Donaldson added that 'Hemingway and Buck Lanham used to talk about suicide during some of the fighting of World War, if pushed to extremities, they agreed, people should have the right to decide whether to live or die. Nonetheless Lanham concluded that,' ' Ernest had not one goddamned bit of respect for his father.' 'He could probably have accepted Dr. Hemingway's murdering his wife, Lanham speculated, but killing himself to escape her was simply an act of cowardice.' Lanham added, 'It wasn't suicide qua suicide that got to Ernest, but suicide in the sense of a guy running out on a fight' (Donaldson (1995). Another instance I thought should be noted, came from The Hemingway's: An American tragedy (Meyers, 1999). While talking to the film director Joseph Losey, 'Martha praised

PSY303: FINAL PAPER 24 Hemingway's enormous potency and skill as a lover.' Hemingway told his friend Gustavo Duran that 'Martha doesn't like any woman except her mother. She only likes me because I fuck her every night.' Offended by the remark, Duran thought: 'Tell me what you boast about and I'll tell you what you lack' (Meyers, 1999). Consistency Among Collateral Sources: There is a great deal of consistency among those who characterize Hemingway's personality. It was apparent to most, that “his image was something he carefully constructed in both his private life and in the characters that were woven into the stories he wrote” (Meyers, 1984). I an article entitled Memoirs of Hemingway: The Growth of a Legend, Meyers addresses some of these same ideas about the “very calculated, conscious efforts on the part of Hemingway to carefully construct and build upon his own legend. Hemingway seemed to have an obsession with cultivating the image of the ultimate man's man, with all the qualities of masculinity, bravery and integrity that he held in high regard. He exaggerated and wildly dramatized the events of his exploits and learned to use his charisma to help bring his character to life.” He felt 'the need to recreate himself in his novels' (which) 'complemented the creation of his public persona' (Meyers, 1984). Hemingway made a point of cultivating friendships among many elite literary figures, prominent artists and screen stars of his day. Many of these relationships were marked by a largely unspoken image of a man who outwardly held himself in high regard, commanded respect and valued his public acclaim, but behind this almost mythological side of him, there seemed to be a strong sense among many that his obsessive character clearly indicated a man who was insecure and struggling with internal conflicts regarding his own self-image. These impressions are evident in many statements made by those who knew him (Bio., 2017).

PSY303: FINAL PAPER 25 Matthew Bruccoli once noted 'how difficult it is to establish the truth about virtually everything Hemingway,' how 'difficult to differentiate the public Papa from the private writer.' In The Wound and the Bow, Edmund Wilson (1941) spoke out against Hemingway, writing that he had digressed 'into a phase where he was occupied with building up his public personality. Hemingway has created a Hemingway who is not only incredible but obnoxious. He is certainly his own worst-invented character.' His fourth wife, Mary, said he was 'on the skids from egotism and publicity seeking' (Meyers, 1984). As the Memoirs of Hemingway article continues, some consistent patterns of inconsistency between Hemingway the legend and Hemingway the man, begin to become more apparent. Speaking of the time between 1949 and 1980, discussions regarding a series of 17 memoirs written by people who knew him on a personal level are examined. As Meyers (1984) points out, the impressions of Hemingway expressed in these writings display everything 'from reverence and awe to condemnation and hostility.' Much of the motivation behind these works was concerned with selling books, many of them reflecting obvious bias and ulterior motives that muddy the water, but there also many accounts of events in the author's life that can provide important pieces to the puzzle that was Ernest Hemingway. In characterizing the family memoirs by Leicester Hemingway, Marcelline Sanford, Madelaine Miller, and Mary Hemingway, Meyers is quick to point out the 'valuable information' they contain, but 'show little understanding of the man.' Meyers also makes a distinction between the memoir of Gregory Hemingway and that of others in the family, characterizing it as 'more intelligent,' but also predominantly self-serving, seemingly concerned with 'settling old scores and a clear attempt to lay to rest some ghosts of his own past' (Meyers, 1984).

PSY303: FINAL PAPER 26 Impressions; These characterizations and the information, or lack thereof, presented in the first-hand accounts of some of Hemingway's closest family members, seem to be quietly telling with regard to the nature of their family relationships. A closer look at the dynamics of Hemingway’s family and the interpersonal relationships that existed between them, can be useful in gaining a better understanding of the internal feelings Hemingway may have had regarding these close familial relations. The details of Hemingway's family life, especially during his childhood, can be quite troubling at times, as was evident in my documentation of his personal and family histories. This is a subject that undoubtedly played a crucial role in affecting the inner thoughts and emotions that influenced Hemingway throughout his life. A deeper understanding of these dynamics can provide further insight into the complex nature of his psyche. Margaux Hemingway, the daughter of Ernest's first son John 'Jack,' Hemingway, suffered from seizures, depression, bulimia, and alcoholism. The Los Angeles coroner ruled her 1996 death a suicide by an overdose of phenobarbital (Marano, 1996). As Marano noted, family and friends of the beloved actress and model would not accept the findings. Margaux's death was the sixth suicide within four generations of Hemingway’s. The shocking frequency of suicide that plagued the Hemingway's, represents a long history of affective psychological disorders, substance abuse issues and other dysfunctions, likely related to hemochromatosis, a rare condition also called 'the Celtic Curse,' Passed on genetically, it was not discovered by Hemingway's doctors in time to help him and was later found to have run in the family, providing a common thread connecting the Hemingway suicides (Cobb, 2016). This pattern that began well before Ernest's birth, has tragically claimed the lives of at least three of the six siblings in his generation, and has continued through two further generations (Martin, 2006).

PSY303: FINAL PAPER 27 In an article entitled, When suicide runs in the family: Lifting the Hemingway curse, Mariel Hemingway, the granddaughter of Ernest and daughter to Jack, speaks about the latest documentary project on the Hemingway 'curse,' entitled Running from Crazy, “Knowing that there’s so much suicide and so much mental illness in my family, I’ve always kind of been ‘running from crazy,’ worried that one day I’d wake up and be in the same position.” In expressing the lack of communication in the Hemingway family, she openly discloses that “Nobody spoke about anything,” (back then) “It was a different generation.” “Suicide has no rhyme or reason,” says Mariel. “Some people think about it for years and plan it. Some people, it’s 20 dark minutes of their life that they decide to take their life that comes out of the blue. It’s very random, it’s very frightening.” Psychological Instability Among Collateral Sources: In the fascinating biographical entitled Ernest Hemingway: A Psychological Autopsy of a Suicide, Martin (2006) reports the troubled nature of his father Clarence's mental condition, the damage it caused to his family and the events leading up to his demise. This was quite possibly the single most significant, tragic event in Hemingway's life and likely the one that affected him the most. In the memoir A Moveable Feast, Hemingway wrote, 'Families have many ways of being dangerous' (Hemingway, 1964, p. 108), but little did he know, his family genes would present the most serious danger (Martin, 2006). 'Ernest's father, a physician, suffered from unpredictable and dramatic mood swings characterized by episodes of depression and irritability' (Reynolds, 1986). 'The Hemingway children complained of the stress their father's 'nervous condition' placed on them, and Dr. Hemingway took frequent retreats away from the family for 'rest cures' (Lynn, 1987; Reynolds, 1986). In December of 1928, an episode of deep depression set in. Burdened by financial

PSY303: FINAL PAPER 28 worries and failing physical health, Dr. Hemingway took his own life with a gunshot to the head (Mellow, 1992). As recorded by Martin (2006) in a citation from the work of Lynn (1987), Ernest was powerfully affected by his father's suicide, and in the aftermath of Clarence's death, Ernest confided to his friend and mentor Owen Wister, 'My life was more or less shot out from under me and I was drinking much too much entirely through my own fault' (Lynn, 1987, p. 337). Grace Hemingway, the author's mother, has been described to have suffered from episodes of insomnia, headaches, and 'nerves' (Reynolds, 1986, p. 86). Certainly the more you learn about her, the more it becomes clear that those conditions do not account for other strange, obsessive behaviors she displayed. As a young boy, Grace Hemingway forced Ernest to dress as a girl, even styling his hair like a girl's hair. Her strange obsession became even more bazaar when she attempted to pass Ernest and his older sister, Marcelline off as twins, even going so far as to hold Marcelline back in school to complete her plan (Lynn, 1987, pp. 40-41). On the back of a photograph of young Ernest wearing a lacey dress and a hat covered in flowers, Grace wrote 'summer girl' (Lynn, 1987, p. 41). Grace commonly called Ernest a 'Dutch dolly,' and Ernest called his mother 'Fweetee.' At age of two, Ernest responded to her embarrassing nick name by telling her, 'I not a Dutch dolly ... Bang, I shoot Fweetee' (Baker, 1961, p. 5). During his childhood, when his father would beat him, Hemingway would secretly retrieve one of his father's hunting rifles, step out of sight and point it at his father's head. Even at a young age, Ernest had enough pent-up anger and aggression toward his parents to play out a fantasy of killing them (Martin, 2006). Throughout his life, Hemingway described his mother as a 'selfish, controlling figure, whose personality dominated that of his more reserved and passive father' (Martin, 2006).

PSY303: FINAL PAPER 29 Hemingway stated to friends, 'She had to rule everything' (Lynn, 1987, p. 395). When his father Clarence committed suicide, Ernest openly blamed his mother and maintained that opinion for the rest of his life. In a letter to friend and publisher, Charles Scribner, in 1949, Hemingway wrote, 'I hate her guts and she hates mine. She forced my father to suicide' (Hemingway, 1981, p. 670). Hemingway's outward belief that his mother was responsible for his father's death, may reflect other deep rooted sources of anger toward her. Hemingway's friend, John Dos Passos, once said that Hemingway was 'the only man I ever knew who really hated his mother' (Lynn, 1987, p. 395). Friend Charles Lanham wrote, 'he always referred to his mother as 'that bitch.' He must have told me a thousand times how much he hated her and in how many ways' (Lynn, 1987, p. 27). Hemingway’s older sister Marcelline also suffered from periods of depression and though her death in 1963 was ruled to be from natural causes, the family suspected suicide (Reynolds, 1986). Similar conditions have been identified in Grace's brother, Leicester, and Clarence's brother Alfred (Reynolds, 1986). Ernest, one of six siblings, was preceded in birth by his sister Marcelline and followed by Ursula, Madelaine, Carol, and his brother, Leicester (Burgess, 1978). Ursula and Leicester both died by suicide (Reynolds, 1986). Ernest's youngest son, Gregory, a physician, was diagnosed with bipolar disorder, making him the third male Hemingway to suffer from the condition. His comorbid conditions led to multiple psychiatric hospitalizations and arrests involving various bizarre behaviors. Gregory also struggled with his sexuality, often taking on the image of a transvestite, which caused a falling out with his father. Gregory finally underwent gender reassignment surgery before his death in 2001. He died assumingly of natural causes in Miami-Dade jail cell after he was arrested for public nudity in Key Biscayne Florida (Schoenberg, 2001).

PSY303: FINAL PAPER 30 IX. Psychological or Behavior Health Medical Reports Beyond the assessments that have been published after his death, I have not located any actual reports that provide official documentation of psychological testing, however there are a number of facts that are known about the diagnosis associated with his physical and mental health, especially toward the end of his life and there are a number of accounts relating to Hemingway's behavior patterns that provide strong indicators of the nature of his psychological condition. His personal physician urged him to undergo hospitalization at the Menninger Clinic in Topeka, Kansas. Hemingway refused, insisting, 'They'll say I'm losing my marbles' (Lynn, 1987, p. 583). This response on the part of Hemingway, as cited by Martin (2006) looms, in hindsight, as a dark indicator of his underlying instability. In October 1954, Ernest received news that he had been awarded the Nobel Prize for Literature, but do to his failing health, could not make the trip to Stockholm to accept the award. He made his acceptance by phone with the following statement, an audio recording of which, is contained in the short Biography film Hemingway – Nobel Prize; 'Writing at its best is a lonely life, he grows in public stature as he shares his loneliness and often his work deteriorates; for he does his work alone and if he's a good enough writer he must face eternity, or the lack of it, each day' (Hemingway, 1954). In August of 1947, Hemingway, looking ill, overweight, and experiencing buzzing in his ears, was diagnosed with high blood pressure. From this point, all the way to his death, he fought hypertension, diabetes, depression and paranoia, symptoms that undoubtedly were attributed to the undiagnosed condition of hemochromatosis. These were identical to many of the problems that led to his father's suicide. It would later be discovered to have run in his

PSY303: FINAL PAPER 31 family, and was directly related to the suicides of a total of seven Hemingway’s. Clarence, his father, his siblings, Ursula, Leicester and Ernest, his two sons John and Gregory, as well as Ernest's granddaughter Margaux (Wagner-Martin, 1999). As the fascinating and tragic story nears its close, Martin (2006) includes further details from Lynn (1987). Hemingway was seen by Mayo Clinic Psychiatrist Dr. Howard P. Rome, who treated the author with electroconvulsive therapy (Lynn, 1987, p. 584). After a seven-week hospitalization, he was discharged home, entering a period of relative wellness (Lynn, 1987, p. 584). During these weeks he ate and slept well and limited his drinking. He also maintained a strict writing regimen and was, in his own words, 'working hard again' (Lynn, 1987, p. 585) on what would become the memoir of his youth in Paris, A Moveable Feast (1964). As Hemingway's depression slowly returned, Martin (2006), citing accounts by Lynn (1987), told of how it began to take hold of the doomed Hemingway. 'He lost the ability to write, breaking down in tears when he could not summon words. It may have been that the years of alcohol abuse and cumulative traumatic brain injury led to cognitive impairment that, combined with depression, robbed him of his skill in writing. Regardless of the precise etiology, the one gift which had meant everything had now deserted him' (Lynn, 1987, p. 589). In April of 1961, Mary came upon him as he was beginning to load a shotgun. Soon afterward, he was hospitalized near his Ketchum, Idaho, home (Lynn, 1987, pp. 589-590). Before long, he asked to return to his house to retrieve some items. While at home, he ran from the hospital staff that were escorting him and grabbed a shotgun preparing to shoot himself.. The hospital staff members caught up with him and disarmed him (Lynn, 1987, p. 590). He was transferred to the Mayo Clinic for a second admission, but as the plane stopped to refuel in South Dakota, Hemingway, started walking toward the plane's spinning propeller, stopping when the pilot cut the engine

PSY303: FINAL PAPER 32 (Lynn, 1987, pp. 590). After attempting suicide four times in three days, Hemingway was hospitalized at the Mayo Clinic for two months. He underwent further treatment with electroconvulsive therapy and was discharged on June 26, 1961. Mary feared that her clever husband had 'charmed and deceived Dr. Rome to the conclusion that he was sane' (Lynn, 1987, p. 591). The day after the couple arrived home in Ketchum, they dined out, and Hemingway told his wife that patrons in the restaurant were actually FBI agents there to monitor him (Lynn, 1987, p. 591). He was by no means well. The next morning, Hemingway awoke before his wife and took his life while she slept (Martin, 2006). X. Results of Evaluation: Ernest Hemingway is quite possibly at the top of the list when you think of cases that are difficult or nearly impossible to evaluate to a degree that could provide sufficient conclusive results. Having been afforded the luxury of hindsight and the invaluable wealth of information available from countless sources, the task becomes somewhat less impossible although by no means straight forward. That being said, I tend to agree with the assessments made by Martin (2006) for the most part although there are additional insights derived from other sources that I find can add to Martin's conclusions. Toward the end of Ernest Hemingway: A Psychological Autopsy of a Suicide, Martin expresses the following: When considering all of the factors that contributed to Hemingway's deeply troubling misery, it is clear that both biological and psychosocial issues were involved in the destruction of Ernest Hemingway, Martin (2006) concludes, 'The list of conditions that brought on the burden of illness that overcame Hemingway at the end of his life are staggering.' 'Bipolar mood disorder, inherited from his family had plagued him with abnormal mood states most of his life. putting him at greater risk of major depression to treat himself. The reserpine and secobarbital

PSY303: FINAL PAPER 33 may have further contributed to his depression. Long term alcoholism, along with several traumatic brain injuries likely caused severe damage to neuronal networks, lowering his ability to control his mood and spurring on the development of a psychotic illness.' 'His childhood experiences led to a tendency toward narcissistic and borderline traits. His father's, fate seemed a constant factor that brought Hemingway to contemplate following his example' (Martin, 2006). XI. Diagnostic Impression with Differential Justification: My personal impressions with regard to diagnosis in the complex case of Ernest Hemingway's lifelong spectrum of illnesses is that he displayed a number of characteristics that show a comorbid connection between the physical and psychological. As noted in Abnormal psychology: DSM-5 update, the American Psychological Association and countless other sources, the connection between mental health and physical health is clear (Getzfeld & Schwartz, 2013). My approach to psychology has always been from the standpoint of a dialectical, existentialist holistic approach. It is easy to sit back and say this now, after the fact, but had I been treating Mr. Hemingway, I believe that I would certainly made the connection between his physical health conditions and his psychological disorders. In understanding those connections, I would have worked closely with his medical doctors to arrive at a treatment plan that took into account all of those factors. I certainly would have required blood tests, brain scans and other tests to find any underlying illness or pharmacological treatments that could have had implications on his mental health. Once those results were objectively reviewed, I have no doubt that the hereditary condition of hemochromatosis would have been identified and a comprehensive treatment plan involving the life threatening illness would then be immediately implemented. I strongly believe that had that happened, Hemingway would not have had to suffer the decades of misery that eventually drove him to suicide. It was the failure of

PSY303: FINAL PAPER 34 Hemingway's treating physicians to recognize these clear connections in their approach to treatment that did not provide the life-saving measures that he so desperately needed. In his publication of Hemingway's Suicide Caused by his Doctors, Dr. Gabe Mirkin, MD. made the very same assessment and provided significant evidence for his assertion that were extremely convincing if not 100% conclusive (Mirkin MD, 2013). Dr. Mirkin put forth the following assessment of Hemingway's comorbid conditions; I have included them unaltered to maintain the precise accuracy and integrity of the vital statistical and medical information: 'In 1961 I was in medical school, and I remember seeing his disease described clearly in medical textbooks, including all of the signs and symptoms that Hemingway's doctors missed. This disease has a simple treatment, well-known at that time, that would have prevented virtually all of his disability.' But What Really Killed Him?  Throughout his life, he suffered severe arthritis, cirrhosis of the liver, severe heart disease, arteriosclerosis, diabetes, depression and loss of teeth.  His father suffered from diabetes, his skin turned a bronze color later in life and he committed suicide.  Hemingway's last years were incredibly similar to those of his father: severe depression, loss of memory, diabetes, and suicide.  He was of Celtic heritage.  His liver damage was not caused just by his heavy drinking.  The year before he died he spent 56 days in the Mayo Clinic being treated for liver, heart and kidney damage, diabetes, arthritis, and depression (one disease can cause all these symptoms). His treatments included electric shock therapy.

PSY303: FINAL PAPER 35  He spent every minute of the last few years of his life suffering from pain all over his body.  He treated his total body pain with drinking mixtures of tomato juice and beer, gin and lime, Angostura bitters, or absinthe and champagne. In 1961, he considered suicide and returned to the Mayo Clinic for more electric shock therapy. He lost even more memory and finally he shot himself. He was driven to suicide by extreme pain, depression and loss of mental facilities. The Diagnosis: 'Medical records made available in 1991 prove that Hemingway was finally diagnosed with hemochromatosis just before he died in 1961. Hemochromatosis is a hereditary disease that most likely affected the five other members of his family who committed suicide. It is most common in people of Irish, Welsh, Scottish and other northern European heritage.' How Hemochromatosis Can Destroy Every Cell in Your Body? 'You need iron to stay alive. It functions in many of the chemical reactions in your body. It also helps your body carry and use oxygen. However, iron is a potent oxidant that can deposit in and damage every cell in your body. To protect you from being poisoned by too much iron, your intestines stop absorbing iron when you have too much.' 'People with hemochromatosis lack the ability to stop absorbing iron when they have too much. This genetic defect causes people to suffer damage to every part of their bodies.' Iron can accumulate: • in your brain to make you lose your memory, cause depression, and interfere with every brain function • in your pancreas to cause diabetes

PSY303: FINAL PAPER 36 • in your liver to cause cirrhosis • in your skin to turn your skin a bronze color • in your eyes to cause loss of vision • in your joints to cause horrible, painful arthritis The Treatment: 'If iron levels are kept in the normal range, there is no tissue damage and a person with hemochromatosis can live a perfectly normal life. Every few months the doctor does a blood test called ferritin, a measure of how much iron is deposited in the person's tissues. When blood levels of ferritin are too high, the excess iron can easily be removed by drawing a pint or two of blood. This blood is perfectly healthy so it can be used in blood banks, although some (including the American Red Cross) refuse to accept it' (Mirkin MD, 2013). What If Doctors Made the Diagnosis Earlier? 'If Hemingway had blood withdrawn every time his tissue levels of iron were too high, he could have avoided all of the horrible pain he suffered and probably would have lived a much longer life. He would not have had to suffer damage to his brain, liver, pancreas, eyes, joints and skin. His suicide can be explained completely by the pain of untreated hemochromatosis. As many as one in every 200 people suffer from this highly treatable genetic defect (Mirkin MD, 2013). XII. Recommendations: The American Psychological Association has published a number of directives promoting the expansion of psychiatric idioms of diagnosis and treatment to involve a comprehensive holistic approach that accounts for the overall health of the individual to achieve optimal effective outcomes (APA, 2017). Former U.S. Surgeon General David Satcher, MD, PhD

PSY303: FINAL PAPER 37 attempted to express this concept by stating, 'In short, mental and physical health are inextricably linked.' “There is no health without mental health.” He might have added, “There is no mental health without health.” This has important implications for the delivery of physical healthcare in close conjunction with mental healthcare in promoting overall health and wellbeing (APA, 2017). It is my strong recommendation that treating medical physicians and psychological professionals alike, begin a much more comprehensive approach to diagnosis and treatment beginning with expanded knowledge through education and a restructuring of the axioms that determine the diagnostic side of medicine as well as the formulation of treatment strategies. An empathetic, existential and entirely more holistic approach to the treatment of all illness is the only means by which treatment professionals can be assured of providing the most effective health outcomes for their patients.

PSY303: FINAL PAPER 38 References Getzfeld, A., & Schwartz, S. (2013). Abnormal psychology: DSM-5 update. San Diego, CA: Bridgepoint Education Inc. Wagner-Martin, L. (1999). A Historical Guide to Ernest Hemingway. Oxford University Press, NY. Retrieved from: http://site.ebrary.com.proxylibrary.ashford.edu/lib/ashford/ APA. (2017). American Psychological Association: Research, Resources and Treatment. APA Official Website. Retrieved from: http://www.apa.org/research/action/glossary.aspx Dömötör, T. (2013). Anxious masculinity and silencing in Ernest Hemingway’s 'Mr. and Mrs. Elliot'. HJEAS: Hungarian Journal of English and American Studies, 19(1), Retrieved from: http://search.proquest.com/docview/1708804237?accountid=32521 Walsh, J. (2011). Being Ernest: John Walsh Unravels the Mystery Behind Hemingway's Suicide. INDEPENDENT UK. Retrieved from: http://www.independent.co.uk/ Martin, D. (2006). Ernest Hemingway: A Psychological Autopsy of a Suicide. Psychiatry 69(4). Retrieved from: http://creativityandmadness.com/ Bio. Editors. (2014). Ernest Hemingway - Macho Man. The Biography.com Website. A&E Television Networks. Retrieved from: http://www.biography.com/people/ernest-hemingway-9334498/ Bio. Editors. (2014). Ernest Hemingway - Nobel Prize. The Biography.com Website. A&E Television Networks. Retrieved from: http://www.biography.com/people/ernest-hemingway Meyers, J. (1985). Hemingway: A Biography. Harper & Row: New York.

PSY303: FINAL PAPER 39 Retrieved from: http://salempress.com/store/pdfs/hemingway.pdf Donaldson, S. (1995). Hemingway and Suicide. The Sewanee Review, 103(2), 287-295. Retrieved from: http://www.jstor.org/stable/27547014 Cobb, S. (2016). Hemingway’s Death and Hemochromatosis Awareness. Fighting Celtic Curse. Retrieved from: http://celticcurse.org/ Reynolds, M. (1985). Hemingway's Home: Depression and Suicide - JSTOR. MICHAEL S. REYNOLDS North Carolina State University. Retrieved from: https://www.jstor.org/stable/2926355 Mirkin, G. (2013). Hemingway's Suicide Caused by his Doctors. Drmirkin. Retrieved from: http://www.drmirkin.com/histories-and-mysteries/hemingways-suicide Robert, M.D. (2000). Hemingway: The final years. World Literature Today, 74(2), 375-376. Retrieved from: https://search.proquest.com/docview/209410425?accountid=32521 History. (2015). History: Biographies – Ernest Hemingway. © 2015 AETN UK. Retrieved from: http://www.history.co.uk/biographies/ernest-hemingway Barcella, L. (2013). Mariel Hemingway: “Nobody talked about anything in my family.” SALON. Retrieved http://www.salon.com/2013/11/05/mariel_hemingway DailyMail. (2015). Mariel Hemingway reveals the story of her famous family haunted by depression, alcoholism and suicide in two new memoirs. Daily Mail, UK Retrieved from: http://www.dailymail.co.uk/femail/article-3029335/Mariel-Hemingway Meyers, J. (1984). Memoirs of Hemmingway: The Growth of a Legend. VQR. National Journal of Literature. Retrieved from: http://www.vqronline.org/essay/memoirs-hemingway- World Health Organization. (20o4). Promoting Mental Health: Concepts, Emerging Evidence

PSY303: FINAL PAPER 40 and Practice. World Health Organization Manual; Updated 2017. Retrieved from: http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf Hemingway Home (2016). The Ernest Hemingway Home & Museum: The Legend. Retrieved from: http://www.hemingwayhome.com/legend/ Meyers, J. (1999). The Hemingway's: An American tragedy. The Virginia Quarterly Review, 75(2), 267-279. Retrieved from: https://search.proquest.com/docview/205380653?accountid=32521 King, S. (2016). The Hemingway's and Suicide. Today in Literature: Today's Story. Retrieved from: http://www.todayinliterature.com/stories.asp?Event_Date=7/2/1961 Olson, S. (2013). The Ongoing Mystery Of Hemingway’s Misdiagnosed Death: Accident, Suicide Or Genetic Disorder? Medical Daily. Retrieved from: http://www.medicaldaily.com/ongoing-mystery-hemingways misdiagnosed-death