by Andrew Farah
To be complete, there are other forms of bipolar illness to consider. The traditional label refers to bipolar “type I,” which involves classic manic episodes that last hours to days on end, along with bouts of depression and mixed states. When the mood state is abnormal, a patient may experience psychosis (delusions and/or hallucinations). Bipolar “type II” is a more subtle form. It involves bouts of depression but no true manias, just periods of “hypomania” that involve a level of hyperactivity, decreased need for sleep, and perhaps rapid mental activity but no symptoms that are sufficiently severe as to significantly impair day-to-day living. Type II is therefore a blunted form of bipolar type I. Type II is twice as common in women as in men, though type I is equally prevalent among men and women. The type II bipolar person may be harder to diagnose, as the symptoms of the illness may be mimicked by personality style or by symptoms of adult attention-deficit disorder or, as is very common, a substance abuse issue. And evidence does suggest that the type II patient is at higher risk for suicide than the general population, so the illness warrants careful monitoring and treatment as well.
Up to 60 percent of bipolar patients abuse alcohol or drugs, further muddying the diagnostic waters. Some patients are “self-medicating,” but others may actually induce the abnormal mood states through their chemical abuse. These patients have mood disorder symptoms—depressive, manic, or mixed states—that are purely the result of alcohol (or other drug) intoxication or withdrawal and/or the psychological manifestations of addicting illness. This is distinct from the bipolar person who drinks to calm down or abuses stimulants to fend off a depression, that is, those who “self-medicate.” Rather, for some people this is primarily a disorder of chemical dependency or abuse that results in marked alterations in mood and behavior. This was Ernest Hemingway. He was more vulnerable to alcohol-induced instability because of his head injuries (which make the brain more sensitive to the effects of chemicals, both prescribed and not prescribed), and these two causes of his mood swings comingled synergistically. And eventually, with more alcohol and more concussive blows, they blurred into the permanent damage of a brain with dementia.
Though chronic and excessive alcohol consumption will of course impair the liver, in many cases abstinence will result in normalization of liver tests over time. But the brain has fewer regenerative properties when damaged. Alcoholic dementia is similar in presentation to Alzheimer’s, but the symptoms may occur much earlier in life and often involve predominantly issues of impaired judgment and lack of inhibition. Small or moderate amounts of alcohol over an adult lifetime most likely confer some degree of protection from dementia; however, when the amounts are continual and excessive, the dementia may set in as early as a person’s thirties. The mechanism may have to do with thiamine (vitamin B1) depletion, as this and indeed all B vitamins are necessary for proper brain functioning.
Initially, patients with alcoholic dementia often present like those with frontotemporal dementia. The frontal lobes govern our morals and inhibitions and our emotions and behavior, and when synaptic loss occurs in the frontal lobes (loss of brain cell connections), one can expect inappropriate anger, outbursts of rage, emotional instability, and personality changes. The temporal lobes are essential for language skills, comprehension, verbal memory, and auditory and visual processing. They allow us to recognize familiar faces and understand what we hear—in short, to interface successfully with our world. Selective damage to these areas of Hemingway’s brain would have no doubt compromised his skills and career and also his very personality and social presentation. Over time, the damage becomes more diffuse and involves all aspects of the brain; eventually, with continued alcohol induced damage, the dementia is indistinguishable from Alzheimer’s.
During his early years, when he was famous only for his World War I injuries, and while recuperating in a Milan hospital, he would enlist the help of anyone (nurses, orderlies) handy enough (and willing) to supply him with alcohol, and when a cache of empty cognac bottles was discovered in his closet, the head nurse was described as less than amused.4 By all accounts he very typically charmed his way out of trouble, but the scene would appear in A Farewell to Arms—although Frederic Henry was accused of attempting to induce jaundice and avoid the front lines. Still, almost twenty-seven years later, in London, Hemingway would once again pull off this gutsy move, albeit not exactly the toughest of the alcoholic’s tricks, and obtain alcohol while in hospital. His drinking life most likely began when he was in his late teens, but he later claimed, probably falsely, that he was drinking by age fifteen. When he was eighteen he boasted in a letter to Bill Smith of downing his usual “18 martinis a day.”5 And, just a month shy of his twentieth birthday, he wrote to another pal of an enormous party at the Toledo Club, where “Your old pal Hem established the club record. 15 martinis, 3 champagne high balls and I don’t know how much champagne then I passed out.”6 Whether true or not, the sophomoric idea that intoxication is the preferable method of entertainment for the truly cool was all too clear, and, unfortunately, it was never outgrown.
Hemingway biographers face a dilemma. If they ignore the alcoholism, then much of the story makes no sense. If they elaborate on the exact amounts and patterns of alcohol use, then they inevitably get bogged down by alcohol’s metastatic influence—on relationships, marriages, writing, health, and depression. The biography then reads like a long and painful AA meeting. The exception is the masterful work of Scott Donaldson, Hemingway vs. Fitzgerald, in which he confronts Hemingway’s alcoholism head on and explains the illness thoroughly and elegantly. In a 1950 letter Hemingway described alcohol as the Giant Killer that “I could not have lived without many times; or at least would not have cared to live without; it was straight poison to Scott instead of food.”7 He never experienced the insidious slow grip of addiction that so many describe, but alcohol was an indispensable part of the lifestyle and the life. To embrace, to use, to wrestle with—Hemingway’s alcoholism was much in the spirit of Churchill’s famous remark: “I have taken more out of alcohol than alcohol has taken out of me.”
Donaldson, in his parallel biographical study of Hemingway and Fitzgerald, traces each man’s drinking life, using his fiction, letters, and the memoirs of friends and doctors to flesh out the fullest picture. It is clear that Hemingway, unlike Fitzgerald, was a functional alcoholic for many years before the embarrassing public displays that were so prominent in Fitzgerald’s short life began to figure prominently in his. Hemingway touted alcohol as a way of “changing his ideas” when stuck: “I have drunk since I was 15 and few things have given me more pleasure. When you work hard all day with your head and know you must work again the next day what else can change your ideas and make them run on a different plane than whiskey?” Donaldson concludes that “Alcohol, in short, was essential to his work and his well-being, as indispensable as food and shelter—and a source of great pleasure.”8 It was also medicinal. As Hemingway reported to Archie MacLeish, “Trouble was all my life when things were really bad I could always take a drink and right away they were much better.”9
Hemingway expected his women to keep pace with him. He bragged about his first serious love in 1918: “the missus [Agnes von Kurowsky] … had heard about my hitting the alcohol and did she lecture me? She did not. She said, ‘Kid we’re going to be partners. And if you are going to drink I am too. Just the same amount.’” He also describes her pouring out some “damn whiskey” for herself.10 The words are not typical of Agnes, and the story is more fantasy than fact, but his fantasy of lover-as-drinking-buddy came true more often than not. Of his wives, all but Martha Gellhorn generally kept pace with him.
During the Paris years, Ernest and Hadley would each have a bottle of wine with lunch and aperitifs before dinner, and then each would down another bottle of wine with that meal. He relied on exercise to “burn off the bad effects,” a daily regimen he adhered to and wrote of in 1929 to his editor, Maxwell Perkins—it was the vigorous exercise, the boxing at the gym,
the hunting, the fishing, the fresh air, that made it possible to “drink any amount.” He went on to state that he “lunched with Scott and John Bishop … drank several bottles of white burgundy.… Knew I would be asleep by 5—so went around with Scott to get Morley to box right away … had a couple of whiskeys enroute.… I finally fought myself out of the alcohol.” No doubt he was not in the best condition at the moment for a match. The fight was more damaging to him than to his friend Morley Callaghan. And controversy remains as to whether Scott Fitzgerald as timekeeper let a round go on far too long while Hem was losing out of incompetence, or whether, as Hemingway said, perhaps Scott was “so interested to see if I would hit the floor!”11
Technically, the body metabolizes ethanol to yield some energy, but these are expensive calories to take in—the natural muscle-relaxant properties, the sedation and depressant effects on the nervous system, as well as the dehydration, all argue that Hemingway would have been more vigorous without it. Protein or even complex-sugar-based calories would have been healthier.
Of course, his protagonists down spirits easily enough, and readers are often amazed at the amounts his characters consume. Throughout The Sun Also Rises, Barnes and company drink pretty much continuously, and, despite our narrator’s occasionally mentioning that he is drunk and at one point convincing us with his perceived bed-spins, Jake still manages to appear throughout the text as the only sober member of the party. Colonel Cantwell (in Across the River and Into the Trees) is also a classic example and, like Barnes, is generally accepted as Hemingway’s stand-in (both men are roughly the age Hemingway was when he created them). His typical drinking day is detailed by Tom Dardis in The Thirsty Muse. The Colonel drinks more than a quart of alcohol over just six hours or so. The afternoon starts with two Campari and gin cocktails, then goes on to six progressively dryer martinis, and finally he shares two bottles of champagne and three bottles of wine (one white, two red) with his lover. When the couple head to the gondola, they take another bottle of the red, a Valpolicella. There is no apparent compromise of the Colonel’s intellectual or sexual energy, and he wakes with no hangover.12
In the 1940s, visitors to Hemingway’s Cuban home, Finca Vigía, were greeted with absinthe, and at dinner there was abundant red and white table wine, with champagne flowing as well. After the meal, Scotch highballs seemed “endless,” according to one visiting couple, and for nightcaps the absinthe bottles returned. Hemingway “never seemed drunk,” according to guests, indicating great tolerance, and only later, when he mixed alcohol with sleeping pills, did he fall asleep in front of his company.
When Lillian Ross followed Hemingway and crew around New York for two days, in November 1949, she remained detached and reported each scene as a documentary filmmaker might. Her now infamous New Yorker article (May 13, 1950) was subtitled “How Do You Like It Now, Gentlemen?” It was Hemingway’s catchphrase of the moment—essentially meaningless and probably quite annoying to hear over and over. The result of her detached stenography, recording Hemingway’s “half-breed Choctaw” talk, as he termed it, was widely believed to be a hatchet job. The famous Hemingway, she suggested, was no genius, just a loquacious buffoon.
It was commonly thought that Ross and Hemingway were enemies, if not before certainly after her article. Hemingway scoffed at the idea, noting that they couldn’t be enemies because no money or sex had ever been exchanged between them. But, to most readers, the piece was largely understood to be a deliberately destructive effort. Yet the article makes perfect sense once one realizes that Ross had been recording the actions and words of a man who began his trips with bourbon shots in the airport bar, started each morning with champagne, and sipped from his silver flask while strolling the Metropolitan Museum of Art. The camera recorded a self-important man on vacation, disinhibited by alcohol and rambling on, not the expected literary genius. As Hemingway wrote to one friend, “I had just finished a book and when you have done that you do not really give a damn for a few weeks.” And he added, “There was no harm intended and much received. But I am still fond of Lillian.”13
Only intoxication can explain some of the disjointed and inappropriate content of many of his letters, particularly since Hemingway knew his letters were being saved at least for posterity and certainly for scholarship. He wrote to Charles Scribner on July, 22, 1949: “we ought to keep copies of our letters like Mr. Lord Byron and [John] Murray [his publisher]. I know some funny things that could write you if wasn’t so inhibited. Now I know the copywrite [sic] remains with me am liable to write you goddamn near anything.”14 A month later, he did write “-damn near anything”: “In regard to the new medium sized book I want you to get it into the Book of the Month Club and start chopping down trees for the paper now. If it isn’t good you can hang me by the neck until dead. I let Mary read 121 pages of it yest. and she hasn’t been any good for anything since. Waits on me hand and foot and doesn’t give a damn if I have whores or countesses or what as long as I have the luck to write like that. Have a lovely new whore so beautiful she would break your heart and three fine contessas in Venice. Three, I guess, is about the right number. But the finest one writes a lovely letter too. You would like her very much I think. Is an admirable woman. All this time I work at being a good and faithful husband to Mary whom I love. Think you will like the book.”15
But eventually Mary had seen enough whores and countesses. Hemingway even invited an eighteen-year-old Havana prostitute he had nicknamed “Xenophobia” to Finca, but at least he waited until Mary was out of the country.16 When she wrote to her husband the next year (May 1950) that she was leaving, she left no doubt that alcoholism was the reason: “Maybe it is ambiguous for me to explain my reasons for leaving. But I write them down because I think this time you should have the opportunity of knowing precisely how I feel about this marriage. It began in 1944 in bed in the Ritz Hotel in Paris and my own reasons for it were two: I thought you were a straight and honorable and brave man and magnetically endearing to me. And because, although I was suspicious of your over-drinking, you said so often that your chief desire was to be good and adult and to live your one and only life intelligently, I believed you and in you … you could if you want to, be a companionable and considerate husband—as well [as] gay and charming and sturdy in spirit, which you are when you are not drunk.… Your principle [sic] failure is that, primarily because of your accumulating ego and because of your increasing lapses into over-drinking, you have not been the good man you said you intended to be. Instead you have been careless and increasingly unthinking of my feelings, at times to the extent of brutality.” He is also described as remorseless, scoffing, petulant, and irritable and as believing that his “infallibility” should not be questioned.17
Mary never left. She was as determined as ever to be the last “Mrs. Hemingway.” But the themes are certainly familiar—the substance abuser who promises to straighten up and fly right, the woman who understands her role as the catalyst for his transformation, her belief that new love will be all he needs to do so, and, of course, the inevitable (and repeated) disappointments. No doubt, her frustration was compounded by the realization that when her husband wasn’t drunk, he was a classic dry-drunk.
It was also around this time that José Sotolongo, Hemingway’s Cuban doctor, removed the guns from Hemingway’s home. The Cuban lifestyle he had carved out not only included Papa Dobles at the bar but also pitchers of martinis at home. He and Mary were fighting very frequently, and the tension was fueled by Hemingway’s infatuation with his young Italian muse, Adriana, who came to stay in Cuba for an extended visit. “On one occasion I had to interfere bodily,” Sotolongo explained. “I left the house at four in the morning when I saw that the danger was over. They had threatened each other with firearms, and each of them had a shotgun. I had to take their guns away and hid them in my car.… That night I wrote to tell him, that our friendship was over, but he called me the next day and asked me to help him dry out.”18 During those Cuba years, Hemingway
was “always” intoxicated, according to Dr. Sotolongo, who had already warned him that “If you keep on drinking this way you won’t even be able to write your name.”
By the time he was fifty-seven, and only after further and stricter medical orders (because of an enlarged liver and hypertension), Hemingway did reduce his intake to two glasses of light wine at supper. It was at this point that he found himself and his surroundings boring and made the famous comment that equated the sober life with racing a car without motor oil. Yet there is evidence that his intake eventually crept up to its former level again. One researcher discovered a bill from March 1958 labeled “Papa’s Liquor” and added that “the bill for the month was $95 for wine and $45 for whiskey; Mary’s was $95.69 for vodka and gin. Throughout the summer, the liquor bill varied, but Hemingway’s personal consumption was averaging four to six bottles of whiskey a month and two or three cases of wine.”19
Though he did successfully limit his intake for a period of time, he was well on a downward slide by then. The damage caused by his alcoholism to cells that had suffered multiple concussive injuries was largely irreversible. The brain damage from chronic alcohol comes not only from vitamin deficiency, though this can be one mechanism, but also from a variety of other effects. As with any toxin a body ingests, the liver can deal with only so much. When the liver’s capacity to “detoxify” a chemical is overwhelmed, the toxic effects on brain cells lead to synaptic loss, just as in other forms of dementia: the brain cells literally lose their connections to one another.
