title: 'A man can be destroyed but not defeated': Ernest Hemingway's near-death experience and declining health.
abstract: Ernest Hemingway is one of the most popular and widely acclaimed American writers of the 20th century. His works and life epitomize the image of the hyper-masculine hero, facing the cruelties of life with 'grace under pressure'. Most of his writings have a quasi-autobiographical quality, which allowed many commentators to draw comparisons between his personality and his art. Here, we examine the psychological and physical burdens that hindered Hemingway's life and contributed to his suicide. We first take a look at his early years, and review his psychopathology as an adult. A number of authors have postulated specific diagnoses to explain Hemingway's behavior: borderline personality disorder, bipolar disorder, major depression, multiple head trauma, and alcoholism. The presence of hemochromatosis, an inherited metabolic disorder, has also been suggested. We describe the circumstances of his suicide at 61 as the outcome of accumulated physical deterioration, emotional distress and cognitive decline. Special attention is paid to the war wound he suffered in 1918, which seemed to involve a peculiar altered state of consciousness sometimes called 'near-death experience'. The out-of-body experience, paradoxical analgesia and conviction that dying is 'the easiest thing' seemed to infl uence his future work. The constant presence of danger, death, and violence in his works, as well as the emphasis on the typical Hemingway 'code hero', can all be traced to particular psychological and neurological disorders, as well as his early brush with death.
authors.affiliation: Laboratory of Cognitive Neuroscience, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dieguez
mesh_terms: D005197:Famous Persons; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008513:Medicine in Literature; D001523:Mental Disorders / Q000266:history* / Q000523:psychology*; D008875:Middle Aged