Hi, everyone. My name is Ken Rosenberg. It's really a delight to welcome you to the beginning, or maybe even the pre-beginning of the AAAP Conference. We have an amazing task ahead of us. We're going to watch curated clips from Hemingway. Before that, we're going to watch one more trailer. So if you can, turn off your sound. We're going to have a Q&A session at the end after we speak about this. But let's watch one more trailer, and then I'm going to introduce you to our illustrious panel. Sarah, if you could play that trailer, please. So what we're going to see tonight is about 40 minutes of clips that Lynn Novick and her team at Florentine Films have been kind enough to pull for us. And Lynn's going to join us. But I'm going to introduce our two psychiatrist guests first. First, Dr. Andrew Farah is a Distinguished Fellow of the American Psychiatric Association and currently serves as the Medical Director of the Strategic Interventions Act Team in Central North Carolina, as well as attending hospitalist for Noven Health of the Triad. He is a forensic psychiatrist and the leading expert, the leading expert, I should add, again, on the mental, neurological, and medical illnesses of Ernest Hemingway with his 2017 publication of what I think is probably the seminal work on the medical experiences of Mr. Hemingway called Hemingway's Brain. Andy, just a pleasure to have you with us. We are also joined by Dr. David Previn, who is Clinical Professor of Psychiatry and Behavioral Science at the Albert Einstein College of Medicine at the Montefiore Medical Center. Dr. Previn's career has been focused on teaching psychiatry. He has been an active participant in the major psychiatric exams, including the American Board of Psychiatry and Neurology and the PRIDE exam. And finally, in addition to his clinical practice, he works as a forensic psychiatrist. And since my days at Einstein, I'm just very pleased to say Dr. Previn has been my mentor in so many ways. David, it's such a pleasure to have you join us. Thanks for being here. Nice to be here. And last but not least, there's Lynn Novick. The 92 hours of acclaimed PBS programming she has created in collaboration with her partner, Ken Burns, includes Ernest Hemingway, John Moore, Croabition, Jazz, Frank Lloyd Wright, The War, and Baseball. They have received 19 Emmy nominations, and Lynn herself has received an Emmy, a Peabody, an Alfred DuPont Columbia Award. She has done her own four-part series, College Behind Bars, in collaboration with her colleagues, and that was her 2019 debut as solo director. And College Behind Bars, if you haven't seen it, is an amazing work which explores the transformational journeys of incarcerated men and women. And full disclosure, Lynn is also my life partner, and she is broadcasting from the other end of our apartment here in New York City. Lynn, how are things at the north end of our apartment? Everything's good here. Sounds good. I can't hear you, so it's all good. So starting with Andy, if I may, you know, you have really dedicated many years of your life to exploring Hemingway, to writing this book. You appeared in Lynn and Ken's film many times. You know, you were just so helpful to them and so helpful to many people trying to understand Hemingway. But I guess my question for everyone, but for you especially, why Hemingway? I mean, why did you, you could have looked at so many people in literature and film in the world at large, why choose Ernest Hemingway? That's a great starting point. I had met one of the Hemingway biographers who asked me, I had done a lot of research on shock therapy, ECT, and he said, why did Hemingway deteriorate and get worse after ECT instead of get better? And I said, well, patients who generally get worse, not better, they tend to have some organic brain disease. And the ECT is just a stressor that propels that and accentuates that rather than has a curative effect. And he said, well, what was Hemingway's organic brain disease? I said, well, let me read your biography and let me read. And it was so addicting. I began reading all the biographies I could, and I was stunned at how no one had put the pieces of the puzzle together and had, as you know, from the book, I mean, the man had numerous minor and many major concussions. And he seemed to me to have, by the time he was in his early fifties, a form of chronic traumatic encephalopathy, a form of dementia, but that was where it started was just trying to answer that question. And I'd always been a fan of the work and I felt it was transcendent in a way. And I came to modernism through him, I became a Joyce fan and so forth, but the biographies were so addicting. And like they say, the, his biography is more fascinating than many of his fictional works. I mean, if you think of the 20th century, you know, world war one, the lost generation, um, world war two, the Cuban revolution, the depression. I mean, he's, he's part of everything up until his death. He's a major player or a figure in just about everything, but that's where my interest started. And I, and I was so tired of hearing people get it wrong and say, well, he was just an alcoholic. Well, yeah, that's a piece of the puzzle. Or he was a bipolar, which is, I think is not true, but some people still- We're going to argue about that, I hope. No, but that's great. That's great. And, um, I mean, you're, you're, you, you, you wrote the book with such a literary flair. Uh, are you a writer also, Andy? Um, you know, I, I, I tell people I've been writing since I was in third grade, but nobody cared until I was in my forties. So, you know, yeah, I, I kind of, uh, always been a writer and always enjoyed it. And I think psychiatry, as many of your people listening, like Charles Krauthammer said, it's the closest you can be to a philosopher nowadays is to go ahead and do psychiatry. So, uh, yeah, I, um, I think it's the right branch of medicine for me, but yes, you're very kind to say that and that that's very flattering. It's true. I mean, I, I, I think the book is just a fantastic read, not only about Hemingway, but about the history of psychiatry. It's fantastic. Dr. Previn, who I know since my days at Einstein. So nice to have you here. When you, you were one of the people who watched Hemingway with Lynn and Ken Burns and gave notes on it. Um, you were the person who said to Lynn, I, you know, we should really do this as a grand rounds in some kind of psychiatric, you know, event. Um, and I'll ask you the same question. Why Hemingway? I mean, that we could talk about so many different artists. I mean, it's people. Why, why did you think Hemingway would be important to discuss? Well, let me segue on the, on the writing, uh, that was talked about at first, I really hated Hemingway, uh, in college, uh, because we had a new writing course that really emphasized the new way of writing, uh, Hemingway's. I came from central high school, Scranton, Pennsylvania, everyone would use adjectives and adverbs, long sentences. I thought they were great. So on my first paper on St. Augustine, I got an E minus minus needless to say, I was crushed and I thought, what the hell is going on here? And then as time went on, I discovered that writing simple declarative sentences, wasn't a bad way to go. And as I began to look into Hemingway a little bit closer, um, I thought what Hamlet said, what a piece of work is man, uh, really was appropriate for, uh, for Hemingway as well. An amazing person. Uh, he won a Nobel prize and a Pulitzer prize. He was a womanizer who, for the macho guy that he was, cross-dressed and often had a menage a trois. He was a great hunter for both animals and fish. He was a gambler. Uh, he was of course a wonderful writer. Uh, he was a poet and he was a short storyteller. And once, uh, in his bon vivant, uh, appearance, he was at the cafe in, uh, at the Gauntlet Hotel and he made a bet with some of his buddies that he could write a short story in six words. And they said, forget it, you'll never do it. And they put their money down and he told the following, for sale, baby shoes, never worn. Needless to say, he collected. So, um, uh, I would like to, uh, share with others, um, after they see the clips, my thoughts on, uh, on Hemingway. And of course, most compelling for this, uh, audience is the fact that he was one of the most remarkable alcoholics I've ever seen written about, talked about, uh, or in any way referred to. Martinis, Mojitas, Bloody Marys, he lived on them. And, uh, I, I would like to spend some time emphasizing that in terms of his, uh, downfall. We will indeed. We will indeed. Thanks, David. Lynn, um, I, as you and I know, you spent years working on this. When you, when you work on a project, you really have to dedicate probably close to a decade, you know, from beginning to end and, you know, and, and from the time you conceive it to the time you publicize and talk about it. Um, why Hemingway for you, Lynn? Well, first of all, just to say, thank you for having me and for having the opportunity to have this conversation about Ernest Hemingway, because when we were working on the film, we're thinking about some of the questions we're going to be speaking about tonight and really never got to the bottom of, you know, what his problems were. So I'm very eager to hear the conversation that we would get into later. For me, I, I am an avid reader of literature and I discovered Hemingway in high school and I did find his work totally transporting. He has a way to conjure a world and people with sort of very spare prose, not always, but often. And I found it just riveting. And I, um, I'll talk about this a bit later, but the short stories in particular, they're just so, um, compressed is the word. He, he, he packs so much in by saying so little and he leaves a lot to the reader to kind of fill in the gaps. And I love that, that you have to participate as a reader in his work. And yeah, I will admit it. I was fascinated by his persona. I mean, as David was saying, he was larger than life and we'll see that in the clips that we're going to show. So, you know, I remember reading a farewell to arms and looking at the picture of the author and thinking, oh my goodness, this guy is gorgeous and fascinating. And he wrote this. And so that was sort of a lifelong, somewhat innocent, you know, interest in Hemingway. Um, delving into this film was an opportunity to look at the life of an artist, a complicated person and, you know, iconic American. And we also had to deal with as anyone would the fact that the moment we're in, you know, the 21st century, he's a very problematic figure. He's a white man of a certain generation with certain attitudes and ways of being in the world that we find quite concerning and problematic. And so we wanted to wrestle with all of those questions too. So I guess that's, that's good. Oh yeah. So as a great star, so a complicated man, material for a very complicated and, and I would say brilliant series. And the critics certainly agree with that. Um, before you introduce the clips, I just want to say, you know, so you understand the format, uh, we're going to look at 10 minutes of clips, talk to differential diagnosis, look at another few minutes of clips, talk more about differential diagnosis, look at maybe 15 minutes of clips, and then we're going to open it up to a Q and a, and which, if you have any questions, please put them in the chat. We'll pay attention to those. And what we'd also like to do is call on people, you know, not to, not to, to, to go on, on, but to, but to ask a question really to, to have an exchange with artists, incredible experts, you know, here we have the filmmaker, I know the director and producer, we have, you know, an expert on bipolar disorder and mood disorders and alcoholism and expert on Hemingway himself. So put your questions in the chat. So we'll get to them. Lynn with that, would you introduce the first 11 minutes of clips before? So we're going to show you what we call the overture, the introduction to the entire series. The series is three parts, six hours. So we delve into his life and work in a great deal of depth. So we're going to show you the first eight minutes just to kind of introduce the audience to who is this person? Why should we care about him? And then there's a clip that covers a little bit about his childhood, because certainly as biographers, we always are fascinated by where did somebody come from and what was the family situation and what shaped him. So you'll get a little taste of that. And then we will come back and chat some more. Great. So everyone mute yourself and we'll roll the clips for 11 minutes. Okay. So that is our first jumping off point. David, Andy and Lynn, if you could turn your. Yeah, great. Are you there, Lynn? Lynn, that was our stopping point, wasn't it? Yeah, yeah. I think. Okay, good. I just want to make sure we're on track. So just again, to reiterate how we're going to do this, we're going to talk about the differential. We called this Hemingway's Psychiatric Autopsy. I think post-mortem might've been a better, more accurate title. I mean, really what we're going to try to think about are the psychiatric and psychological problems that he faced without being overly burdened by the psychiatric nosology, but to understand where in his first few decades at this point, do we see what would later come to haunt and even destroy him in terms of personality, in terms of alcohol, if you will, in terms of mood disorders. I don't think we've really yet got to the CTE issues. We will soon in the next clip, but let me start off with you, Andy, because you've studied this so closely. What do you see now in the first two decades or three decades of Hemingway's life that you're like, that's going to be a problem? Yeah, there's certainly the genetic underpinnings. You know, his father committed suicide using the Colt pistol carried by his own father in the Civil War. His father had diabetes and some anginal pain, but he ruminated about some financial matters that probably weren't as big a deal as he thought. Long story short is of course, his father suicided. And there's a story that he wrote, well, there's a letter he wrote to Mary in the 1940s when he was talking about his grandfather Hall. So his mother's father who had Bright's disease, which is a form of kidney inflammation and kidney disease. But this man was suffering and he wanted to kill himself and his own father had taken the bullets out of the gun that this grandfather had hidden under his pillow. And Hemingway wrote about how this was a rotten thing to do, but he, it's probably an apocryphal story because Hemingway himself was only five years of age at the time, but he believed himself to be the descendant of suicidal men on both sides of his family. And when he was marrying his second wife, he wrote to his future mother-in-law that he hoped that their bloodline would quote, breed the suicidal streak, you know, out of their children. So he felt he had inherited that. And then the other, this dynamic between his mother and father, there's a wonderful story, the doctor and the doctor's wife, which is really not disguised. It's his father and his mother. And his father has this altercation with somebody who's very upset and he comes in and he just wants to vent to his wife and he just wants to be angry. And sometimes I come home, I just want to vent to my wife and just be angry and just let it go. But his wife quotes, quotes scripture to him, a man that rule is as anger is better than a man that rule at the kingdom or something like that. And so his father leaves even more frustrated. And that was a microcosm of how the relationship played out between his parents that he's this passive aggressive mother who felt that she had sacrificed for her, her own career as an opera singer for the family. And the, the, the father who was just kind of trudging away. And if people couldn't pay him, he didn't mind sort of thing. So that, that one author, one of his friends wrote later and one of the biographers picked up on the idea that Hemingway truly hated his mother. And he saw his father as sort of both cruel and abused was the famous line. So, and then there's a lot of talk about the, the sort of the gender blending. Now, later in life, he he did enjoy the company of his first wife and his future second wife together. And he and all of his wives tend to except for Martha did participate in this sort of activity where they were all intimate together. But this, this idea that he was somehow repressed. I mean, there were a lot of Victorian babies who were dressed in gowns. And I think he was far too young to be, to be impressed by the fact, oh, I'm dressed like a girl. I think he was far too young to be affected in that psychological sense of the 20, but a lot, but it's wonderful for the psychoanalysis of literature, people kind of take off on that. But I think that his, his libido was certainly active. And he's, he was certainly ahead of his time, as we might say. And if you read the latter fiction, I mean, here's a man in his fifties writing garden of Eden, which is a book about a couple of women and a guy and their intimacies. And the women seem to have this, what we would call a borderline personality disorder, which a lot of his female characters do have Brett Ashley, Margo McComber, and the women in garden of Eden. So anyway, long story short, I don't put as much emphasis on that as other people do. I think there was the, the father, mother dynamic and the, and of course, his understanding of his genetics and his, and his genetics, of course. Great. Thank you so much. And, and David, same question. What do you see in these, in the, in the clips and also, you know, we've talked about Hemingway quite a bit in these first 25 years, let's say, where you see the groundwork for what might later haunt him? Well, actually, we don't see when he's a little bit older in the next clip. And then I think one can get a little bit more from that. But I would agree with much of what Andy said. He called his mother a bitch, actually. And by all accounts, she seemed to be very, very tough and very, very unpleasant. I also agree with Andy that his being dressed as a girl or as a boy, having his sister dressed as a boy, did not have the impact that he has later in life when he likes to cross-dress when having sex. And, well, is that genetic? The curious thing is even his son Gregory actually became one of the earliest, probably, trans women and got into great difficulty whether he liked to cross-dress too and would actually do it on the street and eventually ended up in jail. So at this point, we have just sort of a little bit of taste of a place that has no saloons. And, of course, he's one of the most impressive alcoholics, if you can use a word impressive, that one will encounter. And it's kind of a teaser, I see it as, this particular clip, because it really begins to show a great deal, I think, in the next clip where you can really wonder, whoa, who the hell is this guy by his numerous kind of facades and the way he behaves? The next clip, I really think, begins to really give you some meat to chew on and wonder, who is this man? How did he get to be like this? Yeah, thank you. Thank you, David. Lynn, I know you're not a psychiatrist, but we won't let that stop you from opining about his psychiatric and psychological. You know, we talk a lot about not just the CTE, which we'll get into in my part, but just in general, personality disorders, impulsivity, narcissism. Do you see any of that in your knowledge of his first two decades? No, yes, I mean, I agree with everything Andy and David have said so far, but just to focus on his early life and the mother, father, and the family dynamic, I do think that's an interesting way to understand his personality and his psychology. And we sat around with, early in the process, the leading Hemingway experts, and they had quite a discussion about whether or not he really hated his mother, how bad was she? And to present a more nuanced picture of her, which we do later on in the film, that she was an artist and she gave him his artistic sensibility and his sense of kind of grandiosity also. The opera singer, the center of attention and the charisma, but that she taught him discipline, she taught him to love the arts and self-expression, and that in some ways he was very close to her, but he could also see a somewhat difficult relationship between the mother and the father. The father was somewhat passive, as Andy was saying, and he was depressive and anxious, and he actually had to go away to have a rest cure multiple times in his life, Hemingway's life. And the family didn't know what to do with that, and that speaks to the stigma of mental illness back then. You know, no one could talk about it. It was sort of not just taboo, but just not addressed. And so I think that set Hemingway up to sort of not deal with problems when they would come up, in a way, and to see it as a weakness. And so I just think, and the other thing of the alcoholism I was thinking about in watching the clip is that he grew up in this puritanical home, I guess I would say, no drinking, no dancing, no swearing, you know, all of that. And so, not surprisingly, he came of age during Prohibition, and he just went completely the other way. And we all know, you know, Prohibition didn't work, but partly because the, you know, the allure of something you're not supposed to have, he just hook, line, and sinker. I think that did have an effect on his attitude towards alcohol, which certainly was very destructive to him. I think Lynn's point is very good about that. You know, the alcoholism was kind of a rebellion against mom at a young age. And later in life, Mary was very maternal, his fourth and last wife. And that was another way he would just kind of be the naughty boy, was to be drunk and disruptive. And then she was, you know, the Martinette and so forth. And so it's almost like he, later in life, he replayed that adolescent relationship with his mother, with his fourth wife. Hmm. So Lynn, do you want to set up the next set of clips? And just for Sarah and Kelly, who are going to play the clips, we're going to go to 1428 in that timeline. Go ahead, Lynn. Okay, right. This is just to bring him up to, you know, Hemingway really wanted to be a soldier. He wanted to be a hero. And he was, he didn't want to go to college. So he basically went, didn't run away from home, but he went to work in the newspaper business in Kansas City. And as soon as he could, he volunteered. He had bad eyesight, so he couldn't be a soldier in World War I. So he joined the ambulance service and was sent to the Italian Alps. And we're just going to drop you, and this is a seminal experience in his life, psychologically, physically, and every other way, as it was for anyone who went through it. And he, you know, as Andy said, became the voice of his generation. So we're going to show you his experiences in the First World War. Great. And we'll be back very soon. Right. Remember, if you have questions, put them in the chat. And I will just say, one of the joys of making this film is that Hemingway saved everything, as you'll see. So, and his family saved everything. Every letter he ever wrote, every letter he received, every photograph. And that was a very helpful to get insight into him. These letters and the way he expresses himself helped us a lot. Great. So now some more from Hemingway. And if I die, I'm lucky. Received that letter from a child of mine, I have to say. Imagine the parents getting that letter. Imagine getting that. Quite incredible. So, I mean, there's so much there in those four minutes. We're going to look at 12 minutes very soon and go in greater detail. But again, going, starting with you, Andy, what do you hear in those four minutes where you're, aha, the plot's thickening. You know, I could get a better sense of who this man is becoming and what he may face down the road. Right, you're right. There's so much there. There's just this incredible wisdom for such a young person and this sort of these, I guess you'd call them heroic statements. At the same time, he was getting this gradual cynicism about the war and what it meant and so forth. I think his first assignment was to clean up an explosion at a munitions dump or something where he was just removing body parts or something. And that was this horrible initiation to the war. But we have this five-gallon Austrian mortar blows up and he was not the first American to be wounded in Italy, but he was the first American to be wounded and survive. There was a death before him. But the bottom line is he had this blast injury and he described beautifully in Farewell to Arms this out-of-body experience, which you know about if people have a blast wave concussive injury as opposed to a direct blow concussive injury, but a blast wave, sort of a shock wave concussion, about 20% of those folks will report an out-of-body experience just like Hemingway had. So is it, you know, and there's a debate, you know, I've talked to neurologists who believe it's just a neurological event. And I've talked to more spiritually minded folks who believe it's a spiritual event that leaves a neurological footprint perhaps. Is a transcendent event? Is it not a transcendent event? And we've had patients that leave, you know, that talk about out-of-body experiences and they somehow register what's in the room and they know what's as they're floating above themselves. So, but what's fascinating is, yes, we do see this with this type of head injury, but a blast wave head injury versus a direct blow head injury disrupts the connections between the white and the gray matter of the brain. So the connections and the cortex, right? The thinking part and the connection part are significantly disrupted in that type of head injury. And that's a particular setup for chronic traumatic encephalopathy. So that one injury enough could have caused him a lot of trouble later on. He wrote about that, of course, in Farewell. He wrote about it in a story called Now I Lay Me, which is about an individual who's afraid to go to sleep because, you know, he's afraid his soul will leave him. And strangely, in 54, when he's on the safari with Pauline, he's writing in his Africa journal about how he believed that he had a soul because it left his body. But now as an older, as a middle-aged gentleman, he doesn't believe that there's a soul. He believes that when you die, you're what he would call deader than the lion, you know? So it's so strange to watch his spiritual progression from being this sort of devout congregationalist Protestant family to becoming a Catholic for his second wife, to eventually rejecting Platonism altogether and saying that there is no, the soul is, there is no soul. I don't believe in it. There's no such thing. Even though it left my body, I believe it in at one time. So you see this showing up in his writing and you see it as the central event. In fact, when he has the skylight incident where he comes in drunk in 1928 and he's been drinking with Archie MacLeish, goes to his Paris apartment and pulls his cord to flush the commode and instead pulls a skylight on his head, gives himself another concussion. It was that that reminded him, the blood flow, the taste of blood reminded him of his World War I days and what was just a story going nowhere became farewell to arms, you know? And we'd mentioned earlier, you know, about the narcissism perhaps. And I think it kind of being honest about it, if I could do sun also rises and farewell to arms by the time I was like 28, I'd be pretty narcissistic, you know? So I think there is a baseline of that where he recognizes at a young age, his own genius, which is that, I don't know if it's good or bad, but he recognized that. But I think the main thing here is that significant head injury. You see that beautiful hospital, the Villard photo in the hospital where he looks just like a movie star. I mean, just incredible good looks. And of course he begins his affair with Agnes and he falls in love with her, thinks he's gonna marry her, she rejects him. There's also the story while he was in the hospital that he did develop jaundice. It was probably just hepatitis A from drinking contaminated water out there, but the head nurse accused him of drinking too much to avoid going back to duty and giving himself that sort of alcoholic hepatitis, which was not the case, but that shows up in also Farewell to Arms. So that great little clip, there's so much biography in it. And you've said so much that's thought provoking. One of the things you said is that, you know, you talked about his narcissism and if we could do anything of that order, we would have the same ailment, if you will, as he suffered. But I would actually turn that over to you, David, and say, is it possible that narcissism even acquired through legitimately, if you will, can then lead to problems that did plague Hemingway? I mean, do you see any of that we'll call acquired narcissism being coming, not just, you know, justifiable bragging, but something that gets him into deeper trouble in the rest of his life? Well, you have to define what you look at. You mean when you say narcissism, it's a personality disorder, if you want to go according to the DSM-5, and as such, it begins very early in life. He certainly isn't narcissistic when Agnes dumps him. He is very bereft. He thinks he's never going to find someone else and he's not narcissistic at that point. And I don't know if narcissistic is a fair word to use someone who's a star. They really feel so positive about who they are that it's almost natural. And there were periods of time where he gets quite depressed and where's the narcissism then? Narcissism is supposed to be a personality disorder that's forever with you. I don't think that's him. What I do think is striking, and Andy's book is terrific, and I don't agree with all of it, his reaction towards this terrible event is so strange. He's smiling in bed. Of course, he has, if you look at another picture, he has a bottle of booze underneath the sheets, so he's kind of a little tanked up too. And he's talking about how great it is to be in kind of this disaster, how much you've grown. And so if I die, so what? It doesn't matter. Well, that's kind of thinking very, very overly positively. And you wonder, is he a little bit elevated at that point? His talk about suicide, well, if you're an old man, it's okay. Well, but it's okay also if you're a young person, then you die young. He really twists it around in a way that you wonder, where is this guy coming from? 200 charge of shrapnel, four bullets. I mean, who could be responding like that? And the nurses found him real trouble. He demanded this, he demanded that, but he was very charming. And as you can see, a very, very good looking guy. So I really saw this piece as an example of a kind of response that Hemingway had, which is kind of unique. You could say, well, other people have such experiences. And finally, let me say a word about the so-called experience of dying. I wonder if another way it might be looked at is the way we looked at hypnopompic and hypnagogic experiences, where the person isn't totally awake, isn't totally asleep, and they have an unusual experience, which doesn't mean very much in terms of psychopathology, unless there's more. And I wonder if it's a kind of that experience that people have when they almost die. Is that a kind of uncensored experience, which is related to what's happening to them? I don't know. And I think what Andy says is true. There's lots of ways to look at it, but it seems like he looked at it this way later in his life. More to follow. Yeah, to your point, David, it's when people do PET studies of people who can have out-of-body experiences, the parts of the brain that are most active are your visualizing movement. So somebody says, oh, remember, think about running down the field playing soccer as your visualizing movement. So that's sort of, again, is it something transcendent that leaves a neurological imprint, or is it something neurological that we mistake as transcendent? And also to your, gosh, you had another great point about this attitude. And it seemed like this event sort of propelled him to this adolescent sense of invincibility, because he sure lived his life as if nothing could hurt him. I mean, he was in World War II, which we'll talk about. He was constantly just a daredevil. I mean, shells would whistle through a farmhouse and he would keep eating dinner while everybody would run to the basement, or he would force a pilot of a plane to go to dangerous areas. He even got in a lot of trouble when he forced his little bicycle driver, and he was in the sidecar, go in what they called no man's land, and we'll talk about that German anti-tank round that threw him out of the bike. But yeah, he almost at that point had this sort of, this like teenage invincibility thing that just never, he just never outgrew. But is that, I thought that you might've been suggesting, David, that that was hypomania or a prodrome or a sign that there was a mood disorder and that there was mania. Isn't that what you're saying? Yeah, but you know, an adolescent, one could say is almost someone who is manic or hypomanic. But he wasn't an adolescent, he was an adult in a hospital bed, so. Well, he's 19, he's 18, he's 18. Yeah, and he grew up very quickly when he went back into, got married, and then he went to Paris, he grew up very quickly. But I do think his response is a little bit unusual and is a little bit more positive than the average person would have, given the fact that it must've been several months that he was in the hospital. And then he just fell apart when, of course, Agnes dumped him. So I'm not sure that he was still adolescent at that point. I think it may have been the form first, as they say, of a kind of a bipolar existence, which Andy, by the way, doesn't think he has, and we'll kind of discuss that. I'm gonna turn it, we're gonna argue about that for a few more clips. But I wanna, Lynn, you were struck by something. You said, can you imagine how horrible it is for a parent to get that kind of letter? Yeah. It actually says something about his personality there, doesn't it? Yeah, I've puzzled over that. I mean, if I die, I'm lucky. Who would write that to their parents? Right. It sounds like he wants to die or he doesn't mind. And that's the one thing any parent whose son is in a war zone, that's the last thing you wanna hear. But so I don't know, with Hemingway, you just really never quite know, even though he's only 18 or 19 when he wrote that letter, there's a lot of bravado and posturing that seems to be happening to me in the letter. He's sort of trying out different things of pontificating or opinions about death and life, and it's better to die young when you're in your full glory. But I wonder whether that's not just trying to deal with what he's just been through. And he is a kid. He's never been through anything like it before. I mean, he volunteered to go to the front lines because he really wanted to be a hero and he wanted to be remembered. All of that, like a lot of young men who go to war, I've made many films about war, and I can tell you that's a very common theme. And then as soon as you get there, you realize, wait a minute, this isn't at all what I thought it was gonna be like. Well, I don't wanna harp on this. That attitude, but hang on, that attitude, I mean, the three of you were talking about as adolescent, that attitude doesn't really shift, that attitude towards death and glory. Right. So it's not like this is like 19-year-old talk and it changes when you're gonna be a man and a woman has a baby. I mean, the thing is, yes, he's obsessed with and fascinated by death, even before he went to World War I. So there's a lot of things going on here and it's very clinical. You know, he was kind of an amateur naturalist. He loved to hunt and fish as a child, like Andrew or David was saying. And he loved to study these creatures, kill them and, you know, hold them. And that's his relationship to the natural world. And this wonder of a child, of what happens when you're gone, which is what we were talking about, the soul leaving your body and coming back, or is there anything? I mean, that's something every human being wants to know the answer to. And he was unusually willing to really face it and think about it and all the different manifestations of that. It's unusual. I think it's very unusual. So I just wanna move along because we have so much to get to and we have great questions and we're gonna open it up for a Q&A. So Lynn, Andy and David, when you have a chance, go to the chat and look at some of the amazing questions that are coming in. Lynn, could you set up the next, I guess it's like 12 minutes of film we're gonna watch. Yes, I believe this next series of clips is essentially a little bit of the farewell to arms where he took some of his experiences in real life and put them into a great novel. And I think that's interesting just how he takes the trauma that he's been through and does something with it. And then there's sort of what happens in his life right after that, which I won't give away. And then sort of how he deals with the question of suicide in his art. I think that's what we have. That's gonna take us till 2908 on the timeline and we will be back soon. Thank you. Okay, so much there to discuss. And just to remind you, we're gonna look at one more set of clips after this and then we'll have our Q&A period. Much, much to discuss in that the cerebral thing, as it was called by the narrator using Hemingway's words, his thoughts and flirtation, and maybe you could say obsession with death and suicide. The alcohol thing for sure. And the King Lear thing. And I like to, we'll talk about whatever you all think is important, but I think I like to at least each of you to hit one of those points and maybe starting with you, Andy, to talk about the cerebral thing. Yeah, so much to unpack there. You know, after those two plane crashes, that's when people said, you are just different. And the irritability, volatility, violence towards Mary just escalated so dramatically. And there's this wonderful statement where he says, you hear yourself saying things, you know, and that's what a head injury patient will do is say, you know, I find myself doing these things, but I can't stop myself. And of course the use of alcohol will sort of disinhibit and make those things more accentuated. And it's funny that Patrick, you know, Patrick himself had a car wreck before he went to college while he was in Cuba. And his reaction to the head injury was to develop a disorder that looked like schizophrenia, which some people do after traumatic brain injury. The good news is it's not schizophrenia, it goes away, but he actually got ECT, he got shock therapy treatments, but he was so volatile they had to do them in the pool house in Cuba, but he recovered and did not have sequelae from that. But it's fascinating that Patrick mentions King Lear because we started with farewell to arms. And, you know, you have this terrible death of Catherine Barclay and the baby, and it's almost like Hemingway in farewell has done just what Lear's fool has done, which is why does all this horrible stuff have to happen? Well, you know, there's three explanations for all this horrible stuff. One is, you know, we're fortune's fool, you know, it's just random. One is that it's, you know, full circle is just what goes around, comes around, it's karma. The other is we're just play things. We're like flies to wanton boys pulling off our wings. And so there's this scene in farewell where Hemingway's kind of turning the camp, the log in the campfire so the ants don't get burned up. And of course they wind up running towards the fire and getting burned up. And there's that wonderful retreat in Caporetto in farewell where Frederick Henry makes every wrong decision and people die and he's like, this is all my fault. We've all been in that situation where everything we do seems to magnify something wrong. And so it's funny how farewell is Hemingway's own version of Lear where it accounts for a lot of the, why do bad things happen? Why should bad, you know, we can't explain it, but all those explanations are hidden in farewell, even in Catherine's death. Then we moved to Robert Jordan who talks about the suicide. Now, it's fascinating. After Hemingway learned about his father's suicide, his girlfriend from teen years, Prudy Bolton, who was an Indian girl in Michigan, Native American, I guess, Hemingway would call her Indian. We'd call her Native American. So she would have been 14, he was 17. And he always remembered her as his first romantic contact. She committed suicide. She became pregnant and took strychnine. So he learned of her death. He learned of his father's death about the same time. And he wrote this Joycean story called Fathers and Sons. So, and I think that's another way to think about Hemingway is that his, you know, everything he wrote that was good was autobiographical in some way. And I think his writing was a form of therapy. I think he processed his life through his writing. And I think he was a good therapist, you know, in that way. But a long story short is I think that, you know, and then finally, and then that other clip, it talks about Mary, of course. And, you know, and of course, she actually, there's an argument that she was an alcoholic as well, later in life, certainly. So there's so much in that. But I think getting back to your original question, yeah, the plane crashes were the last of the two major, major concussions. And people wonder, well, why did he bang his head against the door while he had injured his shoulders in the other, one arm and one shoulder in the first crash? So he really wasn't able to manipulate the door with them, but very unwisely used his head as a battering ram. And he had, you know, in his letters, he wrote multiple times about double vision, headache, you know, tinnitus and, you know, the headache that doesn't go away. So he wrote frequently about his post-concussive symptoms. And anyway, that's, I kind of tried to hit everything there, which I probably shouldn't have. No, no, that's great. And we're gonna come back to that. But I think that really what you're saying is there's a lot going on, but the predominant diagnosis, if you had to pick one, would be CTE. Is that- Right, I mean, yeah. The umbrella is by the time he's in his early fifties, you've got a dementia. And by the time he's 55, you're clearly got a dementia. Now, where did that come from? Well, it's mostly CTE, but this is a gentleman who drank heavily. So could there be a component of alcoholic dementia? Of course. And then you have a fella who had poorly treated hypertension and pre-diabetes versus occasionally untreated diabetes. So there may have been a vascular component as well. So I think those are the three contributors to this. And he was having delusions by the time he's 55. And by the time he was in his last two years, he was very delusional about certain things, not hallucinatory, but delusional. Great. We're gonna get back to you. David, your thoughts about what you see at this point as the differential in sort of, in order of importance or valence, if you will. David, you are muted. We have to make sure you are, you have to unmute yourself or someone has to unmute you. Let me jump in a little. Yeah. David, while you figure it out, then do you, what are your thoughts about? Yeah, go ahead. Cause I was thinking, no, go ahead. Cause I was thinking that, you know, you spent a lot of time with Pat. Okay, I'm off. Okay. Okay. I see it a little bit differently. I'm gonna look at more of what the clinical evidence is here. First of all, in his second plane accident, what else could he use but his head? It sounds like he was stuck in there. And yes, it wasn't a good idea because he smashed his skull, but there was nothing else to use. And he did have a post-concussion syndrome, no question about it, with all the kind of sensory problems. But then he had a reprieve. And during the reprieve, he was kind of okay. And then he lashes out at everyone. Well, you don't really need to think of some kind of a cerebral problem. He was probably drinking heavily. And when some people drink heavily, they are obnoxious. They can tear the place apart. They insult you. They do all kinds of things. And I wonder what the importance was of that in terms of his acting so badly towards Patrick and everyone else. And then finally, and this is one thing I don't understand, Andy. You said from then on, he was demented. I don't get the evidence, in your book at least, of his dementia. I mean, he then travels around. He goes to Paris. He goes to Africa. I didn't see where the dementia comes in. And then finally, in terms of his being suspicious, paranoid, if you recall, his father had the same kind of syndrome with his depression. And we know that depression alone, if it's psychotic depression, one gets feelings of being paranoid. People are against you. So it's very much mood congruent. And he's drinking and drinking alone with a great deal of alcohol in your system can cause all kinds of sensory problems. So I raised the question, do we need a continuing organic problem when he has so much going for him that couldn't the same thing happen without his having this brain injury secondary to the smashing his head against the window? Yeah, Lynn will tell us. You know, I mean, look, you know, there's like you both have said, there's a lot going on and there's clearly something wrong. And there's also, you know, this comes up again a little bit more, I think what we're gonna show next, but you have a very, someone who was in up until this moment, extremely powerful person. He's very controlling, his wives, his children, the people around him, he's the center of attention. There's no one that really can kind of match him. And so his behavior, whether it's drinking or anything else, it just happens, you know? And so I think that sort of exacerbates a problem in that no one can really get help for him. No one can, he can't talk, no one, he won't listen to anybody else. He's always in charge and he's so much bigger. He looms so much larger than everybody around him. So I feel that's part of the train wreck that's happening. And I'm not medically qualified to solve this, you know, to weigh in on this question, but I just, it feels very foreboding in that, you know, the story that Patrick was talking about when they're on the safari or at the fishing camp and he's just raging, nothing can be done except just to leave. So, you know, that does suggest that whatever's going on, he's not going to end well, we already know. But I just would say also that I think that we chose the clip from the, for whom the bell tolls, where he's writing about someone having the internal monologue of suicidal ideation and the arguments back and forth. I find very, you know, I don't know. We don't want to say that's him. It's a work of fiction, but his capacity, the work of imagination to put you in the headspace of someone who's in that place. And this is not someone who's suicidally depressed. He's thinking about, is this the hero's way? You know, back to the question of being a hero. Should I do the heroic thing? Or should I, you know, what's the right thing to do in this situation? I just think that's interesting insight. I'm not sure where it goes. Yeah, no, go ahead. That's the classic Hemingway hero is somebody who is cynical about everything, but still maintains a loyalty to the core group of people that they love. Right. And it's funny, that book comes out in 42 and it's right when Casablanca comes out. And you think of Rick in Casablanca, who's cynical about everything, but ultimately is loyal to the love of the people around him. You know, sort of the, it's all, I think those writers kind of bounced off for whom the bell tolls. But Lynn, when you were looking at the last 10 years of letters, did you see a deterioration in anything, in cognition and handwriting? Was there a change? There was one particular letter that we decided we couldn't show here because it contains a very distressing use of racial epithets that just, we decided not to include here because we didn't have a version that was appropriate to show. But he's a little unhinged in that letter. It's a, he was asked to comment on James Jones's novel, "'From Here to Eternity." And he wrote this scathing letter back about how he wouldn't give it the time of day, but he said it in a much worse way and used this horrendous racial epithet to explain why. Anyway, and this is someone who saved every letter. He mailed that letter. That letter was sent. And so, what is there to say? But- What drugs was he on at the time? What drugs was he on at the time? Well, we're gonna get into that in the next clip actually. Okay. So yes, I can't diagnose it. I can just tell you that he seems, yeah, disinhibited at the very best or just, he just says whatever he wants to whomever he wants. Well, let's look at the next set of clips. I think they're about 15 minutes or so, and then we're gonna come back and open it up to questions. If you could put your questions in the chat, then I will call on you. And if you would ask your questions succinctly, I know that's very hard for us psychiatrists to do, but if we could do that, then we will have an incredible conversation with as many of you as we could fit in. So we're gonna watch the last set of clips on Hemingway, and then we'll be back in about 15. Okay, we are back. So we're gonna open it up for questions in just a moment, but I really wanted to ask each of my panelists a couple of questions or at least one question. David, in that last section, what do you see that informs your differential diagnosis? Of Hemingway? I think you have to unmute yourself. While you're, you're gonna get it soon, but I'm gonna turn to Lynn. Could you just tell us what, because we're not gonna see it in our film clips. But David, you're back, right? Yes, I'm back. I can't, the light's on me and I can't see. Well, there's several things. First of all, everything that we see could be secondary to alcohol. In fact, I suspect if you have alcohol on board, your ECT isn't as effective. That's the first thing. The second, if he were really out of it, I don't think the doctors would be inviting him to their homes for dinner. In fact, at one point, he remembers several wines that he had, some French wines that he wouldn't know otherwise. And his inability to write, to talk could be related to just alcohol. You don't need to bring in another source of his difficulty. Alcohol can affect short-term memory very much. And finally, there's his actual suicide. This is so carefully done. He gets out of bed and carefully, he goes to get the key. Carefully, he opens a part that the, open the cabinet that the gun is in. Carefully, he goes downstairs quietly. He sets it up and he blows his brains out. He acts very focused, executive functioning, is working very well. There's not evidence of a demented person doing that kind of thing. And the one that comes before that, he also sets up, but Mary finds him and a doctor comes and takes him off. So I don't think that he's not very, very impaired, but I think his impairment is possibly secondary to alcohol. And certainly in that last scene, he acts like someone who's unimpaired and knows exactly what he's doing very effectively, unfortunately. Andy, please. Yeah, this is a lovely debate. It reminds me of the debate whether Margo McComber shot her husband on purpose or by accident. And that morphed into a discussion, a recent, the Idaho Hemingway Conference, where we talked about how Mary, yeah, his guns were locked up, but she put the keys on the windowsill. He knew where to get the keys to the gun. So a lot of us have blamed Mary for the suicide. I think that what informed my differential was, that first clip you showed is just so hard to watch, when he's just, he's reading the period and he's having such trouble, that to me speaks to head injury. But the other, the nature of his delusions were he felt that he'd be arrested for undeclared gambling winnings. He thought he'd be arrested for indecent liberties with a minor, although there were no recent activities like that with a minor, although his secretary, Valerie Danby Smith, later Valerie Hemingway, she was younger. And he felt that she was in the country illegally, he'd be arrested for that. He believed one of the, oh, he believed to be hunting on land that was not theirs. And the owner of the land said, it's okay to hunt here. And he still wasn't reassured, looking the guy in the eye saying, it's okay to hunt here. He thought he would still be arrested. He believed one of the- There was Deba too. Yeah. Deba too was underage. Yes. Yeah, there was some underage. Yeah. Yeah, there was Deba in Africa and so forth. But at any rate, there's no evidence they were intimate. But long story short, the other delusion, he felt that one of the interns at the hospital was an FBI agent. They're just a spy on him. So to me, those were sort of the delusions we see with more of a dementing illness rather than alcoholic hallucinosis or those just in the context of depression. You know, and the other thing, Lynn talked about a man who was disinhibited. And I think a lot of these contacts with these younger women that he became, like Adriana or Deba in Africa or Valerie Damby Smith, these are women who, these were not long-term romantic associations where he got to know these people. And there was, these were just people who randomly drifted into his orbit. And he had to immediately kind of latch onto them and his libido kind of took over. So I think that speaks to disinhibition. But those things kind of inform my differential. And the other thing about this clip, you know, it talks about the drugs. You know, there was, reserpine was given to him for blood pressure and people that get depressed on reserpine are people who are prone to depression already. Sequinol was given to him at one point, which mixed very terribly with alcohol. The Ritalin that was given to him wasn't a bad idea. The testosterone was not a bad idea. So some of these therapies are being used today, but the cocktail he took was just, was certainly problematic. And I'll end with this last statement that around this time, you know, in Cuba before, before he went off to the States, he had a, Jean-Paul Sartre came and Mary was so excited. We got Sartre and him and we had the greatest novelist, the greatest philosopher. And what do they talk about? They talk about book contracts and royalty arrangements. And she was so upset. They never shared the secret, you know, that we all wanted to know. If I had those two in a room, I'd say, come on guys, tell me the secret, tell me what it's about. The secret to making lots of money. So I want to take some questions. And if you would like to speak, please raise your hand. If you know how to do that, or say in the chat that you would like to talk. There's, you know, we have a differential that we've talked about of alcoholism, substance use disorder, bipolar disorder, certainly CTE. What we haven't mentioned, it came up in the chat and it was, I think it's an original idea. Dr. Boyger, I'm going to mispronounce your name. Pardon me, if you're here, please un-mic yourself and come on the screen. But Dr. Boyger had raised the question of an infectious process. Is there a chronic infectious process to, not that, because we don't have enough diagnoses for hemingway, is that something that we could also consider? Andy or David or Lynn, would you like to opine about that? You know, the hepatitis A in Italy was what it was, and it was transient. You know, I don't know, David, can you think of a sort of a chronic central nervous system inflammatory issue that would be subclinical, but have manifestations? Well, I would think when he was in the hospital at Mayo, they must have done every blood test possible. And I would think they'd seen perhaps a low lymphocyte or something to suggest there was inflammation. So it's a very interesting idea and it's being posted around now that some of our most serious psychiatric illnesses are due to inflammation. But I think they would have caught it when they did all these blood tests, but maybe not. Yeah, now there are all these weird autoimmune things going on now that we did not have knowledge of previously, but those people get very, very sick and they're very rapidly progressing. Well, I see Dr. Severino in there, maybe you could add to this, because you had raised in the chat a couple of questions about CT and alcoholism, neurosyphilis even. Do you wanna ask those questions now? Well, sure, in terms of neurosyphilis, I'm sure back then they would have done a VDRL at Mayo. The question comes up whether in somebody so famous that would have actually gone public. But the idea of CTE, his disinhibition with alcohol when he was younger may have been much less than what would have occurred in his 50s when the CTE could have been progressing. And it is in his history, hard to ignore at least two of these episodes of pretty severe head trauma that I think could have had an effect on him. I just, I can't ignore the drinking though and the chronic effects that it could have had, but he could have been a moving picture is my thought that drinking when he was in his 20s would be very different than drinking when he's in his 50s. And how many patients do we see who have a substance use disorder who have compounded problems and it becomes synergistic, each problem feeding off the other. Dr. Kozin had raised the issue about PTSD, which is not a diagnosis that I think we've talked about. Dr. Kozin, are you there? Well, if you're not, let's maybe again, we could talk about PTSD, if that is. I was gonna, not being the doctor here, but just to jump in about the drinking that one of the questions that we've wrestled with was he was in such bad shape and yet he managed to write the old man in the sea. And if he was really, and how it's pretty coherent, he was unable to write after that anything really publishable. So that says something about his disordered mind. He couldn't edit himself. He just wrote and wrote and wrote. He had all these projects. He couldn't finish anything. The Little Feast was edited by his wife after he died. So we don't really know exactly how far along he got that. But when he was working on old man in the sea is the one time that we have some evidence that he did try to stop drinking to some degree or reduce his alcohol intake. He didn't really stop completely. He never, I don't think he ever went into a full withdrawal but he cut back significantly. And I wonder, that's an interesting period of time when the alcohol, he was able to control it somewhat and create, still do something worthwhile. Yeah, I love that point because old man in the sea is, it was actually a short story that he had kind of discarded earlier and he kind of made it into something. But to me, it's the perfect metaphor for, the man holding onto this fish that ultimately is destroyed and ultimately misunderstood is sort of Hemingway holding onto what he can do, holding onto his work as best he can. I think he's kind of landing the plane as best he can. And PTSD is something that he, when he came home from World War I, he kind of talked to his doctors about it but he never really had the manifestation. Certainly in the Nick Adams stories, there are a lot of them about PTSD, but he was an expert at just sitting in that hospital room and absorbing everything and just taking it all in and understanding what those things were like, whether it be PTSD symptoms or the retreat at Caporetto or, I mean, anyway, even the other folks who had head injuries and he saw them in the hospital and wrote about that in a terribly named story where you'll never be. So let's go back to neurosyphilis. You know, who had ocular syphilis, you know, that's going back a long time was James Joyce. I mean, Hemingway called him his best friend, but Hemingway's iritis and ocular and basically progressive blindness have been diagnosed posthumously as ocular syphilis. And his daughter, Lucia Joyce, who actually had a brief affair with Samuel Beckett and wanted to marry him and he skedaddled, he was only interested in her father's work and so forth, but she was a schizophrenic. And Joyce himself would go to various psychiatrists and say, and doctors say, look, she's not schizophrenic. She has neurosyphilis, which looks like schizophrenia. And I gave it to her through her conception because I was a naughty fellow going around to the brothels and such. And they would say, no, no, it's schizophrenia. And when she saw Carl Jung, Joyce tried to convince Carl Jung that Lucia was not psychotic, but that she was just clairvoyant and that she was using language as he used language. And Jung said, well, that may be, but the difference is two people are going to the bottom of a lake. One is diving and one is falling. So he didn't buy it. Dr. Sharif has raised a question about complex PTSD. Dr. Sharif, could you come on board? Are you able to do that? While Dr. Sharif is coming on muting, I'll just say that I was thinking about PTSD in Hemingway. It's not just World War I, it's also World War II. He had a car accident before the war, another head injury, and then also a serious head injury then in London. But also during the war, when he went into the Hurtgen Forest, which is a really horrific battle site, some of the carnage there, he wrote a lot afterwards in letters about how it was recurring nightmares. I guess we'd say flashbacks of just, he couldn't take it anymore after that. He had to go home. The war wasn't over. So I think putting himself in the place really just a degree of violence that most people never see in their lives. Certainly he had not seen in the first World War, in the Hurtgen Forest. I think he did have more trauma. Your documentary was beautiful at elaborating that. I had no idea about the post-Hurtgen stuff he went through. That was beautifully done. Thank you. The Hurtgen Forest is about World War II. Now I'm talking about, did he ever have any manic episodes? In World War II, he was over there as a reporter, but he took it upon himself to become a leader of a group. And he actually fought as if he were the head of a group of army people, got into a great deal of trouble. And one other episode in which he decided to go native, he dyed his clothes so they were kind of camouflaged and he hunted with a spear, which was very, very dangerous. I bring those two episodes up as, how do we understand them if not on the manic spectrum? And I might add, before you answer that question, I might just add to make, we have such a rich history of mood disorders and suicide in his family. We have not talked about that in detail, but as we heard in the film, as we know, father, son, is it grandfather, Lynn? Uncle, it's an uncle. Uncle and children. And then also his, yeah, there's. Yeah. So clearly something is happening in the genes, which we have to account for. I wanna go to Dr. Francis who asked a question early on. I don't know if you could come on Dr. Francis, but I'll ask a question for you if you can't, which is a general question for everyone and everyone. Oh, Dr. Francis is here. Yeah. Yeah. Hi, by the way, it's a great presentation. It just occurred to me that something like two thirds of American Nobel Prize winners in literature and so many Brits who had depression and so many Japanese great writers who committed suicide, one in public television. What's going on with all these artistic folk that have alcohol, depression, suicidality, bipolar? Can you comment on that? I know you know a lot of those folks, Ken. Yes, and so do you. We've shared a couple of them. So what are your thoughts, Dr. Francis? I think the genes may be close to each other. I also think that if you have a troubled childhood, it was mentioned that it's good therapy to write. And if you have a lot of losses, it's good therapy to write as a way of repairing yourself. But I don't know the answer. That's why I asked you. Go ahead, David. Well, there's a book written called Touched by Fire in which Jameson talks about a whole group of people who in fact have some kind of mood disorder, often bipolar, and they're often manic or just below manic when they're most productive. I don't know what the incidence of suicide is in these people, except bipolar illness is among the most of the suicidal illnesses that one has. The suicide rate is the highest in bipolar compared to just depression alone. Yeah, Jameson's book said the poets are the worst. They're at risk for depression. The novelists are also at risk for depression. The biographers are flat normal, have no problems, and they tend to be good looking. So I don't know what that means. But yeah, there's this idea since Rimbaugh that the derangement of the senses is the ideal position from which to be creative. And I think we know about the Van Goghs and the Hemingways because their stories are so dramatic, but there are far more people doing good creative work that don't have these serious problems. At the same time, someone like Robert Lowell, who was truly, I mean, just as bipolar as the day is long, when he was, it gave him great information. It gave him great material when he was well, but he couldn't write when he was sick. Even James Dickey, someone as regularly drunk as him, just said, you just have to, it's work. You can't write while you're impaired. So it may be that patients with affective illness have also that comorbid genetic aspect of creativity, but it's a heck of a price to pay. And we don't think about Bach wasn't particularly mentally ill or something. Some of the Glenn Gould wasn't particularly ill. So there's some great creators who don't have that. So it's kind of an unanswerable question. And I think that Rimbaugh kind of messed everybody up with that derangement of the senses quotation. And of course, substance use, the impairment itself is not conducive to creativity. I mean, there's just, there's like what a handful of works you can name that were done under the influence and that's probably, they probably really weren't. I mean, Burroughs probably wasn't impaired when he wrote Naked Lunch. He was actually clean when he wrote that. So long story short, yeah, I think it's, yeah, there may be some enhanced material and creativity that goes with those genes, but it's a heck of a price to pay, isn't it? I couldn't agree with you more, but I do think that there's something to being hypomanic and something to be narcissistic, which is consistent with, you know, believing that you could write the great American novel, lock yourself in a room, tell your family and your friends, I'm sorry, I'm writing, I can't see you for a couple of weeks. Having that narcissism, having that hypomania to the extent that you can even tease them apart is helpful. Lynn, you wanted to say something? Yeah, I just- She's unmuted, so we can- Okay, I'll make this very quick. On this question of artists and addiction, just generally, whether it's alcohol or drugs or anything, from my lay person's point of view, I think, you know, they live outsized lives and we know about them. So we know if they die by suicide, and thank you for the comment that commit suicide is really not the way to say it. I think die by suicide is a much better way to express it, or if they die from addiction overall. And I think a lot of people who want to be successful artists see that and mistake the addiction for some way to become a great artist. And the example I would give is Charlie Parker. We did a series on the history of jazz and Charlie Parker became addicted to heroin from having had a car accident and injury and medication for that, et cetera. And a whole generation of jazz musicians, he was brilliant and he would have been equally brilliant if not more brilliant if he had not been addicted to heroin. And he wasn't able to perform when he was using as well. And so, but people saw how brilliant he was. He was a true virtuoso off the charts. There was nobody like him and they saw that he used drugs and they thought mistakenly that that was the reason. Somehow this, you know, there was a link there and there was no link. So I just think we have, just from my perspective, you know, there's causality of, you know, and a lot of people, a lot of artists, writers would emulate Hemingway or Fitzgerald thinking that if they drink a lot, they're gonna, you know, you have to be a great writer, you have to drink a lot and live this certain life. And it's- If I could say something, not everyone can become an alcoholic or an addict. You have to have something special about you, genetic or otherwise, because other people could drink and they just don't get drunk or they don't wanna drink anymore. And the same as with drugs. So I don't think we can accept that as, you know, oh, I'm gonna become an alcoholic and you just start drinking. No. You know, when we first put this together, we were told, you have two hours to do this. And I said, no way we're gonna talk for two hours. Well, actually, if I'm not mistaken, I think we're gonna, it sort of lights out in two minutes to our two hour point. So I think we have to say goodbye. But I do wanna give each of my panelists the last word. And I wanna ask you a question. What would Hemingway think about this conversation if he could hear it? What point of life, what day, what week? Because he was such a man of so many changes regardless of what caused them. I think it will depend on what mood he was in. How can you- Andy? Yeah, I think he hated psychoanalysis and he would be very angry when all these psychiatrists are talking about him. And he really resented the fact that people would look at his work and analyze it and relate it to his trauma life and so forth. But when people said, do you have a therapist? He said, well, my Corona is my therapist. And again, I think he meant that the process of working was therapeutic for him, but take it a step further. The process of integrating his life into these beautiful fictional works was his way of dealing with what happened in his life. Whether it was his father's suicide or his own near death experience or his head injuries and so forth. So I think that he was his own therapist. And I think that the next generation of Hemingway scholarship is looking, not reading him backwards saying, aha, these are the people in Farewell to Arms or these people in Son of Osiris that were biographical for him, but reading him forwards and saying, look, he processed fathers and sons after his father's suicide. Here's how he lived out his life as a reaction to that therapeutic process. Now it's unanswerable, but I think that's kind of the next dimension to his scholarly work. Being a good psychiatrist, I'm gonna stop us on time. I'm gonna say thank you, Lynn, for your monumental work that brought us together. So thank you all and thanks everyone to participating. Okay? Yes. All right, have a good night and the rest of the meeting is gonna be even more awesome.

panel discussion

Ernest Hemingway

mental health

forensic psychiatrist

war experiences

head injuries

diagnoses

bipolar disorder

PTSD

genetics

research