Every now and then some ignoramus will announce that, because he killed himself, Ernest Hemingway was a coward. This view of why Papa ended his own life begs a better answer. A modern one. An enlightened one. An explanation that does not subtract from who the man was.

Among the three men who ignited my spirit to fish, the first was my grandfather, the second was my father, and the third was Ernest Hemingway.  His short story, “A Big Two-Hearted River,” gave a compass to my life.  For his sake and mine, and because I’ve learned something about suicide since I was a young fisher boy, I’d like to set the record straight about what really killed Ernest Hemingway.

First, Papa did not die only of – as we say in my line of work – “a GSW to the head.”  In this dismal field, a “GSW” stands for gunshot wound. Yes, this was the manner of death, but the cause is much more complex. Suicidology (the study of suicide) is what I do when I’m not fishing. Since Ernest Hemingway ended his life by suicide, a better understanding of his death is part of my business.

I deal with death by suicide pretty much on daily basis, and called our county medical examiner by his first name because we have that much truck between us. So I know – without seeing it – what the coroner’s report said about Ernest Hemingway’s suicide. In determining manner of death and later rating the seriousness of a self-inflicted wound, shotguns top the list, even ahead of .44 magnum pistols. Death by pills, slashed wrists, and hanging are no less deadly, but it takes an extra special something to terminate consciousness with a shotgun.  Shotguns are forever.

As a suicidologist, the first thing I know about Ernest Hemingway’s death was that his decision to die was premeditated. The older folks get, the better they plan. At Papa’s age – 62 – pulling that final trigger was no impulse. Thoroughly familiar with firearms and their deadly force, he had no intention of being rescued, saved by a crack 911 crew, or somehow surviving a carefully-placed blast to the skull.

As a side note, not everyone dies from a GSW to the head. One young fellow I evaluated years ago had placed a 7mm magnum rifle to his forehead while sitting in the front seat of his pickup with the windows rolled up.  When he pulled the trigger he blew a gaping hole in his scalp, but the bullet ricocheted off his hard Irish skull.  A year later he was combing his hair down over the sutures and smiled easily when I asked him how it felt to not die. “It’s great,” he said, “but I don’t hear so well anymore.” We both laughed.

The second thing we know about Hemingway’s suicide is that his decision appears to have been unequivocal. We will never know if he had last minute thoughts about signing off, but his plan did not include a chance to be interrupted. Others may have tried to dissuade him from his decision in the days and weeks before, but we can assume that in the final moments his actions were on automatic.

The third thing we know is that this final decision was made with an impaired brain. Research has shown that persons who die by suicide using very violent methods have often conducted careful post-death scenario planning as regards how things will unfold after they are dead.

This analysis includes the selection of lethal means, timing, place, and who will find the body. We call these preparations “deadly planning.” Of note, on physical autopsy of brain tissue after a suicide there are often only trace amounts of essential neurotransmitters in the brain. If serotonin and dopamine are the neurotransmitters that make us happy, cheerful, and full of goodwill toward strangers, they also help our frontal lobes solve problems quickly and well. Absent these necessary neuro-juices to float our noodle in, our brains become like a dry socket after a tooth extraction – a mass of pain-emitting, raw nerve-endings.

Some in our field call this mental pain “psych-ache.” Research confirms it is real, measureable, and one of the most serious drivers of suicidal behavior. People experiencing this ache explain that only death seems to offer any hope of relief – thus does hope spring even from the minds of those praying for their suffering to end.

It’s important to understand that bench science on the suicidal brain is underway, and that much more is needed. For now, what we know is that the neurochemistry of suicidal brains is so out of kilter that, more often than not, the person cannot think properly, let alone make life-and-death decisions. Just as a Cadillac won’t run long and well without sufficient oil in the engine pan, neither will a human brain run long and well without sufficient neurotransmitters in the brain pan.

Lesson four. Serious thinking about death and suicide are symptoms of a medical illness, most commonly an untreated mood disorder.  These illnesses are, now and thankfully, quite treatable.  Some are resistant to treatment, yes, but most are not. As it turns out when Ernest Hemingway died many of the effective treatments for mood disorders we have today were not available to him. Had they been available to the physicians trying to help him during his illness, he might well have lived to fish and hunt again, and to write well again.

Lesson five. Most people do not understand that serious clinical depression is a potentially fatal disease. I’m pretty sure Ernest Hemingway considered depression a character flaw, or a personal failure of some kind. Maybe he thought of himself as “weak” because he could not kick his depression in the ass or knock it down the stairs. Add alcohol to depression and you have a remedy for disaster.  People suffering from bi-polar disorder (formerly called manic-depression), have a one-in-five chance of dying by suicide if they do not receive competent medical care.

Lesson six. Had Hemingway survived his suicide crisis without making what proved a fatal attempt, we don’t know if, one day, he would have responded to a new medication, or an emergent new treatment.  With a successful intervention, we have every reason to believe that he would have re-embraced life and relished it as few others know how.

Having spent 35 years treating suicidal people, and having known dozens who did not die as the result of a serious suicide attempt, I can tell you almost all of them went on to live a full and merry life. Yes, some had relapses of depression (it is a recurrent condition for many), but research shows that most people who seriously consider, and even attempt suicide, don’t die by suicide in the decades that follow.  And once the crisis is behind them, they never become suicidal again. Because they learned greatly from this deep existential experience – unlike most of us suicide attempt survivors have looked death in the eye and death blinked. Many go on to achieve great things. Abraham Lincoln, Buckminster Fuller, Martin Luther King, Jr., and J.K. Rowling come to mind.

Lesson seven. Many people think Hemingway died of a gunshot wound to the head, and that suicide is the “coward’s way out.” Not so. That was only the mode of death. It takes great fearlessness to actually kill oneself. To be able to actually pull that trigger requires a state of mind few of us, thankfully, have. To develop this capacity for self-inflicted violence one has to build up to it through the hard work of exposing oneself to trauma, gore, pain, violence, and by enduring life-threatening circumstances and experiences. (My colleague and friend, Dr. Thomas Joiner, is the chap to read on these matters; especially his book, The Myths about Suicide. http://www.amazon.com/Myths-about-Suicide-Thomas-Joiner/dp/0674061985 )

Therefore, the real causes that led to Papa’s death were the excruciating pain and suffering he experienced from an unsuccessfully treated mood disorder, the ravages of alcohol – perhaps abused in an unsuccessful effort to treat his unending anguish. Some authors argue that the residual symptoms of traumatic brain injury (fist fights, plane crashes, etc.) may have impaired his writing ability, thus fueling his depressed mood and sense of despair. More than anything else, Ernest Hemingway died of hopelessness. The GSW to the head was only the coup de gras, in this case delivered by the sufferer himself.

If you’ve read Mr. Hemingway’s collected letters carefully you will find that shotgun trigger was cocked in his youth, most likely by his father when he shot himself to death while Ernest was still a boy. As a blood relative and survivor of suicide, Papa’s risk for self-destruction quadrupled immediately. From my reading of his Paris letters, he was ready and prepared to make his own ending before he’d turned 25 and well before he’d come to any true adult power or recognition as a writer. If we knew his mind as a boy and the life script written for him by his father, we might all remember the playwright’s rule that if you introduce a gun in Act I, you must use it by Act III.

Lesson eight. Dying by suicide is not a character flaw. It is not a weakness. It is a method of delivering oneself from a living hell that has become unbearable and unendurable. To the oft repeated questions, “Why did he leave us?”  “How could he be so selfish?” and the accusations of cowardice, I can only say that unless you have been the same place yourself you will never understand the final motive, and that unless you can develop a terrible fearlessness of death, you will never be able to kill yourself. Only when you have personally experienced the searing psychological pain and suffering of utter despair and hopelessness can you imagine what a wonderful, simple, logic suicide-as-solution makes. The very best book on the subject is William Styron’s, Darkness Visible.

In Ernest Hemingway’s case, treatments had failed him; hope was gone. One of my psychiatrist colleagues had been a resident where Hemingway was treated for a short time in the months before his death, and even took him for a spin in his sports car to get him out of the hospital for an hour or so.  “We didn’t have much to offer him,” said my psychiatrist friend, “other than shock treatment.” When Papa was ill those many decades ago, there was no medicine but hope and, as Emily Dickinson wrote of hope, “… the thing with feathers that perches in the soul and sings” was a simple wing shot for a man like Hemingway.

May I make a small request on behalf of a much-loved man of letters? I think Papa would approve.

If someone you know  seems down, cranky, despondent, or irritable, and has stopped fishing or having fun, and who says anything at all about desiring death or wishing life was over, get them immediately to a competent mental health professional for evaluation and possible treatment. Don’t wait. Don’t pause. Don’t think it over. Just do it.

Remember, suicide prevention is not so much the stopping of a self-inflicted death as it is the restoration of hope in the hopeless before the fatal planning begins.

Finally, when we speak of one of America’s greatest writers, can we say that Ernest Hemingway died of an untreated brain disorder and chose to end his own suffering rather than continue to endure the unendurable?

Thanks.

Dr. Paul