In one of Ernest Hemingway's first published stories, a man goes into the woods and meets a disfigured prizefighter — insightful, though prone to fits of paranoia and violence.
"You're all right," says the visitor after they've chatted a while.
"No, I'm not. I'm crazy," the fighter says. "Listen, you ever been crazy?"
"No. How does it get you?"
"I don't know. When you got it you don't know about it."
Nearly a century after "The Battler" was written, psychiatrist Andrew Farah contends, we would recognize that the prizefighter suffered from chronic traumatic encephalopathy or CTE — the same concussion-induced brain disease now infamous in sports, particularly professional football.
And the prizefighter's renowned author had CTE, too, Farah argues in his new book, "Hemingway's Brain."
The psychiatrist from High Point University in North Carolina wrote of nine serious blows to Hemingway's head — from explosions to a plane crash — that were a prelude to his decline into abusive rages, "paranoia with specific and elaborate delusions" and his suicide in 1961.
Hemingway's bizarre behavior in his latter years (he rehearsed his death by gunshot in front of dinner guests, for example) has been blamed on iron deficiency, bipolar disorder, attention-seeking and any number of other problems.
After researching the writer's letters, books and hospital visits, Farah said he is convinced that Hemingway had dementia — made worse by alcoholism and other maladies, but dominated by CTE, the improper treatment of which likely hastened his death. "He truly is a textbook case," Farah said.
Farah dates Hemingway's first known concussion to World War I, several years before he wrote his short story, "The Battler." A bomb exploded about three feet from his teenage frame.
Another likely concussion came in 1928, when Hemingway yanked what he thought was a toilet chain and brought a skylight crashing down on him.
Then came a car accident in London — then more injuries as a reporter during World War II, when an antitank gun blew Hemingway into a ditch.
The psychiatrist describes his reported symptoms: double vision, memory trouble, slowed thought. And headaches that "used to come in flashes like battery fire," Hemingway wrote in a letter.
These were "classic and typical" symptoms of head trauma, Farah writes.
And not the last that Hemingway would suffer. After the war: another car accident. Then a fall on his boat "Pilar," two years before he published "The Old Man and the Sea."
Farah did not include in his list of concussions Hemingway's flirtations with boxing, or accounts of head injuries he could not verify. But by the time Hemingway survived two consecutive plane crashes on a 1954 safari trip — escaping the second wreck by "batter[ing] open the jammed door with his head," Farah writes — his remarkable brain was beyond repair.
"The injuries from earlier blows resolved, but, with additional assaults, his brain developed CTE," Farah wrote.
Chronic traumatic encephalopathy is a degenerative brain disease that can manifest as memory loss, anger, dementia and suicidal behavior usually decades after the head blow, according to the Centers for Disease Control and Prevention.
Unknown in Hemingway's day, it has been found in the brains of at least 17 dead athletes. While Farah can't autopsy Hemingway, much of his book is spent detailing the writer's many symptoms.
For example: an episode two years before his death, when Hemingway drove past a bank, noticed the lights were on after dark, and became convinced that the FBI must be rooting through his account.
Less bizarre but perhaps more devastating to the author: his deteriorating ability to arrange words. "The genius who had written masterpieces such as 'A Farewell to Arms' and 'The Snows of Kilimanjaro' was now paralyzed, fully in the grip of a severe mental illness" as he struggled to assemble simple sentences for his memoirs in 1961, Farah wrote.
Smithsonian Magazine contacted Kevin Bieniek, a research fellow who studies CTE at the Mayo Clinic, where Hemingway was hospitalized.
Bieniek agreed that Hemingway sustained traumatic brain injuries and that his paranoia and other symptoms tracked the accounts of confirmed CTE cases. But without an autopsy on Hemingway's brain — now impossible — he called Farah's theory "largely speculative."
"Only an autopsy can put the 100 percent stamp of approval" on a diagnosis, Farah acknowledged. But he didn't back down from his conclusions in the book. "The symptoms are just so obvious," he said.