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One of the most influential writers of the 20^th century, Ernest Hemingway’s stripped-down prose new literary voice captivated critics and readers alike. His outsized personality and macho swagger made him a star beyond the printed pages of his newspaper articles, short stories and novels. Behind the façade, however, Hemingway faced a lifelong battle against depression, alcoholism and mental health issues, all of which contributed to his death by suicide on July 2, 1961. But it wasn’t just Hemingway who suffered, as several generations of his family confronted similar issues, in what one of his granddaughters called the “Hemingway curse.”

Hemingway had a troubled relationship with his parents

He was the second child of Clarence “Ed” Hemingway and his wife, Grace. Ed was a successful doctor and Grace was a former singer and music teacher. Much of his childhood was split between the family’s home in Oak Park, Illinois, and a house in the woods of Michigan, where Ed passed down his love of hunting and the outdoors. But Hemingway struggled to connect with his father, who despite his placid exterior could be a violent, domineering bully.

He also had a fraught relationship with his mother, who dressed Hemingway as a girl when he was a child. Hemingway’s third wife, journalist Martha Gellhorn, would later attribute Hemingway’s difficulties with women, including infidelity, cruelty and abandonment, to his relationship with Grace. As Gellhorn would write years after the collapse of their marriage and Hemingway’s death, ”Deep in Ernest, due to his mother, going back to the indestructible first memories of childhood, was mistrust and fear of women.”

READ MORE: 10 Things You May Not Know About Ernest Hemingway

He seemed set on a path of self-destruction from an early age

Seeking adventure and an escape from his suburban life, Hemingway left home as a teen, eventually volunteering as an ambulance driver in World War I. Severely wounded in Italy, he fell in love with his nurse, and her eventual rejection of him led to a depressive episode that would become characteristic of his life. While working as a journalist back in America, he married his first wife, Hadley Richardson, and the couple moved to Paris so Hemingway could focus on writing fiction.

He soon found himself at the center of an artistic circle of fellow expats, known as the “Lost Generation,” forming relationships with future luminaries like F. Scott Fitzgerald, Gertrude Stein, Ezra Pound, John Dos Passos and others. But Hemingway’s mercurial temperament, exacerbated by the prodigious drinking and often-pugilistic personality that would become his trademarks, led to conflicts with Richardson and his circle of friends, who struggled to cope when his mood turned towards jealousy, mistrust and extreme competitiveness.

His father’s suicide left a deep wound

Despite Hemingway’s destructive personal life, he found professional success, publishing his first novel, The Sun Also Rises, in 1926. Earlier that year, he had begun an affair with journalist Pauline Pfeiffer, and soon divorced Richardson — a decision that caused him great mental anguish and which he reportedly regretted for the rest of his life.

In December 1928, when Hemingway was 29, his father killed himself, shooting himself with a family revolver after a long period of both physical and financial setbacks. Hemingway was deeply shaken by his father’s death, which he largely blamed on his mother. He alternated between anger at what he considered a “cowardly” move, and a sense of resignation that he might suffer the same fate as his father, writing to his then-mother in law shortly afterward, “I’ll probably go the same way.” He also fictionalized the events in his 1940 novel, For Whom the Bell Tolls, in which the father of the main character commits suicide in a similar manner.

For many of his family and friends, Hemingway’s risky life choices, including his obsessions with hunting and the gory, spectacle of bullfighting, as well as his rush to join the action during the Spanish Civil War and World War II, reflected a perhaps morbid fascination with darkness and death. As he reportedly told actress and close friend Ava Gardner in 1954, “I spend a hell of a lot of time killing animals and fish so I won’t kill myself.”

READ MORE: The Many Wives of Ernest Hemingway

Hemingway’s final years were troubled

In 1940, Hemingway bought a home in Cuba, and although he continued to travel the globe, it would be his primary residence for the next 20 years. He published his last major work of fiction, The Old Man and the Sea, in 1952, winning a Pulitzer Prize in 1953 and the Nobel Prize in Literature in 1954, bringing him a new level of international fame. That same year, Hemingway was nearly killed following two plane accidents while traveling in Africa, suffering a cracked skull, ruptured liver and spleen, two cracked discs, as well as other injuries. The accidents led to a precipitous decline in both his physical and mental health, with a bedridden Hemingway disregarding doctors’ orders to curb his drinking.

When he and his fourth wife, Mary Welsh, finally returned to Cuba in 1957, he began work on A Moveable Feast, a memoir of his early years in Paris. But unlike all the earlier works that seemingly flowed out of him, he struggled to finish the piece (it would be published posthumously), and his frustration further deepened his depression. As the political situation in Cuba worsened, Hemingway and Welsh left in July 1960, and over the next few months, Hemingway became increasingly isolated and paranoid, convinced that he was under surveillance by the FBI.

He attempted to get help at the Mayo Clinic shortly before his death

In the fall of 1960, the couple settled into a newly-built house in Ketchum, Idaho. Hemingway’s instability intensified, as his worried mind became convinced that, despite his publishing success, he was on the verge of going broke. In November, Welsh and Hemingway’s physician convinced him to travel to Minnesota’s renowned Mayo Clinic. His doctors prescribed the then-new drug Librium, as well a course of electroconvulsive treatments, which robbed him of his short-term memory and seemed to provide little relief. But Hemingway’s doctors, perhaps persuaded by his still powerful and persuasive charm, released him into Welsh’s care after just seven weeks.

Back in Ketchum, he found himself unable to write, often struggling for hours or even days to write a few sentences and was forced to cancel plans to attend the inauguration of John F. Kennedy that January. He threatened to kill himself several times, and when he was being transported back to the Mayo Clinic for a second time in April, he reportedly tried to walk into the propeller of the plane carrying him there. By this time, news of his Mayo stay had made headlines, with locals reporting sightings and interactions with Hemingway, whose doctors allowed him to come and go as he pleased (and also permitted him to drink despite medical tests that revealed significant liver damage).

Doctors once again released him in late June. Two days after he arrived home, on the morning of July 2, 1961, he found the keys to the gun cabinet that Welsh had poorly hidden, pulled out his favorite rifle and several bullets and then shot himself in head inside the home’s foyer. He was less than three weeks shy of his 62^nd birthday. Early newspaper accounts described his death as accidental, the result of a misfire while he was cleaning his guns. But these early reports were largely fueled by Welsh, who refused to publicly admit that he had killed himself until several years after his death.

READ MORE: Inside Ernest Hemingway’s Key West Home and How It Inspired Many of His Famous Writings

New research has helped shed light on contributing causes for Hemingway’s struggles

In 2006, Dr. Christopher D. Martin, a psychiatrist and Hemingway fan, published a groundbreaking study based on medical records, correspondence, biographies and interviews that aimed to shed light on Hemingway’s mental health history. He found what he believed to be significant evidence that Hemingway presented symptoms of bipolar disorder, as well as possible borderline and narcissistic personality traits, which were exacerbated by a lifetime of alcoholism. Martin also delved into both Ed and Grace’s history of depression, arguing that Hemingway likely carried a genetic predisposition towards mental illness, as well as deep, unresolved anger at both his parents for his upbringing.

In his 2017 book Hemingway’s Brain, psychiatrist Andrew Farah argued that Hemingway’s symptoms more closely resembled chronic traumatic encephalopathy (CTE) than bipolar disorder. According to Farah, Hemingway suffered at least nine concussions or severe brain traumas during his lifetime, which might explain his increased instability and volatility. And the electroconvulsive treatments Hemingway received in his final months may have actually exacerbated his psychological decline.

Yet another theory holds that Hemingway suffered from hemochromatosis, a rare genetic disorder that leads to an inability to absorb iron. Left untreated, it can lead to intense fatigue, memory loss, depression and diabetes, all of which affected both Hemingway and other family members. But as with other conjectures about the cause of Hemingway’s mental health struggles, experts are unable to be 100 percent sure of any diagnosis.

Several other Hemingway family members later struggled with mental health issues

Just five years after Hemingway’s death, his sister Ursula, who was battling both cancer and ongoing depression, died due to a deliberate overdose of pills. Leicester, Hemingway’s only brother and the youngest of the six siblings, was the author of several books, including a biography of his brother. He shot himself in 1982, following years of health issues stemming from diabetes. Hemingway’s youngest child, Gregory (also known as Gloria), suffered from alcoholism and was diagnosed with manic depression, and his relationship with his father was further strained by Hemingway’s reluctance to accept his child’s transgendered identity.

Two of Hemingway’s granddaughters faced their own mental health battles. Joan, nicknamed “Muffet” and the eldest daughter of Hemingway’s first son, Jack, was diagnosed with manic depression. Her sister Margaux struggled to overcome learning disabilities, including dyslexia, and found fame as a supermodel and actress in the late 1970s. Fascinated by the mystique of her famous grandfather, she later claimed she lived her fast-paced life in emulation of him. But epilepsy, eating disorders, depression and substance abuse derailed her once-promising career. She committed suicide in 1996, with her body discovered on the 35^th anniversary of her grandfather’s death.

His granddaughter has become a fierce advocate for mental health

Mariel Hemingway, Margaux and Muffet’s younger sister, also became an actress, earning an Oscar nomination for her work in Manhattan. She, too, struggled with depression at several points in her life, unable to process the multi-generational mental illness and substance abuse that plagued her family. Born several months after Hemingway’s death, she recalls a dangerous and chaotic upbringing, in which she and her sisters were told little about their famous grandfather but experienced a chaotic and sometimes dangerous upbringing in line with the Hemingway family. As she told the Miami Herald, “I grew up watching a family that was completely amazing and creative but also destructive and self-medicating. All of them, they were addicts. I didn’t want to end up like that. I was on a mission.”

Determined to both erase the stigma surrounding mental illness and depression and break what she’s referred to as the “Hemingway curse,” she’s become a wellness and self-help advocate, publishing several books and starring in a 2013 documentary. She hopes that by shedding a light on her family’s history, she can help others seek the help and acceptance they deserve. As she told WNYC in 2016, “I think we live in a world where creativity is defined by how much pain you go through, and that’s a misinterpretation of artistry… I think if my grandfather were around today, he would go, ‘Wow, I didn’t have to suffer.'”