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Drinking in earnest Gregory H. Miday, MD Alcoholic paradigms in Hemingway’s For Whom the Bell Tolls The author is an intern in Internal Medicine at Washington University in St. Louis. This essay won third prize in the 2008 Alpha Omega Alpha Helen H. Glaser Student Essay Competition. A cold crisp glass of Cava while watching the bullfights. Absinthe, emerald green poured over sugar, shared between young lovers. And cocktails—before reading, before dining, before dancing, before everything. Scenes from Hemingway are inexorably bound to drinking, so it is no surprise that his work may inform us on the topic of alcoholism. The pages of his fiction are figuratively soaked in booze and, in many cases, probably literally as well. The descriptions of distinct and complex alcohol- related behaviors range from abstention to healthy social imbibing to pathologic, chronic, and relapsing alcoholism. Hemingway describes the disease with such vividness and clarity that medical professionals might benefit from studying the models presented in his novels. The author once remarked, “I’m trying in all my stories to get the feeling of the actual life across—not just to depict life— or to criticize it—but to actually make it alive. So that when you have read something by me you actually experience the thing.” 1p153 He succeeds, and his pen strokes illustrate both the full-blown end-stage alcoholic and early alcoholism, as well as the many gradations between the alcohol abusive problem drinker and the alcohol dependent. His works capture the diverse symptoms and complications of pathologic drinking, going beyond the pathology well known to medical students: neuropathy, cirrhosis, encephalopathy, delirium tremens, etc. These organic consequences of alcoholism, while medically important, are dangerously late manifestations of the disease. Hemingway conveys the subtle and sometimes not so subtle nuances of the alcoholic, including but not limited to comorbid psychopathology, personality changes, “craving,” isolation, obsessive thinking, and compulsive behavior. Another compelling reason to regard Hemingway’s fiction as a potent source for understanding alcoholism is the concept of “autopathography” put forth by Dr. Stephen Moran, which describes “a type of literature in which the author’s illness is the primary lens through which the narrative is filtered.” 2 Papa pours a shot… Photo by Tore Johnson/Pix Inc./Time Life Pictures/Getty Images. 4 The Pharos/Spring 2009
The Pharos/Spring 2009 5
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Page 33 and 34: learning on, not learning from. Wha
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Page 37 and 38: I learned from Dr. Lynn Carmichael
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Page 41 and 42: Philippe, who was brought up strict
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Page 45 and 46: Life in the Balance: A Physician’
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