In broad daylight, aloud, he says like Susan Sontag, who wrote on this a beautiful and worthy essay, The Illness as a metaphor: the psychic explanation of cancer is both a myth without scientific foundation and a villainy moral, because it makes the sick feel guilty. This is the official thesis, the Party line. In the dark, however, he says what Fritz Zorn or Pierre Cazenave say: that his cancer was not a foreign aggressor but a part of him, an intimate enemy and perhaps not even an enemy. The first way of thinking is rational, the second is magic. We can argue that becoming an adult, which is supposed to help psychoanalysis, is giving up magical thinking for rational thinking, but we can also argue that nothing should be abandoned, that what is true on one level of the mind is not true on the other, and that one must live on all the levels, from the cellar to the attic. I feel like that’s what Etienne is doing.

Le Livre de Pierre is a long interview by Louise Lambrichs with Pierre Cazenave, a psychologist who suffered from cancer for fifteen years and died of it before the book came out. He described himself not as “having cancer” but as “being cancerous.” “When I learned of my cancer,” he says, it seemed “that I had always had it. It was my identity.” Psychoanalyst and “cancerous,” he became a psychoanalyst for “the cancerous,” grounding his approach in his intuitive understanding that “the worst suffering is the one you cannot share. And a cancer patient usually feels that suffering twice over. Because she cannot share the anguish of her sickness with those around her and because beneath this pain lies another, more ancient one, dating back to childhood, and it, too, has never been shared, never been seen. And that is the worst of fates: never to have been seen, never to have been acknowledged.”

This other suffering, says Cazenave, is what he aspires to cure, by leading his patients to see and recognize it for what it is and thereby escape its torment. His patients will still die, but between Molière, who mocked doctors who “cured” their victims to death, and the great English psychoanalyst D. W. Winnicott, who asked God for the blessing of dying completely alive, Cazenave focuses on people who approach their cancer not as the random visitation of catastrophe but as a truth that concerns them intimately, an obscure consequence of their own history, the ultimate expression of their unhappiness and dismay as they deal with life.

Cazenave is speaking of himself as well when he says that in such patients something has gone wrong in the developmental stage of primary narcissism, leaving a profound flaw in the oldest core of the personality. This means that there are two kinds of people: those thus damaged, who often dream about falling. into a void, and everyone else – all those who have been well supported by a “holding environment” and can thus stand and live confidently on solid ground. The damaged ones, though, will suffer all their lives from vertigo and anguish, from a sense of not really existing. The infantile malformation may persist a long time in the adult as a kind of background noise, a depression – unrecognized even y its victim –  that will one day become malignant.  Such patients, informed they have cancer, are not surprised, for they somehow recognize the malignancy, knowing that it was themselves. All their lives, they have feared something that has in fact already happened. Cazenave believes that in patients damaged by this childhood malformation of the self (and who have of course forgotten it), the memory pf the wound awakens as the news of their mortal illness, as the fresh disaster reactivates the old one, causing an intolerable psychic distress whose specific origin they do not yet fully understand.