Foreword

This book describes natural methods of health care that contribute to preventing the development of cancer or to bolstering its treatment. They are meant to serve as a complement to conventional approaches (such as surgery, radiotherapy, chemotherapy). The contents of this book cannot replace a physician’s opinion. It is not intended to be used to make a diagnosis or to recommend a treatment.

All the clinical cases I refer to in the following pages are drawn from my own experience (except for a few cases described by fellow physicians in the medical literature, which are indicated as such). For obvious reasons, patients’ names and other identifying features have been changed.

I have chosen to set forth our present understanding of cancer and of natural defenses in simple terms. In certain cases, this hasn’t allowed me to describe the full complexity of biological phenomena or the details of controversies over existing clinical studies. Though I believe I have been faithful to the spirit of their research, I apologize to biologists and to oncologists for thus simplifying what for many of them represents their life’s work.

I have always felt that the only trouble with scientific medicine is that it is not scientific enough. Modern medicine will become really scientific only when physicians and their patients have learned to manage the forces of the body and the mind that operate via vis medicatrix naturae [the healing power of nature].

—RENÉ DUBOS, professor of biology, Rockefeller University; discoverer of the first antibiotic in clinical use (1939); founder of the first earth summit (1972) of the United Nations


Introduction to the Second Edition

Seventeen years ago, I discovered from my own brain-scanning experiment that I had brain cancer. From the waiting room on the tenth floor of the oncology building, I remember looking down at people in the street—distant and oblivious, going about their everyday life. I had been cast out of that life, separated from its goal-oriented busyness and from its promises of joy, by the prospect of a probable early death. No longer wrapped in the comfortable mantle of physician and scientist, I had become a cancer patient. This book is the story of what happened next—of the return to life and health—in fact, to a level of health I had never experienced before—while knowing I had cancer. It is the story of how I used my skills as a physician and a scientist to find out everything in the medical literature that would help me change the odds. Most important, it offers a new, scientifically based perspective on cancer that gives all of us a chance to better protect ourselves from this disease.

The publication of Anticancer two years ago launched a new chapter in my journey. After having kept my illness a secret for fourteen years, I was able to take what I had learned and bring it around the world to people who were frightened, depressed, or had lost hope. I was able to discuss these ideas with doctors, scientists, politicians, and activists and to compare my observations directly with their experiences. I also met a considerable number of patients who had changed the course of their illness with the advice that is given here. After publication in thirty-five languages in close to fifty countries, and after more than a million copies sold, my conviction that we can all powerfully strengthen our bodies’ natural defenses against cancer has been reaffirmed. As has my belief that this approach should be a part of preventing or treating cancer for everyone. In the past two years, research has also yielded new proofs, explanations, and perspectives on how we can all learn to strengthen our health and improve our “terrain” by creating an anticancer biology within our body, and it has confirmed the importance of paying attention to how our emotions may affect the course of cancer.
So what exactly is new in this revised edition?

In my many discussions with my medical colleagues—doctors, oncologists, psychiatrists—and with the public, I realized that the book’s message about nutrition has been much more easily grasped than the analysis of mind-body factors and the crucial role played by the feeling of helplessness in promoting cancer. If there is one single, clear, and emphatic message I’d like to send with this revised edition, it is that we must pay close attention to the mind-body connection, especially the negative impact of prolonged feelings of helplessness and despair. When left unattended, these feelings—not the stresses of life themselves—contribute to the inflammatory processes that can help cancer grow. There are truly effective and simple methods for taming those feelings, experiencing life on a more satisfying level, and reducing inflammation at the same time.

To address this, I’ve completely revised chapter 9, “The Anticancer Mind,” and I’ve also updated it with new studies that confirm how important it is to treat feelings of helplessness and despair in order to fight the progression of cancer. I have taken this opportunity to share the story of Kelly, who, in her struggle against breast cancer, was able to rely on friends to give her the support and love she needed to get through her ordeal. Recent studies show, in fact, that it’s not only the love of a husband, a wife, or children that can enable morale to remain strong and slow the progression of illness, but also the simple love and caring attention of friends old and new.

In terms of nutrition, promising recent studies have attested to a number of new anticancer foods. Large-stoned summer fruit, such as plums and peaches, can now be included in this category. New data about olive oil, which was already strongly recommended in the first edition, now make it a fully fledged anticancer food with activity against a variety of specific cancer types.

Also, two new studies have shown exactly how many cups of green tea need to be drunk per day to reduce the risk of breast or prostate cancer relapse by more than 50 percent. New natural sweeteners—acacia honey and coconut sugar, characterized by a low glycemic index—have appeared on the market alongside agave nectar. These are introduced in chapter 6.

New research has confirmed the importance of vitamin D3 in preventing cancer, particularly in countries where the lack of sunshine means that the skin cannot synthesize enough of this vitamin during the winter. I’ve therefore given more attention to this topic, and made new and more specific recommendations.
Finally, information has become available on how different cooking methods may preserve or, to the contrary, reduce the benefits of anticancer foods.

Almost every time I give a lecture, I’m asked whether cell phone use can cause cancer. In order to respond to these questions, in 2008 I brought together a group of cancer specialists, toxicologists, epidemiologists, and a physicist. We published an appeal recommending a number of precautions to take for better, safer use of cell phones, as they are now an unavoidable feature of everyday life. The appeal was quickly picked up around the world and even led to a House of

Representatives hearing in the United States in September 2008 and a public roundtable organized by the Ministry of the Environment and the Ministry of Health in France in April 2009. This edition summarizes the scientific literature on this subject and reprises the precautions that can be taken toward safer cell phone use.
Animal studies have now clearly identified links between a number of chemical products present in our daily environment and the progression of existing tumors. They include bisphenol A, which is contained in polycarbonate plastics (present in reusable plastic bottles and baby bottles, plastic microwave-safe containers, and a wide range of containers with plastic inner linings, such as cans). This substance diffuses into liquids when they are heated in a lab. When human breast cancer cells are exposed to doses of bisphenol A (BPA) corresponding to levels often found in people’s blood, the cells no longer respond to chemotherapy. Comparable data have been obtained in studies of food additives based on inorganic phosphates (found in sweetened sodas, processed baked goods, etc.), which promote the progression of non-small-cell lung cancers. I felt this new data was important to discuss for people who may be undergoing treatment for these cancers.

In early 2009, a statement by the French National Cancer Institute and a study at Oxford University in Britain concluded that alcohol can increase the risk of developing cancer at any dose, even one glass of red wine. Together with Professor Béliveau from Montreal and researcher Michel de Lorgeril—a cardiologist, nutritionist, and pioneer of the Mediterranean diet—I published my disagreement with these conclusions, and that position is detailed here as well.

Since the original publication of Anticancer: A New Way of Life, numerous studies have confirmed its core message about the importance of the “terrain” in preventing or controlling cancer. I have integrated the information from these studies into the various chapters of this new edition. For example, one study published in the journal Nature in 2007 concluded that cancer can be understood as a breakdown in the balance between cancer cells that have always been “dormant” in the body and the natural defenses that normally keep them at bay (see chapter 4). This type of study highlights how important it is to nourish and strengthen our “terrain,” a topic revisited throughout Anticancer. To my mind, measures to reinforce the terrain should always accompany conventional treatments—which, of course, remain indispensable.

There was also a major, 517-page report published in 2007 by the World Cancer Research Fund that synthesized several thousand studies. This report concurred with Anticancer that at least 40 percent of cancers can be prevented by simple changes in nutrition and physical activity (not to mention environmentalfactors).1Another report, released in 2009 by the French National Cancer Institute, reached these same conclusions.2

Two major epidemiological studies, one conducted within eleven European countries and spanning twelve years (the HALE study)3 and the other in a single region of the United Kingdom (twenty thousand subjects followed over the course of eleven years),4 reported results that were even more dramatic: a more than 60 percent reduction in cancer mortality over the course of the study among people who had adopted a healthier lifestyle. Increased life expectancy wasn’t the only benefit: the English researchers concluded that people who practiced healthier living were fourteen years younger in terms of their biological age throughout the duration of the study. That translates into more energy to devote to work and family, an increased ability to concentrate, improved memory, and a reduction in physical discomfort. In their conclusion, the Cambridge researchers explain, “The evidence that behavioral factors such as diet, smoking, and physical activity influence health is overwhelming.”

The importance of limiting consumption of refined sugar and white flour has been confirmed by new analysis of the massive American Women’s Health Initiative. This study demonstrated that the link between obesity and breast cancer is dependent on the level of insulin in the blood, and thus the level of sugar in the diet. The study also showed that sugar may be contributing more to cancer than hormone replacement therapy.

In November 2008 a research article in the journal Cancer made the perfect case for the legitimacy of the advice presented in Anticancer. Women whose breast cancer had spread to their lymph nodes were followed for eleven years after they had received conventional treatment. Over the years, those who followed, in addition to their medical treatment, a program of nutritional education, physical activity, and better stress management saw their risk of dying decrease 68 percent compared to those who received conventional treatment only (see chapter 9).

In another nicely executed study, in 2008 Professor Dean Ornish of the University of California at San Francisco demonstrated that lifestyle changes in diet and exercise and stress reduction actually modified gene expression deep within cancer cells (see chapter 2).

Since Anticancer was published, I’ve given over a hundred lectures in fifteen different countries. In talking with the people who have come to hear me speak, I’ve learned a great deal about how we experience fear of cancer, and I think I’ve come to understand what people have found worthwhile in this book. Simply put, we’re used to receiving a message of despair. Cancer is perceived as a kind of unlucky draw in the grand genetic lottery, an illness that does not respond well to most treatments and for which all hopes are pinned on the advent of a miraculous new cure—one that only the largest research labs could possibly develop.
In this context, I realize that any approach that is not focused on conventional treatment risks being accused of arousing “false hope.” But I know—having learned this when I faced my own cancer—that such thinking robs patients of their power to act; and I mean this in terms of real power, not some illusion. Promoting this mind-set of helplessness is psychologically demeaning, medically dangerous, and most important, it is not grounded in good science. In the past thirty years, science has made prodigious advances and has demonstrated that all of us have the ability to protect ourselves from cancer and to contribute by our own means to healing it.Refusing to explain that we have this ability contributes to a sense of false hopelessness, and it is because they reject that false hopelessness that so many people have found Anticancer appealing.

I have been heartened by the positive reaction of many institutional cancer specialists to the book’s message. In Europe, Professor Jean-Marie Andrieu, who heads the department of Oncology at the Georges Pompidou European Hospital, told the daily newspaper Le Monde, “I learned an enormous amount from this book. And you know what? I’ve changed my diet. And I’ve already lost six kilos (13 pounds).”

In Italy, the national Anti-Cancer Leaguea endorsed Anticancer, placed its logo on the book jacket, and organized the press launch in Rome in October 2008. The League emphasized the importance of the book’s message in terms of how best to prevent cancer, bolster the benefits of conventional treatment, and minimize relapses.

And in the United States, Professor John Mendelsohn, the president of the M. D. Anderson Cancer Center—the largest cancer treatment and research center in the country—wrote, “I found Anticancer to be a highly readable and well-researched book. It provides the understanding needed for the practice of evidence-based cancer prevention and risk reduction. It also fills an important gap in our knowledge of how patients can contribute to their own care by supplementing conventional medical treatment.”

I’ve lost some friends since this book was first published. Some of them were people who applied its principles in their own lives. Unfortunately, the methods and principles outlined here do not guarantee success against cancer. Yet I was deeply moved when I heard from them, or from their families, that they never regretted having tried all the suggestions in the book. One family member wrote to me: “Right up until the end, it’s given her the feeling that she still held her life in her own hands.” It’s been a relief for me to learn that I had not encouraged false hopes, and it has confirmed my conviction that even if the Anticancer program cannot (and does not) claim to hold cancer at bay for everyone, it does help sustain life, whatever the outcome.

An amazing number of patients and their families have sent me messages—in person, by e-mail, or through my blog—bearing witness to the benefits they’ve gained from reading Anticancer and applying its advice. A fifty-year-old salesman who does not have cancer told me how much his life has changed since he started drinking green tea, adding turmeric to his food every day (with black pepper!), and managing his stress with cardiac coherence. A woman suffering from lymphoma wrote that she has read and reread Anticancer, in snippets, before going to sleep, like a book you might read to soothe a child. An engineer with prostate cancer sent me a graph of his blood tests from the past three years: His blood marker of cancer activity (PSA) has been dropping regularly since he began applying Anticancer principles, and his oncologist has been repeatedly persuaded to delay the surgery that was initially scheduled two years ago. A thirty-two-year-old woman, undergoing chemotherapy for a relapse of her breast cancer—so young!—wrote to tell me about the positive effects of the aerobic exercises she’s been doing since she read the story of Jacqueline, who started practicing karate during her own treatment (see chapter 11).

Last, and a very particular source of satisfaction for me, is that two of the oncologists I consulted over the years for my own treatment contacted me after having read Anticancer. They asked me how best to slow down the progression of their own cancer by improving their “terrain.” It was a great pleasure to be able to draw upon my research and return a measure of the compassion these doctors once showed me when I needed it most.

I’m happy and proud to present this second edition. The task of rereading the manuscript and improving it was a light one. Several times I noted with surprise that I had forgotten the details of a particular study, or of a story, since writing it. Reading all of them again has encouraged me to hold the course toward what I hope will continue to be full health. And I wish the same for you.

Introduction

Cancer lies dormant in all of us. Like all living organisms, our bodies are making defective cells all the time. That’s how tumors are born. But our bodies are also equipped with a number of mechanisms that detect and keep such cells in check. In the West, one person in four will die of cancer, but three in four will not. Their defense mechanisms will hold out, and they will die of other causes.1,2

I have cancer. I was diagnosed for the first time fifteen years ago. I received conventional treatment and the cancer went into remission, but I relapsed after that. Then I decided to learn everything I could to help my body defend itself against the illness. As a physician, established researcher, and former director of the Center for Integrative Medicine at the University of Pittsburgh, I had access to invaluable information about natural approaches to prevent or help treat cancer. I’ve kept cancer at bay for seven years now. In this book, I’d like to tell you the stories—scientific and personal—behind what I learned.

After surgery and chemotherapy for cancer, I asked my oncologist for advice. What should I do to lead a healthy life and what precautions could I take to avoid a relapse? “There is nothing special to do. Lead your life normally. We’ll do MRI scans at regular intervals and if your tumor comes back, we’ll detect it early,” replied this leading light of modern medicine.

“But aren’t there exercises I could do, a diet to follow or to avoid? Shouldn’t I be working on my mental outlook?” I asked. My colleague’s answer bewildered me: “In this domain, do what you like. It can’t do you any harm. But we don’t have any scientific evidence that any of these approaches can prevent a relapse.”

In reality, what my doctor meant was that oncology is an extraordinarily complex field that is changing at breakneck speed. He was already hard pressed to keep up with the most recent diagnostic and therapeutic procedures. We had used all the drugs and all recognized medical practices relevant to my case. In our present state of knowledge, we had reached the limits. As for more theoretical mind-body or nutritional approaches, he clearly lacked the time or interest to explore these avenues.

I know this problem as an academic physician myself. Each in our own specialty, we are rarely aware of fundamental discoveries recently published in prestigious journals such as Science or Nature. Not until they have been the subject of large-scale human studies do we take note. Still, these major breakthroughs may sometimes enable us to protect ourselves long before they have led to new drugs or protocols that will become the mainstream treatments of tomorrow.

It took me months of research to begin to understand how I could help my body protect itself from cancer. I participated in conferences in the United States and in Europe that brought together researchers who were exploring this type of medicine, which works with the “terrain” at the same time that it addresses the disease. I scoured medical databases and combed scientific publications. I soon perceived that the available information was often incomplete and widely dispersed. It only took on its full meaning when it was brought together and combined.

Taken as a whole, the mass of scientific data reveals an essential role for our natural defenses in the battle against cancer. Thanks to key encounters with other physicians or practitioners who were already working in this field, I managed to put all this information into practice along with my treatment.

This is what I learned: If we all have a potential cancer lying dormant in us, each of us also has a body designed to fight the process of tumor development. It is up to each of us to use our body’s natural defenses. Other cultures do this much better than ours.

The cancers that afflict the West—for example, breast, colon and prostate cancer—are seven to sixty times more frequent here than in Asia.3 Nevertheless, statistics reveal that relative to men in the West, just as many precancerous microtumors are found in the prostates of Asian men who die before fifty from causes other than cancer.4 Something in their way of life prevents these microtumors from developing. On the other hand, the cancer rate among Japanese people who have settled in the West catches up with ours in one or two generations.5 Something about our way of life weakens our defenses against this disease.

We all live with myths that undermine our capacity to fight cancer. For example, many of us are convinced that cancer is primarily linked to our genetic makeup, rather than our lifestyle. When we look at the research, however, we can see that the contrary is true.

If cancer was transmitted essentially through genes, the cancer rate among adopted children would be the same as that among their biological—not their adoptive—parents. In Denmark, where a detailed genetic register traces each individual’s origins, researchers have found the biological parents of more than a thousand children adopted at birth. The researchers’ conclusion, published in the prestigious New England Journal of Medicine, forces us to change all our assumptions about cancer. They found that the genes of biological parents who died of cancer before fifty had no influence on an adoptee’s risk of developing cancer. On the other hand, death from cancer before the age of fifty of an adoptive parent (who passes on habits but not genes) increased the rate of mortality from cancer fivefold among the adoptees.6 This study shows that lifestyle is fundamentally involved in vulnerability to cancer. All research on cancer concurs: Genetic factors contribute to at most 15 percent of mortalities from cancer. In short, there is no genetic fatality. We can all learn to protect ourselves.b

It must be stated at the outset that to date, there is no alternative approach to cancer that can cure the illness. It is completely unreasonable to try to cure cancer without the best of conventional Western medicine: surgery, chemotherapy, radiotherapy, immunotherapy, and soon, molecular genetics.

At the same time, it is completely unreasonable to rely only on this purely technical approach and neglect the natural capacity of our bodies to protect against tumors. We can take advantage of this natural protection to either prevent the disease or enhance the benefits of treatments.

In these pages I will tell you the story of how I changed from a scientist-researcher, completely ignorant of the body’s natural defenses, to a physician who relies above all on these natural mechanisms. My cancer helped me make that change. For fifteen years I protected the secret of my disease ferociously. I love my work as a neuropsychiatrist, and I never wanted my patients to feel they had to look after me instead of letting me help them. Nor, as a researcher and teacher, did I want my ideas and my opinions to be seen as the fruit of my personal experience instead of the scientific approach that has always guided me. From a personal point of view, as everybody who has had cancer knows, I wanted to be able to go on living, fully alive, among the living. Today it is not without apprehension that

I’ve decided to talk about it. But I am convinced that it is important to make the information that I’ve benefited from available to those who may wish to use it.
The first part of this book presents a new view of the mechanisms of cancer. This view is based on the fundamental but still little-known workings of the immune system, on the discovery of the inflammatory mechanisms underlying the growth of tumors, and on the possibility of blocking their spread by preventing new blood vessels from nourishing them.

From this new perspective on the illness follow four new approaches. Anyone can put them into practice and engage both body and mind to create their own anticancer biology. These four approaches consist of: (1) guarding ourselves against the imbalances of our environment that have developed since 1940 and promote the current epidemic of cancer, (2) adjusting our diet so as to cut back on cancer promoters and include the greatest number of phytochemical components that actively fight tumors, (3) understanding and healing the psychological wounds that feed the biological mechanisms at work in cancer, and (4) creating a relationship with our bodies that stimulates the immune system and reduces the inflammation that makes tumors grow.

But this is not a biology textbook. Confrontation with illness is a searing inner experience. I wouldn’t have been able to write this book without going back over the joys and sorrows, the discoveries and failures that have made me a lot more alive today than I was fifteen years ago. I hope that by sharing them with you, I will help you find pathways of healing for your own adventure, and that it will be filled with beauty.

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CHAPTER 1

One Story

I had been in Pittsburgh for seven years, and away from my native country for more than ten. I was doing my internship in psychiatry while continuing research I had begun for my PhD in neuroscience. With my friend Jonathan Cohen, I ran a laboratory of functional brain imaging funded by the National Institutes of Health. Our goal was to understand the mechanisms of thought by linking them to the workings of the brain. I could never have imagined what this research would reveal—my own disease.

Jonathan and I were very close. We were both physicians specializing in psychiatry. We had enrolled together in the PhD program in Pittsburgh. He came from the cosmopolitan world of New York via San Francisco, and I from Paris via Montreal. We had suddenly found ourselves in Pittsburgh, in the remote heartland of America, which was foreign to both of us. We had recently published a paper in the prestigious Psychological Review on the role of the prefrontal cortex, a rather unexplored area of the brain, which helps to bridge consciousness of the past and the future. Thanks to our computer simulations of brain function, we proposed a new theory in psychology. The article had caused something of a stir, which had enabled us, though still mere students, to get government grants and set up the research lab.

To Jonathan, computer simulations were no longer enough if we wanted to move ahead in this field. We had to test our theories by observing brain function directly, using state-of-the-art technology—functional magnetic resonance imaging (MRI). At the time, that technique was only just beginning to be used. Only research centers at the cutting edge had high-precision scanners. Hospital scanners were much more common but also significantly less accurate. In particular, no one had been able to measure prefrontal cortex activity—the object of our research—on a hospital scanner. In contrast to the visual cortex, whose variations are very easy to measure, the prefrontal cortex is very difficult to observe in action. In order for it to display its activity on MRI images, complex tasks have to be invented to “goad” it into revealing itself. At the same time, Doug, a young physicist specializing in MRI techniques, had an idea for a new method of recording images that might make it possible to get around this difficulty. Our hospital agreed to lend us its scanner between eight and eleven in the evening, after consulting hours, so we could test our ideas.

Doug worked out the mechanics while Jonathan and I invented mental tasks to stimulate this area of the brain to the maximum. After several failures, we were able to catch sight of the famous prefrontal cortex at work on our screens. It was a rare moment, the culmination of a phase of intense research, all the more exciting because it was part of our friendship.

We were a little arrogant, I have to admit. All three of us were in our early thirties, we had just gotten our PhDs, and we already had a laboratory. With our new theory that interested everyone, Jonathan and I were rising stars of American psychiatry. We had mastered the latest technology that no one was using yet.

Computer simulations of neural networks and functional brain imaging by MRI were still little known to university psychiatrists. That year, Jonathan and I had even been invited by Professor Widlöcher, the leading light of French psychiatry at the time, to come to Paris and conduct a seminar at the Hospital La Pitié-Salpêtrière, where Freud had studied with Charcot. For two days, in front of an audience of French psychiatrists and neuroscientists, we had explained how computer simulations of neural networks could help us understand psychological and pathological mechanisms. At thirty, there was cause enough to be proud.

I was living life to the fullest—a certain life that now seems a little strange to me. Quite sure of success, confident in hard science, I was not really interested in having contact with patients. As I was busy with both my internship in psychiatry and the research laboratory, I was trying to do as little clinical work as possible. I recall a certain rotation in the training program that I had been asked to do. Like most residents, I wasn’t enthusiastic. The workload was too heavy, and anyway, it wasn’t real psychiatry. The program consisted of spending six months at the general hospital looking after the psychological problems of patients hospitalized for physical problems—they had undergone a coronary bypass, received a liver transplant, or had cancer, lupus, multiple sclerosis . . . I had no desire to do a rotation that was going to prevent me from running my laboratory. Besides, all those people with medical problems didn’t really interest me. I wanted to do research on the brain, write papers, speak at conferences, and contribute to the advancement of knowledge.

A year earlier, I had gone to Iraq as a volunteer with Doctors Without Borders. I had witnessed the horror there, and I had thrown myself into trying to alleviate the suffering of so many people day after day. But the experience hadn’t really woken me up to what I could do once back at my hospital in Pittsburgh. It was as if they were two completely different worlds. Above all, I was young and ambitious.

The dominant importance of work in my life surely played a role in the painful divorce that I was just emerging from at that time. Among other reasons for our breakup, my wife couldn’t bear the fact that I wanted to go on living in Pittsburgh for the sake of my career. She wanted to return to France, or at least move to a city like New York, which would be more exciting. But to me, Pittsburgh meant the fast track, and I didn’t want to leave my laboratory and my colleagues. We wound up in front of a judge, and I lived alone for a year in my tiny house between a bedroom and a study.

And then one day, when the hospital was practically deserted—between Christmas and New Year’s, the quietest week of the year—I saw a young woman in the cafeteria reading Baudelaire. Someone reading a nineteenth-century French poet at lunchtime is a rare sight in the United States. I sat down at her table. She was Russian, with high cheekbones and large black eyes, and an air both reserved and extremely sharp. At times she would stop talking altogether and leave me disconcerted. I’d ask her what she was doing and she’d reply, “I’m running a sincerity check on what you just said.” That made me laugh, and I liked being kept in check. That was the beginning of our relationship. It took time to develop. I wasn’t in a hurry, and neither was she.

Six months later, I left for the University of California at San Francisco to work for the summer in a psychopharmacology laboratory. The head of the laboratory was getting ready to retire, and he would have liked me to take over from him. I remember telling Anna that if I met someone in San Francisco, it might mean the end of our relationship, that I would understand if she did the same thing. I think that this saddened her, but I wanted to be perfectly frank.

When I returned to Pittsburgh in September, Anna moved in with me and shared my doll’s house. I felt something developing between us, and I was happy. I wasn’t sure where this relationship was heading. I still remained somewhat on my guard—I hadn’t forgotten my divorce. But my life was looking up. In October we had two magical weeks. It was Indian summer. I was working on a movie script that I’d been asked to write about my experience with Doctors Without Borders. Anna was writing poetry. I was falling in love. Then my life took a sudden turn.

I remember that glorious October evening in Pittsburgh, gliding on my motorcycle down avenues lined with flaming autumn leaves toward the MRI center. Jonathan and Doug were meeting me there for one of our sessions of experiments with student “guinea pigs.” For a minimum fee, our subjects slid into the scanner and we asked them to carry out mental tasks. Our research excited them, and so did the expectation of receiving a digital image of their brain at the end of the session that they could dash home and put up on their computer. The first student arrived around eight o’clock. The second, scheduled for nine to ten, didn’t show up. Jonathan and Doug asked me if I would be willing to step in. Naturally, I accepted. Of the three of us, I was the least “technical.” I lay down in the scanner, a narrow tube where my arms were held tight against my body, a little like a coffin. Many people can’t bear the confinement of a scanner: 10 percent to 15 percent of patients are so claustrophobic that an MRI is out of the question.

There I am, in the scanner. We begin as we always do, with a series of images that aim to identify the subject’s brain structure. Brains, like faces, are all different. Before taking any measurements, a sort of map of the brain at rest (called the anatomic image) must first be recorded. This is then compared to pictures (known as functional images) taken while the subject is executing the mental tasks. Throughout the process, the scanner emits a loud clanging sound, like that of a metal staff striking the floor repeatedly. It corresponds to the movements of the electronic magnet that quickly turns on and off to induce variations in the magnetic field in the brain. Depending on whether anatomic or functional images are involved, the pace of the clanging varies. From what I can hear, Jonathan and Doug are doing anatomic images of my brain.

After ten minutes, the anatomic phase is complete. In the small screen just above my eyes, I expect to see the mental task we have programmed to stimulate activity in the prefrontal cortex—which is the object of the experiment. It consists of pushing a button each time consecutive letters that appear in a rapid sequence on the screen are identical (the prefrontal cortex is activated to remember for a few seconds the letters that have disappeared from the screen so they can be compared to those coming after them). I’m waiting for Jonathan to send me the task and for the particular pulsing sound of the scanner registering the functional activity of the brain. But the pause goes on. I don’t understand what is happening. Jonathan and Doug are behind a shielded glass in the control room; we can communicate only by intercom. Then I hear in the headphone: “David, we have a problem. There’s something wrong with the images. We have to do them over.” Fine. I wait.

We begin over again. We do ten more minutes of anatomic images, and then comes the time for the mental task to begin. I wait. Jonathan’s voice says: “Listen, there’s something wrong. We’re coming in.” They come into the scanner room and slide out the table I am lying on. Emerging from the tube, I see that they have strange expressions on their faces. Jonathan puts his hand on my arm and says, “We can’t do the experiment. There’s something in your brain.” I ask them to show me on the screen the images they had just recorded twice by computer.

I was neither a radiologist nor a neurologist, but I’d seen a lot of brain images; it was our daily work. In the right-hand region of my prefrontal cortex there was a sort of ball the size of a walnut. Placed in that position, it was not one of those benign brain tumors that one sometimes sees that are operable or not among the most virulent—such as meningiomas or adenomas of the pituitary gland. In that location it could be a cyst or an infectious abscess, provoked by certain diseases such as AIDS. But my health was excellent. I got a lot of exercise, and I was even captain of my squash team. So it couldn’t be that.

It was impossible to deny the gravity of what we had just discovered. At an advanced stage, a brain tumor can kill in six weeks without treatment, in six months to a year with treatment. I didn’t know what stage I was at, but I knew the statistics. Not knowing what to say, all three of us remained silent. Jonathan sent the films to the radiology department so that they could be evaluated the next day by a specialist, and we said good night.

I set out on my motorcycle toward my little house at the other end of town. It was eleven o’clock; the moon was very beautiful in a bright sky. In the bedroom, Anna was asleep. I lay down and looked at the ceiling. It was really very strange that my life might end like this. It was inconceivable. There was such an abyss between what I had just found out and what I had been building up over so many years—the momentum I had accumulated for what promised to be a long race and should have led on to meaningful achievements. I felt like I was only just beginning to make a useful contribution. In pursuing my education and my career, I had made many sacrifices, invested a lot in the future. And suddenly I was facing the possibility that there would be no future at all.

And besides, I was alone. My brothers had been students in Pittsburgh for a time but had since graduated and moved away. I no longer had a wife. My relationship with Anna was very new, and she was surely going to leave me, for who would want a partner who is condemned at thirty-one? I saw myself like a piece of wood floating down a river, suddenly tossed against the shore, caught in a stagnant pool. It would never go all the way to the ocean. By a twist of fate, I was a captive in a place where I didn’t have any real ties. I was going to die. Alone. In Pittsburgh.

I remember something extraordinary happening as I lay there, contemplating the smoke from my little Indian cigarette. I didn’t really want to sleep. I was caught up in my thoughts when suddenly I heard my own voice speaking in my head, gently, with self-assurance, conviction, clarity, a certitude that I didn’t recognize. It wasn’t me, and yet it was definitely my voice. Just as I was repeating, “It can’t be happening to me; it’s impossible,” the other voice said, “You know what, David? It’s perfectly possible, and it’s all okay.” Something happened then that was both astonishing and incomprehensible. From that second onward, I was no longer paralyzed. It was obvious; yes, it was possible. It was part of the human experience. Many others had experienced it before me, and I wasn’t special. There was nothing wrong with being simply, completely human. All by itself, my mind had found the path to some relief. Later on, when I was frightened again, I had to learn to tame my emotions. But that night I went to sleep, and the next day I was able to go to work and take the necessary steps to begin to face the disease, and to face my life.

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