Aaron Beck: the man who usurped Freud

The current issue (Autumn 2009) of American Scholar profiles Aaron Beck, the Philadelphia psychiatrist (now nearing 90) who developed cognitive-behavior therapy (CBT).

Unless you work in the field, you’ve probably never heard of Beck. (I hadn’t.) Yet, he is the man perhaps most responsible for debunking the ideas of a psychiatrist you undoubtedly have heard of: Sigmund Freud.

Beck brought on the fall of Freudian analysis by insisting that treatments for mental illnesses undergo rigorous empirical studies to determine their effectiveness — or lack of it.

In other words, he was — and is — a believer in evidence-based science.

Beck began his career as a Freudian analyst. But, as writer Daniel Smith tells the tale, Beck always found “psychoanalysis’s emphasis on invisible psychic forces … soft-minded and esoteric, more a faith than a medical discipline.” And whenever Beck questioned his professional colleagues about whether there was any evidence to back up psychoanalytical interpretations for schizophrenia, neurosis and other mental illnesses, he was confronted with a stunning response:  “[H]is friends suggested that unconscious resistances were preventing him from realizing the truth,” writes Smith.

But Beck persisted. In one of his earliest studies he compared the dreams of depressed and nondepressed people. Psychoanalysis attributed depression to “retroflected hostility.” But Beck found that the dreams of the depressed were actually less hostile (but more laden with disappointment and hopelessness — the feelings they were experiencing in real life) than those of their nondepressed peers.

The more Beck’s research suggested that the emperor (psychoanalysis) had no (or few) clothes, the more his peers attempted to isolate him.

He was, for example, rejected for membership in the then-all-powerful American Psychoanalytic Institute “on the grounds that his mere desire to conduct scientific studies signaled that he’d been improperly analyzed,” reports Smith.

Eventually, however, the findings from Beck’s randomized, controlled studies — the gold-standard methodology for scientific research — were too compelling to be ignored. In 1977, he published a seminal study that showed for the first time that a psychotherapy [CBT] could be more effective than placebo and as or more effective than drugs for the treatment of depression.

Today, reports Smith, “dozens of states have initiated programs to train mental-health professionals in empirically supported psychotherapies.  In 2001, Congress created the National Child Trauma Stress Network, funded at more than $30 million a year, to disseminate empirically supported therapies to traumatized children and their families. Since 2005, the Veterans Administration, the closest thing America so far has to a nationalized health-care system, has allocated more than $250 million a year to train therapists in [enriched supportive therapies like CBT] in an effort to cope with the influx of traumatized veterans returning from Iraq and Afghanistan. All of these programs highlight CBT.”

And in 2006, Beck — the man whose ideas were once dismissed by the world’s leading psychiatrists — won the Lasker Award, which is sometimes referred to as the “American Nobel Prize” for science.

The story-behind-the-story of this profile is a familiar one: A scientist steps forward to tell his or her colleagues that some treatment they’ve believed in for years or even decades has little or no merit based on the empirical evidence. The scientist is then ignored and/or ridiculed for many more years — until the evidence is so overwhelming that it can’t be ignored.

Aaron Beck may not be a household name, but he’s certainly brought hope and help to millions of American households — those wtih a family member with depression or other mental illness that can be treated with CBT.