Later On

It really boils down to one guy:

In the basement of Aaron Beck’s house, nine miles northwest of downtown Philadelphia, in a dimly lit, dusty, concrete-walled room dedicated to his archives, there sits a pink plastic box containing patient notes from a 40-year-old case of psychotherapy. Beck, a professor emeritus of psychiatry at the University of Pennsylvania, has short-cropped white hair, sharp blue eyes, and, at 88, a hunched and shuffling gait. He has been a practicing psychiatrist for 59 years. Among the thousands of patients Beck has treated during this time, this case rates as persistent but uncomplicated. The patient was in his mid-40s and had a good career, a loving wife, four beautiful children, and a trove of close friends. Privately, however, he struggled with an acute tendency toward self-criticism. He was of the type that can’t help but interpret neutral events as harsh reflections on his personal worth. He was forever searching for approval, and forever anticipating disapproval.

When the patient’s treatment began—the earliest notes date from the mid-1960s—the dominant psychotherapeutic approach in the United States was psychoanalysis. Sigmund Freud had made his first and only visit to this country in 1909, and in the half century that followed, his approach to mental suffering took firm hold of American psychiatry, splintering into a multitude of camps but always retaining a focus on the unconscious mind, the central feature of Freudian analysis. Beck was trained in this tradition. He was a graduate of the Philadelphia Psychoanalytic Institute, and from 1950 to 1952 he worked at the Austen Riggs Center, a world-renowned psychoanalytic hospital in Stockbridge, Massachusetts. Beck was an eager student. “I have come to the conclusion,” he wrote to a colleague in 1958, “that there is one conceptual system that is peculiarly suitable for the needs of the medical student and physician-to-be: Psychoanalysis.”

Fewer than 10 years later, …

Beck’s case notes betray none of this confident enthusiasm and not a hint that he had applied his training to his patient’s complaints. In the treatment, nothing analytic has survived. Whereas psychoanalysis uncovers deeply buried impulses, Beck is interested in those thoughts that lie barely concealed beneath conscious awareness. Whereas psychoanalysis uncovers the historical motives behind troubling emotions, Beck scrutinizes the present-tense logic of his patient’s emotions. And whereas psychoanalysis is ultimately pessimistic, seeing disappointment as the price for existence, Beck’s approach is upbeat, conveying a sense that, with hard work and determined rationality, one could learn not only to tolerate but to stamp out neurotic tendencies.

The patient is none other than Beck himself. The notes, and the self-therapy they trace, date from a period of his life when he was working, to the disdain of his analytic colleagues and the indifference of most everyone else, to develop the system of psycho­therapy for which he is now revered in the field of mental health. Beck is the inventor of …

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