Aaron Beck loved to share how he came to reject psychoanalysis and revolutionize the way talk therapy for mental disorders was conducted in the United States and much of the world.
Like other psychiatrists in the mid-20th century, Dr. Beck was trained in Freudian concepts, including the idea that depression was the result of inward-looking anger. In what would become a permanent model, he decided in the late 1950s to test this idea in a more scientific way. He found little evidence that his patients were angry on the inside, but they were suffering from negative and irrational thoughts about themselves.
He spoke of a patient in psychoanalysis who feared that his stories about his sexual experiences would bother him. They certainly weren’t. He started asking other patients what they were thinking and found that they too were eating a diet of negative thoughts. They saw themselves as failures in love and in life.
Dr Beck, who died in his Rittenhouse Square condominium on Monday at the age of 100, wondered if it might not be better for patients to learn to think more logically and precisely in the present than to spend countless billable hours analyzing childhood slights. Cognitive therapy – now known as cognitive behavioral therapy (CBT) – was born.
Dr Beck, who spent nearly seven decades working and teaching at the University of Pennsylvania, as well as psychologist Albert Ellis, who independently explored similar ideas, are credited with developing faster treatment and evidence-based for depression and, later, many other mental illnesses. With more than 2,000 studies on its impact, CBT is the most studied non-drug mental health treatment. Research has generally shown CBT to be at least as effective as drugs for non-psychotic disorders and to have longer lasting results, said Steven Hollon, a psychologist at Vanderbilt University who trained with Dr. Beck.
“He’s the world’s most important psychiatrist of the 20th century,” said Martin Seligman, a psychologist at Penn who is himself known as the founder of positive psychology. He and Dr Beck have met once a month for the past decade to talk shop and share books.
Robert DeRubeis, a psychologist who runs Penn’s clinical training program for psychologists, said he would change Seligman’s assessment. “I would put him without doubt as the most important figure in Mental Health in the last century, âhe said. “I wouldn’t reduce it to psychiatry.”
âHe was a giant,â said Frank Farley, former professor of psychological studies in education at Temple University and past president of the American Psychological Association (APA). He said that Dr Beck, along with Ellis, had dethroned Sigmund Freud, the very influential creator of psychoanalysis. Farley thought Dr. Beck deserved a Nobel Prize.
Seligman said Dr Beck was, in fact, shortlisted for this award, but did not win it. (A 2008 Inquirer story said that Penn booked a limo in 2007 just in case Dr. Beck won.) He did, however, win the Heinz Prize for the Human Condition in 2001 and the Albert Lasker Prize for Clinical Medical Research. in 2006. He also wrote or co-authored 25 books.
Arthur C. Evans Jr., executive director of the APA and former commissioner of the Philadelphia Department of Behavioral Health and Developmental Disability, praised Dr. Beck for bringing “hope and healing” to people. suffering from mental disorders and drug addiction. âHe was truly one of the most amazing human beings I have ever known,â Evans said. âHis legacy will be deep and lasting. “
Aaron Temkin Beck, who was Tim for his best friends and ATB for his colleagues at the Beck Institute for Cognitive Behavioral Therapy, was a warm, deeply inquisitive, compassionate and self-effacing man who never stopped working.
Two days before his death, Dr. Beck spent hours on the phone with Paul Grant, director of the institute’s Center for Recovery-Oriented Cognitive Therapy, discussing an article they were writing together that they called ” The keys to their kingdom â. He explained the theories they had developed over the past two decades to help patients with serious mental illnesses, including schizophrenia, benefit from CBT. Working with this often overlooked group had become Dr. Beck’s passion. Both focused on harnessing the ‘adaptive mode’ periods when patients were receptive to communication and change.
When asked why Dr Beck continued to work so late in life, Grant said his mentor, who was already at work before Grant was born, was always excited about new ideas. But he suspected that part of his enthusiasm at the end of his life was that his ideas were rejected by many of his peers until he was over 50. Few have come to his first talks. The psychoanalysts fired him. âI always thoughtâ¦ he was making up for lost time,â Grant said. After a fall that broke his hip in January, Grant said, Dr Beck’s desire to work became more urgent. âHe was worried that this would happen, that he wouldn’t have the chance to see the document finished. “
Friends said Dr Beck, who was the son of Russian immigrants who settled in Providence, RI, has always maintained a healthy work-life balance. He married Phyllis Whitman in 1950. She was associate dean of the University of Pennsylvania Law School and was the first female judge of the Superior Court of the Commonwealth of Pennsylvania. They had four children. He co-founded the Beck Institute in 1994 with his daughter Judith Beck, a psychologist.
He was an avid reader who favored stories. Although macular degeneration took his sight, he enjoyed listening to books. Seligman suggested Our wife in Moscow, a Cold War spy novel, less than two weeks before Dr. Beck’s death. Before his vision became too bad to see the ball in the late 1980s, Dr. Beck also frequently played tennis. DeRubeis, who is 32 years younger, said Dr Beck wanted his help improving his net game when he was around 70.
Dr Beck himself loved to tell a story about watching Boris Becker, famous for his meltdowns during matches, play at Wimbledon, DeRubeis said. Becker, frustrated with his performance that day, turned to the crowd and asked, âDoes anyone want to play for me?
Dr Beck, who was sitting near the front and was probably in his sixties at the time, stood up and said, âI will. “
“Sit!” the crowd yelled. Dr Beck took a hit.
Leading psychologists have said that Dr. Beck’s greatest contribution has been to challenge the dominant treatment of his day – psychoanalysis – and to give patients a way to harness their own mental powers for positive change. Seligman said Dr Beck’s predecessors believed the thoughts of people with mental illness were caused by conflicting and agitated emotions beneath the surface. âBeck,â he said, âknocked him over and said, ‘No, it’s our way of thinking that changes our emotion. “
Hollon said Dr Beck’s key idea was that his patients could actually believe what they told him.
It would challenge patients to reexamine their thoughts and change their habits. It was a hands-on approach that often made the difference quickly. Grant said Dr Beck joked that he knew the technique was working because his practice had faded. âIn fact, people got better,â he said.
Dr. Beck and the therapists who learned his techniques believed in scientific tests, and they quickly began to prove that the treatment worked. Hollon said that psychoanalysts have never adopted this type of test, so there are no good direct comparisons.
CBT is now used for a wide variety of mental illnesses, including depression, eating and personality disorders, anxiety, and substance abuse. Dr. Beck also developed a widely used measure of symptoms of depression.
He was generous with his time and attention when it came to students and supported young researchers. DeRubeis said he has met Dr Beck every week for 20 years. He sometimes brought students with him. Dr. Beck invariably asked everyone what they were working on.
In July, a virtual meeting for Dr. Beck’s 100th birthday drew a dozen good friends, many of whom were former interns. A recurring theme in their remarks, Hollon said, was that Dr Beck noticed them early on and helped them out. âHe was a guy who spotted young talent and brought them in with them,â he said.
This support to other clinicians has helped spread CBT and the research that has shown it to work, said Lisa Pote, executive director of the Beck Institute. âHe planted seeds through the people he worked with, and they planted seeds,â she said.
Dr Beck is survived by his wife and four children, Roy, Judith, Daniel and Alice Beck Dubow, as well as 10 grandchildren and 10 great grandchildren. Family service will be private. The Beck Institute will host a public memorial at a later date.