Thirty years ago I took aim at theory and research concerning the role of cognition in depression. I fired away at research studies appearing in the best of journals like beer bottles lined up on a fence. Cognitive therapy and its associated theory provided the unchallenged, dominant perspective on depression at the time. No one had ever written such a sustained, harsh critique or, at least, no one had ever gotten one published.
Shortly after the resulting Psychological Bulletin article appeared in 1983, I received some fan mail fromAaron T. Beck. I had never before been in contact with him, but he expressed great enthusiasm for the critique. He was even amused by its awful pun about quarking ducks.
Dr. Beck was the major inspiration for the work that I was criticizing, and some of the key studies were his own. I was too taken aback to respond. What could I say, especially when he was being so gracious and disarming in accepting my criticisms?
Dr. Beck eventually wrote to me again, expressing curiosity about whether I received his last letter. Embarrassed, I responded and in the subsequent exchange, Dr. Beck invited me to his 65th birthday party in Toronto (1986). When I put on my name tag at the party, Dr. Beck immediately came over and warmly greeted me. He introduced me to the entourage that was following him around. "Jim is a tough critic. He circled my herd of ideas like a wolf and picked off the weaker ones. You know, sometimes that kind of thing strengthens the health of the remaining herd."
Yesterday, July 18, he celebrated his 90th birthday, and I want belatedly to wish him well and to express appreciation for his continued support over the years.
Almost 30 years after the critical paper was published, and eight Psychological Bulletin articles later, I still have never had another such an encouraging response from someone whose work I criticized.
My critique was far-reaching. Too much of research on cognition at the time was conducted with college students picked merely because they scored above a cutoff on a depression questionnaire. There was a glut of such studies, but the students were distressed or simply unhappy, not necessarily depressed. My criticism of this widespread practice added to the pressure to shift away from studying distressed students to patients meeting diagnostic criteria or getting treatment, at least when the interest of is in learning something about depression. Within a few years, the Journal of Abnormal Psychology adopted a policy of routinely rejecting manuscripts based on such college student studies.
I also ridiculed the idea that investigators could tally up self statements endorsed on a questionnaire and infer the ratio of positive to negative thoughts. If depressed persons endorse twice as many negative self statements as positive, researchers would infer that they had twice as many negative thoughts has positive. Like a lot of the things that cognitive researchers were doing at the time, the answers they got dependent on the questions they asked-and how would we ever possibly know how many positive versus negative thoughts were going on in the head, anyway.
A lot of supposed demonstrations that depressed persons were less accurate or more accurate in their perceptions than the nondepressed persons were simply a result of the matching of the situations or that investigators provided and the responses research participants were already predisposed to make. How about depressed persons evaluating their performance on laboratory tasks more negatively than nondepressed persons? Maybe they were not just responding to how they had all done in the laboratory, but to how badly they were doing in important areas of their life outside of the lab. Depressed persons, you know, often have lives that are going badly and often have some responsibility for their lives going badly. Cognitive theory and research at the time was ignoring this simple observation.
Given the right situation, investigators could demonstrate that depressed persons were more accurate or that nondepressed persons were more accurate. The bias of the investigator's questions determined the fit with the bias of the responses of research participants that they were predisposed to provide anyway. It was not a matter of depressed persons being 'sadder, but wiser" or of nondepressed persons seeing accurately, it was just response bias.
I went on to provide my own interpersonal alternative to cognitive interpretations of the self-report data that were being collected at the time. Namely, the negative things that depressed persons say about themselves can serve purposes, they have interpersonal functions. Their self statements can variously serve to elicit sympathy and support, offer excuses for their ineptness, or make other people feel guilty and not retaliate when the other people are already feeling frustrated and depressed themselves by the depressed person's behavior. That depressed persons can sometimes prove depressing (especially when someone is trying too hard to cheer them up) and consequently get rejected had been the focus of my dissertation.
In a later paper, I even offered the hypothesis that sometimes depressed people just kvetch out of habit, and they don't even necessarily believe what they're saying themselves. No one ever seems to ask depressed persons except maybe in interpersonal therapy "do you really believe all that nonsense that you're saying?"
Oh, the pun about quarking ducks. I thought it was particularly dumb that cognitive researchers at the time, as many of them still do, thought they could infer thinking processes from peoples' responses to leading force choice questions on self-report questionnaires. So I came up with a Monty Pythonesque experiment, which I supposedly conducted at an AABT meeting (I actually had in some version). I asked attendees at a symposium "what is the fundamental particle of matter?" and I got various answers from the psychologists like neutron, proton, and electron. When I patiently asked the ducks swimming in a pond outside, I eventually got the correct answer "quark, quark" and on that basis concluded that ducks has a superior knowledge of physics and that's why, unlike psychologist they could fly.
Ouf, Ok, the bad joke sounds terrible today, but maybe my Massachusetts accent was thicker then and so "quark" and "quack" were not so far part in sound. And, if I could change anything in the 1983 paper, I would remove this silly pun.
It was only a couple years ago the Dr. Beck and I co-authored two papers. The occasion was a particularly terrible meta-analysis of long-term psychodynamic psychotherapy that appeared in JAMA. The average effect size claimed for this therapy was much larger than what was found in the individual studies. And the authors had a significant conflict of interest in wanting to reverse an unfavorable decision about insurance companies in Germany not paying for long term dynamic therapy.
Dr Beck and I met at a suburban lunch spot near his Institute and we agreed that we would mobilize a team of graduate students headed by his postdoctoral fellow, Dr. Sunil Bhar. The team we assembled demolished the JAMA article, by examining its claims in excruciating detail and exposing their nonsense. The authors of the JAMA paper responded back, and the title of our reply said it all: Missed Opportunity to Rectify or Withdraw a Flawed Meta-analysis of Longer-Term Psychodynamic Psychotherapy.
I'm quite proud of that pair of papers and I'm sure that lots of people were shocked that someone whose work I had so criticized for so long would agree to collaborate with me.
Belated happy birthday Dr. Beck! I look forward to writing more papers with you and to your continued contributions to the field.
And, no, if anyone thinks otherwise, I'm not a cognitivist and certainly not a cognitive therapist, and Dr. Beck can verify that. Yet, you don't have to be a a loyal cognitivist to appreciate the contribution of Dr. Beck and to collaborate with him, and thankfully he does not demand that you convert.