It was an answer to Freudian analysis: a pragmatic, thought-monitoring approach to treating anxiety, depression and other mental disorders, and it changed psychiatry.Dr. Aaron T. Beck, whose brand of pragmatic, thought-monitoring psychotherapy became the centerpiece of a scientific transformation in the treatment of depression, anxiety and many related mental disorders, died on Monday at his home in Philadelphia. He was 100.His death was confirmed by Alex Shortall, an executive assistant at the Beck Institute for Cognitive Behavior Therapy in Bala Cynwyd, Pa., outside Philadelphia. Dr. Beck’s daughter Dr. Judith Beck is its president.Dr. Beck was a young psychiatrist trained in Freudian analysis when, in the late 1950s, he began prompting patients to focus on distortions in their day-to-day thinking, rather than on conflicts buried in childhood, as therapists typically did. He discovered that many people generated what he called “automatic thoughts,” unexamined assumptions like “I’m just unlucky in love” or “I’ve always been socially inept,” which can give rise to self-criticism, despair and self-defeating attempts to compensate, like promiscuity or heavy drinking.Dr. Beck found that he could undermine those assumptions by prompting people to test them out in the world — say, by socializing without alcohol to observe what happens — and to gather countervailing evidence from their own experience, like memories of healthy relationships. Practicing these techniques, in therapy sessions and in homework exercises, fostered an internal dialogue that gradually improved people’s mood, he showed.Dr. Beck’s work, along with that of Albert Ellis, a psychologist working independently, provided the architecture for what is known as cognitive behavior therapy, or C.B.T. Over the past several decades, C.B.T. has become by far the world’s most extensively studied form of psychotherapy. In England, it forms the basis for a nationwide treatment program offering a number of related talk therapies.“There is more to the surface than meets the eye,” Dr. Beck was fond of saying.The influence of C.B.T. on the treatment of mental disorders is hard to exaggerate. Researchers have adapted the approach — originally developed for depression — to manage panic attacks, addictions, eating disorders, social anxiety, insomnia and obsessive-compulsive disorder. Therapists teach a variation to help parents manage children’s outbursts at home, and some have used it, in combination with medication, to manage the delusions and hallucinations of schizophrenia. Sports psychologists have made use of the principles for performance anxiety.Dr. Beck, who spent his career at the University of Pennsylvania, led the way.“One by one, he took each condition in psychiatry and laid out his thinking about how it should be addressed — and others followed up,” said David Clark, a professor of psychology at Oxford University, who designed and helped institute England’s talk therapy program. “I’m not sure that that’s ever been done, in quite that way.”Steven Hollon, a psychologist at Vanderbilt University, said of Dr. Beck: “He took a hundred years of dogma, found that it didn’t hold up, and invented something brief, lasting and effective to put in its place. He basically saved psychotherapy from itself.”Aaron Temkin Beck, known to friends and colleagues as Tim, was born in Providence, R.I., on July 17, 1921, the youngest of four children of Russian Jewish immigrants. His father was a printer who had socialist leanings and wrote poetry; his mother ran the household. As a child, Aaron was in perpetual motion. He was a Boy Scout who played basketball and football with friends until age 8, when he developed a serious infection after surgery for a broken arm. The month he spent in the hospital became a pivotal experience, turning him toward more intellectual pursuits, like reading and writing.After high school, he entered Brown University, finishing summa cum laude in 1942. He went on to get a medical degree from Yale University and did his residency in psychiatry at the Cushing Veterans Administration Hospital in Framingham, Mass.He was still in training at the Philadelphia Psychoanalytic Institute (now the Psychoanalytic Center of Philadelphia) when he began to have doubts about the scientific basis of Freud’s open-ended talk therapy, which was then the gold standard of treatment in American psychiatry. Though Freudian analysts agreed that there were “deep factors at work” in many cases of mental distress, Dr. Beck told The New York Times in 2000, no one could agree on what they were.After searching in vain to find some empirical basis for Freud’s ideas, he began to focus on patients’ thinking in the here and now. For years he worked in relative obscurity, unsure of his footing and supported primarily by his wife, Phyllis, whom he called his “reality tester.” (He and Phyllis Whitman married in 1950.) Judge Phyllis W. Beck, who is now retired and survives him, was the first woman to serve on the Pennsylvania Superior Court.In addition to her and his daughter Judith, Dr. Beck is survived by another daughter, Alice Beck Dubow, a judge in the Pennsylvania courts; two sons, Roy and Daniel; 10 grandchildren; and 10 great-grandchildren.Dr. Beck openly cited the influence of other thinkers, like the German psychoanalyst Karen Horney (1885-1952), the American psychoanalyst George Kelly (1905-1967) and Dr. Ellis, in developing his ideas. Dr. Ellis’s “rational emotive behavior therapy,” as Dr. Ellis called it, shared many common-sense principles with Dr. Beck’s approach.In contrast with Dr. Ellis, a flamboyant, tough-love father figure who died in 2007, Dr. Beck came across as an affectionate paterfamilias. Smiling softly beneath a rich sweep of white hair, wearing a bright bow tie and tailored suit, he engaged patients gently, chipping away at defeating beliefs with Socratic questions: Would you agree it is against your interests to have this belief? Do you think it’s possible to ignore these thoughts?He had a different effect, however, on many of his contemporaries. When he first described his approach, Freudian analysts ventured that he “had not been well analyzed,” the ultimate insider’s put-down, implying that he was unequipped to understand others because he had not fully understood himself in his training therapy.Later, in the 1980s, Dr. Beck was hit from the other side: So-called biological psychiatrists, who focused on drug treatments, questioned the strength of C.B.T. studies, saying that they were unimpressive compared with drug trials. To the extent that the therapy worked, argued Dr. Donald Klein, then director of the New York State Psychiatric Institute, it was because of a general morale-boosting effect rather than a specific, targeted treatment. Dr. Beck hardened with a blunt New England edge when challenged. But he typically responded with a pile of new data, and avoided being drawn into intellectual blood feuds with other theorists.Cognitive therapy spread worldwide, in part because therapists found it useful and in part because its techniques could be summarized simply in manuals, making it easy to standardize, teach and use in research studies. Dr. Beck, patient, plain-spoken and persuasive, was its most effective ambassador.In the first chapter of his classic 1967 book, “Depression: Causes and Treatment,” he observed: “There is an astonishing contrast between the depressed person’s image of himself and the objective facts. A wealthy man moans that he doesn’t have the financial resources to feed his children. A widely acclaimed beauty begs for plastic surgery in the belief that she is ugly. An eminent physicist berates himself ‘for being stupid.’”He wrote or co-wrote 22 books in all, on technical psychiatric topics as well as love, anger and chronic pain, including three with his daughter Judith.In his last years Dr. Beck applied cognitive techniques to help largely forgotten groups of people, like destitute drug addicts and people with late-stage schizophrenia. “These people have some capacity to do better, but they have all these defeatist attitudes and expectations; they assume they’re going to fail,” he said in an interview with The Times in 2009 in Bala Cynwyd.He was also advising a friend who had terminal cancer. “He’s having mood problems, and who wouldn’t?” Dr. Beck said. “I’m having him spend 30 minutes every day, at the beginning of the day, to think about how important this day is — that it may be the most important day of his life, or one of richest.”

I’ve reported on behavior and mental health for 20 years. As I exit, I can’t help but wonder why researchers have placed so little emphasis on helping people in distress today.When I joined the Science staff in 2004, reporters in the department had a saying, a reassuring mantra of sorts: “People will always come to the science section, if only to read about progress.”I think about that a lot as I say goodbye to my job, covering psychiatry, psychology, brain biology and big-data social science, as if they were all somehow related. The behavior beat, as it’s known, allowed tremendous freedom: I wrote about the mental upsides of binge drinking, playing the lotto and sports fandom. I covered basic lab research, the science of learning and memory, the experience of recurrent anguish, through the people who had to live with it. And much, much more.Like most science reporters, I had wanted to report on something big, to have a present-at-the-creation run that would shake up our understanding of mental health problems. At minimum, I expected research that would help people in distress improve their lives.But during my tenure, the science informing mental health care did not proceed smoothly along any trajectory. On the one hand, the field attracted enormous scientific talent, and there were significant discoveries, particularly in elucidating levels of consciousness in brain injury patients who appear unresponsive; and in formulating the first persuasive hypothesis of a cause for schizophrenia, based in brain biology.On the other hand, the science did little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health — rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use — went the wrong direction, even as access to services expanded greatly.What happened? After 20 years covering the field, here and at The Los Angeles Times, I have a few theories, and some ideas on what might be required to turn things around.Early on in my job, I started to field a steady stream of calls and emails, usually from parents asking for advice.“My son is suicidal. We’ve tried everything. What do we do?”“Our daughter is cutting herself, she’s out of control. Can you recommend a therapist, or someone to talk to?”More than a few of these queries came from colleagues at The Times. Others came from friends and family.I always provided suggestions and referrals (with a disclaimer), and helped decode the psychiatric jargon, if needed. I also followed up later, to see how things were going. This second conversation was a reminder, every time, that the mental health system, for all its caring professionals, is chaotic and extremely difficult to navigate. There are few systemwide standards, and vast and hidden differences in quality of care. Good luck finding an authoritative guide to navigating the full range of appropriate options.In time, those seeking help became the lens through which I saw my job, and their questions became my own. What does a diagnosis of bipolar really mean, in a young child? Is this drug necessary? How trustworthy is the evidence?One answer to that last question came in the mid-2000s, when the Food and Drug Administration held a series of hearings on whether antidepressant drugs, like Paxil, Prozac and Zoloft, backfired in a small number of users, causing suicidal thinking and behavior.The hearings were hair-raising. Hundreds of family members who had lost a loved one crowded the rooms, their anger and expectation sucking up most of the oxygen; and some of the parents, it was clear, knew at least as much about the drugs as the doctors.By 2006, the F.D.A. had concluded that a so-called black-box warning on antidepressant drug labels was warranted, citing the suicide risk for children, adolescents and young adults. Many psychiatrists were dismayed by the decision, insisting it would discourage the use of valuable medications.The antidepressant wars, as this debate came to be known (it rages on today), also helped uncover the influence of industry money on academic psychiatry. The pharmaceutical industry paid researchers at brand-name institutions to talk up drugs at seminars and conferences; it paid for “expert panels” to promote their use; and it often had outside firms write up the studies themselves, massaging the data.This state of affairs made it virtually impossible to interpret psychiatric drug studies. Some experiments were undoubtedly honest, rigorous efforts to document the diffuse effects of a medication. Others were no more than “infomercials,” in the phrase of the late Dr. Bernard Carroll, one of the most stubborn critics of his own profession — drug ads, in effect, dressed up as research. The infomercials were usually easy to spot, but not always; and without knowing the back story, the money trail, you couldn’t be sure what to believe.When it came to judging government-funded research projects — a cleaner enterprise, presumably — I again asked the questions that people in crisis continually asked me. Is this study finding useful for my son, or my sister, in any way? Or, more generously, given the pace of research: Could this work potentially be useful to someone, at some point in their lifetime?The answer, almost always, was no. Again, this is not to say that the tools and technical understanding of brain biology didn’t advance. It’s just that those advances didn’t have an impact on mental health care, one way or the other.Don’t take my word for it. In his forthcoming book, “Recovery: Healing the Crisis of Care in American Mental Health,” Dr. Thomas Insel, former director of the National Institute of Mental Health, writes: “The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased by threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unemployed and dying 20 years early.”And on it goes, to this day. Government agencies, like the National Institute on Drug Abuse and the National Institute of Mental Health, continue to double down, sinking enormous sums of taxpayer money into biological research aimed at someday finding a neural signature or “blood test” for psychiatric diagnoses that could be, maybe, one day in the future, useful — all while people are in crisis now.I have written about some of these studies. For example, the National Institutes of Health is running a $300 million brain-imaging study of more than 10,000 young children with so many interacting variables of experience and development that it’s hard to discern what the study’s primary goals are. The agency also has a $50 million project underway to try to understand the myriad, cascading and partly random processes that occur during neural development, which could underlie some mental problems.These kinds of big-science efforts are well-intended, but the payoffs are uncertain indeed. The late Scott Lilienfeld, a psychologist and skeptic of big-money brain research, had his own terminology for these kinds of projects. “They’re either fishing expeditions or Hail Marys,” he’d say. “Take your pick.” When people are drowning, they’re less interested in the genetics of respiration than in a life preserver.In 1973, the prominent microbiologist Norton Zinder took over a committee reviewing grants by the National Cancer Institute to investigate viruses. He concluded the program had become a “gravy train” for a small group of favored scientists, and advised slashing their support in half. A hard, Zinder-like review of current behavioral science spending would, I suspect, result in equally heavy cuts.How can the fields of behavior and brain science begin to turn the corner, and become relevant in people’s lives? For one, prominent scientists who recognize the urgency will have to speak more candidly about how money, both public and private, can warp research priorities. And funders, for their part, will have to listen, perhaps supporting more small teams working to build the psychological equivalent of a life preserver: treatments and supports and innovations that could be implementedin the near future.There’s a reason that so many people use binge drinking, playing the lotto and runaway eating to support their mental health: because the effects are reliable. Because they don’t require a prescription. And because they’re available, right now.

#masthead-section-label, #masthead-bar-one { display: none }The British Royal FamilyInterview and FalloutWhat Meghan and Harry DisclosedWhat We LearnedMemories of DianaAdvertisementContinue reading the main storySupported byContinue reading the main storyA Trauma Expert Puts the Meghan and Harry Interview in ContextCommentators describe the couple’s experience as “trauma.” But strictly speaking, trauma is an event that alters your mind, leaving you helpless and terrified.Prince Harry, Duke of Sussex, and Meghan, Duchess of Sussex, in London last year.Credit…Justin Tallis/Agence France-Presse — Getty ImagesMarch 9, 2021, 3:05 p.m. ETOprah Winfrey’s interview this week with Prince Harry and his wife, Meghan, Duchess of Sussex, revealed simmering divisions within the royal family, and a deep, abiding sense of loss felt by the prince after his mother’s death in 1997 that intensified amid the subsequent tabloid coverage. Prince Harry, who has become a prominent advocate for mental health causes, has frequently spoken about this loss and its effect on his mental health.The couple left Britain in part because they said that the royal family would not provide them support after repeated attacks by the press on the duchess that left her feeling isolated and distraught. Many in the news media and on social platforms are interpreting their decision as a result of the “trauma” that Harry experienced from the loss of his mother, Princess Diana, and that Meghan experienced after she became part of the royal household.But throwing around these mental health terms risks creating a misunderstanding of what Harry and Meghan are talking about and what they are asking for. It’s clear that the couple lived through periods of deep emotional distress and, in Meghan’s case, isolation and perhaps depression. She described “not wanting to live anymore.”But trauma, in the clinical sense, means something different, according to Dr. Bessel van der Kolk, a psychiatrist based in Boston and the author of “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.” He talked to The New York Times about how trauma differs from distress, even though trauma can be the source of distress.What qualifies as trauma, particularly childhood trauma?The strict definition of childhood trauma does not include the loss of a mother or a father. Strictly speaking, a trauma is different from a rupture in one’s attachment system, though often the two of them go together, as they do in cases of physical abuse or sexual abuse at the hands of one’s caregivers. The attachment system is a different dimension from trauma: Trauma is an event that blows your mind and leaves you helpless and terrified. The attachment system defines who we belong to, who is there for us, who sees and cherishes us.Losing your mother as a boy certainly shapes your identity because a central relationship is ruptured and your core sense of security is affected.Exposure to long periods of parental discord forces a child to take sides and often makes children overprotective of an injured parent. When their parents are distressed, children often feel responsible to manage their parental relationship as well as they can. A little boy seeing his mom being hurt or humiliated may well develop a deep sense of caring, protection and possibly a deep sense of guilt for not having been able to do more.What are the long-term effects of childhood trauma?The terror of being assaulted is quite different from not being seen or noticed — to being made to feel you don’t belong. Feeling unwanted and despised creates a deep sense of feeling godforsaken and tends to make you feel that you may as well be dead.Sexual and physical abuse tends to put you on guard. You automatically recoil from being involved with others; you may feel a deep sense of threat when you get close to other people. It’s very hard to give up that hyper-alertness. It makes a person extremely cagey, careful not to be caught in the same situation ever again. However, after repeated trauma, some people develop a sense that being used is all they are good for, causing them to become compliant with their abusers.Being treated by family members as irrelevant — the attachment trauma, or being a witness to ongoing patterns of abuse — creates another kind of psychological pattern. People’s identity is formed around questions like “What did I do wrong?” or “What could I have done differently?” That becomes the central preoccupation of their lives.The important factors are what those challenges are, and at what age they occur. Character is formed in the first 10 to 14 years of life. These years are the most critical, and the earlier a real trauma occurs, the more lasting impact it usually has. As people grow older, they become more independent agents and can tolerate more rejection, more emotional pain.Don’t most children live through at least one experience that they later consider traumatic or severely challenging?Yes. Most people have very challenging lives, and major conflicts with family members is not at all out of the ordinary. Being rejected by your in-laws — this is not uncommon, of course, and it does not matter how prominent you are or whether you live in a palace. Then a major issue in the couple’s relationships becomes whether one’s spouse chooses to side with you or with their family.Could the same experience that upends one child’s life have a smaller impact on another child’s life?Yes. People have very different impulses, very different reactions to the same kinds of challenges. But your attachment system — who you belong to, who knows you, who loves, who you play with — this is more fundamental than trauma. As long as people feel safe with the people in their immediate environment, in their families, tribes or troops, they are amazingly resilient.Risking or giving up those bonds, as Harry did, is a very profound step. The default position, psychologically, is to adjust your behavior and expectations to fit in with your family of origin. It takes enormous courage to sever those ties and to create new and more fruitful affiliations.If you are having thoughts of suicide, call the National Suicide Prevention Lifeline in the United States at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.AdvertisementContinue reading the main story