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.
more from Daniel B. Smith at The American Scholar here.