Chapter 3

The Dirty Little Secret of Drugs and Therapy

I am an old hand at cultivating funding for science. I have spent much of the last forty years as a supplicant for government funding, and my knees are just about worn out. I have been funded continuously for forty years by the National Institute of Mental Health (NIMH), however, and I know an important breakthrough when I see it. The findings presented in the last chapter are such a breakthrough: not conclusive, of course, but easily intriguing enough to merit the big bucks in the effort to find out if such inexpensive treatments of depression work reliably.

According to the World Health Organization (WHO), depression is the most costly disease in the world, and the treatments of choice are drugs and psychotherapy. On average, treating a case of depression costs about $5,000 per year, and there are around ten million such cases annually in America. Antidepressant drugs are a multibillion-dollar industry. Imagine a treatment—giving positive psychology exercises on the web—that is dirt cheap, massively disseminated, and at least as effective as therapy and drugs. So I was shocked when I applied for funding from the NIMH three times to pursue these findings, and the proposals were rejected unreviewed each time. (This chapter is not special pleading for personal funding, which I am happy to say that I have more of than I know what to do with. Rather it is about misplaced government and industry priorities.) For you to understand why this proposal was rejected, I have to tell you a bit about the hammerlock that two industries—the drug companies and the Psychotherapy Guild—have over the treatment of mood disorders, including depression.

Cure Versus Symptom Relief

The first dirty little secret of biological psychiatry and of clinical psychology is that they both have given up the notion of cure. Cure takes too long if it can be done at all, and only brief treatment is reimbursed by insurance companies. So therapy and drugs are now entirely about short-term crisis management and about dispensing cosmetic treatments.

There are two kinds of medications: cosmetic drugs and curative drugs. If you take an antibiotic long enough, it cures by killing the bacterial invaders. When you’re done taking it, the disease will not recur because the pathogens are dead. Antibiotics are curative drugs. On the other hand, if you take quinine for malaria, you get only temporary suppression of symptoms. When you stop taking quinine, malaria returns full-blown. Quinine is a cosmetic drug—a palliative—and all medications can be classified either as curative in intention or cosmetic in intention. Palliation is a good thing (I wear hearing aids), but it is not the highest good, nor is it the ultimate end of intervention. Symptom relief should be a way station on the road to cure.

But the road has come to a dead end at symptom relief. Every single drug on the shelf of the psychopharmacopoeia is cosmetic. There are no curative drugs, and no drug is in development that I know of that aims at cure. Biological psychiatry has given up on cure. I am by no means a Freudian, but one thing that I find exemplary about Freud is that he was after a cure. Freud wanted a psychotherapy that worked like an antibiotic; his talking cure was an attempt to cure the patient by ridding her of the symptoms forever by using insight and catharsis. Freud was not after symptom relief—some symptom relief can even be seen as a defense called “flight into health,” which preserves the disease intact—and palliation is not a significant goal in psychodynamic psychotherapy. The stringencies of managed care, far more than the decline of the Freudian influence, has seduced psychology and psychiatry into working only on symptom relief, not on cure.

The 65 Percent Barrier

I’ve spent a good part of my life measuring the effects of psychotherapy and of drugs, and here’s the second dirty little secret. Almost always, the effects are what is technically called “small.” Depression is typical. Consider two treatments that are certified by vast literatures to “work”: cognitive therapy for depression (which changes how you think about bad events) and selective serotonin reuptake inhibitors (SSRIs, such as Prozac, Zoloft, Lexapro, to name a few). Taking an average over the entire huge literature, for each you get a 65 percent relief rate, accompanied by a placebo effect that ranges from 45 percent to 55 percent. The more realistic and elaborate the placebo, the higher the placebo percentage: so high is the placebo response that in half the studies on which the U.S. Food and Drug Administration (FDA) based its official approval of the antidepressant drugs, there was no difference between placebo and drug.

Recent studies of the antidepressant drugs are even more discouraging. A prestigious consortium of psychologists and psychiatrists took the data from all 718 patients together from the six best-done studies of drug versus placebo, dividing the patients by severity of depression. For very severe depression (if you have depression this severe, you likely would not be reading a paragraph as challenging as this one), the drugs showed reliable effects, but for moderate or mild depression, the effects were nonexistent. The vast majority of prescriptions for antidepressant drugs, unfortunately, are written for just these patients—moderate and mild depressives. So a 20 percent drug edge over placebo would be a generous, maximum estimate of their benefit. This 65 percent number crops up over and over, whether you’re looking at the percentage of patients that gain relief or at the percentage of symptom relief within patients. I call this problem the “65 percent barrier.”

Why is there a 65 percent barrier, and why are the effects so small?

From the first day I took up skiing until five years later when I quit, I was always fighting the mountain. Skiing was never easy. Every form of psychotherapy I know, every exercise, is a “fighting the mountain” intervention. In other words, these therapies are not self-reinforcing, and so the benefits fade over time. In general, talk therapy techniques all share the property of being difficult to do, no fun at all, and difficult to incorporate into your life. In fact, the way we measure how efficacious talk therapies are is by how long they last before they “melt” once treatment ends. Every single drug has exactly the same property: once you stop taking it, you are back to square one, and recurrence and relapse are the rule.

By contrast, try this next positive psychology exercise. It is fun to do and self-maintaining once you catch on.

Active, Constructive Responding

Strangely, marriage counseling usually consists of teaching partners to fight better. This may turn an insufferable relationship into a barely tolerable one. That’s not bad. Positive psychology, however, is more interested in how to turn a good relationship into an excellent one. Shelly Gable, professor of psychology at the University of California at Santa Barbara, has demonstrated that how you celebrate is more predictive of strong relations than how you fight. People we care about often tell us about a victory, a triumph, and less momentous good things that happen to them. How we respond can either build the relationship or undermine it. There are four basic ways of responding, only one of which builds relationships:

ACTIVE AND CONSTRUCTIVE RESPONDING

This table illustrates two examples of the four styles.

 

YOUR PARTNER SHARES POSITIVE EVENT	TYPE OF RESPONSE	YOUR RESPONSE
“I received a promotion and a raise at work!”	Active and Constructive	“That is great! I am so proud of you. I know how important that promotion was to you! Please relive the event with me now. Where were you when your boss told you? What did he say? How did you react? We should go out and celebrate.” Nonverbal: maintaining eye contact, displays of positive emotions, such as genuine smiling, touching, laughing.
	Passive and Constructive	“That is good news. You deserve it.” Nonverbal: little to no active emotional expression.
	Active and Destructive	“That sounds like a lot of responsibility to take on. Are you going to spend even fewer nights at home now?” Nonverbal: displays of negative emotions, such as furrowed brow, frowning.
	Passive and Destructive	“What’s for dinner?” Nonverbal: little to no eye contact, turning away, leaving the room.
“I just won five hundred dollars in a charity raffle!”	Active and Constructive	“Wow, what luck. Are you going to buy yourself something nice? How did you buy that ticket? Doesn’t it feel great to win something?” Nonverbal: maintaining eye contact, displays of positive emotions.
	Passive and Constructive	“That is nice.” Nonverbal: little to no active emotional expression.
	Active and Destructive	“I bet you are going to have to pay taxes on that. I never win anything.” Nonverbal: displays of negative emotions.
	Passive and Destructive	“I had a bad day at work today.” Nonverbal: little eye contact, turning away.

ACTIVE AND CONSTRUCTIVE RESPONDING

Here’s your assignment for the week: listen carefully each time someone you care about tells you about something good that happened to them. Go out of your way to respond actively and constructively. Ask the person to relive the event with you; the more time he or she spends reliving, the better. Spend lots of time responding. (Laconic is bad.) Hunt all week long for good events, recording them nightly in the following form:

 

OTHER’S EVENT	MY RESPONSE (VERBATIM)	OTHER’S RESPONSE TO ME

 

If you find you are not particularly good at this, plan ahead. Write down some concrete positive events that were reported to you recently. Write down how you should have responded. When you wake up in the morning, spend five minutes visualizing whom you will encounter today and what good things they are likely to tell you about themselves. Plan your active, constructive response. Use variants of these active and constructive responses throughout the week.

In contrast to fighting the mountain, this technique is self-maintaining. But it does not come naturally to most of us, and we need to practice it with diligence until it becomes a habit.

I was delighted to see my sixteen-year-old son, Darryl, sitting in the front row of a workshop I gave in Berlin in July 2010. Finally, a chance to show Darryl what I really do for a living, other than sitting in front of my computer, writing and playing bridge! In the first hour, I gave the six hundred participants the active-constructive exercise, dividing them into pairs, with person A presenting a good event and person B responding, then switching. I saw that Darryl found a stranger and did it as well.

The next day, the whole family went to the enormous flea market in the Tiergarten. We scattered, buying trinkets and various souvenirs of our tour of Eastern Europe. My two little girls, Carly, age nine, and Jenny, age six, were thrilled about this adventure, and they sprinted from booth to booth. It was a record hot day in Berlin—one hundred degrees—and we were out of steam and money before too long, so we reassembled for air-conditioning and iced coffee at the nearest café. Carly and Jenny were both sporting gold tiaras made of plastic and encrusted with costume jewels.

“We got them for thirteen euros,” Carly said proudly.

“Didn’t you bargain?” I retorted unthinkingly.

“Now, that is a great example of active destructive, Dad,” commented Darryl.

So I am still practicing it, and with lots of coaching.

Once you start doing it, however, other people like you better, they spend more time with you, and they share more of the intimate details of their lives. You feel better about yourself, and all this strengthens the skill of active, constructive responding.

Dealing with Negative Emotions

In the therapeutic century we’ve just lived through, the therapist’s job was to minimize negative emotion: to dispense drugs or psychological interventions that make people less anxious, angry, or depressed. Today, too, the healer’s job is minimizing anxiety, anger, and sadness. Parents and teachers have taken on the same job, and I worry about this because there is another, more realistic approach to these dysphorias: learning to function well even if you are sad or anxious or angry—in other words, dealing with it.

My posture emerges from the most important (and most politically uncongenial) research discovery in the field of personality of the last quarter of the twentieth century. This rock-solid finding disillusioned an entire generation of environmentalist researchers (me included), but it is true that most personality traits are highly heritable, which is to say that a person may have genetically inherited a strong predisposition to sadness or anxiety or religiosity. Dysphorias often, but not always, stem from these personality traits. Strong biological underpinnings predispose some of us to sadness, anxiety, and anger. Therapists can modify these emotions but only within limits. It is likely that depression, anxiety, and anger come from heritable personality traits that can only be ameliorated, not wholly eliminated. This means that, as a born pessimist, even though I know and use every therapeutic trick in the book about arguing against my automatic catastrophic thoughts, I still hear the voices frequently that tell me, “I am a failure” and “Life is not worth living.” I can usually turn down their volume by disputing them, but they will always be there, lurking in the background, ready to seize on any setback.

What can a therapist do if the heritability of dysphoria is one cause of the 65 percent barrier? Oddly enough, therapists can use information from the way that snipers and fighter pilots are trained. (I’m not endorsing sniping, by the way; I want only to describe how training is conducted.) It can take about twenty-four hours for a sniper to get into position. And then it can take another thirty-six hours to get off the shot. This means that snipers often haven’t slept for two days before they shoot. They’re dead tired. Now, let’s say the army went to a psychotherapist and asked her how she would train a sniper. She would use wake-up drugs (Provigil is a good one) or psychological interventions that relieve sleepiness (a rubber band on the wrist snapping you into temporary alertness is a good one).

That is not how snipers are trained, however. Instead you keep them up for three days and have them practice shooting when they are dead tired. That is, you teach snipers to deal with the negative state they’re in: to function well even in the presence of fatigue. Similarly, fighter pilots are selected from rugged individuals who do not scare easily. But many things happen to fighter pilots that scare the pants off even the toughest of them. Again, flight instructors don’t call on therapists to teach them the tricks of anxiety reduction (which are legion), thereby training candidates to become relaxed fighter pilots. Rather, the trainer sends the jet into a dive straight for the ground until the trainee is terrified, and then the trainee—in a state of terror—must learn to pull up.

Negative emotions and the negative personality traits have very strong biological limits, and the best a clinician can ever do with the cosmetic approach is to get patients to live in the best part of their set range of depression or anxiety or anger. Think about Abraham Lincoln and Winston Churchill, two severe depressives. They were both enormously well-functioning human beings who dealt with their “black dog” and their suicidal thoughts. (Lincoln came close to killing himself in January 1841.) Both learned to function extremely well even when they were massively depressed. So one thing that clinical psychology needs to develop in light of the heritable stubbornness of human pathologies is a psychology of “dealing with it.” We need to tell our patients, “Look, the truth is that many days—no matter how successful we are in therapy—you will wake up feeling blue and thinking life is hopeless. Your job is not only to fight these feelings but also to live heroically: functioning well even when you are very sad.”

A New Approach to Cure

So far I’ve argued that all drugs and most psychotherapy is only cosmetic and that the best they can do is to approach 65 percent relief. One way to do better than 65 percent is to teach patients to deal with it. But more important is the possibility that the positive interventions may break through the 65 percent barrier and move psychotherapy beyond cosmetic symptom relief toward cure.

Psychotherapy and drugs as they now are used are half baked. On the rare occasions when they are completely successful, they rid the patient of suffering, misery, and the negative symptoms. In short, they remove the internal disabling conditions of life. Removing the disabling conditions, however, is not remotely the same as building the enabling conditions of life. If we want to flourish and if we want to have well-being, we must indeed minimize our misery; but in addition, we must have positive emotion, meaning, accomplishment, and positive relationships. The skills and exercises that build these are entirely different from the skills that minimize our suffering.

I am a rose gardener. I spend a lot of time clearing away underbrush and then weeding. Weeds get in the way of roses; weeds are a disabling condition. But if you want to have roses, it is not nearly enough to clear and weed. You have to amend the soil with peat moss, plant a good rose, water it, and feed it nutrients. (In Pennsylvania, you also need to bathe it with the latest wonder drugs of modern horticochemistry.) You have to supply the enabling conditions for flourishing.

Similarly, as a therapist, once in a while I would help a patient get rid of all of his anger and anxiety and sadness. I thought I would then get a happy patient. But I never did. I got an empty patient. And that is because the skills of flourishing—of having positive emotion, meaning, good work, and positive relationships—are something over and above the skills of minimizing suffering.

When I started out as a therapist almost forty years ago, it was common for my patient to tell me, “I just want to be happy, Doctor.” I transformed this into “You mean you want to get rid of your depression.” Back then I did not have the tools of building well-being at hand and was blinded by Sigmund Freud and Arthur Schopenhauer (who taught that the best humans can ever achieve is to minimize their own misery); the difference had not even occurred to me. I had only the tools for relieving depression. But every person, every patient, just wants “to be happy,” and this legitimate goal combines relieving suffering and building well-being. Cure, to my way of thinking, uses the entire arsenal for minimizing misery—drugs and psychotherapy—and adds positive psychology.

Here then is my vision of the therapy of the future, my vision for cure.

First, patients need to be told that the drugs and therapies are temporary symptom relievers only, and that they should expect recurrence when treatment stops. Hence, explicit, successful practice in dealing with it and functioning well even in the presence of the symptoms must be a serious part of therapy.

Second, treatment should not end when suffering is relieved. Patients need to learn the specific skills of positive psychology: how to have more positive emotion, more engagement, more meaning, more accomplishment, and better human relations. Unlike the skills of minimizing misery, these skills are self-sustaining. They likely treat depression and anxiety and they likely help prevent them as well. More important than relieving pathology, these skills are what flourishing is, and they are crucial to everyone’s search for well-being.

But who will disseminate these skills to the world?

Applied Psychology Versus Basic Psychology: Problems Versus Puzzles

When the University of Pennsylvania’s top administration was debating in 2004 whether to offer a new degree in order to cash in on the public demand for positive psychology, the dean of natural science said, with a touch of venom, “Let’s make sure we put an A in it. After all, it is the psychology department that does the pure science, and we wouldn’t want people to be confused, would we?”

“Will Professor Seligman go along?” wondered the dean of social science. “It is sort of insulting. An A for ‘applied’—master of applied positive psychology?”

Far from being insulted, I welcomed the A. Even though Penn was founded by Benjamin Franklin to teach both the “applied” and the “ornamental,” by which he meant “not currently useful,” the ornamental has long won out, and I have labored for four decades as the “applied” maverick in an almost solely ornamental department. Pavlovian conditioning, color vision, serial-versus-parallel mental scanning, mathematical models of T-maze learning in rats, the moon illusion—these are the high-prestige enterprises in my home department. Researching the real world has a slightly fetid odor in the high reaches of academic psychology, an odor that wafted through the deans’ debate about creating the new degree.

Originally, I went into psychology to relieve human suffering and to increase human well-being. I thought I was well prepared to do this, but I was actually miseducated to this task. It took me decades to recover and to work my way out of solving puzzles and into solving problems, as I explain below. Indeed, this is the story of my entire intellectual and professional development.

My miseducation is instructive. I went to Princeton in the early 1960s afire with the hope of making a difference in the world. I got ambushed in a manner so subtle that I did not know I had been ambushed for about twenty years. I was attracted to psychology, but the research in that department seemed pedestrian: laboratory studies of college sophomores and white rats. The world-class heavy hitters at Princeton were in the philosophy department. So I majored in philosophy, and, like so many bright young people, I was seduced there by the ghost of Ludwig Wittgenstein.

Wittgenstein, Popper, and Penn

The overlord of philosophy at Cambridge University, Wittgenstein (1889–1951) was the most charismatic figure in philosophy of the twentieth century. He fathered two major movements. He was born in Vienna, fought gallantly for Austria and was taken prisoner by the Italians. A prisoner of war in 1919, he finished Tractatus Logico-Philosophicus, a collection of sequential, numbered epigrams that led to the founding of logical atomism and of logical positivism. Logical atomism is the doctrine that reality can be understood as a hierarchy of ultimate facts, and logical positivism is the doctrine that only tautologies and empirically verifiable statements have meaning. Twenty years later, he changed his mind about what philosophy should do, arguing in Philosophical Investigations that the task was not to analyze the building blocks of reality (logical atomism) but rather to analyze the “language games” humans play. This was the trumpet call to ordinary language philosophy, the systematic analysis of words as they are spoken by laymen.

At the heart of both incarnations of the Wittgensteinian movement is analysis. The job of philosophy is to analyze in rigorous and minute detail the basic underpinnings of reality and of language. The larger issues that concern philosophy—free will, God, ethics, beauty—cannot be tackled (if ever) until this preliminary analysis succeeds. “Of what we cannot speak, we must be silent,” the Tractatus famously concludes.

Just as important as Wittgenstein’s ideas was the fact that he was a spellbinding teacher. Crowds of the brightest Cambridge students turned up to watch him pace his bare room, mouthing his epigrams, striving for moral purity, overpowering his students’ queries, and all the while demeaning himself for being so inarticulate. The combination of his brilliance, his striking good looks, his magnetic and unusual sexuality, and his exotic otherworldliness (he renounced a huge family fortune) was seductive, and his students fell in love with the man and with his thought. (It is commonplace for students to learn best when they fall in love with their teacher.) These students then fanned out across the intellectual world through the 1950s and ruled English-speaking academic philosophy for the next forty years, passing along their infatuation to their own students. The Wittgensteinians certainly ruled the Princeton philosophy department, and we students were imbued with Wittgensteinian dogma.

I call it dogma because we were rewarded for doing rigorous linguistic analyses. For example, my senior thesis, later the subject of an eerily similar publication by my advisor under his name, was a careful analysis of same versus identical. We were punished for trying to speak about “what we could not speak about.” The students who took Walter Kaufmann, the charismatic teacher of Nietzsche (“the point of philosophy is to change your life”), seriously were dismissed as woolly headed and sophomoric. We did not ask the “naked emperor” questions such as “Why bother to do linguistic analysis in the first place?”

We were assuredly not taught about the historic encounter between Ludwig Wittgenstein and Karl Popper at the Moral Philosophy Club in Cambridge in October 1947. (This event is re-created in David Edmonds and John Eidinow’s gripping Wittgenstein’s Poker.) Popper accused Wittgenstein of suborning an entire generation of philosophers by setting them to work on puzzles—the preliminary to the preliminaries. Philosophy, Popper argued, should not be about puzzles but about problems: morality, science, politics, religion, and law. So infuriated was Wittgenstein that he brandished a poker at Popper and walked out, slamming the door.

How I wish I had suspected in my college years that Wittgenstein was not the Socrates but the Darth Vader of modern philosophy. How I  wish I’d had the sophistication to recognize him as an academic poseur. I did eventually realize that I had been turned in the wrong direction, and I started to correct my course by entering Penn to pursue psychology as a graduate student in 1964, turning down a fellowship to Oxford to study analytic philosophy. Philosophy was a mind-bending game, but psychology was not a game, and it could, I fervently hoped, actually help humanity. I was helped to this realization by Robert Nozick (my undergraduate teacher of René Descartes), to whom I went for advice when I was awarded the fellowship. In the cruelest—and wisest—career advice ever vouchsafed me, Bob said, “Philosophy is a good preparation to something else, Marty.” Bob would later, as a professor at Harvard, challenge the Wittgensteinian puzzle parade and carve out his own method of solving philosophical problems rather than unraveling linguistic puzzles. He did it so adroitly, however, that no one threatened him with a poker, and so he helped to nudge high academic philosophy in the direction that Popper urged.

I had also turned down the opportunity to become a professional bridge player for the same reason, because it too was a game. Even though I had changed fields from philosophy to psychology, I was still a Wittgensteinian by training, and as it turned out, I had entered a very congenial department that was and is a shrine to ornamental knowledge and to solving psychological puzzles. Academic prestige at Penn came from working rigorously on the puzzles, but my longing to work on the problems of real life, such as achievement and despair, gnawed incessantly at me.

I did my PhD with white rats, but while it satisfied the puzzle masters who edited the journals, it took hesitant aim at problems: unpredictable shock produced more fear than predictable shock because the rat never knew when it was safe. I had also worked on learned helplessness, the passivity induced by uncontrollable shock. But that too was a laboratory model, acceptable therefore within the high journals but also taking only hesitant aim at a human problem. The turning point came shortly after I had taken the equivalent of a psychiatric residency under psychiatry professors Aaron (Tim) Beck and Albert (Mickey) Stunkard from 1970 to 1971. I had resigned from an assistant professorship at Cornell—my first job after I finished my PhD in 1967—as a political protest and with Tim and Mickey was attempting to learn something of real psychiatric problems in order to tie my puzzle solving closer to real-world problems. Tim and I met for an occasional lunch at Kelly and Cohen, our local deli (Kelly was fictitious), after I rejoined the Penn Psychology Department in 1972.

“Marty, if you keep working as an experimental psychologist with animals, you will waste your life,” said Tim, giving me the second best advice I ever got and watching me choke on my grilled Reuben. And so I became an applied psychologist, working explicitly on problems. I knew I was from that moment consigned to the role of maverick, “popularizer,” and a wolf in sheep’s clothing among my peers. My days as a basic academic scientist were numbered.

To my surprise, Penn nonetheless appointed me associate professor with tenure, with the secret faculty debate, I am told, centered on the awful possibility that my work would drift in an applied direction. It has been an uphill battle for me at Penn ever since, but I never understood just how uphill until I was on a committee to hire a social psychologist in 1995. My colleague Jon Baron made the revolutionary suggestion that we advertise for someone who did research on work, love, or play. “That’s what life is about,” he said, and I agreed enthusiastically.

Then I had a sleepless night.

I mentally scanned (serially) the tenured faculty in the ten leading psychology departments in the world. Not a single one focused on work or on love or on play. They all worked on “basic” processes: cognition, emotion, decision theory, perception. Where were the scholars who would help guide us about what makes life worth living?

The next day, it happened that I had lunch with psychologist Jerome Bruner. Then in his mideighties and almost blind, Jerry is a walking history of American psychology. I asked him why the entire faculties of the great universities work only on so-called basic processes and not on the real world.

“It happened at a moment in time, Marty,” said Jerry, “and I was there. It was at a 1946 meeting of the Society of Experimental Psychologists. [I am a nonattending member of this elite fraternity—now a sorority as well—of ivy-covered professors.] Edwin Boring, Herbert Langfeld, and Samuel Fernberger, the chairmen of Harvard, Princeton, and Penn, respectively, met at lunch and agreed that psychology should be more like physics and chemistry—doing basic research only—and that they would hire no applied psychologists. All the rest of academia immediately fell into line.”

This decision was a momentous error. For an insecure science like psychology in 1946, imitating physics and chemistry might have earned some brownie points with deans, but it made no sense at all scientifically. Physics was preceded by an ancient science of engineering, which actually solved problems, before it grafted on abstract, basic research. Applied physics predicted eclipses, floods, and the motions of heavenly bodies—and it coined money. Isaac Newton ran the British mint in 1696. Chemists made gunpowder and learned an enormous amount of scientific fact even as they pursued what turned out to be the dead-end of trying to turn lead into gold. These real-world problems and applications set the boundaries for the basic puzzles applied physics would then go on to unravel. Psychology, in contrast, had no engineering—nothing that was proven to work in the real world—no underpinning that would guide and constrain what its basic research should be about.

Good science requires the interplay of analysis and synthesis. One never knows if basic research is truly basic until one knows what it is basic to. Modern physics came into its own not because of its theories—which can be enormously counterintuitive and highly controversial (muons, wavicles, superstrings, the anthropic principle, and all that)—but because physicists built the atomic bomb and modern nuclear power plants. Immunology, a backwater enterprise in medical research in the 1940s, came into its own on the back of the Salk and Sabin vaccines against polio. The burgeoning of basic research only followed.

In the nineteenth century, a dispute raged in physics about how birds flew. The controversy was settled in twelve seconds on December 17, 1903, when the Wright brothers flew an airplane they had built. Therefore, many concluded, all birds must fly that way. This is, indeed, the logic of the artificial intelligence endeavor: if basic science can build a computer that can understand language, or speak, or perceive objects, merely by networking binary switching circuits, this must be how humans do these wondrous things. Application often points the way toward basic research, whereas basic research without a clue about how it might be applied is usually just wanking.

The principle that good science necessarily involves the active interplay between application and pure science sits uneasily both with the pure scientists and with the prime appliers. Being a maverick in the Penn Psychology Department to this day gives me weekly reminders of how pure scientists look askance on application, but I did not find out how skeptical the appliers are of science until I became president of the American Psychological Association (APA) in 1998. I was elected by the largest majority in history, and I attribute the landslide to the fact that my work stands squarely between science and application, and so attracted many of both the scientists and the clinicians. The emblematic work that I had done was to help with the 1995 Consumer Reports study of the effectiveness of psychotherapy. Using sophisticated statistical tools, Consumer Reports, in a massive survey, found good results of psychotherapy generally, but, surprisingly, the benefits were not specific to any one kind of therapy or to any one kind of disorder. This was welcomed by the rank and file of applied psychologists who do all sorts of therapy on all sorts of disorders.

When I arrived in Washington to preside over the American Psychological Association, I found myself in exactly the same situation among the leaders of the applied endeavors that I was in among my pure-scientist colleagues: a wolf in sheep’s clothing. My first initiative as president, evidence-based psychotherapy, never got off the ground. Steve Hyman, then the director of the National Institute of Mental Health, told me that he could find about $40 million to support work on this initiative. Greatly heartened, I met with the Committee for the Advancement of Professional Practice, the high council of independent practitioners, which, except for my election, had a hammerlock on the election of APA presidents. I outlined my initiative to an increasingly stone-faced group of these twenty opinion makers, talking up the virtues of basing therapy in scientific evidence of its efficacy. Stan Moldawsky, one of the staunchest of the old-timers, brought down the curtain on my initiative by saying, “What if the evidence doesn’t come out in our favor?”

Afterward, Ron Levant, one of Stan’s allies, told me over a drink, “You’re in deep shit, Marty.” Indeed, it was from this bloody nose that positive psychology—an endeavor not quite as inimical to independent practice as evidence-based therapy—was born.

So it was exactly with this tension between application and science in mind that in 2005 I happily consented to direct the Positive Psychology Center at the University of Pennsylvania and to create a new degree—the master of applied positive psychology (MAPP)—that would combine cutting-edge scholarship with the application of the knowledge to the real world as its mission.