“NOOOO,” BURBLED AMANDA from the car seat.
“SNOOOOW,” corrected Kerry. “Look at all that snow.”
On either side of the road as we sped away down Van Ostrand Road, snowdrifts stood taller than the car. It was the last day of a turbulent decade: December 31, 1969. I was leaving Cornell.
As we drove out of Ithaca, I congratulated myself for showing at least a shred of courage. I thought about Adrian at just my age. Forty years before, faced with the Great Depression, he had been afraid. He decided to forgo possible fortune and fame for a lifetime of financial security. I guessed I had more backbone, but I was staring at joblessness. So I was driving our pale yellow bottom-of-the-line Buick, fleeing from a badly broken university. But I was also heading for something positive.
ALBERT STUNKARD AND Tim Beck had blazed a trail for me to learn some real psychopathology back at Penn in the psychiatry department. Albert was called “Mickey,” I guess because of his Mickey Mouse outsize ears. In the mid-1960s, with Tim Beck at his right hand, Mickey had wrested control of the psychiatry department from the psychoanalysts and had since been busy reshaping this huge, amorphous department. He was determined to build a field of research-based psychiatry with Penn at the center. Mickey saw me as a possible recruit and rescued me from joblessness and poverty. He found private donors to support my stay at Penn, and Louise Harper, a generous Washington socialite, pledged $10,000. So Mickey offered me a two-year psychiatric residency to train in psychiatry. I went on to learn about mental illness firsthand and was given the strange, long title of “visiting associate professor of psychology in psychiatry.” Tim Beck was my mentor. I was twenty-seven, and Tim suggested that I grow a beard to try to look as old as my fellow residents.
I was given an office in the psychiatry department and spent the next two years on the inpatient and outpatient floors of the ram-shackle University of Pennsylvania Hospital. Henry Bachrach, a PhD psychologist, was director of residency training and my first therapy supervisor. His high training position was an encouraging sign of how well Mickey and Tim’s regime tolerated psychologists. I did not know about Henry’s biases, but I soon found out.
“Marty, you’ll never believe what I just heard about Arnold Lazarus.” Arnold, you may recall, was the behavior therapist expelled from Joe Wolpe’s inner circle for introducing cognition into Joe’s orthodox behavior therapy.
“A patient came to see him, worrying that his penis was too small,” Henry continued.
“Well, let’s measure it,” Arnold said.
After a few seconds of silence, I realized that this was a punch line, and I was supposed to laugh. I chuckled, but the gulf between the old Freudians and the new cognitive behaviorists had never seemed more unbridgeable.
I was decidedly nervous about seeing my first real patient, but Henry reassured me. “You’re smart, Marty. Don’t forget you have that edge, but never take a patient who is smarter than you.”
My first patient may not have been smarter than I was, but he was slyer. Jerry, in his early twenties, was a mustachioed, ghostly pale college dropout. He was markedly depressed according to the standard symptom checklist, which I made a habit of using early in therapy. His eyes were downcast, he told me tearful stories of one failure after another, and his speech and gait were painfully slow. He told me he had just shaved his head. When I asked Henry about head shaving, he told me that it was a textbook red flag for suicide, although quite unproven. I saw Jerry once a week, using the new moves that Tim Beck was in the process of inventing with his residents for what would soon be called the “cognitive therapy” of depression.
Aaron Temkin (Tim) Beck and I first met in 1967. Tim was my principal teacher of psychopathology, particularly depression. A model of how to age, Tim turned ninety-six in July 2017. I still have the privilege of a once-a-month research lunch with him. Photo courtesy of Aaron Beck.
After three months, Jerry appeared at my office without an appointment. Bright-eyed, brisk of gait, tan, and normal of speech for the first time, he was grinning broadly. His hair was growing back. My very first case is a success. This new cognitive therapy sure works wonders, I thought to myself.
“I am here to terminate,” Jerry gushed, “but I want to thank you for all you did. Particularly for the letter you wrote to my draft board about my depression. They have reclassified me 4-F. No Vietnam for me!”
Tim Beck and I met once a week with Igor Grant, the chief resident, and Dean Schuyler to discuss our cases from the point of view of the new cognitive theory of depression—that depression stems from thoughts of loss—which Tim advanced in 1967.1 These meetings were the seedbed from which cognitive therapy emerged five years later.2 Dean was the most acute teacher of therapy I’d ever had. Tim formulated the abstractions—for example, “That’s an automatic thought about her husband’s never reciprocating”—but Dean hit the nail on the head with the concreta: “When she gives him a Hershey bar, he never gives her back a Baby Ruth.” Igor kept us focused on the case, and I sat in deep respect for their different skills, skills uncommon in the airy world of psychology departments.
I contributed by extrapolating the current scientific literature to the cases: for example, that childhood experience with helplessness should lead to automatic thoughts of being a victim and a loser. Tim called himself “Mr. Outside” and me “Mr. Inside,” using a West Point football metaphor to say that he viewed his theories as far out, while mine were nestled cozily inside academia. That was not my view, however, since I also saw myself as an iconoclast.
MY TWO YEARS of clinical training left me with an open, even a credulous mind about therapy and what causes mental illness. By the end of my residency in 1972, I believed that large swaths of mental illness were straightforward. Unfortunate Pavlovian conditioning, maladaptive instrumental habits, debilitating automatic thoughts, learned helplessness, stunted social skills, malign genetics, and neural imbalance were at play. The new cognitive and behavior therapies seemed useful here. And never to be derided or ignored was a big “placebo” benefit: to the extent a disorder involved the loss of hope, entering therapy in and of itself provided some. Often patients just needed a supportive, nonjudgmental listener. Therefore eclectic techniques in the hands of a skilled therapist would do considerable good.
But I also believed that deep, mysterious forces were at play that we had barely glimpsed, and in the hands of a witchy therapist, dramatic relief could come. By the end of my residency I came to regard the human psyche and its deformations as objects of awe.
WHILE MY PROFESSIONAL life was expanding, my parents’ lives were crumbling. Adrian had not been expected to survive his strokes, but he had an unbreakable will to live, still on display fifteen years later. He had been kept on at the Court of Appeals and, with enormous determination, had returned to work as deputy state reporter within the year. He would always be paralyzed on his left side and was but a shadow of his former self intellectually. He was also emotionally labile, and I often saw him burst into tears. All this made him an object of pity at the office, and I was sure he knew it. By the time I finished college, he’d cashed in his generous disability pension and decamped to an apartment in Miami Beach. Irene and Adrian had been squabbling more and more, and she stayed in Albany. They talked of separation, but it never became official.
Irene was relieved when Adrian moved to Florida and he was out of her hair. She continued her job as the head stenographer for an office full of New York State lawyers. Her many “girls” there prized her as fair-minded and turned to her for wise advice. But her arthritis became severe, and by the time I left college, I’d seen her at her worst, on all fours crawling up two flights of stairs to the bedroom, unable to walk. We drove up to Lake Luzerne one rainy autumn afternoon, and she told me that she had expected the last third of her life to be “golden years.” She tearfully confessed that they were far from it.
Watching my parents’ marriage fall apart and their health deteriorate made me feel helpless and sad. I thought about my own work on helplessness, and search as I might, I found no answers. I was good at compartmentalizing, however, and had my own consuming work and a growing family to distract me.
But things got worse.
Adrian flew up from Florida to visit Kerry and me and to meet his grandchild. While this gave him some pleasure, he was morose and talked of suicide. As I drove to the supermarket, he threw open the door of the speeding car and made the gesture of throwing himself out. I yanked the door closed but knew that this was beyond anything I could handle. I checked him into the inpatient psychiatry ward of Philadelphia General Hospital, where on heavy tranquilizers he regained some stability. I was mortified to have to turn my own father over to the care of my colleagues. A few days later, I drove him to the airport, and he flew back to Florida. This was the last time I saw my father.
MY RESEARCH TOOK a decided turn toward mental illness in humans. I began looking for point-to-point mapping between learned helplessness in the lab and depression in the clinic. The question I had asked Jim Geer five years before, “What is depression?” was now getting answered with some welcome precision, and this was a sea change in psychiatry. Tim Beck’s Beck Depression Inventory, published in 1961, was now in widening use. It asked patients to report on a zero-to-three scale the severity of each of twenty-one symptoms of depression. Now these symptoms were being codified into a diagnosis of depression in what would soon become DSM-3, the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. The categories began as mere research tools that made their way in draft around the scientific end of the therapy community. This community was trying to get some purchase on a very slippery thing: diagnostic agreement from hospital to hospital. What was called schizophrenia in New York City was often called manic depression in London. Without consistent diagnostic agreement, serious research on therapy could not even start.
Depression was a fine test case. As codified in the new diagnostic manual, depression was sensibly split in two. Bipolar depression (manic depression) involved moods that alternated over long periods from irrationally high to extremely low. Unipolar depression had only lows, broken down into nine symptoms:
- Sad mood
- Loss of interest
- Weight loss
- Sleep problems
- Psychomotor problems
- Fatigue
- Feelings of worthlessness
- Indecisiveness or poor concentration
- Thoughts of suicide
“Those dogs are depressed,” Jim had said, and I now thought about the formal requirements if learned helplessness was truly a model of unipolar depression in patients. A laboratory model had great advantages for science. It could allow systematic exploration of what drugs and what therapies would work in depression. So I began a research program to pin down the parallels. Ultimately I found that learned helplessness induced experimentally mapped to eight of the nine symptoms, the only exception being suicide and suicidal thoughts—an unlikely symptom for mild bad events to produce in the laboratory. Not only did inescapable shock and inescapable noise produce the symptoms of depression, but the converse occurred as well: depressed people who did not experience inescapable events behaved in the laboratory as if they had, showing passivity in the shuttle box and giving up on cognitive problems.3
My other niche in academic psychology was biological constraints on learning, and the heavyweight Psychological Review published the fruits of my undergraduate lectures.4 The blank slate view of learning had exerted a dead hand on the theory of mental illness, and I began to wonder if biological constraints applied to mental illness just as they did to learning. Phobias fit. Recall John Garcia’s finding that rats learned in one trial, and retained over long delays, a sense that a distinctive taste goes with stomach illness but distinctive sounds do not. This made very good evolutionary sense, and other features of prepared learning also stared me in the face. Unlike ordinary Pavlovian conditioning, taste aversions do not go away. I still hated the taste of sauce béarnaise a good five years after the incident. Furthermore, Pavlovian conditioning appeared cognitive. Bob Rescorla was gathering mounting evidence that conditioning was just an expectation (e.g., that a shock would follow the tone), thus a rational cognition that mirrored accurately the real contingencies of the world.5 But taste aversions crept under the cognitive radar. Once I had recovered from my seeming food poisoning, I found out that a flu had swept through the lab. So I knew that the sauce had not caused my illness, but that did not weaken my distaste.
Phobias look a lot like prepared learning. First, they are highly selective for objects that long ago in our primate history were common and dangerous: snakes, spiders, lightning storms, strangers, the dark, and going outside alone, for example. And despite their modern, but not ancient, dangerousness, there do not exist knife phobias or electric outlet phobias. A young girl sees a snake in a park in England (quite unusual for that country) and a bit later goes back to the family car and has her hand smashed in the car door. She develops a lifelong fear of … snakes but not car doors.
Also phobias don’t extinguish readily and are decidedly irrational—merely knowing that you will not jump or be pushed off the cliff does not remotely stifle your fear of heights. And so I extended my work on preparedness to phobias and obsessive-compulsive disorders, arguing that as a species we are evolutionarily prepared for them and the objects they focus on and that some individuals might be more genetically vulnerable to specific disorders than others.6
I was not yet thirty, and these two contributions attracted considerable academic notice. Mickey and Tim asked if I might be willing to stay on in the psychiatry department. I was aware, however, that medical departments in America had very shaky funding. There was almost no “hard” money (Mickey had the only assured salary out of his two hundred faculty members), and so, for the research professors who populated the great departments, salaries depended almost entirely on either getting large federal grants or seeing patients, the latter generally dreaded. This meant that psychiatry departments, just to survive, were in a never-ending scramble to keep up with the latest trends that were popular in Congress. In fact, the National Institute of Mental Health (NIMH) had by this time, despite its “health” charter, become the National Institute of Mental Illness, and it was the sole institution that kept the great psychiatry departments from bankruptcy. So having a tenured appointment in a psychiatry department amounted to having a concession stand to try to absorb federal funds, and if that failed … you were “tenured” but with no salary.
Mickey had a scheme for me. The NIMH had just started granting “Career Scientist Awards,” a way of supporting research scientists by paying their salaries within psychiatry departments for at least five years. Mickey and Tim urged me to apply, and I did, proposing a program of research to test whether learned helplessness was indeed a model of unipolar depression and whether it captured some or even all forms of these depressions. The institute received my proposal warmly, and a “site visit” was arranged. Four of America’s leading psychiatrists assembled at Penn to spend a day grilling me. We were on the same wavelength, and it went swimmingly.
But there was a joker in the pack, and he was scowling at me. He was a psychologist from Harvard named Bill Morse, an acolyte of B. F. Skinner. He had discovered that when shocked, monkeys “chain-rattled” neurotically, and he and Skinner argued that this was “all in the schedule”—code for the dogma that the environment shaped behavior entirely, and cognition and evolution played no role at all. Morse challenged me, and I was fearless enough to give an evolutionary explanation of his very findings and then to reject the Skinnerian notion of “superstition” as an explanation of learned helplessness. I cited Steve Maier’s crucial “holding still” experiment. A visibly exasperated Morse silently continued to scowl.
When the group reassembled in Washington, I later learned, the four psychiatrists all gave my application a “1.0,” the highest NIMH score, equivalent to an A+. Morse asked the group, “What mark do I have to give Seligman to prevent him from getting any money?” They told him a “5.0,” the almost never-used equivalent of an F. He did, and I now take this opportunity to thank Bill Morse for unintentionally doing me one of the great favors of my life.
In parallel with this, the University of Pennsylvania’s psychology department was considering appointing me with tenure. Psychology departments, unlike psychiatry departments, were “hard” money, with the (generally much lower) salary secure for life, even without soliciting grant support or seeing patients. Indeed, this was the financial basis of “academic freedom,” the freedom to write what one will, no matter how unpopular. The Penn psychology department’s considering me was almost unprecedented, since the last Penn PhD granted tenure was Frank Irwin, four decades before. Tenured appointments, it was sensibly argued, should come from the outside to avoid nachschleppers and so bring in new blood.
On the favorable side, there was a push for clinical and abnormal psychology in the psychology department. The undergraduates, then as now, continually complained about “rats” and demanded more “relevant” courses. The basic researchers were annoyed when pressured to offer applied courses. The department, with an aversion to anything applied, particularly anything clinical, continued to appoint only “basic” scientists, and it had successfully resisted the hue and cry from the unenlightened mob. I, of course, agreed with the mob, and the student pressure continued to build. The department thought I might “look” like a clinical psychologist and that it could fob the applied courses off on me, all the while hoping that my rock-bottom loyalty lay with basic laboratory research. This, I suspect, was much debated, and if asked, even I could not have answered definitively. But I was not asked.
The vote was taken, and I was offered an associate professorship of psychology with tenure.
By accident, I walked by the room during the debate and heard only two words. A basso profundo voice that I recognized as that of the chair of the clinical wing boomed out, “On balance …”