Psychoanalysis was the first of the systematic talking therapies. The first couple of generations of psychoanalysts consisted principally, with some notable exceptions, of Central European Jews from Vienna, Budapest, Berlin and elsewhere. By the 1930s, this part of Europe had fallen to fascism, and this cataclysm was ominous (and eventually catastrophic) for Jews. A diaspora ensued, with Freud himself relocating to London, and many others moving there also, with other prominent destinations including Paris and the Americas. In these diverse environments, various sub-schools of psychoanalysis emerged, with considerable differences in their theory and practice. ‘Ego psychology’ was the sub-school which dominated psychoanalysis in the US to such an extent that it came to be identified (by some) as the only ‘true’ form of psychoanalysis. It was out of this context – post-war US, mass demand for psychological interventions, and the growing influenced of managed care – that Beck’s CBT first emerged.
The identification of ego psychology as the true bearer of Freud’s legacy is problematic, in that Beck and his followers seem entirely unaware that it does not represent the whole of psychoanalysis. Ego psychology in Chicago and New York was a very different sort of psychoanalysis to that practiced in London, Paris, and Buenos Aires or, for that matter, by Freud himself. One can imagine that if CBT emerged in London, perhaps its practitioners would have had a better grasp of relational psychology, through Klein and Winnicott. In Paris, Beck might have learned something about linguistics and philosophy under Lacan, who spent the 1950s critiquing his US counterparts. Instead, Beck tried and failed to become an ego psychologist, eventually splitting from them, but retaining a number of their features.
What were the problems with ego psychology? The sharpest critique of ego psychology comes, in my view, from within psychoanalysis, namely, from the work of Jacques Lacan in the 1950s. Lacan’s objections to ego psychology are worth noting, if only because the apply even more emphatically to Beck’s ideology. First, ego psychology functioned as the police bureau of international psychoanalysis through its Stalinist capture of the institutions (i.e. the IPA). CBT has continued this tradition in various settings where its proponents have won bureaucratic control, and where they try to regulate other perspectives out of existence (through protocols, or credentialism). The moniker ‘evidence-based’ does some heavy-lifting in justifying these purges, in which CBT relates to the rest of clinical psychology much as ego psychology dominated the rest of psychoanalysis.
Secondly, ego psychology positioned itself as ‘classical’ psychoanalysis, its practitioners the true heirs of Freud, much as CBT asserts its place as a properly scientific form of psychology and intervention. Of course, the ego psychologists displayed considerable ignorance of the texts of Freud (and the other founders of psychoanalysis), and deviated from the latter’s teachings to the point of constructing a brittle dogma that was frequently antithetical to them.
Thirdly, both ego psychology and CBT are directed towards a conformist mode of ‘adaptation’, in which subjects develop a ‘conflict-free’ ‘autonomous ego’ or free themselves from ‘distorted cognitions’, the better to take their place as automatons in a consumerist-liberal social context. Unsurprisingly, in the context of post-war USA, CBT has taken up this normatising, conformist role with more ruthless efficiency than the ego psychologists ever could. Why spend years, multiple times per week, gradually identifying with your ego psychologist’s ‘healthy ego’, when a CBT practitioner can simply panel beat your distorted cognitions into the correct shape in a few sessions? Whenever one hears the claim that CBT is the more ‘effective’ treatment, we can confidently translate this to refer to its role as the most cost-effective form of psychological social control.
Fourth, the very notion of an autonomous consciousness, of a conflict-free zone within the ego is more or less shared by both ego psychology and Beck. (Of course, the latter has appropriated the discourse of cognitive science rather than ego psychology, but has essentially duplicated the same aims and concepts). Both approaches presuppose a wilful ignorance and devaluation of the unconscious, even though the unconscious is the fundamental concept of psychoanalysis (and a significant, if not absolutely vital concept for cognitive science). If the unconscious exists, then there literally cannot be an ‘autonomous ego’ any more than there can be truly ‘non-automatic cognitions’, as these phenomena would both be subject to a causality that lies elsewhere. Such logical niceties, however, are of even less interest to CBT than they were to the ego psychologists. The consequences of this ignorance are nonetheless grave. Both CBT and ego psychology are committed to a ‘correcting’, or making ‘healthy’, or strengthening of the ego. Both are directed towards greater ‘self-reliance’, and a managerialising (or even militarising) of the self. The self that is assumed by these ideologies is always, of course, the alienated subject of neoliberal economies. (This is well-illustrated by some recent, hubristic declarations that CBT promotes ‘human rights’ for psychotics. The rights in question are, our humanitarians tell us, those of ‘consumer empowerment’. This grotesquery of neoliberal buzzwords is not satire.)
Fifth, perhaps the final key point of Lacan’s critique of ego psychology was its ahistoricism, namely, its utter failure to register that these sorts of means and ends – ‘adaptation’, a ‘conflict-free’ ego, and so forth – were entirely historically contingent, and specifically localisable to a US context. The notion that one should pursue ‘happiness’ at all (and the other notions of ‘growth’, ‘self-actualisation’, etc, beloved of US psychology) is stripped of its inherently narcissistic, consumerist and individualist historically-specific context. Moreover, this applies also to the notion that one attains a ‘healthy ego’ or ‘non-distorted cognitions’ through indoctrination and identification with a supposed ‘expert’. These notions – so ubiquitous as to be virtually self-evident in the Anglophone world at the present time, would be recognised by many in (say) Russia, or China, or Greece as glib and patronising idiocy. Nevertheless, the explicitly ‘corrective’ function of psy-intervetion was introduced into psychoanalysis not by Freud but by the ego psychologists, and greatly exacerbated by Beck and his followers. (It should be added that psychoanalysis in the US has, for some decades, moved away from the ego psychology of the 1950s and 60s).
Thus it was that in virtually every key respect, Beck the failed psychoanalyst remained an ego psychologist par excellence, and took its goals for granted, albeit, with a more hardnosed, Taylorist focus on efficiency, productivity and micro-management. The main differences between ego psychology and CBT are in the ‘scientific’ language employed by each, with Beck (presciently) taking his nomenclature from the experimental discipline of cognitive science. Cognitive science is an attempt to study mental processes on the functionalist analogy of the mind as information processor. It has lent some empirical rigour to the study of certain phenomena, such as learning and memory, though it is fatally constrained by its assumptions. For instance, it operates on the basis of almost-total metaphysical/ontological ignorance, and completely distorts certain topics (such as language, or emotion, neither of which are primarily or principally reducible to mere ‘information’). Still, cognitive science has some merits to go along with its limitations. Unfortunately for CBT, Beck borrowed the latter without also taking the former, and CBT stands in roughly the same relation to cognitive psychology as does Gestalt therapy to Gestalt psychology. This is to say that, apart from some appropriation of language, they have virtually nothing whatsoever to do with each other. ‘Cognitive’ terms and language help to market CBT as a credible discipline (in spite of the positive thinking, distraction, managerialism and other ‘strategies’ it deploys) but one should not imagine any underlying continuity between the two disciplines. CBT emerged from a failure in US psychoanalysis, and not from a then-nascent experimental science of mind.
Beck and his followers based their ostensible rejection of psychoanalysis on two primary arguments. The first was Beck’s rejection of Freud’s theory of wish fulfilment, and the second was Beck’s rejection of the psychoanalytic theory of melancholia. Both of these rejections derived from Beck’s attempts to test the above experimentally, which his mentors in the IPA bureau took as proof of his resistance to psychoanalysis (hence his failure to become an analyst). An analysis is essentially a private matter, and we are in no position to ascertain whether Beck was ‘properly analysed’, but his experiments, if nothing else, produce the clearest evidence available that he barely understood a word of basic psychoanalytic theory (not to mention linguistics, philosophy, science…). Nevertheless, both Beck’s entry into psychoanalysis and his attempt to refute it were unambiguous failures.
Let us tackle Beck’s ‘refutation’ of the psychoanalytic theory of wish fulfilment. (As ever, Beck appears largely ignorant of the psychoanalytic literature, and apparently does not take into account Freud’s later modifications of his theory, in Beyond the Pleasure Principle, for instance). Beck attempted to study dreams experimentally by surveying the dreams of depressed and non-depressed individuals, hypothesising that depressives should dream in such a way as to exhibit hostility, ultimately for themselves.
The problem, however, is that neither Freud nor any other analyst of note ever claimed that dreams could be interpreted in an ad hoc, experimental context outside of an analysis. To attempt to interpret the dreams of others – even if one rejects psychoanalysis – involves ascribing a meaning to their language as if it were transparent and self-evident. Yet this is obviously not the case, which means that Beck’s attempts to make dream interpretation empirical not only missed the ‘latent’ content entirely, they completely and more grievously did violence to the manifest content. To borrow from Walter Benjamin on translation, Brot and pain are strictly not ‘interchangeable’ words which can stand in for some universal notion of bread, in that a German and Frenchman refer to specifically different things by these terms. Moreover, these differences are amplified further when one turns from entire cultures to individuals. ‘Bread’ as symbol or signifier cannot be given a universal, self-evident meaning. It may mean something different to a baker than to a gluten-intolerant person, and something different for a Catholic (for whom it is linked with the Body of Christ) than to a Russian (who may have heard from his or her babushka stories of horror involving bread during the siege of Leningrad). In short, there is literally no way to interpret such a symbol except with a detailed knowledge of a subject’s history and linguistic/conceptual associations (i.e. by a subject interpretating for themselves within a psychoanalysis, or something closely resembling it). This richness of difference, the intricate nuance of each symbol in a subject’s psychic life was bulldozed and levelled off in its entirety by Beck, who imposed his own interpretations onto his experimental subjects. As ever in psychology, qualitative phenemona are distorted to the point of destruction when forced to submit to some quantitative fetish. With such woeful misunderstandings of the theory he was ‘testing’, and with such a grossly inappropriate experimental method, the results of Beck’s labours are literally irrelevant, and tell us nothing either about psychoanalytic theory or dreams in general. This sort of slapdash engagement with psychoanalytic ideas is characteristic of CBT attempts at rapprochement, and if Beck’s early efforts were intellectually embarrassing, they are nonetheless brighter and more honest than those of his followers, who eschew the close reading of theory entirely.
The second plank of support for Beck (and CBT’s) ‘empirical’ repudiation of psychoanalysis is a critique of the psychoanalytic theory of melancholia. All that Beck appears to have gathered from the many psychoanalytic papers on the topic is that depression has something to do with ‘internalised’ or ‘retroflected’ hostility. Beck tried to refute this on the basis of experimental data, arguing that depressives actually did not want to be depressed, but, for instance, sought encouragement from others. Beck then observed (correctly) the depressives exhibit harsh self-reproaches, or pessimistic statements about the future or the world, and inferred (rather wildly) that these views were necessarily irrational and causal of the depression itself.
There is so much amiss with Beck’s position here that an essay-length response is needed, and I will offer a few mere remarks. First, we should recall that Freud’s key text on depression (‘Mourning and melancholia’) was a speculative paper written during a transitional period. It makes no reference to introjection, to masochism, to the superego, or to any of the other concepts that dominated US ego psychology theories of depression, to say nothing of the many other psychoanalytic works on the matter available in the UK or France. Freud made little reference to aggression, instead emphasising, above all, ambivalence and libidinal withdrawal. It is not difficult to demonstrate that, once again, Beck was recklessly reductionist in his treatment of psychoanalytic concepts, to the extent that he could not possibly have examined them ad hoc and experimentally, or any other way. There was always much more to melancholia than ‘internalised anger’, and a less dogmatic and provincial approach to things might have led Beck to a closer reading of Freud, or to the ideas of Klein, or Lacan, or Winnicott, or Spitz, or Bowlby. Instead, he was left ‘experimenting’ with nonsensical concepts in order to refute the straw-theories of his imagination, which is to say, setting an example followed by much CBT research since. Moreover, just as dream symbols are strictly non-generalisable, so are depressive complaints and symptoms. Beck would be suffering from cognitive distortions of his own if he thought that he could magically divine the proper meaning of utterances in experimental subjects whom he did not know. For Beck, symptoms, symbols and signifiers all become mere units that take on a bland, meaningless equivalence, with the necessary consequence that his ‘refutation’ of psychoanalysis actually has nothing to do with psychoanalysis.
Beck apparently saw (and sees) language and thought as interchangeable, when patently, they are not. If Beck had considered that others’ ‘cognitions’ were by definition unknowable, and had instead focused on patients’ discourse, he might have been able to see beyond a one-to-one correspondence with speech and subjective suffering in depression. (For instance, in a given context, a depressive self-reproach may have little to do with a patient’s worldview, but instead be an invitation to an interlocutor to offer praise or comfort. The nature of language is exchange, not cognitive ‘information’). Moreover, Beck’s explanation for the statements of his depressives is hopelessly tautological. It is definitional of melancholia that the subject experiences subjective misery, and, in general, that he or she says unkind things about self, world or future. One of Molière’s doctors, when asked how it is that opium causes sleep, says that it is due to the ‘sleep-inducing faculties’. Like the good doctor (and like psychometricians), Beck attributes depression to the depression-inducing faculties. Of course, such answers belong in comedy.
With such inauspicious and unscientific beginnings, it is worth wondering how it is that CBT could have become so successful. A certain proportion of its success can be explained by its capture of the bureaucracies, and its penchant for senseless quantification and standardisation, beloved of policy makers and corporate health providers. It was radically unscientific and unempirical, but was nonetheless able to market its laughable notion of empiricism as a kind of scientific norm. It also took what are to my mind the very worst elements of ego psychology – its unethical, and subtly coercive push toward ‘adaptation’ – and made it quicker and cheaper. Unsurprisingly, Beck’s followers are embarrassed about CBT’s origins, and are unreserved when it comes to attacking psychoanalysis. Is this tendency not itself a little symptomatic? In Australia, a majority of the population is terrified and outraged by asylum seekers arriving by boat, an anxiety which perhaps harks back to the original ‘boat people’ (i.e. British colonisers) who indeed did conduct a program of land seizures and extermination. In the shrill attacks on psychoanalysis from CBT, one would be deaf to hear only fair-minded ‘scientific’ criticism.