Poverty and mental health

Dr. Aaron Beck, the founder of cognitive behavioral therapy (CBT), passed away earlier this month at age 100. His contributions resulted in a profound shift in the way we think about mental illness, mostly for the better. His work is also gradually reshaping practices in a wide variety of social and human services fields, including criminal justice and even workforce development.

Prior to Beck, the predominant theoretical framework for treating mental illness was Freudian talk-therapy, which emphasizes uncovering repressed thoughts as the source of neuroses. Beck’s insights countered Freudianism by arguing that streams of negative thoughts with obscure or sometimes nonexistent sources, rather than deep-seated guilt or longings, caused disorders like depression and anxiety. Such automatic thoughts, Beck said, interfere powerfully with the ability to function normally.

Beck proposed that the key to improving psychological well-being among those suffering from depression and a variety of anxiety disorders was to find ways of helping the patient interrupt their own negative thought patterns and develop positive substitutes. Beck himself overcame a childhood phobia to the sight of blood and the smell of ether by gradually desensitizing himself through repeated exposure during his training at Yale Medical School. CBT’s success, particularly when paired with the new class of anti-depressants that emerged in the late 1980s, has led to its crowning as “the gold standard” of mental health treatment.

Mental health problems like anxiety and depression often lie at the root of persistent poverty, and CBT principles and insights are now being deployed in a range of social and human services settings to help improve outcomes for low-income individuals and families. Economic Mobility Pathways (EMPath), a program highlighted in our recent volume on non-cognitive skills, uses a CBT-informed process for helping welfare-dependent families develop and implement self-sufficiency goals and plans. In Rethinking Reentry, we looked at the use of CBT in prison (one of the very few interventions that has been shown to improve outcomes for offenders) to meet inmate mental health needs and reduce criminal recidivism. Earlier this year, the National Fund for Workforce Solutions published a paper on “trauma-informed” workforce development that urged workforce development authorities and employers to pay attention to symptoms of anxiety and depression among workers dislocated by the pandemic.

Mental illness can profoundly disrupt individual and family efforts to pursue healthy and productive lives, and often becomes the self-perpetuating core of poverty itself. Aaron Beck’s path-breaking work to reduce and remove psychological barriers to human flourishing is one of the ongoing blessings of progress for which we can give thanks this week.

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