Wednesday, April 02, 2008

My Thesis Prospectus

Part of my absence the last few months has been my initial work on my thesis. After much work with my primary thesis advisor, this is the mostly-finished prospectus:

Embodying Cognitive-Behavioral Therapy of Depression:
A Phenomenological Critique of Aaron Beck

Cognitive-behavioral therapy (hereafter CBT) is one of the dominant therapeutic paradigms in our time. With its focus on cognition, however, CBT virtually ignores the body and its role in human existence. My thesis will be a philosophical critique of CBT through the question of the body’s role in human existence. While it is admitted that CBT is a clinical and not a philosophical discipline, I believe that every method in every discipline is grounded by (sometimes implicit) philosophical theories and that an examination of those theories should be a vital aspect of psychology (Gadamer, 1960/1989; Slife & Williams, 1995). I will focus on Aaron Beck’s CBT model and will use depression as the target psychological phenomenon by which to compare Beck’s model with my phenomenological alternative. My analysis will primarily be informed by Maurice Merleau-Ponty’s phenomenology of embodiment. This thesis is not meant as a refutation of CBT, but an attempt to find those structures of active embodiment that essentially undergird and give meaning to cognition as understood by CBT.

The first section of the thesis, essentially the first chapter, will be my literature review of CBT followed by a brief look at the body’s place within that literature. Aaron Beck’s (1976) cognitive-behavioral therapy combines cognitive psychology’s focus on meaning with behaviorism’s theory of learning (Rupke, Blecke, & Renfrow, 2006). Beck (1976) proposed that “[p]sychological problems…result from commonplace processes such as faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, and not distinguishing adequately between imagination and reality” (p. 20). The behavioral aspect of cognitive-behavioral therapy provides a theory of learning and action. Psychological disorders develop when we habitually pair objects, people, events, and actions to certain values, beliefs, and/or consequences (Farmer & Chapman, 2008). With this understanding, depression is grounded in various beliefs: “I am unworthy,” “I am/life is hopeless,” or the unrealistic and ultimately futile belief that “I must be perfect” (Riso & Newman, 2003). These beliefs are “maladaptive schemas” through which the depressed person interprets the events in their lives, essentially filtering out those things that don’t cohere with the belief and emphasizing those things that do. The goal of the therapist, then, is to help the patient correct their maladaptive schemas through vigilant reflection and evaluation of their beliefs, reality testing, and the development of cognitive skills to similarly evaluate and work past future maladaptive schemas, possibly supplemented by medication (Beck, Emery, & Greenberg, 1985, Chapter 11).

The body is rarely mentioned in works on CBT. Naturally, the body is implied in the very notion of behavior and one can easily find discussions of the brain in relation to the usefulness of medication. Beyond these, the most prevalent use of the body is in reference to the “body image”: “one’s perceptions, attitudes, and experiences related to one’s body, especially his or her physical appearance” (Cash & Hrabosky, 2003, p. 255). The body, then, can be said to have a two-fold significance in CBT: first, it is the physical (what I will call the objective) body; second, it is the body as represented in the mind (what I will call the cognitive body).1

The second part of the thesis will be an extended exposition of Merleau-Ponty’s phenomenology of embodiment. The first chapter will be a discussion of Merleau-Ponty’s notions of “form” in Structure of Behavior (1942/1963) and the figure-ground structure of experience in Phenomenology of Perception (1945/1958). These concepts form the background from which to understand the motile structure of the body. The second chapter will be an analysis of the arguments and evidences given by Merleau-Ponty and others (e.g., Gallagher, 2005) for the “body schema” —“a global, practical, and implicit notion of the relation between our body and things, of our hold on them…[a] system of possible movements, or ‘motor projects’” (Merleau-Ponty, 1962/1964, p. 5)—in contrast to the “body image” of either objectivistic or cognitive models of the body. The final chapter of this section will be an analysis of the temporal structure of embodiment, including the encultered nature of embodied action and experience (Ingold, 2000; Bourdieu, 1980/1990).

The final section will consist of an analysis of depression through Merleau-Ponty’s phenomenology of embodiment. It will attempt to answer the following questions: how is depression situated within the motile body? What is the relation between the temporal structure of embodiment and the most common symptoms of depression? Why is it important to examine depression by way of the objects that we interact with in an embodied way? How does the above account for the success of cognitive-behavioral therapy? Finally and tentatively, what potential therapeutic techniques can help in developing a therapeutic approach geared to the motile body?

Notes:
1. Bennett and Hacker (2003) point to a propensity within cognitive science and neuroscience to equate the brain with the whole person. Though pertinent to the issues discussed in this thesis, neural reductionism is not going to be explicitly addressed, though I believe the critique I will give can also apply to this approach.

References

Beck, A. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

Beck, A., Emery, G., and Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.

Bennett, M., and Hacker, P. (2003). Philosophical foundations of neuroscience. Oxford: Blackwell.

Bourdieu, P. (1980/1990). The logic of practice (R. Nice, Trans.). Stanford: Stanford University Press.

Cash, T., and Hrabosky, J. (2003). The effects of psychoeducation and self-monitoring in a cognitive-behavioral program for body-image improvement. Eating Disorders 11(4), 255-270.

Farmer, R., and Chapman, A. (2008). Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action. Washington, DC: American Psychological Association.

Gadamer, H-G (1960/1989). Truth and method (J. Weinsheimer & D. Marshall, Trans.). New York: Continuum.

Gallagher, S. (2005). How the body shapes the mind. Oxford: Clarendon Press

Ingold, T. (2000). The perception of the environment: Essays in livelihood, dwelling and skill. New York: Routledge.

Merleau-Ponty, M. (1942/1963). The structure of behavior (A. Fisher, Trans.). Pittsburgh: Duquesne University Press.

Merleau-Ponty, M. (1945/1958). Phenomenology of perception (C. Smith, Trans.). London and New York: Routledge & Kegan Paul.

Merleau-Ponty, M. (1962/1964). An unpublished text (A. Dallery, Trans.). In The primacy of perception (pp. 3-11). Evanston, IL: Northwestern University Press.

Riso, L., and Newman, C. (2003). Cognitive therapy for chronic depression. Journal of Clinical Psychology, 59(8), 817-831.

Rupke, S., Blecke, D., and Renfrow, M. (2006). Cognitive therapy for depression. American Family Physician, 73(1), 83-86.

Slife, B., and Williams, R. (1995). What’s behind the research: Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: SAGE Publications.

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9 Comments:

Blogger Anthea Wilson said...

Hi, Kevin
This is an interesting blog. I'm using phenomenology for my PhD; just starting to collect data. I'm sure I'll learn something from your blog.
Best wishes
Anthea

12:50 PM  
Blogger Clark Goble said...

Is this for a PhD or Masters Kevin?

9:42 PM  
Blogger Kevin Winters said...

It's for my Masters. My advisor says it might be a tad ambitious, but that is what I'm aiming for.

5:46 AM  
Blogger chris said...

M-P's phenomenology of embodiment... To me this is an interesting turn of phrase. It's interesting because, for me, "embodiment" is such a loaded term. It implies the mind-body dualism of Descartes' philosophy - a philosophical tradition against which M-P is working, undoing in fact. It implies that there is a mind that is "embodied." That the body is the container for the mind. The common use of the term "embodiment" privileges the one over the other. M-P, in fact, believes that the "body is brain," that perception is primary. In other words, there is no brain/mind without body. The sense-perceiving body is how we come to know and have consciousness...

If "embodiment" is actually intended to refer to something akin to Bourdieu's concept of "hexis" then that distinction needs to be articulated. Because "embodiment" and "hexis" are not quite the same thing.

Btw, thanks for stopping by and commenting over at my place. I'm interested to see what other convos you'll be engaging here...

Good luck on the thesis.

1:26 AM  
Blogger Kevin Winters said...

Chris,

Yes, the term "embodiment" is problematic, but it is still useful as long as I elucidate what Merleau-Ponty says in Phenomenology of Perception: "there are several ways for the body to be a body, several ways for consciousness to be consciousness" (124 in first edition, 143 in second edition). Insofar as it is a genuine "phenomenology of embodiment," I hope that my description will include both the body as relatively distinct (such as in cases of illness, fatigue, various kinds of agnosias) and the body as subject (motor intentionality, motivation, etc.). There do seem to be more than just these two modalities of embodiment. Sartre has three ways for the body to be a body and J.H. van den Berg adds two more useful dimensions (see his "The Human Body and the Significance of Movement: A Phenomenological Analysis," Philosophy and Phenomenological Research 13/2, 159-183; you can get this through JSTOR). So, yes, the equivocal meaning of embodiment is a central concept in Merleau-Ponty's work.

On a relation between Merleau-Ponty and Bourdieu, I think the habitus is a better correlate than hexis, though Merleau-Ponty and Bourdieu would both admit that the body is not the end-all of discussion. Though it does ultimately depend on embodiment as its ground, reason and rationality also move beyond situated embodiment in some important respects, insofar as we can have access to more-or-less atemporal laws and truths. Bourdieu's own arguments about the relative temporal structures of theory and practice point to this. This is just another indication that there are "several ways for consciousness to be consciousness."

Thanks for coming over. I hope to take some time to look over your blog and see what you've already done. Might be of some use for my thesis. And perhaps I can be of some use to yours. :o)

6:59 AM  
Blogger C said...

I just composed a lengthy comment that has apparently disappeared into the ether of the internets...

In it I acknowledged a need to broaden my knowledge of different "modalities" of embodiment - especially within my own field. So thanks for the reference to the article.

The second part was a lengthy disagreement on the point that habitus is a better correlate than hexis. Since I think I do a pretty thorough job of articulating the differences over at my place, and since it was a lengthy comment that I don't have time to re-type, I'll simply link to that post:
http://illinoisnative.blogspot.com/2008/02/bourdieu-and-literacy-as-activity-pt-ii.html

1:30 PM  
Blogger chris said...

http://illinoisnative.blogspot.com/2008/02/bourdieu-and-literacy-as-activity-pt-ii.html

1:31 PM  
Blogger Ben said...

Hi - I wonder whether you've come across Mark Williams's work on 'mindfulness based cognitive therapy'. It's an attempt to integrate CBT with Jon Kabat-Zinn's version of eastern mindfulness. I think it could offer an interesting perspective on the whole phenomenology/CBT thing - eg. the role of the body, the distinction between being and doing...

4:02 AM  
Blogger Mitdasein said...

I've been working on a correlative to the evental occurrence that I'm tentatively terming the 'invental' subject. The main idea is that rather than being a subject-thing the mind is a constantly changing emergent system that self generates a 'subject' when needed for decision and action. This subject is necessarily simple and takes into account little of the complexity of the 'self' as system.

While involved in everyday activities the subject disappears andd we are involved in the activity and unaware of any 'I-thing' because it simply isn't there.

While all the details are not yet worked out if you have any interest let me know through my blog at kalountos.blogspot.com.

1:20 PM  

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