The Invention of Cognitive Therapy

The invention and development of Cognitive Behavioural Therapy (CBT) is generally recognised to have been in the twentieth century by Aaron Beck, based on other twentieth century work for example that of Ellis. However there are historical examples of the use of cognitive therapy in previous centuries. One such example is incorporated in Daniel Defoe's Robinson Crusoe, arguably the first English novel. The book was published in 1719.

 

The cognitive therapy is delineated in a table of 'evil' or negative thoughts which are countered or reframed in a sequence of corresponding 'good' thoughts. The purpose of this exercise in written self therapy is to 'deliver my thoughts from daily poring upon them and afflicting my mind' and to 'master my despondency'. This is a fair description of intrusive depressive thinking.

 

 

The table set out by Defoe is as follows:

 

Evil	Good
I am cast out upon a horrible desolate island, void of all hope of recovery.	But I am alive, and not drown'd as all my ship's company was.
I am singled out and separated as it were, from all the world to be miserable	But I am singled out too from all the ship's crew to be spared from death; and he that miraculously saved me from death, can deliver me from this condition.
I am divided from mankind, a solitaire, one banish'd from human society.	But I am not starv'd and perishing on a barren place affording no sustenance.
I have not clothes to cover me.	But I am in a  hot climate, where if I had clothes I could hardly wear them.
I am without any defence or means to resist any violence of man or beast.	But I am cast on an island, where I see no wild beasts to hurt me, as I saw on the Coast of Africa. And what if I had been shipwreck'd there/
I have no soul to speak to or relieve me.	But God wonderfully sent the ship in near enough to the shore, that I have gotten so many necessary things as will either supply my wants, or enable me to supply my self even as long as I live.

 

 

An evaluation of the self therapy is given thus 'let this stand as a direction from the experience of the most miserable of all conditions in the world, that we may always find in it something to comfort our selves from, and to set in the description of good and evil, on the credit side of the accompt.'

 

I think this demonstrates that the principles of CBT existed in Defoe's mind when he was writing Robinson Crusoe and that the notion of the use of rational argument to treat his fictional hero's depressed mood is clearly evident. I would be interested to know of any other prior examples of this form of therapy in literature or the history of psychiatry.

 

References

 

Beck,  A T (1970) Cognitive Therapy: nature and relation to behaviour therapy. Behaviour Therapy 1, 184-200.

 

Defoe, D. (1719) Robinson Crusoe. Edition quoted from here: Penguin Classics (2001) pages 53-54.

 

Ellis, A. (1962) Reason and emotion in psychotherapy. Lyle Stuart, New York.

 

Dr Ben Green,

Consultant Psychiatrist, Honorary Senior Lecturer,

Cheadle Royal Hospital and the University of Liverpool.

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