Thomas Aquinas and Cognitive Therapy

Thomas Aquinas and Cognitive Therapy: An Exploration of the Promise of the Thomistic Psychology
Giuseppe Butera
Abstract: Although Thomas Aquinas never developed an account of the emotional disorders, he anticipated all the major principles and methods of cognitive therapy (CT) in his philosophical psychology. This fact has gone largely unnoted by philosophers and psychologists alike. The purpose of this article is to demonstrate the complementarity of these two psychologies by arguing that Aquinass philosophical psychology (APP) can serve as a theoretical framework for CT, especially as it appears in Aaron Becks classic introduction to the subject, Cognitive Therapy and the Emotional Disorders. The motivation for this article is both theoretical and practical in nature: Theoretical, because Aquinas provides a profound and cogent philosophical framework for CT, which in turn is able to draw out much that is only implicit in Aquinass thought; practical, because APP offers useful insights and suggests interesting lines of development for CT. Finally, I suggest that the disagreements dividing the various different psychologies and their related approaches to the emotional disorders may be due to a failure to grasp the dynamic structure of the human psyche at a level that can be reached only through careful philosophical analysis, a feat I believe Aquinas to have in large measure achieved. Keywords: automatic thought, behavior, cogitative power, emotion, habit, judgment, philosophical psychology
n his classic introduction to the subject, Cognitive Therapy and the Emotional Disorders, Aaron Beck observes that the philosophical underpinnings of cognitive therapys (CT) approach to the emotional disorders go back thousands of years, certainly to the time of the Stoics, who considered mans conceptions (or misconceptions) of events rather than the events themselves as the key to his emotional upsets (Beck 1976, 3). But beyond acknowledging that the stoics anticipated the central insight of CT, Beck has very little to say about the philosophical underpinnings of CT, content it would seem for it to be an empirically grounded system of psychological principles and therapeutic methods. Yet even this little is sufficient to invite philosophical investigation of the dynamic realities underlying these principles and methods. In addition to its inherent interest, such an investigation is, as I hope to show, attractive for its promise of providing a deeply rooted and highly articulated philosophical explanation for the effectiveness of CT. With a philosophical foundation on which to ground all of its principles and methods, CT would be more intellectually satisfying. Complemented by a philosophical psychology,
2011 by The Johns Hopkins University Press
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it would also have greater conceptual resources with which to deepen its own understanding of the inner life of human beings and the emotional disorders to which they are prone. It might even discover a means of entering into a more fruitful dialogue with rival accounts of the emotional disorders, such as those provided by the various depth psychologies pioneered by Freud and his disciples. Granting the desirability of exploring the philosophical underpinnings alluded to by Beck, one might think to start with a closer examination of stoicism. The purpose of this paper is to argue that a better place to start would be with the philosophical psychology of St. Thomas Aquinas. For as impressive as the stoic anticipation of CTs central insight may be, it pales in comparison with the remarkable but virtually unnoted complementarity that exists between CT and the philosophical psychology developed by the great thirteenth-century Catholic theologian. In what follows, I attempt to show that the principles and methods of CT can be grounded philosophically using Aquinass philosophical psychology. I say philosophical, not theological, even though Aquinas was first and last a theologian, because the psychology he developed is able to stand on its own, independent of his theological commitments. This is not to imply that these latter had no effect on his thinking about human beings. They most definitely did. However, the cogency of his theologically inspired thinking about the inner dynamics of the human person does not depend on an acceptance of his Catholic beliefs. As with his investigation of other matters influenced by his faith but not falling exclusively within the purview of theologymatters concerning such things as metaphysics, natural philosophy, and ethics Aquinass investigation of human psychology is philosophical both in its starting point and in its method, rooted as it is in ordinary experience, not in the dogmas of the Catholic faith. To avoid any misunderstanding, I should hasten to add that my motivation for bringing Aquinass philosophical psychology (APP) into dialogue with CT is not in the least historical. All the evidence strongly suggests that he exerted no influence on Becks formulation and development of CT. As such, the purpose of this paper is wholly theoreti-
cal, namely, to demonstrate the complementarity of these two psychologies and to explore some of the ways they might enrich each other. This claim is sure to strike some as hopelessly nave. After all, Aquinas and Beck not only come from different times; they come from different worlds. What can the medieval theologian possibly have to do with the post-Enlightenment psychiatrist? There is no denying the historical and philosophical differences separating them. Yet each has much to learn from the other precisely because they take very different approaches to the study of the same subject, each bringing a different set of philosophical and methodological assumptions to his study, resulting in very different, although mutually enriching and compatible, accounts of the inner dynamics of the human psyche. Even so, the objection might continue, comparing these two psychologies without an examination of the underlying post-Enlightenment philosophical presuppositions of CT is to compare apples and oranges. This would be true if what was being attempted were a mere side-by-side comparison of APP with CT. However, what is being attempted in this paper is something else entirely: The grafting of the principles and methods of CT onto APP, a possibility strongly suggested by the remarkable clinical effectiveness of CT and the philosophical cogency of APP. Indeed, one of the primary motives for bringing these two very different psychologies into dialogue with each other is my sense that CT and its rivals, especially all the various forms of depth psychology, are like the blind men of the fable who, having run their hands over different parts of an elephant, cannot agree on a description of the beast. Each, mistaking his own partial experience of the elephant for the whole, takes his description to contradict the others. But imagine what would happen if one of the blind men, in a flash of insight, were to grasp the underlying structure of the elephant? Suddenly, what had previously seemed to be a wild menagerie of outlandish beasts would give way to a surprising yet satisfyingly organic vision of a single animal. What I would like to suggest (and the limits of my paper will permit me to do no more than this) is that Aquinas, for all the limitations of the science of his day, offers just such a fundamental insight into the underlying structure
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of the human psyche. By employing the rational, dialectical method of the philosophers, he is able to sound depths inaccessible to the scientific method, limited as it is to the quantifiable in its exploration of reality.1 For this reason, APP might be able to function as a unifying explanatory framework for all the successful therapeutic methods of the various and disparate modern psychologies; it might also serve as an arbiter in the disputes concerning the various theoretical differences which make it so difficult for them to talk to each other. Admittedly, the ambitions of this paper far exceed its scope. Less ambitious but an important first step in the completion of the much larger project I have hinted at is to show that all the major principles and methods of CT may be derived from and explained in terms of APP. To this end, the rest of the paper considers seven points of contact between CT and APP. Although other points of contact may exist, I believe these to be the most important for our purposes. To a greater or lesser extent, each of the following defining positions of CT may also be found in APP, some explicitly, others only implicitly but capable nevertheless of being fully articulated (as well as further elaborated) within the philosophical framework developed by Aquinas: (1) Emotions are caused by evaluative thoughts, typically called automatic thoughts; (2) Rules for evaluating our experiences operate without our consciously being aware of them; (3) The application of these rules to stimuli results in automatic thoughts; (4) Automatic thoughts are accessible to the person experiencing the emotions caused by them; (5) The specific content of an automatic thought leads to a specific emotional response; (6) Emotional disorders are caused by incorrect automatic thoughts, which can be modified through rational considerations; and (7) Habituation, in addition to awareness of such automatic thoughts, is necessary to change incorrect automatic thoughts and to inculcate correct ones. To these may be added the fact that the models underlying both psychological theories are anti-physicalist and humanistic. Anyone familiar with Aquinass work knows that it is no easy task to summarize his views on most philosophical subjects, because these are usually strewn throughout his voluminous writings. Yet because his most mature reflections
on the subject of philosophical psychology are found in his Summa theologiae, a clear idea of APP may be gained from a careful reading of this single work. And although a detailed account of the reasoning supporting APP is beyond the scope of this paper, an attempt will be made to draw its broader outlines, with the goal of revealing something of the coherence and cogency of APP as well as its potential to function as a theoretical framework for the empirical observations and theories encompassed by CT. Beyond this, there is, as has been noted, also the exciting potential to forge a synthesis between CT and its apparently incompatible rivals. In the first part of the paper, we get a broad overview of APP, one sufficient to supply the conceptual apparatus needed to grasp the similarities between APP and CT. Although somewhat detailed, it is not so detailed as to burden our discussion with distinctions that would, for the purposes of this introductory study, prove only distracting. In the second part, we examine the seven major points of contact between APP and CT mentioned above with a view to showing three things: (1) That Aquinas anticipated each of them either in whole or in part; (2) That his philosophical psychology offers a theoretical foundation from which the principles and methods of CT may be derived and thus grounded in an account of the human person that avoids the materialist reductionism that is the hallmark of the majority of post-Enlightenment psychologies; and (3) That APP offers important insights into the nature and causes of the emotions, insights that complement and in some ways go beyond those offered by CT, even suggesting possible avenues of development that envision at least a partial synthesis of the most valuable insights of CT with those of its rivals psychologies.
An Overview of Aquinass Philosophical Psychology

Aquinass Method for Studying Human Psychology
A complete overview of APP would require us to take a close look at Aquinass existential metaphysics, a daunting task, to be sure. Happily, we need only point out that, for Aquinas, the human
person is a single entity comprising a material body and an immaterial soul. Here, we must be careful not to take him for a proto-Cartesian, dividing the human person into two independently existing substances or entities bound together, somehow, to form a complex whole. Rather, for him, the entire human person, body and soul, is a single substance in which the body does not exist independently of the soul but in and through it (see Aquinas, Summa theologiae [ST] I, q. 76, a. 1, ad 5).2 In this way, he preserves the existential unity of the human person, avoiding many of the problems that have dogged Cartesian dualism from its earliest days. Aquinass method for peering into this complex unity is to reason back from observable effects to their underlying causes or, to be more precise, from specific kinds of action, like seeing, back to the specific potential to perform such actions, in this case, the power of sight. For each of the different kinds of action the human person performs, there must be a corresponding preexisting ability or power, rooted in the soul and, with the exception of thinking and willing, realized in the body in some one physical organ or group of organs (see ST I, q. 75, a. 3).
The Powers of the Human Person

Because ordinary observation reveals that we are capable of performing five basic kinds of action, Aquinas reasons that we must have five basic kinds of power: Locomotive, vegetative, sensitive, rational, and appetitive (see ST I, q. 78, a. 1). To allay any suspicion that he reduces the human person to a collection of faculties, it is important to note his insistence that when any of the powers is activated, it is the whole person who acts through it. To assert the contrary would be to reduce the human person to a collection of independently existing faculties, a sack of organs, as it were, rather than a single human being marked by a profound and irreducible existential unity (see ST I, q. 76, a. 1). It is important not to lose sight of this point, for although we often speak as if a specific action may be wholly attributed to this or that power, the eye seeing and the hand grasping, for instance (a convention that is both convenient and one which Aquinas adopts in his
writings), it is the person, strictly speaking, who does these things, doing them by means of these powers (see ST I, q. 75, a. 2, ad. 2). When the (locomotive) power to chew and swallow ones food as well as the (vegetative) power to digest it are used, it is the person, properly speaking, who does these things by means of these powers. It is the person who sees by means of the (sensitive) power of sight; who commands the act of eating by means of the (intellectual) power of practical reason; who chooses to eat by means of the will (the rational appetitive power); who feels delight in the food by means of the sensitive appetitive power. (See Table 1 for a quick reference guide to the powers of the human person.) Of the five basic kinds of power, only three enter directly into the inner mental life of the human person: The sensitive powers, through which all our knowledge of reality comes to us; the intellectual powers, by means of which we transcend the physical limits of the senses to arrive at an intellectual apprehension of sensible reality and beyond; and the appetitive powers, by means of which we are moved or move ourselves in response to sensibly and rationally apprehended goods or evils. We need concern ourselves, therefore, only with these three kinds of power. And even among these, only a few specific powers are of special interest to APP. Like any good philosopher, Aquinas aims at economy in his theories. One more preliminary point, and then we will be ready to take a closer look at these powers. To understand the distinct roles of the sensitive, intellectual, and appetitive powers in APP, we should note that, for reasons both philosophical and theological, Aquinas held all the powers to be hierarchically ordered, some commanding, others commanded, still others commanding and commanded. Following a tradition tracing its roots at least as far back as Plato, Aquinas placed reason and will at the top of the souls hierarchy of powers: Reason because through it we grasp truths and direct our actions; will because through it we move ourselves to pursue things judged by reason to be good (see ST I, q. 95, aa. 12). And subordinate to these two powers (ideally) are the emotions. Already we can see a profound similarity between APP and CT: Each holds that the
Table 1. The Formal Structure of the Emotions The Five Generic Powers of the Human Person Intellectual The Sub-Generic Powers The Specific Powers
Speculative (These are not two distinct powers Practical but rather two modes of reasoning of which one and the same power, the intellect, is capable.) Will Concupiscible Irascible Sight Hearing Taste Touch Smell Common Sense Imagination Cogitative Power Memory
Appetitive Rational Sensitive Sensitive External Internal Locomotive
NA Legs, arms, and other muscle groups. NA Powers common to animals and plants involved in nutrition, growth, sexual reproduction, and the maintenance of physical health.
Vegetative
emotions do not normally exercise an executive function over human behavior. In animals, emotions rule because there is no higher appetitive power to check them. In human beings, however, the emotions,3 although sometimes unruly and difficult to control, are usually within our power both to resist and to command (especially for those who are virtuous),4 because reason and will working together function as the executive power. More will be said about this later. Below the powers of intellect and will, we find all the rest, serving in one capacity or another to make possible the flourishing of a free and rational animal (see ST I, q. 77, a. 2). Among these are the external and internal sense powers, the different kinds of sensitive power. It is through them that we first come to know ourselves and the world around us. As we will see, the internal sense powers are especially important for APP. Without these humble powers, the intellect could not scale
the heights of existence; the higher, to quote a medieval maxim, cannot stand without the lower. Next comes the power through which we experience the whole range of human emotions, from love and hate to sorrow and delight: The sense appetite. As I endeavor to show later in this paper, the basis for the remarkable complementarity that exists between APP and CT is the relationship that exists between the sense appetite and reason as mediated by one of the internal sense powers, the cogitative power. Below the sensitive powers in the hierarchy of powers are the locomotive and vegetative powers, essential for human life and well-being, but far removed from the psychological dynamisms that are part of the inner mental life of human beings. With that, we are ready to take a closer look at each of the three generic kinds of powers whose activity and interactions constitute the bulk of this inner life. We begin with the sensitive pow-
ers, through which we first become aware of the world and ourselves. These include both external and internal sense powers. To the external sense powers belong the five familiar to all of us: Sight, hearing, taste, touch, and smell. Of the four internal sense powers enumerated by Aquinas, only one, the imagination, is familiar to us. The other three, the cogitative, the memorative, and the common sense, although alien to our way of thinking, are not so alien as to be incomprehensible. Some might even seem uncannily modern in their anticipation of problems that stump cognitive scientists to this day. Common sense is the power that corresponds to our ability to compare and contrast the different sensible qualities perceived by means of the external sense powers, such as the green color of an apple and its sour taste. Aquinas reasons to the existence of the common sense in the following way. Although sight is able to apprehend color but not flavor, and taste is able to apprehend flavor but not color, we are nevertheless able to perceive the color and the taste as belonging to one and the same apple. If we possessed nothing but the external sense powers, we could never apprehend the green color and the sour taste of the apple as belonging to one and the same thing; for our apprehension would be of two separate and distinct sensible qualities having nothing to do with each other. To explain our ability to experience these sensible qualities as belonging to one and the same object, Aquinas posits the existence of an internal sense power capable of comprehending and thus bringing the separate sensations of the external senses together in a single, unified apprehension of a complex whole. Hence the common sense (see ST I, q. 78, a. 4, ad 1 and 2). The next internal sense power is the imagination, which Aquinas calls the treasure chest (thesaurus) of the sensible images apprehended through the external sense powers (see ST I, q. 78, a. 4). Its existence is indicated by our ability to remember sensible things previously apprehended through the external senses. If we did not have this power, we would be unable to feel anything for absent things, a conclusion contradicted by the experience of wanting, for example, to spend time with an absent friend. Our ability to take the
sensory images (visual or otherwise) of things apprehended through the external sense powers and combine them to form new images is also taken by Aquinas to be traceable to the imagination. Golden mountains and flying horses are examples of such products of the imaginations synthesizing activity (see ST I, q. 12, a. 9, ad 2). In addition to comparing and storing the sensible images of things perceived through the external senses, human beings and animals also experience inclinations to behave in specific ways toward specific objects. To use Aquinass examples, a sheep will tremble at the sight of a wolf, and a sparrow will be moved to use straw in the construction of its nest. In each instance, the mere appearance of the object is insufficient to account for the animals behavior. For in addition to sensing the objects, they must also apprehend them as desirable or undesirable or, to use Aquinass highly refined terminology, suitable or unsuitable. But because these properties are not reducible to any sensible quality, neither the external sense powers nor the internal sense powers of common sense and imagination are able to apprehend the suitability of the bit of hay for the sparrow or the unsuitability of the wolf for the sheep. Consequently, Aquinas takes the highly specific and seemingly intelligent response of animals to sensible things as demonstrative of a third interior sense power, one capable of judging the suitability or unsuitability of things perceived through the senses. In animals, he calls this the estimative power (see ST I, q. 78, a. 4; see also ST I-II, q. 9, a. 1, ad 2), the seat of instinct. Although something like the estimative power exists in humans, it is not quite the same. For unlike animals, which rely upon instinctual judgments for the apprehension of the suitability or unsuitability of sensible objects, humans make most if not all of their judgments about such things on the basis of knowledge gained either directly through experience or indirectly from others (see ST I, q. 78, a. 4 as well as Aquinass De Veritate [DV] q. 1, a. 11). Rationality gives us the ability to tailor our actions with an intelligence that often exceeds anything nature supplies the beasts through instinct and the limited tutoring of their parents and their own experience. Indeed, the instinctual responses of animals are judgments
only by analogy. There is no question of animals using reason to arrive at judgments; instinct offers a sufficient explanation for their behavior. Nevertheless, the deliverances of the estimative power may be likened to the judgments of reason because they function in a similar way, namely, as the sizing up of things and situations as they enter into the field of awareness, demanding a response of some kind. Even so
we cannot suppose that the sheep fears the wolf as wolfthe sheep has no notion of wolf, for this is an intellectual understanding. . . . Thus, the sheep fears the wolf, is not to be understood formally; wolf in this statement designates the thing the sheep fears, not the object of the sheeps fear as the sheep knows it. (emphasis in original; Klubertanz, 1965, 37)
Being born with very few instincts (see Klubertanz, 1953, 1425),5 but possessing the ability to grasp things intellectually, human beings are constantly called upon to make rational judgments about the suitability or unsuitability of things. So, to take an example, when someone perceiving a wolf begins to fear it, he does so not because of instinct, but because of his understanding of the nature of wolves and the danger they naturally pose. Now, if we tried to explain his affective response exclusively in terms of what he knows about wolves in general, we would not be able to explain why he feels intense fear only for this particular wolf and not all wolves. The intellect trades in universal concepts and judgments; it does not reach down to the level of concrete particulars. Somehow, the universal must be united with the particular to form a judgment capable of causing his affective response toward this particular object of sense experience. That is to say, at the level of the concrete particulars of the situation in which he finds himself, he must judge this particular wolf to be unsuitable to him. Given this necessity, Aquinas infers the existence of a third internal sense power, the cogitative power (also known as the particular reason). Immersed in the world of sensible particulars, the cogitative power, under the guidance of reason, issues judgments about the suitability or unsuitability of sensibly perceived individuals (see Klubertanz, 1965, 369). It is by means of such judgments that the emotions are elicited.
Like the estimative power in brute animals, the cogitative power is the direct cause of our affective responses to sensible things. But whereas the estimative power in animals is virtually hardwired by nature to make specific judgments about specific kinds of thing, the cogitative power is a relatively blank slate, capable of being programmed and reprogrammed by reason to make predetermined judgments about individual sensible things. It is important to note that, like the judgments of the estimative power, the judgments of the cogitative power are themselves only analogously judgments, arising as they do from a non-rational6 power, although the cogitative power, unlike the estimative power, is directed by reason. It is also important to note that the correctness of the cogitative powers judgment has no bearing on a persons emotional response; it a persons judgment of the wolfs apparent unsuitability, not its actual unsuitability, that causes his fear.7 We must keep this point firmly in mind in the ensuing discussion of the complementarity of APP with CT. It is only in light of it that APP is able to explain why the emotional disorders are even possible, let alone treatable. If the sense appetite could respond only to true goods or true evils in proportion to their suitability or unsuitability, respectively, not only would the emotional disorders never arise, it would be impossible for them to do so. But because emotions result from judgments about apparent suitability or unsuitability, it follows that a person can feel an attraction or repulsion for the wrong things, just as much as he can for the right things. Before moving on to the last of the internal sense powers, we would do well to observe that Aquinass reason for concluding to the cogitative powers openness to rational control is based squarely on experience. In ST I (q. 81, a. 3), where he discusses the nature and limits of reasons control of the emotions, he notes that emotions can be modified or excited through the application of universal considerations. By calling to mind a universal truth, reason is able to alter the judgment of the cogitative power, thus eliciting a different emotion in response to the same object or stimulus, viewed now in a different light. So, for instance, anger toward someone who has
spoken an unkind word to us may give way to pity upon recalling that he very recently suffered a great personal loss. For the purposes of providing a theoretical grounding for CT, there is perhaps no more important philosophical doctrine in APP than this, explaining as it does why the emotions are susceptible to rational modification and control. More will be said later about the mediating role played by the cogitative power in the complex relationship between reason and emotion.8 The fourth and final internal sense power is the memorative power. Aquinas infers its existence from our ability to store and later recall past judgments of the cogitative power (see ST I, q. 78, a. 4). For this reason, he likens it to the imagination. When a sheep has received a number of shocks from an electrified fence, for instance, it comes to judge the fence as unsuitable. The next time it encounters an electrified fence (or, for that matter, anything that sufficiently resembles one, electrified or not), it will simply draw upon its store of judgments and thus instinctively feel an aversion to it. It is by means of the same sort of power that humans are able to do something similar, albeit of a kind vastly more supple, because the internal sense powers participate in rationality.9 Of course, nothing could cause a person to be inclined to pursue something judged to be suitable (or avoid something judged to be unsuitable) unless he had the potential to be so inclined in the first place. Hence the need to posit the existence of yet another kind of power in addition to all the others, namely, the appetitive. It is through this power that both animals and humans are moved to pursue the goods they lack and to rest (that is, delight) in them once acquired. Sensation and reason alone are insufficient to account for the movement stimulated by apprehension. Were it otherwise, we should find ourselves feeling an inclination of one sort or another toward every apprehended object. Complicating matters is the fact that the empirical evidence points to the existence of two specific kinds of appetitive power, one sensitive and common to both humans and animals, the other rational and unique to humans. For Aquinas, as for the tradition stretching all the way back to Platos study of the soul in the Republic (see
especially book 4, 435a441c), the evidence for this distinction is found in the observation that we sometimes experience inclinations for things at two distinct levels, the sensible and the rational. Consider the dieter. He knows and even chooses to eat less notwithstanding a strong contrary inclination to eat more. Aquinas takes the explanation for this inner conflict to be the fact that there is in the dieter more than one kind of appetite. At the unreasoning, animal level there is the desire to eat more; at the rational, volitional level, the desire to eat less. It is worth noting that the reverse conflict also furnishes Aquinas with evidence for this distinction: The same dieter, although desiring to eat spinach at the rational appetitive level, might experience a strong aversion to it at the sensitive appetitive level. In general, the appetitive powers are capable not only of being moved by apprehended goods (things judged to be suitable) but also of moving other powers to the execution of those acts necessary to attain an apprehended good or avoid an apprehended evil (see ST I-II, q. 17, aa.19). In a cat, for example, an animal devoid of reason and will, the movement or change elicited in the sense appetite by the apprehension of a mouse (a movement identical in this case with the emotion of desire) causes the cat to chase the mouse (see ST I-II, q. a. 2, ad 2). But, as intimated above, in humans, the inclination arising from the sense appetite is, by itself, insufficient to cause a person to act, because the rational appetite is higher than the sense appetite, occupying as it does a position among the powers analogous to that of a general among the officers and soldiers of an army, to use Aquinass example (see ST I-II, q. 9, a. 1). The sense appetite inclines in vain toward this or that desirable object if a person refuses to act on his inclination. This is not to say that the emotions can have no effect on his choices. In fact, as we will see, the emotions can have an all-but-determinative influence on them. However, Aquinas insists that as long as a person retains the use of reason, he can act contrary to his passions (see ST I, q. 81, a. 3 and ST I-II, q. 17, a. 7; see also Aquinass treatise on evil, De Malo, q. 3, aa. 911). Aquinass account of the passions is rendered more complex by the fact that we experience
inclinations not just for things that are easy to pursue or avoid but also for things that are difficult to pursue or avoid. This fact, he argues, cannot be accounted for on the supposition that there is only one sense appetite. If we possessed only a simple appetite for things judged to be suitable or unsuitable, we would never pursue things judged suitable but difficult to attain, or confront and resist things judged unsuitable but difficult to overcome. The fear and aversion aroused by such judgments would cause us either to give up or give in. Yet there are times when we find ourselves torn between contrary inclinations at the animal level, feeling the urge to take on a difficult and painful task, for example, even as part of us, the one that longs for comfort and safety, would have us give up the struggle. For these reasons, Aquinas concludes that the sense appetite must actually be a generic power comprising two distinct appetitive powers. The first of these concerns things judged simply as suitable or unsuitable, and is called the concupiscible appetite. The second concerns things judged as suitable and difficult to attain or unsuitable and difficult to avoid or fight off. This power is called the irascible appetite (see ST I, q. 81, a. 2). Together, these powers account for all the various emotions we may experience toward anything judged by us to be good or evil.
The Formal Structure of the Emotions

For our sketch of APP to serve our purposes, we must take a look at the emotions and their causes. The following contains some of Aquinass most interesting insights into the emotions, insights that might serve to deepen CTs own understanding of the emotional disorders by adding some refinements to its theoretical construction of the formal structure of the cognitive content implicit in the emotions or, to put it in terms more familiar to CT, the formal structure of the eliciting cognitions that consistently result in specific emotional responses. (For a quick reference guide to the emotions, see Table 2.) It is important to note, however, that whereas CT makes a sharp distinction between emotions and their eliciting cognitions, APP does not. In keeping with his metaphysical account of
the existential unity of body and soul, Aquinas sees the eliciting cognitions and the physical changes and sensations arising from them as co-principles of one and the same thing, namely, emotion. Much more could be said about this topic, but for now it is enough to be aware of this difference between CT and APP (see Butera 2001, 5161). To say more at this juncture would be to add needless complexity to what is, after all, meant only to be an introductory study. Because there are two sense appetitive powers, Aquinas reasons that there must be two sets of human emotions, one belonging to the concupiscible appetite, the other to the irascible. In all, he argues that there are eleven distinct and irreducible kinds of emotion, six for the concupiscible appetite and five for the irascible. This is not to say that there are only eleven emotions; Aquinas recognizes the complexity and enormous variety of human affectivity. Rather, each of these eleven emotions is best thought of as a kind or species of emotion to which any number of subspecies may belong. No matter how subtle or complex the emotion, however, he maintains that it will fall under the general description of one or more of these basic kinds of emotion. Hence, ambition and lust, although different in many respects, are at base species of the same kind of emotion, namely, desire. Moreover, some emotions are actually a complex of two or more emotions, such as the anxiety felt by many just before an important and difficult exam, caught as they are between hope and despair (see Baker 1941, 57). In distinguishing these eleven emotions, Aquinas provides a derivation of the emotions that is both simple and powerful (see ST III, q. 23, a. 4). He begins by stating that there must be a distinct kind of emotion for every distinct and irreducible way that a thing may be judged to be suitable or unsuitable. And because there are eleven basic and irreducible ways that this may happen, there must be eleven basic kinds of emotion. Some emotions, however, are more basic than others. Hope, for example, cannot exist without desire, although desire can exist without hope. Neither, however, can exist without love. Love indeed is first among the emotions; without it, none of the others could exist.
Aquinas arrives at this conclusion in the following way. He begins by making the crucial and very subtle point that an animal must undergo a change before it can feel any inclination to pursue or flee a perceived object, even one judged to be suitable or unsuitable. The only thing that can explain a cats sudden inclination to chase a mouse is a prior disposition to be thus moved. Before bounding after a mouse, a cat must first judge it to be suitable for itself. When this happens, the cats appetite undergoes a change, one that Aquinas tell us in his technical Aristotelian idiom causes its sense appetite to become suitable or proportionate to the apprehended good (see ST III, q. 25, a. 2). And it is precisely this first movement or activation of the concupiscible appetite, this first and most fundamental emotion, that he calls love (amor; see ST III, q. 23, a. 4). What is true of animals is also true of humans. It is love that makes a person become the sort of thing that is able to desire this food, for example, and to delight in it once it is acquired (see ST III, q. 26, a. 2, ad 3). For Aquinas, love is neither the desire for nor the delight taken in the food; rather, it is the necessary emotional disposition without which none of the other emotions could be elicited. Love explains the desire a person feels when an object judged to be suitable is absent and the delight he experiences when it finally comes into his possession. Because love is an emotion that causes an animal to become oriented toward something perceived through the senses, it follows that there should also be an emotion of hate (odium), a contra-orientation, as it were, for whatever is opposed to something loved. If we hate anything, it is only because we already love something else, which we take to be threatened in some way by the hated object. We hate disease, for example, because we love our bodies. It should be noted that both love and hate belong to the concupiscible appetite because they concern things simply considered as suitable or unsuitable without any thought of the difficulty that might be involved in acquiring or avoiding them, a point that will be made clearer when we turn to the emotions of the irascible appetite. With love and hate in place, Aquinas uses the distinction between good (i.e., suitability) and
evil (i.e., unsuitability), on the one hand, and absence and presence, on the other, to derive all the other emotions of the concupiscible appetite. If an object is loved but as yet not possessed (or, to use Aquinass terminology, not present) a person experiences the emotion of desire (desiderium or concupiscientia), which is the inclination to pursue the loved object. If, on the contrary, an object is hated but absent and may as yet be easily avoided, the same person will experience the emotion of dislike or aversion (fuga or abominatio), which is the inclination to avoid the hated object. The possession of the loved object now present gives rise to the emotion of delight or joy (delectatio or gaudium), which is not an inclination but rather a resting in the possession of the loved object. And the presence of the hated object gives rise to sorrow or sadness (dolor or tristitia), the contrary of delight, which is neither an inclination nor a resting in the loved good but a state of resignation to an evil that it hates, but no longer looks to escape or overcome. In all, the number of emotions belonging to the concupiscible appetite is six, consisting of three pairs of contrary emotions: (1) Love and hate; (2) desire and aversion; and (3) delight and sorrow. Because the irascible appetite concerns suitable things insofar as they are difficult to attain and unsuitable things insofar as they are difficult to avoid or overcome, the emotions of the irascible appetite must be rooted in the emotions of the concupiscible appetite. Because love and hate, the most basic and essential affective dispositions, are emotions of the concupiscible appetite, the activation of the irascible appetite must follow upon that of the concupiscible (see ST III, q. 23, a. 4). Children hate rainy weather because of their great love of the outdoors; and when it rains, the same love animates their hope that the rain will soon go away. Thomas derives five emotions of the irascible appetite. He does so by employing the distinction between the possible and the impossible, in addition to the more basic distinctions between good and evil, and absence and presence. In the case of the good that is difficult to attain, two emotions are possible. If the good is judged possible to attain, a person will experience hope (spes), but if
it is judged impossible to attain, he will instead experience despair (desperatio). A third irascible emotion, one aroused by the possession of the difficult good, does not exist because the difficult good ceases to be difficult once it is possessed, causing a person to experience delight, an emotion of the concupiscible appetite. In the case of evil that is difficult to avoid or overcome, three emotions are possible. Two concern evil that is absent, the other evil that is present. Daring or courage (audacia) inclines a person to confront a difficult evil that is, as yet, absent. Fear (timor) also concerns a difficult evil that is absent, but it inclines one to avoid it. When a difficult evil is present, so that it can no longer be avoided but must instead be endured, it will cease to be regarded as difficult if no hope of escaping it remains. For although difficult is a term that in common parlance is usually said of things to be done, it is actually descriptive of an agents ability to do these things: What is difficult for one person may be easy for another. Moreover, a thing can only be difficult if it is tried. So if a difficult evil is present and judged permanent or unshakable, it will cease to be regarded as something that might be overcome. It will go from being viewed as a difficult evil to being a simple one. But where a present evil admits of no remedy, there is sorrow, which is an emotion of the concupiscible appetite. Hence, there is no irascible appetite regarding a difficult evil that is present and judged impossible to overcome. Finally, there is the difficult evil that is present and about which there is hope that it may yet be overcome. Such a state of affairs arouses anger (irae), the inclination to combat the difficult evil. In all, the five emotions of the irascible appetite consist of two pairs of contrary emotions, and one unpaired emotion: (1) Hope and despair; (2) daring and fear; and (3) anger. It is important to note that the irascible emotions find their ultimate resolution in the concupiscible emotions, because every emotion has its origin in the love of some good which must, in time, result either in delight over its possession or sorrow over its loss. Although a great deal more could be said about Aquinass derivation of the emotions, not to mention other important details of APP, enough has
been said to make it possible for us to see just how APP may be used to provide a philosophically sophisticated and illuminating explanatory account of the principles and methods of CT. In the following section, each of the seven points of contact between CT and APP mentioned in the introduction will, after receiving a brief description, be explained in terms of APP.
A Thomistic Grounding for Cognitive Therapy

1. The Emotions Are Caused by Evaluative Thoughts, Also Known as Automatic Thoughts
At the heart of CT is the doctrine that emotions are caused by evaluative thoughts. Unlike some other major schools of psychotherapy, CT holds to the principle that there is a conscious thought between an external event and a particular emotional response (Beck 1976, 27). Beck explains that
the specific content of the interpretation of an event leads to a specific emotional response. Further, based on examination of numerous similar examples, we can generalize that, depending on the kind of interpretation a person makes, he will feel glad, sad, scared, or angryor he may have no particular emotional reaction at all. . . . The thesis that the special meaning of an event determines the emotional response forms the core of the cognitive model of emotions and emotional disorders: The meaning is encased in a cognitiona thought or an image. (Beck 1976, 52)
A major motivation for holding to this principle, Beck tells us, is that it is
difficult to conceive of how a person can react emotionally to an event before he has appraised its nature. . . . Judgment is required to decide whether a situation is safe or harmless, whether another person is friendly or unfriendly. . . . If not for cognitive processes such as discrimination and integration of stimuli, we would react willy-nilly to events. Whether we laughed, cried, or raged would have no sensible relation to the reality of what was happening. (Beck 1976, 29)
As we saw in our overview of APP, Aquinas also concludes that emotions arise in response to thoughts. Neither external nor internal stimuli are immediate causes of emotion. Rather, thoughts or, to be more precise, judgments, made about the
Table 2. A Thomistic Grounding for Cognitive Therapy Sense Appetite Basic Object of Sense Appetite Concupiscible Simple good Simple evil Irascible Difficult good Difficult evil Adjudicated Relation of Object to Person Absent / Present Possible / Impossible NA Absent Present NA Absent Present Absent Absent Present Absent Absent Present Present NA NA NA NA NA NA Possible Impossible NA Possible Impossible Possible Impossible Emotion
Love Desire Delight Hate Aversion Sorrow Hope Despair (Delight) Daring Fear Anger (Sorrow)
things we perceive through our senses, are said to be their immediate causes. Concerning this last point, we should note that Aquinas is not always explicit about the causal connection between judgment and emotion, although when he does mention it, he says that the connection is essential. In ST I (q. 81, a. 3), where he examines the nature and scope of reasons control of the emotions, he argues that reasons control is limited by the fact that the external senses and the imagination have the ability to suddenly and without warning present the sense appetite with a sensible good or evil. At first glance, this might seem to run counter to the view that every emotion arises in response to a judgment because he says nothing about the cogitative or memorative powers being involved in such instances. However, he clarifies his teaching in a later article of the Summa, where he states very clearly that the image of a thing alone without a judgment of the things suitability or unsuitability is insufficient to move the sense appetite (see ST III, q. 9, a. 1, ad 2). Now, although the automatic thoughts of CT are comparable to the judgments of the cogitative power, it is important to recall that these latter are not, strictly speaking, thoughts, since the cogitative power is not a rational power. How-
ever, if the term thought is widened to include anything that functions like a thought, then the judgments of the cogitative power may be likened to thoughts, originating as they do under the tutelage of reason. Although Aquinas is silent on this matter, there is nothing in his psychology to prevent us from concluding that the judgments of the cogitative power are naturally non-conscious, that is, normally outside our immediate conscious awareness, yet capable of being brought to mind and articulated in the form of a thought.10 It might be that the cogitative judgments providing the formal structures of our emotions are naturally articulated by the intellect as thoughts whenever we turn our attention to our emotions, but only when we do so. This might explain both why it is that most people are unaware of their automatic thoughts and yet perfectly capable of accessing them once they know to look for them.
2. Rules for Evaluating Our Experiences Operate Without Our Being Aware of Them
In Cognitive Therapy and the Emotional Disorders, Beck explains that
a person has a program of rules according to which he deciphers and evaluates his experiences and regulates his behavior and that of others. These rules operate with-
out the persons being aware that he has a rule-book. He screens selectively, integrates, and sorts the flow of stimuli and forms his own responses without articulating to himself the rules and concepts that dictate his interpretations and reactions. (Beck 1976, 95)
Although Aquinas says nothing about a program of rules, we know that for him the emotions arise from judgments about the suitability or unsuitability of sensible goods. However, there is reason to believe that these judgments, guided by reason but made at the level of the cogitative power, can become habitual. The judgments arising from such habits would thus issue in emotional responses rule-like in their predictability. More will be said about these habitual responses and their non-conscious status in our discussion of point 3. Here, one might object that habitual judgments at the level of the cogitative power cannot be equated with the rules spoken of by CT because the habits of making such judgments, if they exist, result from the application of such rules (see point 3). To take one of Becks examples, he asserts that the rule governing the emotional response of a person suffering from anxiety is the belief that [i]f a particular event occurs, it will probably have adverse results (Beck 1976, 97). Fear and anxiety are caused by the application of this rule to stimuli; the rule does not result from the stimuli or the anxious persons response to them. In reply to this objection, it should be noted that Aquinas distinguishes between natural inclinations and acquired or habitual inclinations. Every power, having a nature, is inclined to perform some specific action. The eye, for example, is inclined to see. Or, to put it slightly differently, the eye has a natural tendency to respond to color. Similarly, the cogitative power has a natural tendency to make judgments about the suitability of sensible things. In infants, as in adults, one such inclination is to avoid loud objects, a tendency that we might articulate as a rule: Loud objects should be avoided. Over time, however, the cogitative power comes to be informed by more complex rules, acquired through experience and refined by reflection. Thus, for example, a young child will naturally know enough to retreat from a barking dog. Reinforced perhaps by a few more similar incidents, such experience could easily result in
the formation of an acquired rule for judging the suitability of dogs, one ill-suited to reality but nevertheless powerful and operative at the nonconscious, pre-reflective level so that even years later the mere sight of a dog will cause him to become fearful and anxious. And he would do so as a result of a habitual judgment being applied to a stimulus in a rule-like manner, as CT demands. Before leaving this point, it is worth noting that Beck provides support for Aquinass distinction between the concupiscible and irascible appetites when he says that the content of the rules for coding experiences and steering behavior seem to revolve around two main axes: danger versus safety and pain versus pleasure. Patients difficulties arise in their assessments of risk and safety or in their conceptions of pain and gratification (Beck 1976, 247). Aquinas maintains virtually the same thing, holding that the concupiscible and irascible appetites revolve around two axes: Pain and gratification in the case of the former, risk and safety, in the case of the latter.
3. The Application of These Rules to Stimuli Results in Automatic Thoughts

According to the cognitive model, a stimulus results in conscious meaning, which then results in emotion. These meanings are expressed in automatic thoughts, which arise through an application of rules that are learned at a young age. By applying these rules, standards, or principles, the individual evaluates the significance of other peoples actions and interprets how they regard his actions (Beck 1976, 44). In terms of his philosophical psychology, Aquinas would say that the stimulus triggers a judgment, which in turn results in an emotional response to the stimulus. As I argued in our discussion of point 2, these judgments follow either from the application of rules built into the cogitative power or acquired and possessed as habitual responses to specific stimuli. Hence, on this understanding, automatic thoughts are the result of the application of habitual judgments to stimuli. Returning to the example of the person who feels intense fear and anxiety at the mere sight of a dog, CT would explain his response as a direct result of a rule such as All dogs are dangerous
and should be avoided being brought into play whenever he sees a dog. Although irrational and perhaps contrary to what he knows, he has a strong tendency to apply this rule in most situations involving dogs, the automatic thought This dog is dangerous and should be avoided and the consequent fear and anxiety following without fail. Aquinas would explain this persons response by saying that his past experience with dogs has resulted in the formation of habits at the level of the cogitative and memorative powers that, for all practical purposes, may be expressed as the belief that all dogs are dangerous and should be avoided. Thus, when presented with a dog by his external senses (or by his imagination in the form of a vivid recollection, as might occur, for example, in a dream), he reflexively judges it to be dangerous and something to be avoided. If the dog were visible but so far away as to pose no immediate threat, he might only experience a feeling of aversion for the animal. If, however, his judgment was that the dog is dangerous and difficult to avoid, aversion would lead by a short route to fear and anxiety.
intimates as much in his derivation of the emotions in ST III (q. 23, a. 4), where, as we have seen, he argues that each specific kind of emotion arises in response to a specific judgment. This last point leads naturally to the fifth point of contact between CT and APP, because it concerns the relationship between the emotions and the thoughts that give rise to them.
5. The Specific Content of an Automatic Thought Leads to a Specific Emotional Response

If CT works quickly, it must be partly because the cognitive therapist knows what to look for even before setting out in search of the causes of specific emotional disturbances. Based on experience, Beck was able to discover what he calls an essential relation:
The specific content of the interpretation of an event leads to a specific emotional response. Further, based on examination of numerous similar examples, we can generalize that, depending on the kind of interpretation a person makes, he will feel glad, sad, scared, or angryor he may have no particular reaction at all. . . . The thesis that the special meaning of an event determines the emotional response forms the core of the cognitive model of emotions and emotional disorders: The meaning is encased in a cognitiona thought or an image. (Beck 1976, 512)
4. These Automatic Thoughts Are Accessible to the Person Experiencing the Emotions
Against some other major schools of psychotherapy, CT believes that the causes of our emotions are directly accessible to the person experiencing them. After listing some examples of distressing emotional experiences taken from clinical practice, Beck tells us that
each of the patients . . . was aware of having had a sequence of thoughts that intervened between the event and the unpleasant emotional reaction. When a person is able to fill in the gap between an activating event and the emotional consequences, the puzzling reaction becomes understandable. With training, people are able to catch the rapid thoughts or images that occur between an event and the emotional response. (Beck 1976, 26)
Although Aquinas said nothing about automatic thoughts, his explicit teachings point very clearly in the direction mapped out by Beck. Because our emotions are caused by judgments, it must be possible to access the causes of our emotions, even those we find distressing. Aquinas
To give just one example of the sort of thing Beck means by special meaning, take sadness. He says that it stems from the patients tendency to interpret his experiences in terms of being deprived, deficient, or defeated (Beck 1976, 82). Now compare that with what Aquinas says about sadness: It is caused by a judgment that something that is loved and was once desired is irretrievably lost. Or take anger. Beck says that the common factor for arousal of anger is the individuals appraisal of an assault on his domain, including his values, moral code, and protective rules (Beck 1976, 71). Compare that with Aquinass view that anger is elicited by the judgment that a loved object is under attack. The similarities are nothing short of remarkable. For both Beck and Aquinas, what gives rise to specific emotions is not so much the specific object being judged as the formal structure of the judgment. Although
Beck appreciates this point, observing that if we know the meanings attached to [an] event, we can generally predict which emotion will be aroused (Beck 1976, 74), he does not go quite as far as I think he might. For given our understanding of the formal structure of the judgments that give rise to specific emotions, it should also be possible to predict the form, although not the content, of the judgments or automatic thoughts that lie at the root of our specific affective responses. To see what I mean, take the case of a person conscious of his being angry about something, but not sure what. Simply given the nature of the judgment underlying his anger, we can say that at some level he has apprehended something he loves to be under attack from someone or something he judges capable of being repulsed. Knowing the formal structure of anger could not by itself reveal the identity of the attacker, of course, but it could offer invaluable guidance in the search for its underlying cause. Rather than groping in the dark for the cause of ones anger, having no idea what it could be, a person would know to look for something judged by him to be unsuitable and difficult, threatening one or more of his loves and perceived in some way to be present but not impossible to overcome. At this point, one might wonder whether any of the judgments causing emotions could be hidden from the person having them. As on so many other points that were not raised in his own day, Aquinas offers no explicit answers. Nevertheless, APP suggests that the judgments of the cogitative power, especially habitual ones, might not always be obvious or even easily accessible to us for two, possibly three reasons. First, we must not lose sight of the fact the judgments of the cogitative power are not, properly speaking, thoughts. They are not acts of the intellect but of a lower, sub-rational power. Nevertheless, something analogous to judgments made by the intellect must be at work in the cogitative power, for all the reasons discussed earlier. Second, Aquinas maintains that we are able to hold some thoughts and choices in mind without being aware of them. This is possible because a choice or a judgment once made can become habitual (see ST III, qq. 50 and 51). Like all habits, they can operate in the background automatically;
it would be very easy to overlook them. This fact alone might explain why automatic thoughts took so long to be discovered and why they are accessible to everyone with very little training. Third, it might be that the cogitative power is naturally inclined to suppress painful memories, but not the judgments arising therefrom. In such cases, the content of the underlying judgment, although not its form, would be hidden from view. Before leaving this section, I would like to draw attention to a feature of APP that makes it immune to certain recent criticisms of CT. Writing in the pages of this journal, Demian Whiting has argued that sometimes the correct approach to treating persons suffering from emotional disturbances is not to alter any eliciting cognitions, but rather
. . . to directly effect changes in the persons chemical or hormonal imbalances (say, by the use of medication). And again in other cases it might be that treatment should not be about resolving some underlying psychological fact about the person (or directly effecting chemical or hormonal changes), but rather it should be about the cultivation of more appropriate emotions (where, for instance, this might involveas Aristotle believed, and a number of contemporary behavioral therapists will attempt to showencouraging a person to behave in ways that then directly counteract, or effect changes in, the emotions that are undergone). (Whiting, 239, 245)
Without taking sides in Whitings dispute with CT, I will say Aquinas agrees with his insistence that the emotions can and sometimes do have causes other than eliciting cognitions or, to use his own terminology, judgments of the cogitative power. As we discussed in our overview of APP, Aquinas takes the human person to be an existential unity of body and soul; so much so, in fact, that the activity of the body is thought to be the activity of the person. It is the person who sees by means of his eyes, the person who feels desire by means of his sense appetite. When it comes to the emotions, Aquinas is careful to distinguish them from sensations such as hunger, thirst, and pain. Whereas an emotion is a passion of the soul (passio animae), a sensation is a bodily passion (passio corporalis; DV q. 26, a. 2.). The difference is rather straightforward: Whereas passions of the soul begin in the soul (as an apprehension of a dangerous animal,
for example) and end in the body (as a rising of ones blood pressure and the preparation to fight, which occurs in anger), bodily passions begin in the body (as when one steps into bright sunlight) and ends in the soul (as a feeling of warmth on ones face). Now, what is important to note here is that in both cases, the body is necessarily involved. There is no anger, sadness, or pleasure that does not involve some characteristic bodily change. Indeed, none of these emotions could exist without the body; without bodily changes the very stuff (i.e., the material cause) of the emotions would be missing. Consequently, because such changes may occur independent of apprehension through the influence of some physical agent, Aquinas would not at all be surprised to learn that hormones can alter a persons mood (see ST I-II, q. 17, a. 7, esp. ad. 2; see also Klubertanz, 1953, 2656). Furthermore, because the cogitative power uses a bodily organ, it would be reasonable to suppose that it, too, could be affected by such physical agents. Consequently, on APPs terms, one would expect that at least in some cases treatment with CT would be enhanced through medication; conversely, one would also expect CT to effect changes in a persons brain, not just in his emotions. Aquinas would also agree with Whitings contention that, sometimes, what is needed is not a resolution of some underlying psychological fact about the person (or directly effecting chemical or hormonal changes), but rather, as Aquinas would put it, the inculcation of the moral virtues. Psychological well-being is not simply a matter of being free of erroneous beliefs or of having correct ones; it is also a matter of having a good character, the complex of habits that enables us to know and to incline toward the kinds of choices that make for a flourishing human life. Often enough, emotional distress serves as a warning that we are walking down the wrong path.
during the persons cognitive development (Beck 1976, 3). It also maintains that the patient has at his disposal various rational techniques he can use, with proper instruction, to deal with these disturbing elements in his consciousness (Beck 1976, 3). Regardless of their origin, [CT believes] it is relatively simple to state the formula for treatment: The therapist helps a patient to unravel his distortions in thinking and to learn alternative, more realistic ways to formulate his experiences (Beck 1976, 3). Although Aquinas said very little about the emotional disorders, hardly a word needs to be added to what has already been said about APP to see that it contains all the elements necessary to develop virtually the same account and approach to treating them that Beck developed. On Aquinass terms, most emotional disorders may be said to result from incorrect habitual judgments at the level of the cogitative and memorative powers. And these, as we have seen, may be modified through rational considerations. That having been said, given the stability and obduracy of habit, we should not expect rational considerations alone to be sufficient to effect a permanent change in a persons habitual outlook. New habits must be formed to replace the old ones, a process of returning again and again to rational considerations and acting on them, a point on which APP and CT seem to be only in partial agreement. We turn now to a closer examination of this last point.
7. Habituation, in Addition to Awareness of Such Automatic Thoughts, Is Necessary to Change Incorrect Automatic Thoughts and to Inculcate Correct Ones
In comparing the different approaches of CT and behavior therapy to treating emotional disorders, Beck writes that
both cognitive and behavior therapists seek to alleviate the overt symptom or behavior problem directly. The focal point differs, however. The cognitive therapist directs his techniques to modifying the ideational content involved in the symptom, namely, the irrational inferences and premises. The behavior therapist concentrates on changing the overt behavior, for example, the maladaptive avoidance response. (Beck 1976, 321)
6. Emotional Disorders Are Caused by Incorrect Automatic Thoughts, Which Can Be Modified Through Rational Considerations
CT maintains that the conscious elements that cause a persons emotional disorders are incorrect conceptions [that] originated in defective learning
In assessing the effectiveness of behavior therapy, Beck concludes that his own clinical observations and some systematic studies suggested that behavior therapy was effective because of the attitudinal or cognitive changes it produced (Beck 1976, 335). Although Aquinas would certainly agree with Becks insistence that a change in ones outward behavior is unlikely to have a lasting effect in the absence of any change in ones outlook, nonetheless he would probably agree with the behavior therapist that most incorrect habitual judgments (or automatic thoughts) cannot be corrected simply by bringing them to light and subjecting them to rational considerations. The cogitative power, being non-rational rather than irrational, may be likened to a dog that, having formed the habit of sleeping in its masters bedroom, still has the ability to obey an order to sleep elsewhere. Yet, just as the dogs habit of sleeping in his masters bedroom will continue to reassert itself unless he is made to do otherwise on many successive nights, so too the old habits of the cogitative power will continue to reassert themselves unless it is taken through the process of arriving at correct judgments through the application of rational considerations again and again. And the reason for this necessity is rooted in the fact that the driving out of one habit by another habit is not simply or even primarily the work of the mind but that of the body. For this reason, Aquinas might expect the techniques of both therapies to be indispensable in the treatment of at least some of the emotional disorders, especially those that are deeply ingrained. In his later work, Beck has modified his views slightly and granted a larger scope to behavioral techniques in the treatment of emotional disorders. In Cognitive Therapy of Substance Abuse, we read:
In a sense, the behavioral methods can be regarded as a series of small experiments designed to test the validity of the patients negative hypotheses or ideas about themselves. As the negative ideas are contradicted by these experiments, the patient gradually becomes less certain of their validity and is motivated to attempt more difficult assignments. (Beck et al. 1993, 238)
utility lies wholly in their ability to bring a patient face-to-face with reality as often as is necessary to shatter and sweep away those beliefs that lie at the root of his emotional disorders. He does not seem to consider the possibility that the cure for these problems might require a physiological change as well as a mental one. What is so interesting about APP is that it explains better than CT why this process must be repeated often and why rational insight alone is almost never enough to give a patient permanent relief from emotional distress.
8. The Model of the Human Person Underlying Both Psychological Theories Is Anti-Physicalist and Humanistic
To these seven points of contact, this eighth point might be added, as well. One of the virtues of the cognitive therapeutic approach to the emotional disorders, Beck tells us, is that it
changes mans perspective on himself and his problems. Rather than viewing himself as the helpless creature of his own biochemical reactions, or of blind impulses, or of automatic reflexes, he can regard himself as prone to learning erroneous, self-defeating notions and capable of unlearning or correcting them, as well. By pinpointing the fallacies in his thinking and correcting them, he can create a more self-fulfilling life for himself. (Beck 1976, 4)
From this and other things Beck has to say about behavioral techniques, it seems that for him their
Rather than reducing the human person to the sum of his material parts and his behavior to the necessary causal interaction of those parts, the cognitive approach insists that ideas are real and have consequences, exerting an influence for better or worse on the lives we live in and through our bodies. Being more than the sum of our material parts, we cannot be defined along purely physicalist lines. Our fate lies in our own hands, not in the hands of some faceless material necessity. Unencumbered by the metaphysical prejudices of post-Enlightenment psychiatry, and essentially opposed to any materialistic or deterministic reductionism, APP has all the conceptual resources needed to place CT on a solidly anti-physicalist and humanistic foundation. Because the human person is a strange and marvelous existential unity of body and soul, bound in the flesh by physical laws but free in spirit to soar out of time and space,
we are free to choose our actions even if we are not free to choose all the factors that influence our choices. The basic unit of human action is, properly speaking, the human person, not this or that faculty, much less this or that complex collection of organs or cells. As such, Aquinass psychology is anti-physicalist or, to be more precise, antireductionistic, as well as humanistic, refusing on solid philosophical grounds to reduce the human to something less than human.
Conclusion
In this paper, I have argued that Aquinas anticipated all of CTs major principles and methods. I have done so in an effort to show that he offers a profound philosophical foundation on which to ground the principles and methods of CT. There is a depth and coherence to his understanding of the human person that complements the breadth and precision of CTs understanding of the emotional disorders. Alone, each is powerful, capable of explaining much, yet incomplete without the other: CT because it does not understand the causes of the emotions well enough nor therefore the ultimate reasons for its own effectiveness; APP because it is largely silent on the nature, causes, and methods of treating the emotional disorders. When challenged to address these issues, APP is both insightful and articulate. It also has interesting things to say about how the principles and methods of CT might be further developed, suggesting for example that Aquinass derivation of the emotions might be used to refine the formal schema of the underlying rules and automatic thoughts responsible for emotional disturbances developed by CT. Additionally, APP strongly suggests that behaviorism should be given greater due, at least when it comes to explaining the effectiveness of behavioral techniques in the treatment of addictions and other emotional disorders. More promising, still, is APPs potential to offer an explanatory philosophical framework not just for CT but also for its rivals. Indeed, if APP is correct, then there is every reason to suppose that it may serve as the framework for a grand synthesis of all the disparate schools of psychology, one capable of providing an explanation of the limits and effectiveness of the therapeutic methods of each
one, even the most disparate. This is not to say that psychology, much less psychiatry, could then be done from the comfort of ones armchair. The complexities of the human person are such as to demand careful empirical observation. There is no substitute for experience. As a good Aristotelian, Aquinas believed this true not just for the scientist but also for the philosopher. All knowledge begins in the senses. Indeed, as we have seen, it is by starting with observable human behavior that Aquinas arrives at his views. If he sounds greater depths than the scientist in his quest to understand the inner dynamics of the human person, it is because the philosophic method is open to reality in all its dimensions, not just the quantifiable. Other avenues of development doubtless beckon. Given the scope of the paper, I could only hint at the possibility of a rapprochement between CT and other psychologies. Most intriguing is the possibility of a synthesis of at least some of the principle elements of the depth psychologies with those of CT. Although fairly well understood, there is yet an irreducibly physiological facet of the corporeal internal sense powers, most importantly the imagination, memory, and cogitative power, that points in the direction of certain fundamental Freudian notions when translated into Thomistic terms and transformed by Aquinass anti-physicalist metaphysics. Much more could be said on this and other related topics, but if this cursory investigation of the mutual complementarity of APP and CT is successful, it will inspire other attempts to bring this thirteenth-century theologian into dialogue with modern psychiatry and psychology.
Acknowledgments
The author thanks Andrew J. Peach, PhD, Paul Gondreau, STD, Kevin J. Majeres, MD, and Steven J. Jensen, PhD, for helpful comments on earlier drafts of this paper.
Notes
1. Augros (2004) contains a very penetrating and lucid account of the differences and complementarity of the methods employed by philosophers and scientists. 2. For a lucid and detailed historical and philosophical treatment of Aquinass doctrine of the metaphysical unity of the human person, see Pegis (1978).
3. The term emotion is here used to translate a very precisely defined term in Aquinass philosophical vocabulary, namely a passion of the soul (passio animae). Passions of the soul, for Aquinas, are not simply ideas or feelings that exist in the mind. Rather, they are changes that occur in the human body in response to judgments made about perceived objects. As Aquinas puts it, passions begin in the soul and end in the body. Hence, emotion and passion in this paper will be used exclusively to refer to passions of the soul. See Aquinass De Veritate q. 26, a. 2. See p. 3612 above for more on the nature of passio animae and the way emotion differs from sensation, which Aquinas calls a passio corporalis. 4. Although reason and will are executive powers, giving human beings control over their actions, Aquinas observes that this control may be temporarily lost when a person loses the ability to reason, either temporarily through a violent passion, physical illness or sleep, or permanently through physical injury; see ST I-II, q. 77, a. 2. See also Butera 2006. 5. Although the human being does not, for the most part, have instincts, Aquinas does hold that newborn human infants are guided by a limited range of instinctive estimations (White 1998, 226, n. 38). 6. Following Aristotle, Aquinas makes a distinction between non-rational and irrational powers. Although both lack reason, the former, such as the sense appetite and the imagination, are capable of responding to reason, even to the point of forming rational habits, such as the virtues of temperance and fortitude; the latter, however, such as the digestive and circulatory systems, for example, have no such capability. If the sub-rational powers of the human person were exclusively irrational, the emotions would not be susceptible to rational modification. It is only because the sense appetite is nonrational that our affective responses are amenable to rational considerations and, in the case of the emotional disorders, healing via therapeutic methods employing the methods of CT. 7. This is not to say that the wolfs unsuitability for the sheep is purely subjective. The sheeps instinctual emotional response to the wolf is what it is because the wolf is what it is. However, for the purposes of understanding an animals emotional responses, the meaning of suitability may be reduced to a things perceived potential to preserve or increase another things excellence in some way, unsuitability to a things potential to do the opposite. Whether something really is suitable or unsuitable to an animal is beside the point as far as the emotional response itself goes. What matters is that something is judged to be suitable or unsuitable. Nevertheless, every judgment aims at determining the true suitability or unsuitability of a thing. Where the estimative power is concerned, subjectivity aspires to objectivity.
8. A very clear and concise treatment of the cogitative power (also known as the discursive power and the particular reason) can be found in Klubertanz (1965, 3447). For the most exhaustive treatment of the notion of the cogitative power and the history of its development, see Klubertanz (1952). 9. Whether the observational evidence really does point to the existence of this fourth internal sense power is an open question. The evidence that estimations are retained is obscure and problematical; it seems that imagination, association of images, and modifications of the discursive estimation [e.g. the estimative power] are sufficient to account for all the alleged evidence (Klubertanz 1965, 478). Although an interesting problem, it is not important for our purposes. All I will say here is that my hunch is that the clearest evidence for the memorative power lies in learned behavior that cannot be explained merely in terms of the animals response to pleasure or pain. 10. For an interesting argument in favor of the view that the cogitative power is able to operate without our being consciously aware of its operation, see Klubertanz (1965, 858).
References
Augros, M. 2004. Reconciling science with natural philosophy. The Thomist 68, no. 1:10541. Baker, R. R. 1941. Thomastic theory of the passions and their influence upon the will. Notre Dame, IN: University of Notre Dame Press. Beck, A. T. 1976. Cognitive therapy and the emotional disorders. New York: Penguin Books. Beck, A. T., F. D. Wright, C. F. Newman, and B. S. Liese. 1993. Cognitive therapy of substance abuse. New York: The Guilford Press. Butera, G. 2001. Thomas Aquinas on reasons control of the passions in the virtue of temperance. Ph.D. dissertation. The Catholic University of America. . 2006. On reasons control of the passions in Aquinass theory of temperance. Medieval Studies 68:13360. Klubertanz, G. P. 1952. The discursive power. Saint Louis: The Modern Schoolman. . 1953. The philosophy of human nature. New York: Appleton-Century-Crofts. . 1965. Habits and virtues. New York: AppletonCentury-Crofts. Pegis, A. C. 1978. St. Thomas and the problem of the soul in the thirteenth century. Toronto: The Pontifical Institute of Mediaeval Studies. St. Thomas Aquinas. 1995. On evil, trans. J. A. Oesterle and J. T. Oesterle. Notre Dame, IN: University of Notre Dame Press. . 1981. Summa theologica: Complete English edition in five volumes, trans. Fathers of the English
Dominican Province. Westminister, MD: Christian Classics. . 1954. Truth [De Veritate] vol. 3, trans. R. W. Schmidt. Chicago: Henry Regnery Press. White, L. 1988. Why the cogitative power? American Catholic Philosophical Quarterly 72, annual supplement:21327.
Whiting, D. 2006. Why treating problems in emotion may not require altering eliciting cognitions. Philosophy, Psychiatry, & Psychology 13, no. 3:237-46.
About the Authors 385
About the Authors
Tim Bayne is University Lecturer in Philosophy of Mind at the University of Oxford and a Fellow of St. Catherines College. He is the author of The Unity of Consciousness (OUP, 2010) and an editor of the Oxford Companion to Consciousness (OUP, 2009). He can be contacted via e-mail at tim.bayne@gmail.com Giuseppe Butera is Associate Professor of Philosophy at Providence College. Before this he was a visiting assistant professor at the University of Dallas (20032004), the Gilson Fellow at The Pontifical Institute of Mediaeval Studies in Toronto (20022003), and a postdoctoral fellow at The Center for Philosophy of Religion at The University of Notre Dame (20012002). Recently, he published an article in vol. 68 (2006) of Mediaeval Studies entitled On reasons control of the passions in Aquinass theory of temperance and another article in vol. 71, no. 4 (2007) of The Thomist entitled The moral statue of the first principle of practical reason in Thomass naturallaw theory. Other interests include virtue ethics and metaphysics. He is a member of the American Maritain Association and the American Catholic Philosophical Association. He may be contacted via e-mail at gbutera@providence.edu Eugene M. DeRobertis holds a BA in philosophy from St. Peters College and a PhD in clinical psychology from Duquesne University. He has been teaching psychology at the college level since 1996. Before committing himself to teaching full time, Dr. DeRobertis worked as a developmentally
2011 by The Johns Hopkins University Press
oriented psychotherapist and addictions counselor. His scholarly interests lie in humanistic approaches to child psychology and Thomistic psychology. Some representative publications include his book, Humanizing Child Developmental Theory: A Holistic Approach (2008) and his article, St. Thomas Aquinass philosophical-anthropology as a viable underpinning for a holistic psychology: A dialogue with existential-phenomenology (Janus Head, in press). He may be contacted via e-mail at ederobertis@brookdalecc.edu George Graham is on the philosophy and neuroscience faculty at Georgia State University, having taught previously at UAB and Wake Forest University. He is the author of The Disordered Mind (Routledge). He publishes extensively on issues at the interface of philosophy and psychiatry. He can be contacted via e-mail at ggraham@gsu.edu Michael Loughlin is the Reader in Applied Philosophy at Manchester Metropolitan University and author of Ethics, management and mythologyRational decision making for health professionals. He can be contacted via e-mail at m.loughlin@mmu.ac.uk Christopher Megone is Professor of Interdisciplinary Applied Ethics at the University of Leeds and has been Director of the Centre for Inter-Disciplinary Applied Ethics there since its inception in 2005. He studied Classics at Oxford where he went on to do a BPhil and a DPhil in Philosophy. He has been a member of the Phi-
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Thomas Aquinas and Cognitive Therapy: An Exploration of the Promise of the Thomistic Psychology

2011 by The Johns Hopkins University Press

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An Overview of Aquinass Philosophical Psychology

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The Powers of the Human Person

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Appetitive Rational Sensitive Sensitive External Internal Locomotive

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The Formal Structure of the Emotions

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A Thomistic Grounding for Cognitive Therapy

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3. The Application of These Rules to Stimuli Results in Automatic Thoughts

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5. The Specific Content of an Automatic Thought Leads to a Specific Emotional Response

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About the Authors 385

About the Authors

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