Thomas Aquinas and Cognitive Therapy

Embed Size (px)

Citation preview

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    2011 by The Johns Hopkins University Press

    Thomas Aquinas and

    Cognitive Therapy:An Exploration ofthe Promise of the

    Thomistic Psychology

    Giuseppe Butera

    Abstract: Although Thomas Aquinas never developedan account of the emotional disorders, he anticipated allthe major principles and methods of cognitive therapy(CT) in his philosophical psychology. This fact hasgone largely unnoted by philosophers and psychologistsalike. The purpose of this article is to demonstrate thecomplementarity of these two psychologies by arguing

    that Aquinass philosophical psychology (APP) canserve as a theoretical framework for CT, especially as itappears in Aaron Becks classic introduction to the sub-ject, Cognitive Therapy and the Emotional Disorders.The motivation for this article is both theoretical andpractical in nature: Theoretical, because Aquinas pro-vides a profound and cogent philosophical frameworkfor CT, which in turn is able to draw out much that isonly implicit in Aquinass thought; practical, becauseAPP offers useful insights and suggests interesting linesof development for CT. Finally, I suggest that the dis-agreements dividing the various different psychologiesand their related approaches to the emotional disordersmay be due to a failure to grasp the dynamic structure

    of the human psyche at a level that can be reached onlythrough careful philosophical analysis, a feat I believeAquinas to have in large measure achieved.

    Keywords: automatic thought, behavior, cogitativepower, emotion, habit, judgment, philosophical psy-chology

    In his classic introduction to the subject, Cog-nitive Therapy and the Emotional Disorders,Aaron Beck observes that the philosophi-

    cal underpinnings of cognitive therapys (CT)approach to the emotional disorders go backthousands of years, certainly to the time of theStoics, who considered mans conceptions (ormisconceptions) of events rather than the eventsthemselves 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 philosophicalunderpinnings of CT, content it would seem for itto be an empirically grounded system of psycho-logical principles and therapeutic methods. Yeteven this little is sufcient to invite philosophicalinvestigation of the dynamic realities underlyingthese principles and methods.

    In addition to its inherent interest, such an in-

    vestigation is, as I hope to show, attractive for itspromise of providing a deeply rooted and highlyarticulated philosophical explanation for the ef-fectiveness of CT. With a philosophical foundationon which to ground all of its principles and meth-ods, CT would be more intellectually satisfying.Complemented by a philosophical psychology,

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    348 PPP / Vol. 17, No. 4 /December 2010

    it would also have greater conceptual resources

    with which to deepen its own understanding ofthe inner life of human beings and the emotionaldisorders to which they are prone. It might even

    discover a means of entering into a more fruitfuldialogue with rival accounts of the emotionaldisorders, such as those provided by the variousdepth psychologies pioneered by Freud and hisdisciples.

    Granting the desirability of exploring thephilosophical underpinnings alluded to by Beck,one might think to start with a closer examinationof stoicism. The purpose of this paper is to arguethat a better place to start would be with the philo-sophical psychology of St. Thomas Aquinas. For asimpressive as the stoic anticipation of CTs central

    insight may be, it pales in comparison with theremarkable but virtually unnoted complementarity

    that exists between CT and the philosophical psy-chology developed by the great thirteenth-centuryCatholic theologian.

    In what follows, I attempt to show that theprinciples and methods of CT can be groundedphilosophically using Aquinass philosophical psy-chology. I say philosophical, not theological,even though Aquinas was rst and last a theolo-gian, because the psychology he developed is able

    to stand on its own, independent of his theologicalcommitments. This is not to imply that these latterhad no effect on his thinking about human beings.They most denitely did. However, the cogency ofhis theologically inspired thinking about the innerdynamics of the human person does not dependon an acceptance of his Catholic beliefs. As withhis investigation of other matters inuenced by his

    faith but not falling exclusively within the purviewof theologymatters concerning such things asmetaphysics, natural philosophy, and ethicsAquinass investigation of human psychology isphilosophical both in its starting point and in itsmethod, 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 withCT is not in the least historical. All the evidencestrongly suggests that he exerted no inuence onBecks formulation and development of CT. Assuch, the purpose of this paper is wholly theoreti-

    cal, namely, to demonstrate the complementarity

    of these two psychologies and to explore some ofthe ways they might enrich each other.

    This claim is sure to strike some as hopelessly

    nave. After all, Aquinas and Beck not only comefrom different times; they come from differentworlds. What can the medieval theologian possiblyhave to do with the post-Enlightenment psychia-trist? There is no denying the historical and philo-

    sophical differences separating them. Yet each hasmuch to learn from the other precisely becausethey take very different approaches to the studyof the same subject, each bringing a different setof philosophical and methodological assumptionsto his study, resulting in very different, althoughmutually enriching and compatible, accounts of

    the inner dynamics of the human psyche. Evenso, the objection might continue, comparing these

    two psychologies without an examination of theunderlying post-Enlightenment philosophicalpresuppositions of CT is to compare apples andoranges. This would be true if what was being at-tempted were a mere side-by-side comparison ofAPP with CT. However, what is being attempted inthis paper is something else entirely: The graftingof the principles and methods of CT onto APP, apossibility strongly suggested by the remarkable

    clinical effectiveness of CT and the philosophicalcogency of APP.

    Indeed, one of the primary motives for bring-ing these two very different psychologies intodialogue with each other is my sense that CT andits rivals, especially all the various forms of depthpsychology, are like the blind men of the fablewho, having run their hands over different parts of

    an elephant, cannot agree on a description of thebeast. Each, mistaking his own partial experienceof the elephant for the whole, takes his descriptionto contradict the others. But imagine what wouldhappen if one of the blind men, in a ash of in-sight, were to grasp the underlying structure of the

    elephant? Suddenly, what had previously seemedto be a wild menagerie of outlandish beasts wouldgive way to a surprising yet satisfyingly organic

    vision of a single animal. What I would like to sug-gest (and the limits of my paper will permit me todo no more than this) is that Aquinas, for all thelimitations of the science of his day, offers just sucha fundamental insight into the underlying structure

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 349

    of the human psyche. By employing the rational,

    dialectical method of the philosophers, he is able tosound depths inaccessible to the scientic method,limited as it is to the quantiable in its exploration

    of reality.1

    For this reason, APP might be able tofunction as a unifying explanatory framework forall the successful therapeutic methods of the vari-ous and disparate modern psychologies; it mightalso serve as an arbiter in the disputes concerning

    the various theoretical differences which make itso difcult for them to talk to each other.

    Admittedly, the ambitions of this paper farexceed its scope. Less ambitious but an importantrst step in the completion of the much larger proj-ect I have hinted at is to show that all the majorprinciples and methods of CT may be derived from

    and explained in terms of APP. To this end, therest of the paper considers seven points of contact

    between CT and APP. Although other points ofcontact may exist, I believe these to be the mostimportant for our purposes. To a greater or lesserextent, each of the following dening positions ofCT may also be found in APP, some explicitly, oth-ers only implicitly but capable nevertheless of be-ing fully articulated (as well as further elaborated)within the philosophical framework developed byAquinas: (1) Emotions are caused by evaluative

    thoughts, typically called automatic thoughts;(2) Rules for evaluating our experiences operatewithout our consciously being aware of them; (3)The application of these rules to stimuli resultsin automatic thoughts; (4) Automatic thoughtsare accessible to the person experiencing theemotions caused by them; (5) The specic con-tent of an automatic thought leads to a specic

    emotional response; (6) Emotional disorders arecaused by incorrect automatic thoughts, whichcan be modied through rational considerations;and (7) Habituation, in addition to awareness ofsuch automatic thoughts, is necessary to changeincorrect automatic thoughts and to inculcate

    correct ones. To these may be added the fact thatthe models underlying both psychological theoriesare anti-physicalist and humanistic.

    Anyone familiar with Aquinass work knowsthat it is no easy task to summarize his viewson most philosophical subjects, because theseare usually strewn throughout his voluminouswritings. Yet because his most mature reections

    on the subject of philosophical psychology are

    found in his Summa theologiae, a clear idea ofAPP may be gained from a careful reading of thissingle work. And although a detailed account of

    the reasoning supporting APP is beyond the scopeof this paper, an attempt will be made to drawits broader outlines, with the goal of revealingsomething of the coherence and cogency of APPas well as its potential to function as a theoretical

    framework for the empirical observations andtheories encompassed by CT. Beyond this, thereis, as has been noted, also the exciting potential toforge a synthesis between CT and its apparentlyincompatible rivals.

    In the rst part of the paper, we get a broadoverview of APP, one sufcient to supply the

    conceptual apparatus needed to grasp the simi-larities between APP and CT. Although somewhat

    detailed, it is not so detailed as to burden ourdiscussion with distinctions that would, for thepurposes of this introductory study, prove onlydistracting. In the second part, we examine theseven major points of contact between APP andCT mentioned above with a view to showing threethings: (1) That Aquinas anticipated each of themeither in whole or in part; (2) That his philosophi-cal psychology offers a theoretical foundation

    from which the principles and methods of CTmay be derived and thus grounded in an accountof the human person that avoids the materialistreductionism that is the hallmark of the majorityof post-Enlightenment psychologies; and (3) ThatAPP offers important insights into the nature andcauses of the emotions, insights that complementand in some ways go beyond those offered by

    CT, even suggesting possible avenues of develop-ment that envision at least a partial synthesis ofthe most valuable insights of CT with those of itsrivals psychologies.

    An Overview of AquinassPhilosophical Psychology

    Aquinass Method for Studying HumanPsychology

    A complete overview of APP would require usto take a close look at Aquinass existential meta-physics, a daunting task, to be sure. Happily, weneed only point out that, for Aquinas, the human

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    350 PPP / Vol. 17, No. 4 /December 2010

    person is a single entity comprising a material

    body and an immaterial soul. Here, we must becareful not to take him for a proto-Cartesian, di-viding the human person into two independently

    existing substances or entities bound together,somehow, to form a complex whole. Rather, forhim, the entire human person, body and soul, is asingle substance in which the body does not existindependently 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 existentialunity of the human person, avoiding many of theproblems that have dogged Cartesian dualismfrom its earliest days.

    Aquinass method for peering into this complexunity is to reason back from observable effects

    to their underlying causes or, to be more precise,from specic kinds of action, like seeing, back to

    the specic potential to perform such actions, inthis case, the power of sight. For each of the dif-ferent kinds of action the human person performs,there must be a corresponding preexisting abilityor power, rooted in the soul and, with the excep-tion of thinking and willing, realized in the bodyin 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 weare capable of performing ve basic kinds of ac-tion, Aquinas reasons that we must have ve basickinds of power: Locomotive, vegetative, sensitive,rational, and appetitive (see ST I, q. 78, a. 1). Toallay any suspicion that he reduces the humanperson to a collection of faculties, it is importantto note his insistence that when any of the pow-ers is activated, it is the whole person who acts

    through it. To assert the contrary would be toreduce the human person to a collection of inde-pendently existing faculties, a sack of organs, asit 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 losesight of this point, for although we often speakas if a specic action may be wholly attributed tothis or that power, the eye seeing and the hand

    grasping, for instance (a convention that is bothconvenient and one which Aquinas adopts in his

    writings), it is theperson, strictly speaking, who

    does these things, doing them by means of thesepowers (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 itare used, it is the person, properly speaking, whodoes these things by means of these powers. It isthe person who sees by means of the (sensitive)power of sight; who commands the act of eating

    by means of the (intellectual) power of practicalreason; who chooses to eat by means of the will(the rational appetitive power); who feels delightin the food by means of the sensitive appetitivepower. (See Table 1 for a quick reference guide tothe powers of the human person.)

    Of the ve basic kinds of power, only three enter

    directly into the inner mental life of the humanperson: The sensitive powers, through which all

    our knowledge of reality comes to us; the intel-lectual powers, by means of which we transcendthe physical limits of the senses to arrive at anintellectual apprehension of sensible reality andbeyond; and the appetitive powers, by means ofwhich we are moved or move ourselves in responseto sensibly and rationally apprehended goods orevils. We need concern ourselves, therefore, onlywith these three kinds of power. And even among

    these, only a few specic powers are of special in-terest to APP. Like any good philosopher, Aquinasaims at economy in his theories.

    One more preliminary point, and then we willbe ready to take a closer look at these powers.To understand the distinct roles of the sensitive,intellectual, and appetitive powers in APP, weshould note that, for reasons both philosophical

    and theological, Aquinas held all the powers tobe hierarchically ordered, some commanding,others commanded, still others commanding andcommanded. Following a tradition tracing itsroots at least as far back as Plato, Aquinas placedreason and will at the top of the souls hierarchy

    of powers: Reason because through it we grasptruths and direct our actions; will because throughit we move ourselves to pursue things judged by

    reason to be good (see ST I, q. 95, aa. 12). Andsubordinate to these two powers (ideally) are theemotions. Already we can see a profound simi-larity between APP and CT: Each holds that the

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 351

    emotions do not normally exercise an executivefunction over human behavior. In animals, emo-tions rule because there is no higher appetitivepower to check them. In human beings, however,the emotions,3 although sometimes unruly anddifcult to control, are usually within our powerboth to resist and to command (especially forthose who are virtuous),4 because reason and willworking together function as the executive power.More will be said about this later.

    Below the powers of intellect and will, we ndall the rest, serving in one capacity or another to

    make possible the ourishing of a free and rationalanimal (see ST I, q. 77, a. 2). Among these are theexternal and internal sense powers, the differentkinds of sensitive power. It is through them thatwe rst come to know ourselves and the worldaround us. As we will see, the internal sense

    powers are especially important for APP. Withoutthese humble powers, the intellect could not scale

    the heights of existence; the higher, to quote amedieval maxim, cannot stand without the lower.Next comes the power through which we experi-

    ence the whole range of human emotions, fromlove and hate to sorrow and delight: The senseappetite. As I endeavor to show later in this paper,the basis for the remarkable complementarity thatexists between APP and CT is the relationshipthat exists between the sense appetite and reasonas 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 andwell-being, but far removed from the psychologi-cal dynamisms that are part of the inner mentallife of human beings.

    With that, we are ready to take a closer look ateach of the three generic kinds of powers whoseactivity and interactions constitute the bulk ofthis inner life. We begin with the sensitive pow-

    Table 1. The Formal Structure of the Emotions

    The Five Generic Powers o the Human Person The Sub-Generic Powers The Specifc Powers

    Intellectual Speculative (These are not two distinct powersPractical but rather two modes of reasoning

    of which one and the same power,the intellect, is capable.)

    Appetitive Rational WillSensitive Concupiscible


    Sensitive External SightHearingTasteTouchSmell

    Internal Common SenseImaginationCogitative PowerMemory

    Locomotive NA Legs, arms, and other musclegroups.

    Vegetative NA Powers common to animals andplants involved in nutrition, growth,sexual reproduction, and the main-tenance of physical health.

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    352 PPP / Vol. 17, No. 4 /December 2010

    ers, through which we rst become aware of the

    world and ourselves. These include both externaland internal sense powers. To the external sensepowers belong the ve familiar to all of us: Sight,

    hearing, taste, touch, and smell. Of the fourinternal sense powers enumerated by Aquinas,only one, the imagination, is familiar to us. Theother three, the cogitative, the memorative, andthe common sense, although alien to our way of

    thinking, are not so alien as to be incomprehen-sible. Some might even seem uncannily modern intheir anticipation of problems that stump cognitivescientists to this day.

    Common sense is the power that correspondsto our ability to compare and contrast the differ-ent sensible qualities perceived by means of the

    external sense powers, such as the green color ofan apple and its sour taste. Aquinas reasons to the

    existence of the common sense in the followingway. Although sight is able to apprehend color butnot avor, and taste is able to apprehend avorbut not color, we are nevertheless able to perceivethe color and the taste as belonging to one andthe same apple. If we possessed nothing but theexternal sense powers, we could never apprehendthe green color and the sour taste of the apple asbelonging to one and the same thing; for our ap-

    prehension would be of two separate and distinctsensible qualities having nothing to do with eachother. To explain our ability to experience thesesensible qualities as belonging to one and the sameobject, Aquinas posits the existence of an internalsense power capable of comprehending and thusbringing the separate sensations of the externalsenses together in a single, unied apprehension

    of a complex whole. Hence the common sense (seeST I, q. 78, a. 4, ad 1 and 2).

    The next internal sense power is the imagi-nation, which Aquinas calls the treasure chest(thesaurus) of the sensible images apprehendedthrough the external sense powers (see ST I, q.

    78, a. 4). Its existence is indicated by our ability toremember sensible things previously apprehendedthrough the external senses. If we did not have

    this power, we would be unable to feel anythingfor absent things, a conclusion contradicted bythe experience of wanting, for example, to spendtime with an absent friend. Our ability to take the

    sensory images (visual or otherwise) of things ap-

    prehended through the external sense powers andcombine them to form new images is also taken byAquinas to be traceable to the imagination. Golden

    mountains and ying horses are examples of suchproducts of the imaginations synthesizing activity(see ST I, q. 12, a. 9, ad 2).

    In addition to comparing and storing the sensi-ble images of things perceived through the external

    senses, human beings and animals also experienceinclinations to behave in specic ways toward spe-cic objects. To use Aquinass examples, a sheepwill tremble at the sight of a wolf, and a sparrowwill be moved to use straw in the construction ofits nest. In each instance, the mere appearance ofthe object is insufcient 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 rened ter-minology, suitable or unsuitable. But because theseproperties are not reducible to any sensible quality,neither the external sense powers nor the internalsense powers of common sense and imaginationare able to apprehend the suitability of the bit ofhay for the sparrow or the unsuitability of the wolffor the sheep. Consequently, Aquinas takes thehighly specic and seemingly intelligent response

    of animals to sensible things as demonstrative of athird interior sense power, one capable of judgingthe suitability or unsuitability of things perceivedthrough the senses. In animals, he calls this theestimative power (see ST I, q. 78, a. 4; see also STI-II, q. 9, a. 1, ad 2), the seat of instinct.

    Although something like the estimative powerexists in humans, it is not quite the same. For

    unlike animals, which rely upon instinctual judg-ments for the apprehension of the suitability orunsuitability of sensible objects, humans makemost if not all of their judgments about such thingson the basis of knowledge gained either directlythrough 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 abil-ity to tailor our actions with an intelligence that

    often exceeds anything nature supplies the beaststhrough instinct and the limited tutoring of theirparents and their own experience. Indeed, theinstinctual responses of animals are judgments

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 353

    only by analogy. There is no question of animals

    using reason to arrive at judgments; instinct of-fers a sufcient explanation for their behavior.Nevertheless, the deliverances of the estimative

    power may be likened to the judgments of reasonbecause they function in a similar way, namely, asthe sizing up of things and situations as they enterinto the eld of awareness, demanding a responseof some kind. Even so

    we cannot suppose that the sheep fears the wolf aswolfthe sheep has no notion of wolf, for this is anintellectual understanding. . . . Thus, the sheep fearsthe wolf, is not to be understood formally; wolf inthis statement designates the thing the sheep fears, notthe object of the sheeps fear as the sheep knows it.(emphasis in original; Klubertanz, 1965, 37)

    Being born with very few instincts (see Klu-bertanz, 1953, 1425),5 but possessing the abilityto grasp things intellectually, human beings areconstantly called upon to make rational judgmentsabout the suitability or unsuitability of things. So,to take an example, when someone perceiving awolf begins to fear it, he does so not because ofinstinct, but because of his understanding of thenature of wolves and the danger they naturallypose. Now, if we tried to explain his affective

    response exclusively in terms of what he knowsabout wolves in general, we would not be ableto explain why he feels intense fear only for thisparticular wolf and not all wolves. The intellecttrades in universal concepts and judgments; it doesnot reach down to the level of concrete particulars.Somehow, the universal must be united with theparticular to form a judgment capable of causinghis affective response toward this particular object

    of sense experience. That is to say, at the level ofthe concrete particulars of the situation in whichhe nds himself, he must judge this particularwolf to be unsuitable to him. Given this necessity,Aquinas infers the existence of a third internalsense power, the cogitative power (also known as

    the particular reason). Immersed in the world ofsensible particulars, the cogitative power, under

    the guidance of reason, issues judgments aboutthe suitability or unsuitability of sensibly perceivedindividuals (see Klubertanz, 1965, 369). It is bymeans of such judgments that the emotions areelicited.

    Like the estimative power in brute animals, the

    cogitative power is the direct cause of our affectiveresponses to sensible things. But whereas the esti-mative power in animals is virtually hardwired by

    nature to make specic judgments about specickinds of thing, the cogitative power is a relativelyblank slate, capable of being programmed andreprogrammed by reason to make predeterminedjudgments about individual sensible things. It is

    important to note that, like the judgments of theestimative power, the judgments of the cogitativepower are themselves only analogously judgments,arising as they do from a non-rational6 power, al-though the cogitative power, unlike the estimativepower, is directed by reason. It is also important tonote that the correctness of the cogitative powers

    judgment has no bearing on a persons emotionalresponse; it a persons judgment of the wolfs ap-parentunsuitability, not its actual unsuitability,that causes his fear.7

    We must keep this point rmly in mind in theensuing discussion of the complementarity of APPwith CT. It is only in light of it that APP is ableto explain why the emotional disorders are evenpossible, let alone treatable. If the sense appetitecould respond only to true goods or true evils inproportion to their suitability or unsuitability,

    respectively, not only would the emotional disor-ders never arise, it would be impossible for themto do so. But because emotions result from judg-ments about apparentsuitability or unsuitability,it follows that a person can feel an attraction orrepulsion for the wrong things, just as much as hecan for the right things.

    Before moving on to the last of the internal

    sense powers, we would do well to observe thatAquinass reason for concluding to the cogitativepowers openness to rational control is basedsquarely on experience. In ST I (q. 81, a. 3), wherehe discusses the nature and limits of reasonscontrol of the emotions, he notes that emotions

    can be modied or excited through the appli-cation of universal considerations. By calling tomind a universal truth, reason is able to alter the

    judgment of the cogitative power, thus eliciting adifferent emotion in response to the same objector stimulus, viewed now in a different light. So,for instance, anger toward someone who has

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    354 PPP / Vol. 17, No. 4 /December 2010

    spoken an unkind word to us may give way to

    pity upon recalling that he very recently suffered agreat personal loss. For the purposes of providinga theoretical grounding for CT, there is perhaps

    no more important philosophical doctrine in APPthan this, explaining as it does why the emotionsare susceptible to rational modication and con-trol. More will be said later about the mediatingrole played by the cogitative power in the complex

    relationship between reason and emotion.8

    The fourth and nal internal sense power is thememorative power. Aquinas infers its existencefrom our ability to store and later recall past judg-ments 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 electried fence, for instance, it comesto judge the fence as unsuitable. The next time it

    encounters an electried fence (or, for that matter,anything that sufciently resembles one, electri-ed or not), it will simply draw upon its store ofjudgments and thus instinctively feel an aversionto it. It is by means of the same sort of power thathumans are able to do something similar, albeitof a kind vastly more supple, because the internalsense 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) un-less he had the potential to be so inclined in therst place. Hence the need to posit the existenceof yet another kind of power in addition to allthe others, namely, the appetitive. It is throughthis power that both animals and humans aremoved to pursue the goods they lack and to rest

    (that is, delight) in them once acquired. Sensationand reason alone are insufcient to account forthe movement stimulated by apprehension. Wereit otherwise, we should nd ourselves feeling aninclination of one sort or another toward everyapprehended object.

    Complicating matters is the fact that the em-pirical evidence points to the existence of twospecic kinds of appetitive power, one sensitive

    and common to both humans and animals, theother rational and unique to humans. For Aquinas,as for the tradition stretching all the way backto Platos study of the soul in the Republic (see

    especially book 4, 435a441c), the evidence for

    this distinction is found in the observation thatwe sometimes experience inclinations for thingsat two distinct levels, the sensible and the rational.

    Consider the dieter. He knows and even chooses toeat less notwithstanding a strong contrary inclina-tion to eat more. Aquinas takes the explanationfor this inner conict to be the fact that there is inthe dieter more than one kind of appetite. At the

    unreasoning, animal level there is the desire to eatmore; at the rational, volitional level, the desireto eat less. It is worth noting that the reverse con-ict also furnishes Aquinas with evidence for thisdistinction: The same dieter, although desiring toeat spinach at the rational appetitive level, mightexperience a strong aversion to it at the sensitive

    appetitive level.In general, the appetitive powers are capable

    not only of being movedby apprehended goods(things judged to be suitable) but also ofmovingother powers to the execution of those acts neces-sary to attain an apprehended good or avoid anapprehended evil (see ST I-II, q. 17, aa.19). Ina cat, for example, an animal devoid of reasonand will, the movement or change elicited in thesense appetite by the apprehension of a mouse (amovement identical in this case with the emotion

    of desire) causes the cat to chase the mouse (seeST I-II, q. a. 2, ad 2). But, as intimated above, inhumans, the inclination arising from the senseappetite is, by itself, insufcient to cause a personto act, because the rational appetite is higher thanthe sense appetite, occupying as it does a positionamong the powers analogous to that of a generalamong the ofcers and soldiers of an army, to use

    Aquinass example (see ST I-II, q. 9, a. 1). Thesense appetite inclines in vain toward this or thatdesirable object if a person refuses to act on hisinclination. This is not to say that the emotions canhave no effect on his choices. In fact, as we will see,the emotions can have an all-but-determinative

    inuence on them. However, Aquinas insists thatas long as a person retains the use of reason, he canact contrary to his passions (see ST I, q. 81, a. 3

    and ST I-II, q. 17, a. 7; see also Aquinass treatiseon evil, De Malo, q. 3, aa. 911).

    Aquinass account of the passions is renderedmore complex by the fact that we experience

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 355

    inclinations not just for things that are easy to

    pursue or avoid but also for things that are dif-cult to pursue or avoid. This fact, he argues,cannot be accounted for on the supposition that

    there is only one sense appetite. If we possessedonly a simple appetite for things judged to be suit-able or unsuitable, we would never pursue thingsjudged suitable but difcult to attain, or confrontand resist things judged unsuitable but difcult to

    overcome. The fear and aversion aroused by suchjudgments would cause us either to give up or givein. Yet there are times when we nd ourselves tornbetween contrary inclinations at the animal level,feeling the urge to take on a difcult and painfultask, for example, even as part of us, the one thatlongs 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 powercomprising two distinct appetitive powers. Therst of these concerns things judged simply assuitable or unsuitable, and is called the concupis-cible appetite. The second concerns things judgedas suitable and difcult to attain or unsuitableand difcult to avoid or ght off. This power iscalled the irascible appetite (see ST I, q. 81, a. 2).Together, these powers account for all the various

    emotions we may experience toward anythingjudged by us to be good or evil.

    The Formal Structure of theEmotions

    For our sketch of APP to serve our purposes, wemust take a look at the emotions and their causes.The following contains some of Aquinass most

    interesting insights into the emotions, insights thatmight serve to deepen CTs own understanding ofthe emotional disorders by adding some rene-ments to its theoretical construction of the formalstructure of the cognitive content implicit in theemotions or, to put it in terms more familiar to CT,

    the formal structure of the eliciting cognitions thatconsistently result in specic emotional responses.

    (For a quick reference guide to the emotions, seeTable 2.) It is important to note, however, thatwhereas CT makes a sharp distinction betweenemotions and their eliciting cognitions, APP doesnot. In keeping with his metaphysical account of

    the existential unity of body and soul, Aquinas sees

    the eliciting cognitions and the physical changesand sensations arising from them as co-principlesof one and the same thing, namely, emotion. Much

    more could be said about this topic, but for nowit is enough to be aware of this difference betweenCT and APP (see Butera 2001, 5161). To saymore at this juncture would be to add needlesscomplexity 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 hu-man emotions, one belonging to the concupiscibleappetite, the other to the irascible. In all, he arguesthat there are eleven distinct and irreducible kindsof emotion, six for the concupiscible appetite and

    ve for the irascible. This is not to say that thereare only eleven emotions; Aquinas recognizes the

    complexity and enormous variety of human af-fectivity. Rather, each of these eleven emotions isbest thought of as a kind or species of emotion towhich any number of subspecies may belong. Nomatter how subtle or complex the emotion, how-ever, he maintains that it will fall under the generaldescription of one or more of these basic kinds ofemotion. Hence, ambition and lust, although dif-ferent in many respects, are at base species of the

    same kind of emotion, namely, desire. Moreover,some emotions are actually a complex of two ormore emotions, such as the anxiety felt by manyjust before an important and difcult exam, caughtas they are between hope and despair (see Baker1941, 57).

    In distinguishing these eleven emotions, Aqui-nas 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 distinctkind of emotion for every distinct and irreducibleway that a thing may be judged to be suitable orunsuitable. And because there are eleven basicand irreducible ways that this may happen, there

    must be eleven basic kinds of emotion. Someemotions, 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 isrst among the emotions; without it, none of theothers could exist.

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    356 PPP / Vol. 17, No. 4 /December 2010

    Aquinas arrives at this conclusion in the fol-

    lowing way. He begins by making the crucial andvery subtle point that an animal must undergo achange before it can feel any inclination to pursue

    or ee a perceived object, even one judged to besuitable or unsuitable. The only thing that canexplain a cats sudden inclination to chase a mouseis a prior disposition to be thus moved. Beforebounding after a mouse, a cat must rst judge it to

    be suitable for itself. When this happens, the catsappetite undergoes a change, one that Aquinastell us in his technical Aristotelian idiom causes itssense appetite to become suitable or proportionateto the apprehended good (see ST III, q. 25, a. 2).And it is precisely this rst movement or activationof the concupiscible appetite, this rst 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 aperson become the sort of thing that is able todesire this food, for example, and to delight in itonce it is acquired (see ST III, q. 26, a. 2, ad 3).For Aquinas, love is neither the desire for nor thedelight taken in the food; rather, it is the necessaryemotional disposition without which none of theother emotions could be elicited. Love explains thedesire a person feels when an object judged to be

    suitable is absent and the delight he experienceswhen it nally comes into his possession.

    Because love is an emotion that causes ananimal to become oriented toward somethingperceived through the senses, it follows thatthere should also be an emotion of hate (odium),a contra-orientation, as it were,for whatever isopposed 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 bythe hated object. We hate disease, for example,because we love our bodies. It should be notedthat both love and hate belong to the concupis-cible appetite because they concern things simply

    considered as suitable or unsuitable without anythought of the difculty that might be involved inacquiring or avoiding them, a point that will be

    made clearer when we turn to the emotions of theirascible appetite.

    With love and hate in place, Aquinas uses thedistinction between good (i.e., suitability) and

    evil (i.e., unsuitability), on the one hand, and ab-

    sence and presence, on the other, to derive all theother emotions of the concupiscible appetite. Ifan object is loved but as yet not possessed (or, to

    use Aquinass terminology, not present) a personexperiences the emotion of desire (desiderium orconcupiscientia), which is the inclination to pursuethe loved object. If, on the contrary, an object ishated but absent and may as yet be easily avoided,

    the same person will experience the emotion ofdislike or aversion (fuga or abominatio), whichis the inclination to avoid the hated object. Thepossession of the loved object now present givesrise to the emotion of delight or joy (delectatio or

    gaudium), which is not an inclination but rathera resting in the possession of the loved object.

    And the presence of the hated object gives rise tosorrow or sadness (dolor or tristitia), the contrary

    of delight, which is neither an inclination nor aresting in the loved good but a state of resigna-tion to an evil that it hates, but no longer looksto escape or overcome. In all, the number of emo-tions 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 difcult to attain andunsuitable things insofar as they are difcult toavoid or overcome, the emotions of the irascibleappetite must be rooted in the emotions of theconcupiscible appetite. Because love and hate,the most basic and essential affective dispositions,are emotions of the concupiscible appetite, theactivation of the irascible appetite must follow

    upon that of the concupiscible (see ST III, q. 23,a. 4). Children hate rainy weather because of theirgreat love of the outdoors; and when it rains, thesame love animates their hope that the rain willsoon go away.

    Thomas derives ve emotions of the irascible

    appetite. He does so by employing the distinctionbetween the possible and the impossible, in addi-tion to the more basic distinctions between good

    and evil, and absence and presence. In the case ofthe good that is difcult to attain, two emotionsare possible. If the good is judged possible to at-tain, a person will experience hope (spes), but if

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 357

    it is judged impossible to attain, he will instead

    experience despair (desperatio). A third irascibleemotion, one aroused by the possession of thedifcult good, does not exist because the difcult

    good ceases to be difcult once it is possessed,causing a person to experience delight, an emotionof the concupiscible appetite.

    In the case of evil that is difcult to avoidor overcome, three emotions are possible. Two

    concern evil that is absent, the other evil that ispresent. Daring or courage (audacia) inclines aperson to confront a difcult evil that is, as yet,absent. Fear (timor)also concerns a difcult evilthat is absent, but it inclines one to avoid it. Whena difcult evil is present, so that it can no longer beavoided but must instead be endured, it will cease

    to be regarded as difcult if no hope of escapingit remains. For although difcult is a term that

    in common parlance is usually said of things to bedone, it is actually descriptive of an agents abilityto do these things: What is difcult for one personmay be easy for another. Moreover, a thing canonly be difcult if it is tried. So if a difcult evil ispresent and judged permanent or unshakable, itwill cease to be regarded as something that mightbe overcome. It will go from being viewed as adifcult 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 adifcult evil that is present and judged impossibleto overcome. Finally, there is the difcult evil thatis present and about which there is hope thatit may yet be overcome. Such a state of affairsarouses anger (irae), the inclination to combat

    the difcult evil.In all, the ve emotions of the irascible appetite

    consist of two pairs of contrary emotions, andone unpaired emotion: (1) Hope and despair; (2)daring and fear; and (3) anger. It is important tonote that the irascible emotions nd their ultimate

    resolution in the concupiscible emotions, becauseevery emotion has its origin in the love of somegood 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 men-tion 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 philosophi-cally sophisticated and illuminating explanatoryaccount of the principles and methods of CT. In

    the following section, each of the seven points ofcontact between CT and APP mentioned in theintroduction will, after receiving a brief descrip-tion, be explained in terms of APP.

    A Thomistic Grounding forCognitive Therapy

    1. The Emotions Are Caused by EvaluativeThoughts, Also Known as AutomaticThoughts

    At the heart of CT is the doctrine that emo-

    tions are caused by evaluative thoughts. Unlikesome other major schools of psychotherapy, CTholds to the principle that there is a consciousthought between an external event and a particu-lar emotional response (Beck 1976, 27). Beckexplains that

    the specic content of the interpretation of an eventleads to a specic emotional response. Further, basedon examination of numerous similar examples, we cangeneralize that, depending on the kind of interpreta-tion a person makes, he will feel glad, sad, scared, orangryor he may have no particular emotional reactionat all. . . . The thesis that the special meaning of an event

    determines the emotional response forms the core of thecognitive model of emotions and emotional disorders:The meaning is encased in a cognitiona thought oran image. (Beck 1976, 52)

    A major motivation for holding to this principle,

    Beck tells us, is that it is

    difcult to conceive of how a person can react emotion-ally to an event before he has appraised its nature. . . .Judgment is required to decide whether a situation issafe or harmless, whether another person is friendlyor unfriendly. . . . If not for cognitive processes suchas discrimination and integration of stimuli, we wouldreact willy-nilly to events. Whether we laughed, cried,or raged would have no sensible relation to the realityof what was happening. (Beck 1976, 29)

    As we saw in our overview of APP, Aquinasalso concludes that emotions arise in response tothoughts. Neither external nor internal stimuli areimmediate causes of emotion. Rather, thoughts or,to be more precise, judgments, made about the

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    358 PPP / Vol. 17, No. 4 /December 2010

    things we perceive through our senses, are saidto be their immediate causes.

    Concerning this last point, we should notethat Aquinas is not always explicit about the

    causal connection between judgment and emo-tion, although when he does mention it, he saysthat the connection is essential. In ST I (q. 81,a. 3), where he examines the nature and scopeof reasons control of the emotions, he argues

    that reasons control is limited by the fact thatthe external senses and the imagination have theability to suddenly and without warning presentthe sense appetite with a sensible good or evil.

    At rst glance, this might seem to run counterto the view that every emotion arises in responseto a judgment because he says nothing about thecogitative or memorative powers being involved insuch instances. However, he claries his teaching ina later article of the Summa, where he states veryclearly that the image of a thing alone without ajudgment of the things suitability or unsuitability

    is insufcient to move the sense appetite (see STIII, q. 9, a. 1, ad 2).

    Now, although the automatic thoughts of CTare comparable to the judgments of the cogitativepower, it is important to recall that these latterare not, strictly speaking, thoughts, since thecogitative power is not a rational power. How-

    ever, if the term thought is widened to includeanything that functions like a thought, then thejudgments of the cogitative power may be likenedto thoughts, originating as they do under the

    tutelage of reason. Although Aquinas is silent onthis matter, there is nothing in his psychology toprevent us from concluding that the judgments ofthe cogitative power are naturally non-conscious,that is, normally outside our immediate conscious

    awareness, yet capable of being brought to mindand articulated in the form of a thought.10 It mightbe that the cogitative judgments providing theformal structures of our emotions are naturally

    articulated by the intellect as thoughts wheneverwe turn our attention to our emotions, but onlywhen we do so. This might explain both why it isthat most people are unaware of their automaticthoughts and yet perfectly capable of accessingthem once they know to look for them.

    2. Rules for Evaluating Our

    Experiences Operate Without OurBeing Aware of Them

    In Cognitive Therapy and the Emotional Dis-orders, Beck explains that

    a person has a program of rules according to which hedeciphers and evaluates his experiences and regulates hisbehavior and that of others. These rules operate with-

    Table 2. A Thomistic Grounding for Cognitive Therapy

    Sense Appetite Basic Object o Sense Appetite Adjudicated Relation o Object to Person Emotion Absent / Present Possible / Impossible

    Concupiscible Simple good NA NA LoveAbsent NA DesirePresent NA Delight

    Simple evil NA NA HateAbsent NA AversionPresent NA Sorrow

    Irascible Difcult good Absent Possible HopeAbsent Impossible DespairPresent NA (Delight)

    Difcult evil Absent Possible DaringAbsent Impossible Fear

    Present Possible AngerPresent Impossible (Sorrow)

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 359

    out the persons being aware that he has a rule-book.He screens selectively, integrates, and sorts the ow ofstimuli and forms his own responses without articulat-ing to himself the rules and concepts that dictate hisinterpretations and reactions. (Beck 1976, 95)

    Although Aquinas says nothing about a pro-gram of rules, we know that for him the emo-

    tions arise from judgments about the suitabilityor unsuitability of sensible goods. However, thereis reason to believe that these judgments, guidedby reason but made at the level of the cogitativepower, can become habitual. The judgments aris-ing from such habits would thus issue in emotionalresponses rule-like in their predictability. Morewill be said about these habitual responses and

    their non-conscious status in our discussion of

    point 3.Here, one might object that habitual judgmentsat the level of the cogitative power cannot beequated with the rules spoken of by CT becausethe habits of making such judgments, if they ex-ist, result from the application of such rules (seepoint 3). To take one of Becks examples, he assertsthat the rule governing the emotional response of

    a person suffering from anxiety is the belief that[i]f a particular event occurs, it will probablyhave adverse results (Beck 1976, 97). Fear andanxiety are caused by the application of this ruleto 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 inclinationsand acquired or habitual inclinations. Every pow-

    er, having a nature, is inclined to perform somespecic action. The eye, for example, is inclinedto see. Or, to put it slightly differently, the eye hasa natural tendency to respond to color. Similarly,the cogitative power has a natural tendency tomake judgments about the suitability of sensiblethings. In infants, as in adults, one such inclina-tion is to avoid loud objects, a tendency that we

    might articulate as a rule: Loud objects shouldbe avoided. Over time, however, the cogitativepower comes to be informed by more complexrules, acquired through experience and rened byreection. Thus, for example, a young child willnaturally know enough to retreat from a barkingdog. Reinforced perhaps by a few more similarincidents, such experience could easily result in

    the formation of an acquired rule for judging the

    suitability of dogs, one ill-suited to reality butnevertheless powerful and operative at the non-conscious, pre-reective level so that even years

    later the mere sight of a dog will cause him to be-come fearful and anxious. And he would do so asa result of a habitual judgment being applied to astimulus in a rule-like manner, as CT demands.

    Before leaving this point, it is worth noting that

    Beck provides support for Aquinass distinctionbetween the concupiscible and irascible appetiteswhen he says that the content of the rules forcoding experiences and steering behavior seemto revolve around two main axes: danger versussafety and pain versus pleasure. Patients difcul-ties arise in their assessments of risk and safety

    or in their conceptions of pain and gratication(Beck 1976, 247). Aquinas maintains virtually the

    same thing, holding that the concupiscible andirascible appetites revolve around two axes: Painand gratication in the case of the former, risk andsafety, in the case of the latter.

    3. The Application of These Rulesto Stimuli Results in AutomaticThoughts

    According to the cognitive model, a stimulusresults in conscious meaning, which then resultsin emotion. These meanings are expressed inautomatic thoughts, which arise through an ap-plication of rules that are learned at a young age.By applying these rules, standards, or principles,

    the individual evaluates the signicance of otherpeoples actions and interprets how they regardhis actions (Beck 1976, 44).

    In terms of his philosophical psychology,Aquinas would say that the stimulus triggers ajudgment, which in turn results in an emotionalresponse to the stimulus. As I argued in our dis-cussion of point 2, these judgments follow eitherfrom the application of rules built into the cogita-

    tive power or acquired and possessed as habitualresponses to specic stimuli. Hence, on this un-derstanding, automatic thoughts are the result ofthe application of habitual judgments to stimuli.

    Returning to the example of the person whofeels intense fear and anxiety at the mere sight ofa dog, CT would explain his response as a directresult of a rule such as All dogs are dangerous

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    360 PPP / Vol. 17, No. 4 /December 2010

    and should be avoided being brought into play

    whenever he sees a dog. Although irrational andperhaps contrary to what he knows, he has astrong tendency to apply this rule in most situa-

    tions involving dogs, the automatic thought Thisdog is dangerous and should be avoided and theconsequent fear and anxiety following withoutfail. Aquinas would explain this persons responseby saying that his past experience with dogs has

    resulted in the formation of habits at the level ofthe cogitative and memorative powers that, forall practical purposes, may be expressed as thebelief that all dogs are dangerous and should beavoided. Thus, when presented with a dog byhis external senses (or by his imagination in theform of a vivid recollection, as might occur, for

    example, in a dream), he reexively judges it tobe dangerous and something to be avoided. If

    the dog were visible but so far away as to poseno immediate threat, he might only experiencea feeling of aversion for the animal. If, however,his judgment was that the dog is dangerous anddifcult to avoid, aversion would lead by a shortroute to fear and anxiety.

    4. These Automatic Thoughts AreAccessible to the Person Experiencingthe Emotions

    Against some other major schools of psy-chotherapy, CT believes that the causes of ouremotions are directly accessible to the personexperiencing them. After listing some examples

    of distressing emotional experiences taken fromclinical practice, Beck tells us that

    each of the patients . . . was aware of having had asequence of thoughts that intervened between the eventand the unpleasant emotional reaction. When a person isable to ll in the gap between an activating event and theemotional consequences, the puzzling reaction becomesunderstandable. With training, people are able to catchthe rapid thoughts or images that occur between an

    event and the emotional response. (Beck 1976, 26)

    Although Aquinas said nothing about auto-matic thoughts, his explicit teachings point veryclearly in the direction mapped out by Beck.Because our emotions are caused by judgments,it must be possible to access the causes of ouremotions, even those we nd distressing. Aquinas

    intimates as much in his derivation of the emotions

    in ST III (q. 23, a. 4), where, as we have seen, heargues that each specic kind of emotion arises inresponse to a specic judgment.

    This last point leads naturally to the fth pointof contact between CT and APP, because it con-cerns the relationship between the emotions andthe thoughts that give rise to them.

    5. The Specic Content of anAutomatic Thought Leads to aSpecic Emotional Response

    If CT works quickly, it must be partly becausethe cognitive therapist knows what to look foreven before setting out in search of the causes of

    specic emotional disturbances. Based on experi-

    ence, Beck was able to discover what he calls anessential relation:

    The specic content of the interpretation of an eventleads to a specic emotional response. Further, basedon examination of numerous similar examples, we cangeneralize that, depending on the kind of interpreta-tion a person makes, he will feel glad, sad, scared, orangryor he may have no particular reaction at all.. . . The thesis that the special meaning of an event de-termines the emotional response forms the core of thecognitive model of emotions and emotional disorders:The meaning is encased in a cognitiona thought oran image. (Beck 1976, 512)

    To give just one example of the sort of thing Beckmeans by special meaning, take sadness. He saysthat it stems from the patients tendency to in-terpret his experiences in terms of being deprived,

    decient, or defeated (Beck 1976, 82).Now compare that with what Aquinas says

    about sadness: It is caused by a judgment thatsomething that is loved and was once desired isirretrievably lost. Or take anger. Beck says thatthe common factor for arousal of anger is theindividuals appraisal of an assault on his domain,including his values, moral code, and protective

    rules (Beck 1976, 71). Compare that with Aqui-nass view that anger is elicited by the judgmentthat a loved object is under attack. The similaritiesare nothing short of remarkable. For both Beckand Aquinas, what gives rise to specic emotionsis not so much the specic object being judged asthe formal structure of the judgment. Although

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 361

    Beck appreciates this point, observing that if we

    know the meanings attached to [an] event, we cangenerally 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 ofthe formal structure of the judgments that give riseto specic emotions, it should also be possible topredict the form, although not the content, of thejudgments or automatic thoughts that lie at the

    root of our specic 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 thejudgment underlying his anger, we can say that atsome level he has apprehended something he lovesto be under attack from someone or something

    he judges capable of being repulsed. Knowingthe formal structure of anger could not by itself

    reveal the identity of the attacker, of course, butit could offer invaluable guidance in the searchfor its underlying cause. Rather than groping inthe dark for the cause of ones anger, having noidea what it could be, a person would know tolook for something judged by him to be unsuitableand difcult, threatening one or more of his lovesand perceived in some way to be present but notimpossible to overcome.

    At this point, one might wonder whether anyof the judgments causing emotions could be hid-den from the person having them. As on so manyother points that were not raised in his own day,Aquinas offers no explicit answers. Nevertheless,APP suggests that the judgments of the cogitativepower, especially habitual ones, might not alwaysbe obvious or even easily accessible to us for two,

    possibly three reasons. First, we must not lose sightof the fact the judgments of the cogitative powerare not, properly speaking, thoughts. They are notacts of the intellect but of a lower, sub-rationalpower. Nevertheless, something analogous to judg-ments made by the intellect must be at work in the

    cogitative power, for all the reasons discussed ear-lier. Second, Aquinas maintains that we are able tohold some thoughts and choices in mind without

    being aware of them. This is possible because achoice or a judgment once made can become ha-bitual (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 tookso long to be discovered and why they are acces-sible to everyone with very little training. Third,

    it might be that the cogitative power is naturallyinclined to suppress painful memories, but not thejudgments arising therefrom. In such cases, thecontent of the underlying judgment, although notits form, would be hidden from view.

    Before leaving this section, I would like todraw attention to a feature of APP that makes itimmune to certain recent criticisms of CT. Writingin the pages of this journal, Demian Whiting hasargued that sometimes the correct approach totreating persons suffering from emotional distur-bances is not to alter any eliciting cognitions,

    but rather. . . to directly effect changes in the persons chemical orhormonal imbalances (say, by the use of medication).And again in other cases it might be that treatmentshould not be about resolving some underlying psy-chological fact about the person (or directly effectingchemical or hormonal changes), but rather it shouldbe about the cultivation of more appropriate emotions(where, for instance, this might involveas Aristotlebelieved, and a number of contemporary behavioraltherapists will attempt to showencouraging a personto behave in ways that then directly counteract, or effectchanges in, the emotions that are undergone). (Whit-ing, 239, 245)

    Without taking sides in Whitings dispute with CT,I will say Aquinas agrees with his insistence thatthe emotions can and sometimes do have causesother than eliciting cognitions or, to use his ownterminology, judgments of the cogitative power.

    As we discussed in our overview of APP, Aqui-nas takes the human person to be an existentialunity of body and soul; so much so, in fact, that the

    activity of the body is thought to be the activity ofthe person. It is the person who sees by means ofhis 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 sensa-tions such as hunger, thirst, and pain. Whereas anemotion 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 straight-forward: Whereas passions of the soul begin in thesoul (as an apprehension of a dangerous animal,

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    362 PPP / Vol. 17, No. 4 /December 2010

    for example) and end in the body (as a rising of

    ones blood pressure and the preparation to ght,which occurs in anger), bodily passions begin inthe body (as when one steps into bright sunlight)

    and ends in the soul (as a feeling of warmth onones face). Now, what is important to note here isthat in both cases, the body is necessarily involved.There is no anger, sadness, or pleasure that doesnot involve some characteristic bodily change.

    Indeed, none of these emotions could exist withoutthe body; without bodily changes the very stuff(i.e., the material cause) of the emotions would bemissing. Consequently, because such changes mayoccur independent of apprehension through the in-uence of some physical agent, Aquinas would notat 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, itwould be reasonable to suppose that it, too, couldbe affected by such physical agents. Consequently,on APPs terms, one would expect that at least insome cases treatment with CT would be enhancedthrough medication; conversely, one would alsoexpect CT to effect changes in a persons brain,not just in his emotions.

    Aquinas would also agree with Whitings con-

    tention that, sometimes, what is needed is not aresolution of some underlying psychological factabout the person (or directly effecting chemical orhormonal changes), but rather, as Aquinas wouldput it, the inculcation of the moral virtues. Psycho-logical well-being is not simply a matter of beingfree 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 toincline toward the kinds of choices that make fora ourishing human life. Often enough, emotionaldistress serves as a warning that we are walkingdown the wrong path.

    6. Emotional Disorders Are Caused byIncorrect Automatic Thoughts, WhichCan Be Modied Through RationalConsiderations

    CT maintains that the conscious elements thatcause a persons emotional disorders are incorrect

    conceptions [that] originated in defective learning

    during the persons cognitive development (Beck

    1976, 3). It also maintains that the patient hasat his disposal various rational techniques he canuse, with proper instruction, to deal with these

    disturbing elements in his consciousness (Beck1976, 3). Regardless of their origin, [CT believes]it is relatively simple to state the formula for treat-ment: The therapist helps a patient to unravel hisdistortions in thinking and to learn alternative,

    more realistic ways to formulate his experiences(Beck 1976, 3).

    Although Aquinas said very little about theemotional disorders, hardly a word needs to beadded to what has already been said about APPto see that it contains all the elements necessaryto develop virtually the same account and ap-

    proach to treating them that Beck developed. OnAquinass terms, most emotional disorders may be

    said to result from incorrect habitual judgments atthe level of the cogitative and memorative pow-ers. And these, as we have seen, may be modiedthrough rational considerations. That having beensaid, given the stability and obduracy of habit, weshould not expect rational considerations aloneto be sufcient to effect a permanent change ina persons habitual outlook. New habits must beformed to replace the old ones, a process of re-

    turning again and again to rational considerationsand acting on them, a point on which APP and CTseem to be only in partial agreement. We turn nowto a closer examination of this last point.

    7. Habituation, in Addition toAwareness of Such AutomaticThoughts, Is Necessary to ChangeIncorrect Automatic Thoughts and toInculcate Correct Ones

    In comparing the different approaches of CTand behavior therapy to treating emotional disor-ders, Beck writes that

    both cognitive and behavior therapists seek to alleviatethe overt symptom or behavior problem directly. The fo-cal point differs, however. The cognitive therapist directshis techniques to modifying the ideational content in-volved in the symptom, namely, the irrational inferencesand premises. The behavior therapist concentrates onchanging the overt behavior, for example, the maladap-tive avoidance response. (Beck 1976, 321)

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 363

    In assessing the effectiveness of behavior therapy,

    Beck concludes that his own clinical observa-tions and some systematic studies suggested thatbehavior therapy was effective because of the at-

    titudinal or cognitive changes it produced (Beck1976, 335).

    Although Aquinas would certainly agree withBecks insistence that a change in ones outwardbehavior is unlikely to have a lasting effect in the

    absence of any change in ones outlook, nonethe-less he would probably agree with the behaviortherapist that most incorrect habitual judgments(or automatic thoughts) cannot be corrected sim-ply by bringing them to light and subjecting themto rational considerations. The cogitative power,being non-rational rather than irrational,may be

    likened to a dog that, having formed the habit ofsleeping in its masters bedroom, still has the ability

    to obey an order to sleep elsewhere. Yet, just asthe dogs habit of sleeping in his masters bedroomwill continue to reassert itself unless he is made todo otherwise on many successive nights, so too theold habits of the cogitative power will continue toreassert themselves unless it is taken through theprocess of arriving at correct judgments throughthe application of rational considerations againand again. And the reason for this necessity is

    rooted in the fact that the driving out of one habitby another habit is not simply or even primarilythe work of the mind but that of the body. Forthis reason, Aquinas might expect the techniquesofboth therapies to be indispensable in the treat-ment of at least some of the emotional disorders,especially those that are deeply ingrained.

    In his later work, Beck has modied his views

    slightly and granted a larger scope to behavioraltechniques in the treatment of emotional disor-ders. In Cognitive Therapy of Substance Abuse,we read:

    In a sense, the behavioral methods can be regarded asa series of small experiments designed to test the valid-ity of the patients negative hypotheses or ideas aboutthemselves. As the negative ideas are contradicted bythese experiments, the patient gradually becomes lesscertain of their validity and is motivated to attempt moredifcult assignments. (Beck et al. 1993, 238)

    From this and other things Beck has to say aboutbehavioral techniques, it seems that for him their

    utility lies wholly in their ability to bring a patient

    face-to-face with reality as often as is necessary toshatter and sweep away those beliefs that lie at theroot of his emotional disorders. He does not seem

    to consider the possibility that the cure for theseproblems might require a physiological change aswell as a mental one. What is so interesting aboutAPP is that it explains better than CT why thisprocess must be repeated often and why rational

    insight alone is almost never enough to give apatient permanent relief from emotional distress.

    8. The Model of the Human PersonUnderlying Both PsychologicalTheories Is Anti-Physicalist andHumanistic

    To these seven points of contact, this eighthpoint might be added, as well. One of the virtuesof the cognitive therapeutic approach to the emo-tional disorders, Beck tells us, is that it

    changes mans perspective on himself and his problems.Rather than viewing himself as the helpless creature ofhis own biochemical reactions, or of blind impulses, orof automatic reexes, he can regard himself as prone tolearning erroneous, self-defeating notions and capableof unlearning or correcting them, as well. By pinpoint-ing the fallacies in his thinking and correcting them, hecan create a more self-fullling life for himself. (Beck1976, 4)

    Rather than reducing the human person to thesum of his material parts and his behavior to thenecessary causal interaction of those parts, thecognitive approach insists that ideas are real andhave consequences, exerting an inuence for betteror worse on the lives we live in and through ourbodies. Being more than the sum of our materialparts, we cannot be dened along purely physical-ist 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 re-ductionism, APP has all the conceptual resourcesneeded to place CT on a solidly anti-physicalistand humanistic foundation. Because the humanperson is a strange and marvelous existential unityof body and soul, bound in the esh by physical

    laws but free in spirit to soar out of time and space,

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    364 PPP / Vol. 17, No. 4 /December 2010

    we are free to choose our actions even if we are

    not free to choose all the factors that inuence ourchoices. The basic unit of human action is, prop-erly speaking, the human person, not this or that

    faculty, much less this or that complex collectionof organs or cells. As such, Aquinass psychologyis anti-physicalist or, to be more precise, anti-reductionistic, as well as humanistic, refusing onsolid philosophical grounds to reduce the human

    to something less than human.


    In this paper, I have argued that Aquinas antici-pated all of CTs major principles and methods. Ihave done so in an effort to show that he offers aprofound philosophical foundation on which to

    ground the principles and methods of CT. There isa depth and coherence to his understanding of the

    human person that complements the breadth andprecision of CTs understanding of the emotionaldisorders. Alone, each is powerful, capable of ex-plaining much, yet incomplete without the other:CT because it does not understand the causesof the emotions well enough nor therefore theultimate reasons for its own effectiveness; APP be-cause it is largely silent on the nature, causes, andmethods of treating the emotional disorders.

    When challenged to address these issues, APP

    is both insightful and articulate. It also has in-teresting things to say about how the principlesand methods of CT might be further developed,suggesting for example that Aquinass derivationof the emotions might be used to rene the formalschema of the underlying rules and automaticthoughts responsible for emotional disturbancesdeveloped by CT. Additionally, APP strongly sug-

    gests that behaviorism should be given greater due,at least when it comes to explaining the effective-ness of behavioral techniques in the treatment ofaddictions and other emotional disorders.

    More promising, still, is APPs potential to offeran explanatory philosophical framework not justfor CT but also for its rivals. Indeed, if APP is cor-rect, then there is every reason to suppose that it

    may serve as the framework for a grand synthesisof all the disparate schools of psychology, one ca-pable of providing an explanation of the limits andeffectiveness of the therapeutic methods of each

    one, even the most disparate. This is not to say

    that psychology, much less psychiatry, could thenbe done from the comfort of ones armchair. Thecomplexities of the human person are such as to

    demand careful empirical observation. There is nosubstitute for experience. As a good Aristotelian,Aquinas believed this true not just for the scientistbut also for the philosopher. All knowledge beginsin the senses. Indeed, as we have seen, it is by start-

    ing with observable human behavior that Aquinasarrives at his views. If he sounds greater depthsthan the scientist in his quest to understand theinner dynamics of the human person, it is becausethe philosophic method is open to reality in all itsdimensions, not just the quantiable.

    Other avenues of development doubtless

    beckon. Given the scope of the paper, I could onlyhint at the possibility of a rapprochement between

    CT and other psychologies. Most intriguing is thepossibility of a synthesis of at least some of theprinciple elements of the depth psychologies withthose of CT. Although fairly well understood,there is yet an irreducibly physiological facet ofthe corporeal internal sense powers, most impor-tantly the imagination, memory, and cogitativepower, that points in the direction of certain fun-damental Freudian notions when translated into

    Thomistic terms and transformed by Aquinassanti-physicalist metaphysics. Much more couldbe said on this and other related topics, but if thiscursory investigation of the mutual complemen-tarity of APP and CT is successful, it will inspireother attempts to bring this thirteenth-centurytheologian into dialogue with modern psychiatryand psychology.


    The author thanks Andrew J. Peach, PhD, PaulGondreau, STD, Kevin J. Majeres, MD, and Steven

    J. Jensen, PhD, for helpful comments on earlierdrafts of this paper.


    1. Augros (2004) contains a very penetrating andlucid account of the differences and complementarity ofthe methods employed by philosophers and scientists.

    2. For a lucid and detailed historical and philosophi-cal treatment of Aquinass doctrine of the metaphysicalunity of the human person, see Pegis (1978).

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Butera / Thomas Aquinas and Cognitive Therapy 365

    3. The term emotion is here used to translate avery precisely dened term in Aquinass philosophicalvocabulary, namely a passion of the soul (passio ani-mae). Passions of the soul, for Aquinas, are not simplyideas or feelings that exist in the mind. Rather, they are

    changes that occur in the human body in response tojudgments made about perceived objects. As Aquinasputs it, passions begin in the soul and end in the body.Hence, emotion and passion in this paper will beused exclusively to refer to passions of the soul. SeeAquinass De Veritate q. 26, a. 2. See p. 3612 abovefor more on the nature ofpassio animae and the wayemotion differs from sensation, which Aquinas calls a

    passio corporalis.4. Although reason and will are executive powers,

    giving human beings control over their actions, Aquinasobserves that this control may be temporarily lost whena person loses the ability to reason, either temporarilythrough a violent passion, physical illness or sleep, orpermanently through physical injury; see ST I-II, q. 77,a. 2. See also Butera 2006.

    5. Although the human being does not, for the mostpart, have instincts, Aquinas does hold that newbornhuman infants are guided by a limited range of instinc-tive estimations (White 1998, 226, n. 38).

    6. Following Aristotle, Aquinas makes a distinctionbetween non-rational and irrational powers. Althoughboth lack reason, the former, such as the sense appetiteand the imagination, are capable of responding to rea-son, even to the point of forming rational habits, suchas 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-rationalpowers of the human person were exclusively irratio-nal, the emotions would not be susceptible to rationalmodication. It is only because the sense appetite is non-rational that our affective responses are amenable torational considerations and, in the case of the emotionaldisorders, healing via therapeutic methods employingthe methods of CT.

    7. This is not to say that the wolfs unsuitability forthe sheep is purely subjective. The sheeps instinctualemotional response to the wolf is what it is because thewolf is what it is. However, for the purposes of under-standing an animals emotional responses, the meaningof suitability may be reduced to a things perceived

    potential to preserve or increase another things excel-lence in some way, unsuitability to a things potentialto do the opposite. Whether something really is suitableor unsuitable to an animal is beside the point as far asthe emotional response itself goes. What matters is thatsomething isjudgedto be suitable or unsuitable. Never-theless, every judgment aims at determining the true suit-ability or unsuitability of a thing. Where the estimativepower is concerned, subjectivity aspires to objectivity.

    8. A very clear and concise treatment of the cogita-tive power (also known as the discursive power and theparticular reason) can be found in Klubertanz (1965,3447). For the most exhaustive treatment of the notionof the cogitative power and the history of its develop-

    ment, see Klubertanz (1952).9. Whether the observational evidence really does

    point to the existence of this fourth internal sense poweris an open question. The evidence that estimations areretained is obscure and problematical; it seems thatimagination, association of images, and modicationsof the discursive estimation [e.g. the estimative power]are sufcient to account for all the alleged evidence(Klubertanz 1965, 478). Although an interesting prob-lem, it is not important for our purposes. All I will sayhere is that my hunch is that the clearest evidence for thememorative power lies in learned behavior that cannotbe explained merely in terms of the animals responseto pleasure or pain.

    10. For an interesting argument in favor of the viewthat the cogitative power is able to operate without ourbeing consciously aware of its operation, see Klubertanz(1965, 858).


    Augros, M. 2004. Reconciling science with naturalphilosophy. The Thomist68, no. 1:10541.

    Baker, R. R. 1941. Thomastic theory of the passionsand their inuence upon the will. Notre Dame, IN:University of Notre Dame Press.

    Beck, A. T. 1976. Cognitive therapy and the emotionaldisorders. New York: Penguin Books.

    Beck, A. T., F. D. Wright, C. F. Newman, and B. S. Liese.1993. Cognitive therapy of substance abuse. NewYork: The Guilford Press.

    Butera, G. 2001. Thomas Aquinas on reasons controlof the passions in the virtue of temperance. Ph.D.dissertation. The Catholic University of America.

    . 2006. On reasons control of the passions inAquinass theory of temperance. Medieval Studies68:13360.

    Klubertanz, G. P. 1952. The discursive power. SaintLouis: The Modern Schoolman.

    . 1953. The philosophy of human nature. NewYork: Appleton-Century-Crofts.

    . 1965. Habits and virtues. New York: Appleton-

    Century-Crofts.Pegis, A. C. 1978. St. Thomas and the problem of the

    soul in the thirteenth century. Toronto: The PonticalInstitute of Mediaeval Studies.

    St. Thomas Aquinas. 1995. On evil, trans. J. A. Oesterleand J. T. Oesterle. Notre Dame, IN: University ofNotre Dame Press.

    . 1981. Summa theologica: Complete Englishedition in ve volumes, trans. Fathers of the English

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    366 PPP / Vol. 17, No. 4 /December 2010

    Dominican Province. Westminister, MD: ChristianClassics.

    . 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 supple-ment:21327.

    Whiting, D. 2006. Why treating problems in emotionmay not require altering eliciting cognitions. Philoso-

    phy, Psychiatry, & Psychology 13, no. 3:237-46.

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    About the Authors 385

    2011 by The Johns Hopkins University Press

    About the Authors

    Tim Bayne is University Lecturer in Philosophy ofMind at the University of Oxford and a Fellow of

    St. Catherines College. He is the author of TheUnity of Consciousness (OUP, 2010) and an edi-tor of the Oxford Companion to Consciousness

    (OUP, 2009). He can be contacted via e-mail [email protected]

    Giuseppe Butera is Associate Professor of Phi-losophy at Providence College. Before this he wasa visiting assistant professor at the University of

    Dallas (20032004), the Gilson Fellow at ThePontical Institute of Mediaeval Studies in To-ronto (20022003), and a postdoctoral fellowat The Center for Philosophy of Religion at TheUniversity of Notre Dame (20012002). Recently,he published an article in vol. 68 (2006) of Me-diaeval Studies entitled On reasons control ofthe passions in Aquinass theory of temperance

    and another article in vol. 71, no. 4 (2007) ofTheThomistentitled The moral statue of the rstprinciple of practical reason in Thomass natural-law theory. Other interests include virtue ethicsand metaphysics. He is a member of the AmericanMaritain Association and the American CatholicPhilosophical Association. He may be contactedvia e-mail at [email protected]

    Eugene M. DeRobertis holds a BA in philoso-phy from St. Peters College and a PhD in clinicalpsychology from Duquesne University. He hasbeen teaching psychology at the college level since1996. Before committing himself to teaching fulltime, Dr. DeRobertis worked as a developmentally

    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: AHolistic Approach (2008) and his article, St.Thomas Aquinass philosophical-anthropology asa viable underpinning for a holistic psychology: Adialogue with existential-phenomenology (JanusHead, in press). He may be contacted via e-mailat [email protected]

    George Graham is on the philosophy and neuro-science faculty at Georgia State University, havingtaught previously at UAB and Wake Forest Uni-versity. He is the author ofThe Disordered Mind(Routledge). He publishes extensively on issues atthe interface of philosophy and psychiatry. He can

    be contacted via e-mail at [email protected]

    Michael Loughlin is the Reader in AppliedPhilosophy at Manchester Metropolitan Uni-versity and author of Ethics, management andmythologyRational decision making for health

    professionals. He can be contacted via e-mail [email protected]

    Christopher Megone is Professor of Inter-disciplinary Applied Ethics at the University ofLeeds and has been Director of the Centre for

    Inter-Disciplinary Applied Ethics there since itsinception in 2005. He studied Classics at Oxfordwhere he went on to do a BPhil and a DPhil inPhilosophy. He has been a member of the Phi-

  • 7/27/2019 Thomas Aquinas and Cognitive Therapy


    Reproducedwithpermissionof thecopyrightowner. Further reproductionprohibitedwithoutpermission.