Friday, April 14, 2017
Jim McCullough came to Virginia Commonwealth University in 1972. Shafer Street was a gravel road and the Monroe Park Campus did not extend south of Main Street. VCU was a fledgling university, barely five years removed from the merger that created it.
“Most of this place was just fast-food hamburger shops and a bunch of townhouses,” McCullough said. “What was it like? I was wondering what in the heck I had gotten myself into.”
VCU, he said, had to grow up. So did McCullough’s field of psychology. Researchers and practitioners who published in the 1970s diagnosed all dysphoric disorders with a generic label: depression. No effort was made to distinguish depression’s various forms.
This was a problem, said McCullough, a professor of psychology in the College of Humanities and Sciences.
“People talked about depression in the generic,” he said. “An analogy would be people talking about cancer — ‘You have cancer.’ Well the first question is: ‘What kind have I got?’ … I started working with people who presented with chronic depression when I first came here. Back then, chronic depression was thought to be a personality disorder, which meant it was not treatable, either with psychotherapy or drugs.”
McCullough, 80, who will retire this spring after a 45-year career at VCU, was instrumental in changing this. He labored for more than three decades to help establish chronic depressive disorder as an independent diagnostic category, decoupling it from major depression. He also developed the first and only empirically validated psychotherapy model for the chronically depressed patient.
The two efforts are closely linked, he said.
“They are the successes of my career, and I’m very proud of it,” McCullough said. “Now we no longer talk about depression in the general. Now it’s, ‘What type of depression do you have?’ And it requires different types of treatment.”
‘It doesn’t matter what I do? Like hell it doesn’t.’
As an adolescent, McCullough was depressed. He was still depressed when he went to college. When he was 25, he began seeing a psychiatrist named Hank Olivier.
“Hank was a hell of a guy and he really had an effect on my life,” McCullough said. “I met him in Baton Rouge, Louisiana. It was a happenstance encounter, but thank goodness I did meet him. He really turned my life around.”
McCullough went into clinical psychology because he wanted to help people the way Olivier helped him. When he came to VCU, about 10 years later, McCullough made the chronically depressed patient a focal point of his career.
“I’ve been there — I’m not there anymore,” he said of battling depression. “I’ve just always had an affinity for this kind of patient.”
People talked about depression in the generic. An analogy would be people talking about cancer — ‘You have cancer.’ Well the first question is: ‘What kind have I got?’
McCullough began seeing patients who said they had been depressed for decades. He started treating them. Over time, his efforts evolved into the Cognitive Behavioral Analysis System of Psychotherapy, or CBASP, a new model to treat the chronically depressed. A person suffering from chronic depressive disorder (now persistent depressive disorder) is characterized as being in a depressed mood for most of the day, for more days than not, for at least two years (one year for children and teens).
Hopelessness and helplessness are hallmarks of chronic depression, McCullough said. CBASP involves teaching people they are not helpless by showing them their actions have consequences, he said.
“We teach them to look at what they produce. And they realize they aren’t helpless at all — they have effects and some are negative effects,” McCullough said. “All of a sudden, the issue becomes if you don’t like the consequences you produce, you have to change your behavior. We attack the helplessness. ‘It doesn’t matter what I do?’ Like hell it doesn’t. The very quality of your living is at stake.”
As he was honing CBASP, McCullough and likeminded colleagues also were producing mountains of research differentiating chronic depression from the more episodic acute forms of depression. Beginning in 1980, they began to chip away at the old way of thinking. In the three-plus decades since, McCullough has revealed more nuances regarding depression and his work helped establish a separate category for persistent depressive disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
These efforts have cut through the politics that sometimes slow clinical advancement, said Wendy Kliewer, Ph.D., chair of the VCU psychology department.
“I think it comes out of a profound, deep sense of caring about VCU, education, students and his patients,” Kliewer said. “Jim has a real genuine concern for people who are suffering. A lot of his passion comes from that place.”
A patient-first approach
McCullough has made seminal advances in the field. Beginning in 1988, he served as principal investigator for four clinical trials involving more than 2,200 chronic depression patients — the largest chronic depressive studies ever. In 2004, McCullough conducted what is believed to be the first successful treatment of a chronic depression case via Skype, communicating weekly for more than seven months with a female patient in Japan.
“The encounter [via video] is just as intense as you and me,” he said.
As an educator, McCullough has trained and supervised psychotherapy students — in VCU’s clinical psychology program and around the world — to treat the chronically depressed patient. His contribution to VCU’s undergraduate mission also should be recognized, Kliewer said.
She will remember McCullough for his forceful opinions and his desire to do well by his patients.
“We serve a diverse world and a diverse student body,” she said. “The academy in general has a tendency to be very insular and not pay attention to the wider world. What I will miss about Jim is his willingness to not go along with the crowd if he does not believe in a particular perspective.”
We teach them to look at what they produce. And they realize they aren’t helpless at all — they have effects and some are negative effects. All of a sudden, the issue becomes if you don’t like the consequences you produce, you have to change your behavior. We attack the helplessness. ‘It doesn’t matter what I do?’ Like hell it doesn’t. The very quality of your living is at stake.
McCullough will deliver a final lecture April 17 at the Academic Learning Commons. He will continue to see a few patients. He’s also working on a memoir. The psychology department is compiling written tributes in celebration of his career.
He said he will remember the work with affection, particularly the efforts he and his colleagues made to advance the knowledge of chronic depression. The four national clinical trials he participated in remain a highlight of his career.
“Everybody in those trials pooled their resources and talents. It was like heaven for me,” McCullough said. “It was research, with the patient at the top, and all the turf wars were absent. Those years were fantastic.
“Those are the fondest memories I have as an academic.”
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