Sullivan, Harry Stack

I. Life AND WorkAlfred H. Stanton

BIBLIOGRAPHY

II. Interpersonal TheoryPatrick Mullahy

BIBLIOGRAPHY

I. LIFE AND WORK

Harry Stack Sullivan (1892-1949), American psychiatrist, who conceived of psychiatry as the study of interpersonal relations, was born in Norwich, New York, into an Irish Catholic home. Little information is available about his early life. He was the only surviving child of a shy and retiring farmer and his partially invalid wife. A lonely child, he had serious difficulties learning how to get along with other children at school, and for many years his only friends were the animals on the f’irm. He often spoke of the drastic reorganization of his personality during adolescence, but nothing more specific is known. He attended the Chicago College of Medicine and Surgery and, after receiving his M.D. in 1917, worked as a civilian with the U.S. Army during World War I. In 1922 he became a liaison officer for the Veterans Administration at Saint Elizabeths Hospital in Washington. He had learned something about psychoanalysis as a medical student, but it was at Saint Elizabeths that he first encountered psychiatry as a specialty and developed his long-standing interest in schizophrenic patients.

Saint Elizabeths Hospital was a major center of psychiatric activity. William Alanson White had introduced many new treatments there—in particular, the application of Freud’s psychoanalytic principles to the diagnosis and treatment of hospital patients. White’s influence on Sullivan was profound and freely recognized by Sullivan throughout his life, but Smith Ely Jelliffe, Edward J. Kempff, Ernest Hadley, and others also helped to make the hospital a center for the attempt to reorganize psychiatric thought and practice on psychoanalytic and psychological principles. While Sullivan’s duties were only those of a consultant, he had diagnostic interviews with a large number of schizophrenic patients, and his ability to reach patients who had been thought beyond contact was soon recognized. He became progressively convinced that the interviews he had as a consultant had important effects upon the patient and could not, therefore, be sharply distinguished from treatment.

Sullivan’s approach to psychiatry led to his moving to Sheppard and Enoch Pratt Hospital near Baltimore. He also attended staff conferences at the neighboring Johns Hopkins University’s Phipps Clinic and, thus, came to know Adolf Meyer and his group, notably Clara Thompson. He was assistant physician at Sheppard Pratt from 1923 to 1925 and then became director of clinical research, a position he held until 1930. This position gave him the opportunity for the detailed study of schizophrenic patients that was needed if the patients were to be understood regularly in “human” terms. With detailed records on several hundred patients, he demonstrated that even the most disturbed patients do not develop any type of symbol activity that is entirely outside the realm of the human, no matter how bizarre it may appear to be; it is, therefore, never impossible to understand the patient in some sense if sufficient contact with him is possible. This is important because many people respond intuitively to much of schizophrenic behavior as if it were not human.

Sullivan was strongly influenced by psychoanalytic studies of schizophrenic patients but always related psychoanalytic interpretations to the broader concepts developed by nonpsychoanalytic psychiatrists. A most important influence was the work of Adolf Meyer—above all, his early work. Sullivan noted with approval Meyer’s insistence that “mental illnesses” could be profitably considered “reaction types” to situations confronting the patient. If the biography of the patient were fully known, it would explain much of his pathological reaction. In a paper from this period, Sullivan identified the so-called conservative aspects of early schizophrenia as ”attempts by regression to genetically older thought processes . . . successfully to reintegrate masses of life experience which had failed of structuralization into a functional unity, and finally lead by that very lack of structuralization to multiple dissociations in the field of relationship of the individual not only to external reality, including the social milieu, but to his personal reality” (1924, p. 24).

The concept of “illness” as a problem-solving effort became intrinsic to his whole work; he considered the more static descriptions of Eugen Bleuler, Emil Kraepelin, and John T. MacCurdey to be clinically sterile in comparison with dynamic formulations that recognize a teleological aspect to the disturbance. His clinical observations led him to emphasize the existence not only of the conserving aim but of the frequent conserving effect of a schizophrenic episode. In contrast to the usual view at that time—that nearly all such patients were damaged, if they recovered at all—he mentioned patients who were more competent after the episode than before and undertook a number of studies to try to identify the factors responsible. One of Sullivan’s characteristic conclusions was that the patient’s own appraisal of his circumstances—his foreseeable future, as it were—was a major contributing factor to the outcome of a psychotic episode.

During much of the period of his study of patients at Sheppard Pratt, Sullivan lived on the grounds, and he made his home available to all his co-workers for discussions of clinical problems. These discussions made him progressively more aware that the interactions of the patient with other persons is a primary determinant of the outcome of his “effort to reintegrate masses of life experience.” This led in 1929 to his organizing a special admission ward for young male schizophrenic patients that would function almost independently of the rest of the hospital and depart from its customary practices. He selected his staff with great care, with a preference for candidates who had experienced psychological disturbances similar to those of the patients. All staff members were men—no women were allowed on the ward. Sullivan not only had frequently lengthy informal interviews with the patients but also talked freely and informally with the staff, often in the evenings at his home. This type of indirect intervention was based upon a number of newly developed views— a recognition of the potential benefits to be gained when persons with similar backgrounds share their experience and of the therapeutic import of human interactions other than the patient’s interview with the psychiatrist. Although the experience of the ward was never analyzed systematically, the outcomes for the patients were extraordinarily favorable. They continued to be favorable under William Silverberg, Sullivan’s successor (Sullivan 193la, p. 290).

Sullivan did not by any means work in intellectual isolation . As these experiences with therapy led him to recognize the importance of interpersonal relations, he turned freely to social scientists for help. In particular, he came to know, and often to work with, Lawrence K. Frank, W. I. Thomas, Ruth Benedict, Harold D. Lasswell, and Edward Sapir. He was instrumental in organizing two influential national colloquia on personality investigation, which explicitly recognized the need for collaboration between the social sciences and psychiatry in developing the study of personality. He asserted the view that psychiatry is the study of interpersonal relations, a discipline sui generis, synonymous in a sense with social psychology, and that the concepts of personality and of its structure are, in effect, working hypotheses that account for the interpersonal relations that constitute the core material of the psychiatrist’s useful observations. Personality and its disorders manifest themselves only in interpersonal relations, and it is by the psychiatrist’s participant observation of his patient in such relationships that he does his clinical and scientific work (Sullivan 1938, pp. 32-33). Psychiatry then is a social science (regardless of what its practitioners may think), and recognition of this prevents many common misconceptions.

Sullivan moved to New York in 1930; there he turned his attention to the obsessive disorders and collaborated with Sapir, the linguist and cultural anthropologist. Sapir organized a highly significant seminar in culture and personality at Yale in 1932 and 1933, to which Sullivan made important contributions. Many prominent social scientists who later studied culture and personality trace their interest, in large part, to this seminar. The depression and financial pressures forced Sullivan to move back to Washington around 1933.

The years which immediately followed were less productive ones for Sullivan. He finished and rewrote a book-length manuscript, but it did not satisfy him; it did not proceed from the clearly interpersonal approach he had adopted by this time and which he was to elaborate in his later writings. (The manuscript was never published.) He devoted much of his time to teaching, largely by the individual supervision of practitioners, an art in which he excelled.

In 1933 he took part in founding the William Alanson White Foundation, with branches in Washington and New York. The establishment of the Washington School of Psychiatry and of the journal Psychiatry followed later, in 1936 and 1938, respectively. The journal, of which he was the editor, quickly became a leading organ for reporting on the growing body of work on interpersonal relations. The school, then temporarily in a short-lived, unhappy partnership with the Washington-Baltimore Psychoanalytic Institute, soon took the leadership in developing both teaching and research in the field. Lass well was very active in the school for a short time, before the demands of the impending war forced his withdrawal. Several highly experienced psychiatrists and psychoanalysts gave great strength to the school and the journal. During these years, Sullivan also worked on a joint research project with Charles Johnson at Fiske University and collaborated with Dexter Bullard and his staff at Chestnut Lodge Sanitarium.

Sullivan had taught almost continuously after going to Sheppard Pratt in 1923—at the University of Maryland School of Medicine, at Yale, and for a short time at the Georgetown School of Medicine—as well as doing a great deal of graduate psychiatric teaching and supervision, but it was at the Washington School that his educational abilities were to flower. A relatively full presentation of his psychiatric formulations was delivered as the first William Alanson White Lectures of the school, which were later published (William Alanson White Association 1952). Only the students in the lecture courses he gave at the school had the opportunity to hear him develop these formulations further. The generalizations he made on the basis of his clinical observation were made explicit in a series of brilliant clinical discussions held (and recorded) for some years at Chestnut Lodge. In spite of his untimely death, these materials were sufficiently developed to provide a reasonably reliable statement of his views (1953; 1954; 1956).

Sullivan was very active as a consultant to the chief of the Selective Service before, and at the time of, the entry of the United States into World War ii. Only after the war, however, did he become fully involved in broader fields of public affairs. He characteristically called for a “remobilization for enduring peace and social progress.” Since the newly organized World Health Organization did not represent psychiatrists, Sullivan was active in helping to create the World Federation for Mental Health; he served on the preparatory commission which led to its foundation and which ensured the inclusion in it of other social and behavioral scientists. The newly organized United Nations Educational, Scientific, and Cultural Organization asked him to take part in what was to be an influential discussion of tensions which cause wars; he later continued as a consultant to UNESCO. But these activities did not prevent him from producing a stream of theoretical, analytical, and expository papers on the subject of his interpersonal theories. When he died suddenly in Paris, on a consultation, he left a mass of unpublished but relatively finished work which contains some of his most developed thought.

Sullivan never married; however, while in Baltimore he took James Sullivan into his home to live with him as an adopted son. His friendships were many, deep, and lasting and were usually intellectually productive. Yet, gifted with a trenchant, often ironic wit and not disposed to compromise, he also earned his full share of professional enemies. His love of music provided him with such relaxation as came his way; combined with an ability in physics, this love of music led to an early and lasting interest in electronics and recordings. He put this interest to use in his professional work, being among the first to try to record psychiatric interviews. He was also interested in experimental plant breeding and in horses and dogs. In his personal affairs, he was likely to be thoroughly impractical and at times became dependent on his friends. But personal difficulties would deter him only momentarily from developing a program or organizing a meeting whose necessity he had noted.

He was plagued almost throughout his adult life by poor health, suffering from heart disease, which twice was nearly fatal; the discovery of penicillin enabled him to live his last six, most productive years. His death was the result of a massive apoplexy. Although his thought led him far from his childhood beliefs, it was at his own request that he was buried with a Roman Catholic military service.

Alfred H. Stanton

[For the historical context of Sullivan’s work, see Psychiatry; Psychoanalysis, article on classical Theory; and the biographies of Benedict; Kraepelin; Meyer; Sapir; Thomas. For discussions relevant to Sullivan’s ideas, see Psychoanalysis, article on ego Psychology; Schizophrenia; and the biography Of Horney

BIBLIOGRAPHY

The bibliography for this article is combined with the bibliography of the article that follows.

II. INTERPERSONAL THEORY

Harry Stack Sullivan is known primarily for his theory of interpersonal relations, though he is also well known for his system of psychotherapy, to which it is closely related. Essentially, Sullivan’s theory holds that human experience primarily consists of interactions or transactions between people, whether the people are real, imaginary (as in many dreams and psychotic experiences), or a blend of both the real and imaginary. Thus, Sullivan’s theory tends to merge with social psychology except that it emphasizes problems which are connected with psychotherapy. He rejected individual psychology (the psychology of individual differences ) partly because he thought that individuality cannot be scientifically understood, since no individual can be understood apart from his relationships with others. However, in a given sociocul-tural context, what a person has “in common” with others, as it is manifested or made manifest in behavior, can be the object of scientific investigation. Sullivan did not profess to know the extent to which human behavior embodies principles or laws which transcend any given sociocultural setting. If there are such principles of human behavior, they appear to be as yet little understood, if at all.

Sullivan’s intellectual heritage included Freudian psychoanalysis, the psychiatry of Adolf Meyer, and American social psychology going back to Charles Morton Cooley. Such anthropologists as Edward Sapir and Ruth Benedict also exerted some influence on his thinking, though it seems to have been exaggerated. [See the biographies of Cooleyand Meyer.]

While Sullivan did not emphasize biological determinants—perhaps in reaction to Freud—his theory leaves room for them logically. He asserted that there are four generic factors which enter into, and have a causative influence on, any act: biological potentiality, maturation, the “results” of previous experience, and foresight. However, it should be added that no one yet-knows how much weight should be given to biological determinants.

Continuous effects of experience . It is hardly an exaggeration to say that an individual’s history influences every moment of his life, for it provides a dynamic structure and definition for his experiences. Since interpersonal relations begin at birth and are normally significantly correlated with the orderly sequence of biological maturation, Sullivan held that a thorough understanding of people’s interpersonal relations requires an understanding of the development of their personalities, as well as a study of their present relationships. It must be stressed that for Sullivan, personality development is primarily the ever-increasing elaboration and modification of the individual’s social relations in connection with the demands, limitations, and opportunities of his society. However, he did not agree with Freud that the basic structure of personality is laid down during the first five years of a person’s life. Personality structure takes fifteen or twenty, or even more than twenty, years for its essential development, depending partly on sociocultural conditions and partly on the idiosyncrasies of each individual’s career. Favorable or unfavorable influences may significantly modify development at any of the “eras,” or stages of development, which Sullivan distinguished. The quality and kind of interpersonal relations that one experiences in the home, school, playground, summer camp, and neighborhood are crucially important. But in human life there is nothing static. Everything changes. Some things change quickly; others, slowly and imperceptibly, although the latter too can have a cumulative effect. Hence, significant personality change, for better or for worse, can occur at any time in life, depending to a great extent on the nature and course of one’s social life —on one’s interpersonal relations. Therefore, from a Sullivanian point of view, social structure and social change, as they are encountered directly as well as indirectly, are very significant in an individual’s life experience. [See Personality, article on personality development

The development of the self

It is largely by means of the self that the limitations, facilitations, and opportunities of a society are mediated in personality. The self begins to develop in late infancy and grows through several stages—namely, infancy, childhood, the juvenile era, preadolescence, early adolescence, and late adolescence, normally culminating in maturity. But, these stages of development are not instinctually determined. Sullivan’s formulations held that before one can enter into any stage (except the first) in the normal course of development, one must have successfully “negotiated” the previous stage, for an arresting of development, due to environmental circumstances, can occur at any era and gravely handicap further growth. For such reasons, there are many “chronically juvenile” people who are chronologically adult.

Infancy . The first two stages are normally lived through in the home under the supervision of authoritative adults, on whom the powerless offspring depends not only for his physical survival but also for the necessities of psychological development. As Sullivan said, the mother or mothering one (”mother surrogate”) provides the basic patterns of being human. For example, an infant’s activities arising from the tension of needs are said to induce a certain tension in the mothering one, experienced by her (or him) as tenderness and as an impulsion to activities more or less suited to the relief of the infant’s needs. In the course of time, the manifest activities of the mothering one toward the relief of the infant’s needs come to be experienced by him as tender behavior. Thus, the needs of the infant, whose satisfaction requires the cooperation of the mothering one, take on the character of a general need for tenderness. Sullivan claimed that the need for tender behavior is an interpersonal need because its fulfillment requires the cooperation of another person who has a complementary need to manifest appropriate activity, a need to behave tenderly. [See Affection; Infancy.]

Empathy. It is not clear in Sullivan’s later work just how the tender attitude of the mothering one is communicated to the infant long before he can grasp the meaning of her behavior. In earlier lectures (1940-1945), he maintained that empathy, an as yet not understood mode of emotional contagion or communion between infant and mothering one, is the vehicle by which approving and disapproving attitudes are somehow conveyed, from ages 6 to 27 months. In later lectures (The Interpersonal Theory of Psychiatry 1953) Sullivan maintained that it is by means of empathy that anxiety is induced in the infant when the mothering one is anxious or otherwise upset or disapproving. The infant’s experiences of anxiety and his gradually developing power to distinguish between increasing and diminishing anxiety serve to canalize his behavior in various ways because he strives to avoid anxiety. Thus, as Leon Salzman (1962) has pointed out, Sullivan thought that anxiety is the “mainspring” of all human development. The self or self-dynamism develops in order to avoid or minimize anxiety and gain approval from the significant adults, who embody various cultural attitudes and values. [See Sympathy and empathy.]

Childhood . Childhood begins with the development of language—that is, the capacity for articulate speech, a development of several years’ duration. Since language is a very powerful too for communication, it contributes greatly to the development of the self. From early childhood, the social responsibility experienced by the mothering one brings about an alteration of tender behavior because of the necessity of “training” and educating the child along socially approved or permissible lines. Thus, certain behaviors of the child that were previously tolerated are now so strongly disapproved of that they become inhibited, sublimated, or, in some instances, dissociated (i.e., functionally split off from the developing self-dynamism).

The juvenile era . The juvenile era appears upon the maturation of the need for compeers. According to Sullivan, it is the time for becoming “social.” For the first time, limitations and peculiarities of the home are open to remedy by the school and by the society of one’s peers. Schooling is a wholly necessary experience for anyone growing up in a complex industrial society. The school not only imparts skills and subject matters but also, as a rule, provides the youngster with a broader outlook on life.

During the juvenile era, one begins to acquire supervisory patterns of the self, which pertain not only to moral conduct but to behavior generally. These supervisory patterns, developed in connection with authoritative figures in the home, school, and church, tend to make the juvenile more self-critical. Normally, there is a considerable elaboration of the self. The youngster learns patterns of cooperation, competition, and compromise.

Preadolescence . Preadolescence extends roughly from 8½ to 12 years of age. During this era, the capacity to love matures: a relationship in which the satisfactions and security of another person, a “chum,” a member of one’s own sex, are as important to one as one’s own satisfactions and security. The intimacy which flowers between the two chums has essentially nothing to do with sex. Preadolescence is not a homosexual stage. The preadolescent relationship encourages the “consensual validation” of personal experiences. For the first time, one can communicate freely with another human being. In the process of communication, personal inadequacies carried over from previous stages may be alleviated or overcome. [See Identity, psychosocial.]

Adolescence and late adolescence . In Western society, adolescence is a notoriously difficult period for many people. New adjustments have to be accomplished; new relationships, for which there is no precedent in personal experience, have to be established; and one is expected to put away childish things once and for all. So, adolescence is a time of trial and of opportunity. Many people who have developed various inadequacies during the previous eras founder in adolescence because they cannot handle the new demands and opportunities that life presents at this time. Early adolescence is the period from the “eruption” of true genital interest, experienced as lust, to the patterning of sexual behavior. Normally, there is a change in the type of object needed for the intimacy, previously experienced, during preadolescence, with a chum or close friend. The change is influenced by the concomitant maturation of the genital lust dynamism. There is a movement of interest toward members of the opposite sex.

In Sullivan’s formulation, late adolescence extends from the patterning of preferred genital activity to the establishment of a fully human repertory of interpersonal relations—both personal and social—insofar as opportunity permits. For a great many warped, immature people, the failure to achieve late adolescence is the “last blow,” the culminating defeat. [See Adolescence.]

The functions of the self system

It is self-system functions which prevent many people from getting very far in late adolescence. The self, which comes into being largely in order to protect or enhance one’s security, normally operates according to the structure and direction it has acquired progressively during the eras of development. It provides a framework for one’s experiences. The problems of adolescents are manifested as inadequate and inappropriate personifications of the self—that is, as warped “self concepts”; adolescents are unable to grasp the fact that their personifications of themselves are distorted, because any tendency to gain insight stirs up anxiety when, otherwise, the incongruity and inappropriateness of situations might be evident. Since no one can transcend his own experiences, no one with an inadequate personification of himself can perceive others with any particular refinement except in terms of his own personification and imagined criticisms of himself. These limitations ensure an inadequate grasp of what others are like. A person’s conceptions of others tend to be stereo-types, embodying prejudices, intolerances, fears, hatreds, aversions, and revulsions, which are some-times compensated for by spurious idealizations of others. Security operations (”defense mechanisms”) are employed extensively. [SeeDefense mechanisms; Self concept.] Maturity . Sullivan held that the difference between the normal and the mentally ill is one of degree only. But, in a mature person, the outstanding achievements of each of the developmental eras will be manifested. He will, for example, have the ability to relate intimately with another person or persons. He will have insight into the needs which customarily characterize one’s interpersonal relations, the circumstances appropriate to their satisfaction, and the more or less remote goals for whose attainments one will forgo current opportunities for satisfaction or for the enhancement of one’s prestige.

In Sullivan’s lectures, there seems to be too much emphasis on the restrictive functions of the self. His work with patients appears to have led him to a too limited and rigidly deterministic view of the entire personality. His theory does not leave enough room for growth and independence, although it can be rectified without being abandoned.

Anxiety . Anxiety is a central explanatory concept in interpersonal theory. Operationally, any felt threat to self-esteem constitutes anxiety or, more generally, any felt threat to one’s emotional well-being or interpersonal security. Anxiety arises and operates only in interpersonal relations. It is the motivating force of selective inattention, a process whereby one inadequately perceives or grasps relevant factors in many situations and, thereby, often fails to profit from experience. Selective inattention is a function of the self. [See Anxiety.]

Modes of experience .

A knowledge of Sullivan’s ideas on the three “modes of experience” provides a better grasp of his theory. As the self begins to develop, it tends to restrict and channel awareness, which is manifested soon after birth. This awareness is apparently of a very diffuse, unstructured kind, presumably quite different in many ways from the consciousness of adults, lacking the attributes of self-consciousness and the controls over awareness exercised by the supervisory patterns of the self.

Prototaxic mode. Some psychologists regard the period from birth to about 1 1/2 years of age as the “sensorimotor stage,” wherein the infant receives impressions and reacts without the intervention of a mediating self. Hence, there is no distinction between the self and the external world. Piaget called this state of affairs an undifferentiated absolute of self and environment (Allport 1961, p. 112). [See Developmental psychology, article on a theory of development; Sensory and motor development.]

Sullivan’s notion of the prototaxic, or “primitive,” mode of experience is similar but more elaborate. It forms the basis of memory (retention), although it ordinarily defies formulation and hence, discussion. The infant has not yet learned how to differentiate and categorize experience. Thus, distinctions in terms of “now,” “before,” “after,” “here,” “there,” “I,” “you,” etc., are lacking. Of course, he undergoes and registers experience, perhaps from moment to moment, but he is apparently unable to discriminate the order of events impinging on his senses. Sullivan thought that all the infant “knows” are momentary states, merging and vanishing like raindrops into the vast reservoir of memory. He may register earlier and later states but without discerning any serial connection between them. The alternation of need and satis-faction is first experienced in the prototaxic mode.

But, within the flux of experience, the infant gradually “prehends” or registers a recurrent pattern of events—such as the nipple-lips sequence— which serves as a sign that the state called satisfaction is about to supervene. Sullivan inferred that anxiety tension also is first experienced in the prototaxic mode.

The prototaxic mode is not confined to infancy. Sullivan “presumed” that from the beginning to the end of life individuals continue to undergo these momentary prototaxic experiences (1953). If Sullivan’s assumption is valid, it may be that all diferentiated experiences occur in connection with, and rest on, the prototaxic mode. He thought that some dream processes, certain schizophrenic episodes in which he held that the person’s experiences are “cosmic,” and perhaps some experiences that are classed as mystical occur in the prototaxic mode (personal communication to the writer in 1945).

Parataxic mode. With increasing maturation and learning, the infant gradually begins to make some discrimination between himself and the world. He learns to make elementary discriminations in his experience. Thus, the original global experience is sundered into parts or various, di-verse aspects, which, however, are not logically connected. They may, or may not, occur together, depending on circumstances. In the language of traditional psychology, the sundered or disconnected aspects of experience may become associated when circumstances (categorized in terms of laws of association) permit. These “elements” of experience are lived or perceived as concomitant but not yet (if ever) recognized as being connected or related in any sort of orderly fashion; this is experience in the parataxic mode. The youngster, because of his limited store of experience and knowledge, takes this mode for granted and, in a manner of speaking, as the natural way of things.

Suppose a youngster is beaten or otherwise mis-treated by his mother for no evident cause—a not too rare occurrence. And suppose further that shortly after, the youngster is subjected to “sweetness and light” and “love,” also without evident cause. Let us assume that the mother is a bit im-mature and “neurotic” and that this sequence of behavior is a common occurrence. To an intelligent adult observer her behavior is inconsistent—is, in fact, senseless in relation to the proper upbringing of a child. To the youngster, there is no inconsistency. That is the way things happen; that is the way life is, although the child may wish things were different or try to circumvent them. While this illustration may seem oversimplified, it is essentially the sort of thing that happens in countless homes where one or both parents are immature and, perhaps, anxiety-ridden or otherwise disturbed. A recurrent pattern of this sort will often be assimilated by the child into his developing self system. Thus, the child may for years experience the incongruous and irrational behavior of his parents without ever questioning it. Furthermore, even in more normal homes, children are subjected to various kinds of irrational behavior, chiefly because the parents reflect the inadequacies, prejudices, and superstitions, as well as the virtues, of their sociocultural background. The life of almost any person is inextricably bound up with the social order of which he is a member.

Selective inattention, which, as suggested above, often makes it difficult to profit from experience, including formal education, occurs in the parataxic mode. Illusory me-you patterns, or “parataxic distortions,” occur in the parataxic mode; they often manifest themselves in our dealings with strangers, with acquaintances, perhaps with friends, and certainly in “romantic” attachments, in which the partners often sustain a great many illusions about each other, as well as in disturbed marital relation-ships. Often, it is anxiety which stimulates these distorted perceptions. But, experience in the parataxic mode also is often a normal occurrence. Much of our living and talking is carried on in this mode.

Syntaxic mode. In the main, any experience that one can discuss occurs in either the parataxic or syntaxic mode. The syntaxic mode begins to appear at the end of infancy or the beginning of childhood and involves an appeal to principles that are accepted as true by the hearer—what Sullivan calls consensual validation. “A consensus has been reached,” he says, “when the infant or child has learned the precisely right word for a situation, a word which means not only what it is thought to mean by the mothering one, but also means that to the infant” (1953, pp. 183-184). Summarily, what distinguishes syntaxic operations from every-thing else that occurs between people is that under appropriate circumstances, they can work quite precisely.

Assumptions underlying Sullivan’s theory

In order to round out this outline of Sullivan’s theory, I wish to point out certain assumptions underlying his theory. First, any living organism may be “considered” in relation to three ultimate factors: its “communal” existence with a necessary environing medium, its organization, and its functional activity. By and large, while Sullivan recognized the communal existence of man at all levels (physical, biological, psychological, sociocultural), he stressed the psychological and sociocultural levels. In regard to organization, the smallest useful abstraction in the study of the human being is the “dynamism,” denned as “the relatively enduring pattern of energy transformations which recurrently characterize the organism in its duration as a living organism” (1953, p. 103). Personality may be conceived as a network of dynamisms hierarchically arranged. Sullivan held that the dynamisms of interest to the psychiatrist are the relatively en-during patterns of energy transformations which recurrently characterize interpersonal relations. They constitute personality, of which the self is a substructure or subdynamism. Since structure and function are two aspects of the same thing in nature, functional activity also is conceived in terms of dynamisms. Thus, love and hate are dynamisms, involving characteristic patterns of activity in interpersonal relations. [See Personality, article on THE FIELD.]

A second assumption is that, given a biological substrate, man is a sociocultural being. As sociologists have pointed out, man, and man alone, has a culture. One becomes a human being through the processes of acculturation. Complementary to this is the fact that man has a superior neuro-psychic structure. Thus, man can employ signs and symbols as no animal can, making possible the marvelous development of mind.

A third assumption is that human beings are all much more human than unique, whether they are mentally healthy, mentally disordered, or whatever. Partly for this reason, Sullivan ignored the psychology of individual differences. Neither would he countenance the notion that people who suffer mental illness, such as schizophrenics, are sub-human.

A fourth assumption is that human behavior on both the biological and cultural levels is directed toward the maintenance of euphoria, a state of well-being. Experiencing needs and anxiety lowers one’s euphoria and motivates behavior for a resto-ration of well-being or, insofar as circumstances permit, for the maintenance of a level of well-being at which one can function adequately. To be sure, euphoria is never absolute. On the physiological level, there is a more or less rhythmic cycle of euphoria and the tension of needs. But, anxiety is a much more complex affair, having to do basically with cultural demands, expectations, restrictions, and opportunities. Among other things, anxiety interferes with the satisfaction of needs. For ex-ample, it may make one nauseous or sexually frigid or impotent. If severe and prolonged, it tends to undermine whatever self-confidence and self-assurance one possesses. It very frequently hinders the development of various capacities.

A fifth assumption is that in the processes of acculturation, physiological needs become “conditioned” in various complex ways. A basic drive such as hunger becomes, in the course of personality development, thoroughly “invaded” and structured. A much more spectacular example is the sexual drive, which can be profoundly distorted, inhibited, and, in many cases, denied satisfaction. The meaning of sexual behavior is learned. Interpersonal relations provide definition and direction to sexual behavior.

Finally, one of the most significant of all of Sullivan’s “theorems” is the theorem of reciprocal motivational patterns: “Integration in an interpersonal situation is a reciprocal process in which (1) complementary needs are resolved or aggravated; (2) reciprocal patterns of activity are developed or disintegrated; and (3) foresight of satisfaction, or rebuff, of similar needs is facilitated” (1953, p. 198).

A few illustrations will make this theorem clearer. For example, a baby has a need for tenderness, and the normal mother has a need to give tenderness. The baby gradually learns more and more effective nursing behavior, while the mother learns—if she has not already learned—the reciprocal patterns of tender behavior. Later on, in childhood, the youngster may discover that when he manifests a particular need, he is rebuffed, and then all evidence (manifest activity) of the need disappears. Instead, he may manifest mischievous or malevo-lent behavior if some vital need such as the need for tenderness has been painfully thwarted by the mothering one. Finally, he will anticipate the fulfillment or thwarting of his needs, in accordance with previous experience.

This theorem is applicable to every stage of development and, to a degree, throughout life. Furthermore, it provides a handle for exploring interpersonal relations and their distortions as no other known theory does. [See Interaction, article on interaction and personality.]

Mental illness and psychotherapy

Sullivan’s interpretation of functional mental illness is logically based on his theory of interpersonal relations. He did not think there is any absolute difference between the experience and behavior of normal people and the mentally ill. Even the experiences of schizophrenics are essentially no different from what perhaps everyone experiences during sleep at some time in his life—namely, nightmares. Functional mental illness, like mental health, is an outcome of interpersonal relations. Essentially, mental illness is an expression or manifestation of interpersonal relations complicated by parataxic distortions (illusory meyou patterns), dissociated emotional and motivational patterns, and an enormously time-consuming and energy-consuming set of security operations. It is these things which result in the “difficulties in living” from which patients suffer. Mental illness ultimately stems from, first and foremost, inadequacies and irrational restrictions in the upbringing of the patient and, second, inadequacies and irrational restrictions in the society of which the patient is a member—shortcomings which are sometimes enhanced by rapid and con-fusing social changes. [See Mental DISORDERS; Neurosis.]

Sullivan regarded as damnable and destructive the point of view that the person who comes to the psychiatrist for help is a “case.” The patient is, rather, a suffering human being, a victim of circumstances over which he had little or no control. On the other hand, sentimentality has no place in therapy. Patients are not cured or helped by “love.”

The nature of the person’s problems or difficulties dictates the procedures and techniques employed by the psychiatrist in treatment. These difficulties do not have to do with sexual problems, except incidentally, although the patient may pre-sent sexual problems as his actual difficulties. Sexual problems are symptoms of disordered interpersonal relations. However, when they are properly understood, they may provide clues to what is impairing the patient’s ability to live with people and, in the process of treatment, may disappear.

The psychiatric interview. Psychotherapy is an interview: an interpersonal situation of a special kind. In the interview, the psychiatrist or inter-viewer is always a “participant observer”—never simply a “mirror,” as Freud thought. The interviewer must at all times be alert to the fact that he is interacting with his patient and that the situation in which he is involved often gives rise to many parataxic distortions in his patient. To the extent that the psychiatrist is unconscious of his participation in the interview, he does not know or understand what is happening. Even silence is a form of interaction, but the silence of the inter-viewer on certain occasions during the interview can be fatal to further therapy, since, for example, it may signify to the patient that his therapist does not understand. On the other hand, Sullivan taught that silence at times is preferable to statements that reflect lack of understanding. Therapy is not effected by word magic. There must be no hocuspocus in word or deed and no “social hokum” of any kind.

The psychiatric interview is, then, a situation of a primarily vocal, though not merely verbal, communication, in a more or less voluntarily integrated relationship between two people, on a progressively unfolding expert-client basis. Its purpose is the progressive elucidation of the patient’s characteristic patterns of living, patterns that are experienced as very troublesome or especially valuable. Perhaps needless to say, it is a process from which the patient expects to derive benefit. In other words, therapy aims at significant improvement of the patient’s interpersonal relations so that he will be appreciably more able to achieve the satisfactions and security he needs. At the same time, it aims at the removal of handicaps which stand in the way of the client’s effective use of his abilities. Sullivan’s guiding principles in psychiatric diagnosis and prognosis were to determine what the outstanding difficulties in living and the (potential or actual) abilities or liabilities and assets of the patient are, and to determine what can or might be done by primarily vocal, psychological therapeutic procedures. These have to be learned in a series of consultations. [See Interviewing, article on therapeutic interviewing.]

In seeking the information the psychiatrist needs from the patient, he must realize the necessity of contending with the client’s self-system functions, evolved, however inadequately, to protect self-esteem and to ward off anxiety. Sullivan said:

Unless the interviewee is revealing data bearing on his aptitudes for living, on his successes, or on his unusual abilities as a human being, the operations of the self-system are always in opposition to achieving the pur-pose of the interview. That is, it always opposes the clear revelation of what the interviewee regards as handicaps, deficiencies, defects, and what not, and it does not facilitate communication except in the realms where that which is communicated clearly enhances his sense of well-being, his feeling of making a favorable impression. (1954, p. 104)

However, it should never be forgotten that the self also stands in the way of unfavorable change. Hence, clumsy, inept handling of the patient’s self-system functions may precipitate graver problems. When this happens, the patient may have greater and greater difficulty in having a restful sleep, may become more and more discouraged and “sicker,” or may resort to dissociation. Consequently, the therapist must employ his skill to avoid arousing unnecessary anxiety, while obtaining dependable indices of what the interviewee considers to be his misfortunes, unfortunate incidents in the past, handicaps, etc.

It is the pattern of the course of events in the interview which provides the data that the psychiatrist must obtain if he is to help the patient. In other words, he observes the ways in which the interpersonal occurrences (statements, questions, emotional expressions, silences, pauses) follow one another, what striking inconsistencies occur, the timing and stress of what the patient says, the slight misunderstandings that may happen on occasion, the times when the patient gets off the subject, perhaps the volunteering of information not asked for, etc. From such events the psychiatrist learns to infer the information he requires. Perhaps needless to say, he is skilled in the eliciting of information as well as in the evaluation of the client’s statements.

Free association. With any patient, the technique of free association has to be used with discrimination and discretion, if only because many people can ramble on and on indefinitely—”free associating” until they grow old or bankrupt. This technique is generally not suited to certain kinds of patients, such as schizophrenics and obsessional neurotics. Where free association was useful, Sullivan employed it when he wanted to know something that the patient was unable to recall be-cause it was “repressed.” In this way, the patient’s blind spots were attacked, and he often learned that his personality had the faculty to present unknown data by more or less free flow of thought.

Sullivan mapped out the areas of the patient’s experience which, normally, the psychiatrist must deal with in therapy. These are (a) current events (including his current job) in the patient’s life, outside the treatment situation; (b) his current relations with the psychiatrist in the treatment situation; and (c) the events of the patient’s past. It is perhaps not difficult to understand why current relationships provide information regarding the patient’s difficulties, but one may wonder about the reasons for delving into the past. One reason is that the patient’s difficulties may be masked by a variety of sophisticated operations or stratagems. A knowledge of the past provides information about the handicaps he has, since it reveals when arrests of development occurred and their probable consequences. For example, if a client has gotten bogged down in the juvenile era, he may be very facile at competition, cooperation, and compromise but have little or no ability to achieve intimacy with people. That tells one a great deal, partly because intimacy is probably the greatest source of happiness in life and a bulwark against misfortune, suffering, and sorrow.

The length of time required for therapy varies, of course, with the individual and his psychiatrist’s skill. If the therapy proceeds successfully, there is normally a growing insight into one’s interpersonal relations—although sometimes patients are benefited without much insight—and a gradual modification or reorganization of one’s way of life.

The Psychiatric Interview (1954) gives an excellent formal outline of Sullivan’s therapeutic procedures and techniques and is brilliantly supplemented by a lecture given by Mary Julian White, entitled “Sullivan and Treatment,” which vividly portrays Sullivan in action with patients (1952).

Because of its power, one may surmise that interpersonal theory will be considerably elaborated and refined in the coming years.

Patrick Mullahy

[Other relevant material may be found in Interaction, article on interaction and personality; Interviewing, article on Therapeutic INTERVIEWING; Motivation, article on Human MOTIVATION; Personality, article on Personality DEVELOPMENT; Psychiatry; Psychoanalysis; Self CONCEPT

BIBLIOGRAPHY

Allport, Gordon W. 1961 Pattern and Growth in Personality. New York: Holt.

Klineberg, Otto 1952 Discussion. Pages 215-221 in William Alanson White Association, The Contributions of Harry Stack Sullivan: A Symposium on Inter-personal Theory in Psychiatry and Social Science. New York: Hermitage.

Salzman, Leon 1962 Developments in Psychoanalysis.

New York: Grune & Stratton.

Sullivan, Harry Stack (1924) 1962 Schizophrenia; Its Conservative and Malignant Features: A Preliminary Communication. Pages 7-22 in Harry Stack Sullivan, Schizophrenia as a Human Process. New York: Norton.

Sullivan, Harry Stack (1924-1933)1962 Schizophrenia as a Human Process. New York: Norton. → Contains Sullivan’s major articles from 1924 to 1933, with an introduction by Helen Swick Perry. SULLIVAN, Harry Stack (1931a) 1962 Socio-Psychiatric Research: Its Implications for the Schizophrenia Problem and for Mental Hygiene. Pages 256-270 in Harry Stack Sullivan, Schizophrenia as a Human Process. New York: Norton.

Sullivan, Harry Stack (1931b) 1962 The Modified Psychoanalytic Treatment of Schizophrenia. Pages 272-294 in Harry Stack Sullivan, Schizophrenia as a Human Process. New York: Norton.

Sullivan, Harry Stack (1938)1964 The Data of Psychiatry. Pages 32-55 in Harry Stack Sullivan, TheFusion of Psychiatry and Social Science. New York: Norton.

Sullivan, Harry Stack (1940-1945) 1953 Conceptions of Modern Psychiatry. With a critical appraisal of the theory by Patrick Mullahy. 2d ed. New York: Norton. → First published in the February 1940 and May 1945 issues of Psychiatry.

Sullivan, Harry Stack 1949 Psychiatry: Introduction to the Study of Interpersonal Relations. Pages 98-121 in Patrick Mullahy (editor), A Study of Interpersonal Relations. New York: Hermitage.

Sullivan, Harry Stack 1953 The Interpersonal Theory of Psychiatry. Edited by Helen Swick Perry and Mary Ladd Gawel. New York: Norton.

Sullivan, Harry Stack 1954 The Psychiatric Interview. Edited by Helen Swick Perry and Mary Ladd Gawel. New York: Norton.

Sullivan, Harry Stack 1956 Clinical Studies in Psychiatry. Edited by Helen Swick Perry, Mary Ladd Gawel, and Martha Gibbon. New York: Norton.

Sullivan, Harry Stack 1964 The Fusion of Psychiatry and Social Science. With an introduction by Helen Swick Perry. New York: Norton.

Thompson, Clara (1949) 1962 Harry Stack Sullivan, the Man. Pages xxxii-xxxv in Harry Stack Sullivan, Schizophrenia as a Human Process. New York: Norton. → Contains biographical material by the best informed of his early associates.

White, Mary Julian 1952 Sullivan and Treatment. Pages 117-150 in William Alanson White Association, The Contributions of Harry Stack Sullivan. New York: Hermitage.

William Alanson WHITE ASSOCIATION 1952 The Contributions of Harry Stack Sullivan: A Symposium on Interpersonal Theory in Psychiatry and Social Science. Edited by Patrick Mullahy. New York: Hermitage.

Harry Stack Sullivan

1892-1949
American psychiatrist who based his approach to mental illness primarily upon interpersonal theory.

Harry Stack Sullivan, born on February 21, 1892, in the farming community of Norwich, New York, was the only surviving child of a poor Irish farmer. His childhood was apparently a lonely one, his friends and playmates consisting largely of the farm animals. His mother, who was sickly, was unhappy with the family's poor situation, and is reported to have shown her son little affection. These personal experiences seem to have had a marked effect on Sullivan's professional views in later life.

Sullivan took his medical degree in 1917 at the Chicago College of Medicine and Surgery. In 1919 he began working at St. Elizabeth's Hospital in Washington, D.C., with William Alanson White, an early American psychoanalyst. Clinical research at Sheppard and Enoch Pratt Hospital occupied a portion of Sullivan's life, as did an appointment in the University of Maryland's School of Medicine. In 1936, he helped establish the Washington School of Psychiatry. In later life, he served as professor and head of the department of psychiatry in Georgetown University Medical School, president of the William Alanson White Psychiatric Foundation, editor of Psychiatry, and chairman of the Council of Fellows of the Washington School of Psychiatry.

Sullivan's approach to psychiatry emphasized the social factors which contribute to the development of personality . He differed from Sigmund Freud in viewing the significance of the early parent-child relationship as being not primarily sexual but, rather, as an early quest for security by the child. It is here that one can see Sullivan's own childhood experiences determining the direction of his professional thought.

Characteristic of Sullivan's work was his attempt to integrate multiple disciplines and ideas borrowed from those disciplines. His interests ranged from evolution to communication, from learning to social organization. He emphasized interpersonal relations. He objected

to studying mental illness in people isolated from society. Personality characteristics were, he felt, determined by the relationship between each individual and the people in his environment . He avoided thinking of personality as a unique, individual, unchanging entity and preferred to define it as a manifestation of the interaction between people.

On January 14, 1949, while returning from a meeting of the executive board of the World Federation for Mental Health , Sullivan died in Paris. He was buried in Arlington National Cemetery.

Further Reading

Mullahy, Patrick, ed. The contributions of Harry Stack Sullivan: a symposium on interpersonal theory in psychiatry and social science. 1952.

Ellenberger, Henri F. The discovery of the unconscious: the history and evolution of dynamic Psychiatry. 1970.

Chapman, A. H. (Arthur Harry). Harry Stack Sullivan: his life and his work. New York: Putnam, 1976.

Chatelaine, Kenneth L. Good me, bad me, not me: Harry Stack Sullivan: an introduction to his thought. Dubuque, Ia.: Kendall/Hunt Pub. Co., 1992.

Chatelaine, Kenneth L. Harry Stack Sullivan, the formative years. Washington, DC: University Press of America, 1981.

Harry Stack Sullivan

The American psychiatrist Harry Stack Sullivan (1892-1949) based his approach to mental illness primarily upon interpersonal theory.

Harry Stack Sullivan, born on Feb. 21, 1892, in the farming community of Norwich, N.Y., was the only surviving child of a poor Irish farmer. His childhood was apparently a lonely one, his friends and playmates consisting largely of the farm animals. His mother, who was sickly, was unhappy with the family's poor situation, and is reported to have shown her son little affection. These personal experiences seem to have had a marked effect on Sullivan's professional views in later life.

Sullivan took his medical degree in 1917 at the Chicago College of Medicine and Surgery. In 1919 he began working at St. Elizabeth's Hospital in Washington, D.C., with William Alanson White, an early American psychoanalyst. Clinical research at Sheppard and Enoch Pratt Hospital occupied a portion of Sullivan's life, as did an appointment in the University of Maryland's School of Medicine. In 1936 he helped establish the Washington School of Psychiatry. In later life he served as professor and head of the department of psychiatry in Georgetown University Medical School, president of the William Alanson White Psychiatric Foundation, editor of Psychiatry, and chairman of the Council of Fellows of the Washington School of Psychiatry.

Sullivan's approach to psychiatry emphasized the social factors which contribute to the development of personality. He differed from Sigmund Freud in viewing the significance of the early parent-child relationship as being not primarily sexual but, rather, as an early quest for security by the child. It is here that one can see Sullivan's own childhood experiences determining the direction of his professional thought.

Characteristic of Sullivan's work was his attempt to integrate multiple disciplines and ideas borrowed from those disciplines. His interests ranged from evolution to communication, from learning to social organization. He emphasized interpersonal relations. He objected to studying mental illness in people isolated from society. Personality characteristics were, he felt, determined by the relationship between each individual and the people in his environment. He avoided thinking of personality as a unique, individual, fixed unchanging entity and preferred to define it as a manifestation of the interaction between people.

On Jan. 14, 1949, while returning from a meeting of the executive board of the World Federation for Mental Health, Sullivan died in Paris. He was buried in Arlington National Cemetery.

Further Reading

Two quite different works relating to Sullivan's contributions to psychiatric thought and to his place in its history are Patrick Mullahy, ed., The Contributions of Harry Stack Sullivan: A Symposium on Interpersonal Theory in Psychiatry and Social Science (1952), and Martin Birnbach, Neo-Freudian Social Philosophy (1961). Sullivan and his work are discussed in Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (1970).

Additional Sources

Chapman, A. H. (Arthur Harry), Harry Stack Sullivan: his life and his work, New York: Putnam, 1976.

Chatelaine, Kenneth L., Good me, bad me, not me: Harry Stack Sullivan: an introduction to his thought, Dubuque, Ia.: Kendall/Hunt Pub. Co., 1992.

Chatelaine, Kenneth L., Harry Stack Sullivan, the formative years, Washington, DC: University Press of America, 1981.

Perry, Helen Swick, Psychiatrist of America, the life of Harry Stack Sullivan, Cambridge, Mass.: Belknap Press, 1982. □

SULLIVAN, HARRY STACK (1892-1949)

American psychiatrist and psychoanalyst, born on February, 21, 1892, in Norwich, New York, and died on January 14, 1949, in Paris.

The only son of a farming couple in rural upstate New York, Sullivan had a very lonely childhood and went through a deep psychological crisis upon entering Cornell University. He graduated from medical school in Chicago in 1917, but only in 1921 did he start working in psychiatry, under William Alanson White (1870-1937) at St. Elisabeth's Hospital, Washington, D.C. Between 1923 and 1930 he worked at Sheppard-Pratt Hospital, Maryland, where he devised a very successful combination of milieu and individual therapy aimed at young schizophrenic patients. A good friend of Abraham Brill and a charter member of the Washington Psychoanalytic Society (1930), Sullivan progressively withdrew from Freudian psychoanalysis in order to concentrate on initiatives like the Washington School of Psychiatry (1936), the journal Psychiatry (1938), and on the development of his own interpersonal theory. In the early 1940s, on the invitation of Dexter Bullard, he worked as teacher and supervisor at Chestnut Lodge Hospital, where he influenced a whole series of colleagues, among them Frieda Fromm-Reichmann (1889-1957).

In New York City in 1943, Sullivan, together with Clara Thompson, Erich Fromm, Frieda Fromm-Reichmann, and Janet and David Rioch founded the William Alanson White Institute, which became the major institution committed to the teaching and development of interpersonal psychoanalysis.

With the exception of Conceptions of Modern Psychiatry (1940), six of his seven books available in English were published posthumously. The Psychiatric Interview is considered a classic and is still widely read.

Marco Conci

See also: Dismantling; Object relations theory; Schizophrenia; Second World War: The effect on the development of psychoanalysis.

Bibliography

Perry, Helen Swick. (1982). Psychiatrist in America. The life of Harry Stack Sullivan. Cambridge, MA: The Belknap Press of Harvard University.

Sullivan, Harry Stack. (1940). Conceptions of modern psychiatry. Washington, DC: W.A. White Psychiatric Foundation.

——. (1953). Interpersonal theory of psychiatry. New York: W.W. Norton.

——. (1954). The psychiatric interview. New York: W.W. Norton.

——. (1962). Schizophrenia as a human process. New York: W.W. Norton.