SULLIVAN, Harry Stack (1892-1949).

American psychiatrist, (graduated as M.D. Chicago College of Medicine and Surgery, 1917). He is remembered for his extension of Freudian psychoanalysis to the treatment of patients with severe mental disorders, particularly schizophrenia. In his work on the subject of schizophrenics, Sullivan argued that such individuals were not incurable, and that cultural forces were largely responsible for their condition. Sullivan’s work greatly influenced that of R.D. Laing.

To understand Sullivan’s work, it helps to recognize the influences of Sandor Ferenczi and his mentor, Adolf Meyer. Meyer, like Sullivan, believed in “participative observation” as opposed to psychotherapy or intrusive therapies such as insulin shock, electro-shock or lobotomy. For example, Meyer taught as follows:

• Primarily, your point of reference should be life itself and not the imagined cesspool of the unconscious.
• One should not be particularly interested in data concerning which one has to accept the fact that the dice have already been cast and that life is practically nothing but the dance of factors largely settled by heredity and constitution.
• One should struggle against the false conception of science, and not depend too much on the test tube and microscope. Psychiatry has to be found in the function and the life of the people.

The Western Buddhist leader, Mark Epstein notes that Harry Stack Sullivan talked about the belief in a unique personal individuality as “the mother of all illusions”, saying

“Sullivan was the founder of what became known in America as the interpersonal school of psychotherapy. He believed in the existence of relationships, but not of individuals. The British child analyst D.W. Winnicott expressed much the same thing when he said that babies don’t exist, only baby-mother dyads. We exist in relationships, Sullivan realized, not as individuals”.

A few observations on the philosophy of Harry Stack Sullivan:

A healthy personality is the result of healthy relationships. This was the cornerstone of Sullivan's theory of interpersonal relations. Sullivan spent his life working with patients, psychiatrists, and social psychologists to prove that people are influenced mostly by their relationships with others. Sullivan believed that personality develops according to people's perception of how others view them. "Others" for Sullivan included personifications, like the government, as well as imaginary and idealized figures.

During his clinical work Sullivan came to appreciate the immense impact that interpersonal relationships have on personality development. He also noted that people tend to carry distorted views and unrealistic expectations of others into their relationships. As a psychotherapist, his solution was to become a "participant observer" with his clients, a more active therapeutic stance than the psychoanalytic "blank screen" popular at the time. In this role, Sullivan would focus on observable interpersonal behaviour, including the client's reactions to the therapist. He believed that emotional well-being could be achieved by making an individual aware of his dysfunctional interpersonal patterns.

Sullivan called his approach an interpersonal theory of psychiatry because he believed psychiatry is the study of what goes on between people.  This is in contrast to Freud’s paradigm that focuses on what goes on inside people. 

For Sullivan, relationships are primary.  Personality is a hypothetical entity that cannot be observed or studied apart from interpersonal situations wherein it is made manifest.  The only way personality can be known is through the medium of interpersonal interactions.  Therefore the unit of study is not the individual person, but the interpersonal situation.  Since personality is defined by what it does in an interpersonal field, there is no I without a Thou, as Buber noted.

Motivation: Sullivan proposed two sources of motivation: the pursuit of satisfactions and the pursuit of security.

On the one hand, we seek to maximize the satisfaction of mainly biological bodily needs.  The goal here is to reduce tension.  This is similar to Freud’s homeostatic hunch that humans want to maximize pleasure and minimize displeasure.

On the other hand, we desire to minimize insecurity that arises from cultural and social needs.  In Sullivan’s model, the main motive force of personality is the avoidance and reduction of anxiety.  We seek to avoid a greater anxiety by selecting a lesser anxiety.

Anxiety: Where does this anxiety come from?  According to Sullivan, it’s contagious.  We pick it up from our caretakers – usually our mother.  Infants are born with an empathic capacity to sense the attitudes and feelings of significant people around them, which leads them to experience two different states.

• Infants experience euphoria when they sense approval from others.  A non-anxious persona is experienced as the good mother.  And the good me is the one who evokes approval, tenderness, and less anxiety in the other. This is accompanied by a sense of security and relaxation.
• Infants experience dysphoria when they sense disapproval and derogation from others.  An anxious persona is experienced as the bad mother.  And the bad me is the one who evokes disapproval.  This is accompanied by mounting anxiety.

Sullivan describes one additional infant state, the non-me, which is felt as the unknown, the uncanny, the unintegrated because it is dreadful and repressed.  This state is accompanied by intense anxiety such as nightmares and schizophrenic experiences.  To avoid this much anxiety, we try to limit awareness to just the good me and bad me states.

Anxiety, then, is caught from our caretakers.  It is an interpersonal phenomenon rooted in the expectation of derogation and rejection by others or by oneself. Anxiety, in turn, arouses the need for security.

Mental Disorder: In Sullivan’s system, mental disorder refers to interpersonal processes either inadequate to the situation or excessively complex because of illusory persons also integrated in the situation.  Unresolved situations from the past colour our perception of present situations and over-complicate action in them. This is Sullivan’s description of transference. We interpret our current relationships through the internal representations or schemas constructed from our earlier interactions. We overlay our past templates on our present scenarios. The remedy is to look at the lenses through which we perceive our interpersonal world and then interact more Zen-like with one real person at a time.

Sullivan makes the point that, paradoxically, more security may ensue from abandoning a complex security-seeking process than was ever achieved by it.

Mental Well-being: For Sullivan, mental health can be measured by the balance between the pursuit of satisfactions and security.  Life is lived between our needs for satisfaction and security.  Satisfaction leads to constructive integrations with others and the joyful exercise of functions. Our ability to attain satisfactions according to socially approved patterns causes a feeling of well-being, self-approval, and security. If satisfactions are not fulfilled, then we feel anxious, insecure, and uneasy. Insecurity leads to non-constructive integrations and self-absorbed fantasy and illusion.

Beginnings of the Self-System: Successful training of the functional activity of the anal zone of interaction accentuates a new aspect of tenderness -- namely, the additive role of tenderness as a sequel to what the mothering one regards as good behaviour. Now this is, in effect -- however it may be prehended by the infant -- a reward, which, once the approved social ritual connected with defecating has worked out well, is added to the satisfaction of the anal zone. Here is tenderness taking on the attribute of a reward for having learned something, or for behaving right.

Thus the mother, or the parent responsible for acculturation or socialization, now adds tenderness to her increasingly neutral behaviour in a way that can be called rewarding. I think that very, very often the parent does this with no thought of rewarding the infant. Very often the rewarding tenderness merely arises from the pleasure of the mothering one in the skill which the infant has learned ... (Source: The Interpersonal Theory of Psychiatry)

Heterosexual Intimacy and Lust: Sullivan notes a problem of timing:

Women undergo the puberty change somewhat in advance of men, and this leads to a sort of stutter in developmental progress between the boys and the girls in an age community [like the school] so that by the time most of the boys have gotten really around to an interest in girls, most of the girls are already fairly wound up in their problems about boys. (Source: The Interpersonal Theory of Psychiatry)

Then, in the Early Adolescence period, Sullivan discusses the “collisions between the intimacy need and lust”

A much more common evidence of the collision of these two powerful motivational systems is seen among adolescents in this culture as the segregation of object persons, which is in itself an extremely unfortunate way of growing up. By this I refer to the creating of distinctions between people toward whom lustful motivations can apply, and people who will be sought for the relief of loneliness -- that is, for collaborative intimacy, for friendship. The classical instance is the old one of the prostitute and the good girl. ... Nowadays, the far more prevalent distinction is between sexy girls and good girls, rather than this gross division into bad women and good women. But no matter how it comes about that the other sex is cut up into two groups -- one of which can satisfy a person's loneliness and spare him anxiety, while the other satisfies his lust -- the trouble with this is that lust is a part of personality, and no one can get very far at completing his personality in this way. Thus satisfying one's lust must be at considerable cost to one's self-esteem, since the bad girls are unworthy and not really people in the way that good girls are. So wherever you find a person who makes this sharp separation of members of the other sex into those who are, you might say, lustful and those who are non-lustful, you may assume that this person has quite a cleavage with respect to his genital behaviour, so that he is not really capable of integrating it into his life, simply and with self-respect.

These sundry collisions that come along at this stage may be the principle motive for pre-adolescents or very early adolescents getting into "homosexual" play, with some remarkable variations. But a much more common outcome of these various collisions -- these difficulties in developing activity to suit one's needs -- is the breaking out of a great deal of auto-sexual behaviour, in which one satisfies one's own lust as best one can; this behaviour appears because of the various inhibitions which have been inculcated on the subject of freedom regarding the genitals. Now this activity, commonly called masturbation, has in general been rather severely condemned in every culture that generally imposes marked restrictions on freedom of sexual development. That's very neat, you see; it means that adolescence is going to be hell whatever you do, unless you have wonderful preparation for being different from everyone else -- in which case you may get into trouble for being different. (Source: The Interpersonal Theory of Psychiatry)

Other Excerpts from Sullivan’s writings:

· When the satisfaction or security of another person becomes as significant to one as is one’s own satisfaction or security, then the state of love exists. So far as I know, under no other circumstances is a state of love present, regardless of the popular usage of the word.

(Source: Conceptions of Modern Psychiatry)

· The self is made up of reflected appraisals. (ibid)

· Apathy is a curious state. It is a way used to survive defeat without material damage, although if it endures too long one is damaged by the passage of time. Apathy seems to be a miracle of protection by which a personality in utter fiasco rests until it can do something else. (Source: The Psychiatric Interview)

· Normal Grieving: The first day after the loss, since intimacies interpenetrate so much of life, it is almost impossible not to be reminded of the loss by any little thing – even the position of the saltcellar on the table, for instance. But each time this happens, the power of that particular association to evoke the illusion of the absent one is lessened….Thus, immediately after a loss, the position of the saltcellar may be reminiscent to you of dear John, because it was always placed halfway between you and John. But the next time you see the saltcellar, you might become a little bored; its power to evoke dear John is diminished by the very fact that you have clarified the associational link with him. And so it goes: by erasing one tie after another, and releasing the personality to move on into life and seek satisfactions by co-operation or collaboration with other people, grief protects us from making a retreat….The experience is, of course, an extremely painful one, but the pain diminishes day by day; fewer and fewer things have the power to evoke this erasing process, which I insist grief is. (Source: Clinical Studies in Psychiatry)

• Morbid Grief: Like all other dynamisms of living, grief can be distorted into a horrible caricature of its functions by certain complex operations. It becomes dangerous and destructive to the extent that the erasing function is abandoned and grief becomes an adequate mode of life….Under those circumstances, the self, of course, is not engaged in erasing processes, for the self-system is solely concerned with maintenance of security. That is, IF THE LOSS THROWS ONE TERRIBLY OPEN TO ANXIETY AND TO THE LOSS OF ONE’S SELF-RESPECT AND PRESTIGE IN THE COMMUNITY, THE ERASING ACTION OF THE SELF WILL NOT APPEAR. Instead, these associational links will become a preoccupation in many ways analogous to any other substitutive process….We find that, instead of progressively losing its power to evoke tragic recollections, the saltcellar is now surrounded by a very elegant doily, or is in some other fashion enhanced and made a symbol, extravagantly fortified in its power to evoke the lost one. (Source: Clinical Studies in Psychiatry)

• No great progress can be made in the psychiatric field of study until it is realized that the field of observation is what people do to each other, what they can communicate to each other about what they do to each other. When that is done, no such thing as the durable, unique, individual personality is ever clearly justified. For all I know, every human being has as many personalities as he has interpersonal relations. (Source: A paper entitled ‘The Illusion of Personal Identity’ wherein Sullivan describes his sense of collective creativity, and an acute awareness of how one’s thoughts and hopes change dramatically in a new situation with another person)

• Isophilac relationship with a same-gender chum is extremely important around 8-12 years of age – the pre-adolescent stage – so as to have a confidante around whom trust can be tested out – this is a prerequisite to the later “trust” stage in mating.

• People who have very stressful experiences in the juvenile era are not members of New York bridge circles or suburban clubs. They are likely, in fact, to have a quite restricted interest in games and a very sharply restricted interest in people with whom to play them. (Source – The Psychiatric Interview)

• The brute fact is that man is so extraordinarily adaptive that, given any chance of making a reasonably adequate analysis of the situation, he is quite likely to stumble into a series of experiments which will gradually approximate more successful living. Work toward uncovering those factors which are concerned in the person's recurrent mistakes, and which lead to his taking ineffective and inappropriate action. There is no necessity to do more. (Source: The Interpersonal Theory of Psychiatry)

· All of us are afflicted by the fact that long before we can make brilliant intellectual formulations, we catch on to a good deal which is presented to us, first by the mothering one and then by other people who have to do with keeping us alive through the period of our utter dependence. Before anyone can remember, except under the most extraordinary circumstances, there appears in every human being a capacity to undergo a very unpleasant experience. This experience is utilized by all cultures, by some a little and by some a great deal, in training the human animal to become a person, more or less according to the prescriptions of the particular culture. The unpleasant experience to which I am referring I call anxiety. (Source: The Interpersonal Theory of Psychiatry)

• The tension of anxiety, when present in the mothering one, induces anxiety in the infant. (ibid)

· Heuristic Stages in Development (Source: The Interpersonal Theory of Psychiatry)

Infancy extends from a few minutes after birth to the appearance of articulate speech, however uncommunicative or meaningless.

Childhood extends from the ability to utter articulate sounds of or pertaining to speech, to the appearance of the need for playmates -- that is, companions. Cooperative beings of approximately one's own status in all sorts of respects. This ushers in the

Juvenile Era which extends through most of the grammar-school years to the eruption, due to maturation, of a need for an intimate relation with another person of comparable status. This, in turn, ushers in the era that we call

Preadolescence - an exceedingly important but chronologically rather brief period that ordinarily ends with the eruption of genital sexuality and puberty, but psychologically or psychiatrically ends with the movement of strong interest from a person of one's own sex to a person of the other sex. These phenomena mark the beginning of

Adolescence which in this culture (it varies, however, from culture to culture) continues until one has patterned some type of performance which satisfies one's lust, one's genital drives. Such patterning ushers in

Late Adolescence which in turn continues as an era of personality until any partially developed aspects of personality fall into their proper relationship to their time partition; and one is able, at

Adulthood to establish relationships of love for some other person, in which relationship the other person is as significant, or nearly as significant, as one's self. This really highly developed intimacy with another person is not the principal business of life, but is, perhaps, the principal source of satisfaction in life; and one goes on developing in depth of interest or in scope of interest, or in both depth and scope, from that time until unhappy retrogressive changes in the organism lead to old age

P. Mullahy in his book Oedipus, myth and complex (1948), observes on Sullivan’s classification of experiential modes:

Modes of experience:

· Prototaxic - All experience occurs in one or more of three ‘modes’ – the prototaxic, parataxic, and syntaxic. As the Greek roots of this horrendous term indicate, the prototaxic mode refers to the first kind of experience the infant has and the order or arrangement in which it occurs. . . . All that the infant "knows" are momentary states, the distinction of before and after being a later acquirement. The infant vaguely feels or 'prehends' earlier and later states without realizing any serial connection between them. . . .He has no awareness of himself as an entity separate from the rest of the world. In other words, his felt experience is all of a piece, undifferentiated, without definite limits. It is as if his experiences were 'cosmic'. . . . [it is impossible for the entity to communicate his cognitions]

· Parataxic - As the infant develops and maturation proceeds, the original undifferentiated wholeness of experience is broken. However, the 'parts,' the diverse aspects, the various kinds of experience are not related or connected in a logical fashion. They 'just happen' together, or they do not, depending on circumstances. In other words, various experiences are felt as concomitant, not recognized as connected in an orderly way. The child cannot yet relate them to one another or make logical distinctions among them. What is experienced is assumed to be the 'natural' way of such occurrences, without reflection and comparison. Since no connections or relations are established, there is no logical movement of 'thought' from one idea to the next. The parataxic mode is not a step-by-step process. Experience is undergone as momentary, unconnected states of being. [cognition is personal, pre-logical, and communicated only in distorted form]

· Syntaxic - The child gradually learns the 'consensually validated' meaning of language - in the widest sense of language. These meanings have been acquired from group activities, interpersonal activities, social experience. Consensually validated symbol activity involves an appeal to principles which are accepted as true by the hearer. And when this happens, the youngster has acquired or learned the syntaxic mode of experience.

[interpersonal communications are meaningful],

Conclusion:

H.S. Sullivan’s influence continues to be felt through the impetus and direction that he gave interpersonal and field theory** concepts. He was a pioneer student of the social, relational sources of personality development that today constitute the main interest not only of interpersonal psychoanalysis but of two other principal psychoanalytic schools, object relations and self psychology. Relational concepts can also be expected increasingly to enter neuroscience as evidence for the social construction of the human brain accumulates.

**Field theory remains a challenge to psychiatric research. Sullivan contended that the site of psychiatric observation was not the patient alone but the field of patient and observer together; psychological observation is inevitably participant observation. Thus, the importance of counter-transference has come to rival that of transference in both analytic treatment and research.

Posted 13-10-04

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