Harry Stack Sullivan, a prominent psychiatrist of his time, combined concepts from both social sciences and psychiatry to create what is known as interpersonal psychiatry (Sharfstein, n.d.). He emphasized the significance of interpersonal connections and believed that certain aspects of one’s mental health can be hinted through the way in which they interact with other people.
He believed that troubling or painful interpersonal experiences could lead to mental disorders. Another focus of his work was the ways loneliness can impact one’s mental health (“Harry Stack Sullivan (1892-1949)”, 2015). He developed theories and concepts relating to the effects interpersonal relationships have on one’s personality. His creativity and innovation with his theories significantly impacted the world of psychiatry.
Harry Stack Sullivan was born in Norwich, New York on February 21, 1892. He experienced a very lonely childhood. He grew up on a secluded farm near Smyrna, New York (“Harry Stack Sullivan (1892-1949)”, 2015; Patterson, 2002). His father was quiet and reserved, while his mother was miserable, unhappy with the family’s impoverished financial condition (Patterson, 2002). As the only surviving child of his parents, Sullivan had very few playmates (“Harry Stack Sullivan (1892-1949)”, 2015; Patterson, 2002).
In fact, most of his playmates consisted of farm animals. At school, Sullivan struggled to fit in with his peers, mostly due to the fact he was a Catholic in a Protestant community. However, he did manage to develop one friendship with an older boy named Clarence, who lived on a neighboring farm. Sullivan believed that his friendship with Clarence played a major role in his interpersonal development (Patterson, 2002).
Sullivan did exceptionally well in high school and graduated at the age of sixteen at the top of his class (“Harry Stack Sullivan (1892-1949)”, 2015; Patterson, 2002). Afterwards, he spent his first year of college at Cornell University studying physics. Surprisingly, he had to leave after his second semester due to failing grades in 1909.
By 1911, he was back in school at the Chicago College of Medicine, where he earned his medical degree in 1917. With this medical degree, he worked with numerous insurance and industrial businesses, the Army, the National Guard, and the federal government. It was not until later, working at the St. Elizabeth’s Hospital in Washington D.C., that he encountered psychiatry (Patterson, 2002).
During his time at the hospital, he worked under William Alanson White as a neuropsychologist (“Harry Stack Sullivan (1892-1949)”, 2015). White, a psychoanalyst who happened to be an important individual in American psychiatry, influenced Sullivan and his theories significantly. He also helped Sullivan land another job at the Shepard Pratt Hospital in Baltimore, Maryland (“Harry Stack Sullivan (1892-1949)”, 2015; Patterson, 2002).
Sullivan’s work at the Shepard Pratt Hospital was a pivotal point in his career. Here he started a ward for young males with schizophrenia (Patterson, 2002; Sharfstein, n.d.). He was quite successful at treating his patients, which helped him develop a great reputation.
This success also led to him becoming the Director of Clinical Research at the hospital in 1925 (“Harry Stack Sullivan (1892-1949)”, 2015; Patterson, 2002). Around this time, he started writing and publishing works. He also became an associate editor of the American Journal of Psychiatry, and a professor at Georgetown University’s medical school. In 1931, he moved to New York and established a very prosperous outpatient practice. Two years later, he helped create the William A. White Psychiatric Foundation.
A few years after that, he helped found the Washington (D.C.) School of Psychiatry, and in 1938, he started and edited the journal Psychiatry. Sullivan moved back to Washington D.C. in 1939, where he would stay until 1947. One year later, he played a part in founding the World Federation for Mental Health. Sadly, while returning from a World Federation for Mental Health executive board meeting on January 14, 1949, Sullivan died. It is believed that he perished from either a heart attack or a brain hemorrhage. Sullivan’s body was buried in the Arlington National Cemetery (Patterson, 2002).
As stated previously, Sullivan created theories and concepts on his ideas of personality. The concepts and theories focus on how the presence of interpersonal relationships affect one’s personality. They also discuss other social factors that play a role in the way one views themselves and others. His work is known as the interpersonal theory of psychiatry (Morgan, 2014).
Sullivan created the term dynamism, which he described as the simplest component of interpersonal relationships. Dynamism is made from the transference of energy, which means it can stem from any kind of mental experience or act. This behavior transforms into habits that affect the body physically.
There are many different dynamisms that can be separated into various categories, but Sullivan believed that the primary three were malevolence, lust, and intimacy. Sullivan described malevolence as a negative dynamism that presents itself when one is living amongst their enemies. An adult may never experience a fully trusting relationship with someone else if they happen to develop this dynamism as a child. Lust is a dynamism comprised of emotions, impulses, and interpersonal behaviors that have sexual activity as the instant or distant goal.
Sullivan believed that although lust starts in early adolescence, it is not a motivating force until later adolescence. Lastly is intimacy, which Sullivan said occurs when someone else’s prosperity is equally as important to an individual as their own. Sullivan believed that lust could destroy intimacy because its objective is to please itself rather than another person (Morgan, 2014).
Another idea of Sullivan’s was this thought that through interaction with others, people form these mental images that help them better comprehend themselves and the world. These mental images are ways in which people view themselves.
He called these mental images personifications (“Chapter 5: Section 6: Harry Stack Sullivan”, n.d.). Personifications are a network of attitudes, emotions, and beliefs that develop from one’s experiences with satisfaction and anxiety. They can eventually transform into stereotypes when they are shared by a big group of people (Morgan, 2014).
To protect oneself from anxiety, Sullivan believed that people used what he coined “the self-system” (Morgan, 2014). According to Sullivan, there are three primary elements in the self-system: the good-me, the bad-me, and the not-me. The parts of themselves that people are willing to share with others is known as the good-me.
People are willing to reveal these aspects of themselves because they are the things they like about themselves. These parts are what people tend to focus on more often because they do not produce anxiety. The bad-me consists of the parts of oneself deemed as negative. As a result, they are hidden away from others, and possibly even from oneself. One will often feel anxiety, guilt, or embarrassment when they are aware of these negative things.
Lastly, the not-me is comprised of the pieces of oneself that produce so much anxiety that one simply refuses to think of them as parts of themselves. These features are pushed far down into the unconscious so they are kept out of awareness. If not, they would create an anxiety so great, that one would constantly be trying to avoid it for all their lives (“Chapter 5: Section 6: Harry Stack Sullivan”, n.d.).
Sullivan also came up with three types of experiences that deal with the way one experiences their reality. These experiences, protaxic, parataxic, and syntaxic, reveal the role of cognition in Sullivan’s personality theory. First is the protaxic type of experience, which happens to be the most basic one. This kind of cognition is composed of images, feelings, and sensations that are not necessarily connected to each other.
Sullivan said that this occurs during the earliest months of infancy and paves the way for the development of the other types of experiences. Next, is the parataxic experience. During this kind of experience, one will create causal relationships between events that happened simultaneously, although they are not related in any way. The focus of this mode is illogical thinking and making the wrong connections between events. It occurs frequently throughout childhood, and a small amount carries over into adulthood.
Syntaxic is the word Sullivan used to describe the last type of experience, which focuses on analytical and logical thinking. In this kind of experience, one develops the ability to comprehend both spatial and physical causality. They are also able to make hypotheses based on their knowledge of the cause or effect. Sullivan believed that the use of numbers and the definition of words were the most powerful examples of the function of syntaxic experience (Morgan, 2014).
Finally, Sullivan created seven developmental stages of personality known as developmental epochs. He believed that although people experience these epochs in a certain order, the timing can vary depending on one’s social surroundings. This theory primarily focuses on the adolescence period and the troubles that can occur. Sullivan thought that difficulties in adulthood stemmed from problems in our adolescence (“Chapter 5: Section 6: Harry Stack Sullivan”, n.d.).
The first developmental epoch is Infancy, which spans from birth to a year old. During this stage, the child starts developing. Following Infancy is Childhood, which spans from one to five years of age. In this stage, speech development and improved communication are essential.
After Childhood comes the Juvenile stage, which starts at age six and lasts until around age eight. The need for playmates is important in this stage. This interaction between the child and their playmates helps the child develop healthy social skills. Social skills increase in significance during this stage. The next stage is Preadolescence, which spans from ages seven to twelve. This stage is centered around the child’s ability to establish close friendships.
These friendships will contribute to the child’s self-esteem later and will help them feel liked and valuable. If the child is not able to make any close friends, they will struggle in the later stages with intimate relationships (“Chapter 5: Section 6: Harry Stack Sullivan”, n.d.; “Harry Stack Sullivan (1892-1949)”, 2015).
Early Adolescence, the fifth epoch, lasts from ages thirteen to seventeen. The onset of puberty causes friendships to take a sexual turn, and the focus of relationship with peers becomes romantic.
A teenager’s sense of self-worth now stems from how sexually attractive they are to their peers. At the age of eighteen, the epoch Early Adolescence transforms into Late Adolescence, and last until the early twenties. Now the focus is on both friendly and romantic relationships. There is also a struggle between parental control and the young adult’s need to express themselves and have a separate identity from their parents. Lastly is the epoch Adulthood, which lasts from around age twenty-three until death.
Struggles with family, financial security, and career are all major factors in this stage. If the adult experienced success in the past stages with their relationships, then during adulthood socialization and relationships will be much easier to have. However, if the adult struggled during the previous stages, anxiety provoking interpersonal problems can occur (“Chapter 5: Section 6: Harry Stack Sullivan”, n.d.; “Harry Stack Sullivan (1892-1949)”, 2015).
Although Sullivan was schooled in Freudian psychoanalysis, he disagreed with Freud on the significance of the early child-parent relationship. Sullivan believed that the child-parent relationship was important because of the child’s want for security, not the child’s sexual desires.
Also, when it comes to psychotherapy, Sullivan decided to use a more active approach when working with his clients, rather than the “blank slate” approach typical to psychoanalysis. Additionally, he believed that the psychoanalyst should not get involved with the client in any way and should act as a “participant observer” instead. However, just like Freud, he thought that the analyst’s relationship with the patient must be founded upon the analyst being the expert in relationships (Morgan, 2014).
Sullivan had three main objectives he hoped to achieve during his therapy sessions: find the problems within the client’s interpersonal relations, assist in the enhancement of their foresight, and mend the client’s ability to engage in approved, authentic experiences (Morgan, 2014).
However, he said that these goals can only be accomplished when certain questions are addressed. For each session he would ask himself things pertaining to the best and most effective word formation for his client, the common methods of communication between himself and the client, and what exactly the client is saying to him. With those things in mind, Sullivan was able to successfully treat his schizophrenia patients (Morgan, 2014).
Sullivan utilized the therapeutic interview as a method of treatment for his clients. The therapeutic interview consists of four different stages: formal inception, reconnaissance, detailed inquiry, and termination (Morgan, 2014). During formal inception, the psychiatrist allows the patient to explain reasons for seeking therapy and boosts their confidence by showing them interpersonal skills. Next is reconnaissance, which focuses on establishing social, general, and personal history of both the patient and the therapist.
The therapist also asks questions about the patient’s parents, occupational history, siblings and other family, children, marriage history, etc. These questions happen to be open-ended so that the patient feels like they can express their emotions freely. Following reconnaissance is detailed inquiry. The main purpose of this stage is for the therapist to develop a better understanding of the client’s situation and how it relates to why the client sought out therapy.
Lastly is termination, which just means the ending of the therapy session. The therapist may assign the patient homework to complete before the next session. Also, the therapist creates notes on the session to see what new problems may have surfaced, and if progress has been made since the previous session (Morgan, 2014).
There are a few inconsistencies that exist in Sullivan’s theories that have been criticized. Sullivan refused to analyze the here and now transference phenomena because it not only produced an overwhelming amount of anxiety within himself, but he believed that it would also produce anxiety in his clients.
He also contradicted himself because he believed that the analyst should be a “participant observer”, but at the same time play the role of both a detective and expert of reality to counteract any analytic subjectivity (Hirsch, 2004). However, despite his criticisms, Sullivan’s theories tremendously impacted the field of psychiatry. His focus on interpersonal relationships provided a unique perspective on personality and has had a powerful effect on the treatment of mental disorders.
