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:
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.
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)
·
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)
·
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
Keith and Marnie Elliott’s “REMEDY” Site
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