Harry Stack Sullivan and His Study of Interpersonal Relationships

Harry Stack Sullivan

Harry Stack Sullivan (1892-1949)

On February 21, 1892, American Neo-Freudian psychiatrist and psychoanalyst Harry Stack Sullivan was born. Sullivan developed a theory of psychiatry based on interpersonal relationships. He believed that anxiety and psychotic behavior could be traced back to families who did not know how to relate to their children, who consequently did not feel accepted and loved. Sullivan‘s work on interpersonal relationships became the foundation of interpersonal psychoanalysis.

“If you do not feel equal to the headaches that psychiatry induces, you are in the wrong business. It is work – work the like of which I do not know. True, it ordinarily does not require vast physical exertion, but it does require a high degree of alertness to a sometimes very rapidly shifting field of signs which are remarkably complex in themselves and in their relations. And the necessity for promptness of response to what happens proves in the course of a long day to be very tiring indeed. It is curious, but there are data that suggest that the more complicated the field to which one must attend, the more rapidly fatigue sets in. For example, in dealing with a serious problem in a very competent person, the psychiatrist will find that grasping the nuances of what is reserved, and what is distorted, and what is unknown by the communicant but very relevant to the work at hand, is not easy.”
– Harry Stack Sullivan, The Psychiatric Interview (1954)

Harry Stack Sullivan – Early Years

Harry Stack Sullivan was a child of Irish immigrants and grew up in the then anti-Roman Catholic town of Norwich, New York, resulting in a social isolation which may have inspired his later interest in psychiatry. He attended the Smyrna Union School, then spent two years at Cornell University from 1909, receiving his medical degree in Chicago College of Medicine and Surgery in 1917.  In 1921 he began psychotherapeutic treatment of schizophrenic patients under the supervision of William Alanson White at St. Elizabeth’s Hospital in Washington, D.C. He can thus be considered a pioneer in the psychodynamic-psychotherapeutic treatment of psychotic patients, which Sigmund Freud considered unanalysable.[7]

A Therapy for Schizophrenia

In 1923, a special schizophrenic ward was opened for Sullivan at the Sheppard-and-Enoch-Pratt Hospital in Towson, Maryland. Publications about his sensational healing successes made Sullivan famous among psychiatrists in the USA. Contrary to the prevailing doctrine of biological psychiatry, he believed that schizophrenia has life-historical connections and causes and can therefore be cured with therapy. In 1923 he also met Clara Thompson (1893-1958) for the first time. At that time she worked as a psychiatrist at the Phipps Clinic of Johns Hopkins University in Baltimore, which was run by Adolf Meyer (1866-1950), who had immigrated from Switzerland. In 1930 Sullivan opened a private practice in New York, taught at the Maryland School of Medicine and organized the “New Psychoanalytic Association” in Washington and Baltimore, of which Clara Thompson became the first president. In 1933 he underwent a teaching analysis with Clara Thompson, who was herself an analyzer of Sandor Ferenczi.

The Concept of Interpersonal Psychiatry

During this time Sullivan met Erich Fromm and Karen Horney in New York, who had come to the USA on the run from National Socialism.[9] Together with Silverberg and Thompson they studied Sullivan’s concept of interpersonal psychiatry and developed neopsychoanalysis. The inclusion of the other social sciences led to collaboration with the ethnologists Ruth Benedict, Margaret Mead,[10Bronisław Malinowski, the linguist Edward Sapir and others. In 1938 the journal Psychiatry was founded, which became the most important mouthpiece of the interpersonal direction in psychiatry and psychoanalysis. Sullivan developed a theory of psychiatry based on interpersonal relationships where cultural forces are largely responsible for mental illnesses. Sullivan prodeeced to characterize loneliness as the most painful of human experiences and extended the Freudian psychoanalysis to the treatment of patients with severe mental disorders, particularly schizophrenia.

The Self System

Harry Sullivan also developed the so called Self System, meaning that psychology traits were developed during childhood and reinforced by positive affirmation and the security operations developed in childhood to avoid anxiety and threats to self-esteem. He further described the Self System as some kind of steering mechanism toward a series of I-You interlocking behaviors. Sullivan coined the term Parataxical Integrations, noting that certain action-reaction combinations could dominate the thinking pattern of adults and limit their actions and reactions toward the world. He termed the resulting inaccuracies in judgment parataxic distortion. Further, Sullivan introduced the concept of prototaxic communication as a more primitive, needy, infantile form of psychic interchange and syntactic communication as a mature style of emotional interaction. Harry Sullivan and his work on interpersonal relationships became the foundation of interpersonal psychoanalysis. The school of psychoanalytic theory and treatment stressed the detailed exploration of the nuances of patients’ patterns of interacting with others.

I Never Promised you a Rose Garden

Sullivan was among the founders of the William Alanson White Institute, considered by many as the world’s leading independent psychoanalytic institute, and of the journal Psychiatry in 1937. In 1939 after the death of his friend Edward Sapir, Sullivan left New York and moved to Bethesda, Maryland, near Washington, D.C. Shortly thereafter he began intensive training for the doctors and nursing staff of the private Chestnut Lodge Clinic in Rockville, Maryland, which later became internationally renowned for its pioneering work in the treatment of schizophrenics. The autobiographical book by Hannah Green alias Joanne Greenberg I Never Promised You a Rose Garden (New York 1964), which was later filmed, is about Chestnut Lodge and the psychotherapist Frieda Fromm-Reichmann. In 1943 Sullivan, Clara Thompson, Erich Fromm and Frieda Fromm-Reichmann founded the William Alanson White Institute in New York. Sullivan recorded his theory in his most important book The Interpersonal Theory of Psychiatry which was published posthumously in 1953. Harry Stack Sullyvan died on January 14, 1949, in ParisFrance, at age 57.

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