Family Therapy's Unpaid Debt to Harry Stack Sullivan
'Proficient Me' or 'Bad Me'— The Sullivan approach to personality
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September 24, 1972
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The work of Harry Stack Sullivan, generally re garded as America'due south most original psychiatrist, is only now beginning to win widespread recognition. Sullivan died in 1949. Today interest in Sullivanian handling and training methods is growing; more than and more references to him are actualization in the professional literature, and his books are doing ameliorate than ever. At the centre of his contributions to gimmicky psychiatric theory and practice and to social scientific discipline lies his genius for empathise ing interpersonal relations in all their manifold levels and communicating that understanding. What follows are an interpretation of his ideas and a cursory sketch of his life.
The Work
Traditionally, psychiatry has been a medical specialty non dissimilar pediatrics or cardiology. Mental illness was looked upon as a sort of disease of the heed to exist treated similar whatsoever other affliction. The vari ous drug and nutritional therapies (which may have therapeutic value) and the current resurgence of in terest in lobectomy and lobotomy (brain surgery to alleviate psychotic symptoms) reflects this medical model of mental affliction.
Although rooted in biology, Freudian theory was in some ways opposed to the medical model. Freud argued that near neurotic disturbances resulted from interference by other persons in an individual'southward normal processes of development. Sullivan believed that Freud did not get far enough with this idea because he left the disease, the neurosis, within the private as an encapsulated entity. Sullivan argued forcefully that mental illness had to practice with the ways in which people bargain with people and was, therefore, "interpersonal" and not "intrapersonal." Even when we are alone, our thinking and beliefs always relates to other people, real or imaginary. What Sullivan wanted to practise was to reformulate the problems and concepts of psychiatry from this interpersonal perspective.
Accept, for example, a archetype category of neurosis like hysteria. This was ever defined in terms of repression of sexual impulses, with symptoms such equally hysterical blindness or paralysis. Sullivan wanted to substitute for these formulations descriptions of interpersonal behavior that made for difficulties in living, such equally the "negativistic" person, who feels insecure and inadequate and who accentuates his ain significance by constantly disagreeing with others. "Self‐captivated" people, in Sullivan's scheme, are those who relate to others on an all‐or‐nothing ground: "People whom I like are all good while people whom I dislike are all bad." In each case the person must be described by his typical ways of relating to other people, not by a list of self‐ contained symptoms.
Basic to Sullivan's conception of psychiatry was the "ane‐genus" postulate: No thing how much homo individuals differ from ane another these differences are minuscule compared to the differ ences between a human and a fellow member of whatsoever other species; our weaknesses, no less than our virtues, are human weaknesses. In effect, Sullivan tried to do for psychiatry what Skinner is trying to practice for psychology merely in the opposite direction. Skinner wants psychology to emphasize human being'south animalness, the fact that our behavior tin be shaped and modified according to the same prin ciples used to shape and alter the behavior of rats and pigeons. Sullivan wanted psychiatry to emphasize human's humanness, the fact that man'south feelings, motives, thoughts and values are uniquely man and have no counterpart at the animal level.
This approach was key to Sullivan's concep tion of psychiatry and personality evolution considering he recognized the very human being tendency to feel united nations‐human. When we make an mistake, fail in what we undertake or hurt someone else demand lessly, our tendency is to feel that we are unique, that only we could have done something so sinful and evil. What we tend to experience, if not recollect, in such situations is that somehow we have been removed from the human being race by our failings. Information technology is very human to feel this way, and the mentally ill experience that they are un‐human to an extraordinary degree. Thus Sullivan emphasized that nonorganic mental disturbance differed from the experience of "normal" people not in kind but simply in degree, timing and circumstance.
The one‐genus postulate was also the basis for Sullivan'due south dissatisfaction with training in the med ical profession. He believed that physicians and nurses were trained primarily to exercise things to the patient rather than to be things to the patient, were thus often led to consider the patient as some how having more differences than likenesses to themselves. Such an attitude was unjustified in whatever medical specialty, he felt, but peculiarly so in psychiatry. Sullivan believed that unless the psychiatrist was respectful, understanding and accepting, he could not really assist the patient, whose self‐respect and esteem had to be the focus of therapy.
Not surprisingly, Sullivan's theory of personality concerns the evolution of the "self‐concept." This is entirely interpersonal in origin and is gradually elaborated out of the reflected appraisals of other persons ("Johnny is so good‐looking," "Helen is so impuissant" and so on.) Although the self‐concept evolves gradually, the demand to maintain self‐respect and self‐esteem, which Sullivan calls the need for "security," is present from the very start. Threats to self, to one's self‐esteem and respect, are experienced equally "anxiety." Anxiety, in plough, produces defensive maneuvers to relieve anxiety and to protect the self. The Sullivanian theory of personality evolution tin be described as a theory of the development of the self and its defensive maneuvers.
Sullivan's acquaintance with infants and children was largely secondhand, derived from case histories of his developed patients, his wide reading in the kid development literature (he read Piaget in the ix teen‐twenties) and his discussions with his many friends, such as Margaret Ribble, who were engaged in child‐evolution enquiry. However his empathize ing of people of all age levels was such that many of the observations he made most children and adolescents have since been substantiated by enquiry investigations. His concept of the self has, in fact, been a fruitful starting indicate for many investigators now exploring social development.
In Sullivan'south view, the kid's sense of self evolves gradually during the commencement yr of life, primarily as a consequence of the ministrations of the person who takes care of the child. If this caretaker is loving, comforting and meets the infant's needs, the infant has a generalized feeling of "good me." On the other paw, if the caretaker is broken-hearted, tense and rejecting, this too is commu nicated to the babe, who experiences a full general ized feeling of "bad me." The caretaker communi cates to the infant primarily by ways of a process which Sullivan calls "empathy." This is non partic ularly mysterious—all of us communicate through empathy. When someone says that a tense, antsy person "makes me nervous," he is talking most empathy.
The importance to the baby of a generally posi tive sense of "practiced me" has now been well docu mented. Infants need to exist mothered, held, rocked, touched and talked to if normal evolution is to occur. The mere coming together of physical needs— nutrition, etc.—is not enough. In the absence of adequate mothering or the presence of a pervasive sense of "bad me," some infants withdraw, become blah and may fifty-fifty literally shrivel upwards and dice. Others become permanently impaired, both emotion ally and intellectually. With the development of speech at nearly the age of ii, the child passes into the era of what Sullivan calls childhood (what is today called early on child hood—from ii to v). Language opens up a wide new range of potentials for elaborating the self‐concept, which now becomes stocked with verbal appraisals of approval and disapproval, of affection and rejec tion. The nature of the child's self‐concept will be determined by the balance of approving and disap proval in his experience.
Have, for case, the case of what Sullivan called the "malevolent" child. Such a child, because of rejecting or biting parents, may have received a preponderance of negative appraisals —"Can't you do anything correct?," "Oh, you lot are and so clumsy," "Why practise you always look like a rag doll?" and "Exit me alone." The youngster may have had some good self‐appraisals too, but these have been "dissociated," or dropped from awareness and thus play less part in his interpersonal dealings than does the overwhelming negative appraisal.
In his search for security, the malevolent child sees in others primarily what he sees in himself (this is a bones dominion in Sullivan'south theory). Accord ingly, a kid of this sort volition see only the negative aspects of a person, even if that person is kind and interested in helping him. Many a teacher has had the experience of trying to be friendly to a withdrawn child only to be attacked in the near barbarous way. The child, through the microscope of his negative cocky‐concept, seeks out and finds the negative aspects of the helping person'southward behavior and ignores the residual. In and then doing the child restores his feeling of being man (his security demand) past finding that others are every bit bad as he feels himself to be.
When the kid arrives at schoolhouse age (roughly from 5 to 10), which Sullivan calls the "juvenile" era, new opportunities for the elaboration of the self are opened up. In school the child can at present incorporate the appraisals of teachers and other adults into his self‐concept. He also begins to incorporate the evaluation of his peers as he engages in group activities and is involved in com petition and collaboration with others. In Sullivan'due south view, the self‐concept is never static and the nega tive self‐image inculcated past rejecting parents tin can, with the offices of patient teachers and peers, sometimes be subordinate to a positive self‐con cept. Unfortunately, the reverse is likewise truthful, and lifelong negative self‐appraisals can be caused from peers and teachers during this era.
Some of the kinds of injuries to the self that occur during the juvenile land derive from inter actions with unthinking teachers and other adults. One 6‐year‐old rounded the corners of the paper on which he had painted a picture because he idea this made it expect "prettier." When the teacher saw what he had washed, she said, with an angry expres sion, "You've ruined it" From then on the kid thought he had no artistic talent at all and was afraid to venture some other painting. Another 6‐year‐ old was so praised for a detail drawing that she never drew anything else, for fear of not doing and so well with something new.
Peradventure the nigh distressing and widespread evidence of what can happen to a child's self‐con cept during this catamenia is exemplified past the slow reader. If, for whatever reason, a child in our society is not reading by the end of first grade, he already begins to feel that he is a "flop" in life. More than and more, reading comes to be associated with the anticipation of negative self‐appraisals. It is not long before anything continued with reading arouses anxiety and, to protect the self, reading avoided. Such avoidance further complicates the problem, of course, considering it makes further prog gress in reading impossible. In helping such chil dren, the major job is not to teach them to read but to refurbish their self‐concept.
Showtime with the preadolescent era (roughly 10 to 12) a new and very of import opportunity for the elaboration of the cocky‐concept occurs through the formation of what Sullivan chosen "chumships." Upward until the preadolescent menstruum, the child is concerned primarily with the elaboration and welfare of his ain self‐concept and sense of security. (To exist sure, he loves his siblings, parents and friends, but his own needs still ccme offset—the kid is his own get-go priority.) In preado lescence, withal, the young person forms a close relation ship with a friend of the same sex, a chum, whose self‐con cept and security get equally important to the preadolescent as his own cocky‐concept and security. Such a relationship, in which the other person's security becomes every bit important every bit 1'due south own, is what Sullivan terms "intimacy."
The formation of chumship is crucial to personality growth. The preadolescent who successfully enters a chumship finds someone with whom he can share his inner virtually thoughts and feelings. To his chum, he can reveal what he feels to be the most terrible (as well equally positive) things about himself in an at mosphere of full credence. In this way, he tin can accept (if not condone) equally office of his bones humanness such things as hateful impulses and thoughts. Successful chum ships thus requite the preado lescent the opportunity to neutralize many of the nega tive self‐evaluations he re ceived as a child, and he can move into boyhood with greater personal cocky‐esteem and a greater agreement of others than he had earlier.
The immature person who does non experience a chumship, nevertheless, and moves into ado lescence with a predominant ly negative self‐concept is oftentimes headed for disaster. In human action, to Sullivan, schizo phrenia, which ordinarily oc curs in heart adolescence, is a issue of the demand to cope with newly emergent sex drives without the resource that a positive self‐concept provides. (One of his early contributions to psychiatric theory and practice was his demonstration that schizo phrenics could be helped past psychotherapy—despite Freu dian admonitions to the con trary.) Schizophrenia, in the Sullivanian view, is simply the extreme of a continuum of at tempts to escape anxiety—an anxiety produced by interper sonal situations that pose a threat to the self. In such peo ple "the search for some measure of self‐respect is a never‐ending task, and be comes an end rather than a consequence of interpersonal relations."
Sullivan's emphasis on the chumship period derived both from the case histories of his patients and from his ain personal history. He grew up an merely child on an isolated farm in upstate. New York, and in reporting some of the situations which interfere with successful chumships he de scribes the "geographically isolated" boy in a fashion that sounds autobiographical: "The capacity for sympathy be comes peculiarly differentiated considering of the elaboration of its underlying tendencies in loneliness…. From this back ground there may come… a personality that stands out well above the average level of achievement…. The force of public opinion on such a personality may remain rela tively unimportant…. On the other hand, the isolated male child… lacks the do that ensues in unthinking ac commodation of oneself to others with whom one has sympathy. His interpersonal relations are not easy…. Pos sessed of capacity for intimacy of boggling depth, his experience of fraudulent folk may conspicuously drive him into skepticism nigh people that is extremely annoying to more socialized personalities."
Following preadolescence is a phase in development which Sullivan regards as a kind of watershed—the midadolescent menstruation from nearly 12 to 15. What emerges at this fourth dimension is genital sexuality (Sullivan chosen information technology "lust") which con fronts the self with many new threats as well as opportuni ties. Physical attractiveness for girls, height for boys and interpersonal skills for both sexes become all‐of import in the new evaluations of the self provided past peers, parents and other adults.
Among those young people fortunate enough to laissez passer through a successful chum ship period and to accept air conditioning quired accepting attitudes to ward their own sexuality, midadolescence may accept its ups and downs but presents no serious difficulties. It is the teen‐agers whose parents pun ished their torso explorations as infants and young children and who never adult in timacy with chums who find adolescence nigh too much behave. A pervasive loneliness resulting from failures to attain intimacy, possibly combined with feet almost sexuality, may atomic number 82 to mental disorder.
In my experience adoles cence can sometimes nowadays severe bug even for those young people who enter it with a reasonably positive self‐concept and with some chumship feel. This is because of the wide individual difference in the charge per unit of ma turity. The late‐maturing boy who retains his short stature, red cheeks, baby fat and high vocalism (while his age mates have grown tall, are shaving and speak in deep baritones) suffers long‐standing injury to his self‐concept. I have seen many such young men in fam ily court (often dressed in boots, long hair, and lumber jack shirts in the way of larger and maturer boys) who get into trouble with the law to "prove" their manhood, to win cocky‐respect and esteem.
The most common difficulty in midadolescence is the in ability to integrate the re cently emerged sexual and intimacy needs. This, by the mode, is true for both boys and girls. The midadolescent boy will often have a sacred profane notion that sex is only to exist had with "bad" girls while marriage is but en visioned with "skilful" girls. The sacred‐profane split united nations derlies the double standard and the still‐prevalent desire of young men to marry virgins. The young girl, who is more often romantic than erotic, is oftentimes frightened to discover the crude passions subconscious in the boy she had fantasied, in her romantic dreams, as thoughtful, sensi tive and considerate.
With belatedly adolescence (commonly 15 to xviii) the dissever be tween intimacy and sexuality is bridged and the immature per son can at present discover someone to relate to sexually who can likewise be loved—in the sense that the other person'southward self‐ esteem and security are placed on a par with the self's. To he sure this is non ever true; many people may not develop such a relationship until later in life and some people may never develop it at all. Many marriages neglect considering, in part at least, the people involved could not or did not integrate intimacy and sexuality in their relationship.
Sullivan does non say a good bargain about maturity. He suggests that the potential for further elaborating and developing the cocky continues throughout life as one engages in new activities and assumes new roles. He believed that the natural tendency of each individual is to grow and to realize his abilities, but that few individuals ever come up shut to fully realizing their potentials. He also believed that an overblown self‐con cept could exist as negative as a totally deprecating i. The mentally healthy individual has a predominantly positive self‐image only also has things he does not similar or approve of in himself.
In addition to his theory of personality development, Sullivan also outlined a con ception of the psychiatric interview that has had con siderable touch on upon psycho therapeutic practice. Many of his innovations in therapy have been elaborated in such new approaches equally the family group therapy of Virginia Satir and the transactional analysis of Eric Berne. As in his conception of psychiatry and personality development, Sullivan made the interper sonal dimension the disquisitional ane in therapy.
Sullivan was among the first to recognize that the therapist is non a disembodied spirit just rather affects the patient in significant means that have to be taken into consideration. The therapist must be a "participant ob server" in the sense that he must both interact with the patient and, at the same time, monitor the interaction from the standpoint of an outside, objective observer. Most of us appoint in participant observa tion at ane time or another (bargaining with a car sales man often requires the states to inter human activity with him at i level while monitoring the inter action from a dissimilar level).
With an understanding of this principle, i can begin to appreciate the communica tion difficulties which occur when any two people engage in chat. In any such situation the maintenance of self‐esteem is ever an united nations derlying Consequence where true intimacy does non exist. Each individual is constantly moni toring the other's communica tions to make up one's mind what they indicate about himself. Merely the lines of communication are far from articulate and in that location is a great deal of distortion or "racket" in the arrangement. Therapy is concerned with helping people communicate more than conspicuously with one an other. In his discussion of the reciprocal, ongoing nature of communication, Sullivan anticipated concepts such equally feedback that have been made popular today by cybernetics and information theory.
The closest almost of united states come up to true advice is what Sullivan called the "syntaxic" mode, the situation when both individuals are using the aforementioned words to mean the same things. Simply this type of com munication is impeded by two other modes of interpreting some other person's pregnant. What the other individual says is always interpreted in the context of how he says it—his facial expression, tone of voice and gestures. This mode of interpretation Sulli van calls "prototaxic." In ad dition, what the other indi vidual says is also interpreted in terms of who he is—the same words coming from a child and from an developed are interpreted in quite unlike means. When a remark is so interpreted, Sullivan speaks of the "parataxic" fashion.
Suilivan observed that emotionally troubled people were prone to prototaxic and parataxic distortions in their interpretations of other peo ple's expressions. Some troubled people, whom Sulli van called "asocial," misconstrue prototaxically and are super sensitive to whatever signs of rejection, withdrawing from a relationship at the slightest hint of dislike. The asocial person's sense of personal worthlessness is so great that he cannot believe that anyone else would want to have any matter to do with him.
Other types of troubled peo ple show primarily parataxic distortions in their interper sonal relations. Hither is an example from Sullivan, which also reveals the charming wit of the therapist, who was becoming bald:
"Most the 300th 60 minutes, the patient came in… from the waiting room in a peculiar country of agitation. She said she was overwhelmed to dis cover that I looked quite dif ferent than she had hitherto seen me. She had known me equally a fat old homo with white hair. Disregarding the other characteristics, I tin scarcely have had white hair. This is both an extreme and decep tively simple illustration of parataxic distortion of the psychiatrist in the treatment situation."
On the basis of this con ceptualization, psychotherapy seeks to help people over come their prototaxic and parataxic distortions so that they can arrive at a correct, or syntaxic, agreement of other persons' expressions. The procedure of arriving at this right understanding of other people is what Sullivan called "consensual validation." Both the therapist and the patient accept to check their interpre tations by verbalizing and dis cussing them. A patient says, for example, "I hate to have people staring at me," to which the therapist replies, "Why do they stare at you?" That is, the therapist has ac cepted the statement equally valid and with the patient seeks consensual validation for the ascertainment.
A major hindrance to achiev ing a consensually valid in terpretation of reality is what Sullivan called "selective in attention." He kickoff observed this miracle—every bit he did many others that he described —within himself. It occurred when he went to his family dwelling house to nurse his begetter dur ing the latter'south concluding ill ness. While father and son were talking, Sullivan seemed distracted and his father asked him whether he had no ticed the new wallpaper in the room. Sullivan had not no ticed information technology even though he had been looking directly at the wall. In analyzing this bit of behavior, he establish that he did not really want to see the change just equally he did not desire to think virtually his fa ther's impending death.
Selective inattention of a more pernicious sort is a per vasive phenomenon in inter personal relations. Such inat tention is most obvious in those relationships wherein one person is more "in love" than the other. A wife, for example, who badly needs her husband's love to maintain her sense of self‐esteem will selectively ignore the evidence that he does not really care for her—all the large and petty hurts that he has inflicted— and will magnify, far out of proportion to their real hateful ing, those few acts which be token that he might indeed care. One sees the same selec tive inattention in some par ents of retarded children. Re tardation of a child is diffi cult to accept, at least in part because it is a threat to the parent's sense of self‐respect. Equally a consequence, some par ents "selectively inattend" to all the many evidences of lim ited ability while they magnify and exaggerate any slight sign of intellectual prowess. Such inattention was for Sullivan a very human being process in that it ever came into play in lodge to protect the self.
Sullivan's approach to treatment, which has been called "intensive psychother apy," is related to his theory of personality development. In a manner Sullivan tried to re create with the patient the chumship of preadolescence. In that relationship of total acceptance, the immature person could examine all the various aspects of himself and gain some consensual validation of his basic humanness. The aim of therapy is to practice the same matter and thus help the pa tient refurbish his sense of self‐esteem and respect. While the treatment process is obvi ously more than circuitous than what has been described here, its aim is always to help the private to the indicate where his sense of positive self‐ regard outweighs his sense of existence worthless and un human being.
Critics contend that Sulli van was derivative rather than original, borrowing from men similar Freud, Adler and Ferenezi. To exist sure, he was influenced by Freud but he was every bit influenced by the social psychology of George Herbert Mead, the holistic psychiatry of Adolf Meyer and the operational philoso phy of Percy Westward. Bridgman. Although the critics take cited the similarity between Sulli van's concert of parataxic baloney and Freud's con cept of transference, a close reading of the two reveals that the similarities are more apparent than real.
For Freud, who worked with neurotics, transference meant that the patient at tached to the therapist feel ings that were once attached to the parents. For Sullivan, who worked with psychotics as well every bit neurotics, para taxic distort ions were the actual perceptual and con ceptual distortions which pa tients imposed on the thera pist (like the patient who saw Sullivan as fat and white‐haired). Similar differ ences tin be constitute in every case where Sullivan is said to have just renamed some 1 else'southward conceptions. Sulli van had his failings, merely he
The Man
The belated recognition given to Harry Stack Sulli van's contributions to psy chiatry can be traced to sev eral factors. For one thing, Sullivan never learned to "suf fer fools gladly" and he could publicly demolish a preten tious colleague or an sick‐pre pared educatee. There were a good many people who, be cause of personal animosity, may have found information technology difficult to acknowledge a debt (intel lectual or otherwise) after Sullivan natural language‐lashing. Fifty-fifty with his friends Sullivan could be hard.
In early Jan, 1949, Sullivan was in Amsterdam attention the executive‐board meetings of the newly formed World Federation for Mental Health. Sullivan was gravely ill and had made the trip despite pleas of his friends and in the confront of a correct premonition that he would non render to America alive. The trip was important to Sullivan considering he had been instrumental in setting upwards the Federation and because he was deeply concerned that it serve the needs of the under developed as well as the de veloped countries. At the meetings, Sullivan managed to alienate a proficient many of the participants by his insistance that the board include more representatives from Asian and African cultures.
Later on the last session, Sul livan was sitting alone and dejected outside the confer ence room. An former friend, anthropologist Otto Klineberg, approached Sullivan and told him that he had stepped on the toes of many of the lath members. And then Klineberg added, "You know, Harry, you stepped on my toes, likewise." Sullivan, his caput in his easily, replier without looking up: "Otto, that is the to the lowest degree of my worries." If they had been casual friends this might have been taken as a hostile retort. Only Klineberg knew that it was Sullivan'due south way of saying, "Otto, you can under stand and accept why I had to do it." Klineberg felt closer to Sullivan at that moment than he ever had before.
For another thing, Sullivan published relatively little dur ing his lifetime. Although he did a great deal of teaching— a goodly number of the senior psychiatrists practicing and teaching in America today were trained by him—he was never satisfied with what he put down on paper. Endlessly revising his copy, he pro duced only a number of ar ticles for the professional person journals; editorials for Psy chiatry, the journal he founded and edited, and the book, "Conceptions of Mod ern Psychiatry," a compilation of highly condensed lectures. (After his death, his students and colleagues created a num‐ ber of volumes from his re corded lectures and notes.*)
But maybe the virtually im portant factor in Sullivan's delayed recognition is that, similar most innovators, he was considerably ahead of his time. But today are his con cern for the dignity of blacks, his demand that professionals care for and about the people to whom they minister, his emphasis on the humanness of mental disorder and his criticism of sexual taboos coming to be function of the value structure of the society at large. Although most young people have not however discovered Sullivan, he nas foreshadowed many of their criticisms of contemporary society.
Judged by his back ground, Sullivan was nearly every bit far from the stereotype of a psychiatrist as 1 can imagine. The psychiatrist, par ticularly the annotator, is often portrayed as having grown upwardly in cosmopolitan Europe, as being Jewish and speaking with a heavy Viennese ac cent. Sullivan was born in 1892 in Norwich, Northward.Y., and inherited from his Irish‐ Catholic family an emphasis that was, if anything, pure Coun ties Cork and Clare. Merely his life as a lone subcontract boy, one of the few Cosmic boys in a largely Protestant and Yankee community, played a large part in Sullivan'due south tre mendous insight into the alone liest souls in our social club, the schizophrenics, whom the analysts had written off as hopeless. Sullivan also attrib uted to his solitary boyhood the fact that he never de veloped a strong need to take other people similar him and call up well of him so could be a severe critic without feeling guilty about information technology.
Sullivan's loneliness equally a boy was aggravated by his female parent's chronic unhappiness and his father's taciturn with drawal. His childhood ex periences probably contrib uted to his choosing psychi atry every bit a career despite an bent for concrete science. After Sullivan graduated from the Chicago Higher of Medi cinematics and Surgery in 1917, he served in the Ground forces Medical Corps and then in the re habilitation section of the Federal Board for Vocational Pedagogy, where he drafted policies for dealing with men with psychiatric disabilities. Equally a consecuence of this work, he was appointed in 1922 to be the United States Veteran'south Service liaison of ficer at St. Elizabeth's Hos pital in Washington, D.C.
St. Elizabeth's was the Fed eral hospital for the mentally ill and at the time was under the management of William Alan son White, ane of the near prominent psychiatrists in America and an early on advo cate of psychoanalysis in this country. White stimulated Sullivan's interest in Freud merely as well communicated to him his clashing feelings almost Freud'south domination of the psychiatric field. For Sullivan, the ebullient, socially adept and mannerly White quickly became a professional father figure. Years afterwards the Wil liam Manson White Founda tion in psychiatry and psycho analysis was set up under Sullivan's direction.
In 1923, Sullivan left St. Elizabeth's for Sheppard and Enoch Pratt Infirmary, a pri vate mental infirmary near Baltimore. It was at Shep pard that Sullivan did his original work with schizo phrenics and where he first began to see the outlines of what was afterward to evolve as his interpersonal theory of psychiatry. In his work with schizophrenics Sullivan showed a sympathy, a toler ance and a tenderness hardly imaginable to those who knew him in an bookish setting, where his criticism could de vastate a colleague. Once, after being hit, by a severely disturbed patient, Sullivan asked, softly and without ran cor: "Feeling improve now?" As a clinician he seemed to piece of work all-time with acutely disturbed schizophrenics, those who had just recently go psy chotic and who, in his view, were retreating from prob lems in living and could be helped dorsum to health. His success with such patients demonstrated that schizo phrenia was a legitimate field for psychotherapeutic meth ods.
It was during his stay at Sheppard that Sullivan first became acquainted with Clara Thompson, another young psychiatrist. In 1923 Miss Thompson presented her start professional person paper at the Phipps Dispensary in Baltimore. Sullivan was in the audience and afterward made a point of coming together her. A close friend ship developed, and eventu ally it was decided that 1 of them should go to Europe and be analyzed, then return and analyze the other. A few years later on, later on both had moved to New York, Miss Thompson did make the trip to Budapest where she was analyzed by Sandor Ferenczi. And true to the understanding, Miss Thompson afterward analyzed Sullivan for at least 300 hours.
Equally meaning during the Sheppard years was Sul livan'south introduction to leading social scientists and the be ginning of his collaboration with them. At an informal conference on personality in vestigation held in 1928 under the auspices of the American Psychiatric Association, Sul livan met Edward Sapir, the linguist and anthropologist, so at the University of Chi cago. Sapir was particularly interested in the relation be tween culture and personality. This consequence also interested Sul livan, who had been consider ing the effect of the social milieu on mental disorder. The two men became friends and together with Harold Lass well, the political scientist, worked during the next dec ade to develop an understand ing of human personality in its sociocultural context.
While at Sheppard Sulli van also adopted a teen‐anile youth, James Sullivan, a for mer patient. Jimmie, as he however prefers to be called, came to play an of import role in Sullivan'south life every bit a trusted confidant, secretary and gen eral director. And Sullivan's diplomacy required managing. He was completely impractical when it came to coin and would support friends and patients without worrying where the coin was coming from. "There is always more than," he would reply when the re cipients asked him whether he could afford the largess he was bestowing on them.
At Sheppard, Sullivan'southward work had led him to con clude that schizophrenia was closely linked to the compul sive behavior of obsessional neurotics, who, it seemed to him, were also continually at tempting to maintain self‐ respect and esteem. Private practice, he felt, would afford a better opportunity to ob serve such patients, and in 1931 he left Sheppard to set upwards his own exercise in New York. But as usual, Sul livan was short of cash. A.A. Brill, the analyst, loaned him $2,000 to institute his New York office, and with typical disregard for financial mat ters, Sullivan: used much of the money for a phonograph and records to indulge his love of music.
While in New York Sul livan gained a reputation as a therapist with amazing in sight. Psychiatrists often sought his help when they ran into a block with their own patients. Examples of his clinical apprehending abound. He in one case gave an exact descrip tion of the husband of a patient's sis, simply from hearing how the sister treated the patient.
Another patient recalls his commencement meeting with Sullivan. He was quite frightened by the whole affair and did not know what to say as he sat in Sullivan's comfortable sitting room with its vivid, cheery fire. Sullivan, a man of slight build, with thinning pilus and wearing classes, was at his desk shuffling papers and did non acknowledge the patient at all. Instead, he kept opening and shutting drawers, lifting papers and mumbling to himself, "At present where in the world did 1 put that affair; it must exist here some place! Oh my, oh my, oh my." After about five minutes of this puttering, the patient felt quite at ease. He spent about two hours with Sullivan, and when he left, he felt euphoric, as if he had been relieved of a bang-up weight.
But Sullivan could also exist unnecessarily severe with fledgling every bit well as experi enced psychiatrists. To one he remarked, later on hearing an ac count of the therapy 60 minutes, "You must have been asleep or fatigued to have missed that." To another young psy chiatrist, who had failed to gather relevant instance‐his tory textile, he said, "And you call yourself a psychia trist!"
In 1937 Sullivan decided to surrender his New York prac tice. Nevertheless, he did not im mediately sell the brownstone on Due east 64th Street that served as his domicile and office and allowed a number of his acquaintances to live at that place free of accuse. Among these were Erich Fromm, the ana lyst; Phil Sapir, Edward Sapir'southward son; Patrick Mullahy, a young Irishman who became Sulli van's good friend and the most noted of his interpreters, and Katherine Dunham, the dancer, whom Sullivan "res cued" from the Chicago an alysts he idea were doing her harm. Sullivan'southward early in terest in the issues of blacks was shown not only by his concern for Katherine Dunham but also by the fact that he had at to the lowest degree i other black patient in those years and spent some time with black youth in the Deep Due south in 1938.
Eventually Sullivan bought an old house on 1½ acres of land in Maryland, and this became his centre of opera tions until his death in 1949. Besides his editorial and su pervisory work, he lectured at the Washington (D.C.) School of Psychiatry, at the William Alanson White In stitute in New York and at Chestnut Lodge, a private mental infirmary in Maryland. In 1940, he became consultant in psychiatry for the Selective Service System. He left shortly after Gen. Lewis B. Hershey took over as Selective Service director the post-obit year, and it was rumored that the two men had had a falling out. General Hershey, however, paid a glowing tribute to Sul livan on his divergence. Sullivan was called back for other Government service during World State of war II and was in strumental in setting up the World Federation for Mental Health after 1945.
In the last decade of his life he became increasingly concerned with social psychi atry and the formulation and refinement of his theory of personality and his conception of psychiatry and psycho therapy. The war and par ticularly the diminutive bomb also turned his attention to international diplomacy. He be lieved that social scientists working together could observe a way to reduce international tensions and foreclose futurity wars. This belief was, as Clara Thompson put it, "a fire with in him that sustained his frail body during the last years of his life."
Unfortunately, Sullivan's personal life has been the field of study of much word‐of mouth criticism. Within and outside the profession it is rumored that he was at vari ous times in his life schizo phrenic, homosexual and alco holic. In researching this article, I found information technology difficult to separate the facts from the malicious gossip. My impres sion, from the many people I interviewed and who knew Sullivan, is that the gossip far outweighs the truth in these allegations. But in the end, what divergence does it make? Sullivan left a mag nificent legacy to psychiatry and social scientific discipline. Hundreds of patients are living more than productive and happy lives be cause of his efforts. Many gifted and talented men and women cherished his friend ship, and at his death he was seeking ways to reduce the tensions that crusade wars. Many people, myself included, would gladly exist labeled al coholic, schizophrenic and homosexual if they could give a similar accounting of their life work.
Toward the finish, Sullivan's physical status deterior ated rapidly. In 1947 he de veloped a severe infection and would accept died had not his students procured some of the newly developed penicil lin which was then deficient and not by and large available. Mary White, whom Sullivan had trained as a therapist, helped to nurse him for the next two years, although most of that ordeal was borne by Jimmie.
Then in the wintertime of 1949, Sullivan went to Amsterdam for the meetings of the World Federation for Mental Health. In recalling the prepara tions for that last trip, Jimmie has reported that Sullivan was set to have off for Amsterdam two hours alee of time. This was unusual because Sullivan was most e'er late for trips and meetings. He told Jimmie that he didn't want to go only felt that he had to. When they parted, both knew they would not see each other over again. On his return from Amsterdam, Sullivan stopped in Paris for a few days. He died in his Paris hotel room on Jan. 11, 1949, of a cerebral hemor rhage.
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Source: https://www.nytimes.com/1972/09/24/archives/-good-me-or-bad-me-the-sullivan-approach-to-personality-starting.html
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