Abstract

Harry Stack Sullivan was one of the most important seminal thinkers in American psychiatry.
His period was marked by intense excitement over psychoanalysis and the emergence of
sociology and anthropology as fields of thought and endeavour. He synthesized the
contemporary ideas of psychiatry and social science together to form what has been called
"social psychiatry." He was one of the first stalwarts in the field of community mental health
movement.
Key words: Harry Stack Sulliva

INTRODUCTION

Harry Stack Sullivan (1892 - 1949) was born to Irish immigrants, and said to have grown-up in
an anti-Catholic town. The resultant social isolation might have laid to his later interest in
psychiatry. [13- ] He received his medical degree from Chicago College of Medicine and
Surgery in 1917. He was one of the founders of the William Alanson White Institute, considered
to be the World's leading independent psychoanalytic institute, and of the journal Psychiatry in
1937. [2, 3]
He headed the Washington School of Psychiatry (DC) from 1936 to 1947. [3] In 1940, Sullivan
and his colleague Winfred Overholser formulated guidelines for the psychological screening of
inductees to the United States military. [3]
Contributions
Tensions and Sullivan [4]
Sullivan conceptualized personality as an energy system, with energy existing either as tension
(potentiality for action) or as energy transformations (the actions themselves). He further divided
tensions into needs and anxiety.
Needs

Needs can relate either to the general well-being of a person or to specific zones, such as the
mouth or genitals. General needs can be either physiological, such as food or oxygen, or they can
be interpersonal, such as tenderness and intimacy.

Anxiety

Unlike needs, which are conjunctive and call for specific actions to reduce them, anxiety is
disjunctive and calls for no consistent actions for its relief. All infants learn to be anxious
through the empathic relationship that they have with their mothering one. Sullivan called
anxiety the chief disruptive force in interpersonal relations.
Dynamisms and Sullivan [1, 4]

Sullivan used the term dynamism to refer to a typical pattern of behaviour.

Malevolence

The disjunctive dynamism of evil and hatred is called malevolence, defined by Sullivan as a
feeling of living among one's enemies. Those children who become malevolent have much
difficulty giving and receiving tenderness or being intimate with other people.
Intimacy

The conjunctive dynamism marked by a close personal relationship between two people of equal
status is called intimacy. Intimacy facilitates interpersonal development while decreasing both
anxiety and loneliness.
Lust

Lust is a self-cantered need that can be satisfied in the absence of an intimate interpersonal
relationship. In other words, although intimacy presupposes tenderness or love, lust is based
solely on sexual gratification and requires no other person for its satisfaction.
Self-system

The most inclusive of all dynamisms is the self-system, or that pattern of behaviours that protects
us against anxiety and maintains our interpersonal security

Security operations: These are the behaviours designed to reduce interpersonal tensions, and
include:

Dissociation: This includes all those experiences that we block from awareness.
Selective inattention: This involves blocking only certain experiences from awareness.

Personifications and Sullivan [1, 4]

Sullivan believed that people acquire certain images of self and others throughout the
developmental stages, and he referred to these subjective perceptions as personifications.
Bad-Mother, Good-Mother

The bad- mother personification grows out of infants'experiences with a nipple that does not
satisfy their hunger needs. All infants experience the bad-mother personification, even though
their real mothers may be loving and nurturing. Later, infants acquire a good-mother
personification as they become mature enough to recognize the tender and cooperative behaviour
of their mothering one. Still later, these two personifications combine to form a complex and
contrasting image of the real mother.
Me personifications

During infancy children acquire t hree "me" personifications:

 the bad-me, which grows from experiences of punishment and disapproval,
 the good-me, which results from experiences with reward and approval, and
 the not-me, which allows a person to dissociate or selectively not attend to the
experiences related to anxiety.
Eidetic personifications

One of Sullivan's most interesting observations was that people often create imaginary traits that
they project onto others. Included in these eidetic personifications are the imaginary playmates
that preschool-aged children often have. These imaginary friends enable children to have a safe,
secure relationship with another person, even though that person is imaginary.
Modes of experiencing and thinking about the World
[2, 4]

Sullivan recognized three levels of cognition, or ways of perceiving things:

Prototaxic Level

Experiences that are impossible to put into words or to communicate to others are called
prototaxic. This occurs normally in infancy and also appears in patients with schizophrenia.
Parataxic Level

Experiences that are prelogical and nearly impossible to accurately communicate to others are
called parataxic. Included in these are erroneous assumptions about cause and effect, which
Sullivan termed parataxic distortions.
Syntaxic Level

Experiences that can be accurately communicated to others are called syntaxic. Logical, rational,
and most mature type of cognitive functioning of which a person is capable.
Sullivan pioneered the notion of the therapist as a participant observer, who establishes an
interpersonal relationship with the patient. He was primarily concerned with understanding
patients and helping them develop foresight, improve interpersonal relations, and restore their
ability to operate mostly on a syntaxic level. [4]
Chum period
In preadolescence (9 - 12 yrs) the capacity for love and for collaboration with another person of
same sex develops. This is called chum period, and it is the prototype of sense of intimacy. This
chum is often missing in schizophrenia patients. [2]
Developmental Epochs (Table 1)
Another similarity between Sullivan's theory and that of Freud's is the belief that childhood
experiences determine, to a large degree, the adult personality. Unlike Freud, however, he also
believed that personality can develop past adolescence and even well into adulthood. He called
the stages in his developmental theory Epochs. He believed that we pass through these stages in
a particular order but the timing of such is dictated by our social environment. Much of the focus
in Sullivan's theory revolved around the conflicts of adolescence. [5]
Interpersonal therapy
Sullivan evolved a theory of personality that emphasized the importance of interpersonal
relations. He theorized that personality is shaped almost entirely by the relationships one has w i
th ot her p eople. He conceptualized developmental stages. According to him, the therapist is a
participant observer, who establishes an interpersonal relationship with the patient. The
therapist understands patients, and helps them develop foresight, improves interpersonal
relations, and restores their ability to operate mostly on a syntaxic level. [6]

Criticism of Sullivan's Interpersonal theory

Though Sullivan gave much importance to interpersonal relations, his theory of personality and
his approach to psychotherapy lost popularity in coming years. 'In summary, his theory rates
very low in falsifiability, low in its ability to generate research, and average in its capacity to
organize knowledge and to guide action. In addition, it is only average in self-consistency and
low in parsimony. Because Sullivan saw human personality as largely being formed from
interpersonal relations, his theory rates very high on social influences and very low on biological
ones. In addition, it rates high on unconscious determinants; average on free choice, optimism,
and causality; and low on uniqueness.' [5]