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87

THE STALWARTS

Harry Stack Sullivan


Raghuveer Reddy G. Post graduate of Psychiatry, Institute of Mental Health, Osmania Medical College, Hyderabad,
Andhra Pradesh. India.
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 Sullivan

INTRODUCTION

Anxiety

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. [1-3] 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]

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.

He headed the Washington School of Psychiatry (DC)


from 1936 to 1947. [3] In 1940, Sullivan and his colleague
Winfred Overholser for mulated guidelines for t he
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 a s energy t ransfor mations (the actions
themselves). He further divided tensions into needs and
anxiety.

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.

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 ox ygen, or t hey can b e inter p ersonal, such a s
tenderness and intimacy.
Address for correspondence Dr Raghuveer Reddy G.
Postgraduate, Department of Psychiatry, Institute of Mental Health,
Osmania Medical College, Hyderabad-500038. Andhra Pradesh. India.
Phone: 91-9700843200
Email: ragsmbbs@gmail.com

How to cite this article: Raghuveer Reddy G.


The stalwarts: Harry Stack Sullivan. AP J Psychol Med 2011;
12 (2): 879.

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.
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Raghuveer : Harry Stack Sullivan

Security operations: These are the behaviours designed


to reduce interpersonal tensions, and include:

normally in infancy and also appears in patients with


schizophrenia.

Dissociation: This includes all those experiences that we


block from awareness.

Parataxic Level

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
T he b a d-mot h er p er s on if icat ion grow s ou t 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 b ecome 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
D u ri ng i nfa n cy child r en a cqui r e t h re e "m e"
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
AP J Psychol Med Vol. 12 (2) Jul-Dec 2011

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 theor y 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
t hat p ersonality is shap ed almost entirely by t he
r elat ion ship s on e ha s w it h ot h er p e o ple. He
conceptualized developmental stages. According to him,
the therapist is a participant observer, who establishes
an inter personal 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]

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Raghuveer : Harry Stack Sullivan

Table 1 Sullivan's Developmental Epochs


Infancy
Age birth
to 1 year

From birth to about age one, the child


begins the process of developing, but
Sulliva n did not empha size t he
younger years to near the importance
as Freud.

Childhood
Ages 1 to 5

The development of speech and


improved communication is key in
this stage of development.

Juvenile
Ages 6 to 8

The main focus as a juvenile is the


n e e d for play mat es a nd t h e
beginning of healthy socialization

Preadolescence
Ages 9 to 12

During this stage, the child's ability


to form a close relationship with a
p e er is t he m ajo r fo cu s. T his
relationship will later assist the child
i n fe eli ng wo r t hy a nd li ka ble.
Without this ability, forming the
i nt i mat e r elat io n ship s i n lat e
adolescence and adulthood will be
difficult.

Early Adolescence The onset of puberty changes this


Ages 13 to 17
need for friendship to a need for
sexual expression. Self worth will
often b ecome sy nony mous w ith
sexual attractiveness and acceptance
by opposite sex peers.

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 biologica l ones. I n addit ion, it rates high on
unconscious determinants; average on free choice,
optimism, and causality; and low on uniqueness.' [5]
Acknowledgments: Nil
References
1.

Sadock VA, Sadock BJ, Ruiz P, editors. Harry Stack Sullivan. In:
Comprehensive Text book of Psychiatry. 9th Ed. Vol 2. Lippincott Williams
and Wilkins: 2009: 8647.

2.

Sadock VA, Sadock BJ, editors. Synopsis of Psychiatry, Behavioural


Sciences/ clinical Psychiatry.10th Ed.: 2007: 2256.

3.

Harry Stack Sullivan. Wikipedia. Cited 2011 Aug 18. Available from: http:/
/en.wikipedia.org/wiki/Harry_Stack_Sullivan.

4.

Harry Stack Sullivan. In: Personality synopsis. Psychodynamic and NeoFreudian theories. Cited 2011 Aug 18. Available from: http://allpsych.com/
personalitysynopsis/stack_sullivan.html.

5.

Sullivan and Interpersonal theory. Cited 2011 Aug 18. Available from: http:/
/www.theglaringfacts.com/sullivan-interpersonal-theory/

6.

Sullivan: interpersonal theory. Cited 2011 Aug 18. Available from: http://
highered.mcgraw-hill.com/sites/0072316799/student_view0/part2/
chapter8/chapter_outline.html

Source of Support : Nil

Conflict of Interest : None declared

Late Adolescence The need for friendship and need for


Ages 18 to 22 or s ex ua l
ex pr es sio n
get
23
combined during late adolescence. In
this stage a long term relationship
becomes the primary focus. Conflicts
between parental control and selfexpression are commonplace and the
overuse of selective inattention in
prev ious s t ages ca n result in a
skewed perception of the self and the
world.
Adulthood
Ages 23 on

The struggles of adulthood include


financial security, career, and family.
With success during previous stages,
especially those in the adolescent
years, adult relationships and much
needed socialization become easier
to att a i n. W it hou t a s ol id
background, interpersonal conflicts
that result in anxiety become more
commonplace.

Criticism of Sullivan's Interpersonal theory


Though Sullivan gave much importance to interpersonal
relations, his theory of personality and his approach to
AP J Psychol Med Vol. 12 (2) Jul-Dec 2011