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Herbert "Harry" Stack Sullivan (February 21, 1892 – January 14, 1949) was an American psychiatrist who extended Freudian psychoanalysis to the treatment of patients with severe mental disorders, particularly schizophrenia. He developed a model regarding failures in interpersonal relationships as being largely responsible for mental illnesses. In his words, it is the "interactional," not the "intrapsychic," forces that must be studied in order to find the causes, and develop treatments for, even the most severe psychoses. This search for satisfaction via personal involvement with others led Sullivan to characterize loneliness as the most painful of human experiences. His work, along with others such as Karen Horney, Erich Fromm, and Erik H. Erikson, laid the groundwork for understanding individuals based on their networks of social relationships.
Herbert "Harry" Stack Sullivan was born on February 21, 1892, in Norwich, New York, a child of Catholic Irish immigrants. Harry grew up in a rural New York Protestant community known for its intense prejudice toward the Irish. He was the only son of a poor uncommunicative Irish farmer and an extremely unhappy, complaining mother who was reported to show her son little affection. Later in life he wrote:
I escaped most of the evils of being an only child by chief virtue of the fact that mother never troubled to notice the characteristics of the child she had brought forth ... I felt she had no use for me except as a clothes horse on which to hang an elaborate pattern of illusions.
As a child, Sullivan's closest friends were the farm animals, with whom he felt comfortable and less lonely (Chatelaine 2003). His childhood experience of social isolation and loneliness might have been the incentive for his later interest in psychiatry. Sullivan's keen self-awareness contributed to his later work, Schizophrenia as a Human Process, which explored the impact of personal experience on the development of mental illness. Although he was a superior student in grade school and high school, he had no friends and turned to books for companionship. Again, his writings about the pre-adolescent and adolescent stages reflected the powerful insights of his own personal experience.
After graduating from high school, he attended Cornell University for one year, at the end of which, in 1909, he was rumored to have suffered some kind of mental breakdown, possibly a psychotic episode.
In 1911, he enrolled in the Chicago College of Medicine and Surgery, receiving his medical degree in 1917. During the following years practicing psychiatry he was introduced to psychotherapy by Adolf Meyer, and applied these ideas to the treatment of schizophrenia. Later, he elaborated his work into a theory of personality, working with social scientists of diverse backgrounds, including ethnolinguist Edward Sapir.
Loneliness was a key feature of Sullivan's theory, and he is reported to have commented to his close colleague of many years, "Edith, you do not know how lonely I am" (Chatelaine 2003). Sullivan died in a hotel room in Paris, France in 1949, while attending a conference. He was 57.
Once Sullivan began his work as a practicing psychiatrist, he quickly showed his extraordinary ability to relate to patients suffering from schizophrenia. His later work involved extending his ideas relating to the development and treatment of schizophrenia to a general theory of personality development.
Sullivan's work with those suffering from the psychosis schizophrenia began with his ability to communicate with these patients. He believed that their mental functions, although disordered, were not beyond treatment. Having been introduced to psychoanalytic techniques by Adolf Meyer, Sullivan began to apply these to his hospitalized, psychotic patients, despite the fact that Sigmund Freud had originally developed the techniques for use only with those suffering from neuroses.
Following success with such treatments, Sullivan developed his model of the etiology of schizophrenia. He argued that it must be primarily experiential, not solely hereditary or organic. Beginning with Freudian principles, he suggested that the onset of schizophrenia might be traced to unsuccessful interpersonal relationships with significant others during childhood. Thus, distortions in the mother-infant interaction, leading to difficulties in relating appropriately with members of the same sex and the opposite sex in adolescence, resulted in severe loss of self-esteem, precipitating a schizophrenic break from reality.
It appears that Sullivan identified closely with the schizophrenic condition, which led others to posit that he might have suffered such an episode himself. He described the schizophrenic as "the loneliest of the lonely" (Chatelaine 2003).
Sullivan developed the technique of "participant observation," in which the psychiatrist was not just an observer of the patient's behavior, but became a "significant other" in their life through their interactions. In his sessions with patients, Sullivan also began to employ what later came to be known as "reality testing." Questioning the patient about matters that could be verified, he caused them to see how their own view of reality was distorted.
Sullivan's prescribed therapy was to provide a sympathetic, supportive environment, known as the "treatment milieu." He established such an environment in an isolated ward at Shepard Pratt Hospital in Maryland, and with a hand-picked staff was apparently successful in treating a number of young, male schizophrenics. Unfortunately, however, returning to their previous environment often led to a relapse.
In his work with schizophrenics, Sullivan developed a model of the precipitating circumstances leading to the psychotic episodes. The model was based initially on Sigmund Freud's theories, but developed beyond that turned away from several of Freud's concepts. After moving from the hospital environment to a private practice setting in New York, Sullivan expanded his ideas into the area of personality development. Sullivan's work became the foundation of interpersonal psychoanalysis, a school of psychoanalytic theory and treatment that stresses the detailed exploration of the nuances of patients' patterns of interacting with others.
Besides making the first mention of the "significant other" in psychological literature, Sullivan developed the "self system," a configuration of the personality traits developed in childhood, and reinforced by positive affirmation and the "security operations" developed to avoid anxiety and threats to self-esteem. Sullivan further defined this self system as a steering mechanism toward a series of "I-You" interlocking behaviors; that is, what an individual does is meant to elicit a particular reaction. Sullivan called these behaviors "parataxic integrations," and noted that such action-reaction combinations can become rigid and dominate an adult's thinking pattern, limiting his actions and reactions to relating to the world as he sees it, not as it really is.
An important distinction between Sullivan and Freud involves the concept of anxiety. While Freud believed anxiety represented internal conflict between the id and the superego, Sullivan saw anxiety as existing only as a result of social interactions. Sullivan described techniques, such as selective inattention and personifications, similar to Freud's defense mechanisms, that provide ways for people to reduce social anxiety.
Sullivan believed that mothers express their anxiety about raising their children in a variety of ways. The child has no understanding or way to deal with this and so feels the anxiety himself. Selective inattention is the child's reaction to this, ignoring or rejecting the anxiety, or any interaction that could produce uncomfortable, anxious feelings in the child. Later as adults, this technique is used to focus our minds away from stressful situations.
Sullivan suggested that individuals develop "personifications" of themselves and others as a result of social interactions and selective attention or inattention. Defense mechanisms reduce anxiety, but they can also cause a misperception of reality. Personifications, on the other hand, are mental images that help us understand ourselves and the world.
Sullivan described three basic ways we see ourselves, which he called the "bad-me," the "good-me," and the "not-me." The "bad-me" consists of the aspects of the self that one considers negative and therefore hides from others, and possibly even the self. This is sometimes called the "shadow," particularly in Carl Jung's system. Anxiety can result from recognizing the bad part of ourselves, for example, when remembering an embarrassing moment or experiencing guilt from a past action.
The "good-me" is all that seems positive and all that we like about ourselves. This is the part we share with the world because it produces no anxiety. The "not-me" part represents the aspects of ourselves that are so anxiety-provoking that we reject them as a part of us. The "not-me" is hidden from our awareness by being pushed deep into the unconscious.
In a similar fashion to Freud, Sullivan maintained that childhood experiences with other people are a large contributor to the adult personality, the mother playing the most significant role. He differed from Freud in his belief that the primary significance of the parent-child relationship was not predominantly sexual, but rather an early quest for security by the child. He also believed that the personality can continue to develop past adolescence and even well into adulthood.
Sullivan called these stages "developmental epochs," occurring in a particular order but with their timing determined by our social environment. The majority of Sullivan's focus revolved around the periods of adolescence, and he suggested that many adulthood problems arise from the turmoils of adolescence. The developmental epochs are:
Although well recognized by many, Sullivan never acquired the substantial reputation that many of his peers did. Nevertheless, several well known personality theories have their origins in his work. Carl Rogers founded his theory on Sullivan's idea that the self-concept is the product of social interaction. Sullivan's theory of the stages of human development preceded Erik Erikson's theory of the stages of life. Along with Clara Thompson, Karen Horney, Erich Fromm, Erik H. Erikson, and Frieda Fromm-Reichmann, Sullivan contributed to developing an understanding the individual based on the network of relationships in which he or she is enmeshed. This approach moved theories of personality development away from the Freudian "intrapsychic" models of the unconscious mind and more toward the realm of interpersonal relationships; Sullivan went on to develop a theory of psychiatry based on interpersonal relationships where cultural forces are largely responsible for mental illnesses.
Sullivan was one of the founders of the William Alanson White Institute, considered by many to be the world's leading independent psychoanalytic institute, and of the journal Psychiatry in 1937. He also headed the Washington School of Psychiatry from 1936 to 1947.
Although Sullivan published little in his lifetime, he influenced generations of mental health professionals, especially through his lectures at Chestnut Lodge in Washington, DC and he has been considered the most important underground influence in American psychoanalysis. His ideas were collected and published posthumously, edited by Helen Swick Perry, who also published a detailed biography of Sullivan (Perry 1982 ).
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