Interpersonal Theory by Harry Stack Sullivan

Sullivan draws on his own life experiences, especially interpersonal experience, as an important source for his
theories about personality and human nature. (page 35)

Sullivan was born of Timothy Sullivan (the father) and Ella Stack Sullivan (the mother), February 21, 1892, on a cold
winter day in Norwich, New York, a small rural farming community several hundred miles northwest of New York
City (page 36)

Both parents were of family failure as his mother was perilously close to being an old maid and his father had
worked as a laborer. Ella Stack married a man without money, prestige, or education. The underlying tension
between both families was a fertile ground for an enormously intelligent, perceptive, and sensitive young man to
study intrafamily struggles and the social context in which they occur.

Harry Stack Sullivan was Ella and Timothy’s third child. They had two previous children and were born in the same
house in the month of February. However, both had died in convulsions before the Fall of their first year of life. In
this manner, Ella Stack Sullivan was thirty-nine at the time of Harry Stack Sullivan’s birth, despaired about dying
childless, and now had another February baby. Fueled by the local old-time belief that winter babies did not have a
good chance to live through the first summer, as well as her two losses bearing out the prediction, Ella Sullivan
must have keenly experiences, and Harry Stack Sullivan must have been surrounded by, the maternal anxiety that
would become the core concept of his developmental theory.

Harry Stack Sullivan had experience various life tragedies resulting from his family’s lack of social support and aid.
Thus, providing fertile ground for his extensive and unique perspective on the role of cultural, interpersonal, and
family dynamics on the development of personality and mental illness.

His multiple family influences and tragedies would lead him to emphasize “mothering” and other processes of
social learning over the exclusive reliance on the mother-child relationship found in object relations and other
psychoanalytic theories, and to develop tremendous empathy and insight into severe mental illness.

Sullivan used his painful family and community experiences in rural America to plumb the causes of psychosis and
severe personality disorders.

His school years gave Sullivan ample opportunity to explore the interpersonal themes of the juvenile era —the
comparison of authority figures inside and outside the family, the learning of different values of different social
groups, and the importance of the peer group’s acquisition of the social skills of compromise and cooperation

While Sullivan drew much self-esteem from his school experience and some relief from the encompassing familial
worldview occasioned by his physical separateness from parents, his early grade social world was still influenced
by peer isolation at school and complex family dynamics at home. At home, while Sullivan’s grandmother
continued to dominate his mother, diminishing her self-esteem, Ella became more involved with Sullivan during
the school years.
Theory the Chum, page 41

Chumship - a time when friends share openly their inner evaluations of their families and life in general.

In The Interpersonal Theory of Psychiatry, Sullivan’s writing on failure of the integration of lust dynamism reveals
an understanding of obsessive preoccupation with fantasy women of a lonely, immature late adolescent that was
likely drawn from his own experience.

One of Sullivan’s great contributions to personality theory and psychopathology was his cogent analysis of the
grave dangers in adolescence of the failure to integrate the dynamisms of lust, interpersonal security, and
intimacy, which is likely based on the cataclysmic events of his life which began at Cornell.

Sullivan’s ability to survive, and later make great use of, these failures was quite central in his development of
interpersonal theory.

White’s (1933:31) onegenus postulate, that, “the difference between the so-called insane person or the criminal
on one hand and so-called normal or sane person on the other is only a difference in quantity, a difference in the
strength or weakness and the balanced relationships of the various tendencies and stimuli with which he has to
deal”, is essentially the same as Sullivan’s one-genus hypothesis (1940/ 1953:16), “we are all much more simply
human than otherwise, be we happy and successful, contented and detached, miserable or mentally disordered, or
whatever.”

This central organizing principle of both men’s approach to humanity must have been White’s great personal, one
could say therapeutic, contribution to the brilliant, but troubled Sullivan. Instead of hiding his troubled past, it
became the data by which Sullivan came to formulate his theory and develop his approach to treatment. While
Sullivan also felt the influence of Kempf (who was no longer at St. Elizabeth’s when Sullivan was there) on his
theory, borrowing and expanding Kempf’s concepts of “not I, not me, not myself” and “social esteem,” it was
William Alanson White who became Sullivan’s professional and intellectual father.

A strong believer in the importance of the therapeutic milieu in the hospital and of specialized training for hospital
nurses and attendants, he granted privileges to Sullivan regarding the design and conduct of his clinical unit that
were unprecedented for their time (and perhaps remain so today). Chapman allowed Sullivan to establish a small
ward for schizophrenic men set apart from the rest of the hospital that was staffed with hand-picked male
attendants and excluded female nurses. Sullivan requested, and was given, recording equipment to assist him in
his research on schizophrenic thought patterns. He carefully trained his attendants in his theories and gave them
much autonomy to operate on their own with the patients. Deemphasizing the various social status roles of
doctor, attendant, and patient as much as he could, Sullivan established a social treatment environment of people
responding empathically to the troubles of others without prejudice of role differences. As Sullivan stated:

The chosen employees…ceased to regard [the patient] in more or less traditional ideology as “insane,” but
instead had stressed to them the many points of significant resemblance between the patient and the employee
we created a much more useful social situation; we found that intimacy between the patient and the employee
blossomed unexpectedly, that things I cannot distinguish from genuine human friendship sprang up between
patient and employee, that any signs of the alleged apathy of the schizophrenic faded, to put it mildly, and that the
institutional recovery rate became high.
To clarify this passage, Sullivan (1953) believed strongly that intimacy was not essentially sexual, but was instead
the desire of humans to be close and to receive validation of self-worth. Sullivan’s quotation suggests the central
distinction between the interpersonal (or object relation) theorist’s belief that humankind is person oriented as
opposed to pleasure oriented in Freud’s drive theory (1905). Truly, Sullivan’s one-genus hypothesis and
interpersonal orientation came to life on his Sheppard Pratt ward.

In his later years, Sullivan would despair that other psychiatric units did not replicate his results and that medical
education failed to develop sufficient empathy for the patient to be useful for the schizophrenic problem. Putting
Sullivan’s work in historical context, it is important to remember, when evaluating Sullivan’s successes at Sheppard
Pratt, that many of the patients whom Sullivan considered schizophrenic would today be seen as borderline

NOTE:
- About Sullivan’s sexuality, it should only be inserted at the part where “lust” is being discussed to
relatively connect the topic and determine why it is important to discuss about Sullivan’s sexuality.

Sullivan’s access to the Chicago School of Sociology (containing departments of social anthropology, social
psychology, and political science) began his famous Interdisciplinary collaboration between psychiatry and the
social sciences.

Sullivan was the pioneer among the makers of psychodynamic psychotherapy to integrate the findings of
psychiatry and psychoanalysis with other disciplines and to insist on the importance of research, a rich tradition
later furthered by Bowlby’s (1969, 1973, 1980) integration of ethology, infant research, and psychoanalysis and
recently by Stern’s (1985) and Lichtenberg’s (1983) integration of infant research and psychoanalysis.

As Sullivan turned his focus to the outside world of psychiatric research and social science collaboration, events in
Baltimore transpired that made leaving Sheppard Pratt inevitable. Sheppard Pratt was in the process of building a
new Clinical Center and Sullivan was quite active in its design. The centerpiece of Sullivan’s design was a new
reception (admissions) unit which was highly responsive to the patient’s first 24 hours of hospitalization, and even
to the first hour, acknowledging that the patient’s initial impression of the hospital was critical to the patient’s
later recovery. Additionally, this unit emphasized intensive treatment of the first acute attack, giving a
schizophrenic person the greatest chance of recovery. While Sullivan’s design suggestions were largely followed,
he was not chosen to head the new reception center. His significant problems with budgetary casualness and his
“inability to behave patiently toward the average individual” (Perry 1982:288), especially the nursing and
maintenance staff, led the Board of Trustees to effectively censor Sullivan in spite of Chapman’s active support for
him.

At the same time Sullivan was battling to include psychiatry in social science research funding and to establish his
action research and clinical design initiatives at Sheppard Pratt, he began a hard campaign to upgrade psychiatric
education. In 1927– 28, he proposed a new degree, Doctor of Mental Medicine, and a new approach to the
training of psychiatric physicians, emphasizing greater empathy and understanding of the patient’s experience
(puwede as a summary ng theory ni Sullivan) which he thought nearly impossible to attain from current psychiatric
education.

Harry Stack Sullivan developed more intimacy with his father than his mother.
Working with an often highly articulate outpatient population allowed Sullivan to focus on the treatment of
preschizophrenic and related disorders, broadening his context for both his understanding of psychopathology and
of personality, especially of how fortunate social circumstances and inner resilience mitigated against severe
psychopathology (1956). From a psychotherapy perspective, deviating from the growing psychoanalytic canon of
unending analysis (see Freud 1937), Sullivan did not want to see clients indefinitely, but instead focused on
circumventing anxiety long enough to help the client discover a more satisfying life. (page 56)

In 1933 in Washington, DC, Sullivan, along with Edward Sapir, Harold Lasswell, and Ernest Hadley, founded the
William Alanson White Foundation (WAW Foundation). The WAW Foundation was the beginning of a dream that
Sullivan had that would allow Sapir, Lasswell, and himself to obtain funding to support their collaborative research
together for life, unfettered by financial need and institutional pressure. The Foundation was to include research,
psychiatric education, and publication branches with its goals of:

1. most important, funding collaborative social science and psychiatry research with Sapir and Lasswell;
2. establishing an interdisciplinary school for training in a wide range of specialties;
3. beginning an eclectic journal, which emphasized the interpersonal dimensions of psychiatry.