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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

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Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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The Psychiatric System

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The Interpersonal Theory of Harry Stack Sullivan

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The first and foremost psychoanalytic theorist in the United States was Harry Stack Sullivan, who defined psychiatry as the study of interpersonal relations. The theory was a result of his striving for "a rational system as to what can be done about anyone anywhere who is not living as well as he seems capable of living with his fellow man." Sullivan believed that "man is more simply man than different one from another," and therefore he stripped his psychiatric system of any particular cultural heritage in the pursuit of a universal theory.

Born in Norwich, New York, in 1882, Sullivan attended Cornell University briefly and then Chicago College of Medicine and Surgery, from which he graduated in 1917. His professional career can be roughly divided into four periods. During the Chicago period (1917 to 1921), he was first an industrial surgeon at a steel mill, where an interest in psychiatry developed, and then became a lieutenant in the U.S. Medical Corps during World War I. He remained assistant medical officer until 1922, when he was appointed liaison officer of the Veterans Bureau to St. Elizabeth's Hospital in Washington, D.C. During the Washington–Baltimore period (1922 to 1931), he worked at St. Elizabeth's Hospital under William A. White, the superintendent, and then for 7 years at Sheppard and Enoch Pratt Hospital in Towson, Maryland. There Sullivan conducted pioneering research on schizophrenia and laid the foundation of his interpersonal theory. He lived in the hospital and allowed his patients to call on him anytime. David McK. Rioch had the following recollections:

It has seemed to me that though his theoretical contributions have advanced psychiatry as a social-biological discipline, Sullivan's main clinical effectiveness stemmed from championing the schizophrenic group of patients and attacking—tooth-and-nail, as it were—anyone who derogated, molested, or neglected such patients. That is, he was on the patients" side, first and last. In the hospital they were "My schizophrenics!" Nobody should interfere with them! Needless to say, the convulsive, anoxic, and psychosurgical methods were anathema to him. (1985)

During his New York period (1930 to 1939), Sullivan engaged in a private practice and abandoned the study of schizophrenia, choosing to see only patients with the obsessive-compulsive syndrome.

With the outbreak of World War II began the last period of Sullivan's career (1939 to 1949), during which he engaged in private practice in Washington, D.C., and associated with the Washington School of Psychiatry. The William Alanson White Psychiatric Foundation, which Sullivan helped establish in 1938, supported (1) Washington School of Psychiatry, at which Sullivan taught; (2) Psychiatry: Journal of the Biology and the Pathology of Interpersonal Relations, co-edited by Sullivan; and (3) William Alanson White Memorial Lectures, the first of which Sullivan delivered in 1939.

Sullivan also helped establish criteria for the Selective Service System at the outbreak of World War II, and made significant contributions toward international peace after the war and until his death in 1949. During his life, Sullivan authored numerous scientific articles and a book entitled Conceptions of Modern Psychiatry 1940. A large part of his writings, however, are contained in six books published posthumously: The Interpersonal Theory of Psychiatry 1953, The Psychiatric Interview 1954, Clinical Studies in Psychiatry 1956, Schizophrenia as a Human Process 1962, The Fusion of Psychiatry and Social Service 1972, and Personal Psychopathology 1972.

A precept of the interpersonal theory is that humans require interpersonal relations, that they have needs for satisfaction (food, shelter, sleep, the physical presence of another, lust) and for security (self-esteem or self-respect). Sullivan believed that man is vulnerable to anxiety, which "arises from one's relations with others in the later stages of life and manifests itself fairly readily under provocation as a rationalization pertaining to the ill-esteem of another." The relation of infant and mother, upon which so much depends in later life, is the beginning phase of development, from birth to "almost invariably 15 or more years." Sullivan believed that "unfortunate experiences at any developmental phase may do great damage to one's possibilities of future interpersonal relations."

In an introductory lecture to students at Washington School of Psychiatry a year before his death, Sullivan presented the goal of the psychoanalyst:

Some of you who like myself have an agricultural background realize that much of the heartache of the farm is the weeds; but the weeds are not that which is essential on the farm. The crop is essential, but the weeds are the trouble. And so it is in psychotherapy: Anxiety is the problem, but the unnumbered operations which human skill has devised—your patients" skill and experience have devised—to avoid and minimize anxiety, are what you have to struggle with in getting to the problem. But very much like the farmer's experience—after he has killed some weeds, other weeds will appear—in this work concentration on the unnumbered security operation, the protective performances, and so on, called out by hints of anxiety can go on forever. You can make a good living doing that. The only thing you can"t do is make very marked change in the patient, aside from the process of aging.When you have become fairly clear on the specific and particular vulnerabilities to anxiety which are irrational from the standpoint of the broader culture or the particular world in which a person is living or is to live, you have come to that which can be cured, that to which psychotherapeutic technique can apply (1949).

References

  1. Rioch DM. Recollections of Harry Stack Sullivan and of the development of his interpersonal psychiatry. Psychiatry. 1985;48:141–58. [PubMed: 3887444]
  2. Sullivan HS. The study of psychiatry. 1948 Orienting lectures. Psychiatry: Journal for the Operational Statement of Interpersonal Relations. 1949;12:325–37.
Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.
Bookshelf ID: NBK456PMID: 21250274
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