Harry Stack Sullivan

(1892–1949)

PresenterDr Mohd Osman Ali

ChairpersonDr P HimakarProf of Psychiatry

Scheme of

Presentation

•Introduction• Personality theory• Developmental theories•Theory of psychopathology (psychiatric implications)• Interpersonal psychotherapy•Summary

• Brief biography• His works• His main contribution

Introduction

generally acknowledged as

the most original and distinctive

American-born

theorist in dynamic psychiatry

• Sullivan graduated from medical school in Chicago in 1917.

• He made his reputation based on his experimental treatment ward for schizophrenics at the Sheppard Pratt Hospital, between 1925-29.

Works• The Interpersonal

Theory of Psychiatry (1953)

• "The Psychiatric interview”(1954)

• Conceptions of Modern Psychiatry (1947/1966)

• and" Schizophrenia as a Human Process (1962)

• Sullivan's work on interpersonal relationships 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.

• Interactional approach• Needs and anxiety• Security operations• Self system

Personality theory

For many years the primary theoretical dispute within dynamic psychiatry circles was

between

Classic freudi

ans

Sullivanian

s

In his words, one must pay attention to the

"interactional“, not the

"intrapsychic“.

• He emphasized the psychiatrist as participant/observer in the clinical situation

• seeking to keep observations as objective as possible,

• What can be observed is the social interaction of patients

• This search for satisfaction via personal involvement with others led Sullivan to characterize loneliness as the most painful of human experience

• thus, he defined personality as the “relatively enduring pattern of interpersonal relations

which characterize a human life.”

• Sullivan defined a “dynamism” as “the relatively enduring pattern of energy

transformations,” that is, recurrent interpersonal behavior patterns.

Sullivan's theory is fundamentally one of

Needs

and

Anxiety.

Needs• needs for satisfaction(e.g., air, water, food, warmth),• and needs for securityneed to avoid, prevent, or reduce

anxiety.• emotional needs for human contact and for expressing one's

talents and capacities

• Decades before Mahler wrote of a symbiotic stage in infant development, Sullivan spoke of the “empathic linkage” between caretaker and infant

• and described the complicated interaction of infants communicating tension and anxiety, arousing anxiety in the caretaker, leading to tender responses to the infant's needs.

• The tension of anxiety, when present in the mothering one, also induces anxiety in the infant.

• Eventually, the empathic linkage becomes unnecessary and the self-system operates autonomously within the individual, developing ever more subtle and complex ways to manage the person's anxiety.

• Failure to meet these needs results in loneliness and anxiety.

• Because there is no such thing as a perfect mother or parent, anxiety is inevitable and becomes the primary driver for personality development.

Security operations

• Sullivan defined security as the absence of anxiety• The self-system develops a set of mechanisms, called security

operations, which effect this goal. • function within Sullivan's theory much as defense

mechanisms do within psychoanalytic theory. • Some bore the same labels and definitions as Anna Freud's,

but Sullivan is best known for three contributions that bore his distinct stamp: – Apathy, – somnolent detachment, – and selective inattention.

Self System

• a configuration of the personality traits

• developed in childhood and • reinforced by positive affirmation

and the security operations developed in childhood to avoid anxiety and threats to self-esteem.

• and is the outgrowth of interpersonal experiences, rather than an unfolding of intrapsychic forces

• Sullivan equated the self, identity, or ego with the individual's developed patterns for avoiding the discomforts – that arise from the inability of others to

meet one's fundamental needs.– It exists, like all else, purely within an

interpersonal framework.

The self-system

The “good me” associated with an unanxious, tender,

empathic, and approving or

accepting response from the

environment

The “bad me” that provoke anxiety and

disapproval from caretakers

The “not me.” provoke such

intense anxiety that they are

entirely disavowed and

disowned;

•cognitive• social

Developmental

theories

The Prototaxic mode

• undifferentiated thought that cannot separate the whole into parts or use symbols.

• It occurs normally in infancy

• and also appears in patients with schizophrenia, mystical experiences

The Paratax

ic mode

• events are causally related because of temporal or serial connections.

• Logical relationships, however, are not perceived

• Begins early in childhood

• explain transference, slips of the tongue, and paranoid ideation.

The Syntaxic mode

•the logical, rational, and most mature type of cognitive functioning of which a person is capable.•based on the development of language and consensual validation

• These three types of thinking and experiencing occur side by side in all persons; – it is the rare person who functions

exclusively in the syntaxic mode.

• Maturity may be defined as extensive predominance of the syntactic mode of experiencing.

• cognitive

•socialDevelopmental

theories

somewhat based on his three evolving cognitive modes.

However, disturbed interpersonal relationships may cause persistence of the more primitive

(prototaxic or parataxic) ways of experiencing the world.

Social development

• the satisfaction needs, which are predominant,

• and the interpersonal sphere in which these and their resulting security needs are sought to be fulfilled.

• the primary “zone of interaction”—bodily areas through which the individual channels needs, anxiety, and relief—in interactions with the environment.

characterized by the primary need for bodily contact and tenderness

the primary zones of interaction are oral and, to some extent, anal.

To the extent that some anxiety is commonly present in the caretakers,

apathy and somnolent detachment are regularly used as security operations,

persisting into adult life as a basic detached and passive stance.

During infancy

• If anxiety and inconsistency are severe, intense experiences of dread persist, presenting in later life –as the eerie, uncanny, bizarrely disruptive

internal states seen in individuals with schizophrenia

The primary mode of experience shifts to the parataxic, and the most common

zone of interaction is anala child's main tasks are to learn the

requirements of the culture and how to deal with powerful adults

Gratification leads to an expansive self-system with many facets of life

associated with the “good me” and positive self-esteem.

During childhood-- from 2 to 5 years

• Moderate anxiety leads to chronic anxiety, uncertainty, and insecurity.

• Extreme anxiety results in giving up known successful behavior in favor of self-defeating patterns that fulfill others' expectations

The shift to syntactic cognitive modes begins

a child has a need for peers and must learn how to deal with them.

Interpersonal cooperation, competition, play, and compromise become the

gratifying experiences.

As a juvenile, from 5 to 8 years

• The risks of excessive anxiety are either too great a need to control and dominate social situations or they become an internalization of restrictive, prejudicial social attitudes.

the capacity for love and for collaboration with another person

of the same sex develops. This so-called chum period is the prototype for a sense of intimacy.the major shift toward syntactic

thinking takes place

In preadolescence, from 8 to 12 years

• In the history of patients with schizophrenia, this experience of chums is often missing.

• the give and take of the special friend could repair and undo distortions that resulted from excessive anxiety at earlier stages

major tasks include the separation from the family,

the development of standards and values, and

the transition to heterosexuality

During adolescence,

• Problems in living• schizophrenia

Theory of psychopathology

• He saw psychopathology as resulting from excessive anxiety arresting development of the self-system

• thereby limiting both opportunities for interpersonal satisfaction and available security operations.

• He viewed psychiatric patients as struggling to maintain their self-esteem with very limited means.

• To understand them, the developmental phase at which they operate has to be gauged, and the interpersonal needs they express have to be understood.

• Finally, the chance occurrence of stresses encountered during life is deemed a factor

Problems in living• Sullivan was the first to coin the term "problems in

living" to describe the difficulties with self and others experienced by those with so-called mental illnesses.

• This phrase was later picked up and popularized by Thomas Szasz, whose work was a foundational resource for the antipsychiatry movement.

• "Problems in living" went on to become the movement's preferred way to refer to the manifestations of mental disturbances.

• He initiated the first of what are now called therapeutic communities

schizophrenia

• he sought to understand the fundamental human process within his patients, especially his sickest ones.

• Sullivan theorized that anyone might develop schizophrenia, even people with relatively successful developmental histories, should their chosen defenses fail dramatically and their life stresses mount in the extreme

• Four steps of therapy process

Interpersonal psychotherapy

Inception• the very beginning, often only a

part of the first interview, • contract and roles are stipulated.

reconnaissance

• might go on for as many as 10 to 15 sessions,

• therapist identifies the patient's recurring patterns and assesses their adaptive and maladaptive qualities

detailed inquiry• a very lengthy process of seeking to recognize,

clarify, and change persistent parataxic distortions and there is often much ongoing interchange between patient and psychiatrist

Termination • may reflect either extensive or limited goals.

• Sullivan emphasized that the psychiatrist is aparticipant–observer in all interactions with patients.

• Ultimately, persons need to see themselves as they really are, instead of as they think they are or as they want others to think they are.

• He argued that parataxic distortions emerge in all interactions, not only in the classic analytical situation.– This differing view of transference and of it being

a universal human process was among the core debates for decades between classic analysts and interpersonal analysts.

References

• Kaplan and Sadock’s comprehensive textbook of psychiatry 9th edition

Thank You

Questions and

discussion