Harry Stack Sullivan

Psychiatrist

• Born: February 21, 1892
• Birthplace: Norwich, New York
• Died: January 14, 1949
• Place of death: Paris, France

American psychiatrist

The life of Sullivan, the formulator of the interpersonal theory of psychiatry, marks an outsider’s triumph over personal adversity. Formerly diagnosed with schizophrenia, Sullivan broke through his loneliness to deliver rich insights into the human psyche and schizophrenia.

Area of achievement Psychiatry and psychology

Early Life

As Clara Thompson, a close friend and colleague of Harry Stack Sullivan, stated, “Sullivan was a lonely person from his earliest childhood.” His grandparents had emigrated to the United States from Ireland. When Sullivan was three years old, his family moved from the county seat to a farm located near the village of Smyrna. Not many relationships with other children were possible, especially since the Sullivans, a Roman Catholic family, were the only people of their faith in a Yankee Protestant community. Because Sullivan was the only surviving child (two other children had died in infancy), he knew isolation at an early period of his life.

Sullivan’s family environment was not a healthy one for his later maturation. His mother, who believed that she had married beneath her station, was partially disabled and with deep resentment toward her status of wife to a humble farmer. She transmitted little warmth to young Sullivan. Through these difficult years, Sullivan harbored the belief that if he could only reach his father, he would know understanding and warmth. This did, indeed, occur, but only in adult life and after his mother’s death.

It has long been believed that Sullivan’s sole early associations were with the animals on the family farm. Though a bright pupil, he found it difficult to make friends during his early school years. Thanks to his definitive biographer, Helen Swick Perry, it is now known that Sullivan did develop a friendship with an older boy, Clarence Bellinger, who also later became a psychiatrist. No doubt it was this relationship that prompted the mature Sullivan to emphasize the necessity for a young boy to have a “chum,” a close association with another boy.

This chum relationship did not, however, serve to socialize Sullivan, for his later youth was spent in conflicted isolation. Sent to Cornell University to study physics, Sullivan remained an outsider and was suspended from school for poor grades. This trauma set the stage for emotional suffering in a period that is still clouded in mystery. Later, Sullivan would confide to his assistant, Perry, that during his youth he had a schizophrenic reaction. In preparation for her biography of Sullivan, Perry searched in vain for a hospital record of his illness but came to accept its occurrence and concluded that Sullivan had probably been confined to Bellevue. On the other hand, Silvano Arieti, in his book Creativity: The Magic Synthesis (1976), declares that “Sullivan had several schizophrenic episodes.”

Although he never completed college, Sullivan, wanting to study medicine and psychiatry, entered the Chicago College of Medicine and Surgery, where he received his MD in 1917. According to his colleague Thompson, “he finally got to medical school, where his poverty and his feeling of not knowing how to belong kept him still isolated from his contemporaries.” Although Sullivan’s grades in medical school were mediocre, he read widely in the works of Sigmund Freud and others.

During World War I, Sullivan served as a lieutenant and as a junior member of the Board of Examiners for the medical corps of Sixth Service Command. After being discharged from Army service, he was determined to enter psychiatry. In 1919, he was called to become assistant medical officer in the Eighth District Headquarters of the Rehabilitation Division of the Federal Board for Vocational Education. In 1920–21, he served as executive medical officer of the division. In these positions, Sullivan drafted recommendations for the treatment of military veterans who had been disabled by psychiatric trauma.

Having returned to Chicago, Sullivan became United States Veterans Bureau liaison to St. Elizabeth’s Hospital in 1922. At last, he was launched on a career in psychiatry. In 1923, he was appointed assistant physician at Sheppard and Enoch Pratt Hospital in Baltimore, Maryland. In 1925, Sullivan was named director of clinical research, with unlimited power to investigate schizophrenic disorders.

Life’s Work

In Sullivan’s day, Freud’s psychoanalysis was winning broad support in psychiatric circles, which gave up on people with schizophrenia as untreatable. Sullivan, in turn, though he at first attempted to use psychoanalysis in the treatment of psychotics, “humanized” schizophrenia and argued that it was treatable. Not only did he modify Freud in his approach to the disorder, but also he claimed that the malady was treatable by psychotherapy because there was no divorce between the characteristics of most people with schizophrenia and “normal” neurotics. Indeed, Sullivan’s insistence on schizophrenia as a human process led him to a theme that undergirds all of his efforts: the One-Genus Postulate. This postulate holds that all human beings are much more similarly human than otherwise, and the true aim of psychiatry is to develop a science of human similarities rather than individual differences.

Freud’s emphasis was on the intrapsychic, the struggle of the individual against his antisocial biological instincts. Sullivan’s emphasis was on the external shaping of the human psyche through interpersonal relations going back to the mothering one in infancy and extending through the patient’s mature life. Sullivan also came to stress the cultural and social milieu in which the patient’s interpersonal relations developed. This cultural orientation led Sullivan to reach out to the great social scientists of the United States, including Edward Sapir, Charles H. Cooley, Ruth Benedict, and Harold D. Lasswell. Indeed, Sullivan, who envisioned a fusion of psychiatry with the social sciences, was moving toward social psychology.

In Freud’s psychoanalysis, the therapist attempts an objective and largely passive treatment of the patient. Sullivan, on the other hand, depicted the therapist as a “participant observer” who enters into the interpersonal nexus of the patient. By conscious awareness of his participatory role, the psychiatrist seeks to penetrate and reorient the patient with schizophrenia’s distorted symbolic thinking.

Sullivan was a brilliant and compassionate clinician to the “lonely ones,” as he referred to the people with schizophrenia, and the remission rate of patients at Sheppard and Enoch Pratt Hospital was little short of amazing. While Sullivan was a harsh mentor to medical students and a waspish colleague to other psychiatrists, he, according to Thompson, “had another side a gentle, warm friendly one. This was the side he showed his patients.”

In 1931, Sullivan moved to New York, where he entered private practice. From that time onward, he had greater opportunity to observe patients plagued by obsessional neuroses. Such patients had long interested him because of their possible connection to schizophrenia.

In 1938, Sullivan, preoccupied with “practical psychiatry” in the light of the coming international crisis, left New York to return to Washington, DC. He became consultant in psychiatry for the Selective Service System in 1940, serving in this role for a year. In the 1930s and 1940s, Sullivan was a psychiatric consultant for numerous psychiatrists and clinical psychologists in both New York and Washington, DC. During this period (in 1933), he and associates also established the William Alanson White Psychiatric Foundation. The Washington School of Psychiatry, one of the enterprises of the foundation, was established in 1938. (Soon after Sullivan’s death in 1949, however, the school ceased to teach his brand of interpersonal psychiatry, and many of his former students returned to the fold of traditional psychoanalysis.)

After World War II, Sullivan moved toward a messianic role, calling on psychiatrists to develop a “psychiatry of peoples” that would help reduce international tensions between nation-states. In this regard, Sullivan was influential in the founding of the World Federation for Mental Health and was an active participant in the United Nations Educational, Scientific, and Cultural Organization (UNESCO). He had, in the meantime, suffered from heart disease for many years, and his international activities became, according to Thompson, a “fire within him.” It was on such a mission, on January 14, 1949, that Sullivan died in Paris.

Significance

Not only does Sullivan’s life and work mark the personal victory of a troubled outsider; it was also a triumph for America. As Perry states, “At some level, Sullivan’s final contribution was as American as Mark Twain.” After absorbing the European masters of psychology, Sullivan reached out to American social science, incorporating the best of American sociology and anthropology into his theory of interpersonal relations. Furthermore, Sullivan’s theory, with its practical emphasis on visible interpersonal relations, was deeply permeated with pragmatism, the one native American philosophy. The American pragmatist philosophers were oriented toward lived experience, practical reality, life as it is sensed and felt, over lofty metaphysical abstractions.

Finally, Sullivan’s theory of interpersonal relations is ripe with universal importance. Whereas the unconscious in Freudian theory is invisible and difficult to fathom concretely, Sullivan’s emphasis on concrete, external interpersonal relations gave to the psychiatric world a new context for studying human behavior. Indeed, so profound was Sullivan’s work that Arthur H. Chapman noted that he is recognized as “the most important American-born psychiatrist.”

Bibliography

Arieti, Silvano. Interpretation of Schizophrenia. 2d ed. New York: Basic Books, 1974.

Chapman, Arthur H. Harry Stack Sullivan: His Life and His Work. New York: G. P. Putnam’s Sons, 1976.

Chrzawoski, Gerald. Interpersonal Approach to Psychoanalysis: Contemporary View of Harry Stack Sullivan. New York: Gardner Press, 1977.

Gaarder, Kenneth R. “The Life and Legacy of Harry Stack Sullivan.” Psychiatry: Interpersonal and Biological Processes 69, no. 2 (Summer, 2006): 107-109.

Mullahy, Patrick. Psychoanalysis and Interpersonal Psychiatry: The Contributions of Harry Stack Sullivan. New York: Science House, 1970.

Perry, Helen Swick. Psychiatrist of America: The Life of Harry Stack Sullivan. Cambridge, Mass.: Belknap Press, 1982.