The Tao of Sullivan

Harry Stack Sullivan, M.D. (1892-1949) was the founder of the interpersonal theory of psychiatry. He is perhaps best known for his groundbreaking work with schizophrenics whom he compassionately called “the lonely ones” (Evans, 1996).  A brilliant, complicated, deeply empathic, often irascible intellectual pioneer, he was among the first to deviate from Freud’s structural orthodoxy of the time. Sullivan uniquely viewed human development as forming wholly within the context of culture and inseparable from the interference of anxiety with respect to various patterns and problems in living (i.e. psychopathology).

My own interest in Sullivan dates back to a mental health field placement and a supervisor/mentor well versed in Sullivanian thought. My graduate curriculum, heavily psychodynamic and notably comprehensive, barely acknowledged him. I later came to find this was not unusual, even something of a phenomenon. Once exposed, Sullivan’s ideas became, for me, much less than another body of theory or technique than a kind of permission-- a way of being with my clients that resonated viscerally. Without fully knowing it, and as is usually the case with therapist theory of choice, what I also found in Sullivan was clarity, validation and greater hope for resolution of my own particular problems in living.  Most recently, my quest to integrate diverse elements of psychological and spiritual wisdom lead to the rediscovery of the “quantum” core of Sullivan’s ideas.

Sullivan’s work greatly influenced many schools of thought including ecological and family systems, (Yalom’s) interactional group theory, cognitive-behavioral therapy, contemporary relational theory and intersubjectivity.  In addition, his work created an entirely new lens with which to understand and treat individuals with enduring maladaptive personality patterns. In the end, we can’t escape the obvious- psychotherapy, regardless of modality or orientation, is an intrinsically interpersonal process. Indeed Sullivan’s basic conception of personality, mental disorder and psychotherapy flowed from a single source- his fundamental assumption that human nature must be understood from the vantage point of interpersonal relations (Evans, 1996). But perhaps it is the spirit of unity binding his theory; that of the essential oneness of humanity and the human experience that best accounts for the intuitive, timeless applicability of his ideas and the mostly covert influence on the many hallowed theories with which we identify.

Monism, largely considered an Eastern conception with Indian philosophical origins (and subject to many interpretive definitions) is a metaphysical/theological view that all is of one essence, principle, substance or energy (Wikipedia, 2001).  Sullivan’s placing of the personality itself within the interpersonal field presumes a larger metaphysical view based on the principle that life is a process and flux, a never static, continual series of energy transformations (Greenberg and Mitchell, 1983). This echoes his parallel conclusion that “the ultimate reality in the universe is energy” (Sullivan, 1953b). Sullivan’s oft-quoted One Genus Hypothesis “Everyone is much more simply more human than otherwise…” (Sullivan, 1953b) illustrates the monistic heart of his worldview.  For all its compassionate humility, it is also a painfully informed postulate rooted in Sullivan’s profound childhood isolation and early insecure/ambivalent attachments.

This exquisite awareness and Sullivan’s proposed developmental imperatives of interpersonal connectedness and cooperation, security, empathic attunement, compassion, tenderness and consensual validation would stem from a keen ability to sublimate and universalize the frustrations of his early environment.  Sullivan, like most wounded observers of the human condition, generalized his experience and struck a primordial chord of universal truth that echoes in spite of the scant credit he receives to this day. (Ask three therapists today; one will have never heard or know little of his contributions.)

Holism, another concept with ancient Eastern roots and parallels to quantum mechanics, by definition, is the idea that all the properties of a given system cannot be determined or explained by the sum of its component parts alone, but the system as a whole determines how the parts behave (Wikipedia, 2001).  Equal parts humanist, behaviorist, culturalist and psychiatrist, Sullivan was among the first to study and clinically operationalize the non-verbal aspects of the interaction between client and therapist as well as to expound a fundamentally holistic theory of Self as the sum of reflected appraisals of others (Sullivan, 1953a).  Moreover, he was the first to conceptualize the role of the psychotherapist as one of participant-observer.  Perhaps intuitively, Sullivan applied the observer effect phenomenon (similar to the Heisenberg Principle of theoretical physics) in which a difference is always made to an activity or person by the act of observation itself (Wikipedia, 2001).  Sullivan’s participant-observer stance, in stark contrast to the “blank screen” of the psychoanalyst expanded the role and function of therapist to “co-creator” (to quote a contemporary new age term) of the psychotherapy experience. The new paradigm undoubtedly re-contextualized (and likely neutralized) iatrogenic patient responses through the introduction of the first truly holistic, two-person psychology in which a patient is viewed through the wider lens of the therapist-patient dyad.

For all his subjective madness, undeniable brilliance, alleged deviances and idiosyncratic interpersonalisms, Sullivan’s core axiomatic principles, not unlike most deceptively simple and timeless Eastern philosophical/metaphysical concepts remain vital and relevant today despite his comparatively obscure legacy. Unlike some of his contemporaries, Sullivan dwelled little on themes of fantasy, spirit, soul or love.  He steered clear of distinctly teleological arguments, remaining foremost interested in the pragmatic, and more directly inferable problems in living that affected everyone, most notably himself.  There is of course more to Sullivan than presented here, yet it may in fact be the Tao of Sullivan that best accounts for his broad applicability and enduring importance in this whole business of understanding and uniting in our inescapably common humanity.  For this, he should not be forgotten.

Evans, F. Barton III (1996)  Harry Stack Sullivan; Interpersonal theory and psychotherapy. New York: Routledge.

Greenberg, J. & Mitchell, S. (1983)  Object Relations in Psychoanalytic Theory. Cambridge, MA: Harvard University Press.

Sullivan, H.S. (1953a)  Conceptions of Modern Psychiatry.  New York: W.W. Norton & Co., Inc.

Sullivan, H.S.  (1953)  The Interpersonal Theory of Psychiatry. New York: W.W. Norton & Co., Inc.

Wikipedia (2001)  World Wide Web.