Good Me' or Bad Me' - The Sullivan Approach To Personality - The New York Times

11/9/2020 ‘Good Me’ or ‘Bad Me'— The Sullivan approach to personality - The New York Times
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ʻGood Meʼ or ʻBad Me'— The Sullivan approach to

personality
By David Elkind
Sept. 24, 1972
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September 24, 1972, Section SM, Page 18 Buy Reprints
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The work of Harry Stack Sullivan, generally re garded as America's most original
psychiatrist, is only now beginning to win widespread recognition. Sullivan died in 1949.
Today interest in Sullivanian treatment and training methods is growing; more and more
references to him are appearing in the professional literature, and his books are doing
better than ever. At the heart of his contributions to contemporary psychiatric theory and
practice and to social science lies his genius for understand ing interpersonal relations in
all their manifold levels and communicating that understanding. What follows are an
interpretation of his ideas and a brief sketch of his life.
The Work
Traditionally, psychiatry has been a medical specialty not unlike pediatrics or cardiology.
Mental illness was looked upon as a sort of disease of the mind to be treated like any
other disease. The vari ous drug and nutritional therapies (which may have therapeutic
value) and the current resurgence of in terest in lobectomy and lobotomy (brain surgery
to alleviate psychotic symptoms) reflects this medical model of mental illness.
Although rooted in biology, Freudian theory was in some ways opposed to the medical
model. Freud argued that most neurotic disturbances resulted from interference by other
persons in an individual's normal processes of development. Sullivan believed that Freud
did not go far enough with this idea because he left the illness, the neurosis, within the
individual as an encapsulated entity. Sullivan argued forcefully that mental illness had to
do with the ways in which people deal with people and was, therefore, “interpersonal”
and not “intrapersonal.” Even when we are alone, our thinking and behavior always
relates to other people, real or imaginary. What Sullivan wanted to do was to reformulate
the problems and concepts of psychiatry from this interpersonal perspective.
Take, for example, a classic category of neurosis like hysteria. This was always defined in
terms of repression of sexual impulses, with symptoms such as hysterical blindness or
paralysis. Sullivan wanted to substitute for these formulations descriptions of
interpersonal behavior that made for difficulties in living, such as the “negativistic”
person, who feels insecure and inadequate and who accentuates his own significance by
constantly disagreeing with others. “Self-absorbed” people, in Sullivan's scheme, are
those who relate to others on an all-or-nothing basis: “People whom I like are all good
while people whom I dislike are all bad.” In each case the person must be described by
his typical ways of relating to other people, not by a list of self- contained symptoms.
Basic to Sullivan's conception of psychiatry was the “one-genus” postulate: No matter

how much human individuals differ from one another these differences are minuscule
compared to the differ ences between a human and a member of any other species; our
weaknesses, no less than our virtues, are human weaknesses. In effect, Sullivan tried to
do for psychiatry what Skinner is trying to do for psychology but in the opposite
direction. Skinner wants psychology to emphasize man's animalness, the fact that our
behavior can be shaped and modified according to the same prin ciples used to shape and
modify the behavior of rats and pigeons. Sullivan wanted psychiatry to emphasize man's
humanness, the fact that man's feelings, motives, thoughts and values are uniquely
human and have no counterpart at the animal level.
This approach was central to Sullivan's concep tion of psychiatry and personality
development because he recognized the very human tendency to feel un-human. When
we make an error, fail in what we undertake or hurt someone else need lessly, our
tendency is to feel that we are unique, that only we could have done something so sinful
and evil. What we tend to feel, if not think, in such situations is that somehow we have
been removed from the human race by our failings. It is very human to feel this way, and
the mentally ill feel that they are un-human to an extraordinary degree. Thus Sullivan
emphasized that nonorganic mental disturbance differed from the experience of
“normal” people not in kind but only in degree, timing and circumstance.
The one-genus postulate was also the basis for Sullivan's dissatisfaction with training in
the med ical profession. He believed that physicians and nurses were trained primarily to
do things to the patient rather than to be things to the patient, were thus often led to
consider the patient as some how having more differences than likenesses to themselves.
Such an attitude was unjustified in any medical specialty, he felt, but particularly so in
psychiatry. Sullivan believed that unless the psychiatrist was respectful, understanding
and accepting, he could not really help the patient, whose self-respect and esteem had to
be the focus of therapy.
Not surprisingly, Sullivan's theory of personality concerns the evolution of the “self-
concept.” This is entirely interpersonal in origin and is gradually elaborated out of the
reflected appraisals of other persons (“Johnny is so good-looking,” “Helen is so clumsy”
and so on.) Although the self-concept evolves gradually, the need to maintain self-respect
and self-esteem, which Sullivan calls the need for “security,” is present from the very
beginning. Threats to self, to one's self-esteem and respect, are experienced as “anxiety.”
Anxiety, in turn, produces defensive maneuvers to relieve anxiety and to protect the self.
The Sullivanian theory of personality development can be described as a theory of the
evolution of the self and its defensive maneuvers.
Sullivan's acquaintance with infants and children was largely secondhand, derived from
case histories of his adult patients, his wide reading in the child development literature
(he read Piaget in the nine teen-twenties) and his discussions with his many friends,
such as Margaret Ribble, who were engaged in child-development research. Yet his
understand ing of people of all age levels was such that many of the observations he
made about children and adolescents have since been substantiated by research
investigations. His concept of the self has, in fact, been a fruitful starting point for many
investigators now exploring social development.
In Sullivan's view, the child's sense of self evolves gradually during the first year of life,
primarily as a consequence of the ministrations of the person who takes care of the child.
If this caretaker is loving, comforting and meets the infant's needs, the infant has a
generalized feeling of “good me.” On the other hand, if the caretaker is anxious, tense and
rejecting, this too is commu nicated to the infant, who experiences a general ized feeling
of “bad me.” The caretaker communi cates to the infant primarily by means of a process
which Sullivan calls “empathy.” This is not partic ularly mysterious—all of us
communicate through empathy. When someone says that a tense, fidgety person “makes
me nervous,” he is talking about empathy.
The importance to the infant of a generally posi tive sense of “good me” has now been
well docu mented. Infants need to be mothered, held, rocked, touched and talked to if
normal development is to occur. The mere meeting of physical needs— nutrition, etc.—is
not enough. In the absence of adequate mothering or the presence of a pervasive sense of
“bad me,” some infants withdraw, become apathetic and may even literally shrivel up and
die. Others become permanently impaired, both emotion ally and intellectually. With the
development of speech at about the age of 2, the child passes into the era of what Sullivan
calls childhood (what is today called early child hood—from 2 to 5). Language opens up a
wide new range of potentials for elaborating the self-concept, which now becomes
stocked with verbal appraisals of approval and disapproval, of affection and rejec tion.
The nature of the child's self-concept will be determined by the balance of approval and
disap proval in his experience.
Take, for example, the case of what Sullivan called the “malevolent” child. Such a child,
because of rejecting or bitter parents, may have received a preponderance of negative
appraisals —“Can't you do anything right?,” “Oh, you are so clumsy,” “Why do you
always look like a rag doll?” and “Leave me alone.” The youngster may have had some
good self-appraisals as well, but these have been “dissociated,” or dropped from
awareness and thus play less part in his interpersonal dealings than does the
overwhelming negative appraisal.
In his search for security, the malevolent child sees in others primarily what he sees in
himself (this is a basic rule in Sullivan's theory). Accord ingly, a child of this sort will see
only the negative aspects of a person, even if that person is kind and interested in helping
him. Many a teacher has had the experience of trying to be friendly to a withdrawn child
only to be attacked in the most vicious way. The child, through the microscope of his
negative self-concept, seeks out and finds the negative aspects of the helping person's
behavior and ignores the rest. In so doing the child restores his feeling of being human
(his security need) by finding that others are as bad as he feels himself to be.
When the child arrives at school age (roughly from 5 to 10), which Sullivan calls the
“juvenile” era, new opportunities for the elaboration of the self are opened up. In school
the child can now incorporate the appraisals of teachers and other adults into his self-
concept. He also begins to incorporate the evaluation of his peers as he engages in group
activities and is involved in com petition and collaboration with others. In Sullivan's view,
the self-concept is never static and the nega tive self-image inculcated by rejecting
parents can, with the offices of patient teachers and peers, sometimes be subordinate to a
positive self-con cept. Unfortunately, the reverse is also true, and lifelong negative self-
appraisals can be acquired from peers and teachers during this era.
Some of the kinds of injuries to the self that occur during the juvenile state derive from
inter actions with unthinking teachers and other adults. One 6-year-old rounded the
corners of the paper on which he had painted a picture because he thought this made it
look “prettier.” When the teacher saw what he had done, she said, with an angry expres
sion, “You've ruined it” From then on the child thought he had no artistic talent at all and
was afraid to venture another painting. Another 6-year- old was so praised for a
particular drawing that she never drew anything else, for fear of not doing so well with
something new.
Perhaps the most distressing and widespread evidence of what can happen to a child's
self-con cept during this period is exemplified by the slow reader. If, for whatever reason,
a child in our society is not reading by the end of first grade, he already begins to feel that
he is a “flop” in life. More and more, reading comes to be associated with the anticipation
of negative self-appraisals. It is not long before anything connected with reading arouses
anxiety and, to protect the self, reading avoided. Such avoidance further complicates the
problem, of course, because it makes further prog gress in reading impossible. In helping
such chil dren, the major task is not to teach them to read but to refurbish their self-
concept.
Beginning with the preadolescent era (roughly 10 to 12) a new and very important
opportunity for the elaboration of the self-concept occurs through the formation of what
Sullivan called “chumships.” Up until the preadolescent period, the child is concerned
primarily with the elaboration and welfare of his own self-concept and sense of security.
(To be sure, he loves his siblings, parents and friends, but his own needs still ccme first—
the child is his own first priority.) In preado lescence, however, the young person forms a
close relation ship with a friend of the same sex, a chum, whose self-con cept and security
become as important to the preadolescent as his own self-concept and security. Such a
relationship, in which the other person's security becomes as important as one's own, is
what Sullivan terms “intimacy.”
The formation of chumship is crucial to personality growth. The preadolescent who

successfully enters a chumship finds someone with whom he can share his inner most
thoughts and feelings. To his chum, he can reveal what he feels to be the most terrible (as
well as positive) things about himself in an at mosphere of total acceptance. In this way,
he can accept (if not condone) as part of his basic humanness such things as hateful
impulses and thoughts. Successful chum ships thus give the preado lescent the
opportunity to neutralize many of the nega tive self-evaluations he re ceived as a child,

and he can move into adolescence with greater personal self-esteem and a greater
understanding of others than he had before.
The young person who does not experience a chumship, however, and moves into ado
lescence with a predominant ly negative self-concept is often headed for disaster. In deed,
to Sullivan, schizo phrenia, which usually oc curs in middle adolescence, is a consequence
of the need to cope with newly emergent sex drives without the resources that a positive
self-concept provides. (One of his early contributions to psychiatric theory and practice
was his demonstration that schizo phrenics could be helped by psychotherapy—despite
Freu dian admonitions to the con trary.) Schizophrenia, in the Sullivanian view, is simply
the extreme of a continuum of at tempts to escape anxiety—an anxiety produced by
interper sonal situations that pose a threat to the self. In such peo ple “the search for
some measure of self-respect is a never-ending task, and be comes an end rather than a
consequence of interpersonal relations.”
Sullivan's emphasis on the chumship period derived both from the case histories of his
patients and from his own personal history. He grew up an only child on an isolated farm
in upstate. New York, and in reporting some of the situations which interfere with
successful chumships he de scribes the “geographically isolated” boy in a way that
sounds autobiographical: “The capacity for sympathy be comes peculiarly differentiated
because of the elaboration of its underlying tendencies in loneliness…. From this back
ground there may come… a personality that stands out well above the average level of
achievement…. The force of public opinion on such a personality may remain rela tively
unimportant…. On the other hand, the isolated boy… lacks the practice that ensues in
unthinking ac commodation of oneself to others with whom one has sympathy. His
interpersonal relations are not easy…. Pos sessed of capacity for intimacy of
extraordinary depth, his experience of fraudulent folk may clearly drive him into
skepticism about people that is extremely annoying to more socialized personalities.”
Following preadolescence is a phase in development which Sullivan regards as a kind of

watershed—the midadolescent period from about 12 to 15. What emerges at this time is
genital sexuality (Sullivan called it “lust”) which con fronts the self with many new
threats as well as opportuni ties. Physical attractiveness for girls, height for boys and
interpersonal skills for both sexes become all-important in the new evaluations of the self
provided by peers, parents and other adults.
Among those young people fortunate enough to pass through a successful chum ship
period and to have ac quired accepting attitudes to ward their own sexuality,
midadolescence may have its ups and downs but presents no serious difficulties. It is the
teen-agers whose parents pun ished their body explorations as infants and young
children and who never developed in timacy with chums who find adolescence almost too
much bear. A pervasive loneliness resulting from failures to achieve intimacy, perhaps
combined with anxiety about sexuality, may lead to mental disorder.
In my experience adoles cence can sometimes present severe problems even for those
young people who enter it with a reasonably positive self-concept and with some
chumship experience. This is because of the wide individual difference in the rate of ma
turity. The late-maturing boy who retains his short stature, red cheeks, baby fat and high
voice (while his age mates have grown tall, are shaving and speak in deep baritones)
suffers long-standing injury to his self-concept. I have seen many such young men in fam
ily court (often dressed in boots, long hair, and lumber jack shirts in the manner of larger
and maturer boys) who get into trouble with the law to “prove” their manhood, to win
self-respect and esteem.
The most common difficulty in midadolescence is the in ability to integrate the re cently
emerged sexual and intimacy needs. This, by the way, is true for both boys and girls. The
midadolescent boy will often have a sacred profane notion that sex is only to be had with
“bad” girls while marriage is only en visioned with “good” girls. The sacred-profane split
un derlies the double standard and the still-prevalent desire of young men to marry
virgins. The young girl, who is more often romantic than erotic, is often frightened to
discover the crude passions hidden in the boy she had fantasied, in her romantic dreams,
as thoughtful, sensi tive and considerate.
With late adolescence (usually 15 to 18) the split be tween intimacy and sexuality is
bridged and the young per son can now find someone to relate to sexually who can also
be loved—in the sense that the other person's self- esteem and security are placed on a
par with the self's. To he sure this is not always true; many people may not develop such
a relationship until later in life and some people may never develop it at all. Many
marriages fail because, in part at least, the people involved could not or did not integrate
intimacy and sexuality in their relationship.
Sullivan does not say a good deal about maturity. He suggests that the potential for
further elaborating and developing the self continues throughout life as one engages in
new activities and assumes new roles. He believed that the natural tendency of each
individual is to grow and to realize his abilities, but that few individuals ever come close
to fully realizing their potentials. He also believed that an overblown self-con cept could
be as negative as a totally deprecating one. The mentally healthy individual has a
predominantly positive self-image but also has things he does not like or approve of in
himself.
In addition to his theory of personality development, Sullivan also outlined a con ception
of the psychiatric interview that has had con siderable impact upon psycho therapeutic
practice. Many of his innovations in therapy have been elaborated in such new
approaches as the family group therapy of Virginia Satir and the transactional analysis of
Eric Berne. As in his conception of psychiatry and personality development, Sullivan
made the interper sonal dimension the critical one in therapy.
Sullivan was among the first to recognize that the therapist is not a disembodied spirit
but rather affects the patient in significant ways that have to be taken into consideration.
The therapist must be a “participant ob server” in the sense that he must both interact
with the patient and, at the same time, monitor the interaction from the standpoint of an
outside, objective observer. Most of us engage in participant observa tion at one time or
another (bargaining with a car sales man often requires us to inter act with him at one
level while monitoring the inter action from a different level).
With an understanding of this principle, one can begin to appreciate the communica tion
difficulties which occur when any two people engage in conversation. In any such
situation the maintenance of self-esteem is always an un derlying Issue where true
intimacy does not exist. Each individual is constantly moni toring the other's communica
tions to determine what they indicate about himself. But the lines of communication are
far from clear and there is a great deal of distortion or “noise” in the system. Therapy is
concerned with helping people communicate more clearly with one an other. In his
discussion of the reciprocal, ongoing nature of communication, Sullivan anticipated
concepts such as feedback that have been made popular today by cybernetics and
information theory.
The closest most of us come to true communication is what Sullivan called the “syntaxic”
mode, the situation when both individuals are using the same words to mean the same
things. But this type of com munication is impeded by two other modes of interpreting
another person's meaning. What the other individual says is always interpreted in the
context of how he says it—his facial expression, tone of voice and gestures. This mode of
interpretation Sulli van calls “prototaxic.” In ad dition, what the other indi vidual says is
also interpreted in terms of who he is—the same words coming from a child and from an
adult are interpreted in quite different ways. When a remark is so interpreted, Sullivan
speaks of the “parataxic” mode.
Suilivan observed that emotionally troubled people were prone to prototaxic and
parataxic distortions in their interpretations of other peo ple's expressions. Some
troubled people, whom Sulli van called “asocial,” distort prototaxically and are super
sensitive to any signs of rejection, withdrawing from a relationship at the slightest hint of
dislike. The asocial person's sense of personal worthlessness is so great that he cannot
believe that anyone else would want to have any thing to do with him.
Other types of troubled peo ple show primarily parataxic distortions in their interper
sonal relations. Here is an example from Sullivan, which also reveals the charming wit of
the therapist, who was becoming bald:
“About the 300th hour, the patient came in… from the waiting room in a peculiar state of
agitation. She said she was overwhelmed to dis cover that I looked quite dif ferent than
she had hitherto seen me. She had known me as a fat old man with white hair.
Disregarding the other characteristics, I can scarcely have had white hair. This is both an
extreme and decep tively simple illustration of parataxic distortion of the psychiatrist in
the treatment situation.”
On the basis of this con ceptualization, psychotherapy seeks to help people over come
their prototaxic and parataxic distortions so that they can arrive at a correct, or syntaxic,
understanding of other persons' expressions. The process of arriving at this correct
understanding of other people is what Sullivan called “consensual validation.” Both the
therapist and the patient have to check their interpre tations by verbalizing and dis
cussing them. A patient says, for example, “I hate to have people staring at me,” to which
the therapist replies, “Why do they stare at you?” That is, the therapist has ac cepted the
statement as valid and with the patient seeks consensual validation for the observation.
A major hindrance to achiev ing a consensually valid in terpretation of reality is what

Sullivan called “selective in attention.” He first observed this phenomenon—as he did
many others that he described —within himself. It occurred when he went to his family
home to nurse his father dur ing the latter's terminal ill ness. While father and son were
talking, Sullivan seemed distracted and his father asked him whether he had no ticed the
new wallpaper in the room. Sullivan had not no ticed it even though he had been looking
directly at the wall. In analyzing this bit of behavior, he found that he did not really want
to see the change just as he did not want to think about his fa ther's impending death.
Selective inattention of a more pernicious sort is a per vasive phenomenon in inter

personal relations. Such inat tention is most obvious in those relationships wherein one
person is more “in love” than the other. A wife, for example, who badly needs her
husband's love to maintain her sense of self-esteem will selectively ignore the evidence
that he does not really care for her—all the big and little hurts that he has inflicted— and
will magnify, far out of proportion to their real mean ing, those few acts which be token
that he might indeed care. One sees the same selec tive inattention in some par ents of
retarded children. Re tardation of a child is diffi cult to accept, at least in part because it is
a threat to the parent's sense of self-respect. As a consequence, some par ents
“selectively inattend” to all the many evidences of lim ited ability while they magnify and
exaggerate any slight sign of intellectual prowess. Such inattention was for Sullivan a
very human process in that it always came into play in order to protect the self.
Sullivan's approach to treatment, which has been called “intensive psychother apy,” is
related to his theory of personality development. In a way Sullivan tried to re create with
the patient the chumship of preadolescence. In that relationship of total acceptance, the
young person could examine all the various aspects of himself and gain some consensual
validation of his basic humanness. The aim of therapy is to do the same thing and thus
help the pa tient refurbish his sense of self-esteem and respect. While the treatment
process is obvi ously more complex than what has been described here, its aim is always
to help the individual to the point where his sense of positive self- regard outweighs his
sense of being worthless and un human.
Critics contend that Sulli van was derivative rather than original, borrowing from men
like Freud, Adler and Ferenezi. To be sure, he was influenced by Freud but he was
equally influenced by the social psychology of George Herbert Mead, the holistic
psychiatry of Adolf Meyer and the operational philoso phy of Percy W. Bridgman.
Although the critics have cited the similarity between Sulli van's concert of parataxic
distortion and Freud's con cept of transference, a close reading of the two reveals that the
similarities are more apparent than real.
For Freud, who worked with neurotics, transference meant that the patient at tached to
the therapist feel ings that were once attached to the parents. For Sullivan, who worked
with psychotics as well as neurotics, para taxic distort ions were the actual perceptual
and con ceptual distortions which pa tients imposed on the thera pist (like the patient
who saw Sullivan as fat and white-haired). Similar differ ences can be found in every case
where Sullivan is said to have simply renamed some one else's conceptions. Sulli van had
his failings, but he
The Man
The belated recognition given to Harry Stack Sulli van's contributions to psy chiatry can
be traced to sev eral factors. For one thing, Sullivan never learned to “suf fer fools gladly”
and he could publicly demolish a preten tious colleague or an ill-pre pared student. There
were a good many people who, be cause of personal animosity, may have found it difficult
to acknowledge a debt (intel lectual or otherwise) after Sullivan tongue-lashing. Even
with his friends Sullivan could be difficult.
In early January, 1949, Sullivan was in Amsterdam attending the executive-board

meetings of the newly formed World Federation for Mental Health. Sullivan was gravely
ill and had made the trip despite pleas of his friends and in the face of a correct
premonition that he would not return to America alive. The trip was important to Sullivan
because he had been instrumental in setting up the Federation and because he was
deeply concerned that it serve the needs of the under developed as well as the de veloped
countries. At the meetings, Sullivan managed to alienate a good many of the participants
by his insistance that the board include more representatives from Asian and African
cultures.
After the last session, Sul livan was sitting alone and dejected outside the confer ence
room. An old friend, anthropologist Otto Klineberg, approached Sullivan and told him
that he had stepped on the toes of many of the board members. Then Klineberg added,
“You know, Harry, you stepped on my toes, too.” Sullivan, his head in his hands, replier
without looking up: “Otto, that is the least of my worries.” If they had been casual friends
this might have been taken as a hostile retort. But Klineberg knew that it was Sullivan's
way of saying, “Otto, you can under stand and accept why I had to do it.” Klineberg felt
closer to Sullivan at that moment than he ever had before.
For another thing, Sullivan published relatively little dur ing his lifetime. Although he did
a great deal of teaching— a goodly number of the senior psychiatrists practicing and
teaching in America today were trained by him—he was never satisfied with what he put
down on paper. Endlessly revising his copy, he pro duced only a number of ar ticles for
the professional journals; editorials for Psy chiatry, the journal he founded and edited,
and the book, “Conceptions of Mod ern Psychiatry,” a compilation of highly condensed
lectures. (After his death, his students and colleagues created a number of volumes
from his re corded lectures and notes.*)
But perhaps the most im portant factor in Sullivan's delayed recognition is that, like most
innovators, he was considerably ahead of his time. Only today are his con cern for the
dignity of blacks, his demand that professionals care for and about the people to whom
they minister, his emphasis on the humanness of mental disorder and his criticism of
sexual taboos coming to be part of the value structure of the society at large. Although
most young people have not yet discovered Sullivan, he nas foreshadowed many of their
criticisms of contemporary society.
Judged by his back ground, Sullivan was about as far from the stereotype of a
psychiatrist as one can imagine. The psychiatrist, par ticularly the analyst, is often
portrayed as having grown up in cosmopolitan Europe, as being Jewish and speaking
with a heavy Viennese ac cent. Sullivan was born in 1892 in Norwich, N.Y., and inherited
from his Irish- Catholic family an accent that was, if anything, pure Coun ties Cork and
Clare. But his life as a lonely farm boy, one of the few Catholic boys in a largely Protestant
and Yankee community, played a large part in Sullivan's tre mendous insight into the lone
liest souls in our society, the schizophrenics, whom the analysts had written off as
hopeless. Sullivan also attrib uted to his solitary boyhood the fact that he never de
veloped a strong need to have other people like him and think well of him and so could be
a severe critic without feeling guilty about it.
Sullivan's loneliness as a boy was aggravated by his mother's chronic unhappiness and
his father's taciturn with drawal. His childhood ex periences probably contrib uted to his
choosing psychi atry as a career despite an aptitude for physical science. After Sullivan
graduated from the Chicago College of Medi cine and Surgery in 1917, he served in the
Army Medical Corps and then in the re habilitation section of the Federal Board for
Vocational Education, where he drafted policies for dealing with men with psychiatric
disabilities. As a consecuence of this work, he was appointed in 1922 to be the United
States Veteran's Service liaison of ficer at St. Elizabeth's Hos pital in Washington, D.C.
St. Elizabeth's was the Fed eral hospital for the mentally ill and at the time was under the
direction of William Alan son White, one of the most prominent psychiatrists in America
and an early advo cate of psychoanalysis in this country. White stimulated Sullivan's
interest in Freud but also communicated to him his ambivalent feelings about Freud's
domination of the psychiatric field. For Sullivan, the ebullient, socially adept and
charming White quickly became a professional father figure. Years later the Wil liam
Manson White Founda tion in psychiatry and psycho analysis was set up under Sullivan's
direction.
In 1923, Sullivan left St. Elizabeth's for Sheppard and Enoch Pratt Hospital, a pri vate
mental hospital near Baltimore. It was at Shep pard that Sullivan did his original work
with schizo phrenics and where he first began to see the outlines of what was later to
evolve as his interpersonal theory of psychiatry. In his work with schizophrenics Sullivan
showed a sympathy, a toler ance and a tenderness hardly imaginable to those who knew
him in an academic setting, where his criticism could de vastate a colleague. Once, after
being hit, by a severely disturbed patient, Sullivan asked, softly and without ran cor:
“Feeling better now?” As a clinician he seemed to work best with acutely disturbed
schizophrenics, those who had just recently become psy chotic and who, in his view, were
retreating from prob lems in living and could be helped back to health. His success with
such patients demonstrated that schizo phrenia was a legitimate field for
psychotherapeutic meth ods.
It was during his stay at Sheppard that Sullivan first became acquainted with Clara
Thompson, another young psychiatrist. In 1923 Miss Thompson presented her first
professional paper at the Phipps Clinic in Baltimore. Sullivan was in the audience and
afterward made a point of meeting her. A close friend ship developed, and eventu ally it
was decided that one of them should go to Europe and be analyzed, then return and
analyze the other. A few years later, after both had moved to New York, Miss Thompson
did make the trip to Budapest where she was analyzed by Sandor Ferenczi. And true to
the agreement, Miss Thompson later analyzed Sullivan for at least 300 hours.
Equally significant during the Sheppard years was Sul livan's introduction to leading
social scientists and the be ginning of his collaboration with them. At an informal
conference on personality in vestigation held in 1928 under the auspices of the American
Psychiatric Association, Sul livan met Edward Sapir, the linguist and anthropologist, then
at the University of Chi cago. Sapir was especially interested in the relation be tween
culture and personality. This issue also interested Sul livan, who had been consider ing
the effect of the social milieu on mental disorder. The two men became friends and
together with Harold Lass well, the political scientist, worked during the next dec ade to
develop an understand ing of human personality in its sociocultural context.
While at Sheppard Sulli van also adopted a teen-aged youth, James Sullivan, a for mer
patient. Jimmie, as he still prefers to be called, came to play an important role in
Sullivan's life as a trusted confidant, secretary and gen eral manager. And Sullivan's
affairs required managing. He was completely impractical when it came to money and
would support friends and patients without worrying where the money was coming from.
“There is always more,” he would reply when the re cipients asked him whether he could
afford the largess he was bestowing on them.
At Sheppard, Sullivan's work had led him to con clude that schizophrenia was closely
linked to the compul sive behavior of obsessional neurotics, who, it seemed to him, were
also continually at tempting to maintain self- respect and esteem. Private practice, he
felt, would afford a better opportunity to ob serve such patients, and in 1931 he left
Sheppard to set up his own practice in New York. But as usual, Sul livan was short of
cash. A.A. Brill, the analyst, loaned him $2,000 to establish his New York office, and with
typical disregard for financial mat ters, Sullivan: used much of the money for a
phonograph and records to indulge his love of music.
While in New York Sul livan gained a reputation as a therapist with amazing in sight.
Psychiatrists frequently sought his help when they ran into a block with their own
patients. Examples of his clinical acumen abound. He once gave an exact descrip tion of
the husband of a patient's sister, simply from hearing how the sister treated the patient.
Another patient recalls his first meeting with Sullivan. He was quite frightened by the
whole affair and did not know what to say as he sat in Sullivan's comfortable sitting room
with its bright, cheery fire. Sullivan, a man of slight build, with thinning hair and wearing
classes, was at his desk shuffling papers and did not acknowledge the patient at all.
Instead, he kept opening and shutting drawers, lifting papers and mumbling to himself,
“Now where in the world did 1 put that thing; it must be here some place! Oh my, oh my,
oh my.” After about five minutes of this puttering, the patient felt quite at ease. He spent
about two hours with Sullivan, and when he left, he felt euphoric, as if he had been
relieved of a great weight.
But Sullivan could also be unnecessarily severe with fledgling as well as experi enced
psychiatrists. To one he remarked, after hearing an ac count of the therapy hour, “You
must have been asleep or fatigued to have missed that.” To another young psy chiatrist,
who had failed to gather relevant case-his tory material, he said, “And you call yourself a
psychia trist!”
In 1937 Sullivan decided to give up his New York prac tice. However, he did not im
mediately sell the brownstone on East 64th Street that served as his home and office and
allowed a number of his acquaintances to live there free of charge. Among these were
Erich Fromm, the ana lyst; Phil Sapir, Edward Sapir's son; Patrick Mullahy, a young
Irishman who became Sulli van's good friend and the most noted of his interpreters, and
Katherine Dunham, the dancer, whom Sullivan “res cued” from the Chicago an alysts he
thought were doing her harm. Sullivan's early in terest in the problems of blacks was
shown not only by his concern for Katherine Dunham but also by the fact that he had at
least one other black patient in those years and spent some time with black youth in the
Deep South in 1938.
Eventually Sullivan bought an old house on 1½ acres of land in Maryland, and this
became his center of opera tions until his death in 1949. Besides his editorial and su
pervisory work, he lectured at the Washington (D.C.) School of Psychiatry, at the William
Alanson White In stitute in New York and at Chestnut Lodge, a private mental hospital in
Maryland. In 1940, he became consultant in psychiatry for the Selective Service System.
He left soon after Gen. Lewis B. Hershey took over as Selective Service director the
following year, and it was rumored that the two men had had a falling out. General
Hershey, however, paid a glowing tribute to Sul livan on his departure. Sullivan was
called back for other Government service during World War II and was in strumental in
setting up the World Federation for Mental Health after 1945.
In the last decade of his life he became increasingly concerned with social psychi atry
and the formulation and refinement of his theory of personality and his conception of
psychiatry and psycho therapy. The war and par ticularly the atomic bomb also turned
his attention to international affairs. He be lieved that social scientists working together
could find a way to reduce international tensions and prevent future wars. This belief
was, as Clara Thompson put it, “a fire with in him that sustained his frail body during the
last years of his life.”
Unfortunately, Sullivan's personal life has been the subject of much word-of mouth
criticism. Within and outside the profession it is rumored that he was at vari ous times in
his life schizo phrenic, homosexual and alco holic. In researching this article, I found it
hard to separate the facts from the malicious gossip. My impres sion, from the many
people I interviewed and who knew Sullivan, is that the gossip far outweighs the truth in
these allegations. But in the end, what difference does it make? Sullivan left a mag
nificent legacy to psychiatry and social science. Hundreds of patients are living more
productive and happy lives be cause of his efforts. Many gifted and talented men and
women cherished his friend ship, and at his death he was seeking ways to reduce the
tensions that cause wars. Many people, myself included, would gladly be labeled al
coholic, schizophrenic and homosexual if they could give a similar accounting of their life
work.
Toward the end, Sullivan's physical condition deterior ated rapidly. In 1947 he de veloped
a severe infection and would have died had not his students procured some of the newly
developed penicil lin which was then scarce and not generally available. Mary White,
whom Sullivan had trained as a therapist, helped to nurse him for the next two years,
although most of that ordeal was borne by Jimmie.
Then in the winter of 1949, Sullivan went to Amsterdam for the meetings of the World
Federation for Mental Health. In recalling the prepara tions for that last trip, Jimmie has
reported that Sullivan was ready to take off for Amsterdam two hours ahead of time. This
was unusual because Sullivan was almost always late for trips and meetings. He told
Jimmie that he didn't want to go but felt that he had to. When they parted, both knew
they would not see each other again. On his return from Amsterdam, Sullivan stopped in
Paris for a few days. He died in his Paris hotel room on Jan. 11, 1949, of a cerebral hemor
rhage.

Good Me' or Bad Me' - The Sullivan Approach To Personality - The New York Times

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11/9/2020 ‘Good Me’ or ‘Bad Me'— The Sullivan approach to personality - The New York Times

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Sept. 24, 1972

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Basic to Sullivan's conception of psychiatry was the “one-genus” postulate: No matter

The formation of chumship is crucial to personality growth. The preadolescent who

opportunity to neutralize many of the nega tive self-evaluations he re ceived as a child,

Following preadolescence is a phase in development which Sullivan regards as a kind of

A major hindrance to achiev ing a consensually valid in terpretation of reality is what

Selective inattention of a more pernicious sort is a per vasive phenomenon in inter

In early January, 1949, Sullivan was in Amsterdam attending the executive-board

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