Book
Clinical Studies in Psychiatry
A selection from the clinical lectures Harry Stack Sullivan gave to the staff of Chestnut Lodge, the psychiatric hospital in Rockville, Maryland, between October 1942 and April 1946, published after his death by W. W. Norton in 1956 and later counted as the second volume of his collected works. The editors, Helen Swick Perry, Mary Ladd Gawel and Martha Gibbon, kept about 130,000 of more than a million words, most of them from lectures given between April and November 1943. Where Sullivan's other posthumous books set out the interpersonal theory of development and the psychiatric interview, this one shows the clinician applying that theory to the disorders met in practice. After a statement of the interpersonal theory of mental disorder, it treats the processes by which anxiety is kept out of awareness — selective inattention, sublimation, dissociation and the paranoid dynamism — and the emotions, among them envy and jealousy, that can precipitate a major disorder. It then reads hysteria, obsessionalism, hypochondria, manic-depressive psychosis, schizophrenia and paranoid states as patterns of interpersonal living, and closes with the use of clinical entities as a frame of reference in therapy and with the psychotherapy of schizophrenic patients.
Main ideas
- Mental disorders are understood as patterns of inadequate or inappropriate interpersonal living, studied in the field of a person's relations with others rather than as diseases inside the individual.
- Anxiety is the central disturbing force, and much of personality, healthy and disordered, consists of operations that keep it out of awareness.
- Selective inattention is the everyday way in which experience that would arouse anxiety goes unnoticed, at the price of not learning from it; it is given a chapter of its own.
- Dissociation and the paranoid dynamism are graver ways of disposing of what cannot be borne: the one keeps whole tendencies of the personality outside awareness, the other places in others what one cannot accept in oneself.
- Envy and jealousy are examined as emotions that can precipitate the major mental disorders, and hypochondria and algolagnia as steps on the way to a paranoid development.
- Hysteria, obsessionalism, manic-depressive psychosis and schizophrenia are described as characteristic ways of dealing with others and with anxiety, and the classical clinical entities are kept as a frame of reference for therapy rather than as fixed diagnoses.
- Schizophrenic patients can be reached by psychotherapy: the closing chapter turns to the treatment of schizophrenia, the field in which Sullivan had made his name.
What it shows
Harry Stack Sullivan introduced Selective inattention
Sullivan's 1946 foreword to the book admits that the lectures leave selective inattention unstated; Patrick Mullahy's accompanying essay sets it out from Sullivan's oral teaching, and Sullivan's later clinical lectures develop it at length.
Selective inattention diverges from Repression
Where Freud spoke of repression, Sullivan described material kept out of awareness by inattention, or left unformulated because it had never been put into communicable form, reserving dissociation for what the self actively refuses.