Book
Conceptions of Modern Psychiatry
Conceptions of Modern Psychiatry is Harry Stack Sullivan's text of the first William Alanson White Memorial Lectures, given in Washington in the autumn of 1939 and printed in the journal Psychiatry in February 1940; the book of 1947 adds a foreword by the author and Patrick Mullahy's extended exposition of the theory. It was the only general statement of Sullivan's theory published in his lifetime. The first lecture traces psychiatry's double descent, from medicine and from the social traditions of healers and sages, credits Freud, Adolf Meyer and William Alanson White with the move toward a complete psychiatry, and defines the field as the study of interpersonal relations, which the psychiatrist can know only as a participant observer. Conduct is organised around the pursuit of satisfactions, tied to the body, and of security, tied to culture. Anxiety, first caught empathically from the disapproval of the adults who care for the infant, shapes the self-dynamism: built from the appraisals of others, it controls what enters awareness, and what it cannot admit persists as dissociated. The second and third lectures follow the person's growth within a necessary environment of others, through infancy, childhood, the juvenile era, preadolescence, with its first love for a chum of the same sex and the consensual validation it brings, and adolescence. They then sketch ten developmental syndromes, among them the self-absorbed, the incorrigible, the negativistic, the ambition-ridden, the asocial, the inadequate and the chronically adolescent person, offered as better guides to a person's future than the categories of mental disease. The fourth lecture explains mental disorder as patterns of interpersonal process: parataxic distortion of situations; the substitutive states, such as obsessional, hypochondriacal and paranoid conditions; panic as the collapse of the self's power to dissociate; and schizophrenic states, which Sullivan distinguishes from dementia praecox and holds to depend on the situation for their outcome. The fifth lecture derives therapy from Freud, Meyer and White. It presents the interview as a situation both parties shape, whose work is to bring into the patient's awareness what anxiety has kept out, leading to insight into parataxic distortions, including those directed at the psychiatrist. In the foreword Sullivan calls the developmental sketch the weakest part, admits that his accounts of anxiety, the self and selective inattention are inadequate, and attacks the "delusion of unique individuality".
Main ideas
- Psychiatry is the study of interpersonal relations, in whatever circumstances they exist; the psychiatrist knows them only by taking part in them, so participant observation is the basis of psychiatric method.
- Human striving is divided between satisfactions, bound to bodily needs such as food, sleep and lust, and security, bound to the culture a person acquires; the infant's discovery of its powerlessness is where the need for security begins.
- Anxiety is first transmitted through empathy, from the disapproval of the mothering adult to the infant, and is distinct from fear and pain.
- The self-dynamism is built from the appraisals of significant others and guards awareness; what it cannot admit is dissociated, and where the self blocks satisfaction or security a person is to that extent mentally ill.
- Personality develops through epochs from infancy to adolescence; in preadolescence the love of a chum of the same sex brings the first full consensual validation and the shift from egocentricity to a social state.
- Ten developmental syndromes, such as the self-absorbed, negativistic, ambition-ridden, asocial and chronically adolescent person, describe recurring patterns of interpersonal life and predict a person's course better than disease categories.
- Parataxic distortion, in which a present situation is lived through illusory figures from the past, runs through everyday life, the substitutive states such as obsessional and paranoid conditions, and the schizophrenic states.
- Panic is the collapse of the self's power to keep experience dissociated; the schizophrenic state that may follow is an episode in a life, separate from dementia praecox, and its outcome depends on the person's situation.
- Therapy, drawn from Freud, Meyer and White, works through the interview: it widens the patient's awareness of what anxiety excluded and leads to insight into parataxic distortions, including those cast on the psychiatrist.
- Patrick Mullahy's exposition in the book sets out the prototaxic, parataxic and syntaxic modes of experience as Sullivan taught them, and Sullivan's foreword concedes that the lectures leave the self-dynamism's part in selective inattention unstated.
What it shows
Parataxic distortion derives from Transference
Sullivan put his own term in place of Freud's transference and widened it: parataxic distortion colours every relationship, not only the patient's relation to the analyst.