The Interpersonal Theory of Psychiatry

The Interpersonal Theory of Psychiatry (New York: Norton, 1953) is the fullest statement of Harry Stack Sullivan's theory of personality development, published four years after his death. Helen Swick Perry and Mary Ladd Gawel edited it from recordings of the lecture series he gave at the Washington School of Psychiatry in 1946–47 and from the notebooks in which he outlined those lectures; where a lecture had not been recorded, they rebuilt it from his outline. Mabel Blake Cohen's introduction warns that the chapters on infancy are hypotheses about what must happen to every infant rather than direct observations. Sullivan defines psychiatry as the study of interpersonal relations. Personality is the relatively enduring pattern of recurrent interpersonal situations that characterize a life, and it shows itself only in what passes between people, real or imagined. The book opens with definitions and postulates, among them the one-genus postulate that human beings are far more alike than different. Its long middle part follows the developmental epochs. In infancy the baby's needs call out tenderness in the mothering one, while her anxiety reaches the baby through empathy. The avoidance of anxiety becomes the mainspring of development. Experience is organized in three modes. The prototaxic is an undifferentiated flow. The parataxic links things that merely occur together, and it is the source of later parataxic distortions of other people. The syntaxic is consensually validated in shared language. Out of approval, disapproval and overwhelming anxiety the infant forms the personifications good-me, bad-me and not-me. From them grows the self-system, an organization of security operations, chiefly selective inattention and dissociation, that keeps anxiety down at the cost of learning from experience. Childhood brings speech and socialization. A child whose need for tenderness is met with rebuff may come to expect hostility and turn malevolent. The juvenile era teaches competition, compromise and cooperation among peers. Preadolescence brings the first capacity for love, in intimacy with a same-sex chum. Early adolescence brings the lust dynamism and its collisions with intimacy and security, and late adolescence the full range of adult relations. Personality is not settled in the first years, and each era offers a chance to repair earlier warps. A third part treats schizophrenic and paranoid states, sleep, dreams and myths as patterns of inadequate or inappropriate interpersonal relations, continuous with ordinary living. A closing chapter, drawn from Sullivan's 1948 paper, calls for a psychiatry of peoples that would address tensions between nations. The book became a founding text of interpersonal psychoanalysis.