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Harry Stack Sullivan came up with the interpersonal theory as a challenge to the Freud’s psychosexual theory. His interpersonal theory of psychiatry highlight on the role played by interpersonal relations, society and culture in development of personality and psychopathology. His theory can be considered as complement to the theories of object relations, psychosocial development and psychology. The difference between his interpersonal theory and the Freud’s psychosexual theory is that Sullivan focuses on what is happens between people while Freud focuses on what happens within people.
Theorist Harry Sullivan
Harry Sullivan was among the most important innovators and influential thinkers in the American psychiatry. He lived in the first half of the twentieth century. This era was characterized by powerful excitement over psychoanalysis. Other factors were the emergence of sociology and anthropology as areas of thought and enterprise. Sullivan brought together the contemporary thoughts of psychiatry and social science to make what has been referred to as social psychiatry. Sullivan modeled psychiatry as a social science and promoted research based in sociology and mental illness. He proposed the concept of Selective Inattention where he states that patients may maintain some aspects of their interpersonal relationships without their awareness by a psychological behavior. He believed that the information concerning the interpersonal relationships of the patients can give approaches into the causes and cures of mental illnesses (Evans, 1996).
Sullivan also emphasize that analysis done by the psychotherapists should look at relationships of the patients and their personal interactions in order to acquire information on the patterns and tendencies, also known as personifications that affect them. Such analysis could be done by detailed questioning on time to time personal interactions including those with the analyst. According to Sullivan, personifications signify an individual’s assumptions, representation, and internal representation of other people and reflected evaluation of the self. Sullivan worked with other neo-Freudians and just like them; he rejected the conventional Freudian drive model but eh maintains an alternative for the pleasure principle. Sullivan explained personifications as mental images that people to understand themselves and the world better. He named three ways in which we view ourselves. These are the bad-me, the good-me and not me. The bad are those personal aspects which are considered negative but are concealed from the others and sometimes even from the self. People therefore feel anxiety after recognizing their bad self for example when they remember some embarrassing moments, one feels guilty of past actions. The good me is the all things that an individual likes about him/herself. It represents that part that an individual shares with others and that one prefers to concentrate on since it does not cause anxiety feelings. The other part, not me, represents the things that an individual considers to be provoking so much anxiety such that one may not associate with them. This is because associating with them may cause anxiety that an individual lives trying to avoid. This part of pushed deep into one’s consciousness so that it can remain out of our awareness.
Sullivan is also one of the founders of interpersonal school of psychiatry and placed a lot of emphasis on current psychosocial and interpersonal experiences of a patient together with other related processes in understanding psychiatric disorders (loan et al., 2009).
Sullivan’s interpersonal theory of psychiatry
Sullivan named his idea an interpersonal theory of psychiatry because according to him, psychiatry is the study of what happens between people. According to Sullivan, relationships are basic. Personality is a hypothetical unit that cannot be studied but instead observed in interpersonal situations where it is manifested. The only method by which personality can be studied is through a medium for interpersonal interactions. Therefore, the unit to be studied is not the individual but the interpersonal situation. He explains that personality is organized in terms of interpersonal events and not the intra-psychic events. Personality is only apparent when an individual is behaving in relation to others and not alone. The others may be present or illusory (Sullivan, 2003).
Sullivan’s theory also states that the smallest unit that can be involved in the study of an individual is dynamism. This refers to the pattern of behavior that lasts and keeps recurring just as a habit. This means that a new feature may be added to the system without changing the content as long as it does not have much difference with the original contents (Kelly, 1994).
Commentaries from the Sullivan’s interpersonal theory of psychiatry
a). Interpersonal theory of suicidal behavior
Other psychologists have made commentaries regarding other concepts that may relate to Sullivan’s interpersonal theory of psychiatry. For example, Joiner (2005) proposed the interpersonal theory of suicidal behavior that can be used to explain why sme people commit suicide. In explaining the interpersonal theory of suicidal behavior, Joiner tried to answer the question as to why people commit suicide and die and also the difference between those who die of suicide and others who do not die. In explaining why people commit suicide, the theory is based on the fact that none of the humans, including animals is destined for self destruction. However, evolution has instilled a powerful force of self preservation within the human beings. This theory therefore explains that there is an experience of too much fear and pain such that it is only few people who can attempt the act or even to desire death associated with suicide.
According to this theory, the only people who are capable of dying through the act of suicide are those who have experienced a lot of pain in the past and provocation, especially from acts of self injury. Such people have therefore habituated the fear and the pain to an extent that cannot be overcome by self preservation. Therefore any further experience that may cause pain and fear may strengthen this habituation process. Theses are acts such as injury, violence accidents and dreadful behaviors. These experiences that have become habitual give one the ability to endorse lethal self injury. The main point in this theory is that capacity must not always be driven by desire. It is only that some people are capable of inflicting pain upon themselves or others but they do not desire to do so (Joiner, 2009).
The theory goes further to explain what makes up suicidal desires. This is explained as the maintained concurrence of two interpersonally significant states of mind. Theses are perceived burdensome and failed belongingness. Perceived burdensome is explained as the observation that one’s existence causes a burden to the family or to others associated with him or her. One therefore gains the idea that his or her death would be considered better than his presence in the family or among the other people in the society. Therefore one lives with a fatal misperception that may lead one into thoughts of self destructions. Failed belongingness is a feeling that one is secluded from the other people and is not considered an important part of the family, a group of friends and the society. This perception may lead to the thoughts that his death may be preferred over his presence in the family or among the friends .This theory explains that when a person experiences the two conditions simultaneously, one develop the desire for death due to the perception that there is no further reason for one to live (Joiner, 2009).
Therefore, the answer to the question of why people die of suicide is a combination of the three factors of who can, who wants to and who dies by suicide. The one who can is those people through the process of habituation have developed the ability to enact lethal self injury. Those who want to die of suicide are those who perceive themselves as a burden to their family, their friends and the society, and they feel that they do not belong to any valuable group. Those who die of suicide are those who can and want to.
b). Integration of individual psychology and interpersonal theory
The other commentary is on interpersonal manifestation of lifestyle which is explained by Schwartz & Waldo (2003). Their view is an integration of individual psychology of Alfred Adler and interpersonal theory of Sullivan. This integration offers a social or interpersonal approach to view the problem of a client and to approach these problems in counseling. This combination of theories has been done so that they can reflect the basic characteristics of mental health counseling. Theses are characteristics such as ability to focus on the assets and development of the client, making consideration on the interpersonal and environmental factors, therefore employing the counseling relationships as the main mechanism in promoting change.
Theories of individual psychology and the interpersonal theory of Sullivan have been found compatible which can well address the necessities of mental health counseling. This is because the two theories can play a complementary role in describing human personality as well as human nature. Individual psychology explains human beings as social beings with a desire to belong and striving to create significance in their social environment thus avoiding feelings of inferiority. On the other hand, the interpersonal theory describes human beings as inspired by interpersonal anxiety to avoid experiences of rejection and also for them to maintain their self esteem. According to this integration of theories, each individual must be perceived in the context of their social environment. According to Schwartz, & Waldo (2003), the two theories view problems and their solutions from a social and interpersonal perspective. Both of them explain and guide use of counseling relationship relationships to promote client’s positive development within their social context.
Some of the basic concepts of the theories of individual psychology and Interpersonal theory are similar. One of these concepts is that both theories have a similar point on psychotherapy unlike the Freud’s theory of psychoanalysis. Adler differed with Freud on his emphasis on psychosexual development and instead he emphasized on the importance of early social interactiions where children develop rules that help them in managing their world and understanding life better. The Sullivan’s interpersonal theory also differed from the Freud’s theory by stating that Freud’s theory could be understood by analyzing the relationships and that motivation comes from interpersonal anxiety rather than libido (Conte, & Plutchik, 1981).
Another shared concept in the two theories is that the patterns that individuals develop in their early life are as a result of interactions with their families more so their parents. The individual psychology theory suggests that lifestyle is characterized by what an individual learned from the family at the early age as it pursues social importance in the interpersonal relationships. In the same way, the interpersonal theory explains that painful anxiety results where individuals feel rejected by their parents and other members of the society. The two theories therefore share the concept that children develop patterns of interaction in their families, and these patterns continue even when they become adults (Schwartz, & Waldo, 2003).
Other aspects of interpersonal theory
Sullivan also considered the aspect of close relationships and complementary interpersonal styles. This was explained by Leary (1957) and Sullivan (1953) where they stated that complementary personality styles are characteristics of close relationships in the article of Yaughn, & Nowicki, (1999). The Sullivan’s interpersonal theory suggests that people are driven in their interactions with each other by the need to reduce anxiety and to affirm the self concept of one another. After achieving this, the interaction can be said to be complementary. To measure the extent of complimentarity that is achieved by these interactions, other researchers, among them Leary (1975) developed the circumplex model. This model differentiates the degrees of status and affiliation. This model explained that a personality style that is friendly dominant is complimentary to one that is friendly submissive while one that is hostile –dominant would compliment a hostile submissive personality style (Locke, 2000). Therefore, according to Sullivan’s interpersonal theory, a complimentary interpersonal style maximizes decrease in anxiety and confirms the self concepts while the anti complimentary interpersonal style raises anxiety and does not confirm self concepts (Yaughn, & Nowicki, 1999).
Another aspect of interpersonal theory is the phenomenon of asymmetry in beliefs of interpersonal knowledge published by Yohab, et al. (2010). According to this concept, people tend to believe that they know and are able to understand the thoughts and feelings of other people better than those people know and understand our own thoughts and feelings. This phenomenon was the work of various sociologists who after carrying out a series of six studies, they concluded that the phenomenon is robust. Their first study was to examine the knowledge that participants have of their close friends. They asked various questions such as how much they think they know their close friends, how much they think their close friends know them, the extent of their true self that they think is visible to their close friends, and how much of their close friend’s true self they think is visible to them.
From theses studies, the psychologists conclude that there is evidence of asymmetry between close friends, roommates, and strangers who are just familiar with each other. Another conclusion was that this asymmetry is evidenced in both inter and intra-personal knowledge. This rating was found to be higher interpersonal than intrapersonal. The other conclusion from the study was that the asymmetry reduces as the persons become closer to one another. The asymmetry was also seen to occur because people think that their thoughts and feelings reveal more of ourselves that our public behaviors whereas it is the public behaviors that are more revealing that the thoughts and feelings. This concept also explained that there are two mechanisms that may create asymmetry. One is the people’s beliefs that their thoughts and feelings, which are not visible to the peers, are crucial in understanding of whom and what we are thus creating interpersonal asymmetry. The other mechanism is the people’s belief that one is less prone to bias in self judgment than their peers are in their own judgments (Yohab, 2010).
Harry Sullivan’s interpersonal theory has played a great role in psychiatry studies and in mental health. Sullivan modeled psychiatry as social science and he further promoted research based on sociology and mental health. His interpersonal theory was also used by other sociologists to explain various psychological aspects such as suicidal behavior that was explained by the interpersonal theory of suicidal behavior. The other was an integration of the theory of individual psychology and Interpersonal theory. This integration gave insights into human personality as well as human nature. Other aspects have also arisen in relation to Sullivan’s interpersonal theory such as the aspect of close relationships and complementary interpersonal styles and the phenomenon of asymmetry in beliefs of interpersonal knowledge. All these have their roots in Sullivan’s interpersonal theory.
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