1. Presenter
Dr Mohd Osman Ali
Chairperson
Dr P Himakar
Prof of Psychiatry

4. Scheme of
Presentation
•Introduction
• Personality theory
• Developmental theories
•Theory of psychopathology
(psychiatric implications)
• Interpersonal psychotherapy
•Summary

5. Introduction
•Brief
biography
•His works
•His main
contribution

6. generally acknowledged as
the most original and distinctive
American-born
theorist in dynamic psychiatry

7. • Sullivan graduated from medical school in
Chicago in 1917.
• He made his reputation based on his
experimental treatment ward for
schizophrenics at the Sheppard Pratt
Hospital, between 1925-29.

8. Works
• The Interpersonal
Theory of Psychiatry
(1953)
• "The Psychiatric
interview”(1954)
• Conceptions of Modern
Psychiatry (1947/1966)
• and" Schizophrenia as a
Human Process (1962)

9. • Sullivan's work on
interpersonal
relationships
became
the foundation
of interpersonal
psychoanalysis
• a school of psychoanalytic theory and treatment that
stresses the detailed exploration of the nuances of
patients' patterns of interacting with others.

10. Personality
theory
•Interactional
approach
•Needs and
anxiety
•Security
operations
•Self system

11. For many years the primary theoretical dispute
within dynamic psychiatry circles was
between
Classic
freudians
Sullivanians

12. In his words, one must
pay attention to the
"interactional“,
not the
"intrapsychic“.

13. • He emphasized the psychiatrist as
participant/observer in the clinical situation
• seeking to keep observations as objective as
possible,
• What can be observed is
the social interaction
of patients

14. • This search for satisfaction via personal involvement
with others led Sullivan to characterize loneliness as
the most painful of human experience

15. • thus, he defined personality as the
“relatively enduring pattern of interpersonal relations
which characterize a human life.”
• Sullivan defined a “dynamism” as
“the relatively enduring pattern of energy
transformations,”
that is, recurrent interpersonal behavior patterns.

16. Sullivan's theory is fundamentally one of
Needs
and
Anxiety.

17. Needs
• needs for
satisfaction(e.g., air, water, food,
warmth),
• and needs for securityneed to
avoid, prevent, or reduce anxiety.
• emotional needs for human contact
and for expressing one's talents and
capacities
Anxiety
• occurs when
fundamental needs are
in danger of not being
met
• and is the primary
motivator of human
behavior.

18. • Decades before Mahler wrote of a symbiotic
stage in infant development, Sullivan spoke
of the “empathic linkage” between caretaker
and infant
• and described the
complicated interaction
of infants communicating
tension and anxiety,
arousing anxiety in the
caretaker, leading to
tender responses to
the infant's needs.

19. • The tension of
anxiety,
when present
in the
mothering
one,
also induces
anxiety in the
infant.

20. • Eventually, the empathic linkage
becomes unnecessary and the
self-system operates autonomously
within the individual, developing
ever more subtle and complex ways
to manage the person's anxiety.
• Failure to meet these needs results in loneliness and
anxiety.
• Because there is no such thing as a perfect mother or
parent, anxiety is inevitable and becomes the primary
driver for personality development.

21. Security operations
• Sullivan defined security as the absence of anxiety
• The self-system develops a set of mechanisms, called
security operations, which effect this goal.
• function within Sullivan's theory much as defense
mechanisms do within psychoanalytic theory.
• Some bore the same labels and definitions as Anna
Freud's, but Sullivan is best known for three
contributions that bore his distinct stamp:
– Apathy,
– somnolent detachment,
– and selective inattention.

22. Self System
• a configuration of the
personality traits
• developed in childhood and
• reinforced by positive
affirmation and the security
operations developed in
childhood to avoid anxiety and
threats to self-esteem.
• and is the outgrowth of
interpersonal experiences, rather
than an unfolding of intrapsychic
forces

23. • Sullivan equated the self, identity, or ego
with the individual's developed patterns for
avoiding the discomforts
– that arise from the inability of others to
meet one's fundamental needs.
– It exists, like all else, purely within an
interpersonal framework.

25. Develop
mental
theories
•cognitive
•social

26. The
Prototaxic
mode
• undifferentiated thought that
cannot separate the whole
into parts or use symbols.
• It occurs normally in infancy
• and also appears in patients
with schizophrenia, mystical
experiences
The
Parataxic
mode
The
Syntaxic
mode
• events are causally related
because of temporal or serial
connections.
• Logical
relationships, however, are not
perceived
• Begins early in childhood
• explain transference, slips of
the tongue, and paranoid
ideation.
• the logical, rational, and
most mature type of
cognitive functioning of
which a person is capable.
• based on the development
of language and consensual
validation

27. • These three types of thinking and
experiencing occur side by side in all persons;
– it is the rare person who functions
exclusively in the syntaxic mode.
• Maturity may be defined as extensive
predominance of the syntactic mode of
experiencing.

28. Develop
mental
theories
• cognitive
•social

29. somewhat based on his three evolving
cognitive modes.
However, disturbed interpersonal relationships
may cause persistence of the more primitive
(prototaxic or parataxic) ways of experiencing
the world.

30. Social
d
e
v
e
l
o
p
m
e
n
t
• the satisfaction needs, which are
predominant,
• and the interpersonal sphere in
which these and their resulting
security needs are sought to be
fulfilled.
• the primary “zone of
interaction”—bodily areas
through which the individual
channels needs, anxiety, and
relief—in interactions with the
environment.

31. During infancy
• characterized by the primary need for bodily
contact and tenderness
• the primary zones of interaction are oral and,
to some extent, anal.
• To the extent that some anxiety is commonly
present in the caretakers, apathy and
somnolent detachment are regularly used as
security operations, persisting into adult life
as a basic detached and passive stance.

32. • If anxiety and inconsistency are severe,
intense experiences of dread persist,
presenting in later life
– as the eerie, uncanny, bizarrely disruptive
internal states seen in individuals with
schizophrenia

33. During childhood-- from 2 to 5 years
• The primary mode of experience shifts
to the parataxic, and the most
common zone of interaction is anal
• a child's main tasks are to learn the
requirements of the culture and how
to deal with powerful adults
• Gratification leads to an expansive
self-system with many facets of life
associated with the “good me” and
positive self-esteem.

34. • Moderate anxiety leads to chronic anxiety,
uncertainty, and insecurity.
• Extreme anxiety results in giving up known
successful behavior in favor of self-defeating
patterns that fulfill others' expectations

35. As a juvenile, from 5 to 8 years
• The shift to syntactic cognitive
modes begins
• a child has a need for peers and
must learn how to deal with
them.
• Interpersonal cooperation,
competition, play, and
compromise become the
gratifying experiences.

36. • The risks of excessive anxiety are either too
great a need to control and dominate social
situations or they become an internalization
of restrictive, prejudicial social attitudes.

37. In preadolescence, from 8 to 12 years
the capacity for love and for
collaboration with another
person of the same sex
develops.
This so-called chum period is
the prototype for a sense of
intimacy.
the major shift toward syntactic
thinking takes place

38. • In the history of patients with
schizophrenia, this experience of chums is
often missing.
• the give and take of the special friend could
repair and undo distortions that resulted
from excessive anxiety at earlier stages

39. During adolescence,
major tasks include
the separation from
the family, the
development of
standards and
values, and the
transition to
heterosexuality

40. Theory of
psychopathology
•Problems in
living
•schizophrenia

41. • He saw psychopathology as resulting from excessive
anxiety arresting development of the self-system
• thereby limiting both opportunities for interpersonal
satisfaction and available security operations.
• He viewed psychiatric patients as struggling to
maintain their self-esteem with very limited means.
• To understand them, the developmental phase at
which they operate has to be gauged, and the
interpersonal needs they express have to be
understood.
• Finally, the chance occurrence of stresses
encountered during life is deemed a factor

42. Problems in living
• Sullivan was the first to coin the term "problems in
living" to describe the difficulties with self and others
experienced by those with so-called mental illnesses.
• This phrase was later picked up and popularized by
Thomas Szasz, whose work was a foundational
resource for the antipsychiatry movement.
• "Problems in living" went on to become the
movement's preferred way to refer to the
manifestations of mental disturbances.
• He initiated the first of what are now called
therapeutic communities

43. schizophrenia
• he sought to understand
the fundamental human
process within his patients,
especially his sickest ones.
• Sullivan theorized that anyone might develop
schizophrenia, even people with relatively
successful developmental histories, should
their chosen defenses fail dramatically and
their life stresses mount in the extreme

44. Interpersonal
psychotherapy
• Four steps of
therapy process

45. • the very beginning, often only a part of the first
interview,
Inception • contract and roles are stipulated.
• might go on for as many as 10 to 15 sessions,
reconna • therapist identifies the patient's recurring patterns and
assesses their adaptive and maladaptive qualities
issance
detailed
inquiry
• a very lengthy process of seeking to recognize, clarify, and change
persistent parataxic distortions and there is often much ongoing
interchange between patient and psychiatrist
• may reflect either extensive or limited
Termin goals.
ation

46. • Sullivan emphasized that
the psychiatrist is a
participant–observer
in all interactions with
patients.
• Ultimately, persons need to see themselves
as they really are, instead of as they think
they are or as they want others to think they
are.

47. • He argued that parataxic distortions emerge
in all interactions, not only in the classic
analytical situation.
– This differing view of transference and of it
being a universal human process was among the
core debates for decades between classic
analysts and interpersonal analysts.

50. References
• Kaplan and Sadock’s
comprehensive textbook
of psychiatry 9th edition

51. Thank You

52. Questions
and
discussion