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1. 00:02 One of the greatest influences on my work is Harry Stack Sullivan. He is also one of the most abandoned and neglected revolutionaries, geniuses in the field of psychology together perhaps with the likes of Adler or Clara Thompson. And today I want to dedicate this video to him and his work because he has been a major influence on mine. My name is Sam Vaknin. I’m the author of Malignant Self- Love, Narcissism Revisited, and I’m a professor of psychology, Harry Stacivan, and his interpersonal theory of interpersonal One of the greatest influences on my work is Harry Stack Sullivan. He is also one of the most abandoned and neglected revolutionaries, geniuses in the field of psychology together perhaps with the likes of Adler or Clara Thompson. And today I want to dedicate this video to him and his work because he has been a major influence on mine. My name is Sam Vaknin. I’m the author of Malignant Self- Love, Narcissism Revisited, and I’m a professor of psychology, Harry Stacivan, and his interpersonal theory of interpersonal
2. 00:42 relationships. Sullivan deviated diverged from the Freudian psychoanalytic literature and schools by proposing that psychology is about interpersonal relationships or interpersonal relations not about internal dynamic processes. What he proposed is that internal psychonamics are reactive to the way we interact with other people. He established a broad observational platform for the study and treatment of what he called at the time difficulties in living. Sullivan rejected the idea or the convention at the time that mental relationships. Sullivan deviated diverged from the Freudian psychoanalytic literature and schools by proposing that psychology is about interpersonal relationships or interpersonal relations not about internal dynamic processes. What he proposed is that internal psychonamics are reactive to the way we interact with other people. He established a broad observational platform for the study and treatment of what he called at the time difficulties in living. Sullivan rejected the idea or the convention at the time that mental
3. 01:33 disorder is a disease. He said, “Yeah, there are hereditary conditions. There are brain abnormalities. There are accidents like traumatic brain injuries and these result in mental illness or mental dysfunctioning. But all the rest, these are not diseases. He considered the individual not as a fixed entity but as a part of a persontoerson encounter. And because the individual was in flux, because the individual was a river, not a pond, Salivan postulated that there is no such thing as a mental illness or mental disorder is a disease. He said, “Yeah, there are hereditary conditions. There are brain abnormalities. There are accidents like traumatic brain injuries and these result in mental illness or mental dysfunctioning. But all the rest, these are not diseases. He considered the individual not as a fixed entity but as a part of a persontoerson encounter. And because the individual was in flux, because the individual was a river, not a pond, Salivan postulated that there is no such thing as a mental illness or mental
4. 02:20 disease because the individual is always open to external influences which modify and transform and metamorphose the individual on the fly. And so the point of view of Harry Stacivan was a completely a complete departure a revolutionary new dimension in the fields of psychiatry and psychoanalysis. He came up with a phrase interpersonal diad. He said that personal experience um should be focused on. He elaborated on personal experiences, moved it to the foreground of psychology and in this sense he is one of the fathers of what disease because the individual is always open to external influences which modify and transform and metamorphose the individual on the fly. And so the point of view of Harry Stacivan was a completely a complete departure a revolutionary new dimension in the fields of psychiatry and psychoanalysis. He came up with a phrase interpersonal diad. He said that personal experience um should be focused on. He elaborated on personal experiences, moved it to the foreground of psychology and in this sense he is one of the fathers of what
5. 03:09 came to be known later as narrative psychology, the um progeny of case studies in the Freudian the classical Freudian tradition. And so rather than search for and study and observe intra psychic conflicts for example between the id and the forces of the ego and this kind of thing instead of um focusing on alleged energies and processes and so on so forth which are confined within the individual as an impermeable shell. The individual being a kind of firewall. Um Sullivan rejected all this and instead he proposed that um we should came to be known later as narrative psychology, the um progeny of case studies in the Freudian the classical Freudian tradition. And so rather than search for and study and observe intra psychic conflicts for example between the id and the forces of the ego and this kind of thing instead of um focusing on alleged energies and processes and so on so forth which are confined within the individual as an impermeable shell. The individual being a kind of firewall. Um Sullivan rejected all this and instead he proposed that um we should
6. 03:56 focus on uh reactions to other people, interactions with other people, relationships, the environment and so on so forth. There’s of course an enormous influence on my work, the intracychic activation model. He said that metsychological constructs as explanatory props should recede into the background. In Sullivan’s work, the therapist becomes an integral part of the teamwork between two equally responsible individuals. And so there’s a new model that emerges from his work which is much more focus on uh reactions to other people, interactions with other people, relationships, the environment and so on so forth. There’s of course an enormous influence on my work, the intracychic activation model. He said that metsychological constructs as explanatory props should recede into the background. In Sullivan’s work, the therapist becomes an integral part of the teamwork between two equally responsible individuals. And so there’s a new model that emerges from his work which is much more
7. 04:35 specifically anchored in the therapist relational participation. Therapy being a close approximation of life or a simulacum of life or a rendition of life. And so open-ended communication, personal resonance, listening, um commenting, all these became integral posts, integral pillars of the therapeutic implementation of therapeutic therapeutic interpretation of Sullivan’s work. He therefore emphasized reciprocal observations within the context of the therapeutic situation. There’s no hierarchy. The therapist and the patient specifically anchored in the therapist relational participation. Therapy being a close approximation of life or a simulacum of life or a rendition of life. And so open-ended communication, personal resonance, listening, um commenting, all these became integral posts, integral pillars of the therapeutic implementation of therapeutic therapeutic interpretation of Sullivan’s work. He therefore emphasized reciprocal observations within the context of the therapeutic situation. There’s no hierarchy. The therapist and the patient
8. 05:23 or the client work together hand in hand. Checks and balances if you wish. The interpersonal diad went uh through several iterations and modifications um since it was first promulgated in Sullivan’s interpersonal point of view more than um a few decades ago 50 or more years ago. The initial approach of Sullivan assumed that any method of observation alters the object being observed which is one of my greatest beefs with psychology. I think psychology is a pseudocience and can never ever be a science because the or the client work together hand in hand. Checks and balances if you wish. The interpersonal diad went uh through several iterations and modifications um since it was first promulgated in Sullivan’s interpersonal point of view more than um a few decades ago 50 or more years ago. The initial approach of Sullivan assumed that any method of observation alters the object being observed which is one of my greatest beefs with psychology. I think psychology is a pseudocience and can never ever be a science because the
9. 06:06 act of observation changes the observed object. In other words, changes the person being observed. Every human being has a repatory of personal reactions which depends on reciprocal reactions of others. In other words, we are part of a network. We’re a node in a network. And it is the network that vibrates and oscillates and dictates our behavior. It doesn’t emanate from the inside. It comes from the outside. What is happening inside is a reaction to the outside. The internal environment is a act of observation changes the observed object. In other words, changes the person being observed. Every human being has a repatory of personal reactions which depends on reciprocal reactions of others. In other words, we are part of a network. We’re a node in a network. And it is the network that vibrates and oscillates and dictates our behavior. It doesn’t emanate from the inside. It comes from the outside. What is happening inside is a reaction to the outside. The internal environment is a
10. 06:45 resonance of the external environment. And these personal reactions can be traced back to early family dynamics network of family relationships. Sullivan said, and I’m quoting, people have as many personalities as they have relationships with important others in their life. This is a distant echo of what came to be known as ego states or in my work self states and so on. So he emphasized important others what we call today significant others. But how do you do how do you define this significance? How do you draw the line resonance of the external environment. And these personal reactions can be traced back to early family dynamics network of family relationships. Sullivan said, and I’m quoting, people have as many personalities as they have relationships with important others in their life. This is a distant echo of what came to be known as ego states or in my work self states and so on. So he emphasized important others what we call today significant others. But how do you do how do you define this significance? How do you draw the line
11. 07:25 between a casual encounter with someone and a similarly brief encounter with someone else who has a much stronger impact on you? How where is the seat or the locus of significant? So Sullivan said that this important other can be a real person or an idetic person who has been transported from the past. what later came to be called in Bandura’s work and other schools of psychology role models and he said that figures from the past um resonate with human beings as if they’re alive as if he between a casual encounter with someone and a similarly brief encounter with someone else who has a much stronger impact on you? How where is the seat or the locus of significant? So Sullivan said that this important other can be a real person or an idetic person who has been transported from the past. what later came to be called in Bandura’s work and other schools of psychology role models and he said that figures from the past um resonate with human beings as if they’re alive as if he
12. 08:07 this person from the past were identical to the person encountered in the present. Personality characteristics become evident mainly in an ongoing interpersonal process which has its roots in the earlier years of life. And this process at that Adam breaks uh foreshadows the imminent future. And so this means that the future as well of the of the as well as the past participate in all human relationships at present. We cannot isolate an individual in time and from other people and say this is the individual. This is the pure this person from the past were identical to the person encountered in the present. Personality characteristics become evident mainly in an ongoing interpersonal process which has its roots in the earlier years of life. And this process at that Adam breaks uh foreshadows the imminent future. And so this means that the future as well of the of the as well as the past participate in all human relationships at present. We cannot isolate an individual in time and from other people and say this is the individual. This is the pure
13. 08:49 unadulterated quiddity or essence of the individual. We can’t do that. Their propinquity and presence of other people, their feedback and input, even their expectations, they define us. and they define us not only at the present but they define us in constant interaction with our past experience and future imagining. It is important to note that within the interpersonal approach the individual is never central in his or her relationship to the world. The notion of the individual self as unique, unadulterated quiddity or essence of the individual. We can’t do that. Their propinquity and presence of other people, their feedback and input, even their expectations, they define us. and they define us not only at the present but they define us in constant interaction with our past experience and future imagining. It is important to note that within the interpersonal approach the individual is never central in his or her relationship to the world. The notion of the individual self as unique,
14. 09:32 it’s um debatable in Sullivan’s theory. Sullivan considers it actually an illusion kind of psychological maya if you wish. The notion that uniqueness is an illusion does not contradict the assumption that each individual has her own internal world. Um Sullivan did not dispute the fact that we have an experience of innateness. We have an experience of our selves as continuous and and unique and he doesn’t he doesn’t dispute the experience of what we call colloquially or in psychology the self. it’s um debatable in Sullivan’s theory. Sullivan considers it actually an illusion kind of psychological maya if you wish. The notion that uniqueness is an illusion does not contradict the assumption that each individual has her own internal world. Um Sullivan did not dispute the fact that we have an experience of innateness. We have an experience of our selves as continuous and and unique and he doesn’t he doesn’t dispute the experience of what we call colloquially or in psychology the self.
15. 10:19 He he he says we have internal worlds. We possess native or learned special talents. We have unique psychological fingerprints and we have special characteristics but we he rejects the assumption that the unique individual self has a particular impact on persontoerson encounters. He says this innate world is shaped by the environment, shaped by the outside, not the other way around, not that it shapes the outside world. That part of his work is highly debatable and I have discarded it in my work. I He he he says we have internal worlds. We possess native or learned special talents. We have unique psychological fingerprints and we have special characteristics but we he rejects the assumption that the unique individual self has a particular impact on persontoerson encounters. He says this innate world is shaped by the environment, shaped by the outside, not the other way around, not that it shapes the outside world. That part of his work is highly debatable and I have discarded it in my work. I
16. 11:01 completely disagree. I think the interaction is interaction of equals. I think the external environment affects the internal one and the internal one definitely has an impact on the way the individual manifests or expresses it itself in the external world. But back to Sullivan, he he said that interpersonal thinking stresses the manifold unfolding of relatedness that is observable in any you and me encounter. The self is a kind of screen that reflects the impressions and valuations that other people have of completely disagree. I think the interaction is interaction of equals. I think the external environment affects the internal one and the internal one definitely has an impact on the way the individual manifests or expresses it itself in the external world. But back to Sullivan, he he said that interpersonal thinking stresses the manifold unfolding of relatedness that is observable in any you and me encounter. The self is a kind of screen that reflects the impressions and valuations that other people have of
17. 11:39 us. So what we call the self actually are the contours of the way other people perceive us. The contours of the shape that other people attribute to us. So um and this is this resonates this resembles a lot Lan’s view of the unconscious and of course mirroring. He says that um Sullivan says that um the self reflects the appraisals that one has experienced in the eyes of others. In other words, the self emerges from and through via the gaze of others. And when one thinks that one has been seen in the eyes of others, when one us. So what we call the self actually are the contours of the way other people perceive us. The contours of the shape that other people attribute to us. So um and this is this resonates this resembles a lot Lan’s view of the unconscious and of course mirroring. He says that um Sullivan says that um the self reflects the appraisals that one has experienced in the eyes of others. In other words, the self emerges from and through via the gaze of others. And when one thinks that one has been seen in the eyes of others, when one
18. 12:31 apprehends the fact that one is being seen or being perceived, at that moment the notion or the experience of the self emerges. What Salivan implies is that in the absence of all other people, the self dissolves and disappears. Something that is supported by, for example, experiences of people in solitary confinement or in sensory deprivation tanks, for example. So the self in Sullivan’s work is that aspect of the personality that is central in experiencing others and the anxiety that others induce. apprehends the fact that one is being seen or being perceived, at that moment the notion or the experience of the self emerges. What Salivan implies is that in the absence of all other people, the self dissolves and disappears. Something that is supported by, for example, experiences of people in solitary confinement or in sensory deprivation tanks, for example. So the self in Sullivan’s work is that aspect of the personality that is central in experiencing others and the anxiety that others induce.
19. 13:13 This anxiety stems from the dynamics within any interpersonal unit especially originally the family. Anxiety is important in terms of the self in Sullivan’s work because it has to do with the perceived opinions of others with other people’s gaze with being seen. And I borrowed this in my work. In my work, being seen is very critical. It’s the primary process which gives rise to all others. There is no longer, says Sullivan, justification for considering the self as a center of existence. It is likely that the self is This anxiety stems from the dynamics within any interpersonal unit especially originally the family. Anxiety is important in terms of the self in Sullivan’s work because it has to do with the perceived opinions of others with other people’s gaze with being seen. And I borrowed this in my work. In my work, being seen is very critical. It’s the primary process which gives rise to all others. There is no longer, says Sullivan, justification for considering the self as a center of existence. It is likely that the self is
20. 13:53 not essential to the understanding of human behavior. Sullivan compared it to the erroneous notion of the ether in in physics where up until Albert Einstein we believed physicists I’m saying we because I’m a physicist physicist believed that there’s this medium the ether which fills the world and through which light travels and now we understand that this was a complete mistake and there’s no such thing. The background of interpersonal theory um is also very interesting. Theories have not essential to the understanding of human behavior. Sullivan compared it to the erroneous notion of the ether in in physics where up until Albert Einstein we believed physicists I’m saying we because I’m a physicist physicist believed that there’s this medium the ether which fills the world and through which light travels and now we understand that this was a complete mistake and there’s no such thing. The background of interpersonal theory um is also very interesting. Theories have
21. 14:34 roots in various sciences. Freud tried to embed his theory psychoanalysis in neurology. For example, interpersonal theory builds on the sociological formulations of George Herbert me who wrote the classic text mind, society, and self. made made it clear that everyone is imprinted by some generalized other. That the very process of othering, the very process of perceiving the separateness and externality of someone else gives rise to the self-perception as a continuous a continuous entity continuous being continuous process roots in various sciences. Freud tried to embed his theory psychoanalysis in neurology. For example, interpersonal theory builds on the sociological formulations of George Herbert me who wrote the classic text mind, society, and self. made made it clear that everyone is imprinted by some generalized other. That the very process of othering, the very process of perceiving the separateness and externality of someone else gives rise to the self-perception as a continuous a continuous entity continuous being continuous process
22. 15:22 which is distinct from the other. It is the other in other words that gives rise to us. We are creatures of contradistinction. We are who we are in contradistinction to others. And this is what I call in my work the othering process. And this is the fundamental failure in pathological narcissism. Narcissists are unable to perceive others as others. They there is an other ringing failure. They cannot grasp grock um digest apprehend the externality and separateness of other people. They regard them as internal which is distinct from the other. It is the other in other words that gives rise to us. We are creatures of contradistinction. We are who we are in contradistinction to others. And this is what I call in my work the othering process. And this is the fundamental failure in pathological narcissism. Narcissists are unable to perceive others as others. They there is an other ringing failure. They cannot grasp grock um digest apprehend the externality and separateness of other people. They regard them as internal
23. 16:06 object objects and me said that no one can think of himself without including others in his or her thoughts. When you say it’s me, by implication you are saying and you are not me. It’s me and all others are not me. So every me statement goes with an implicit not me statement about the world. Language, culture and society are constantly in a reciprocal relationship where they intermingle with and interpenetrate. And so thought, society, the self depend on one another, cannot be separated out. object objects and me said that no one can think of himself without including others in his or her thoughts. When you say it’s me, by implication you are saying and you are not me. It’s me and all others are not me. So every me statement goes with an implicit not me statement about the world. Language, culture and society are constantly in a reciprocal relationship where they intermingle with and interpenetrate. And so thought, society, the self depend on one another, cannot be separated out.
24. 16:48 There’s been additional work by J. JM Baldwin, Chulie and John Dwey um along these lines and of course Sullivan kind of absorbed all this ambiance ambient thinking um and scholarship and integrated it into a seamlessly beautiful um school of thought in in psychology which is mysteriously much abandoned and neglected although Adler and Sullivan in my view prevailed over Freud and Jung they are the mainstream nowadays and but they are never credited the philosophical ideology represented by these thinkers that I mentioned is There’s been additional work by J. JM Baldwin, Chulie and John Dwey um along these lines and of course Sullivan kind of absorbed all this ambiance ambient thinking um and scholarship and integrated it into a seamlessly beautiful um school of thought in in psychology which is mysteriously much abandoned and neglected although Adler and Sullivan in my view prevailed over Freud and Jung they are the mainstream nowadays and but they are never credited the philosophical ideology represented by these thinkers that I mentioned is
25. 17:32 that of pragmatism typically typically American ideology pragmatism always asks what is best, what works. The question of why is European is much less interesting. It’s um kind of naval gazing. The main question in pragmatism and in pragmatic psychology and metsychology is um how can we build a model that explains the workings of the mind or the workings of the individual so that we can then manipulate this model and manipulate by extension the mind and the individual what works best. Others who thought along the same lines that of pragmatism typically typically American ideology pragmatism always asks what is best, what works. The question of why is European is much less interesting. It’s um kind of naval gazing. The main question in pragmatism and in pragmatic psychology and metsychology is um how can we build a model that explains the workings of the mind or the workings of the individual so that we can then manipulate this model and manipulate by extension the mind and the individual what works best. Others who thought along the same lines
26. 18:17 are linguists such as Edward Saper, anthropologists such as Ruth Benedict, philosophers like Alfred North Whitehead, Whitehead. Uh perhaps most of all, Sullivan is the only Native American who has significantly contributed to analytic theory. He is classified as a neo freudian. It’s important to remember because um he helped to construct an emergent American new world cultural view which much m much later echoed in diagnostic manuals for example like the DSM. So people ask whether Sullivan considered himself a psychiatrist or a are linguists such as Edward Saper, anthropologists such as Ruth Benedict, philosophers like Alfred North Whitehead, Whitehead. Uh perhaps most of all, Sullivan is the only Native American who has significantly contributed to analytic theory. He is classified as a neo freudian. It’s important to remember because um he helped to construct an emergent American new world cultural view which much m much later echoed in diagnostic manuals for example like the DSM. So people ask whether Sullivan considered himself a psychiatrist or a
27. 19:07 psychoanalyst and and so on so forth. He himself regarded himself as a as a psycho as a psychiatrist not a psychoanalyst. He said that psychiatry incorporates the body and medicine and and the approach to the human mind and the human individuality and and so on should be multidisiplinary um and it should be interpersonal. He emphasized reactivity and reactions and perhaps even reactants over isolated constructs. Isolated ideal platonic constructs like the self or the individual. Ziggman Freud made and Adolf psychoanalyst and and so on so forth. He himself regarded himself as a as a psycho as a psychiatrist not a psychoanalyst. He said that psychiatry incorporates the body and medicine and and the approach to the human mind and the human individuality and and so on should be multidisiplinary um and it should be interpersonal. He emphasized reactivity and reactions and perhaps even reactants over isolated constructs. Isolated ideal platonic constructs like the self or the individual. Ziggman Freud made and Adolf
28. 19:49 Mayor um were initially his inspiration and their influence was combined with his personal interest in natural sciences. So go back to Sullivan’s work. The light motif in his work is and I’m quoting him in most general terms we are all much more simply human than otherwise. Be we happy and successful, contented and detached, miserable and mentally disordered or whatever. What Sullivan said so flippantly apparently is that there is an underlying layer of interconnectivity underlying layer that unites us all a Mayor um were initially his inspiration and their influence was combined with his personal interest in natural sciences. So go back to Sullivan’s work. The light motif in his work is and I’m quoting him in most general terms we are all much more simply human than otherwise. Be we happy and successful, contented and detached, miserable and mentally disordered or whatever. What Sullivan said so flippantly apparently is that there is an underlying layer of interconnectivity underlying layer that unites us all a
29. 20:37 common denominator which we call humanity. All the rest is fluctuations perturbations. Sullivan’s scaffolding for interpersonal psychiatry centers on a dichotomy between satisfaction and security and he postulated a series of developmental stages. Now today the dominant theory of developmental stages is Eric Ericson’s but Sullivan’s um theory of developmental developmental theory has a few merits and a few things to recommend it. According to Sullivan, every developmental stage comes to an end when new capabilities common denominator which we call humanity. All the rest is fluctuations perturbations. Sullivan’s scaffolding for interpersonal psychiatry centers on a dichotomy between satisfaction and security and he postulated a series of developmental stages. Now today the dominant theory of developmental stages is Eric Ericson’s but Sullivan’s um theory of developmental developmental theory has a few merits and a few things to recommend it. According to Sullivan, every developmental stage comes to an end when new capabilities
30. 21:26 have been developed by the individual and these capabilities are fostered by some kind of productive participation in a human environment. In other words, human psychological development is driven by some kind of interaction with or integration in a human environment. Human psychological development stalls and dies out, peters out if an individual is isolated physically or psychologically from the environment, which is a great way to explain the ethology and and ontogenesis of pathological narcissism. capacity and have been developed by the individual and these capabilities are fostered by some kind of productive participation in a human environment. In other words, human psychological development is driven by some kind of interaction with or integration in a human environment. Human psychological development stalls and dies out, peters out if an individual is isolated physically or psychologically from the environment, which is a great way to explain the ethology and and ontogenesis of pathological narcissism. capacity and
31. 22:14 the readiness of a person and the sensitive encouragement of the environment all come into play so that some kind of new capability emerges and a new developmental stage is on quue. Maturation according to Sullivan is always an interaction between something innate and the encouragement and responsiveness of a sensitive other. This is where I differ a bit from Sullivan. I think the reaction of the environment is not always encouraging and not always resp responsive. And even when the environment is antagonistic, the readiness of a person and the sensitive encouragement of the environment all come into play so that some kind of new capability emerges and a new developmental stage is on quue. Maturation according to Sullivan is always an interaction between something innate and the encouragement and responsiveness of a sensitive other. This is where I differ a bit from Sullivan. I think the reaction of the environment is not always encouraging and not always resp responsive. And even when the environment is antagonistic,
32. 22:55 conflictridden, conflictive, even when the environment is rejecting and hateful, not embracing and not containing and so on, even then the environment induces the emergence of coping skills and strategies and positive adaptations that drive the individual forward in his or her path or trajectory of personal growth and development. In other words, in my work, the sufficient and necessary condition is the existence of an environment, any kind of environment, even a negative one. Even in Awitz, people have had conflictridden, conflictive, even when the environment is rejecting and hateful, not embracing and not containing and so on, even then the environment induces the emergence of coping skills and strategies and positive adaptations that drive the individual forward in his or her path or trajectory of personal growth and development. In other words, in my work, the sufficient and necessary condition is the existence of an environment, any kind of environment, even a negative one. Even in Awitz, people have had
33. 23:34 epiphies and developed and evolved personally. Ask Victor Frankl. And so according to to Sullivan, it is a time appropriate combination of inner and outer elements that drive the individual forward. Uh drives the individual forward. The and so I will summarize his developmental stages very very briefly. So stage one is infancy up to up to the second year until the acquisition of language which leads to the second stage which is childhood second to fifth year and there’s an a new emerging capacity of epiphies and developed and evolved personally. Ask Victor Frankl. And so according to to Sullivan, it is a time appropriate combination of inner and outer elements that drive the individual forward. Uh drives the individual forward. The and so I will summarize his developmental stages very very briefly. So stage one is infancy up to up to the second year until the acquisition of language which leads to the second stage which is childhood second to fifth year and there’s an a new emerging capacity of
34. 24:16 playing with other children. And then there’s a juvenile phase, 6th to 9th year, playing by the rules, cooperation, competition until there’s a newly emergent capacity for intimacy and um and then there’s a stage stage four which is pre- puberty. According to Sullivan, stages 1, two, and three include the capacity to love another person. The child is totally dependent on his or her family and is not yet able to freely choose a love object. And then pre-puberty which is a four stage is playing with other children. And then there’s a juvenile phase, 6th to 9th year, playing by the rules, cooperation, competition until there’s a newly emergent capacity for intimacy and um and then there’s a stage stage four which is pre- puberty. According to Sullivan, stages 1, two, and three include the capacity to love another person. The child is totally dependent on his or her family and is not yet able to freely choose a love object. And then pre-puberty which is a four stage is
35. 24:54 until the development of identity and sexuality. Some of these things are very reminiscent of Erikson. And then when identity and sexuality emerge as kind of newly acquired skills or new newly acquired potentialities um and and this is rem reminiscent of Muslo’s self-actualization pyramid at that point one can see oneself through the eyes of a friend. One can exchange impressions about self and the world and one can see parents and friends in a different light. There’s a reframing of previous life experience is in the until the development of identity and sexuality. Some of these things are very reminiscent of Erikson. And then when identity and sexuality emerge as kind of newly acquired skills or new newly acquired potentialities um and and this is rem reminiscent of Muslo’s self-actualization pyramid at that point one can see oneself through the eyes of a friend. One can exchange impressions about self and the world and one can see parents and friends in a different light. There’s a reframing of previous life experience is in the
36. 25:34 syntactic mode and concentrum validation is possible. Again, I differ from Sullivan in this because I believe that the need to be seen and the capacity to apprehend or perceive the gaze of others in a meaningful way is inborn is innate. You’re born with this. And I think babies um newborns and and infants and babies and toddlers make profuse use of this capacity. So I wouldn’t I wouldn’t say that it emerges only in pre-puberty. I think that’s counterfactual. And then the fifth stage in Sullivan’s syntactic mode and concentrum validation is possible. Again, I differ from Sullivan in this because I believe that the need to be seen and the capacity to apprehend or perceive the gaze of others in a meaningful way is inborn is innate. You’re born with this. And I think babies um newborns and and infants and babies and toddlers make profuse use of this capacity. So I wouldn’t I wouldn’t say that it emerges only in pre-puberty. I think that’s counterfactual. And then the fifth stage in Sullivan’s
37. 26:14 developmental stage phases is puberty until there’s a capacity for heterosexual meaningful experiences which arises and leads to adult maturity. And in adult maturity there is something he calls the ecological principle. Ecology in his work is concerned with the relationship of the organism to its environment and it’s very biological. This is where his interest in natural sciences informs his work. This is where why he insisted on being called a psychiatrist because psychiatry is branch of developmental stage phases is puberty until there’s a capacity for heterosexual meaningful experiences which arises and leads to adult maturity. And in adult maturity there is something he calls the ecological principle. Ecology in his work is concerned with the relationship of the organism to its environment and it’s very biological. This is where his interest in natural sciences informs his work. This is where why he insisted on being called a psychiatrist because psychiatry is branch of
38. 26:52 medicine. It’s much more scientific. So he said that there’s an ecological principle. Um it studies how the organism and envir and the environment interact and are dependent on each other and drive each other’s transitions and development. Um and this is strictly in a biological sense. Ecology also deals with human relationships to social institutions with special recognition of the fact that the individual is deeply embedded in his total millure and that there is a reciprocal relationship medicine. It’s much more scientific. So he said that there’s an ecological principle. Um it studies how the organism and envir and the environment interact and are dependent on each other and drive each other’s transitions and development. Um and this is strictly in a biological sense. Ecology also deals with human relationships to social institutions with special recognition of the fact that the individual is deeply embedded in his total millure and that there is a reciprocal relationship
39. 27:27 between humankind and nature and this is the classical presentation of ecology. And so in Sullivan’s work, he gave a few examples of how the ecological principle or the biological aspect of ecology would um would get into play. So he started with basics like the oxygen is everywhere. Life is dependent on oxygen. While one breathes oxygen, oxygen comes into the body. While one exhales, carbon dioxide leaves the body and there’s very little capacity in the body to store oxygen. Life is dependent on the eternal between humankind and nature and this is the classical presentation of ecology. And so in Sullivan’s work, he gave a few examples of how the ecological principle or the biological aspect of ecology would um would get into play. So he started with basics like the oxygen is everywhere. Life is dependent on oxygen. While one breathes oxygen, oxygen comes into the body. While one exhales, carbon dioxide leaves the body and there’s very little capacity in the body to store oxygen. Life is dependent on the eternal
40. 28:07 never interrupted exchange uh of oxygen and carbon dioxide through inhalation and exhalation. And it’s he said this is an example where we cannot strictly separate inside and outside. the in the individual as a biological entity is integrated in the atmosphere. An individual that is not in the atmosphere is a dead individual. And so the atmosphere could be perceived as internal because part of the atmosphere is inhaled into the body. Of course, this applies to sexuality as well. The act of penetration never interrupted exchange uh of oxygen and carbon dioxide through inhalation and exhalation. And it’s he said this is an example where we cannot strictly separate inside and outside. the in the individual as a biological entity is integrated in the atmosphere. An individual that is not in the atmosphere is a dead individual. And so the atmosphere could be perceived as internal because part of the atmosphere is inhaled into the body. Of course, this applies to sexuality as well. The act of penetration
41. 28:49 is is sex a unique individual experience or does it depend crucially on the presence of another? The ecological principle in psychiatry states that every human being needs a continuous neverending interplay or interaction or exchange or interchange or intercourse with other people in order to remain a human being. You need other people. other people affirm to you substantiate transmute if I if you wish or transsubstantiate your humanity. Your humanity is a derivative of your integration in the fabric fabric is is sex a unique individual experience or does it depend crucially on the presence of another? The ecological principle in psychiatry states that every human being needs a continuous neverending interplay or interaction or exchange or interchange or intercourse with other people in order to remain a human being. You need other people. other people affirm to you substantiate transmute if I if you wish or transsubstantiate your humanity. Your humanity is a derivative of your integration in the fabric fabric
42. 29:36 of all other humans. Isolation from meaningful human relationships is similar to severe psychopathology. In this sense, Sullivan fully agrees with the likes of Otto Karnburgg who have suggested who has suggested that borderline personality disorder and narcissistic personality disorder are pseudocychosis. They’re on the edge or verge or border of psychosis. In my work as well, narcissistic personality disorder is considered an extreme form of psychopathology even more than borderline because narcissists of all other humans. Isolation from meaningful human relationships is similar to severe psychopathology. In this sense, Sullivan fully agrees with the likes of Otto Karnburgg who have suggested who has suggested that borderline personality disorder and narcissistic personality disorder are pseudocychosis. They’re on the edge or verge or border of psychosis. In my work as well, narcissistic personality disorder is considered an extreme form of psychopathology even more than borderline because narcissists
43. 30:14 are unable to meaningfully interact with other human beings and they are unable to interact with other people because they don’t perceive the existence, separateness and externality of other people. The necessity according to Sullivan for a repeated exchange with other people is seen as a basic human requirement almost a kind of instinct. If such an exchange is not experienced is not felt loneliness results. What one could conflate this a bit with Fairburn’s theory of egouclei which is also highly relational. Object are unable to meaningfully interact with other human beings and they are unable to interact with other people because they don’t perceive the existence, separateness and externality of other people. The necessity according to Sullivan for a repeated exchange with other people is seen as a basic human requirement almost a kind of instinct. If such an exchange is not experienced is not felt loneliness results. What one could conflate this a bit with Fairburn’s theory of egouclei which is also highly relational. Object
44. 30:56 relations by definition is a relational approach to the emergence of the ego in the self and so on. According to uh Sullivan, basic human qualities have to be continually renewed in repeated steady exchanges with some kind of human environment. In Sullivan’s work, it has to be a constructive, supportive, encouraging, embracing human environment which affords sakur and compassion and so on. In my work, it could be any kind of human environment. I claim in my work that any kind of human environment, even relations by definition is a relational approach to the emergence of the ego in the self and so on. According to uh Sullivan, basic human qualities have to be continually renewed in repeated steady exchanges with some kind of human environment. In Sullivan’s work, it has to be a constructive, supportive, encouraging, embracing human environment which affords sakur and compassion and so on. In my work, it could be any kind of human environment. I claim in my work that any kind of human environment, even
45. 31:32 the most negative and dark generates uh internal psychonamics which lead to change, which by definition is a form of growth and development. Not all growth and development is positive. Narcissism, pathological narcissism, for example, is definitely a form of growth and development that is highly negative. It starts off as a positive adaptation and lifelong into adulthood, it becomes a negative adaptation. The anxiety principle in Sullivan’s work is crucial. In my work, anxiety is a positive thing. It’s a form of internal the most negative and dark generates uh internal psychonamics which lead to change, which by definition is a form of growth and development. Not all growth and development is positive. Narcissism, pathological narcissism, for example, is definitely a form of growth and development that is highly negative. It starts off as a positive adaptation and lifelong into adulthood, it becomes a negative adaptation. The anxiety principle in Sullivan’s work is crucial. In my work, anxiety is a positive thing. It’s a form of internal
46. 32:13 signaling which mediates a lot of functions. In Sullivan’s work, anxiety is a totally psychological experience that has no organic basis. And in this he set himself Sullivan set himself apart from Freud. Freud claimed that anxiety is a form of energetic discharge or that anxiety is a form of energy that needs to be discharged. Sullivan said, “No way. Anxiety is totally psychological. There’s no organic basis. It is inter because it is interpersonal. There’s no biological structure that is signaling which mediates a lot of functions. In Sullivan’s work, anxiety is a totally psychological experience that has no organic basis. And in this he set himself Sullivan set himself apart from Freud. Freud claimed that anxiety is a form of energetic discharge or that anxiety is a form of energy that needs to be discharged. Sullivan said, “No way. Anxiety is totally psychological. There’s no organic basis. It is inter because it is interpersonal. There’s no biological structure that is
47. 32:49 connected to it, affiliated with it or underlies it because it’s all relational. It’s all a it’s all to do with the interaction, not with the people involved in the interaction. He kind of sociologized anxiety. He made it a social phenomenon rather than a biological one. Although he said that it’s psychological, he actually made it sociological. I completely disagree. Of course, anxiety has been proven beyond doubt to be connected to certain structures of the brain, certain blood flows in the brain, connected to it, affiliated with it or underlies it because it’s all relational. It’s all a it’s all to do with the interaction, not with the people involved in the interaction. He kind of sociologized anxiety. He made it a social phenomenon rather than a biological one. Although he said that it’s psychological, he actually made it sociological. I completely disagree. Of course, anxiety has been proven beyond doubt to be connected to certain structures of the brain, certain blood flows in the brain,
48. 33:24 certain electrical activity of multiple units in the brain and so on so forth. So it’s wrong. It is embedded in the brain. But I never understood why Sullivan felt the need to engage in this debate which is completely didn’t contribute anything to his work in in my view. I think his contribution was to elevate anxiety or to to to extricate anxiety from the Freudian quagmire of energies and counter energies and what energy balance to extricate it and to imbue it with a relational aspect or a certain electrical activity of multiple units in the brain and so on so forth. So it’s wrong. It is embedded in the brain. But I never understood why Sullivan felt the need to engage in this debate which is completely didn’t contribute anything to his work in in my view. I think his contribution was to elevate anxiety or to to to extricate anxiety from the Freudian quagmire of energies and counter energies and what energy balance to extricate it and to imbue it with a relational aspect or a
49. 33:59 relational meaning. I I think that’s a major contribution because I exactly like Sullivan believe I believe that anxiety emerges mostly in interpersonal and an interpersonal context. I think anxiety is a form of internal signaling that something is wrong in the external environment especially the human external environment external environment that contains other people. I would say that anxiety is a signal of othering failure or a signal of gaze failure other people’s gaze failure of other people’s gaze. relational meaning. I I think that’s a major contribution because I exactly like Sullivan believe I believe that anxiety emerges mostly in interpersonal and an interpersonal context. I think anxiety is a form of internal signaling that something is wrong in the external environment especially the human external environment external environment that contains other people. I would say that anxiety is a signal of othering failure or a signal of gaze failure other people’s gaze failure of other people’s gaze.
50. 34:39 Um so said that anxiety is interpersonal and and so on and all other tensions he said can be resolved through energy transformations but not the tension of anxiety. This is a completely unnecessary debate that he entered into and I think was not his his best moment. He says that he said that anxiety takes precedence over all other tensions and complicates the resolution or the intensification with wi-i which I fully agree with in the presence of anxiety said Sullivan learning from experience is not possible. I also agree with that. Um so said that anxiety is interpersonal and and so on and all other tensions he said can be resolved through energy transformations but not the tension of anxiety. This is a completely unnecessary debate that he entered into and I think was not his his best moment. He says that he said that anxiety takes precedence over all other tensions and complicates the resolution or the intensification with wi-i which I fully agree with in the presence of anxiety said Sullivan learning from experience is not possible. I also agree with that.
51. 35:18 That’s why I I believe and this is based on recent studies that for example psychopathy and narcissism are founded on anxiety because there’s no capacity for learning there. Anxiety controls awareness according to Sullivan in in that important factors that have called out the anxiety remain outside the awareness of the person. Anxiety kind of emerges from the unconscious and you don’t exactly know why are you ill. It is why you I mean if you are a able to identify a reason that’s not anxiety That’s why I I believe and this is based on recent studies that for example psychopathy and narcissism are founded on anxiety because there’s no capacity for learning there. Anxiety controls awareness according to Sullivan in in that important factors that have called out the anxiety remain outside the awareness of the person. Anxiety kind of emerges from the unconscious and you don’t exactly know why are you ill. It is why you I mean if you are a able to identify a reason that’s not anxiety
52. 35:54 that’s fear or distress anxiety is usually amorphous it’s diffused it cannot be traced linearly to some cause and this is also the reason why it is important to recall the actual events that were experienced other under the influence of anxiety because anxiety isolates the person from all possibility of contacts with other people and goes counter to any self any sense of self let alone self-esteem or interpersonal security according to Sullivan anxiety is essentially and originally transmitted that’s fear or distress anxiety is usually amorphous it’s diffused it cannot be traced linearly to some cause and this is also the reason why it is important to recall the actual events that were experienced other under the influence of anxiety because anxiety isolates the person from all possibility of contacts with other people and goes counter to any self any sense of self let alone self-esteem or interpersonal security according to Sullivan anxiety is essentially and originally transmitted
53. 36:34 by the mother figure so you see I’m not the only one who demonizes mothers it’s in the in the entire literature from Sullivan to Balby another principle in in Sullivan’s work and there many revolutionary principles and ideas. It’s pretty shocking that he is not as known as other figures in psychology. So another principle is what he called the principle of similarity. He said that similarities between human beings are always more important than differences. Something connects people by the mother figure so you see I’m not the only one who demonizes mothers it’s in the in the entire literature from Sullivan to Balby another principle in in Sullivan’s work and there many revolutionary principles and ideas. It’s pretty shocking that he is not as known as other figures in psychology. So another principle is what he called the principle of similarity. He said that similarities between human beings are always more important than differences. Something connects people
54. 37:06 to one another that is stronger than what he called the individual difficulties. This there is a common bond common denominator and it is this intersubjective space however contrived however fantastic however imagined this alleged ostensible intersubjective space the presumption of similarity when we tell ourselves we are like this person you know sadness is is universal happiness is universal All emotions are universal. We tell ourselves these things as a way to access other people’s minds to one another that is stronger than what he called the individual difficulties. This there is a common bond common denominator and it is this intersubjective space however contrived however fantastic however imagined this alleged ostensible intersubjective space the presumption of similarity when we tell ourselves we are like this person you know sadness is is universal happiness is universal All emotions are universal. We tell ourselves these things as a way to access other people’s minds
55. 37:48 counterfactually and imaginatively. And by doing so, uh this common bond creates a therapeutic impact. Even not in therapy, even when not in therapy, you talk to a good friend, you’re having a drink. This commonality known as friendship in this case has a therapeutic effect. Mental illness is therefore not an illness according to Sullivan. It’s a way of being. It’s a result of relationships too important to others. So mental illness is when there’s a relationship failure and it’s it implies some kind of counterfactually and imaginatively. And by doing so, uh this common bond creates a therapeutic impact. Even not in therapy, even when not in therapy, you talk to a good friend, you’re having a drink. This commonality known as friendship in this case has a therapeutic effect. Mental illness is therefore not an illness according to Sullivan. It’s a way of being. It’s a result of relationships too important to others. So mental illness is when there’s a relationship failure and it’s it implies some kind of
56. 38:33 state of being not state of mind. uh he said that when relationships with other people don’t work out this creates anxiety. Anxiety is the mother of all what we call mental illness. Difficulties in living as we call it are due to things that went wrong in relationships to important others in the developmental years and cast a shadow into the future. What today we call attachment dysfunctional attachment styles. The difficulties can be seen in timing and inadequate judgments in any given situation. Another principle that state of being not state of mind. uh he said that when relationships with other people don’t work out this creates anxiety. Anxiety is the mother of all what we call mental illness. Difficulties in living as we call it are due to things that went wrong in relationships to important others in the developmental years and cast a shadow into the future. What today we call attachment dysfunctional attachment styles. The difficulties can be seen in timing and inadequate judgments in any given situation. Another principle that
57. 39:11 comes into play in Sullivan’s work is the tenderness principle. He said he he really disliked the word love. The word love. He said that we are misusing, molesting and debasing the word the word love. He said that most people what they have with each other is not love. Is tenderness. It’s a special sense of caring for another person. He said that a child, for example, he wasn’t quite sure that parents love their children. He he thought that a child elicits in parents tenderness or tender feelings. comes into play in Sullivan’s work is the tenderness principle. He said he he really disliked the word love. The word love. He said that we are misusing, molesting and debasing the word the word love. He said that most people what they have with each other is not love. Is tenderness. It’s a special sense of caring for another person. He said that a child, for example, he wasn’t quite sure that parents love their children. He he thought that a child elicits in parents tenderness or tender feelings.
58. 39:49 He limited it limited it to the mother. Later studies have demonstrated that the same reactions are occur in fathers. So this tenderness is parental, not paternal and not maternal but parental. And the it is this tenderness that is triggered in the parent that forces the parent or or convinces the parent into caring. Caring is the behavioral expression of this elicited tenderness reaction. And then the parents supply the necessary conditions for an anxietyfree mother child relationship. In Sullivan’s He limited it limited it to the mother. Later studies have demonstrated that the same reactions are occur in fathers. So this tenderness is parental, not paternal and not maternal but parental. And the it is this tenderness that is triggered in the parent that forces the parent or or convinces the parent into caring. Caring is the behavioral expression of this elicited tenderness reaction. And then the parents supply the necessary conditions for an anxietyfree mother child relationship. In Sullivan’s
59. 40:29 work, for instance, he gave an example. When the child is hungry, the mother understands the message of the child. The child cues the mother. And here my in my work, this is the foundation of the need to be seen. The child needs to be seen by the mother. Yeah. And then the hunger is expressed as tension. The the child experiences the hunger as tension or stress if you wish. And the mother reacts to the tension to the child’s tension as communicated usually by crying or something with tenderness. work, for instance, he gave an example. When the child is hungry, the mother understands the message of the child. The child cues the mother. And here my in my work, this is the foundation of the need to be seen. The child needs to be seen by the mother. Yeah. And then the hunger is expressed as tension. The the child experiences the hunger as tension or stress if you wish. And the mother reacts to the tension to the child’s tension as communicated usually by crying or something with tenderness.
60. 41:06 The the child’s cues generate tenderness and then the child reacts to the mother’s availability and acceptance of of the child’s needs with a healthy appetite. And the mother reacts with a sense of happiness. And the there’s a cascade a cascade here that starts with tenderness and carrying and reactivity and absence of frustration and and uh and uh happiness and and so on. In other words, there is a happy what what could be called a happy chain reaction. And the opposite happens when the reaction The the child’s cues generate tenderness and then the child reacts to the mother’s availability and acceptance of of the child’s needs with a healthy appetite. And the mother reacts with a sense of happiness. And the there’s a cascade a cascade here that starts with tenderness and carrying and reactivity and absence of frustration and and uh and uh happiness and and so on. In other words, there is a happy what what could be called a happy chain reaction. And the opposite happens when the reaction
61. 41:43 doesn’t work. of course is an unhappy chain reaction. And so uh this was the foundation of of uh Sullivan’s um work. Of course, it has undergone many evolutions and and transformations and and uh so on. I I’d like to focus a bit on Sullivan’s view of therapy. Sullivan was very concerned with seriously disturbed patients for example psychotics and schizophrenia. He dedicated himself to working with schizophrenic patients. According to Sullivan, schizophrenia with very few exceptions was not an doesn’t work. of course is an unhappy chain reaction. And so uh this was the foundation of of uh Sullivan’s um work. Of course, it has undergone many evolutions and and transformations and and uh so on. I I’d like to focus a bit on Sullivan’s view of therapy. Sullivan was very concerned with seriously disturbed patients for example psychotics and schizophrenia. He dedicated himself to working with schizophrenic patients. According to Sullivan, schizophrenia with very few exceptions was not an
62. 42:32 illness but a particularly human process and this we have similar thinking by laying and others. Sullivan’s attitude regarding severe mental health disorders or mental disorders can be found in his famous statement famous dictum far more than any single act of the therapist it is the general attitude toward the patient which determines his value. In other words, what the therapist does is not very important. how the therapist views the patient and treats the patient, the human respect and dignity that underly illness but a particularly human process and this we have similar thinking by laying and others. Sullivan’s attitude regarding severe mental health disorders or mental disorders can be found in his famous statement famous dictum far more than any single act of the therapist it is the general attitude toward the patient which determines his value. In other words, what the therapist does is not very important. how the therapist views the patient and treats the patient, the human respect and dignity that underly
63. 43:10 the interaction, they are the driving forces. They pro afford, they provide the energy. And he said it in the 60s. Um he also emphasized transference phenomena. Uh he said um he said that they’re very important because they relieve the introversion of mental life of the patient. He said the transference phenomena allow the patient to exit to exit herself or himself and direct itself towards the therapist. Therapist becomes like a magnet which draws out the internal landscape of the patient and renders it external. the interaction, they are the driving forces. They pro afford, they provide the energy. And he said it in the 60s. Um he also emphasized transference phenomena. Uh he said um he said that they’re very important because they relieve the introversion of mental life of the patient. He said the transference phenomena allow the patient to exit to exit herself or himself and direct itself towards the therapist. Therapist becomes like a magnet which draws out the internal landscape of the patient and renders it external.
64. 43:50 Um Sullivan recommended that for example in a mental hospital there should be an educational setting for personal growth for therapists as well as for patients. Uh he said that therapist should never be guardians or custodians of personality failure. They should be equal participants in personality evolution and growth. According to Sullivan the purpose of psychiatry is the understanding and facilitation of living. There are no there’s no mental illness. There’s just difficulties in living. We need to teach people how to Um Sullivan recommended that for example in a mental hospital there should be an educational setting for personal growth for therapists as well as for patients. Uh he said that therapist should never be guardians or custodians of personality failure. They should be equal participants in personality evolution and growth. According to Sullivan the purpose of psychiatry is the understanding and facilitation of living. There are no there’s no mental illness. There’s just difficulties in living. We need to teach people how to
65. 44:24 live. So his therapy was mainly concerned with the various multifarious forms of anxiety. He believed that every patient has to be educated to recognize the manifestations and expressions of anxiety within the patient. Every patient has to focus on the quality of the voice. the changing in theme, hyper vigilance or hyper sensitivity as he called it, a particular variety of non-involvement, apathy, indifference, unnecessary argumentiveness, selective inattention, suland detachment, exaggerated anger, live. So his therapy was mainly concerned with the various multifarious forms of anxiety. He believed that every patient has to be educated to recognize the manifestations and expressions of anxiety within the patient. Every patient has to focus on the quality of the voice. the changing in theme, hyper vigilance or hyper sensitivity as he called it, a particular variety of non-involvement, apathy, indifference, unnecessary argumentiveness, selective inattention, suland detachment, exaggerated anger,
66. 45:04 um I would add paranoid ideation. These are all forms of threatening anxiety. Threatening in the sense that it could overwhelm and paralyze the patient. Salivan was convinced that meaningful human contact in the presence of anxiety is essentially impossible. That anxiety shuts off the individual, isolates, firewalls individual. So it has to be pierced through. It’s a veil that has to be pierced. It has to be destroyed, deconstructed. It is the nature of the experience of anxiety that experiences in the presence of anxiety um I would add paranoid ideation. These are all forms of threatening anxiety. Threatening in the sense that it could overwhelm and paralyze the patient. Salivan was convinced that meaningful human contact in the presence of anxiety is essentially impossible. That anxiety shuts off the individual, isolates, firewalls individual. So it has to be pierced through. It’s a veil that has to be pierced. It has to be destroyed, deconstructed. It is the nature of the experience of anxiety that experiences in the presence of anxiety
67. 45:41 can never be totally conscious. They may exert some energetic influence on the unconscious level, but they’re not very conducive to personal development and growth. One can only remember what happened prior to the presence of anxiety, but never within it. The experience of anxiety is largely submerged. Loneliness is very important. The need for contact is basic. He said as basic as sleep, hunger, thirst, and sexuality. That’s where we strongly differ. Sullivan believes that interpersonality or interaction with can never be totally conscious. They may exert some energetic influence on the unconscious level, but they’re not very conducive to personal development and growth. One can only remember what happened prior to the presence of anxiety, but never within it. The experience of anxiety is largely submerged. Loneliness is very important. The need for contact is basic. He said as basic as sleep, hunger, thirst, and sexuality. That’s where we strongly differ. Sullivan believes that interpersonality or interaction with
68. 46:21 other people is a core instinct essentially. It’s an urge or a drive to use Freud’s language. I believe that the need to isolate oneself, the the need to avoid other people is the core feature. But we’ll we’ll put it aside. We’re talking about Sullivan right now, not about Vakny. Uh and he believed that this the social need is as foundational as fundamental as sleep, hunger, thirst, and sexuality. Sullivan believed that meaningful human contact is essential for all human beings. other people is a core instinct essentially. It’s an urge or a drive to use Freud’s language. I believe that the need to isolate oneself, the the need to avoid other people is the core feature. But we’ll we’ll put it aside. We’re talking about Sullivan right now, not about Vakny. Uh and he believed that this the social need is as foundational as fundamental as sleep, hunger, thirst, and sexuality. Sullivan believed that meaningful human contact is essential for all human beings.
69. 46:58 Total aloneeness is basically the same as mental illness. When you have a difficulty in living, it means you have a difficulty at being with other people. According to Sullivan, humans have only a limited capacity to store experiences of contact to recall them to process them. So you can’t kind of accumulate a period of contact with other people and then go and disappear off the grid because your capacity to store these emotional and and cognitive experiences is is very limited. So you need to Total aloneeness is basically the same as mental illness. When you have a difficulty in living, it means you have a difficulty at being with other people. According to Sullivan, humans have only a limited capacity to store experiences of contact to recall them to process them. So you can’t kind of accumulate a period of contact with other people and then go and disappear off the grid because your capacity to store these emotional and and cognitive experiences is is very limited. So you need to
70. 47:35 constantly repeat exchanges with other people to remain human. Isolation from the mainstream of life is at the core of mental disorders. In in this Sullivan was preceded by Hervik Cleley who suggested that psychopathy he suggest in the 1940s he suggested that psychopathy um essentially all mental illness is a rejection of life. Anxiety is a frightening experience and Sullivan was pretty obsessed with it honestly. Only loneliness he said can be more terrifying than anxiety. Loneliness will motivate a person to seek contact constantly repeat exchanges with other people to remain human. Isolation from the mainstream of life is at the core of mental disorders. In in this Sullivan was preceded by Hervik Cleley who suggested that psychopathy he suggest in the 1940s he suggested that psychopathy um essentially all mental illness is a rejection of life. Anxiety is a frightening experience and Sullivan was pretty obsessed with it honestly. Only loneliness he said can be more terrifying than anxiety. Loneliness will motivate a person to seek contact
71. 48:13 with another person despite the presence of anxiety. So loneliness is stronger than anxiety. He said I think he was a bit confused here. I think loneliness is often a manifestation of of anxiety. I think loneliness is the behavioral expression of anxiety. I don’t think they’re distinct. I don’t think they’re separate at all. I think he was very mistaken here. And I think anxiety leads to loneliness as a defense as a perimeter defense. The experience of loneliness according to Sullivan takes on different forms at with another person despite the presence of anxiety. So loneliness is stronger than anxiety. He said I think he was a bit confused here. I think loneliness is often a manifestation of of anxiety. I think loneliness is the behavioral expression of anxiety. I don’t think they’re distinct. I don’t think they’re separate at all. I think he was very mistaken here. And I think anxiety leads to loneliness as a defense as a perimeter defense. The experience of loneliness according to Sullivan takes on different forms at
72. 48:49 different times in the life cycle. It appears in infants, in toddlers, and children, juveniles, adults, puberty, you name it. We could be lonely and are lonely at any period in our lifespan. the necessity of being with others um is is crucial and when it when it is unfulfilled we experience it as loneliness and so a baby would need to be held would need to be physically touched skin-to-skin contact there have been experiments which demonstrated that skin-to-skin contact is much more important than food to newborns and different times in the life cycle. It appears in infants, in toddlers, and children, juveniles, adults, puberty, you name it. We could be lonely and are lonely at any period in our lifespan. the necessity of being with others um is is crucial and when it when it is unfulfilled we experience it as loneliness and so a baby would need to be held would need to be physically touched skin-to-skin contact there have been experiments which demonstrated that skin-to-skin contact is much more important than food to newborns and
73. 49:29 infants and So this is crucial and then a bit later the child wants to play next to or with other children or engage in some kind of competitive activities or develop primordial kind of nuclear uh friendships. Then there’s a much much bigger desire to have friends male or female. And so friendships become friendship becomes an organizing principle of human interactions and social activities. And at the next stage there’s a wish for intimacy including sexual intimacy and finally cooperation with others for the infants and So this is crucial and then a bit later the child wants to play next to or with other children or engage in some kind of competitive activities or develop primordial kind of nuclear uh friendships. Then there’s a much much bigger desire to have friends male or female. And so friendships become friendship becomes an organizing principle of human interactions and social activities. And at the next stage there’s a wish for intimacy including sexual intimacy and finally cooperation with others for the
74. 50:08 for the greater good. So political activity, social activism and so on. Sullivan was a visionary. He was well ahead of his time. He said that and I’m quoting the acceleration of social progress has become so great that almost every psychiatrist has some some occasion to realize that the first viewpoint is too narrow. He coined a number of the terms that u are still in use today in clinical settings and detachment for example. He made a distinction between this term son of detachment and the conventional term of for the greater good. So political activity, social activism and so on. Sullivan was a visionary. He was well ahead of his time. He said that and I’m quoting the acceleration of social progress has become so great that almost every psychiatrist has some some occasion to realize that the first viewpoint is too narrow. He coined a number of the terms that u are still in use today in clinical settings and detachment for example. He made a distinction between this term son of detachment and the conventional term of
75. 50:50 apathy or indifference. He said that both of them describe phenomena in interpersonal relatedness but apathy is related to essential needs and requirements while sonolin detachment is a safety device as I said a defense against undesired anxiety in a particular interpersonal setting. The phenomenon of son uh detachment can manifest in the patient but it can also manifest in the therapist. Therapist could also become defensive when they feel that the interaction with the patient could lead to high anxiety. And apathy or indifference. He said that both of them describe phenomena in interpersonal relatedness but apathy is related to essential needs and requirements while sonolin detachment is a safety device as I said a defense against undesired anxiety in a particular interpersonal setting. The phenomenon of son uh detachment can manifest in the patient but it can also manifest in the therapist. Therapist could also become defensive when they feel that the interaction with the patient could lead to high anxiety. And
76. 51:29 in daily life of course we detached detach very often as a way to protect ourselves our integrity our functioning our hope for the future. Claraara Thompson had a which I mentioned before had a lifelong friendship with Sullivan and she pointed out that Sullivan’s uh first therapeutic contacts were with psychotic patients. He only later became interested in the vicissitudes of neurotic obsessional character disorders what today we call personality disorders. So he was exposed mainly to schizophrenics. in daily life of course we detached detach very often as a way to protect ourselves our integrity our functioning our hope for the future. Claraara Thompson had a which I mentioned before had a lifelong friendship with Sullivan and she pointed out that Sullivan’s uh first therapeutic contacts were with psychotic patients. He only later became interested in the vicissitudes of neurotic obsessional character disorders what today we call personality disorders. So he was exposed mainly to schizophrenics.
77. 52:04 Sullivan devoted his research and clinical observations to applying psychoanalytic constructs to the therapy of the psychotic which Freud believe is a futile effort. Carl Youngung and Organer before him had found psychoanalytic tenants applicable in dealing with the behavior and symbolization of psychotic patients. And in this they disagreed strongly with Freud. But the general professional viewpoint at the time in the 60s was that I remember psychoanalysis was the dominant the dominant um paradigm in the 60s Sullivan devoted his research and clinical observations to applying psychoanalytic constructs to the therapy of the psychotic which Freud believe is a futile effort. Carl Youngung and Organer before him had found psychoanalytic tenants applicable in dealing with the behavior and symbolization of psychotic patients. And in this they disagreed strongly with Freud. But the general professional viewpoint at the time in the 60s was that I remember psychoanalysis was the dominant the dominant um paradigm in the 60s
78. 52:43 the evolution the the more evolved forms of psycho analysis like object relations and so on psychonamics psychonamic theories. So the general consensus at the time was that psychoanalysis was not an appropriate method of treatment of psychotic patients. It was at the time believed that psychotic patients are restricted in following the basic rule of saying that what comes to mind and cannot handle transfers. Freda from Rahman classic psychoanalyst worked intensively with psychotic patients and together with Clara Thomson the evolution the the more evolved forms of psycho analysis like object relations and so on psychonamics psychonamic theories. So the general consensus at the time was that psychoanalysis was not an appropriate method of treatment of psychotic patients. It was at the time believed that psychotic patients are restricted in following the basic rule of saying that what comes to mind and cannot handle transfers. Freda from Rahman classic psychoanalyst worked intensively with psychotic patients and together with Clara Thomson
79. 53:19 she actually supported Salivan’s clinical approach. The problem I think is when you’re exposed to only one type of patient while you are developing your theory it’s bound to be partial and biased. Initially, I’ve been I’ve been generating work for 30 plus years now. I now go back to my early work and I see how biased and a lot of it wrong it is because I focused on people with narcissistic personality disorder. When you are hammered, everything is a nail. I’m not the same today. Of course, I she actually supported Salivan’s clinical approach. The problem I think is when you’re exposed to only one type of patient while you are developing your theory it’s bound to be partial and biased. Initially, I’ve been I’ve been generating work for 30 plus years now. I now go back to my early work and I see how biased and a lot of it wrong it is because I focused on people with narcissistic personality disorder. When you are hammered, everything is a nail. I’m not the same today. Of course, I
80. 54:01 study monopoly of mental illnesses and I’m exposed to dozens of schools in psychology and so on so forth. I’m much more eclectic. But I had this problem and Sullivan had this problem too. Sullivan’s perceptivity about schizophrenia as well as his ability as a teacher h are well documented and he conducted many seminars for psychiatric residents and and so on so forth and he documented many case studies others documented his case studies um but it’s clear already that his exposure study monopoly of mental illnesses and I’m exposed to dozens of schools in psychology and so on so forth. I’m much more eclectic. But I had this problem and Sullivan had this problem too. Sullivan’s perceptivity about schizophrenia as well as his ability as a teacher h are well documented and he conducted many seminars for psychiatric residents and and so on so forth and he documented many case studies others documented his case studies um but it’s clear already that his exposure
81. 54:41 to schizophrenic patients led him to postulate or promulgate or create all kinds of principles and so on which were not fully applicable to reality and some of them are counterfactual and were very problematic. So even in his documented case studies, you can see that he’s flailing about and he’s trying this then he’s trying that that he simultaneously applies three different tracks or mechanisms or techniques and and he he he he got lost a bit. He got lost a bit. working with deeply to schizophrenic patients led him to postulate or promulgate or create all kinds of principles and so on which were not fully applicable to reality and some of them are counterfactual and were very problematic. So even in his documented case studies, you can see that he’s flailing about and he’s trying this then he’s trying that that he simultaneously applies three different tracks or mechanisms or techniques and and he he he he got lost a bit. He got lost a bit. working with deeply
82. 55:17 troubled patients uh was very disorienting for him in my view which is why he transitioned later to less troubled patients and um he he had a conflicted relationship relationship with what we call today clinical entities. He wasn’t sure about the frame of reference in therapy. He expressed a lot of reservations about discussing therapeutic approaches in terms of clinical entities but at the same time he believed that they do have some purely pragmatic utility. Sullivan was very um much more interested in in troubled patients uh was very disorienting for him in my view which is why he transitioned later to less troubled patients and um he he had a conflicted relationship relationship with what we call today clinical entities. He wasn’t sure about the frame of reference in therapy. He expressed a lot of reservations about discussing therapeutic approaches in terms of clinical entities but at the same time he believed that they do have some purely pragmatic utility. Sullivan was very um much more interested in in
83. 55:59 what works, how am I going to accomplish results, what can be done about the patient and I don’t care about the patient’s diagnosis. He said I don’t care about which therapy is the therapy toour. I just want to help the patient. I want to help the patient to learn how to live with fewer difficulties. He preferred an approach based on two frames of reference. The first frame of reference is careful viewing of each case in terms of the severity of the difficulties in living and with a lot of what works, how am I going to accomplish results, what can be done about the patient and I don’t care about the patient’s diagnosis. He said I don’t care about which therapy is the therapy toour. I just want to help the patient. I want to help the patient to learn how to live with fewer difficulties. He preferred an approach based on two frames of reference. The first frame of reference is careful viewing of each case in terms of the severity of the difficulties in living and with a lot of
84. 56:30 attention to evidence that the patient has demonstrated a capacity to meet difficult or unusually complex situations. That’s framework number one. Framework number two u so the the first framework is prognostic. Yes, if you identify the difficulties of the patient the you know more or less what is a prognosis. And the second frame of reference is information from the patient about particular assets. So first frame of reference is difficulties. Second one is assets. This is very similar to my work attention to evidence that the patient has demonstrated a capacity to meet difficult or unusually complex situations. That’s framework number one. Framework number two u so the the first framework is prognostic. Yes, if you identify the difficulties of the patient the you know more or less what is a prognosis. And the second frame of reference is information from the patient about particular assets. So first frame of reference is difficulties. Second one is assets. This is very similar to my work
85. 57:02 where where I propose a SWAT SWAT analysis of the patient strength weakness opportunities and threats of the patient. He did the same only he used two. So the second frame of reference is assets. What kind of assets? these assets can open the door, can be leveraged as therapeutic opportunities. Um, Sullivan is very refreshing. He’s a bit econostic, but he’s very grounded in clinical experience and he’s fascinating. He’s compassionate about human beings. He he he understands suffering. where where I propose a SWAT SWAT analysis of the patient strength weakness opportunities and threats of the patient. He did the same only he used two. So the second frame of reference is assets. What kind of assets? these assets can open the door, can be leveraged as therapeutic opportunities. Um, Sullivan is very refreshing. He’s a bit econostic, but he’s very grounded in clinical experience and he’s fascinating. He’s compassionate about human beings. He he he understands suffering.
86. 57:44 The troubled people bothered him. He has respect. He’s a kind of champion of the underdog. He saw the positive in everyone. He assets what he called assets. And so it’s a very uplifting uplifting school. But he failed to systematize it in my view because of his overemphasis on psychosis. And so it did not emerge as a universal highly cerebral intellectual theoretical framework such as Yungs or Freuds or much later even people like Bandura. He failed in this and I think this is why he is The troubled people bothered him. He has respect. He’s a kind of champion of the underdog. He saw the positive in everyone. He assets what he called assets. And so it’s a very uplifting uplifting school. But he failed to systematize it in my view because of his overemphasis on psychosis. And so it did not emerge as a universal highly cerebral intellectual theoretical framework such as Yungs or Freuds or much later even people like Bandura. He failed in this and I think this is why he is
87. 58:28 overlooked and and neglected even by myself in my work. Uh which I regret very much. I think I should have given him given him much more credit. Ironically, his philosophy his philosophy coupled with the philosophy of Adler is I think the mainstream today. Today we emphasize relationships. Everything is relational. We are much less and more much less in love with Freuds and Jung’s concept of a nucleus kind of isolated core uh which is totally in internal and innate has its own dynamics which are overlooked and and neglected even by myself in my work. Uh which I regret very much. I think I should have given him given him much more credit. Ironically, his philosophy his philosophy coupled with the philosophy of Adler is I think the mainstream today. Today we emphasize relationships. Everything is relational. We are much less and more much less in love with Freuds and Jung’s concept of a nucleus kind of isolated core uh which is totally in internal and innate has its own dynamics which are
88. 59:07 independent of everything but we are much less in love with this view of the human mind and we are much more Salivanians and Adlerans. independent of everything but we are much less in love with this view of the human mind and we are much more Salivanians and Adlerans.