At a time when Freudian psychoanalytic theory dominated psychiatry, Harry Stack Sullivan drew on his experiences working with the severely mentally ill to develop an alternative approach to understanding development, the etiology of psychopathology, and effective psychotherapeutic treatments. Observing his patients diagnosed with schizophrenia, Sullivan concluded that those with psychosis were acutely sensitive to the interpersonal environment and that many of the psychotic experiences of his patients heavily influenced their interpersonal interactions. Out of these observations emerged an examination of the interpersonal issues particular to each phase of the lifespan and the notion that early relationships are central to the development of personality. Essentially, Sullivan pioneered a field of psychiatry that challenged the understanding of a human as a single unit and conceptualized human development as inseparable from the interpersonal environment (Mitchell and Black 1995).
Sullivan proposed a series of developmental epochs with each phase characterized by a critical interpersonal experience that affects the trajectory of developmental progress. The transition from one phase to the next is marked by a newly emerging biological need that requires satisfaction. Satisfaction is achieved by mutually gratifying interpersonal interactions with important other people. Transition from one phase to the next is marked by a newly emerging need for satisfaction, or a biological need that drives us to seek its fulfillment through interpersonal relationships, as well as a corresponding integrating tendency, which facilitates having the need met. The role of anxiety is central to his theory of development in that progression from one phase to the next is contingent upon overriding anxieties unique to the previous phase. Each developmental epoch will be reviewed below.
The Developmental Epochs
The infancy phase extends through the first year of life. Sullivan likens the experience of the newborn to that of an amoeba in that the infant’s primary motivation, function, and behavior center on having its needs met. The newborn oscillates between states of comfort and tension, which are functions of having physiological needs for satisfaction, such as hunger and thirst, gratified. Unlike Freud, Sullivan understood these tensions as nonproblematic as long as the caregiver appropriately attends to the need. When in a state of tension, the threat to homeostasis provokes a fear response, such as crying. In turn, this elicits a caregiving response, or an integrating tendency from the mother, which alleviates physiological distress. The child’s first experience of breastfeeding is the infant’s first human interpersonal interaction. The “nipple-in-mouth” experience of the infant is understood as the human’s first interpersonal interaction.
Although the infant’s fear response is physiological, the etiology of anxiety is a function of an empathic linkage or an interpersonal transmission of anxiety between the mother and infant. For example, a new mother may have difficulty detecting the source of her infant’s distress. As a result, her level of anxiety increases, which induces anxiety in the child. In extreme cases, the mother’s anxiety interferes with caregiving and the child’s ability to be soothed. This is known as a disintegrating tendency and can be problematic for the child in later phases.
The introduction of anxiety into the infant-caregiver dyad leads to the development of the self-system. The infant begins to organize his experience of the mother by personifying her as either the good, nonanxious mother or the bad, anxious mother. These symbolic representations of the actual caregiver are indistinguishable for the infant but through learning, the child begins to be able to predict based on social cues (such as tone of voice), which mother is present in an interaction. He learns that he can elicit either the good or bad mother based on his own gestures and organizes his own experience of himself based on what elicits either a positive or negative reaction. Behaviors that are approved by the mother are understood as the good me, those that elicit a negative reaction are organized around the bad me, and those that induce an intense anxious reaction become part of the not me. This set of processes in the self-system lead the infant away from inducing anxiety in the caregiver.
The acquisition of language and the crude comprehension of social cues mark the transition after 1 year of life from infancy to childhood. The infant learns by imitating the caregiver’s various social gestures and behaviors on how to relate to others. Sullivan underscores the importance of parental sensitivity for the development of the child’s socialization. The infant learns through the caregiver’s modeling various social gestures and behaviors that continue throughout the lifespan. It is imperative that the caregivers are sensitive to the child’s capacity for socialization. The acquisition of language enables the child to integrate his symbolic representations of the good and bad mothers to an integrated personification of the actual caregiver.
Children begin to employ sublimation, or demonstrate the ability to change their behavior to be more social acceptable when a behavioral pattern is met with anxiety or is incongruous to the self-system. The child begins to learn to refine his behavior in pursuit of security or to avoid anxiety. If the child cannot modify his behavioral patterns, the pursuit of social needs in this phase may disintegrate and lead to regression or maladaptive behaviors.
Sullivan’s theory of emotion focuses on further personification of the self-system in the childhood phase. When the child behaves in a way that meets their needs, their sense of themselves is enhanced. Sullivan (1953) calls this the good-me. When reciprocal patterns of activity are developed to address needs, the child is further able to personify aspects of the good me. However, if the child’s expressed needs for tenderness are rebuffed, the bad-me will begin to emerge as manifested by disobedience and rebellion.
Further personification of the self evolves through identifying with the same-sex parent, learning socially-approved expectations for behavior, and integrating the behaviors and expectations of authority figures. The child begins to use others to distinguish between reality and fantasy through a process of consensually validating experiences. As this occurs, the child loses interest in his former, fantasy-based ideas with the desire of a shared reality. If he is unable to extract himself from his fantasy world, he is unable to share reality with his peers. The attempt to share reality is a function of personifying others as well as a way for the child to define and understand the nuances of his own self-system.
Beginning at approximately age six, the child enters the juvenile era, which is marked by a wider and more inclusive social network. The child continues to interact with the family and other nonfamily authorities and begins to develop crude relationships with other juveniles. The entrance into more formal educational systems provides alternative social information to what is communicated in the household. The juvenile learns to exercise social accommodation generated by the awareness of differences in living between his family unit and others. Further, the juvenile begins to compare his own parents to other adults in his life leading to a more realistic appraisal of his parents.
Through his exposure to additional families, adults, children, and contexts, the juvenile learns new security operations. Security operations are ways of coping that reduce anxiety or insecurity. They are designed to manage anxiety and teach him what is socially acceptable in generating fruitful interpersonal interactions that fulfill needs for satisfaction. Simultaneously, the juvenile is faced with the emergence of stereotypes, ostracism, and segregation. This is often based on family background, abilities, and differences in the rate of maturation, health, and gender. The juvenile is confronted with being funneled into various in-groups and out-groups. He begins to understand strengths and weakness in himself and others. Additionally, he begins to learn to disparage others as well. The security operation of disparagement often interferes with the juvenile’s ability to detect the personal worth of others.
During the juvenile era, the self-system generates a series of supervisory patterns, defined as self-monitoring systems that continue throughout the lifespan. They allow an individual to maintain feelings of personal worth and self-respect, obtain respect of others, and insure protection of one’s reputation in society.
Marking the end of the juvenile era at approximately age eight is the child’s ability to display insight into a series of integrating tendencies that characterize his relationships. This set of integrating tendencies is known as one’s orientation to living. The juvenile begins to be able to detect the needs of others, understand the circumstances appropriate to satisfaction, and weigh the risks and benefits involved in enhancing his reputation. The juvenile that is unable to do so effectively will display difficulties in managing anxiety and maintaining healthy interpersonal relationships in later life.
Preadolescence, occurring between ages 9 and 12, is characterized by integrating tendencies aimed to satisfy the need for interpersonal intimacy. Although interpersonal relationships were acquired and fostered in previous phases, the necessity for an intimate relationship with a peer or a chum becomes paramount in this epoch. Through this relationship, the preadolescent begins to develop an authentic sensitivity to what is important in others and insight into what he can do to foster another’s well-being. This contemporary relationship minimizes anxiety through a mutually consensual validation of personal worth.
An additional component integral to the social world of the preadolescent is the development of the gang. This social experience provides an opportunity for juveniles who had difficulty associating with others to find alternative, more idiosyncratic groups to join. New anxieties unique to the preadolescent phase arise as a result of some of the members of a social group maturing faster into adolescence than other members. The need for intimate exchange with a chum or a gang is a necessity at this stage of development, and failure to do so threatens a future of positive interpersonal relationships as well as a cohesive self-system.
At approximately age 13, as puberty emerges, the emphasis for interpersonal intimacy shifts from seeking others like oneself, to seeking out romantic and sexual relationships with others unlike oneself. The main integrating tendency in this phase is lust, which serves both as an arena for accomplishment and self-satisfaction as well as error and embarrassment.
The collision between lust and anxiety is a breeding ground for diminished self-esteem. New sexual activity, either masturbatory or with a partner, when compounded with anxiety can foster puzzlement. The shame, confusion, and possible guilt that can occur as a result exacerbates the not me experience. Early adolescents often distinguish between those with whom they foresee sexual relationships and those with whom they are able to have a more collaborative, intimate relationship.
Late adolescence commences when the individual has identified the terms of his sexual life and how this will fit into the trajectory of the rest of his life. He is able to adequately observe and analyze the opportunities – cultural, professional, or otherwise – that come to him. Further, he is able to seek out new, fulfilling opportunities for relationships and integration into larger groups of society. The more opportunities the individual seeks, the greater likelihood that the individual is able to expand his social network.
In this phase, the self-system is characterized by the ability to take on another’s perspective in addition to his own idiosyncratic personification and tolerate the anxiety bred by the awareness of another’s perspective of his character. When this anxiety becomes intolerable or if the late adolescent has difficulties personifying himself, it is likely that he will have impairments in personifying others. In turn, his ability to function interpersonally will be compromised. He may have the tendency to stereotype others as a reflection of the inadequate or inappropriate not me qualities of his self-system. Alternatively, he may selectively attend to anxiety provoking situations or altogether dissociate particularly intense anxiety.
Emotional complications which arise from unattended anxiety or from unresolved emotional problems from earlier phases of development can arise in this phase and interfere with the adolescent’s functioning. It is the primary function of the late adolescent to maintain flexibility and engagement with others to thwart the possibility of rigidity and ritual interfering with positive social interactions.
Self-respect becomes utmost important in this phase, as it is necessary to ensure adequate respect of others. Sullivan posits that one is able to determine an individual’s state of self-respect from the severity with which he disparages others.
Achieving a mature personality, growing in one’s need for intimacy, as well as collaboration with others mark human maturity. The more mature one is, the less his life will be fraught with anxiety that interferes with his ability to value himself and others. Sullivan (1953) writes, “when one is mature, anything which even infinitesimally approximates the complexity of living in the world as we know it today is not apt to become boring.” (p. 310).