Abstract
For those of us who look for clinical wisdom in psychiatry, Harry Stack Sullivan (1892–1949), the founder of the interpersonal theory of mental illness in the USA, never seems to fail. His words are unique, if not easily understandable, and they urge curious minds among us to speak through them. There also seems to be a pervasive sense of frustration among Sullivan enthusiasts about how he has been under-appreciated. Despite his innovative, interdisciplinary approach to mental disorders, Sullivan has been pushed aside from the mainstream because of the extreme specialization and biological reductionism that shape today’s mental health care professions.
Sullivan Revisited belongs to a genealogy of books on Sullivan that share this passion and frustration. It offers an introduction to Sullivan’s life and work, places them in historical context, and attempts to reintroduce Sullivan’s work and legacy into contemporary debate. Originally published in 2000 in Italian and now translated into English, Sullivan Revisited conveys an enduring passion of those who desire to understand mental illness in its entirety, to see patients as people. The book also highlights some of the most challenging, and yet fascinating, aspects of Sullivan’s work – the psychotherapeutic treatment of schizophrenia and the multi-disciplinary collaboration with anthropologists, sociologists and political scientists which Sullivan pursued passionately during much of his adult life.
Indeed, readers of Sullivan Revisited will find a good introduction to Sullivan’s published writing, especially if they are seeking a digest of his numerous publications. The book is generously peppered with quotes from Sullivan, and one does not come out of it feeling deprived of original sources. This is also the case with the copious excerpts from selected secondary literature in psychiatry about Sullivan. Of particular interest to readers in the Anglo-American contexts is Conci’s discussion of Sullivan’s place in Italian psychoanalysis. Furthermore, readers will find a chronicle of important figures who influenced Sullivan. Following what one might call the ‘hagiographical’ tradition, still notable in the history of psychiatry, Sullivan Revisited tells of William James and functionalism; Adolf Meyer and eclectism; George Herbert Mead and symbolic interactionism. No doubt Sullivan lived a colourful life, inspiring and being inspired by intellectual giants.
The history of psychiatry advanced considerably during the last quarter of the twentieth century. We have learned to hear patients, not only doctors, in clinical interactions; we have also learned to de-centralize ideas and theories, because they do not exist independently from historical contexts. But Sullivan Revisited does not engage the scholarship that best exemplifies these approaches. One finds no reference to the thorough analysis of Adolf Mayer by Jack D. Pressman (1998). Similarly, Conci’s chapter on early twentieth-century psychiatry does not engage with Elizabeth Lunbeck’s (1994) work on the cultural and institutional settings that nurtured the ‘new psychiatry’. As a result, turn-of-the-century progressivism comes off as a somewhat dry theoretical ingredient rather than a live historical force that transformed ideas. Readers encounter World War II only through a chronicle of Sullivan’s writing, and Conci’s passages on the international crisis quickly shift to comments on the depth and breadth of Sullivan’s ideas (Conci, pp.159–60, 335–43). Equally noticeable is the absence of patient voices that scholars have sought to find. Sullivan’s Schizophrenia as a Human Process (1962) includes numerous excerpts from patient records; Clarence G. Schulz (1978) discusses clinical records from Sheppard-Pratt, a mental hospital where Sullivan’s ability to talk with patients flourished. For an author who wishes to use Sullivan’s legacy as a reminder of ‘the necessity for us [clinicians] to remain clinicians’ (Conci, p. 22), these are regrettable omissions.
The privilege that Conci’s narrative gives to the famous leads to another disengagement with a fruit of current scholarship: the critical use of biographical ‘facts’. Using the assessment of Edwin G Boring, William James’ biographer, that ‘his [James’s] books, in fact, contain his personality, and there is no reason for us to distinguish between the man and his writings’ (Boring, 1950: 509), Conci asserts that ‘the same could be said of Sullivan’s biography’ (p. 40). Thus, Sullivan Revisited uncritically uses Sullivan’s writing and, to a large degree, Helen S. Perry’s 1982 biography of Sullivan, as a proxy for his life experiences. Supporting ‘the autobiographical character of Sullivan’s interpersonal theory’ (Conci, p. 117), then, Sullivan Revisited offers an unfounded confirmation of the story that Sullivan as a youth had experienced a mental breakdown. Based on Sullivan’s writing about a psychotic boy who experienced a failed love affair with a girl, Conci speculates that Sullivan himself experienced a similar ‘unhappy love for his fellow female student’ at a college (p. 128). However, Conci’s use of the theoretical writing as a source of his biographical information is not uniform. Sullivan’s interpersonal theory includes much discussion of homosexuality, which Conci cites and briefly recognizes as related to Sullivan’s ‘personal experiences’ (p. 251), but does not take it further. For example, James Inscoe, Sullivan’s lifelong male lover and partner, is depicted only as a ‘personal secretary and “household staff”’ (p. 142). The person who lived with Sullivan intimately for more than 20 years has no index entry either.
The decade that followed the original publication of Sullivan Revisited witnessed a rich accumulation of literature on Sullivan as a gay scientist, and it can feel a little odd to read passages uninformed about this shift in scholarship. A word about it in the foreword to the US edition would have been useful for many of us who share Conci’s passion for knowing the life of this complex man ‘in its entirety’ (p. 29). The book presents the psychiatrist as an optimistic, creative, self-made man, devoted to clinical science. That this science involved patients of all stripes living in a society very different from what it is today is not part of the context in which this book places Sullivan.