Two weeks ago I had the pleasure of reading Conci’s biography of Harry Stack Sullivan entitled Sullivan Revisited – Life and Work: Harry Stack Sullivan’s Relevance for Contemporary Psychiatry, Psychotherapy and Psychoanalysis. It’s a wonderful work that contextualizes the radical innovation of Sullivan’s contribution to interpersonal psychoanalysis. Sullivan is the grandfather of contemporary American psychoanalysis and Stephen Mitchell recognized his work as foundational to the contemporary movement. Sullivan began his work at Washington DC’s storied St. Elizabeths Hospital. He then went on to work at Sheppard Pratt Hospital, outside of Baltimore. While at Pratt, he began a therapeutic wing for young male psychotics who recently had psychotic breakdowns. He collaborated and influenced Frieda Fromm-Reichmann’s work at Chestnut Lodge, a hospital located in the DC suburbs (in Rockville, MD).
What was interesting about Conci’s story about Sullivan’s theoretical and therapeutic innovations was the ways in which he re-worked psychoanalytic theory. Although he relied heavily on Freud’s notion of transference (which he re-named) and had an appreciation of unconscious processes, Sullivan was innovative in stressing the social nature of human beings. Sullivan (like many other early dissenters such as Fromm, Thompson, Fromm-Reichmann, etc) argued that Freud had overemphasized the sexual in human nature. Sullivan also collaborated with many social scientists, believing that the cultural and political background greatly informs the ways in which society understands mental illness.
Although I greatly appreciate Sullivan’s contribution to the theory and treatment of schizophrenia (along with the other notables in the interpersonalist tradition such as Fromm-Reichmann and Searles), I was astounded to find how quickly these psychoanalysts dropped sexuality from their theory. When Freud (accompanied by Jung and Ferenczi) traveled to Clark University in 1909 to present his famous introductory lectures on psychoanalysis, he was surprised by how receptive his American audience was to his ideas. It is likely that the disorganization of American psychiatry, at this point in history, made psychoanalysis attractive to the psychiatric community.
Yet Freud remained suspicious of the US and never returned. What’s surprising about contemporary psychoanalysis is the minor role afforded to infantile sexuality. Open up the pages of a contemporary journal and one will find that attachment theory now reigns supreme as the primary theory of human development. Early infant attachment studies populate these journals and now serve as the guide to inform contemporary psychoanalytic treatment. Modern psychoanalysis’ goal is for the patient to install the analyst as a “new object”, which will help to heal the patient’s chaotic and ruptured internal world. Interestingly, although most contemporary psychoanalysts still see a place for aggression as a primary motivational system, sexuality has now been superseded by the need for human connection and attachment.
So what is going on here exactly? The basic conclusion I made from reading Sullivan’s biography and from my knowledge of contemporary psychoanalysis is that America’s puritanical legacy continues to blind us to the foundational role that sexuality plays in the life of human beings from birth to death. It is arguable that psychoanalysis was quickly sanitized of its dirtier, sexual parts to make it more palatable for its American audience. One of my past psychoanalytic supervisors pointed out that the current generation of psychotherapists is more repressed than the baby boomers are when it comes to discussing sexuality with patients. This became apparent to me when I attended a recent lecture on erotic transference. The speaker (whose leanings were in the relational school of psychoanalysis) spoke about how patients often eroticize the transference to avoid their needs for dependency and nurturance. According to her, the sexualization of the relationship serves a defensive function to hide these more primal attachment needs. During the discussion section, I raised the following question: “Is it possible that the patient who develops a dependent attachment on the therapist might be avoiding their repressed sexual wishes that remain hidden underneath the dependent, nonsexual transference?” Her response was dismissive.
This allergy to sexuality has to be held in tension with another cultural belief of the conservatives that America is becoming hypersexual. Sexuality saturates the media and there are even TV shows that feature little girls in beauty pageants wearing scandalous and sexual clothing. Yet, despite these cultural trends, Americans seem to be unable to speak about sexuality. Sure, there are sexual images flooding the airwaves, although we should remember that our censorship laws on television appear to be more sexually conservative than other countries. Ironically, the violence shown on basic cable is overwhelming. For instance, the other night I watched a TV show that featured the beheading of two villains! Beheadings at 9 PM CST!
It has been my therapeutic experience that while individuals freely discuss their aggressive wishes and intense relational needs there is a much greater anxiety when the patient attempts to articulate his or her sexual feelings and fantasies. The de-sexualization of psychoanalysis has served a defensive function for our culture. Sexuality is still censured. It is not to be spoken about. Perhaps it is time to return to the fundamental discovery of psychoanalysis, namely, of the dynamic unconscious and of the relationship between infantile sexuality and neurosis. The depressing rates of childhood sexual abuse in this country validates Freud’s discovery that childhood sexuality continues to fascinate and terrify us. If nothing else, opening up conversations about sexuality (particularly infantile sexuality) might help us provide a better future for vulnerable children. These children are exposed to sexually immature adults who have yet to work out their own sexual conflicts and unfortunately discharge these repressed sexual wishes on the innocent, leading to the tragic victimization their own children.