Sullivan believed that all psychological disorders have an interpersonal origin and can be understood only with reference to the patient's social environment. He also held that the deficiencies found hi psychiatric patients are found in every person, but to a lesser degree. There is nothing unique about psychological difficulties; they are derived from the same kind of interpersonal troubles faced by all people. Sullivan (1953a) insisted that "everyone is much more simply human than unique, and that no matter what ails the patient, he is mostly a person like the psychiatrist" (p. 96).
Most of Sullivan's early therapeutic work was with schizophrenic patients, and many of his subsequent lectures and writings dealt with schizophrenia. Sullivan (1962) distinguished two broad classes of schizophrenia. The first included all those symptoms that originate from organic causes and are therefore beyond the study of interpersonal psychiatry. The second class included all schizophrenic disorders grounded in situational factors. These disorders were the only ones of concern to Sullivan because they are the only ones amenable to change through interpersonal psychiatry.
Dissociated reactions, which often precede schizophrenia, are characterized by loneliness, low self-esteem, the uncanny emotion, unsatisfactory relations with others, and ever-increasing anxiety (Sullivan, 1953b). People with a dissociated personality, in common with all people, attempt to minimize anxiety by building an elaborate self-system that blocks out those experiences that threaten then security. Whereas normal individuals feel relatively secure in their interpersonal relations and do not need to constantly rely on dissociation as a means of protecting self-esteem, mentally disordered individuals dissociate many of then experiences from their self-system. If this strategy becomes persistent, these people will begin to increasingly operate in their own private worlds, with increasing parataxic distortions and decreasing consensually validated experiences (Sullivan, 1956).
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