The Journal of the Alanson-White Psychoanalytic Society

CRITICISM

Critique of "Dr Blechner - The Gay Sullivan "

#1: The Problem with Dr. Blechner's submission "The Gay Sullivan." (see below)
While openly gay Dr. Blechner makes imaginative assumptions concerning the sexual state of Sheppard-Pratt Hospital under Sullivan's directorship in 1929, he ignores much of Sullivan's concise delineation of homoerotic behavior as OFTEN-TIMES a reflection of the paranoid or incipient- schizophrenic mindset, and appears to scramble excitedly through Sullivan's work with all the objectivity of a teen researching Lady Chatterly's Lover for "the good parts."

"Clinical Studies in Psychiatry" (Sullivan) pp163-165:
"One should determine whether this entity is the organization of a definite integrating tendency that satisfies a need or whether it is a complex mental disorder in which the homosexuality is present because it so perfectly fortifies some abnormal mental process, some dynamism of difficulty."

In other words, if a male is 'driven' compulsively to take a stranger's penis in his mouth, and finds the swallowing of that person's body fluid temporarily assuaging his anxieties, Sullivan points out this is a reflection of a 'dynamism of difficulty,' not a seeking of another male for interpersonal security to enhance a relationship. Dr. Blechner, however, seeks to assure us that no one is suffering from any kind of emotional problem which excites at the idea of being used and humiliated. He is simply the victim of internalized cultural condemnation of these 'healthy' pursuits.

HS SULLIVAN: "(within circumstances mentioned)... " I think one is doing a great violence to the therapeutic principle  to accept the notion that that person has anything like a simple drive to secure genital satisfaction by any type of behavior with members of the same sex. To work on this assumption, and to deal with this patient’s “homosexuality,’ is, to my way of thinking, one of the most vicious miscarriages of therapeutic situations. It takes out of the culture a group of terms, which, in referring to behavior, carry all the culture’s evaluations of that behavior.
"Clinical Studies in Psychiatry" (Sullivan) pp163-165

HS SULLIVAN: "You see, if the patient has not found great warmth and satisfaction in intimacy with a member of his own sex, but later on is told by a psychiatrist that such intimacy is what he is after–or has, by his own paranoid processes, come to feel that that is what he is after, and the psychiatrist agrees with him–then he and the psychiatrist are talking about something that is, in its ultimate essence, merely a revolting difference between him and good people. That is all.
"Clinical Studies in Psychiatry" (Sullivan) pp163-165

Alanson-in-the-Woodshed #1 (Blechner)

Dr. Blechner’s article “The Gay HS Sullivan” represents cherry-picking through Sullivan's lectures in search of support to the detriment of professional objectivity. This perhaps give new light to the phrase, "thinking with your penis." My disagreement with his interpretation is not with the fact that Dr. Sullivan was a homosexual. Of that there is little doubt. However, the political program of Dr. Blechner was never that of Doctor Sullivan, and by trying to influence other doctors weak enough to be swayed from pursuing mental health by this gay lobby, Dr. Blechner encourages this spirit of blindness not only in these other doctors, but obviously through them into their patients' mental states as well.
When Dr. Blechner creates misunderstanding regarding Dr. Sullivan’s position, he is not merely proposing a different interpretation; he proposes (in Dr. Sullivan’s own words below), “an atrocious miscarriage of the therapeutic process.”
In Clinical Studies of Psychiatry (pp.160-2)

HS Sullivan, from "The Interpersonal Theory of Psychiatry"p.295

p.295 (Lecturing) “… to think that one can remedy personality warp by tinkering with the sex life is a mistake, even though it is very convenient doctrine for psychiatrists who are chronic juveniles. It may provide them with fees for enjoying their interest in pornography; but if one is a serious psychiatrist, when one is presented with difficulties in the sex life of a patient as the reason the patient is seeking help, my experience has demonstrated rather convincingly that the patient’s difficulties in living is shown rather in his choosing this subject to present as his difficulty. In other words, people don’t go to psychiatrists to be aided in their sexual difficulties; but they do sometimes present this as their problem, and such problems show, when properly understood, what ails their living with people.

This let me warn my fellow psychiatrists: If you want to do psychiatry that can well be crowded into a lifetime, see if you can’t find something besides the sexual problem in the strangers that come to you for help. Quite frequently it is no trick at all to find something very much more serious than the sexual difficulty; and quite often the sexual difficulty is remedied in the process of dealing with the other problems. You may notice there is a slight difference here between  my views  and some of the views that have been circulated in historic times.”*
* ...obviously a dry reference to Sigmund Freud.

Notes REGARDING Homosexuality ("Clinical Studies in Psychiatry" pp163):

As I have indicated earlier, I think that the whole business of the homosexual entity as an explanation is always to be looked pretty firmly in the face by psychiatrists who attempt to effect any great improvement in the mental health of the patient. One should determine whether this entity is the organization of a definite integrating tendency that satisfies a need or whether it is a complex mental disorder in which the homosexuality is present because it so perfectly fortifies some abnormal mental process, some dynamism of difficulty.

Where a person has felt that life is eminently worth living only in the preadolescent stage, when he did enjoy great intimacy with another person of the same sex, irrespective of whether that great intimacy was what may be described as on the non-genital or the genital level, I am quite willing to deal with that person on the basis that he is engaged in actual direct pursuit of satisfaction from members of his own sex, or as in homosexuality, as it may be easily called.

But where such experience is missing from a person’s life, then I think one is doing a great violence to the therapeutic principle  to accept the notion that that person has anything like a simple drive to secure genital satisfaction by any type of behavior with members of the same sex. To work on this assumption, and to deal with this patient’s “homosexuality,’ is, to my way of thinking, one of the most vicious miscarriages of therapeutic situations. It takes out of the culture a group of terms, which, in referring to behavior, carry all the culture’s evaluations of that behavior.

You see, if the patient has not found great warmth and satisfaction in intimacy with a member of his own sex, but later on is told by a psychiatrist that such intimacy is what he is after–or has, by his own paranoid processes, come to feel that that is what he is after, and the psychiatrist agrees with him–then he and the psychiatrist are talking about something that is, in its ultimate essence, merely a revolting difference between him and good people. That is all.

In has no meaning in terms of something that he has experienced, that he has undergone, and that therefore is a part of him. But it does have meaning as a particular type of horribly derogatory formulation. Thus, to attack a paranoid state, for example, on the basis of an attempt to understand the patient’s homosexuality is an atrocious miscarriage of the therapeutic process. This is a very nifty way to make it beyond the most perchance that any intimacy will be established with that patient. The psychiatrist’s approach means” Abandon all hope of a feeling of personal security, and then we might be able to do something.” But the developmental processes which we all have to undergo make it simply inconceivable that there is any such thing as abandoning all hope of personal security. So of course, what the psychiatrist does is to provide the patient with a new paranoid world, in which the psychiatrist is unconsciously taking a very important part. And since he is much more patiently engaged in hateful activity than anybody the patient has previously found, the patient may attempt homicide on the psychiatrist one day. But other than that I can think of no spectacular result except the passing of time.
So it is quite important indeed to discriminate between, first the isophilic phase of personality development and the satisfactions that can be acquired then, and second, the innumerable unhappy caricatures of living to which the term homosexuality is sometimes applied.
The people who have gotten well into the preadolescent phase of personality development before possibilities of further growth failed, and come to us with their life problems formulated in terms of homosexual concepts, are still somewhat near reality.
But people who have not gotten as far as the preadolescent phase of personality development, and who come to us with their life problems formulated in terms of homosexuality, are showing a very much more complex distortion of interpersonal relations and offer a much more treacherous basis for therapeutic relationships because they are that much less mature. Thus this discrimination has prognostic significance.
It is a discrimination between what is a sort of frantic exploration on the base of what is verbal prescriptions, as compared with regressive retreats from hopelessly difficult situations to a time in the past that was actually satisfactory, with new collisions perhaps with the culture in the process. Naturally the latter is much the simpler to attack, and the prognosis–the outcome–is much more apt to become favorable. But if, on the other hand, you combine these two into some doctrine of homosexuality as applied to factors in schizophrenia, paranoid states or what have you, then you have missed the whole point of interpersonal psychiatry, and your results will be sufficiently mongrel so that you will never be able to feel very secure about what is what. But, on the other hand, you will never have any convincing demonstration of being completely wrong."