Private Practices: Harry Stack Sullivan, the Science of Homosexuality, and American Liberalism

It would be an understatement to describe Private Practices as a volume that is long overdue; the lingering damage caused by the pathologizing of homosexuality in American psychiatry has hitherto led to a lack of sustained, reasonable, critical attention to the life and work of gay psychiatrist Harry Stack Sullivan (1892-1949). The Sullivan literature has also been characterized by supposition about the “private” man behind the public image. In her first book, Naoko Wake has broken with this tradition, drawn on original evidence from case notes, conferences, and other documents, and pieced together an original and important account of the relationship between the more private and the more public thoughts of this difficult figure.  

Wake’s six chapters shift our attention towards three decades of Sullivan’s life: the 1920s, the 1930s, and the 1940s. The first two chapters draw on new archival research on the clinical work Sullivan conducted in the 1920s, which brought him fame for his apparent ability to cure schizophrenia. At Sheppard and Enoch Pratt Hospital, Sullivan developed a model of therapy in which male attendants and male patients touched, held and kissed each other, transgressing the usual boundaries of clinical care. Sullivan’s insight was that it was not homosexual acts - but rather the failure to live up to impossible social ideals that they contravened - that led these young men to conclude that their lives were unliveable. Wake shows how this foundational development in Sullivan’s interpersonal theory of personality developed through a two-way exchange of ideas between himself and his patients. In the second chapter, she uses case histories from Sheppard-Pratt to thicken the description of the co-construction of a more tolerant and secular morality between the hospital’s doctors and the young aspiring migrants who were their patients. By so doing, she not only contributes to our understanding of sexual norms and “the new psychiatry” of the 1920s, but she also helps to explain why the challenges of urban life lead an increasing number of people to seek medical help for problems in living during this time.

The third and fourth chapters center on Sullivan’s life and work in New York City in the 1930s, his life with his partner Jimmie Inscoe during this period, his private practice and supervision, and his increasing involvement with anthropologists and other social scientists. Wake focuses on the co-construction of “life history” by psychiatrists who understood that their patients’ problems resulted from the demands of life circumstances, and social scientists who were frustrated with nomothetic levels of analysis. Life history was, for all, a means of bringing science and individual subjectivity together. During the early 1930s, Sullivan wrote, but did not publish, his book Personal Psychopathology, and to her eternal credit, Wake resists the urge that many others have indulged to read this work as a secret cipher of Sullivan’s own biography. Rather, she emphasizes how Sullivan’s critique of dominant sexual values, suggested by the problematic lives of the Sheppard-Pratt patients, became displaced in the 1930s as his clinical attention focused on middle-class New Yorkers. While few writers on Sullivan have given his thoughts about race sustained attention, Wake excavates both insights and shortcomings of Sullivan’s thinking about the intersection of race and sexuality, and the affordances and limits of the analogies that Sullivan drew with cultural anthropologists about the relationship between homo- and hetero-sexuality, and “primitive” and “modern” cultures.  

The final chapters tell how Sullivan became increasingly committed to distinctly American social values of democracy, freedom, and scientific rationality in the context of World War II and its aftermath. Ironically, while Sullivan created a fragile space that homosexual men found liveable within Sheppard-Pratt Hospital in the 1920s, he also played a role in forming procedures for screening enlisted men for “queerness.” Wake is critical of Sullivan for failing to engage with the racism of a military screening system that excluded a greater proportion of African-Americans than Whites from military service, but she also recognizes that Sullivan leaned toward excluding individual men to protect them from military service. She locates Sullivan’s post-war work with UNESCO as part of a pattern of “paternalistic liberalism” toward those countries that were defeated in World War II, including her own native Japan. In this last era of Sullivan’s life, there was no room for “subjectivity” in “life history.” Rather, rallying around the flag muted the more critical tendencies that are evident in the work of the younger Sullivan.  

Regardless of your prior knowledge of Sullivan’s life and work, you will find something of interest in Private Practices. Wake has written a narrative whose shape does justice to the central insight of Sullivan’s interpersonal theory that selfhood is formed by social context. By beginning with the already-adult Sullivan, and by providing such thick descriptions of the social contexts in which he operated, Wake presents us with three somewhat different Sullivans in different stages of a professional career, and in three different stages of his private relationship with Jimmie Inscoe. Moreover, Wake has cited generously from dialogues that appear in case conferences, patient interviews, and academic conference proceedings. By so doing she draws images of the “private” that are dialogical rather than confessional, images in which “the private” still takes its form in human interaction. Moreover, Wake’s reading of these texts often reminded me of the style of contemporary discursive psychology which – like Sullivan’s interpersonal theory – adopts a rather sceptical approach toward internal psychological objects such as “personality.”

Scholars interested in the history of sexuality, and in gay studies more generally, have tended to overlook Sullivan’s life and work, but have much to profit from reading Private Practices. Sullivan’s earliest writings show an understanding of what we now call “heteronormativity,” but his later personal and public failures reveal the limits of his opposition to heteronormativity that take the form of targeting individuals. By tracing the relationship between Sullivan’s public and private writings about homosexuality across these decades, Wake makes a distinct contribution to the history of the closet, as it relates to urbanization, mental illness, culture, life history, war, nationalism, and internationalism. I very much hope that this compelling account draws new attention to Sullivan’s life and work, as well as to this new voice in the history of American psychiatry.