Private Practices: Harry Stack Sullivan, the Science of Homosexuality, and American Liberalism by Naoko Wake (review)

The 2012 film The Surrogate depicts a thirty-eight-year-old man trying to lose his virginity. Because of childhood polio, he can’t move his body below his neck. He hires a woman to help him with his sexual initiation. But the woman is no prostitute: she is a sex surrogate, trained as a therapist and experienced at working with disabled clients. Naoko Wake’s biography of Harry Stack Sullivan (1892–1949) offers a prehistory to this healing method. Somewhere around 1928, Sullivan formulated a psychiatric treatment that included physical contact between male attendants and male patients. Sullivan believed these “private practices,” coupled with talk therapy, restored confidence to disturbed individuals. Although Wake does not delve deeply into the particular rituals or resultant successes of this strategy, she does argue its symbolism within the longer arc of Sullivan’s life. Partnered for much of his life to a man, Sullivan was fiercely private about his domesticity and scrupulously demarcated the boundaries between that private world and his public circulation as an intellectual; likewise, he tended carefully the boundary between his private clinical consultations and public academic arguments. Wake seeks to argue something about the patterns in these differentiations, patterns she attributes to a kind of American liberalism. Unfortunately, this argument is not elaborated in the text, which offers instead a series of interpretive loci in Sullivan’s work.

In his lifetime, Sullivan was renowned for his research on schizophrenia. During the 1920s and 1930s, diagnoses of schizophrenia often accompanied descriptions of so-called homosexual conflicts. In reply to the question “Is homosexuality a form of mental illness?,” many doctors replied, “Yes.” In this conversation, Sullivan played to both sides of the debate, simultaneously debunking stock pathologies associated with homosexual behavior while supplying his own account of the link between schizophrenia and homosexuality. He argued that gender trouble in a patient’s early years often led to mental illness, that a “failed ‘virility’ … was one of the main causes of mental illness, particularly schizophrenia” (25). To be clear, Sullivan believed that homophobia was the primary aggravating factor in such crooked gender formation. Taboos against youthful same-sex intimacy prohibited healthy expression of such developmental experiences. Sullivan believed that in the abstract there could exist a healthy homosexual, but this was unlikely in the given homophobic landscape in which most sexual maturation transpired.

Sullivan stood at a fascinating crossroads. He knew—personally and professionally—that there could be healthy same-sex desire. Yet he also witnessed—personally and professionally—a disproportionate level of suffering on the part of those who claimed such desire. How could doctors distinguish between the healthy and the unhealthy patient when society continued to infect men and women with social prescriptions that made them feel unhealthy? This perplexity contributed to Sullivan’s involvement with a broad circle of psychologists, sociologists, and anthropologists working to understand the relationship between individual consciousness and social life. Like many of his scholarly generation, Sullivan believed that scientific practice offered a microcosm for social intervention. In his clinical environment, Sullivan heard time and again accounts of how social factors (economic instability, educational pressure, population migration) affected individual psychology. “Just as medical doctors were becoming newly aware of a connection between the social and individual,” Wake writes, “a number of social scientists were beginning to see this connection as a central focus of their research” (83). In his writings and clinical practice, Sullivan cultivated a critique of societal heterosexism that defined homosexuality either as a high-risk sexuality or as a passing phase in psychosexual development. With this social appraisal as his guiding developmental premise, Sullivan worked to help his patients develop a better account of why they did what they did. A doctor should be “a willing listener,” Sullivan believed, and help patients form life histories that made sense of themselves in a conscientious and loving way (69). Psychiatrists increasingly understood themselves to...