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THERE IS AN INTERESTING PARADOX in that the content of what Sullivan offered in regard to the manic-depressive states and mood swings is limited to clinical comments made as a well-meaning, interested but detached, observer—in contrast to his total commitment as sensitive, tender, patient, intuitive, participant-observer of young, schizophrenic males, exploring the depths of their psyches, exploring the shaping of personality and the damage done to it by distorting interpersonal and cultural relationships from infancy through adolescence. And, to a considerable extent, he used this approach with obsessional patients. Contrary to the trend of the Freudians, who, based on Karl Abraham's scholarly and clinical opus, linked obsessionalism to manic-depressive states, Sullivan linked it to schizophrenia.
Though his own thinking about the manic-depressive states did not go much beyond his impressions—and even puzzlement and distaste—of the presenting clinical surface, yet I have found one powerful source of help in my understanding and therapeutic efforts with the depressions and their variants, including hyperactive states (subsumed under the stark term, "manic"), from aspects of his reflections and theories of the culture, interpersonal relationships and intrapsychic process, as well as countertransference. I believe that the workability and validity of his general theories is attested to by their applicability to the manic-depressive syndromes to which he barely addressed himself. This is the seeming paradox.
The profundity of Sullivan's block to depressions and manic states is shown by the difference in his approach to the attitudes and literature concerning the schizophrenias and the depressions. While he referred freely to the attitudes of psychiatrists to schizophrenia, and early had used references from the literature and from