The psychoanalytic movement introduced the study of unconscious processes that influence human activity. The movement was fully consistent with the German model of mental activity, going back to the writings of Leibniz and Kant. Although act psychology and the Gestalt movement were also modern expressions of the German model, psychoanalysis emphasized the goal of a homeostatic balance of unconscious energies within personality. Its founder, Sigmund Freud, used his keen powers of observation to devise much-needed therapeutic approaches, and later expanded his formulations to a psychodynamic theory of personality growth dependent on tension reduction. Other theorists modified Freud’s model to include cultural influences (Jung) and social needs (Adler and Horney). In addition, scholars have integrated the psychoanalytic model with a field approach (Sullivan) and existential assumptions (Fromm). As a contemporary movement, psychoanalysis still exerts considerable influence in psychiatry and clinical psychology, although the movement is fragmented owing to a lack of methodological agreement. In addition, Freud’s statements on the unconscious have led to new interpretations of artistic expression. However, as a viable model for psychology, psychoanalysis has departed from the empirical foundations of psychology and shares little with other systems of psychology that rely on that methodological approach.

Sullivan was one of the most influential American psychiatrists active in the early twentieth century. His contributions included establishing a standard method for psychiatric interviews and demonstrating the importance of milieu and psychosocial interventions in the care of first-break schizophrenic patients. He was also one of the founders of interpersonal psychoanalysis, emphasizing the importance of psychosocial forces in shaping personality development and in the pathogenesis of psychiatric illnesses. His uncanny aptitude in working with psychotic patients was linked to his lifelong struggle with homosexual impulses and addiction problems. His profound sense of “marginality” may have been rooted in his difficult childhood, growing up as the only child in an Irish catholic family isolated in a protestant rural New England town. The chapter also includes a brief discussion of the long struggle of mental health professionals toward “depathologizing” homosexuality.