Harry Stack Sullivan on Schizophrenia

Sullivan's Schizophrenia as a human process (1962, pp. 73-83) "Case 6" concluding portion on the uncanny connotations of urination is quoted and interpreted in Conceptions of modern psychiatry (1940, etc. [1939], pp. 144-146), where it serves as an illustration of the "classical schizophrenic spread of meaning":

This patient, having had a disturbingly sudden awareness that he must pass urine, is preoccupied with what the act means. This is no idle philosophizing. Patients who have come to trust one -- part of the time -- often ask questions like "What does it mean when you rub your nose?", or "What does it mean when people cross the right leg over the left?", or "What does it mean when a person sits down to the right of one?". The excerpt gives at least shadowy indication of what is responsible for the puzzlement as to the meaning of urinating. The patient progressed, through a phase of drowsy preoccupation from which the demand implied in my presence aroused him, to an obscure statment which might be translated: 'I have a tension which I think should be connected with my heterosexual love object. This need to urinate arises. I do so, and the tension is gone, as if it had been connected with you instead of her.' [and regarding the urination after shooting the 4-ball] 'I was growing tense in this game with what's-his-name and the 4-ball in some way associated itself with Miss B. and I touched it and the tension became overwhelming and I had an orgasm and I felt I'd better separate myself from this disturbing personal environment by renewing mediate contact with my girl ["--a lady who in fact scarcely knew of the patient's existence"].'

Sullivan suggests that the regressive potential of urethral sensations, confusion with sexual arousal, "often take incipiently schizophrenic patients to the medical man." Sullivan 's following discussion of schizophrenia suggests that

[T]here are two unrelated syndromes confused under the rubric of dementia praecox, or--as it is often used synonymously--schizophrenia. One syndrome is the congeries of signs, and symptoms pertaining to an organic, degenerative disease usually of insidious development. These patients are finally discovered to be psychotic, although no one can say how long the state has been developing. Their outlook is very poor.... I am content that this syndrome be called dementia praecox. The other syndrome is the one about which I am offereing some data. It is primarily a disorder of living, not of the organic substrate. The person concerned becomes schizophrenic--as one episode in his career among others--for situational reasons and more or less abruptly. He may have had months or years of maladjustive living, of one or another of the sorts I have mentioned (pp. 148-149).

Sullivan and schizophrenic language
"Language of Schizophrenia" (1939, in Kasanin, 1944):

Sullivan describes language as a vehicle for obtaining what one wants and needs in the way of interpersonal security via consunsually validated speech. Schizophrenic speech resembles normal speech under circumstances when the normal person does not need to be alert because security is not at issue.

The schizophrenic has given up any hope of satisfaction and is concerned only with the maintenance of security. He shows, often with painful chagrin in retrospect, the autistic type of speech which is probably our seconf nature, and which we certainly show among our intimates, when we are very tired and safe. I diagnose schizophrenia by certain types of disturbance of speech unaccompanied by chagrin, but I have yet to see a schizoprenic early in his illness who has not been chagrined by hearing himselk say certain things to me which he recognized afterwards as incommunicative (p. 13). ... [& the "fantastic auditor" attending to social speech and prodding one toward consensually valid utterances] [I]n the schizophrenic...these mythical observers who watch over the speech of the schizophrenic are as immature and undeveloped as the schizophrenic himself. ... The schizophrenic's critic, his observer of speech, shows the same fugitive integration that is so striking in the personal relationships of schizophrenics. The critic passes, as adequate, expressions which are neologistic, is thereby shocked to alertness, and reviews them with chagrin or fear (pp. 14-15).