- Freud’s Free Clinics: Psychoanalysis and Social Justice 1918-38 by Elizabeth Ann Danto
Columbia, 348 pp, £19.50, May 2005, ISBN 0 231 13180 1
In 1918, Sigmund Freud gave a speech at the Fifth International Congress of Psychoanalysis in Budapest. It was two months before the Armistice, but he looked to the future rather than dwelling on civilisation’s obvious discontents: ‘The conscience of society will awake,’ he promised his audience, ‘and remind it that the poorest man should have just as much right to assistance for his mind as he now has to life-saving help offered by surgery.’ To this end, Freud, sounding more like a health reformer than a psychoanalyst, urged his followers to create ‘institutions or out-patient clinics … where treatment shall be free’. Keen to contribute to a better postwar world, Freud hoped that one day these charitable clinics would be state funded – ‘the neuroses,’ he insisted, ‘threaten public health no less than tuberculosis.’ Max Eitingon, the psychoanalyst who funded the first of these clinics, later wrote that Freud had spoken ‘half as prophecy and half as challenge’.
We don’t think of Freud as a militant social worker, but rather as someone likely to be found excavating the minds of the idle and twitchy rich. The psychoanalyst Karl Abraham complained of just such a clientele in a letter to Freud written before the outbreak of World War One: ‘My experience is that at the moment there is only one kind of patient who seeks treatment – unmarried men with inherited money.’ But in Freud’s Free Clinics, Elizabeth Danto shows that thanks to Freud’s speech in Budapest and the enthusiastic response to it, ‘between 1918 and 1938 psychoanalysis was neither impractical for working people, nor rigidly structured, nor luxurious in length.’ During the interwar years, a dozen or so free clinics were opened in seven countries and ten cities, from London to Zagreb.
Danto’s meticulously researched year-by-year account of the spread of these psychoanalytic clinics focuses on Freud’s pioneering, idealistic, socially committed side, almost to the exclusion of his legendary cultural pessimism. He once admitted that he had thought of becoming a politician, claiming that his schoolfriend Heinrich Braun, a prominent socialist in later life, ‘awakened a multitude of revolutionary trends in me’. The Habsburgs, he wrote to his colleague Sándor Ferenczi, had ‘left behind nothing but a pile of crap’. In postwar Red Vienna, Freud threw in his lot with the Social Democrats, using whatever influence he had to help politicians like Julius Tandler, the university anatomist who, as head of the Public Welfare Office, applied his surgical expertise to Austria’s body politic. As the conservative Christian Socialists grumbled about ‘tax sadism’, Vienna under the SDP became a model of social welfare, as did Berlin, with enviable public housing and public health services.
Freud, in turn, inspired the ‘revolutionism’ of a second generation of analysts, who staffed the free clinics. They included Helene Deutsch (‘revolutionism’ was her term), Wilhelm Reich, Otto Fenichel, Edith Jacobson and Karen Horney. They shared Marxist sympathies and met in Fenichel’s radical Children’s Seminar, so called not because it was devoted to child analysis but because Fenichel liked to think of the analysts as ‘naughty children’. They were ‘a very lively, smart, special group’, Jacobson remembered, and they believed that psychoanalysis could play a utopian role in liberating those it treated from sexual and social repression.
Reich, the group’s self-appointed leader, doubted whether ‘the bourgeoisie [could] live side by side with psychoanalysis for any length of time without damage to itself’. ‘In the 1920s and 1930s,’ Danto suggests, ‘analysts saw themselves as brokers of social change for whom psychoanalysis was a challenge to conventional political codes, a social mission more than a medical discipline.’ It is therefore puzzling that ‘the history of political activism in psychoanalysis has been consistently withheld from public view,’[*] while the Frankfurt School, which incorporated the Frankfurt Psychoanalytic Society and the free clinic it set up in 1929, is often celebrated for its fusion of sociology and psychoanalysis. Figures like Fenichel and Reich linger in the shadow of Horkheimer and Adorno, even though they were the first to marry Marx to Freud in the service of what Reich was to call the ‘sexual revolution’. The SDP newspaper, Die Stunde, mocked them at the time for ‘mixing literary chocolate with economic garlic’ and for confusing historical and ‘hysterical materialism’.
The first of Freud’s free clinics was established in Berlin in 1920 by two members of his inner circle: Max Eitingon, who had directed the psychiatric divisions of several Hungarian military hospitals during the war, and Ernst Simmel, who had been director of a Prussian hospital for shell-shocked soldiers. Almost all the 42 analysts who attended the 1918 Budapest conference appeared in military uniform, having been conscripted as army doctors. The Berlin Poliklinik might be seen as their attempt to adapt the intensive, over-subscribed treatment of ‘war neuroses’ to civilian life. Though he was too old to serve, Freud liked to use fighting talk: in his 1926 essay ‘The Question of Lay Analysis’, in which he hoped to build on the success of his Budapest speech, Freud imagined that social workers might ‘mobilise a corps to give battle to the neuroses springing from our civilisation’.
The Poliklinik was a modest outpost for Freud’s campaign against nervous disease; it occupied the fourth floor of an unassuming apartment block and it had only five rooms. Freud’s son Ernst, an architect who had trained with Adolf Loos, designed the spartan interior. There was a large lecture hall cum waiting-room, with dark wooden floors, a blackboard and forty chairs; four consulting rooms led off it through soundproofed double doors, and were tastefully furnished with heavy drapes, portraits of Freud and a simple cane couch. One patient was struck by the apparent lack of medical paraphernalia and walked out disappointed, muttering: ‘No ultraviolet lamps?’
Eitingon, who came from a wealthy family of fur traders, underwrote the cost of the clinic (he had already assumed the International Psychoanalytic Association’s large debts). He is described by Danto as ‘a small, round-faced man with short, dark hair parted carefully to the side, a neatly trimmed moustache, and a bemused air’, who was ‘not known for his clinical acumen’. (His colleague Sándor Rado said that he was ‘totally inhibited and without a trace of originality or scientific imagination’.) The staff of six were soon swamped by patients from all social backgrounds: they got through 20 analytic sessions on their opening day. Factory workers, office clerks, academics, artisans, domestic servants, a bandleader, an architect and a general’s daughter were expected to pay, as Eitingon defined it, only ‘as much or as little as they can or think they can’ for treatment. Most patients did, in fact, make a modest contribution, evaluated according to their means on a sliding scale from 25 cents to $1 (in 1926 dollars). American analysands paid $5 to $10 per session, which more than made up for the free sessions that every member of the Berlin Psychoanalytic Society was supposed to donate to the clinic.
The Poliklinik was always intended to be a flagship institution, and following its rapid success a second free clinic was opened in Freud’s native city. The Vienna Ambulatorium was started in 1922 by Eduard Hitschmann, a specialist in female frigidity – ‘one of the unsung heroes of psychoanalysis’, according to Danto – with Reich’s assistance. It was even more low-key than its Modernist cousin in Berlin; ‘like a gatekeeper’s house on an opulent estate’ in Danto’s description. The shabby clapboard building was shared with the Society of Heart Specialists, whose physicians vacated it in the afternoon. The emergency entrance for heart attack victims was used by the analysts as a meeting room, and the unit’s four ambulance stations made makeshift consulting rooms. A metal examination table with an uncomfortable springboard mattress doubled as a couch (patients had to use a stepladder to get onto it), and the analyst perched on a wooden stool. ‘After five sessions we felt the effects of so long a contact with the hard surface,’ the analyst Richard Sterba recalled.
In 1926 Ernest Jones set up a clinic on two floors of a town house in West London, with funding from an American industrialist, and Ferenczi initiated another a few years later in Budapest. ‘Eventually,’ Danto writes, ‘other psychoanalytic societies followed with plans, some fulfilled and some not, for free clinics in Zagreb, Moscow, Frankfurt, New York, Trieste and Paris.’ But were these clinics as successful as Danto suggests?
They were certainly besieged by patients: ‘Our work,’ Eitingon wrote to Freud in 1923, ‘needs more and more space.’ (Finding space was difficult because of the postwar housing shortage, and the clinic moved to larger premises only in 1928.) All the other clinics were similarly oversubscribed – the London clinic had a two-year waiting list. Psychoanalysis could no longer be criticised for catering exclusively to the well-to-do (according to a report published by Hitschmann in 1932, 22 per cent of the Ambulatorium’s patients were either housewives or unemployed and another 20 per cent were labourers); Freud praised Eitingon for making psychoanalysis accessible to ‘the great multitude who are too poor themselves to repay an analyst for his laborious work’.
In its first decade, 1445 men and 800 women were treated at the Ambulatorium, and another 1955 at the Poliklinik. These figures are especially impressive considering the small staff with which the institutions operated. But they also show how far psychoanalysis was from providing what Eitingon called ‘therapy for the masses’. The determination of the Marxist analysts to provide this led to ruptures that almost destroyed the profession. Eitingon himself regretted that the clinics couldn’t reach more ‘authentic proletarian elements’.
Perhaps the clinics’ greatest achievement was to have created an environment in which analysts could train new recruits and experiment with technique – with the length of the analytic hour, for example, or of analysis itself. Because there was a steady flow of guinea pigs, and because treatment was free, or affordable, there was room for a good deal of clinical improvisation. ‘In private practice this could never be undertaken,’ Eitingon admitted, ‘because it is only rarely that life allows so costly a performance.’ Melanie Klein, for one, flourished in the experimental atmosphere of the Berlin Poliklinik, where she was able to explore different methods of child analysis. And in Vienna, Reich led the Ambulatorium’s technical seminar, which met in the Society of Heart Surgeons’ windowless basement, to debate his many ‘path-breaking clinical protocols’, as Danto puts it. These focused the analyst’s attention on his patient’s body language rather than on what was said, and were incorporated into his book, Character Analysis (1933), a standard training manual for many years.
Danto’s cast of morally upright pioneers, straitlaced scientists on permanent call against a plague of anxiety, debate in the smoky Romanisches Café; picnic in the woods by the Marditzer lake (Fenichel brings along his typewriter). Alix Strachey, Freud’s translator, has tea with the Eitingons: ‘I suspect the man of having taste,’ she wrote, ‘or perhaps his wife. It was heavenly to lean back and look at rows and rows of bookshelves, and well arranged furniture and thick carpets.’
In making the political Freudians so earnest, Danto makes them seem less avant-garde than they were. Many of the second generation of analysts believed sexual liberation would bring about cataclysmic changes in the family and society, and they practised what they preached, which makes their private lives an integral part of their overall philosophy of life. It is a shame that Danto chooses not to venture there. Peter Heller, a former professor of German and Comparative Literature, was analysed as a child by Anna Freud and paints a different picture of this era in his memoir. His mother was friendly with many left-wing analysts, and Heller remembers going on holiday with them to the Grundlsee in Austria in 1930: ‘The grown-ups indulged in a voyeuristic exhibitionistic fashion of semi-public love affairs, dramatised promiscuity, risqué parties and play-acting, and bathing in the nude.’
The analysts, or at any rate these analysts, Heller writes, ‘acted out and dramatised their sexuality, and let themselves go, in order to parade their opposition to convention’. They ‘experimented with themselves and their modernity to the point of self-destruction’. While this festival of bohemian promiscuity was happening at one end of the lake, the more prudish Freud and his daughter Anna were holidaying at the other; it was, as Heller puts it, ‘the orthodox and proper psychoanalytic establishment, guardian of convention and morality … vis-à-vis the clique of progressive socio-utopians and sexually superfree protagonists of the psychoanalytic left’.
By 1930 the profession was completely polarised. Freud had published Civilisation and Its Discontents, which maintained that civilisation demanded the sacrifice of our freedom, but the younger, more radical analysts believed that these repressions of our natural instincts should be thrown off. In the middle of the Grundlsee was Berta Bornstein, who was then part of Fenichel’s radical Children’s Seminar, but who was about to defect to Anna Freud’s camp, leaving Berlin in 1931 to pursue a career in Vienna as a child analyst. Heller reports that the children, glued to their binoculars, ‘observed Berta Bornstein when she disappeared in the bottom of the rowboat with the art historian Dr Ernst, in the course of their shortlived grand passion’.
Reich worked as the Ambulatorium’s assistant director from 1922 until he moved to Berlin in 1930. ‘He spread an electrifying energy all his own,’ Danto writes. She refers to him as ‘powerful, brilliant and sexy’, writes admiringly about his ‘deep-set eyes, wavy hair and high forehead of the rebellious German intellectual’ and portrays him as the most charismatic of her characters. Reich thought that Civilisation and Its Discontents was a direct response to his own controversial ideas: ‘I was the one,’ he said modestly in an interview in the 1950s, ‘who was “discontented” by civilisation’ (he had by then abandoned psychoanalysis in favour of the Orgone Box). Certain that neuroses were caused by a dearth of orgasms and determined to free the world of the sexual repression that he believed was causing mass neurosis, he envisaged a genital utopia free of all alienation and illness: ‘There is only one thing wrong with neurotic patients,’ he concluded in The Function of the Orgasm (1927): ‘the lack of full and repeated sexual satisfaction’. The incidence of impotence at the Vienna Ambulatorium, where it was the most common condition, might have been so high, Danto suggests, because impotence was ‘one of the most prevalent effects of shell shock’. But it might equally be understood in terms of Reich’s own agenda.
In 1928, Freud described Reich as ‘a worthy but impetuous young man, passionately devoted to his hobbyhorse, who now salutes in the genital orgasm the antidote to every neurosis’. By then, Freud was tiring of his protégé, and Reich’s messianic aspirations were exceeding the limited possibilities that the Ambulatorium offered. That year he began his own battle against collective neuroses, taking his message of liberation directly to the people in a van that doubled as a mobile clinic. Reich’s organisation – which he dubbed Sex-Pol, and whose motto was ‘free sexuality within an egalitarian society’ – offered, as Danto describes it, ‘a blend of psychoanalytic counselling, Marxist advice and contraceptives’.
While Reich talked from his soapbox about the dangers of abstinence, the importance of premarital sex and the corrupting influence of the family, arguing for a ‘politics of everyday life’, the team’s gynaecologist would offer health advice, fitting contraceptive devices and arranging illegal abortions. It was perhaps the most radical, politically engaged psychoanalytic enterprise to date, and before it was disbanded in 1934 it boasted an informal membership of 40,000. Sex-Pol established six free clinics, which were staffed by other left-wing analysts, and they too combined sex education with political indoctrination. ‘The new centres immediately became so overcrowded,’ Reich later recalled, ‘that any doubt as to the significance of my work was promptly removed.’ It was ‘new to attack the neuroses by prevention rather than treatment’.
Before he left for Berlin in 1930, Reich went to see Freud at Grundlsee; it was the summer Peter Heller was on holiday there. Reich told Freud of the importance of removing children from the family setting if the Oedipus complex and the correlated neuroses were to be avoided: ‘I stressed that a distinction must be made between a family based on love, and a coercive family,’ Reich remembered. ‘I said that everything possible had to be done to prevent neuroses. And he replied: “Your viewpoint is no longer compatible with the middle path of psychoanalysis.”’ Freud argued that it was not the job of psychoanalysis to save the world. As he left, Reich looked back and saw Freud anxiously pacing his room. He reminded him of a ‘caged animal’.
Freud responded to Reich’s increasing radicalism – which continued to evolve in Berlin, where Reich joined the Communist Party – with his blunt New Year’s resolution of 1932: ‘Step against Reich.’ ‘My father can’t wait to get rid of him inasmuch as he attaches himself to psychoanalysis,’ Anna Freud wrote to Ernest Jones in 1933. ‘That which my father finds offensive in Reich is the fact that he has forced psychoanalysis to become political, psychoanalysis has no part in politics.’ She was furious that Reich had come to Vienna and given a radical talk, which she felt endangered the psychoanalytic movement, already under attack from the Nazis, by identifying it with Communism. Not long afterwards, Eitingon, then president of the German Psychoanalytic Institute, forbade Reich from inviting training analysts to his seminar, effectively depriving him of students; he was expelled from the International Psychoanalytic Association at the Lucerne Congress the following year. Anna Freud correctly anticipated that separating Reich from the other Marxist analysts would render them harmless by, in her analogy, separating the match from the gunpowder.
In 1933 Freud’s books – and Reich’s – were burned in Berlin, and the German Psychoanalytic Society purged of Jews. Eitingon fled to Palestine and the Poliklinik was taken over by two non-Jewish analysts, Felix Boehm and Carl Müller-Braunschweig, who proved to be effective Nazi collaborators. They signed their letters ‘Heil Hitler!’ and, Danto writes, ‘did not hesitate to expose the estranged psychoanalysts to betrayal and even death if … it would benefit the Aryanised Poliklinik’. Edith Jacobson was interrogated about her patients’ sexual and political lives, and imprisoned when she refused to divulge confidential information. Freud meanwhile tried to protect psychoanalysis by asserting its status as a pure science and retreating from political commentary.
‘I prefer psychoanalysis to be practised by Gentiles in Germany than not at all,’ Ernest Jones wrote in a letter to Anna Freud. (As president of the IPA Jones raised the funds for many Jewish analysts to escape into exile.) He hoped that Boehm and Müller-Braunschweig would be able to appease the Nazis and that psychoanalysis would be ‘saved’, as he put it, until it could flourish again in a less hostile era. The Poliklinik was personally endorsed by Hitler, who used it as a holding pen for the camps – like a ‘virtual psychiatric guillotine’, as Danto describes it – in his battle against degeneracy. Danto wonders how much Jones really knew when he decided, in 1934, to exclude the activities of the clinics from IPA reports.
Nine-tenths of the analysts practising in Berlin and Vienna had already fled by March 1938, when the Nazis marched into Vienna and the Freuds decamped to London. Many analysts left for America, taking with them, Danto notes, ‘a particular humanitarian ideology forged in a curious time’. But the idea of free clinics failed to take root in ‘the land of the dollar barbarians’, as Freud referred to it. Until the mid-1950s, Danto informs us, the only Psychoanalytic Institutes in the United States to have outpatient clinics were in Chicago, initiated by Franz Alexander in 1930, and Topeka, where a centre for training psychoanalysts was started up at the Menninger Clinic 12 years later.
The political Freudians were forced underground, their achievements largely forgotten, their subversive ethos just kept alive in a secret newsletter circulated by Fenichel from Los Angeles and known as the Rundbriefe, which Fenichel described as a ‘written Children’s Seminar of Marxist Psychoanalysis’. The group came up with the slogan ‘For Freud against Freud’ to describe their psychoanalytic politics. ‘When Fenichel and Reich reasoned that their stance on politics and sexuality, and on the totality of theory and praxis, was closer to the original Freud,’ Danto writes, ‘they were correct.’
That is debatable; secessionist movements started by Jung, Rank and Adler made similar claims to authenticity. Danto’s achievement is to look at Freud through the rose-tinted spectacles of those early followers, who refracted Freud through Marx, interpreting him as a political optimist rather than the familiar prophet of doom. These pioneers were subject to much ridicule from both the Communist and the psychoanalytic camps, and Reich himself was castigated as a madman. The Frankfurt School, rehoused at Columbia University before the Second World War, followed Reich and Fenichel in grafting together the two founding fathers, and acknowledged this debt. But they embraced Freud’s theory of the death drive in order to help explain current events, which the political Freudians never did, and emphasised Freud’s political pessimism – Erich Fromm, for example, dismissed the revolutionary Freud as a myth. It was only in 1955 that a member of the Frankfurt School, Herbert Marcuse, revived the more radical Freud in Eros and Civilisation, which came out two years before Reich’s death. Perhaps these vacillating positions represent some ambivalence at the heart of Freud’s politics, allowing us to grasp the possibilities his thought encompassed. As Adorno wrote in Minima Moralia, ‘in psychoanalysis nothing is true except the exaggerations.’
[*] A notable exception is Russell Jacoby’s The Repression of Psychoanalysis: Otto Fenichel and the Political Freudians (1983).