Freud's Free Clinics

Freud's Free Clinics: Psychoanalysis & Social Justice, 1918-1938

Elizabeth Ann Danto
Copyright Date: 2005
Pages: 352
https://www.jstor.org/stable/10.7312/dant13180
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  • Book Info
    Freud's Free Clinics
    Book Description:

    Today many view Sigmund Freud as an elitist whose psychoanalytic treatment was reserved for the intellectually and financially advantaged. However, in this new work Elizabeth Ann Danto presents a strikingly different picture of Freud and the early psychoanalytic movement. Danto recovers the neglected history of Freud and other analysts' intense social activism and their commitment to treating the poor and working classes.

    Danto's narrative begins in the years following the end of World War I and the fall of the Habsburg Empire. Joining with the social democratic and artistic movements that were sweeping across Central and Western Europe, analysts such as Freud, Wilhelm Reich, Erik Erikson, Karen Horney, Erich Fromm, and Helene Deutsch envisioned a new role for psychoanalysis. These psychoanalysts saw themselves as brokers of social change and viewed psychoanalysis as a challenge to conventional political and social traditions. Between 1920 and 1938 and in ten different cities, they created outpatient centers that provided free mental health care. They believed that psychoanalysis would share in the transformation of civil society and that these new outpatient centers would help restore people to their inherently good and productive selves.

    Drawing on oral histories and new archival material, Danto offers vivid portraits of the movement's central figures and their beliefs. She explores the successes, failures, and challenges faced by free institutes such as the Berlin Poliklinik, the Vienna Ambulatorium, and Alfred Adler's child-guidance clinics. She also describes the efforts of Wilhelm Reich's Sex-Pol, a fusion of psychoanalysis and left-wing politics, which provided free counseling and sex education and aimed to end public repression of private sexuality.

    In addition to situating the efforts of psychoanalysts in the political and cultural contexts of Weimar Germany and Red Vienna, Danto also discusses the important treatments and methods developed during this period, including child analysis, short-term therapy, crisis intervention, task-centered treatment, active therapy, and clinical case presentations. Her work illuminates the importance of the social environment and the idea of community to the theory and practice of psychoanalysis.

    eISBN: 978-0-231-50656-4
    Subjects: Psychology, History

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. ACKNOWLEDGMENTS
    (pp. ix-xii)
  4. “The Conscience of Society” INTRODUCTION
    (pp. 1-10)

    IN VIENNA of the 1920s and early 1930s doctors who were very busy, like Sigmund Freud, could issue an Erlagschein, or voucher, to a current or prospective patient who would later use it as a form of currency to pay another doctor. The Erlagscheine were often elegantly printed on pale orange paper, inscribed in classical scripts, and, lacking any particular sequence, made for an especially versatile combination of bank deposit slip and personal check. The vouchers appealed to practically everyone in the city’s psychoanalytic community. Private practitioners could choose to endorse an Erlagschein (figure 1) to a clinic as a...

  5. 1 1918–1922:: Society Awakes

    • “Treatment will be free” 1918
      (pp. 13-33)

      THE GERMAN psychoanalyst Max Eitingon wrote in 1925 that his colleagues could no longer honestly argue that “the factor of the patients paying or not paying has any important influence on the course of the analysis.”¹ But Eitingon was merely announcing the fulfillment of Freud’s forecast from the 1918 Budapest speech on the conscience of society. In that speech Sigmund Freud had explicitly disavowed his prewar position, “that the value of the treatment is not enhanced in the patient’s eyes if a very low fee is asked,”² and had repudiated his earlier 1913 image of the psychoanalyst/ physician as medical...

    • “The polyclinic will be opened in the winter and will grow into a ψ institute” 1919
      (pp. 34-51)

      FOR YOUTH workers at community centers near the Prater, Vienna’s area of seedy amusements and prostitution, the idea of establishing school-based treatment centers for children neglected by four years of war and starvation seemed like a deliverance. An advertisement for just this kind of center had appeared in the fall of 1919, not quite a year after Armistice, on a small bulletin board of the local Gymnasium, the high school on Zircusgasse. The poster also announced the imminent opening of an additional section of the Volksheim, a kind of university settlement house where workers took evening classes. The upcoming courses...

    • “The position of the polyclinic itself as the headquarters of the psychoanalytic movement” 1920
      (pp. 52-80)

      ON FEBRUARY 24, 1920, Freud dispatched his daughter Mathilde and her husband Robert Hollitscher, the Viennese businessman, to attend the opening ceremonies for the new Berlin Poliklinik für Psychoanalytische Behandlung Nervöser Krankheiten, the first psychoanalytic outpatient center specifically designated as a free clinic. The clinic’s opening was “the most gratifying thing at this time” Freud wrote to Ferenczi, and Mathilde’s presence alongside other prominent members of the psychoanalytic community added a measure of authority to the festivities.¹ The Poliklinik, as it came to be known, was the brainchild of Max Eitingon and Ernst Simmel. Their Hungarian friend and benefactor Anton...

    • “An Ambulatorium should exist for psychic treatment in the widest sense of the word” 1921
      (pp. 81-89)

      “IT IS PUZZLING,” Freud wrote to Ernest Jones in March of 1921, “how little ‘Gemeinsinn’ [community spirit] and tendency for organisation there is to be found among the better elements in American society, only robbers and pirates hunt in gangs.”¹ His commentary, that “competition is much more pungent with them, not succeeding means civil death. . . .And success means money,” is followed by Freud’s even more distrustful query, whether “an American [can] live in opposition to the public opinion?” The questions reverberate with important themes, not only in the opposition between American and European psychoanalytic affinities within their respective...

    • “A Psychoanalytic Ambulatorium in Vienna” 1922
      (pp. 90-120)

      THE AMBULATORIUM opened with much fanfare on May 22, 1922, a few weeks after Freud’s sixty-sixth birthday and more than two years after the Berliners had started the Poliklinik. After a full two years of strained negotiations with Vienna’s entrenched medical patricians, Hitschmann welcomed fresh efforts by Paul Federn and by Helene Deutsch and her husband Felix Deutsch to restart the Ambulatorium project (figure 14). Finally this round of exertion paid off. The pivotal intervention came from Felix Deutsch, a physician specializing in heart disease at the Allgemeines Hospital and fairly powerful as director of the Clinic for Heart Diseases,...

  6. 2 1923–1932:: The Most Gratifying Years

    • “This help should be available to the great multitude . . .” 1923
      (pp. 123-134)

      FOR YOUNGER ANALYSTS practicing at the Ambulatorium since its founding the previous year, the new Technical Seminar provided a sort of playing field where everything could be said, diagnoses criticized, and treatment theories argued with far less caution than the Vienna society’s formal meetings required. At the beginning of 1923 Hermann Nunberg passed the seminar’s chairmanship to Eduard Hitschmann. Every week thereafter for the next two years, Paul Federn, as the seminar’s secretary and also deputy director of the Ambulatorium as of October 17, recorded the seminar’s proceedings with a special compassion and intellectual flexibility. In the seminar minutes of...

    • “The honor proceeds from the Social Democratic Party” 1924
      (pp. 135-152)

      BY 1924 fewer and fewer citizens of Red Vienna believed that psychoanalysis was either an arcane science or a dependent stepchild of psychiatric medicine. After the war the public’s interest in psychoanalysis “actually moved faster than that conservative corporation, the medical profession,” Paul Federn wrote, and medical patients demanded psychoanalytic information, referrals, and advice from their doctors in virtually all areas of specialization.¹ But the role of securing even greater popularity for psychoanalysis fell to Siegfried Bernfeld, who organized a special Propaganda-Komitee (publicity committee) for this purpose. “His fascinating personality, sharp sense and powers of oratory,” Freud wrote of Bernfeld...

    • “A warm sympathy for the fate of these unfortunates” 1925
      (pp. 153-166)

      “I SUPPOSE in the long run the success of a clinic would mean a general encouragement of ψa,” James Strachey wrote languidly from London to his wife Alix, still in Berlin, “and would eventually benefit us personally.”¹ The British society had founded their Institute, organized a lecture series, set up a small psychoanalytic library, and hoped soon to open an outpatient clinic, John Rickman announced at the general meeting of the IPA in 1925.² Any London analyst interested in contributing to the outpatient effort was requested to contact the newly formed Clinic Committee. In January they tried to decide “who...

    • “Although absent from the opening of the Clinic, I am all with you” 1926
      (pp. 167-182)

      THROUGHOUT the early years of the free clinics, psychoanalysts in various countries followed a well-organized sequence, a “logical order,” Ernest Jones would say, of first constituting a local society amongst themselves, next issuing a clinical journal, and finally organizing a training institute. After 1920 a fourth component was added, the outpatient clinic. The Berlin and Vienna societies had theirs and now so too would the British. “The chief news from London is good,” Jones had told Freud just before Christmas of 1925, “an old patient of mine has given two thousand pounds to . . . start a clinic early...

    • “Of special value in the promotion of [psychoanalysis is] the establishment of Institutes and Outpatient Treatment Clinics” 1927
      (pp. 183-196)

      A TURNING POINT for Wilhelm Reich, as for Austria’s political left, came on January 30, 1927, when a right-wing terrorist randomly shot into a crowd of Social Democrats in Schattendorf, a small town near the Hungarian border. What particularly enraged the workers and liberals was that the accused perpetrators were swiftly acquitted on July 14. Like Germany’s paramilitary factions, Austria’s conservative Christian Socials were affiliated with autonomous militaristic groups. Austrian reactionary forces had organized their own independent paramilitary factions, the protofascist Heimwehr (Homeland Guards), for just such occasions. The conservative Christian Social party had been defeated once again in Vienna...

    • Freud “knew exactly how things were in the world. But before he could go outside, he first had to know what was inside” 1928
      (pp. 197-207)

      IN 1928 Wilhelm Reich, intensely absorbed in activist politics but still working daily at the Ambulatorium, introduced a vision of social services freed of the boundaries of stigma and ideology. Reich decided to take psychoanalysis in a direction charted through social work, by the late 1920s a well-established profession in its own right, and, as noted earlier, used the term social work interchangeably with sociological work. “Following a conversation with Freud, “Reich recalled, “I explained my plans and asked him for his opinion. Sex-counseling centers were to be opened on a mass scale . . . [and] designed to serve...

    • “The very group of patients who need our treatment are without resources” 1929
      (pp. 208-220)

      “THE CENTERS immediately became so overcrowded,” Reich said of Sex-Pol, “that any doubt as to the significance of my work was promptly removed.”¹ Once the Vienna newspapers announced that the new sexual hygiene clinics for workers and employees had opened, the work of the clinics took off. In January 1929 Reich decided to expand the Sex-Pol network of free community clinics, and add longer-term individual psychoanalysis to the brief contact of the outreach missions. The clinics gained ample encouragement from prospective patients who, for whatever reason, did not go to private therapists or other consultation centers in Vienna, nor to...

    • “Free or low-cost analyses . . . [were] at least a small beginning” 1930
      (pp. 221-230)

      BY 1930 Freud’s bid for free treatment had taken shape much in the way he had envisioned over a decade earlier. Poor men and women in Vienna now had the same social right to mental health treatment as to surgery; mental illness was considered a public health threat much like tuberculosis; and decisions were made by committee, not by individuals, to start institutions where analytically trained physicians were appointed. Though outpatient clinics had been initiated by private charity, the state now recognized their value. Freud could not have been more pleased. The Berlin Poliklinik, he wrote, still “endeavors to make...

    • “As a social-democratic town councilor, Dr. Friedjung has furthered our interests as psychoanalysts” 1931
      (pp. 231-239)

      MARTIN GROTJAHN was already a staff psychiatrist at the Berlin-Buch state mental hospital and, as he later wrote, no exception to the haughty reputation of university professors when he applied for admission to the Berlin Psychoanalytic Institute. Grotjahn’s choice was politically significant. Despite its popularity in Berlin of the 1920s, the status of the psychoanalyst never really achieved that of the psychiatrist/physician, meaning that anyone inclined to pursue psychoanalytic training risked harming their academic career. Conversely, few organizations were more exciting to a socially minded psychiatrist, whose civic bent was increasingly confined to secretive meetings and coded plays, than the...

    • “Male applicants for treatment [were] regularly more numerous than female” 1932
      (pp. 240-250)

      IN MARCH of 1932 the Ambulatorium celebrated its tenth anniversary by publishing its most extensive report to date on those who were ”given the opportunity of undergoing an analysis, free of charge.”¹ Some of Hitschmann’s most trusted analysts had already met to discuss how the clinic’s record should be promoted, and persuaded him follow the Berlin Poliklinik’s example. An initial account would be published in the IJP, they decided, and followed up with a separately printed summary released as a brochure. The report was meant to detail how well the Ambulatorium had carried out Freud’s 1918 mission statement, but it...

  7. 3 1933–1938:: Termination

    • “The Berlin Psychoanalytic . . . Policlinic . . . came to an end” 1933
      (pp. 253-264)

      AT FIRST the Berlin psychoanalysts contended with the political events of February 1933 in a mood for bargaining and Freud’s encounters with the new fascist world were uncharacteristically compromising. Hitler had been named chancellor of the Reich on January 30. Hermann Göring, the politically powerful cousin of Matthias Göring and future scourge of the Poliklinik, was appointed Prussian minister of the interior and immediately expanded the ranks of the SA and SS, the Nazi police forces, while issuing decrees on who was—and was no longer—acceptable to the state. On February 28 opposition to the regime became a punishable...

    • “Psychoanalysis [as] the germ of the dialectical-materialist psychology of the future” 1934
      (pp. 265-273)

      “WE ARE ALL convinced,” Otto Fenichel wrote from Oslo in March of 1934, “that we recognize in Freud’s Psychoanalysis the germ of the dialectical-materialist psychology of the future, and therefore we desperately need to protect and extend this knowledge.”¹ So begins the extraordinary series of 119 letters written between 1934 and 1945 and circulated between and among a core group of activist psychoanalysts who had met at the Berlin Poliklinik in the 1920s, fled the Nazis, and remained close friends and political allies in exile. Otto Fenichel, principal author of the Rundbriefe, or circular letters, embodied that core’s spirit and...

    • “A written Children’s Seminar of Marxist psychoanalysis” 1935
      (pp. 274-279)

      LIKE MOST Nazis in 1935, Felix Boehm did not hesitate to expose the estranged psychoanalysts to betrayal and even death if he thought it would benefit the aryanized Poliklinik. As president of the new DPG, he informed Jones that the exiled Jewish analysts had lost their membership status in the society and were now consigned to the rank of “guest.” Despite Müller-Braunschweig’s urgent interventions with the Kampfbund, Boehm reported, not even Teresa Benedek and the few others left in Berlin were safe. Jones was not fooled. “It looks as if the German Society will soon be forced to expel all...

    • “Social psychoanalysis” 1936
      (pp. 280-291)

      THE POLIKLINIK’S premises at 10 Wichmannstrasse were taken over by the German Institute for Psychological Research and Psychotherapy on October 15, 1936. Headed by Matthias Heinrich Göring, protected by Reichsmarschall Hermann Göring, and assisted by Carl C. Jung, the newly configured Göring Institute was the Nazi regime’s center for racialized psychotherapy training and treatment at least until the end of World War II. Through a set of complex and often ethically compromised maneuvers, Felix Boehm and Carl Müller-Braunschweig managed to retain their society’s membership in the IPA. Boehm and Müller-Braunschweig apparently felt they could count on the support of Anna...

    • “These were traumatic times and we talked little about them later” 1937
      (pp. 292-296)

      A NEW daycare center was Edith Jackson’s answer to several problems. First, Jackson knew that Anna Freud craved a true research environment in which to test out her theories on early childhood development, and a clinical setting in which to conduct long-term observations of one and two year olds would suit this ideally. As the Nazis closed in more and more oppressively on the Freuds, and with her father still refusing to leave the homeland, Anna’s need for new work was palpable. Second, Jackson was immensely grateful to Freud for her own analysis and wanted to repay him with a...

    • “The fate of psychoanalysis depends on the fate of the world” 1938
      (pp. 297-304)

      THE END of the free psychoanalytic clinics came on March 12, 1938, as thousands of bayoneted German Wehrmacht troops marched the conquering Nazi flag into Vienna. “The whole city,” wrote Sterba, “changed overnight.”¹ Schuschnigg had capitulated to Hitler, and so, the Göring Institute believed, Freud should surrender the Ambulatorium to the Nazi analysts. Matthias Göring urged Müller-Braunschweig to seize the moment. “The provisional directorship of the [Vienna] Clinic had best be taken by a therapist from outside the various analytic trends,“he wrote to his colleague on March 20. “Besides, I should not like to have a one-sided clique in Vienna....

  8. NOTES
    (pp. 305-332)
  9. BIBLIOGRAPHY
    (pp. 333-342)
  10. INDEX
    (pp. 343-348)