Elizabeth Ann Danto. Freud's Free Clinics: Psychoanalysis and Social Justice, 1918-1938. New York: Columbia University Press, 2005. xii + 348 pp. $29.50 (cloth), ISBN 978-0-231-13180-3; $23.50 (paper), ISBN 978-0-231-13181-0.
Reviewed by Greg Eghigian
Published on H-Ideas (October, 2009)
Commissioned by Magdalena Zolkos
The Social Mission of Early Psychoanalysis
For many with only a cursory knowledge of the history of the movement, psychoanalysis is synonymous with the works of Sigmund Freud. Scholars inside and outside the psychoanalytic community have now spent around a century reading, rereading, and interpreting Freud’s extensive corpus. While there is widespread agreement that Freud’s legacy casts a long shadow over modern intellectual history, scholarly opinion about the nature and value of that legacy has been subject to acrimony. Like Karl Marx and Marxism, Freud and psychoanalysis have consistently inspired both devout supporters and bitter opponents.
Contentiousness, as Elizabeth Danto’s book confirms, has been a part of psychoanalysis from the very beginning. Danto explores a subject that one rarely hears mentioned in most textbook treatments of Freud and psychoanalysis: the fact that, in the 1920s and 1930s, a second generation of psychoanalysts established free clinics in a number of major cities. It was Freud’s address before the Fifth International Psychoanalytic Congress in Budapest in September 1918--calling for broad social reform and greater civic and state responsibility in realizing social equality--that provided the original motivation for creating a number of psychoanalytic clinics that offered free treatment services to men, women, and children.
Though clinics were eventually set up in Frankfurt, London, and Budapest, Danto focuses on efforts in two central European cities: Vienna and Berlin. In Vienna, psychoanalysts were able to draw on the momentum of progressive-minded social democrats in city hall during the years 1919-34. Alfred Adler proved especially successful in promoting the creation of child guidance clinics throughout the city. Housed in schools and doubling as laboratories, his child guidance clinics used psychodrama, group talk therapy, and individual consultation to involve children in developing stronger ties to their surrounding community as well as dealing with nascent neuroses. Others involved in the venture included August Aichorn, Siegfried Bernfeld, Erik Erikson, Anna Freud, and Willi Hoffer. Adler eventually ran his own clinic as a training center for new cohorts of doctors, teachers, social workers, and psychologists.
Adler’s efforts were paralleled by the founding of a psychoanalytic “Ambulatorium” in Vienna in 1922. The facility’s staff there included director Eduard Hitschmann and Wilhelm Reich, who served as assistant director. The clinic was successful in getting analysts throughout the city to donate one-fifth of their practice to providing services without a fee. The Ambulatorium was also the site for a so-called Technical Seminar on therapeutic technique. Here, under the direction of Reich, emphasis was placed less on theory than on practice, targeting inexperienced analysts and discussing clinical challenges and treatment failures.
In Berlin, the free clinic model was realized in February 1920. The leading figures of Max Eitingon, Karl Abraham, Ernst Simmel, and Karen Horney established a polyclinic there, which, in its first year, received some 350 applications for free treatment. The practice of feeless treatment did prompt some debate within psychoanalytic circles, however, with some critics contending that the practice undermined an important spur for improvement. In the end, the Berlin polyclinic relied on a sliding scale system, asking patients to pay what they believed they could afford.
1923-32 were vibrant years for both clinics. Under the directorship of Helene Deutsch, the Training Institute at the Ambulatorium graduated its first class of students in 1925. Adler’s child guidance clinics continued to enjoy success in Vienna. And there were lively debates and promising innovations in the area of child therapy, driven primarily by Anna Freud and Melanie Klein. At the same time, Simmel in Berlin and Reich in Vienna both made names for themselves promoting their own self-consciously leftist visions of mental hygiene and counseling.
All this came to a crashing halt, however, with the rise of fascism and Nazism in Germany and Austria in the years 1933-38. Felix Boehm plays the leading role in Danto’s narrative, as the collaborating member of the Berlin polyclinic who helped purge and “aryanize” the facility in a non-Freudian direction. Ultimately, the spread of National Socialism throughout central Europe led to around 90 percent of all psychoanalysts there fleeing abroad, mostly to England and the United States.
Danto claims that her study helps to correct the common opinion that psychoanalysis has historically been a male enterprise, focusing on long-term, individual treatment of primarily female patients and having little engagement with social issues. And, on these terms at least, Freud’s Free Clinics is successful. As Danto demonstrates, the second generation of psychoanalysts was replete with active and directive women, in particular Helene Deutsch, Anna Freud, Karen Horney, Edith Jackson, and Melanie Klein. At the same time, far from being insulated, the psychoanalytic community of the twenties and early thirties was international and, more often than not, politically committed and keenly cognizant of the role environmental factors played in mental health. Perhaps most surprisingly, Danto reveals that the clinics regularly carried out short-term analyses and that most clients were male, employed, and relatively young, their most common complaint being impotence.
If there is a major shortcoming here it is Danto’s rather generous--and, at times, triumphalist--reading of the history of psychoanalysis. She is clearly sympathetic to to those she is studying, and this manifests itself in an often less than critical interpretation of their positions and purposes. Never once does she consider the extent to which the free clinic mission might be considered a colonizing project, a self-serving attempt by a Bildungsbürgertum (educated middle class) to expand the reach of psychoanalysis at the emotional expense of working-class men, women, and children. And, as the book title announces, she follows psychoanalytic tradition in crediting Freud with being the engine of the free clinics, despite the fact that it was the second generation of psychoanalysts who did all the work. Danto’s sympathies become particularly obvious and irksome in her penchant for describing the physical attributes of various individuals in her narrative. Historical actors cast in the role of enemies of the movement, such as Julius Wagner von Jauregg (“a thin man of dour appearance,” p. 68) and Felix Boehm (“a fairly short, pale man, with combed-over, thinning brown hair and deep-set eyes,” p. 255), are portrayed in unflattering terms, while psychoanalytic figures like Karen Horney (“a slim woman with wispy blond hair tied back, strikingly large eyes, and the casual style of the well-schooled,” p. 115) and Franz Alexander (“a broad-shouldered and square-jawed man,” p. 248) are described in warm, intimate terms. A technique like this is more suited to novels than to historical writing.
But, in the end, much can be learned from sympathetic readings, and Freud’s Free Clinics makes a worthwhile contribution to the historiography of psychoanalysis.
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Greg Eghigian. Review of Danto, Elizabeth Ann, Freud's Free Clinics: Psychoanalysis and Social Justice, 1918-1938.
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