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 Eric J. Engstrom (Institut für Geschichtswissenschaften, Humboldt Universität)
Published on H-German (October, 2005)
Psychoanalytic Polyclinics: Progressive Institutions?
Elizabeth Ann Danto's Freud's Free Clinics is an account of the aims and motivations that led to the creation of early psychoanalytic out-patient clinics. The book's main focus is on the polyclinics in Vienna and Berlin, with some attention also being given to clinics founded later in London, Budapest, and Frankfurt. Danto aligns psychoanalytic polyclinics with progressive, left-wing politics and civic advocacy. By her account, their history is a history of political activism in psychoanalysis and a history of patients' liberation. The book narrates an account of the polyclinic as a "compassionate alternative" (p. 8) to institutional psychiatric care--an alternative that faced entrenched opposition from academic medicine and that was destroyed by the rise of the National Socialist regimes in Germany and Austria.
Although several analysts (Karl Abraham, Max Eitingon, Ernst Simmel) had already made plans for polyclinics before and during the First World War, Danto sees Freud's address to the Budapest Psychoanalytic Congress in September of 1918 as the seminal event leading to their creation. In this speech Freud stressed the social obligations of psychoanalysis. According to Danto, Freud threw in "his lot with the emerging social democratic government" and turned away from the Austrian monarchy, demanding an interventionist government that would provide free mental health treatment for all. In this vein and like "a born statesman," he recommended the creation of free out-patient clinics that would move psychoanalysis away from "a solely individualizing therapy to a larger, more environmental, approach to social problems" (p. 18). From Freud's speech, Danto traces a direct line to the establishments of the clinics in Vienna, Berlin and Budapest.
Perhaps the most useful aspect of Danto's account is the treatment of the personal contacts and interactions between individual members working in the polyclinics. Danto is strongest here, tracking the movements of analysts as they moved between various clinics and situating them in place and time. Given the heterodox participants, financing, and institutional structures, as well as shifting local political contingencies, Danto brings together an eclectic potpourri of factors that bore on clinical practice. Danto's greatest contribution, however, it to have dug out the many and scattered references to polyclinics that are to be found in the psychoanalytic literature. Given that very little is known about how these clinics operated, Danto's account is a valuable contribution to the study of psychoanalytic practice.
Yet in spite of these achievements, this is a quirky and colloquial book. Its chapters correspond to the years from 1918 to 1938, each year receiving its own chapter. This hampers diachronic analysis and results in repetitiveness. (We are told on at least three occasions that Erik Erikson changed his name from Eric Homburger). The narrative jumps back and forth between Vienna, Berlin and other locations and digresses for little apparent reason to issues that seem far afield. The book's copy editing is below par (see p. 22) and the index unreliable (on p. 266 neither "Hitler" nor "Melanie Klein" are mentioned as cited, while the "International Psychoanalytic Association [IPA]" is mentioned on the page, but not cited in the index).
The book is more consistent when it comes to describing the physiognomic traits of various historical figures. For example: Alfred Adler was "impeccably outfitted in a tailored tweed suit, a white starched shirt, cigar, thoughtful demeanor, mustache and wire-rimmed glasses" (p. 34); Edith Jacobson was "profound and pretty, a smallish woman with intense deep eyes and shiny brown hair brushed back in a loose bun" (p. 60); Julius von Wagner-Jauregg was "a thin man of dour appearance," whose "severe demeanor was underscored by a downturned mouth, a large waxed moustache, and a closely trimmed crewcut" (p. 68); Edith Jackson was "a lean, long-limbed woman with a bob of chestnut hair and imperturbable green-blue eyes" (p. 222); and Wilhelm Reich was a "large man who looked scruffy and elegant at the same time" (p. 118) and who had "darkly darting eyes and a square jaw" (p. 43). As they appear on the book's narrative stage, virtually everyone--except Freud--is subject to this physiognomic shake-down.
Danto makes much of Freud's use of so-called Erlagscheine to financially support the polyclinic in Vienna. Apparently, these "vouchers" were commonly used as a "form of currency" (p. 1) within the psychoanalytic community to pay doctors. However, scant evidence is provided in support of this claim. The Erlagscheine that Danto depicts as "elegantly printed on pale orange paper" and as "surviving artifacts of the vanished civilization of Red Vienna" appear to have been nothing other than commonplace receipts, printed in Fraktur, for deposits to a post office account (p. 98).
This is a book based overwhelmingly on English-language literature. On Vienna and its social services in the 1920s, no German (and only a handful of older English-language) literature was consulted. Neither the work of Gerhard Melinz, nor Karl Sabliks biography of Julius Tandler was used. The Nazi Ermächtigungsgesetz is translated as the "Law for Removing Want" (p. 253). Such deficits cannot but call into question Peter Gay's dust-jacket assessment of the book as being "carefully researched." Given the importance that the book places on municipal welfare programs, it is surprising that neither archival nor published accounts of civic administration in Berlin or Vienna were used. By Danto's account, social democrats, psychoanalysts, and the American Relief Administration were the only groups involved in delivering humane social services to the citizens of Vienna. Yet Julius Tandler's Wiener System worked closely with various private charities (not just psychoanalysts) through a zentrales Wohlfahrtsamt. A much broader and deeper analysis of the municipal policies would have enriched this book considerably and allowed a clearer assessment of the significance of socially oriented psychotherapy in the 1920s and 1930s.
Because the relationship between municipal policies and psychotherapeutic clinics is left so vague, many of the implicit and explicit claims about the role of those clinics in delivering social services remain unproven and open to question. It would seem that various civic institutions referred patients to the clinic, but how and why that happened and just what rules--if any--governed the admission of patients remains inadequately explained. Danto is at pains to stress that the polyclinic's free service attracted patients from all social strata of urban society. While this may well be correct, evidence for it is rather sparse or not cited. Danto relies on data compiled by "Eitingon's unerring eye" (p. 112) to analyze patients' gender and socio-economic background. But the source of this data is unclear and must be divined from the bibliography. Indeed, occasionally it appears that free analysis was delivered mainly to members of the psychoanalytic community itself. Furthermore, a number of paths that could have been profitably pursued have been left untrodden. Danto suggests that one of the strongest impulses bringing members of the general public to the clinic in Vienna were the popular writings of Hugo Bettauer. Yet nowhere are Bettauer's writings consulted.
Danto emphasizes that polyclinics were aligned with progressive, left-wing politics and civic advocacy. Stating this once or twice would probably have sufficed and evoked few complaints from informed readers. But Danto beats this drum at every available opportunity, to the point where the book risks lapsing into partisan polemics. Indeed, there is a largely undifferentiated template of positively valorized left-wing politics and negatively valorized right-wing politics that is brought to bear throughout the book. Danto walks so d'accord with her protagonists that little room for the critical spirit is left in her analysis.
One of the consequences of this conspicuous valorization is a truncated view of the importance of polyclinics for psychoanalytic training. For example, the book notes that clinics were useful in "parlaying patients to psychoanalytic trainees" (p. 48). In this sense, psychoanalytic policlinics were doing in the 1920s what other medical policlinics had been doing for over a hundred years. Constructing free out-patient clinics had long been a strategy used by academic physicians to acquire patients for their teaching and research needs; and these practitioners commonly justified polyclinics on the basis of potential health care benefits that would accrue to local communities. In this sense, there was nothing new or necessarily "progressive" about psychoanalytic polyclinics. So when Danto claims that these clinics represented an attempt "to reject conservative traditions and to supplant them with new mental health institutions under a far more progressive authority" (p. 48), one must pause in doubt. Many psychoanalysts certainly pursued progressive political agendas, but as instruments of patient acquisition and professional training, policlinics were hardly progressive institutions. Furthermore, because plans for psychoanalytic polyclinics had already been drawn up before the war, one is left wondering just how strongly the motivation for these clinics can be attributed to the social democratic policies of postwar Vienna that Danto highlights. To what degree did polyclinics represent a truly progressive political agenda, as opposed to simply an adept exploitation of the opportunities thrown up by Julius Tandler's public health care reforms? Given the polyclinic's very limited impact in the larger scheme of social welfare services, this study would have been stronger if it had focused more systematically on its role in professional training.
Danto's is a history from an orthodox Freudian standpoint: psychoanalysis was beleaguered by hostile forces, the emergence and growth of psychoanalytic polyclinics flowed chiefly from Freud himself, and the internal disputes that plagued the early development of psychoanalysis tend to get downplayed in her account. For those who still choose to construct their histories of psychoanalysis around these tenets, Danto's book will be a welcome addition to the literature.
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Eric J. Engstrom. Review of Danto, Elizabeth Ann, Freud's Free Clinics: Psychoanalysis and Social Justice, 1918-1938.
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