Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918-1938 (Book Review)

Author:  Danto, Elizabeth Ann
Publisher:  Columbia University Press, 2005
Reviewed By:  Marilyn S. Jacobs, PhD, ABPP, Vol. 26 (2), 40-41

The discipline of psychoanalysis that has evolved over the past generation in the United States is not generally considered to be an entity with high aspirations toward social responsibility. Although many individual psychoanalysts have social interests, the culture of psychoanalysis in and of itself is usually not characterized as such. Psychoanalysis has been described in far less favorable terms with regard to its commitment to the general welfare. Further, it has not always been thought to be “liberal.” Psychoanalysis in the second half of the 20th century was regarded as a medically derived, rigid and formal pursuit, which was available only to society’s educated elite and at great cost.

The ascendancy of the concept of the “mental health provider” and the managed care system dominated the public’s view of the opportunities for psychological transformation. The popularity of the cognitive behavioral paradigm and the difficulties in convincing medical providers, educators, legislators and journalists of the value of psychoanalytic theory and practice have been formidable obstacles to portraying psychoanalysis as having value. This trend was especially prominent during the 1980s when the death of Freud was widely proclaimed. The problem with American urban mental health services may have been that it “remains generally allied to the more functionalist model of mental hygiene.” This viewpoint was called “the psychosocial paradigm” by Erik Erickson (p. 207).

Division 39 has always had a progressive mandate and in the last several years, this trend has grown considerably with the highly successful outreach projects, the commitment to diversity and theoretical alternatives to classical theory. Thus, it is most timely that Elizabeth Ann Danto has completed a very compelling work, which is a complement to the progressive values and directions of Division 39. Many of us have some awareness of how those involved with psychoanalysis at its inception were motivated toward social action. What this author has completed is a mesmerizing history of that motivation.

In Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918-1938, Danto tells the story of how the beginning of psychoanalysis was intertwined with the European progressive social movement. Thus, at its inception, the clinical practice of psychoanalysis “conformed to the social-democratic political ideology that prevailed in post World War I Vienna” (p. 2). The early psychoanalysts expressed this commitment by providing services to the working classes and the poor. From 1920 until 1938, psychoanalytic treatment centers were opened in ten cities and seven countries, including Vienna, Berlin and Budapest. The author interprets this trend as due to “ … the heady climate of progressivism and social movements between the two world, wars … (in which) … psychoanalysis was supposed to share in the transformation of civil society, and these new outpatient treatment centers were to help restore people to their inherently good and productive selves” (p. 3). The author describes how the involvement of the first psychoanalysts was intended to promote liberation and contribute to the struggle for a better world.

In a richly compelling, highly detailed and well written narrative, Danto describes a chronology in which psychoanalysis aspired to be and succeeded as an agent of social change. Her story is very well referenced and thus gives the colorful historical context validation. The back-story includes discussion of the socio-political events, personalities and aspects of each culture. The subtext reminds the reader that professional practice is highly influenced by external forces and that professional reality is socially constructed.

The book is complemented by photographs of archival materials (e.g., Sigmund Freud’s vouchers which could be used to obtain treatment at the Vienna Ambulatorium, and Melanie Klein’s patient schedules) and photographs both of the buildings which housed the clinics (e.g., the Berlin Poliklinik, the Ambulatorium in Vienna, the Budapest Clinic on Meszaros Street), and the persons who were a part of this social movement (e.g., Freud, Georg Simmel, Edith Jacobson and others).

After the debacle of World War I, European society was committed to the improvement of life for all, which was described as “civic society, government responsibility and social equality” (p. 17). It was believed that great lessons could be learned from the devastations of the war and that society need never again fall into such an abyss if suitable enlightenment could be afforded to the populations.

Psychoanalysis had a social responsibility in this arena. Freud was noted to have said: “… the poor man should have just as much right to assistance for his mind as he now has to the life-saving help offered by surgery …” and that “the neuroses threaten public health no less than tuberculosis” (p. 17). Psychoanalysis as an arm for social good was understood to depend upon access, outreach, privilege and social inequality. Freud gave a speech in Budapest, Hungary, at the Fifth International Psychoanalytic Congress in September 1918, in which he appealed for postwar social action by psychoanalysis.

Many of the psychoanalysts in the audience for the Fifth Congress actualized this message in their home cities. Most of the clinics that were established attempted to provide psychoanalytic treatment at no charge. It was thought that the psychoanalytic method was so powerful that it could enable those undergoing it to become better human beings, to reach the innate goodness of their being and thus avert future political disasters as had occurred with the war.

The movement to bring psychoanalytic treatment to the man in the street was part of the idea of building a future with new method and with new social inventions was the dominant cultural zeitgeist. In architecture, political systems and the arts, a utopian vision emerged. What the Bauhaus offered to art, psychoanalysis offered to the improvement of mental functioning.

In this milieu, psychoanalysis achieved considerable popularity and innovations were developed including the attempts to understand sexuality, serious work with children and the first short term and crisis treatments. Training centers were developed in close proximity to these clinics, establishing some of the models for training that became standardized. The book is also realistic in reconstructing how conflicts arose in personal relationships in spite of the lofty goals that the early psychoanalysts aspired to achieve.

Danto’s work ends with the tragedy of how the rise of Nazism destroyed the free clinics. The Jewish psychoanalysts fled for their lives. In Berlin, the Poliklinik became the Goring Institute, the Nazi center for racialized psychotherapy. The émigré psychoanalysts established themselves in disparate locations from London to Los Angeles. The heady spirit of the post war days was lost as Europe was plunged once more into violence and destruction with the start of World War II.

The section and chapter headings of the book vividly illustrate its dimensions. For example: Section One: Society Awakens; Chapter 1: Treatment will be free. Chapter 2: An Ambulatorium should exist for psychic treatment in the widest sense of the word. Section Two: The Most Gratifying Years; Chapter 1: This help should be available to the great multitudes. Chapter 7: The very group of patients who need our treatment are without resources. Section Three: Termination; Chapter 5: These were traumatic times and we talked little about them later and Chapter 6: The fate of psychoanalysis depends on the fate of the world.

Danto’s work is a must read for anyone interested in psychoanalysis and progressive social responsibility. Also, it is recommended highly for graduate students and those interested in a model of psychoanalytic social activism. If psychoanalysis can enlarge itself to replicate this aspect of its origins, it would realize its true potential. This is especially so given how troubled times seem to pervade the history of human civilization, regardless of external progress.

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