The detailed history of the Berlin and Vienna free clinics remained largely unknown1 until Elisabeth Danto’s comprehensive work, Freud’s Free Clinics: Psychoanalysis and Social Justice 1918–1938. In it she claims: ‘Between 1918 and 1938 psychoanalysis was neither inaccessible for working people, nor rigidly structured, nor luxurious in length’ (Danto, 2005: 2). Here we can learn how the clinics were set up and run, about the motivations and ideologies of their founders and the issues they faced. It is extraordinary, given the size and creativity of these clinics, that this became such a forgotten history, ignored even in those accounts of psychoanalysis sympathetic to the aims of a more class-inclusive practice. Russell Jacoby’s The Repression of Psychoanalysis (Jacoby, 1983) is the main exception, but he does not discuss the Vienna clinic. This neglect reflects how divorced from mainstream concerns the enterprise of free and low-cost psychoanalysis became and still is, a theme taken up in Chapter 4 and elsewhere.
There is however much that we can learn from the passion and creativity of the founders of these clinics and their commitment to developing a more class-inclusive psychoanalysis, a key theme for this book, and one which could inform the present challenges facing psychoanalysis, something David Fisher (2007) also suggests. Danto’s work is contested in some quarters, as exaggerating the importance and radical nature of the clinics; in many more others it has been welcomed and endorsed.2 Here I outline some of the specifics of how these clinics were founded, their detailed workings and the ideas of their leading figures; attention to the materiality of these inclusive projects is important in understanding what is at stake in the interface of psychoanalysis with various social realities. I am approaching the wealth of information available, not to give any kind of condensed history, but rather to identify the theoretical and practical issues in these early transpositions of psychoanalysis into working-class contexts. Many of these themes resurface in subsequent class-inclusive projects, and in the wider considerations of this book.
The Berlin Polyclinic was established in 1920, and the Vienna Ambulatorium opened in 1922. Both offered free and low-cost psychoanalysis. They were notable for the number and social diversity of their patients, recorded in published reports. They were followed by shorter-lived clinics in Budapest and Frankfurt, and by a smaller London Clinic. Their founders and staff were variously motivated by socialist, revolutionary or social democratic beliefs. They assumed without question the universal applicability and value of psychoanalysis. Otto Fenichel, for example, wrote retrospectively that ‘many analysts… have analysed proletarians, and have established that the scientific laws of man’s inner life which psychoanalytic research has revealed are generally valid irrespective of class distinctions’ (Fenichel, 1967: 310). This continues to be debated and contested (e.g. Fanon, 1952); Fenichel himself was more equivocal than this statement suggests (see p. 32).
These left psychoanalysts also assumed the importance of psychoanalysis for social reform and progress: it would help transform civil society; and it represented human liberation, social empowerment and freedom from bourgeois conventions. They also, and Freud as well, recognised that extending the reach of psychoanalysis to the poorer sections of the population was essential to the future of psychoanalysis and its acceptance by the general public, a vital argument that has renewed relevance now. Alert to the ‘immense neurotic misery of the masses’ (Fenichel, 1967: 310), they devoted considerable energy to popularising psychoanalysis, writing accessible articles and doing outreach work of various kinds. Danto argues that psychoanalysis gained an acceptance and popularity that it has seldom enjoyed since.
The founding of these clinics was framed by the impact of the 1917 Russian revolution, and the experience and aftermath of World War I. The war ended the dominant imperial regimes of Austro-Hungary and Germany; it produced enormous social upheavals, economic collapse and poverty, and led to attempted Communist revolutions in several countries. Post-war Vienna was governed by a Social Democratic council which initiated many social welfare reforms of a far-reaching nature, in housing, education and women’s and children’s health, forming the context for the Ambulatorium. The Weimar Republic in Germany was a time of huge modernist innovation in art, architecture, literature, theatre and music. The earlier youth movements were radicalising influences in the lives of many analysts, such as Fenichel, Siegfried Bernfeld, Wilhelm Reich and Annie Reich. These organised movements challenged conformist and restrictive values and demanded a more informed and less moralistic approach to sexuality, which psychoanalysis was able to provide. The power of psychoanalysis to illuminate sexuality has often been part of socially critical movements.
Danto also attributes the rise of these clinics to Freud’s far-reaching speech to the first psychoanalytic congress after the war. In ‘Lines of Advance in Psychoanalytic Psychotherapy’, Freud makes the much quoted claim: ‘[I]t is possible to foresee that… the conscience of society will awake and remind it that 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 …’ (Freud, 1918: 167). He predicted that institutions and outpatient clinics would be started where treatment would be free. This appears to have acted as a challenge and as encouragement to a younger generation of analysts to set up these clinics. Freud also foresaw that the establishment of free clinics would involve clinical research and standardised training programmes, the bases for which were provided by the clinics. Reviewing progress a decade later, he wrote how the Berlin Poliklinik ‘endeavors to make our therapy accessible to the great multitude who suffer under their neuroses no less than the wealthy but who are not in a position to meet the cost of their treatment’ (Freud, 1930: 257).
Here I address how these clinics were set up and funded, the difficul-ties and resistances they faced externally, the innovations and debates they gave rise to, as well as how they were run and organised internally. There are however few published case histories attributed to work at the clinics. Fenichel claimed that ‘a great many case reports of proletarians have been published by analysts’ but does not give details (Fenichel, 1967: 308). There is a modern resonance in how little is written about clinical work in similar contemporary projects. However, the work of these clinics does represent a time when the political and clinical passions of a substantial number of psychoanalysts were at their most conjoined, and when these were much closer to the mainstream of psychoanalysis than ever since. Many saw themselves working towards a social or Marxist psychoanalysis, and wrestled with theory accordingly. How the social world can be represented within psychoanalytic work is an abiding debate, as well as a central concern of this book. Other left psychoanalysts subscribed to more social democratic beliefs, with the main aim of increasing access to psychoanalysis for those excluded by money, a concern that also continues in many forms today.
The Berlin and Vienna clinics were different in many respects, although there was considerable exchange of ideas and movement of staff between them, mostly from Vienna to Berlin, which was seen as allowing more adventurous thought and practice, and which established a training institute somewhat earlier.
The Berlin clinic was initiated by Ernst Simmel and Max Eitingon. Simmel, a socialist, had been a doctor during the war and was convinced of the usefulness of psychoanalysis in treating traumatised soldiers. Such experiences were important in demonstrating that psychoanalysis could be applied in different contexts. For Simmel, depriving poor people of psychoanalysis, which he saw as an instrument of personal enhancement for the rich, was for him as much part of their class oppression as were their material deprivations. Eitingon, also a war doctor and independently wealthy, provided most of the funding for the clinic, which meant that the core staff could be paid small salaries. Reporting on the first years of the clinic, Eitingon emphasises the urgent need for such provision: neurotic distress had greatly increased, there was great public demand for psychoanalysis, and, he says: ‘we were more confident’ (Eitingon, 1923). It was a ‘favourable moment’, psychoanalysis having had no part in the old illusions, which had now perished. They, together with Karl Abraham, formed the initial staff of the clinic.
Freud’s architect son Ernst designed the layout and furnishings of the clinic in a modernist style, with the whole environment planned to convey a sense of community as well as confidentiality. There was a reading room where psychoanalytic literature could be read by patients and staff, all very different from the traditional, impersonal doctor’s office and planned to dispel fear about beginning analysis. The waiting room was seen as a place where patients could realise they were not alone, neither in their suffering nor in their feelings for their analyst. Such attention to the total environment and the messages it may convey to intending patients has now become part of analytic practice for many clinics.
The clinic was flooded with applications for free treatment. Patients were accepted entirely on diagnostic grounds, and then asked what they could contribute in fees, if anything. In the first two and a half years they received 600–700 applications and conducted 130 analyses (Eitingon, 1923), impressive by any standards. The occupational categories recorded demonstrate conclusively how socially inclusive the Poliklinik was. Danto (2005: 115) suggests that the large lower-class patient population resulted in part from Simmel’s social activism, an indication of how politics and psychoanalysis may need to be conjoined in the interests of inclusivity.
All analysts of the Berlin Psychoanalytic Society were obliged to donate either free time or a financial equivalent. So novel was the idea of free treatment that Eitingon found it necessary to write defending its use, dispelling the notion that it would increase resistance (still a preoccupation of some), and pointing out how it allowed for greater flexibility and experimentation on the part of the analyst. He acknowledged that fees or free treatment could become clinical and transferential issues, but came to believe that payment was more significant for the therapist than for the patient, an issue rehashed many times in the history of the discipline, and which I revisit in Chapter 9.
Eitingon and Fenichel saw the importance of empirical data in proving the clinic’s worth and the value of psychoanalytic treatment. They devised sophisticated schemes of record keeping. Eitingon (1923) used the clinic figures to prove how effective it was, with roughly two-thirds considered cured or improved, most of the rest still in progress, and only a small number discontinued. Unfortunately, it is not clear how these assessments were made. Patients were seen between three and four times a week, and the length of analyses was short by modern standards, but usual then. The most common length was six months or under, although some lasted longer. No arbitrary limit was set. According to Danto, debates about appropriate lengths of treatment were carried on in many clinical discussions, with the notion of ‘fractionary analysis’ advocated as a specific curative technique, whereby unavoidable interruptions to analyses, because of the conditions of life of some patients, could allow for consolidation and re-evaluation of the treatment. Danto suggests that while they experimented extensively with the parameters of treatment, they condemned as ‘useless… the copper of direct suggestion’ that Freud had advocated for work in the free clinics. Rather they adhered closely to the fundamentals of psychoanalytic processes (Danto, 2005: 179). Whether psychoanalytic work under the more constrained conditions of free or low-cost work counts as ‘real’ psychoanalysis is a debate that continues to haunt the field, as Chapter 4 illustrates. The founders of the free clinics, however, never doubted they were practising psychoanalysis, despite the constraints, and were widely seen as doing so.
Initial diagnoses covered a very wide range of conditions, as did the patients’ occupations. At the outset half came from manual occupations, or the unemployed. Eitingon records that the ‘authentic proletarian’ proportion got less with time, with more impoverished intelligentsia and professionals attending, which he bemoaned. By 1927, the clinic had grown so much that it moved to new quarters. By 1930, a total of 721 analyses had been carried out (Danto, 2005: 202).
In 1927, after much fundraising, Simmel opened an inpatient facility, the Schloss Tegel Sanatorium. Simmel’s own account of the sanatorium contains considerable clinical detail but does not specifically address social issues (Simmel, 1929). It is remarkable for the boldness and creativity of his ideas; in many ways the clinic prefigured family therapy, and the insights of modern therapeutic communities.
The Poliklinik was closely connected to the Berlin training institute, and by 1922 Berlin was regarded as the leading centre of psychoanalysis. With Melanie Klein’s involvement it also became one of the pioneers of child analy sis. Danto describes the avant-garde and convivial atmosphere surrounding the clinic and the institute, as does Alix Strachey, who was in analysis with Abraham and involved with her husband in translating Freud into English. Veronika Fuechtner’s research shows the extensive contacts and activities that members of the Berlin Institute had with the cultural modernism and social activism of the society around them (Fuechtner, 2011). Strachey’s letters vividly convey their hectic and intense lives, their passionate commitments to psychoanalysis, but she makes scant reference to the Poliklinik, other than as the place where she attended lectures and seminars. However, she does, in the course of remarking on the feeling of ‘the solid reality of the unconscious mind’ engendered by reading Freud’s Wolf Man case, bemoan the fact that there must be a hundred unwritten records at the Poliklinik which ‘would set psychoanalysis on its feet’ (Meisel and Kendrick, 1985: 199). Strachey supposes that no one there had the time, interest and talent to write such case histories. This does suggest that there were indeed few in-depth clinical accounts stemming from the Poliklinik. It also indicates the losses to psychoanalysis as a whole of all class-inclusive projects not having the resources for writing clinical accounts of their work.
Radical theorising about the relationship between socialism and psychoanalysis was also developing in Berlin; in 1924 Fenichel and his colleagues formed themselves into a group, known as the ‘Children’s Seminar’.3 Operating outside of the main Institute curriculum, it included a diversity of left-wing political views, and met regularly until 1933. Its central topic of discussion was ‘the social factor’ in psychoanalysis. The seminar then evolved into Fenichel’s Rundbriefe, the secret distribution of which kept these left-wing analysts in touch in exile. Some of these analysts were drawn towards the Social Democrats, and others, including Fenichel and Reich, towards the Communists. The debates of the Children’s Seminar also stimulated Simmel’s interest in a burgeoning interdisciplinary group of intellectuals, who later formed the Frankfurt Institute for Social Research and Critical Theory. Erich Fromm, who (according to Jacoby) participated in the Berlin discussions, helped establish a small outpatient clinic in Frankfurt in 1929, alongside the academic institute. The Frankfurt group became the pre-eminent thinkers of Marxist Freudian synthesis. In both cities, there was a fertile period of intense psychoeducational activity, with psychoanalysts much in demand for teaching and outreach work with other professions. All these and many other developments illustrate the immense fertility of thought and practice that flowed from the openness of these psychoanalysts to wider social, cultural and political issues, and their refusal to encase psychoanalysis within narrow social parameters.
The subsequent history of the Berlin Poliklinik in the hands of the Nazis, and the flight of the Jewish analysts has been well told elsewhere (Jacoby, 1983; Steiner, 2000; Frosh, 2009). As the debates of the secret Rundbriefe show, the ideas of these left analysts lived on for some years, even though the practical project of free clinics largely did not. Post-war psychoanalysis largely ‘forgot’ its radical potential and social openness in the increasing conservatism and professional marking out of territories of much American and British practice, legacies which are still with us.
The Vienna clinic had more of a struggle to establish itself than the Berlin one, but faced similar issues. Danto places it firmly in the context of the post-war social democracy of ‘Red Vienna’, the widespread poverty, and the ferment of revolutionary and activist thought. She names this ‘an exceptional nexus of ideology and practice’ (Danto, 2005: 31). The new city government promoted municipal welfare facilities of many kinds: child guidance clinics, sanitation, community health centres, educational reform, housing and leisure facilities. Many young prospective analysts, radicalised by the political context, were keen to learn and apply psychoanalysis to progressive social causes. Among these were Reich and Fenichel who attended the weekly meetings of the Vienna Psychoanalytic Society. Despite the favourable political climate, there was much resistance to the proposal for a free psychoanalytic clinic from the conservative medical and psychiatric establishment who distrusted psychoanalysis as a method of treatment, a recurrent issue throughout the history of psychoanalysis. Freud was much more ambivalent about the prospective Vienna clinic than the Berlin one, fearing that it would depend too heavily on himself and his name, distrusting anyone to run it well, and also wanting to keep psychoanalysis politically neutral (Danto, 2005: 65).
Finally, after two years of persistent petitioning, Eduard Hitschmann, a friend and colleague of Freud’s, obtained a licence for the clinic by promising that it would not compete for patients with the psychiatrists, illustrating the economic forces at work. He also agreed that only medically qualified analysts would work in it, an issue that was to dominate psychoanalytic societies in many countries. Even so, there was a subsequent attempt to close it down. The clinic opened with a staff that included many of the younger generation of left analysts. Between 200 and 250 patients per year registered with the clinic, a demand in excess of what could be met. Hitschmann (1932) records that over ten years 750 patients were analysed, with 40–50 analyses in progress at any one time, again an impressive figure. Hitschmann’s table for the multiple diagnostic categories used shows that sexual impotence, anxiety hysteria, obsessional neurosis and shyness were the most common. Rules for the clinic meant that only very poor non-paying patients could be treated, and the occupational figures Hitschmann gives support this. Every member of the Vienna Psychoanalytic Society donated either time or money to the clinic.
At the outset a separate unit was founded for work with children. Many of the analysts participated in outreach work in various progressive educational projects and youth services,4 again illustrating the desire for engaging psychoanalysis with the social world. In 1929, a new department was founded for patients with borderline and psychotic diagnoses, many of whom were treated psychoanalytically, sometimes with modifications of method. It is striking that at both clinics, widening access to psychoanalysis led to the recognition that different forms of psychoanalytic treatment were needed for the more disturbed patients, leading to many innovations.
Although the Ambulatorium had to battle for its survival, nonetheless it gave rise to many fertile clinical discussions and innovations, as part of its weekly meetings. It was where Reich especially pioneered ideas and practices that still endure. The clinic and the training institute, founded in 1924, were closely connected, but separate enough to allow the training of non-medical analysts. Helene Deutsch (1932) records how under the pressure of the number of applicants to the clinic, the need to train more analysts grew ever greater. Grete Bibring-Lehner describes the transition from the earlier informal and ad hoc discussions to the introduction of a regular group seminar on therapy and technique, as well as yearly reviews (Bibring-Lehner, 1932). The need for such a seminar also arose from how clinic work confronted analysts with many challenges to established practice, with various difficulties in treatment and different patterns of distress (Diercks, 2002). This is a familiar consequence of widening access.
Reich, who was deputy director of the Ambulatorium from 1924 to 1930, and in charge of the technical seminar, thought that it was important to learn from difficulties and failures in clinical work, and to create a forum where analysts felt able to discuss these, an innovation at that time. He describes in Character Analysis (Reich, 1945) how patients who came to the clinic often did not suffer from the classic neurotic symptoms, did not realise they were ill, and often did not follow the analyst’s invitation to freely associate. Reich described antisocial, uninhibited and instinct-driven men, whose ego he saw as remaining infantile and fragmentary, very different from the repressed middle-class neurotics of previous case histories. He also argued that analysts, despite their theoretical knowledge to the contrary, considered resistance simply unwelcome, and would try to challenge or subvert it, rather than understanding how the neurosis is contained in the resistance and needs to be brought into the analysis. Negative transferences were common, and great skill was needed in the timing of interpretations; the established analytic rules about interpreting all material whenever it surfaced had to be adapted to what the patient was able to make use of at any given point in the analysis. Reich also argued against too much analytic passivity and silence. Such need for adaptability in approach, for a wider understanding of the sources of distrust, fear and resistance, is a common, if sometimes disputed, feature of most contemporary projects attempting to widen access to psychoanalysis.
The Vienna Ambulatorium survived until 1938 when Austria was occupied by Nazi Germany and most of the remaining analysts fled. Unlike the Berlin Poliklinik, which was aryanised and which offered Nazi-approved therapy, the Vienna clinic closed completely. Recently, however, the Ambulatorium has been reopened and continues, with some state funding, to offer free and low-cost psychoanalytic psychotherapy (Diercks, 2002).
Danto records how some of the analysts who went to the USA did establish free clinics in two places (Chicago and Topeka), but that largely the project of a more class-inclusive psychoanalysis was not continued. Instead, in the more conservative post-war period, the notion that working-class people were not suitable for psychoanalysis took increasing hold, in both the USA and the UK, and they were mainly offered physical and pharmacological treatments. Some of the original ideas and activities, especially the outreach ones, persisted: in the Hampstead nurseries in London, for example, and within progressive education generally, and also, as Danto suggests, in psychoanalytically informed social work. It was only with the social movements of the 1960s and’70s that accessible free or low-cost community clinics arose again, in a great variety of forms.
However, low-cost clinics attached to training institutes and providing patients for trainees did become and are now common, as the history of the London Clinic, founded in 1926 and continuing today, exemplifies (Crick, 2016). For some years this clinic did take some patients funded by the NHS, although the British Society had previously decided not to become part of the medical organisation of health care. Crick describes the long-running tensions between the needs of the clinic to provide suitable patients for analysis for unpaid trainees and the needs of intending patients, many of whom may not fit the selection criteria. Social obligation has to some extent inspired the clinic, and many low-cost analyses have been carried out, but the priorities of the training have been primary.
The ideas that informed and that were generated from the original clinics do however continue to be debated. Reich and Fenichel are of particular importance in articulating class in relation to psychoanalysis and the quest for a more social form of psychoanalysis. There exists a large and mainly theoretical literature of and about Freudo-Marxism; the purpose here is not to attempt an evaluation of this, which has been done many times, but rather to focus on the ideas of these two analysts whose practice was firmly rooted in the free clinics. Fenichel indeed argued that the schism between culture and instinct (drive) had to be seen as existing dialectically, and could be merged only in practice, as at the free clinics (Danto, 2005: 284), an argument that has informed much of this book.
Reich’s innovations as regards technique, based on his work in the Ambulatorium, became part of many analytic trainings, although insufficiently credited to him. His political commitments and activities earned him dismissal in 1933 from the Berlin clinic (where he had moved in 1930) and the International Psychoanalytic Association, at the same time as he was expelled from the Communist party for his psychoanalytic interests.5 It would be a mistake to split the clinical Reich from the political one, as is often done. His energetic engagement with the intricacies of psychoanalytic work in the clinic were part of his passion for the value of psychoanalysis in understanding the structure of individual misery within society and in informing political struggle. Reich is often rightly criticised for the direction he took in making orgasmic sexual activity so central to his notions of psychic health, and for the biologistic nature of his theo-rising, which led him and his followers to privilege naturalistic ideas of heterosexuality and gender. Despite this, there is much that can be learned from Reich’s earlier writings on the intersection between psychoanalysis, class and politics. His ideas emerged from within a social context of great poverty, huge moralistic disapproval of young people’s sexual curiosity and desires, widespread sexual ignorance and repression, and little availability of contraception, abortion or privacy. In both the Berlin and Vienna clinics, impotence was one of the most common presenting symptoms (Eitingon, 1923; Hitschmann, 1932), indicative of the widespread nature of sexual repression and anxieties.
Reich argued that any political party or campaign had to start from the everyday concerns of ordinary life, including personal and sexual matters, and also housing and leisure. Reich saw psychoanalysis as able to illuminate the kinds of struggles people grappled with to live fulfilling lives, where both external conditions and internal repression could conspire to keep people afraid, confused and subject to mystifying ideologies, such as religion and ‘tradition’. He, along with many of his contemporaries sought to understand why the German Communist revolution had failed, when the conditions had looked promising, and also, later, why national socialism and fascism were able to attract so much popular support. The notion of basing political analysis and activity on people’s everyday concerns brought Reich into conflict with the more Leninist ideas of correct political lines that could be imposed on the masses by party cadres. He wrote Dialectical Materialism and Psychoanalysis (Reich, 1929/1960) to defend psychoanalysis against Communist criticisms, making clear it did not have to be an inappropriate psychologisation of social issues, which error he attributed to some psychoanalysts. This argument reappeared in the political movements of the 1960s and 1970s, when there was a resurgence of interest in Reich’s ideas, in using psychoanalysis to understand and oppose the workings of social oppression, and to create alternative and more inclusive forms of therapy.
Reich put many of his ideas into practice in outreach work and in Sex-Pol. He and other analysts and doctors would speak about sexual concerns, about the politics of everyday life, and would give advice about mental health. Later, individual therapy sessions were provided. It was ‘a blend of psychoanalytic counselling, Marxist advice, and contraceptives’ (Danto, 2005: 118) and very popular. Calling for a politics of everyday life, Reich could show ‘how to relinquish preconceived class barriers and allow the individual to emerge from class constraints’ (Danto, 2005: 116). Along with this practical work Reich engaged in theoretical debates about how psychoanalysis and Marxism could be synthesised.
All the left analysts of the time saw psychoanalysis as the study of individuals in a given society, with social structure reproduced in psychic structure. Importantly, and especially for consideration of the subsequent ideas of contemporary psychoanalysts (see Chapter 8), Reich saw this process not as one of mirroring nor as direct structural reflection, but of the anchoring of the social order in individual character structure, via the vicissitudes of libidinal desire. He used this to explain how and why the exploited sections of the population tolerate or identify with the ideologies of the powerful upper social classes, often at the expense of their own apparent interests – an abiding political question. Reich argued that there was no simple or mechanistic connection between economic structure and character structure, but rather that the forms of sexual repression and inhibition common to different strata of society made some groups, because of their differing relationships to authority within the family, more accessible to nationalistic and fascistic politics. In The Mass Psychology of Fascism (Reich, 1933/1970) Reich argued that the right made much more use of ideology – people’s emotions, beliefs and attitudes, their needs for identification with a strong figure – than did the left, who at that time thought that only objective conditions and correct political analyses would be effective in creating resistance and revolution.6 We can see echoes of this in current political debates.
Reich emphasised the contradictoriness of the dynamics of conformity and rebelliousness, as well as the power of identifications with upper-class figures. While the family structures and forms of sexual repression that Reich saw are no longer so common in modern Western societies, his analysis is still relevant (as I have found in teaching) to contemporary patriarchal societies with high degrees of sexual suppression and ignorance, and gender oppression, in which religion, which Reich saw as a mystical solution, plays a dominant role. Reich’s ideas, especially the use of psychoanalysis in political activism, have had a huge after-life in subsequent social movements, also inspiring new forms of radical and socially conscious therapy.
The writings of Fenichel are less known, yet there is much of relevance to any modern concern with psychoanalysis and class. Fenichel was close to Reich in the early years of the Ambulatorium and later often supported him against the increasing criticism of Freud and other analysts. Eventually however he broke with him. Fenichel himself illustrates many of the difficulties in achieving what was his consistent project, that of a variously social or Marxist psychoanalysis, neither culturally nor biologistically reductionist, which retains the depth and complexity of classical psychoanalysis, but which also includes and integrates what he called ‘the social factor’. Jacoby (1983) records both Fenichel’s enduring loyalty to Freud and classical psychoanalysis, and his equally enduring pursuit of the bridge between this and Marxism. ‘For Freud, against Freud’ appears to sum up his loyal opposition. However, impressive as Fenichel’s efforts were in convening discussion groups of left psychoanalysts, in his own political writings and later in the Rundbriefe of exile, his extensive clinical articles are mainly devoid of any reference to social factors. He seems to have kept the two strands of his interests largely separate, creating, as Jacoby says, a bifurcation in his work. This was perpetuated by the omission of his political and social concerns in Simmel’s obituary of him (Simmel, 1946), written in the context of the psychoanalytic diaspora in America, the developing panic about communism, and the conservatism of American psychoanalysis. In such ways was the amnesia concerning the radical socially committed aspects of psychoanalysis enacted.
In the Rundbriefe7 Fenichel trenchantly criticises both the ‘flat culturalism’ (Jacoby, 1983: 106) of the neo-Freudians such as Karen Horney, the biologistic reductionism of the more conservative analysts and the sexual reductionism of Reich. In doing so, he leaves himself little space between all these poles of error for a more positive evolution of ideas, or any resolution of the conceptual issues involved. He was ‘fighting against two fronts’ (Jacoby, 1983: 87), against those analysts who had no appreciation of social reality and against Marxists who denied individual psychic formations and the role of the unconscious – a difficult position familiar to later generations of political radicals concerned with therapy. However, Fenichel argued that psychoanalysis and Marxism could only be conjoined in practice and not solely theoretically, confronting scepticism with solid work. This is an important argument that has not had the attention it deserves. It foregrounds the materiality of individual suffering and the foundations of psychoanalytic knowledge in clinical practices. Fenichel did indeed devote much energy to the running of the clinics and especially to devising appropriate methods of recording their activities and the characteristics of their clientele. Such data was used to establish the public transparency needed for the wider acceptance of psychoanalysis, something of renewed importance now.
However, these two strands of Fenichel’s thought did come together in some writings where he argued both for the universal applicability of psychoanalysis and for the importance of differences arising from social circumstances (Fenichel, 1934).8 He thought that the Oedipus complex had to be understood socially, within the history and function of the family, and that specific experiences gave rise to neuroses, at the same time as asserting the universal validity of psychoanalytic laws within a capitalist society. He argued that ‘the neuroses of our culture are amazingly similar in all classes; that some differences which do nevertheless exist lead back to differences in the living conditions of middle-class and proletarian children’ (Fenichel, 1967: 310). He continued that, due to the proposition that the ideology of a society is the ideology of its ruling class, the ‘moral views of the proletariat are everywhere amazingly like those of the middle-classes, in any case similar enough to allow a man [sic] of broad sympathies to make contact with people belonging to different classes’ (Fenichel, 1967: 310).
This latter point of Fenichel’s raises but does not explore the intricacies of cross-class relationships, something I address later in contemporary accounts of class within therapy relationships. The notion that ‘broad sympathies’, now perhaps rendered as empathy, were needed is a necessary starting point. However, in the light of modern considerations of power, knowledge and discourse, and of the psychic structurings of class, such sympathies alone are insufficient, as later chapters illustrate. Nonetheless, the achievements of the free clinics were such that working-class people did find it possible to make use of psychoanalysis, and much of this was due to the conviction of their founders as to the general applicability and value of psychoanalysis, as well as to their political concerns with the inequality of access. The argument, novel at the time, that those in oppressed circumstances may adopt dominant ideologies is now familiar to any conjuncture of psychoanalysis and politics, with concepts such as interpellation, internal oppression, identification with the aggressor and recently normative unconscious processes (see Chapter 8) put forward as explanatory mechanisms.
In an article about money still cited today (see Chapter 9), Fenichel lays out an extended argument about the interaction of historical and economic factors with the instinctual drives and psychic structures of individuals (Fenichel, 1938). Capitalism, he argues, modifies instinctual structures, creating the drive to amass wealth; it makes use of instincts but is not a product of them. He argues strongly against the over-psychologisation of the desire to become wealthy, seen by many contemporaries as reducible to anal eroticism. Rather, such unconscious motives, which he elaborates at some length, are harnessed by the social system. The dynamics of capitalist systems, with their relentless pursuit of profit, are the external conditions under which individual desires and motivations exist. Capitalism, understood as an autonomous social force, makes the pursuit of wealth both a rational and a neurotic activity. Fenichel asked how a society avoids rebellion, when the majority cannot ensure their basic needs but wealth abounds, and concluded that as well as force, the ‘cunning’ trick was to produce a drive to accrue wealth with fantasies of a better future, creating identifications with richer people. He argued that ideologies of thrift (today’s austerity) functioned to obscure true class interests, and to create illusions of personal advancement (today’s ‘strivers’).
This chapter has outlined the intense and creative engagement of these left analysts with the aim of a class-inclusive psychoanalysis, and the popularity of this project. This history is a welcome if insufficiently known counterweight to the blanket stereotyping of psychoanalysis as only concerned with the privileged. That it was crushed by fascism and did not re-emerge in the conservative post-war period illustrates the ways that psychoanalysis itself is part of any particular historical moment. Such political contextualisation, which most psychoanalytic education tends to ignore, is part of what is needed in the evolution of any more inclusive project. What we can also learn is how much detailed commitment and struggle is needed to make such projects happen, how fragile they can be to changing political circumstances in a world where resources are so unequally distributed and where opposing vested interests may be at stake. This is a story that repeats over and over in later contexts.
We have further seen how the placing of psychoanalysis in working-class contexts provoked questions concerning its clinical practices and produced many innovations. In this way, the enlargement of the social reach of psychoanalysis can enhance its wider practice, and inform the mainstream (were it willing), a process which is still evident in the many new understandings arising from modern critiques concerning gender, sexuality and ‘race’. Like the free clinics, these have led to practical clinical projects as well as theoretical challenges. The free clinics also raised questions of how the social world can be represented within psychoanalytic theory and whether its laws can be assumed to be universal.
The limited clinical data from these clinics, as well as the theorising of psychoanalysis at that point in time, does not allow much insight into how class may have entered into clinical material, including the therapy relationship itself. Rather, this has mostly emanated from modern attention to the dynamics of the therapy relationship, and to greater reflective awareness of the cultural assumptions and subjectivities of the therapist, as I address later. Further, despite their explicit concerns with extending the reach of psychoanalysis, these radical analysts did not question some of the premises on which psychoanalysis was based. I argue next that it is these founding premises which embed the theoretical disarticulation of psychoanalysis from the social world, leading to its disavowal of class.
1 At least to non-German speakers.
2 See Engstrom (2005). Other reviewers, e.g. Altman (2006), Roazen (2006) and Fisher (2007), are much more positive. I have found Danto’s immersive chronological detail very evocative but also difficult to extract themes from. Her positive assessment of Reich’s substantial contributions to the clinics may fuel criticism, given how he has been written out of much psychoanalysis.
3 This slightly confusing name derives from how these analysts saw themselves as children of Freud, not that it concerned the analysis of children.
4 Anna Freud, who later founded the Hampstead War Nurseries, also participated in such work, as did many of her subsequent colleagues.
5 This illustrates the narrow space available for a politically committed psychoanalytic practice, something not confined to Reich’s case, see e.g. Plotkin (2011) for Bleger’s experiences in Argentina.
6 This capturing of the emotional territory of political arguments by the right is seen for example in anti-abortion campaigns, in the current right-wing assault on people on welfare benefits, in Brexit debates and in the popularity of Trump.
7 My references to the Rundbriefe are only to the ones translated into English or referred to by Danto (2005). The bulk remains untranslated and, as far as I can ascertain, uncommented on.
8 Although, as Jacoby shows, only in the introduction to this classic work.
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