“As a social-democratic town councilor, Dr. Friedjung has furthered our interests as psychoanalysts”

1931

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 psychoanalyst’s Poliklinik. Of course the analysts had their own exclusionary, and some critics would say elitist, practices. The grueling four-part admissions process consisted then, as today, of interviews designed to assess the candidates’ personal motivation, capacity for empathy, and general equanimity—and to screen out individuals deemed unfit to treat others because of their particular neuroses. Grotjahn never forgot his admissions review. First came the interview with Max Eitingon, described by Grotjahn as a “shy, small man with a slight stammer,” who afterward discreetly offered him financial support.¹ Next came the interview with the clinic’s assistant director, Karen Horney. Horney’s seven cats slept on the one comfortable couch in her office and her desk was piled so high with papers and manuscripts that Grotjahn felt both amused and a slightly wicked need to tidy up. Horney herself said very little. When Horney left, an elderly bald man with an enormous beard interviewed him, all the while staking out his own vehemently antipsychiatric position. Any student of theology or anthropology would bring a more open mind to the study of psychoanalysis than a psychiatrist, he said, but nevertheless he refrained from disqualifying Grotjahn entirely. The interviews culminated in a dramatic entrance by Wilhelm Reich, who asked a few questions without even sitting down and generally seemed to regard the interview as a silly formality. Grotjahn’s candidacy was approved and his training analysis soon underway with Ernst Simmel.

At the center of Grotjahn’s account of his training analysis lies a startling metaphor for that era—the cold use of cash. Ernst Simmel had a reputation as a technically meticulous analyst with radical politics but traditional scruples. His waiting room was noteworthy for its massive plain oak table designed by Ernst Freud and the glossy picture book of Charlie Chaplin. Now, however, Simmel insisted on being paid in cash. This kind of expedience was uncharacteristically cynical for him, but, then again, cash resources alone would make escaping the Nazis possible. His conduct was redeemed when, suddenly, in Grotjahn’s fourth month of analysis, the peace of the daily session was shattered by a telephone call. A friend inside the Alexanderplatz precinct house had got wind of a Gestapo sweep and alerted Simmel that the secret police would shortly be sent his way with imminent arrest and a death threat. Grotjahn helped his analyst flee the Nazis by pushing him out a window into the backyard. In contrast, Felix Boehm, a non-Jew who remained at the Berlin Institute after its aryanization in 1933, also demanded cash, raised his fees, was constantly short of money, and often sent his maid to fetch his payment before it was due. In times of receding or less visible anti-Semitism, the analysts had carefully resisted the impact of such tensions on the Poliklinik. Now, with the Nazi presence in the treatment rooms, lecture halls, and seminars increasingly obvious, the analysts’ sense of democracy and openness was fraying. Germany’s economy had plummeted, violence roamed the streets, and the psychoanalysts were no safer (physically or financially) than anyone else. At a discussion of the Institute’s deteriorating finances the Berliners resolved that, among other measures, candidates in training analysis should make a monthly contribution to the Institute equivalent to the analyst’s fee for a single session. “The total fee of patients at the Poliklinik who become able to pay for analysis,” the Berlin society decided, “shall be handed over to the Institute.”² Nevertheless, when Barbara Low, in London, reported to the British society on her visit to Germany and the recent sociological and pedagogical activities of the Berlin society, she emphasized the public activities of the members.³

Faced with censoring rejection from within the IPA and with surveillance and penalty (or worse) from outside, Fenichel “called all left analysts in Berlin together in order to discuss,” in a take on Lenin’s famously pragmatic question, “what was to be done.”⁴ The IPA actively sought to moderate Wilhelm Reich, Otto Fenichel, and their Children’s Seminars group’s resolutely left-leaning approaches to therapy of internal and external worlds. Fenichel was removed as editor of the Zeitschrift and Reich’s 1931 article on masochism was rejected without a disclaimer. But the IPA offensive only solidified their position. The group began to meet, regularly though informally, at Reich’s house. For the first time since 1919, when Reich, Fenichel, Lehner, and Bibring had convened after Julius Tandler’s class to discuss controversial topics outside Vienna’s mainstream medical curriculum, the two leaders found themselves recreating the structure of a leftist caucus. Recently returned from a study trip to the Soviet Union, Fenichel helped the group integrate Reich’s formulations into a Marxist-Freudian synthesis, plan rejoinders to the increasing political conservatism in the psychoanalytic journals, and explore the possibility of a new organization. In 1931 the friends could still devote their evening discussions to investigating the relationship between psychoanalysis, religion, and education in order to make clear the hazardous impact of what Fenichel dubiously called the “bourgeois-analytical viewpoints.” After 1933, however, the group would assume a new appearance: it became a loosely organized network of psychoanalysts in exile, unified by their belief in psychoanalysis as dialectical materialism and bound together by Otto Fenichel’s epistolary energy until 1945.

As the campaign against psychoanalysis (and other modernist venues) intensified in Germany and Austria, the Budapest city government seemed to rediscover its interest in the free clinic it had abandoned more than a decade earlier. On December 18, 1931, the municipality granted the analysts permission to open a polyclinic called the Allgemeines Ambulatorium für Nerven- und Gemütsskranke (General Ambulatorium for Nervous and Mental Patients).⁵ Even after a full year of negotiations, the Ministry of Public Welfare still felt obliged to pacify the entrenched psychiatric establishment. “Since psychoanalysis is not an independent science but a part of general psychology and neuropathology,” the local Budapest official said, “the [psychoanalytic] Association must express this in the title of the polyclinic.” They agreed to call the clinic “simply a clinical agency for nervous and emotional illnesses in which, among other things, psychoanalysis is practiced,” Ferenczi wrote to Freud.⁶ In the end, the same government that had so vociferously impeded the clinic now inaugurated its opening with a laudatory address by the honorable Dr. Rostagni, town clerk. While the short opening program was perhaps more of a public relations gesture than a celebration, nevertheless Ferenczi recounted the history of the psychoanalytic movement in Hungary with joy. Bálint outlined the therapeutic work of the clinic and Hermann its training functions. The future held tremendous possibilities for child analysis, Margit Dubovitz said, despite the recent closing of a child protection society’s psychoanalytic clinic. Alice Bálint, a former classmate of the celebrated infant developmentalist Margaret Mahler, would analyze children there. Istvan Hollós, a master administrator as well as clinician, shed a positive light on the relation between psychoanalysis and psychiatry. The Hungarian society collectively invited Dr. Ferenczi to assume the directorship of the clinic with Michael Bálint as deputy and Drs. Imre Hermann, Istvan Hollós, and Zsigmond Pfeifer providing consultations.⁷

In every respect 12 Mészáros Street (figure 32) was a central location for a free clinic in Budapest. Michael Bálint, Vilma Kovács, and her eldest daughter Alice (who later married Michael Bálint) happened upon the space in an imposing building at the intersection of Mészáros and Ag streets. The building, with its classical apartments and outer corridors on every floor, belonged to Vilma’s husband, the architect Frederic Kovács. At the center of this typical Hungarian residential building was a squared courtyard where patients could easily find their way to the clinic’s entrance on the ground floor. The concierge’s children playing in the open yard rarely ventured to the clinic at the back left-hand corner of the courtyard, but occasionally the elderly lady herself would limp over, child in hand, and admit patients through the thick double doors during the daytime. The society had rented the five-room apartment out of its own funds and remodeled it into treatment rooms and a meeting area off the foyer. In the relatively large vestibule, one could see conference programs on flyers pinned to the right-hand wall, read an issue of Gyógyászat (Therapeutics), the journal edited on the premises, or simply select a chair from the two rows in the waiting room. The vestibule also functioned as a conference room, and a curtain could be pulled between the rows of chairs, one side for patients waiting to see their analysts, the other for perhaps an administrative meeting. Since the treatment rooms opened onto the waiting area, no effort was made to stop patients from meeting other friends and analysts, with the ultimate effect of developing the same sense of community as at the Berlin Poliklinik. Dr. Endre Almásy lived in a room off the clinic in exchange for a quasi full-time position as assistant.

In the hands of lay men and women like Edith Gyömröi, who would later join Fenichel’s Berlin group of activists, the Budapest polyclinic expanded quickly. Patients paid very very little, maybe five pengö per session or nothing at all, and the analysts worked for free. Most analysts accepted referrals from their city’s social service agencies, but the smaller, more private Budapest clinic accepted adult and child referrals only from physicians. The very first patients at Meszaros Street were, in fact, children. One tall pale girl, from a family so poor they ate nothing but potatoes morning, noon, and night, was brought to the clinic faint from crying for days. Her younger sister seemed fine, more concerned about her sibling’s sadness than her own lack of food. “We tried to understand why the two children reacted to the same event so differently,” said Judith Dupont, now a psychoanalyst in Paris.⁸ Most analysts explore individual motivation and support the patient in varying degrees during this process. In Budapest you could see a new kind of psychotherapy evolve just by standing in the waiting room of the clinic, in part because of the intensity of Ferenczi’s influence and in part because more children were treated there than adults. The psychoanalysts pressed for, and obtained, a new child protection agency, a worker’s education program, and a social service center. Unfortunately, once society members finally secured government permission to open the clinic (an important achievement any time but especially significant when “the antirevolutionary and Catholic reaction [was] at the height of its power,” as Ferenczi observed to his colleagues), angry words broke out with little warning.⁹ The pressure of all this work caused squabbles to erupt among the staff and even outside the clinic. Local officials who had supported their efforts showed signs of dissent. Some of the more senior analysts ridiculed the industriousness of the junior, and mostly female, physicians and even withdrew their support for the clinic. Imre Hermann resigned as secretary. Within days of the opening, the analysts had turned on each other their anger at the Budapest professional community and the State Health Council, where, as Ferenczi told Freud, “every medical forum that was asked [for support] was rude and disdainful.”¹⁰ Friction also erupted between Ferenczi and Eitingon, with accusations of envy, pleas of poverty, and demands for sacrifice volleyed between Berlin and Budapest. But loyalty prevailed. This loyalty to the “cause” and to Freud was necessarily fragile and at times seemed to fragment. Nevertheless, in 1931 the Budapest analysts still held fast to the challenge their leader had proposed during the more festive aura of 1918.

32 Doorway of the Budapest Clinic, Apt. no. 5 at 12 Mészáros Street (Judith Dupont)

Freud cultivated this loyalty unabashedly. He had decided to entertain a number of prominent Viennese Social Democrats and initially invited Josef Friedjung to celebrate his sixtieth birthday with a Sunday tea at the Freuds in October. No longer an active member of the City Council, Friedjung nevertheless maintained his threefold involvement in psychoanalysis, academic pediatrics, and child welfare. The child analytic work he undertook at the Ambulatorium, combined with his advocacy efforts among Vienna’s lawmakers, endeared him to his colleagues. “Dr. Friedjung’s interest in social questions,” Hitschmann recorded in the IJP, and “his love of fellow-men caused him to enter politics and, as a social—democratic town councilor, he has exerted a beneficent influence in municipal affairs and furthered our interests as psychoanalysts.”¹¹ Friedjung gladly returned the compliments and, unlike Freud, never hesitated to single out particular political qualities responsible for his colleagues’ effectiveness as an advocate. Friedjung, Hitschmann, and Paul Federn had been friends from their schooldays and remained faithful to each other throughout their involvement with Vienna’s experiments in social democracy. “Their alliance was not without importance in their city, all three having a reputation amongst medical circles there for sound training and early successes in practice,” read Federn’s IJP notice on Hitschmann’s sixtieth birthday (July 28, 1931).”¹²

Indeed, since the early 1920s, and especially since their joint appointment on the City Council’s child welfare funding committee, Freud and Julius Tandler remained in touch. They met periodically to discuss civic projects like the Bernays’s child welfare program and, most likely, the Ambulatorium. “It is uncanny in such an old man, this vital strength, this sexual strength,” Tandler wrote of Freud. Freud was “without a doubt a person who influences his time,” Tandler said, and there was little controversy over his role in Vienna. “He is a person who is only accountable to his own law…. If he were not a Jew he might be Bismarck.”¹³ The greatest of these compliments was the allusion to Bismarck, the architect of social insurance and, for Tandler, the ideal social welfare administrator. Freud was impressed by the Social Democrat’s ongoing campaign to fight rising unemployment with its controversial distribution of municipal layettes to jobless families. In his personal diary of November 29 he noted that his letter to Julius Tandler had been printed in that morning’s Neue Freie Presse. The letter proposed a fund-raising strategy that he had found effective in his various efforts to rescue declining psychoanalytic projects. People should be urged personally, he wrote, to pledge a regular sum to be collected on a weekly basis. Freud promised to contribute twenty schillings per day, except Sundays.” We hope many will be found who will possess the same high degree of awareness of their social obligations,” the Presse’s editor commented, “as this internationally known Viennese scholar.”¹⁴ In fact this was Freud’s characteristic course of action by 1931. “Being poor is no disgrace today,” he wrote to Paul Federn as an explanation of his financial gift to the Ambulatorium.¹⁵ Freud had accepted the Vienna society’s gift of a handsome portrait bust by the sculptor Oscar Nemon and went on to acknowledge the members’ “sacrifice at a time in which financial burdens worry us all.” Then he said that, since he could not reimburse the society for its gift, he would like to see the three thousand Austrian schillings (about four hundred dollars on the official currency exchange, according to Ernst Federn) “used for the benefit of our Clinic and Training Institute.”

Vienna’s public health facilities such as nursing homes and tuberculosis clinics were brilliantly administered by Tandler, but their financial support was as likely to come from America as from the Rathaus. The Rockefeller and the Commonwealth Foundations were, just then, particularly keen on helping European medical institutions. But their generosity came with a social agenda. Maggie Wales, a handsome Bostonian woman, had been sent overseas by the Rockefellers to investigate exactly where the medical dollars went in various Austrian cities. Coincidentally, she was a friend of Edith Jackson and in February the two old acquaintances met for an evening of “opera and café.”¹⁶ Jackson was then attending Anna Freud’s seminar at least four evenings a week from nine until midnight and thought Maggie might be interested. Actually psychoanalysis did not fit with Maggie’s current agenda, but she was hardly opposed to the clinical world that enthralled her friend. By then Anna Freud was immersing her students in child development theory. Anna’s seminars came alive with case examples drawn from her analytic practice, and from the Heitzing school project she intimately led with Dorothy Burlingham and their partner, Eva Rosenfeld. Eva, whose analysis with Freud gave her enough self-assurance to separate from her husband, had recently left Vienna to work with another member of the psychoanalytic circle, Ernst Simmel. In August she accepted the salaried position of house manager for his perennially failing sanatorium near Berlin and helped with its dissolution in 1932.

“Who are the seriously ill patients? The morphine addicts or the melancholics?” Anna demanded to know. “And what are the doctors like?” she asked Eva.¹⁷ On the one hand Anna delved into Simmel’s project with a seemingly prurient curiosity on the other hand she saw with discerning clinical acumen the myriad therapeutic conflicts that could impede solid patient care. One problem was the analyst’s own risk of burnout. “I think that the most difficult thing about dealing with the kind of patients you have in Tegel must be the disillusionment associated with the question of how much pure and how much merely applied psychoanalysis they need and can stand,” she wrote to Eva. The second problem, the risk of inaccurate assessment of the patients’ capacity to tolerate the anxiety provoked by analysis, was even more grave. Gauging a prospective analysand’s anxiety level was a critical factor in determining the success or failure of treatment, and only seasoned analysts like Ferenczi, Aichorn, and Simmel could rightly be trusted with this assessment. If less experienced clinicians were in charge, Anna worried, a symptom like agitation might be misread as energy, or dejection as simple depression instead of psychopathic withdrawal. Drawing an interesting link to child analysis, she suggested that the risk to psychotic people is compounded because, like children, they cannot recover on their own and additionally they lack the child’s natural optimism. Unfortunately, because Tegel’s minimal budget demanded low-priced personnel, most patients were treated by young inexperienced analysts, possibly interns, under Simmel’s supervision. Could Simmel possibly have the time to teach, analyze, and administer the program simultaneously? “An enterprise that can only be kept going when people are fed into it to be devoured and annihilated by it,” wrote Anna Freud, drawing a dramatic analogy between the sanatorium and a child’s fairy tale, “is not viable in this day and age. This is how dragons were served in the olden days.”¹⁸ Could Eva sustain Tegel on hard work alone?

Eva Rosenfeld’s title of “Matron” was, as she said, “two-fold—to deal with the financial crises brought about by the crash of the Danat bank on the one hand, and to cope with the therapists, patients and nurses in the other. The latter might have been possible, although the work required immense physical resources: there were no lifts, nor any relief from the everlasting foot marches along the stupendous corridors—but the financial strain could not be borne.”¹⁹ As long as daily expenses were covered for the large number of patients, everyone was still hopeful. Financing the Schloss Tegel clinic had been worthwhile but difficult from the start. In its brief life Ernst Simmel had acted on his clinical vision, to apply psychoanalysis “for the relief of those patients whose extremity is greatest and who hitherto have been condemned to death in life.”²⁰ And, true to Freud’s Budapest speech, it was funded as a private charity by large Viennese and Berlin companies and by members of the Berlin society. Freud had supported the institution both morally and financially. Repeatedly, he urged his IPA colleagues to “preserve this instrument for our movement and make it available for future work.”²¹ Though Dorothy Burlingham, Raymond de Saussure, Marie Bonaparte, and others did join the fund-raising effort, ultimately the facility, which had declared bankruptcy in the fall of 1929, actually closed in 1931. The institution’s buildings are gone today, though the actual Tegel castle and its red brick barns remain. And in recent years the lovely sloping park, where Anna Freud and her father each found a peace they could call their own, has been reopened for all to savor its ordinary walks.