Freud's Free Clinics: Psychoanalysis and Social Justice, 1918-1938 (review)

Against the background of today's multiculturalism and identity politics, Freud's emphasis on the individual sometimes seems conservative, but Elizabeth Ann Danto situates psychoanalysis in the context of the breakdown of nineteenth-century class society, where its inherent radicalism clearly emerges. The psychoanalytic emphasis on individual emancipation, she demonstrates, had a natural relation to social democracy, women's emancipation, and modernist cultural experiments. The result is a profound revision, not only of our understanding of the history of psychoanalysis, but of twentieth-century medicine as well.

Whereas Carl Schorske's well-known work shows the importance of the modernist context of Adolf Loos, Gustav Klimt, and Gustav Mahler in establishing Freud's radical focus on sexuality and psychological interiority, not enough attention has been paid to fin de siècle Vienna's mutation into "Red Vienna." Thus Danto's book begins in Vienna in the years immediately following World War I. Vienna's social democratic government, responding to the breakup of the Hapsburg Empire, sponsored large-scale housing, educational, and public health reforms. Often these were combined with cultural experimentation—for example, with Schoenberg's "new music," or with modernist architecture or urban planning. Weimar Berlin provides Danto's other focus of attention. Given credibility by its unique response to the war neuroses ("shell shock"), psychoanalysis was integral to the political and cultural life of both cities.

Although Freud once described himself as a "liberal of the old school" (p. 226), Danto quite accurately portrays him as a social democrat, fully involved in many governmental efforts. As Professor of Social Work, Danto lays particular stress on the sensitivity of psychoanalysis to the social environment and on the significance of making it widely available. As the heir to an earlier tradition of atheistic, politically reformist doctors, Freud certainly grasped this significance. In 1918, he wrote: "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." As Danto shows, all analysts donated about a fifth of their time to free or low-cost analysis. Not just in Vienna but also in Berlin, London, Prague, Budapest, Zagreb, and elsewhere, psychoanalysts worked along with sympathetic governments or philanthropists to establish polyclinics, ambulatoria, and sex-education centers.

Since professional, institutionalized psychoanalysis had barely begun before World War I, Danto's work makes it possible to distinguish two ideal types of analytic practice: on the one hand, a socially aware, affordable, practical orientation closely linked to movements for social justice; on the other hand, the expensive, elite, mystified practice that developed in the United States after World War I, and that did so much harm to its cause and (according to some accounts) to some patients. Not incidentally, Freud's political awareness extended beyond social democratic issues to a critique of the "American century." Americans, he wrote to Ernest Jones in 1921, have little "'Gemeinsinn' [community spirit] and tendency for organisation . . . . [C]ompetition is much more pungent with them, not succeeding means civil death" (p. 81).

Danto not only uses the social and political history to illuminate the history of psychoanalysis, she also uses an essentially Freudian perspective on human nature to temper the utopianism of such psychoanalytic radicals as Wilhelm Reich. Thus, the social democratic reform impulse that followed World War I was not immune to anti-Semitism, reactionary populism, and nationalism and other atavistic appeals. These triumphed in Germany in 1933, of course, and in Vienna in 1938, where Nazism received a welcome that shocked even the Germans. The tortured and largely inadequate response of analysts to these events gives pathos to Danto's story, even as it brings out her central point more clearly than ever. The whole idea that medicine in general, and psychoanalysis in particular, could ever be separated from a politics based on social justice and cultural emancipation was a terrible one. There is no health for...