13 minute read
Elizabeth Danto Our Psychotherapy for the People
In September 1918, Anna Freud was in the audience at the Hungarian Academy of Science, in Budapest, on the day when Sigmund Freud offered to “review the position of our therapeutic procedure” (S. Freud, 1919/1955). This “review” would lead Freud to repudiate his earlier and far better-known writings from 1913 on fees and the psychoanalyst/ physician as a medical entrepreneur. With the end of the war, he said, “the conscience of society will awake,” and the new psychoanalytic perspective would advance a platform of modernist beliefs in achievable progress, secular society, and the social responsibility of psychoanalysis. Nearly four months later, when the Social Democratic Party won Austria’s first post-Monarchy election, the government would use its firm majority to promote a highly innovative program of community policies and to redesign virtually every municipal resource. Psychoanalysis fit in perfectly.
Yet even then, Freud worried that psychoanalysis was at risk of isolation partly because “our therapeutic activities are not very far-reaching.” Why? Because therapy was only one side of the psychoanalytic coin. Engagement with social democracy demanded the kind of activism that would mitigate social stigma and place mental health care on a par with physical health care. Poor people, Sigmund Freud (1919/1955) said, have “just as much right to assistance for the mind as they now have to life-saving help offered by surgery. …This treatment will be free.” This goal—psychoanalytic treatment provided for all in the context of a free clinic—would shift the provision of mental health care from the paternalism of individual charity to a broad social welfare paradigm, the welfare of society as a whole.
In the historiography of the psychoanalytic movement, descriptions of the clinics tend to frame them as mere adjuncts to their respective training institutes, essentially laboratories where candidates would find patients on whom they could exercise new skills and theories. Fortunately, we now have excellent primary source data that portray a more accurate picture—namely, that the clinics were started several years before the training institutes and functioned as community-based treatment centers. In Berlin, for example, the psychoanalytic Poliklinik opened in 1920 as an independent clinic at least three years before the advent of a training institute. In mid-July 1919, Max Eitingon, the clinic’s co-director, wrote to Freud:
Last Saturday, our association decided to open a psychoanalytic policlinic in Berlin next winter. We will therefore start our “psychotherapy for the people” without waiting for the state, itself rebuilding, nor for the generous impulses of an individual, to give us the means to pursue this goal . . . As a first step, most of the daily treatment will be provided by a number of experienced colleagues from our association, depending on the time available to them. (Eitingon, 1919/2009a)
In November, Eitingon (1919/2009b) announced: “Our Poliklinik is en marche.” Though it started with the treatment of adults, within two years of operation, the Poliklinik was accepting referrals from Berlin’s Child Welfare administration and treating children and adolescents.
Since the Social Democrats’ election in 1919, the party’s health and welfare department in Vienna had specified that the creation of a healthy nation called for healthy children. More than any other European Social Democratic Party, the Austrians emphasized youth and educational organizations (Rabinbach, 1978). These community services, said the psychoanalyst Josef Friedjung (1937), would combine health and mental health care to “immunize the soul of the child against the hardships of life.” Friedjung’s colleagues were ready. “Back in Vienna then, we were all so excited—full of energy,” Anna Freud told Robert Coles. “It was as if a whole new continent was being explored. We were the explorers, and we now had the chance to change things” (Coles, 1991). Their free clinic on Pelikangasse, the Ambulatorium, opened a Child Guidance Center. The analysts pushed for sex education. They were in the courts, in the hospitals, in journalism, and in the schools.
Traditionally, troubled children and adolescents who had difficulty reaching prescribed educational goals had been singled out or, worse, simply expelled from school. But under the de-stigmatizing rubric of “educational counseling,” and with August Aichhorn at the helm, they were offered accessible psychoanalytic treatment. A core organizer of the city’s childcare institutions, Aichhorn had already set up the local educational counseling offices in Vienna’s fourteen district youth offices. From the truant (and sometimes homeless) youths in his residential facilities, to the families treated at the Ambulatorium’s Child Guidance Center, to the indigent toddlers at the Jackson Nursery, Aichhorn and other analysts insisted that psychoanalysis would be made available to all. Aichhorn’s transformative perceptions of the inner lives of disturbed or delinquent adolescents were gained at the public clinics and remain influential today.
From 1922, the year it opened, until the 1938 Nazi Anschluss of Austria, hundreds of “office workers, shopkeepers and government officials—found help and an indispensable sense of well-being at the Ambulatorium for the destitute” (Hitschmann, 1927). Like the clients of their sometime rival Alfred Adler, the analysts’ target populations lived toward the western edge of the city; in contrast to the bourgeois dwellings inside Vienna’s “Ring” boulevard, the Ottakring district housed, physically and metaphorically, outsider groups of workers, immigrants, gangs, bohemians, and servants (Maderthaner & Musner, 2003). These were precisely the population clusters which would be denied access to psychoanalytic treatment were it not offered in the context of what Freud called a “social right.”
Whether by intent or historical circumstance, community clinics, child analysis, and progressive early childhood education all came on the scene in the early 1920s. Partly in response to the open lectures offered by Anna Freud, Alfred Adler, and Josef Friedjung, interest in child analysis surged among public school teachers at all levels. Anna Freud, for example, supervised a group of teachers engaged in a working collaboration between Montessorian and psychoanalytic pedagogies at the Volksschule Grünentorgasse, a primary school in Vienna’s ninth district. She applied her research based on hands-on practice to the three child-centered areas of education. Psychoanalysis, she said, would be used effectively to “1) critique existing methods; 2) extend the teacher’s knowledge of human beings; and 3) endeavor to repair [childhood] injuries” (A. Freud, 1930/1974a). She also led seminars with Aichhorn, organized the “Vienna Course for Educators” with Willi Hoffer, and welcomed Heinrich Meng1 into the editorial circle of their new publication, the Journal of Psychoanalytic Pedagogy (Zeitschrift für Psychoanalytische Pädagogik). The journal’s mission, its editors announced, was to prevent the incidence and consequences of childhood neurosis and to lay the foundation for psychoanalytically-informed education. This ideal “child-appropriate education” (kindgemässe Erziehung) would parallel the unique developmental needs and capacities of the child.2
With the city’s public school teachers and social workers increasingly attracted to the new methodology, and with the capacity at the Vienna Psychoanalytic Society’s Child Guidance Center reaching its limits, the child analysts decided to expand the scope of their services. Club leaders, teachers, social
1. Heinrich Meng, a Berlin psychoanalyst, was co-founder of the Association of Socialist Physicians with Ernst Simmel. 2. Anna Freud and her life companion Dorothy Tiffany Burlingham made a practice of this theory at their Hietzing School in Vienna, 1927 through 1932.
workers, and school-based doctors were now referring children “from all strata of the necessitous classes” to the Ambulatorium. With child welfare now integrated as a standard feature of Vienna’s education and human service system, the psychoanalysts confronted a wave of previously unacknowledged distress. In response, Anna Freud, August Aichhorn, Siegfried Bernfeld, and Willi Hoffer (who had been meeting privately to discuss psychoanalytic pedagogy) agreed that the time had come to offer counseling and guidance in the community. They started with schoolbased advisory services.
These educational and youth counseling resources, or Beratungstelle (short for Erziehungs und Jugendtlichenberatungstelle), were modeled in part on Aichhorn’s public outreach programs and in part on Anna Freud’s guidelines for child analysis. The core team— Anna Freud, Aichhorn, Hoffer, and Editha Sterba—offered on-site treatment to local children (with or without family present) and adolescents as well as parents and grandparents. The Beratungstelle opened to the public in workers’ education and community centers, large apartment complexes, clubs, and, of course, public schools. “This had the advantage,” commented Hoffer (1932), “of dispelling a number of obstacles to treatment of neglected, neurotic or difficult-to-educate children and those who lived with them.” Medically trained analysts could assist with psychiatric evaluations or referrals if necessary. The psychoanalysts sustained these Beratungstelle around the city through 1935.
Like the Ambulatorium on Pelikangasse, the Beratungstelle were well supported by the local press; in published notices as small as three lines and as long as a half page, the consultations were announced widely. At least 75 meeting notices were printed in 15 local newspapers through 1934. In the February 16, 1932 issue of Kleine Volks-Zeitung, a liberal daily paper, a typical announcement reads: “Education and Youth Counseling Center of the Vienna Psychoanalytic Society. Guidance by A. Aichhorn, Anna Freud, Doctor E. Sterba, Doctor W. Hoffer, Thursday from 6 to 8 o’clock in the Federal high school, Vienna Ninth District, No. 10 Wasagasse (cost-free counseling).”3 The notices appear to be thoughtfully arranged by the newspaper’s typesetter: one is positioned just under the death announcement of a young man and his son, perhaps by suicide, while another adjoins an article about maternal care. While over 140 daily and weekly newspapers were circulated in the 1920s and early 30s (Barnett & Woywode, 2004), those which published Beratungstelle announcements were of the
3. Erziehungs und Jugendtlichenberatungstelle der Wiener Psychoanaltischen Vereinigung. Leitung: A. Aichhorn, Anna Freud, Dottor E. Sterba, Dottor W. Hoffer, Donnerstag von 6 bis 8 Uhr im Bundesgymnasium, Wien 9 Bez, Wasagasse 10 (kostenlose Beratung) left. These same left-of-center publications reviewed new psychoanalytic books and lectures, announced related events like Sigmund Freud’s Goethe Prize, and publicized Anna Freud’s lectures throughout the city.
These advertisements for the Beratungstelle meetings offered all readers an initial snapshot of Anna Freud’s work team. At the same time, interested teachers and analysts could read about cases in greater depth, as clinical illustrations of theory or technique, in the Journal of Psychoanalytic Pedagogy: a depressed grandmother is supporting the child whom her son fathered extramaritally; the eight-and-a-half-year-old Minna is referred because “no one could cope with her strange personality”—she lied, stole, and masturbated openly in the classroom. In an article titled “The Love I Have for Fear” (Sterba, 1933), a young boy describes his psychotic experience: “It is like when a cloth is thrown over my head, like when robbers overcome me. I can‘t get out of there. It can drive you crazy. Now I‘m not sick, but there is a feeling in me that I don‘t think any other person understands.” Perhaps Josef Friedjung did. The pediatric psychoanalyst had identified how urban children thrive when they are free from fear. He repeated this theme in the City Council chambers, in the offices of municipal district leaders, and in local programs developed to educate parents about the equal impact of psychological and physical safety. Friedjung had started this campaign with an essay, “The Education of Parents” (“Die Erziehung der Eltern”), during World War I in 1916. For his psychoanalytic peers, he framed the message in a 1924 essay, “A Dream of a Child of Six.” The point was not to blame parents but rather to show that parents shared with the state an obligation to protect children from trauma.
Interestingly, social conscience is never far behind the intrapsychic material discussed in the Zeitschrift articles. In the Social Democratic city, the analysts included the effects of social class in their case studies: Aichhorn’s grandmother is from a “petit bourgeois family,” while Sterba’s Minna, born to a poor family, was moved through a sequence of foster homes. This case would have come to the attention of Vienna’s child welfare administration at City Hall, which, Anna Freud (1924/2006) said, “knows psychoanalysis well and holds it in high regard.” Freud was sensitive to the needs of marginalized children and families: she welcomed the newly professionalized field of social work, and she saw that “all individual development, whether on social or dissocial lines, [is] the result of interaction between innate and environmental factors” (A. Freud, 1951).
The Beratungstelle analysts offered, in addition to personal counseling, information on psychology, addiction, child development, and marital and family relationships for parents and caretakers. Editha Sterba (1941) would later observe, “In active child guidance work, advice and help cannot be limited to the child. The environment of the child and the members of the child’s family need to be included.” Thus, when social workers and district welfare workers visited homes of families in need or at risk, parents who may have consulted a Beratungstelle analyst seemed open to child treatment. Where the old monarchist Austria had asserted the supremacy of parental authority, social welfare in progressive Vienna now upheld the state’s right to protect the child from abuse.
In her barely veiled criticism of Alfred Adler’s character-building practitioners, for whom “child analysis might [be] some special form of educational guidance,” Anna Freud (1945/1966) outlined how adult anxiety could, in fact, deprive the child of help. Conversely, “analytic education can count among its success greater openness between parents and children…[But] it will be a long time before theory and practice are complete,” she said (A. Freud, 1968/1974b). The argument between Freud’s and Adlerian approaches to child guidance, as well as Siegfried Bernfeld’s and Wilhelm Reich’s, were so well known that even the local newspaper Die Stunde (1928) satirized their alleged competition for progressive credentials: “The Individual-psychologists under Alfred Adler’s leadership tried to persuade us that their soul-searching could fit into Social-democratic theory like a new bed of grass in a large, somewhat overgrown lawn. Well,” continued the metaphor-mixing columnist, “now Dr. Bernfeld proposes that Freudian theory is the genuine mediator between psychology and social progress.” As each of these theorists saw in their own Beratungsstelle cases4, society’s repression of childhood self-regulation could interfere with the adult’s compassion for the child. But like Friedjung and Aichhorn, Anna Freud’s ideas for handling disturbances in childhood concentrated specifically on the child’s autonomous point of view, separate to the extent possible from parents and the state. Many years later, she would apply a similar logic to aspects of family law. “We had to address the tension between the fear of encouraging the state to violate a family’s integrity before intervention is justified, and the fear of inhibiting the state until it may be too late to protect the child whose well-being is threatened” (Goldstein et al., 1980). In other words, government intervention in the lives of at-risk families should be minimal. But if intervention is necessary, the child’s interests should be paramount.
Thus, as their city embraced the pursuit of a just society between the two world wars,
4. Each “camp” ran one or more community-based child guidance centers, though Anna Freud’s and Alfred Adler’s dominated the scene. Wilhelm Reich’s focused more specifically on sexuality and sexual health.
