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Interview with Elizabeth Ann Danto, author of Freud's Free Clinics: Psychoanalysis & Social Justice, 1918-1938 (May 2005)

Elizabeth Danto, author of Freud's Free Clinics: Psychoanalysis and Social Justice, 1918-1938Freud's Free Clinics, by Elizabeth Ann Danto, tells the surprising story of how Erik Erikson, Wilhelm Reich, Erich Fromm, Helene Deutsch, and other psychoanalysts created a network of free outpatient clinics and pioneered important innovations in psychoanalytic treatment and method. In emphasizing the ways in which psychoanalysts implemented their social activism and their commitment to treating the poor and working classes, Danto provides a new perspective on Freud's legacy.

Question: Why has so little been written about Freud’s social awareness?

Elizabeth Danto: In part, it can be explained by Freud’s own divergence from convention. Few traditional narratives – if any – attribute to Freud his rightful place in the history of free clinics or adequately describe his historical role in shaping universal mental health care. In this way Freud has been treated like other providers of free services and considered untraditional because free clinics have occupied the historical role of providing health care to poor or socially disenfranchised people.

Q: Why do many people view Sigmund Freud as an elitist whose psychoanalytic treatment was reserved for the intellectually and financially advantaged?

ED: Everyday knowledge tends to make one think that the psychoanalysts reserved their treatment for the rich and that mental health treatment demanded the luxury of time. But this is not true. In fact, I found concrete evidence in the clinics’ statistical reports that the social range of the psychoanalysts’ patient base was really very wide. I unearthed Freud’s personal checks endorsed to the Ambulatorium (the Vienna Free Clinic), his letters to colleagues thanking them for supporting the clinics, awards he received for his commitment to social welfare, and newspaper clippings reporting on his public advocacy. There are also photos, letters to friends and family, and excerpts from his writing. Freud’s own caseload was 50 percent men, 50 percent women.

Q; Did the psychoanalysts believe specifically in free mental health clinics?

ED: Freud's own circle of analysts did. In 1926 the N.Y. State Board of Charities denied the early psychoanalysts permission to open a free clinic. Since then the American medical mental health establishment has tried to use increasingly elaborate justifications for maintaining a private practice model. But building on the discovery that even simple storefront clinics helped children, adolescents, older people, and families, I show that, in the 1920s psychoanalysis gave rise to a new kind of community-based urban mental health services. Erik Erikson, Erich Fromm, Anna Freud, Wilhelm Reich – some of the most popular thinkers of the era (and still today) – made psychoanalysis accessible to students, artists, craftsmen, laborers, factory workers, office clerks, unemployed people, farmers, domestic servants, and public school teachers.

Q: Did the psychoanalysts disparage women?

ED: The idea that psychoanalysis is antifeminist because it was targeted to a small group of frustrated bourgeois women has long been a legend – especially since Jeffrey Masson’s controversial 1984 book (The Assault on the Truth). In fact, the mid-1920s saw the Vienna clinic treat more men than women. People of all ages and social classes were treated at no cost. Many of the clinicians were highly activist women. Among them were Karen Horney, who openly refuted Freud’s biological determinism in the lives of women, Helena Deutsch, who examined the psychology of motherhood, Edith Jacobson, who later delved into female depression, Hermine von Hug-Hellmuth, who – along with Melanie Klein and Anna Freud – introduced child therapy, and Theresa Benedek, whose later work correlated mood and menstrual cycles. Situating psychoanalysis within a new historical narrative based on the political and cultural contexts of Weimar Germany and Red Vienna (not on fin-de-siècle Vienna), I show the limitations of earlier, erroneous class-based analyses. We must start thinking of psychoanalysis in terms of twentieth-century modernism and refute the allegations of Victorianism that has triggered the spate of “Freud bashing” in recent years.

Q: Why is psychoanalysis so complicated?

ED: Underlying mental health treatment there may be simple models for everyone. Throughout almost the entire history of modern social science mental health itself has been viewed as something fundamental – but treatment for mental illness is not on a par with treatment for physical illness. I suggest that mental health treatment as we perceive it is in fact not so complex, but is instead the large-scale limit of the original psychoanalytic model. The free clinics were founded on this basis – a synthesis of efficient clinical approaches and socially conscious mental health policy – and their work led to new ideas about human sexuality, childhood depression, the nature of psychosis, and the validity of short-term treatment, crisis intervention, task-centered treatment, active therapy, and clinical case presentations. In this way, my book informs the current debates in urban mental health care in the U.S.

Q: So Freud was a liberal?

ED: The real Sigmund Freud was a socially engaged progressive who changed the paradigm of “helping” from power and authority to insight and discovery. In his personal life Freud was traditional, but he voted with the Social Democrats. The clinics’ innovations were the work of a more political but less well-known Freud whose commitment to free treatment reflected his own personal involvement with Social Democracy and the place of psychoanalysis in the history of social reform.