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Danto: the Ambulatorium: Freud's Free Clinic in Vienna

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Danto: the Ambulatorium: Freud's Free Clinic in Vienna The Ambulatorium: Freud's Free Clinic in Vienna Elizabeth Ann Danto At the close of World War I, Freud proposed the creation of clinics providing free treatment, in the first of a series of politically liberal statements promoting the development of a kind of institution that is rarely associated with psychoanalysis today. Using archival and oral history research methods, this study offers a descriptive and statistical history of the Vienna Ambulatorium, the free psychoanalytic clinic and child guidance centre created—we can now surmise—under Freud's direction. Presented within the cultural context of central Europe's inter-war rush of progressivism in 'Red Vienna' and in Germany's Weimar Republic, little-known aspects of the history of psychoanalysis emerge. From 1922 to 1936, the staff of the Ambulatorium treated gratis patients of all ages and social classes, ranging from professional to unemployed. Candidates too were analysed at no cost. Reflecting the urban energy of his era, Freud believed that psychoanalysis could be both productive and free of cost. What emerges is an unexpectedly activist, community-oriented profile of some of the earliest participants in the psychoanalytic movement. In an extraordinary series of speeches and writings between 1918 and 1935, Freud took the politically liberal step of sanctioning the development of free clinics. In a crucial keynote address to the Fifth Congress of the International Psychoanalytical Association, held in Budapest in September 1918, Freud proposed the formation of: 'institutions or out-patient clinics ... where ... treatment will be free', stating that: it 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; and that the neuroses threaten public health no less than tuberculosis, and can be left as little as the latter to the impotent care of individual members of the community. Then institutions and out-patient clinics will be started, to which analytically-trained physicians will be appointed so that men who would otherwise give way to drink, women who have nearly succumbed under the burden of their privations, children for whom there is no choice but running wild or neurosis, may be made capable, by analysis, of resistance and efficient work. Such treatments will be free ... It may be a long time before the State comes to see these duties as urgent ... Probably these institutions will be started by private charity. Some time or other, however, it must come to this ... (1918 p. 167) It did. By 1922, members of the Vienna Psychoanalytical Society had banded together to establish a free psychoanalytic clinic, the 'Vienna Ambulatorium', to which Freud gave moral and financial support. What follows is a historical and organisational overview of the Vienna Ambulatorium from 1922 to 1936. By 1922, the war-ravaged city of Vienna had embarked on an ambitious project of economic and social regeneration. The municipal authorities introduced fundamental reforms that earned the city the name 'Red Vienna', as Vienna became a laboratory for an experimental blend of culture and politics. Led by the Austrian Socialist leader Otto Bauer and by Victor Adler, a labour leader, the Social Democrat party created an urban environment that responded, perhaps for the first time, to the needs of children and of workers' families. At odds with the rest of Austria, the Viennese thrived on liberalism and social experimentation, fending off the militaristic and religious conservatism (Carsten, Copyright © 2016, Psychoanalytic Electronic Publishing. All Rights Reserved. 1986) of Central Europe. The development of the Vienna Ambulatorium, which was overseen by Freud's closest associates, including his daughter Anna, indicates the role of psychoanalysis in this process of reform. For many of the analysts who 'understood society as repressive and saw psychoanalysis as a way of relieving repression' (Stewart, 1995, unpublished interview), the Ambulatorium enabled the original social mission of psychoanalysis to be fulfilled. Besides Freud, Helene Deutsch and Wilhelm Reich—along with Siegfried Bernfeld, August Aichorn, Willi Hoffer and Grete Bibring—emerged as major figures with ideological influence. For them, the Vienna Ambulatorium was an instrument of reform; even its administrative aspects (fees, funding strategies, training services) were the focus of activist participation in changing the status quo. It began as an innovative alternative to Vienna's well-established medical and psychiatric services, and its unique though little-known activities have continued to play a part in the history of psychoanalysis, in European intellectual history and in the evolution of free mental health services. Vienna 1922 Austria's First Republic (1918-1938), the country's first constitutional democracy, sought to introduce comprehensive post-war reforms based on the principles of universal protection from poverty and access to public services. The project of economic regeneration incorporated, for example, a vast public re-housing initiative (the Wohnbau houses). Educational programmes were set up in newly built schools and services such as public assistance, rent control and school construction were introduced (Gay, 1988). Public resources were invested in medical and dental clinics, family assistance programmes, aid to children and youth and mothers' consultation centres. Public health and urban sanitation were improved with the introduction of sprinkler trucks and mechanised garbage collection (Gruber, 1991). Schur recalled that by 1932, Vienna had become 'a very progressive city';' health stations were excellent... and the hospitals were really very good. People had insurances when they worked; people who didn't have money were treated for nothing', (1995, unpublished interview). The Viennese sought more fundamental reform, creating what Bauer called 'a revolution of souls' (Gruber, 1991 p . 6), believing that urban culture should encompass the worker's whole life, from the privacy of individual and family life to the political arena and workplace. The relatively new field of psychology flourished; by 1922 various schools of psychology had emerged at Vienna University, ranging from materialism and physiology to psycholinguistics and psychoanalysis. The early leaders of psychology, with differing scientific approaches, shared a politically liberal idealism combined with a new focus on methodology and observation of behaviour, especially of children. Describing the heady atmosphere of 'Red Vienna', Ekstein remembered service programmes that directly addressed children's needs: 'And then of course, there was Sigmund Freud, Anna Freud, [and] August Aichhorn who were concerned not only with theoretical issues, but also with practical issues of education, desiring to have insight into delinquency, learning disturbances' (1991 p. 8). Families and children were the priority of the new welfare system. Julius Tandler, professor of anatomy at Vienna University and architect of Red Vienna's health-care system, believed that healthy children were the foundation of a healthy state (Pappenheim, 1989). A comprehensive system of aid to children reduced the incidence of tuberculosis (the major health threat to working-class children), reduced infant mortality by 50 per cent and the general death rate by 25 per cent. The system included school lunches, school medical and dental examinations, municipal bathing facilities, publicly sponsored vacations and summer camps, and new after- school centres. Copyright © 2016, Psychoanalytic Electronic Publishing. All Rights Reserved. Perhaps most significant for psychoanalysis, the number of kindergartens increased from twenty in 1913 to a hundred and thirteen in 1931, enrolling 10, 000 children (Gruber, 1991). The Widening Scope of Psychoanalysis As the state increased its activities to meet citizens' basic needs, psychoanalysis also broadened its social field. The Ambulatorium and its services developed in parallel with the state's assistance to children and families. In what Anna Freud later called the 'widening scope of psychoanalysis (1966 p. 7). Vienna's focus on children's needs and rights increased in parallel with the emergence of new scientific studies of child development and treatment techniques, and a developing interest in early education. Child analysis itself emerged from the social context of radicalism and service (Stewart, 1995). From 1924, the Montessori method influenced idealistic educators, psychoanalysts (who were providing free consultative services at the Ambulatorium) and other intellectuals dedicated to children's welfare and education (Kramer, 1976). In this milieu, Anna Freud's career as an elementary school-teacher led to a series of public seminars on the theoretical and practical relationship between psychoanalysis and education. A second, more specifically psychoanalytic, kindergarten model emerged when Siegfried Bernfeld founded the Baumgarten Children's Home in 1919. It was started with municipal funding and directed by Willi Hoffer (Young- Bruehl, 1988), whose 1920 psychoanalytically based 'Vienna Course for Educators' reached teachers from the city's nursery, elementary and high schools (A. Freud, 1966). Hoffer's lectures on public education were published later in the Zeitschrift fur Psychoanalytische Padagogik. The nursery, set up by the American paediatrician and child analyst Edith Jackson
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