Hidden History: Free Clinics

“…the conscience of society will awake and remind it that the poorest man should have just as much right to assistance for his mind as he now has to the life saving help offered by surgery” (Freud, 1918 quoted in Danto: 1999).

Until very recently, psychoanalytic psychotherapy was available in England and Wales through the NHS, and not, as it is almost exclusively now, by paying to see a psychotherapist privately. This meant that people could be referred by their GP if they were unable to afford to pay for therapy, or if they did not want to see a psychotherapist privately.

The division that developed between public and private psychotherapy led to free psychotherapy becoming largely associated with the public sector. However, early on in the history of psychoanalysis, Freud encouraged all analysts to see people for free. In 1918, in a speech to the 5th Psychoanalytic Congress, he urged those present to make psychoanalysis publically available by setting up “institutions or outpatient clinics (where) treatment will be free” (Danto: 1998,1999). This speech was made at a time of considerable and progressive social and political change in the aftermath of World War 1 and it reflects Freud’s agreement with the social democratic politics of the day.

Inspired by Freud’s speech, two free psychoanalytic clinics were founded. In 1920, Max Eitinglen set up the Berlin Poliklinick and, in 1922, the Ambulatorium in Vienna was opened by Eduard Hitschmann, amidst concerted opposition from physicians who were both sceptical of the developing field of psychoanalysis and mindful of the possibility they could lose paying patients (Danto:1998).

These two outpatient clinics enabled men, women and children between the ages of five to 70 to access psychoanalysis to address their difficulties. The psychoanalysts expected people to pay what they could afford; which was very often nothing. Therapy was offered based on the person’s presenting problem, and free and fee-paying patients were seen alongside each other and offered the same length of session and length of treatment (Danto: 1998, 1999).

The records from both of these clinics, kept over a period of 10 years, include details of the age and gender of patients, why people sought psychotherapy and the length and outcome of their analysis. The records illustrate just how diverse a group of people attended the clinics, as well how wide a range of emotional and physiological problems people sought help for. Domestic servants, tradespeople, academics, farmers, unemployed people, factory workers, students and civil servants were amongst the occupations listed for people attending the clinic. The consistently largest group of people seeking psychoanalysis were young adults between the ages of 21 and 30. Many men attended the clinic, and in the 21-30 age group men and women were seen in equal numbers (Danto: 1998, 1999).

The free clinics give us an alternative perspective on the widely held view that psychoanalysis was largely consumed by Viennese bourgeois women. It provides evidence that historically psychoanalysts did not consider working class people to be unable to make use of psychoanalysis. On the contrary, some of the early psychoanalytic theory and practice developed out of the work of these clinics. Karl Abraham, Karen Horney, Erich Fromm, Helen Deutsch, Anna Freud, Sigmund Freud, Wilhelm Reich and Annie Reich were just some of the analysts working in the two clinics (Danto: 1998, 1999). The free clinics also clearly demonstrate that, historically, psychoanalysis was interested in and informed by the material and social context of people’s lives, as important contributory factors to our mental health.

Danto, E.A. (1998). The Ambulatorium: Freud’s Free Clinic in Vienna. Int. J. Psycho-Anal., 79:287-300
Danto, E.A. (1999). The Berlin Poliklinik. J. Amer. Psychoanal. Assn., 47:1269-1292
See also:
Hitschmann, E. (1932). A Ten Years’ Report of the Vienna Psycho-Analytical Clinic. Int. J. Psycho-Anal., 13:245-255
Danto, E.A. (2005) Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918–1938 (New York: Columbia University Press)