Psychoanalysis on the Margins: The Forgotten Legacy of Free Clinics

Ana Tomcic and Ana Minozzo draw our attention to an obscured aspect in the history and present of psychoanalysis: the setting up and running of free clinics. 

Psychoanalysis is often imagined to be an exclusive club, with a history anchored in the ups and downs of the Euro-American middle class. However, since the earliest days, psychoanalysts also sought to organise assistance for those on the margins of society: offenders, children in care, vulnerable parents, victims of political violence and those who could not afford psychological help.

This forgotten aspect of the psychoanalytic movement – past and present – is rescued and documented in the special issue of Psychoanalysis and History,  “Psychoanalysis for the People: Free Clinics and the Social Mission of Psychoanalysis”. The issue stemmed from a series of conferences held at the Freud Museum in January 2021.

On the 25th of February 2023, a five-year multidisciplinary project Free Clinics and a Psychoanalysis for the People: Progressive Histories, Collective Practices, Implications for Our Times (FREEPSY) led by Professor Raluca Soreanu, was launched in North London.

If the legacy of free clinics dates back to Freudian times, what has stopped this history from being inscribed into our discipline?

As our colleagues who contributed to the issue have pointed out, it was Elisabeth Danto’s widely read book Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918-1938 (Danto, 2005) that first challenged the narrative about the elitist nature of psychoanalysis. Danto, who attended the launch of the project, traced the ‘father of psychoanalysis’, Sigmund Freud’s idea of  the social mission of psychoanalysis to the early days of his practice. She documented the vibrancy of the Berlin Polyclinic, the Vienna Ambulatorium, and many other clinics in Europe and North America in the 1920s and 1930s as exemplifying a crucial social element to psychoanalytic practice.

What Danto’s work and our recent research collaborations confirm is that this legacy – although repressed, disavowed or foreclosed by an image of psychoanalysis as a practice for the few – has been alive across various cities and regions over time.

A group of people in a room
Attending the launch of the Free Clinics Project, February 2023 (courtesy of authors).

The special issue and project launch drew together colleagues who work with clinics in Brazil, the UK and the US. These contributors shared stories about their creativity in reinventing the ‘psychoanalytic frame’. This refers to the basic rules that dictate the type of relationship held between analyst and analysand, including boundaries, timings, as well as minutiae on what a practice room should look like. It also includes economics and forms of listening. What needs to be done, for example, in order to reach children, carers, people seeking asylum, migrants, racialised communities and those “at the margins” in general.

In this joint-launch event, the gathering of scholars, students, NHS workers, those from the private sector, and autonomous collectives, on a cold winter’s night was an exercise of commoning: that movement which creates links, novel networks that expand across borders and revitalise our practice as a common-ground. We all gathered there in the name of the many forms that psychoanalysis can take when it is attuned to the unconscious and its time.

Some themes occurred repeatedly throughout our conversations.

The voucher.

Firstly, there is a need to chart the forgotten history of free psychoanalytic clinics following the Second World War – the way they were financed, the people they served, the analysts who worked there, the methods they used and the legacy they left behind in their respective communities. The aim would not only be an act of remembering, but also reviving some of this legacy in the present. Our discussions recalled the ways in which 20th century analysts were institutionally obliged to take on a certain number of patients for free. We considered the possibility of reintroducing the voucher. The voucher was a slip of paper – similar to a cheque – which enabled an analyst to donate an amount of money in case they were unable to fulfil their quota of free sessions. This is another important point: established analysts, including Freud himself, felt morally obliged to support free clinics or to work for free themselves. We compared these historical experiences to the current difficulties analysts who work in free clinics face when accessing public funding or when attempting to sustain the provision of free treatment.

Adapting clinical technique.

The second recurring theme revolved around the innovations in psychoanalytic technique that free clinics often call for. Contemporary and historical free clinics work with groups whose common feature is that they lead complex lives affected, in most cases, by intergenerational trauma. The origin of such trauma tends to have a lot to do with the way societies are structured and the sometimes hidden, sometimes overt routes of exploitation by which these structures are supported. In this context, the traditional divisions between psychosis and neurosis, or the lifting of repressions, may no longer be sufficient. Several of the articles in the special issue show this to be the case. In such a context, the analyst will have to interpret with actions, listen with the body, offer acts of service, or decide to conduct analysis in non-traditional settings, such as taking a walk with the analysand. Most importantly, it is the analyst who needs to adapt to the analysand, rather than the other way around. In analysis, the analyst will often, as Dorothée Bonnigal-Katz puts it, have “to make themselves redundant” and to “suspend all ego-related activity” (Bonnigal-Katz, 2022) and interpretative presumptions, in order to let the fragile and fragmented subjectivity of the analysand develop.

Beyond the private couch.

A third important aspect that emerged in our communal discussion is the necessity of disseminating psychoanalytic knowledge across professions, making it widely accessible beyond the doors of the training institutes with their often-exorbitant fees. To quote Ivan Ward (2022), “psychoanalytic knowledge should be disseminated across many areas of social life, from parenting and teaching, to social work, policing and probation services.” Indeed, the historical clinics did exactly this. They offered psychoanalytically informed courses for teachers, probation officers and medical staff, and published accessible books, sometimes intended as general introductions to psychoanalysis, at other times tailored to the specific needs of the profession. Such a practice and intention are mirrored in contemporary free clinics. Clinics in South America offer courses on “listening to personal experiences of racism” (Yonatan, 2022) and established institutions such as the Freud Museum in London organised a conference on “psychoanalysis and midwifery” and a “series of seminars on psychotherapy and ethnic communities” (Ward, 2022). However, a lot needs to be done to reach even the level of popular accessibility psychoanalysis enjoyed in the 1920s or in the aftermath of World War II, especially in Europe and North America (in South America, with its multiple contemporary free clinics, the situation seems somewhat better).

Who is psychoanalysis for?

Being open to the many forms of psychoanalysis is being open to the many forms of the unconscious. It is true that Freud himself left us some paradoxical remarks to work through. In “The Dynamics of the Transference” (1912), he famously alluded to an “undiluted” form of psychoanalysis, arguing that:

“We shall never be able to do without a strictly regular, undiluted psychoanalysis which is not afraid to handle the most dangerous mental impulses and to obtain mastery over them for the benefit of the patient.”

This passage has been interpreted in many ways. Some have read it as an orthodox defence of five-times-a-week analysis. Others say that it stresses the importance of not shying away from potentially upsetting interpretations and avoiding a service-exchange market logic in which psychotherapy is the key to ‘wellness.’ What we, as researchers and clinicians, take from Freud’s remark is that what needs to be undiluted is our ethical implication, one that situates us in our times.

Dr Kwame Yonatan dos Santos, a Brazilian analyst whose Margens Clínicas collective are close allies of FREEPSY, concluded his remarks at the launch event with a statement that summarises  our invitation perfectly. He asked, to the full room and even fuller virtual livestream space:

“If the psychoanalytic clinic, which began from listening to that which was peripheric to medicine, in the case of hysterics, cannot listen to peripheric bodies, what and who is it for?”

What Kwame is addressing here makes reference to the fact that psychoanalysis, as a praxis, was born not only as a result of the doctor’s knowledge, rather, it is a practice which emerged from Freud’s encounter with his very first patients, those labelled as hysteric women in the late 19th century– at the time marginalised, silenced and pathologised. In this sense, if psychoanalysis is not able to touch social margins, won’t it be just a diluted praxis?  Luckily, as this event was testament to, many psychoanalysts working in today’s free clinics are committed to a psychoanalysis for the people.

About the authors

Dr Ana Minozzo is a psychoanalyst and Postdoctoral Researcher in Psychosocial Studies, University of Essex and Dr Ana Tomcic is a cultural historian and Postdoctoral Researcher in History, University of Essex.

References

Bonnigal-Katz, D. (2022) ‘The Truthfulness of a ‘Sympathetic Ear’: Working with Psychosis in the Community’. Psychoanalysis and History, 2022 24:3, pp.329-333

Danto, E. (2005) Freud’s Free Clinics: Psychoanalysis & Social Justice 1918-1938. New York: Columbia University Press

Freud, S. (1912) The Dynamics of the Transference. SE XII, p.171

Ward,I. (2022) ‘Social Clinics and Analytic Boundaries’. Psychoanalysis and History, 2022 24:3, pp.369-373

Yonatan, K. (2022) ‘The Clinical Space as a Quilombo’. Psychoanalysis and History, 2022 24:3, pp.353-361

 

 

 

 

 

 

 

 

 

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