Red Clinic Initiatives in Communities in Brazil
Red Clinic Initiatives in Communities in Brazil
This is a video of psychoanalysts from Sao Paulo Christian Dunker and Ilana Katz, and Ian Parker from the University of Manchester Discourse Unit discussing the therapeutic work that was being done with displaced communities in Brazil. You will be able to hear in the video how the dispossession of river people by large companies impacted on the psychological wellbeing and functioning of individuals who were uprooted and moved into urban settings. This video was produced to provide a document of the visit of Christian Dunker and Illana Katz to talk about their work. What follows is Ian Parker’s introduction to the subject:
This meeting was about the Red Clinic initiative; an opportunity to learn about Red Clinic initiatives in Brazil. The Red Clinic was set up in London about a year ago and it brings together two aspects of practice. One is the clinical work involving psychotherapists concerned with addressing questions or mental distress and providing a space for people to speak about that distress in a confidential way; and to do it in a way that is accessible to everybody – that is, to provide a low-cost or no-cost clinic so to bring together practitioners talking about their clinical work sit down.
The other aspect is the political aspect to think about the role of psychotherapy in society and the political changes that we need to make the world into a place that doesn’t cause distress and anguish and most of those involved in the Red Clinic set up in London call themselves Communist, and by Communist they mean people involved in actual political struggle as collective struggle to end the rule of capital; to end capitalism as a disgusting misery producing system.
Now the question is how to bring those two aspects together. How to bring the red aspect together with the clinical aspect and to do that in such a way that we don’t fall into two different traps that are possible. One trap is that as therapists we turn all politics into a kind of therapy – that is we try and turn the political struggle into a therapeutic struggle and encourage people to go into therapy themselves as a way of changing the world. The other trap is to inject our politics into the clinic so that the clinic, instead of being a safe space for people to say whatever comes to mind becomes a space where the therapist tells them what they should think in order to be healthy and happy; that is, we don’t envisage the clinic as a place to tell people that they should be Communists.
So this involves a question about the relationship between Red and Clinic that we’ve been thinking through in meetings online and in Manchester over the past few months and we know as a crucial part of our practice, that this is an internationalist question and that our activity here has to be internationalist. It has to link with initiatives from around the world and we’ve been learning from initiatives in Palestine, India, Taiwan and other places.
Today’s meeting is focusing on similar initiatives that have been developing in Brazil for many, many years. Brazilians are far ahead of us in thinking about the relationship between the Red and the Clinic and we’re very lucky to have two guest speakers this afternoon who are visiting from Brazil – Ilana Katz who’s a researcher working at the University of São Paulo who’s been in Manchester for two months working with us; and Chris Dunker who’s here for a briefer time, also a psychoanalyst working in the University of São Paulo – and they’re each going to be speaking about Red Clinic kind of initiatives in Brazil and then we’ll open up to broader discussion about it how it connects with our with our own hopes for a Red Clinic
Professor Christian Dunker, University of São Paulo | USP, Department of Clinical Psychology
Danto, Elizabeth (2005) Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918 -1938. New York: Columbia University Press.
Introduction to Danto’s Book
“IN VIENNA of the 1920s and early 1930s doctors who were very busy, like Sigmund Freud, could issue an Erlagschein, or voucher, to a current or prospective patient who would later use it as a form of currency to pay another doctor. The Erlagscheine were often elegantly printed on pale orange paper, inscribed in classical scripts, and, lacking any particular sequence, made for an especially versatile combination of bank deposit slip and personal check.
The vouchers appealed to practically everyone in the city’s psychoanalytic community. Private practitioners could choose to endorse an Erlagschein (figure 1) to a clinic as a pledge to redeem (in cash or in time) the treatment hours they would ordinarily donate in person. Sigmund Freud regularly endorsed Erlagscheine of two to four hundred shillings to the psychoanalysts’ own free clinic in Vienna, known as the Ambulatorium.
In 1918, just two months before the Armistice, Freud had rallied the psychoanalysts assembled in Budapest for their fifth international congress to start these “institutions or out-patient clinics . . . where treatment shall be free. 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,” he affirmed, embracing the new rhetoric of Austrian social democracy. “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.”
Behind these declarations, as behind all Freud’s psychoanalytic projects, lay an interesting tension between psychological theory and therapeutic practice. Whereas his theory aimed to be ahistorical, a de facto science, Freud’s clinical practice conformed to the social-democratic political ideology that prevailed in post–World War 1 Vienna. When the psychoanalysts in Freud’s circle opened the Ambulatorium for adults, children, and families who sought outpatient mental health treatment in May 1922, the character of social democracy and its social welfare institutions had already so permeated Freud’s native city that their clinic was just one of many free services. And Vienna was neither the first nor the only city to house a psychoanalytic clinic.
In these years of nascent modernism, Freud’s expressions of social conscience inspired the creation of a string of at least twelve other cooperative mental health clinics from Zaghreb to London.2 As late as 1935 Freud still wrote that “out of their own funds, local [psychoanalytic] societies support . . . outpatient clinics in which experienced analysts as well as students give free treatment to patients of limited means.”
The intervening decades saw the practice of psychoanalysis unfold in plain offices, case by case, on couches where theory hovered invisibly over clinical encounters. Between 1918 and 1938 psychoanalysis was neither impractical for working people, nor rigidly structured, nor luxurious in length. At least one fifth of the work of the first and second generation of psychoanalysts went to indigent urban residents. This made psychoanalysis accessible to students, artists, craftsmen, laborers, factory workers, office clerks, unemployed people, farmers, domestic servants, and public school teachers.
Freud’s idea so influenced trainees and medical students that they sought to subsidize their education by agreeing to treat patients at no cost. Established physicians and intellectuals treated troubled young children and their mothers, delinquent adolescents, and people whose psychosomatic illnesses ranged from asthma to epilepsy who would not otherwise have been able to afford treatment. The relatively easygoing nature of this exchange combined with the broad-mindedness of interwar political culture set a tone that allowed people from frankly opposite social worlds to meet in a psychoanalyst’s waiting room.
Even among analysts who outwardly avoided politics, a practice at a free clinic implicitly reflected a civic commitment to human welfare. Helene Deutsch, an active member of Freud’s inner circle who took charge of the Vienna Psychoanalytic Society’s Training Institute after spending 1923 and 1924 in Berlin, spoke for her generation. “Revolutionism,” she wrote in her story of the second generation of psychoanalysts, was “a spirit of reform . . . [that] can never be defined simply through its social application; it is an attribute of individuals who are drawn to everything that is newly formed, newly won, newly achieved.”
From 1920 until 1938, in ten cities and seven countries, the activist generation of psychoanalysts built free treatment centers. Freud had spoken ”half as prophecy and half as challenge,” said Max Eitingon, the psychoanalyst whose wealth and administrative talent made possible the first clinic in 1920, the Berlin Poliklinik. The Poliklinik’s innovations included length-of-treatment guidelines, fractionary (time-limited) analysis, and, of course, free treatment. Child analysis was first formally debated there and psychoanalytic education was standardized. In Vienna the dilemma of how to open a psychoanalytic clinic without needlessly offending the conservative psychiatric establishment hinged on the diplomatic skills of Freud’s friend Eduard Hitschmann who set up the second clinic, Vienna’s Ambulatorium, in 1922.
In 1926 the British psychoanalysts started a clinic in London under Ernest Jones, Britain’s psychoanalytic mastermind and later Freud’s first major biographer. Also in 1926 Ernst Simmel, cofounder with Eitingon of the Berlin Poliklinik, opened an inpatient center at Schloss Tegel just outside the city. In 1929 the pioneer Hungarian analyst Sándor Ferenczi founded a free clinic in Budapest. By then, in Vienna Wilhelm Reich, whose fusion of psychoanalysis and left-wing politics remains as controversial today as in the 1920s, had created the Sex-Pol, a network of free health and mental health clinics with a particularly strong liberationist bent. Eventually other psychoanalytic societies followed with plans, some fulfilled and some not, for free clinics in Zaghreb, Moscow, Frankfurt, New York, Trieste, and Paris.
They were free clinics literally and metaphorically: they freed people of their destructive neuroses and, like the municipal schools and universities of Europe, they were free of charge. In the heady climate of progressivism and social movements between the two world wars, psychoanalysis was supposed to share in the transformation of civil society, and these new outpatient treatment centers were to help restore people to their inherently good and productive selves.
Psychoanalysts believed they had a social obligation to donate a portion of their time to people who could not otherwise afford psychoanalysis. Most never even considered weighing the effectiveness of treatment against the financial burden imposed on the patient. Erik Erikson, Erich Fromm, Karen Horney, Bruno Bettelheim, Alfred Adler, Melanie Klein, Anna Freud, Franz Alexander, Annie Reich, Wilhelm Reich, Edith Jacobson, Otto Fenichel, Helene Deutsch, Alice Bálint, Frieda Fromm-Reichmann, Hermann Nunberg, Rudolf Loewenstein, and Martin Grotjahn—these were just some of the free clinic analysts who later fanned out across the Western world, some carrying the torch of progressivism and others burying it.
Today they are known for their theoretical revisionism and for the many ways in which they followed, transformed, or broke away from classical Freudian theory. But in the 1920s and early 1930s the same analysts saw themselves as brokers of social change for whom psychoanalysis was a challenge to conventional political codes, a social mission more than a medical discipline.
Erich Fromm, in residence at the Frankfurt Institute of Social Research in the late 1920s, and Ernst Simmel, head of the Berlin Association for Socialist Physicians, were Poliklinik analysts who based their practice on a symbiotic relationship with the political values of the Weimar era. Berlin’s intellectual freedom afforded Melanie Klein the autonomy to analyze children in depth. Karen Horney, perhaps best known as the psychoanalyst who introduced cultural relativism into Freudian theory, was a founding member of the Poliklinik and the first woman to teach there.
For Viennese intellectuals like Bruno Bettelheim, Otto Fenichel, and Siegfried Bernfeld, steeped in the romantic activism of central Europe’s left-wing youth movements, psychoanalysis represented human liberation, social empowerment, and freedom from bourgeois convention. Erik H. Erikson, the Pulitzer Prize winner who established, perhaps more firmly than any of the others, the central concept of the social environment’s influence on human development, was trained as a psychoanalyst in early modern Vienna, at the Ambulatorium.
In Budapest the clinic’s first director, Sándor Ferenczi, a lifelong intimate of Freud’s, belonged to a circle of modernist Hungarian intellectuals, poets, and writers that included the left-wing philosopher Georg Lukács and the composer Béla Bartók. Ferenczi, who died in 1933, believed that psychoanalysts who disregarded the “real conditions of the various levels of society” were forsaking the very people for whom everyday life is especially painful. In many ways postwar début de siècle Vienna found psychoanalytic theory and therapy less controversial than it is today. But almost since its inception and certainly since its arrival in America, anticlinical clichés have surrounded psychoanalysis from across the political spectrum.
Some critics suggest that individual psychological investigation precludes environmental advocacy and that psychoanalytic studies place the individual person at a remove from culture. Others have virtually made a career of invalidating psychoanalysis as nonscientific and purely ideological. Psychoanalysts themselves have alleged that clinical objectivity actually demands distance from politics, social policy, and social thought. As Wilhelm Reich, one of the field’s most biting theoreticians, observed, “the conflict within psychoanalysis in regard to its social function was immense long before anyone involved noticed it.”
But Ferenczi and Freud did recognize this conflict and, by 1910, had embarked on a far-reaching corrective strategy. Among the radical changes wrought by World War 1, previously disparaged political attitudes were suddenly dominant within the psychoanalytic movement as elsewhere, while the first Austrian and German republics followed a craggy path into constitutional states. In 1918 Freud might simply have restated the 1913 principles that systematized his prewar approach to patient fees, but he foresaw the history of psychoanalytic theory would ultimately rest on the history of its actual practice.
The new democracies would require of working psychoanalysts, as of other professionals, greater public involvement and accountability. Accordingly, Freud argued for an alternative and nontraditional (even then) view of the collective social obligations of psychoanalysis. The Budapest speech on “the conscience of society” reflected Freud’s personal awakening to the reality of a new social contract, a new cultural and political paradigm that drew in almost every reformer from Adolf Loos in architecture to Clemens Pirquet in medicine and Paul Lazarsfeld in social science.
By the end of 1918 Germany and Austria’s fundamental shifts in size and political outlook were underscored by the advent of “Red Vienna” and “Weimar Berlin” as modern models of urban reconstruction. In both cities the new governments’ policies of aggressive social planning linked postwar economic recovery to a public works approach where highly original largescale projects were instituted along with expansive cultural and aesthetic development.
Freud believed that someday “the State will come to see these duties as urgent,” and indeed the new governments promoted mental health and social services on a far broader scale than public health care had seen before. They drew on the new-sprung professions of utilitarian architecture, public health policy, and professional social work and emphasized the significance of high culture for the socialist cause.
First-hand accounts of life in Red Vienna, its vast communities of public housing, its social welfare programs for families, its art and music, share an exhilarating quality of public commitment and civic pride. Interpretations of these accounts, however, are endlessly contradictory and ideologically driven, speaking of state intrusion and regulation to the conservative analyst, of social democracy’s opportunism and the futility of gradualism in social change to the Marxist, and of fairness and affirmative action to progressives.
In 1919 Austrian women achieved universal suffrage, prompting government policies on health, housing, and family to change from patronizing individual charity to empowering social welfare entitlement—the privileges of citizenship. Public resources were invested in medical and dental clinics, family assistance programs, aid to children, and youth and mothers consultation centers. This array of programs was designed by Julius Tandler, the brilliant anatomist and university professor who transformed Vienna’s welfare department into a system of professional assistance for families and children. Even visiting Americans were impressed. “One thing is clear,” reported a delegation from the Commonwealth Fund.
“It would be grossly inaccurate to think of Austria as a country in which health and social work is in a rudimentary stage.”9 The fund’s representatives met with Otto Bauer, the sophisticated leader of the new Austrian Marxists and foreign secretary in 1918–1919. Editor of the socialist journal Arbeiter-Zeitung, Bauer spoke of the current social movement as a revolution in “the soul of man.”
Urban culture, Vienna’s Social Democrats believed, should encompass the worker’s total life, from the privacy of individual and family life to public policy and the workplace. Among the psychoanalysts the left-leaning neurologist Martin Pappenheim, Eduard Histchmann’s friend and a frequent guest of the Freud’s, maintained that social change should reach “into the structure of family relationships, the social position of women and children, [and] sexual reform.”
In 1920 Adolf Loos, now remembered for his ruthlessly streamlined modernism, was appointed chief architect to the building department of the city of Vienna, then suffering from a chronic housing shortage. Anton von Webern, the brilliant avant-garde composer, was principal conductor of the Vienna Worker’s Symphony and the Vienna Worker’s Chorus (where he remained until 1934) and promoted some of the first performances of Arnold Schoenberg’s modernist compositions.
Schoenberg had trained himself as the organizer of the Social Democrats’ workers’ orchestra. Meanwhile in Germany, the Bauhaus director Walter Gropius’s fame as the quintessential Weimar architect peaked with the production of urban construction. In its workshops for functional, exquisitely crafted furniture and daily utensils, the Bauhaus remade the idea of mass production. Its principles of streamlined design (many of which still seem modern today) were brought to bear on all the common material needs of everyday city life, from copper desk lamps to porcelain tea sets and from chrome-winged toasters to bentwood baby cradles.
Art coexisted with economic reality, culture with politics, citizenship with the newly participatory structure of the state. Berlin in the 1920s was home to the Poliklinik, the psychoanalysts’ flagship program for public therapy and to many the heart of the Berlin Psychoanalytic Society much as the Ambulatorium was to the Viennese. To the Hungarian analyst and teacher Sándor Radó, the Berlin analysts had forged a “wonderful society,” a particularly spirited set of progressive practitioners so popular among the city’s intellectuals that Karl Abraham nearly secured a professorship in psychoanalysis at the university.
International trainees in social work, psychiatry, child guidance, and psychology flocked to the Poliklinik not only from France and England but also from Egypt, Cuba, and the United States. “Please send me all available information concerning your Institute,” wrote the Worcester State Hospital psychologist Norman Lyon in August 1929. “I hope sometime to teach Psychology and conduct a clinic in connection with the teaching.”14 From its modernist interiors designed by Ernst, Freud’s architect son, to its educational projects, the clinic’s efforts to meet the social obligations of psychoanalysis matched Weimar Berlin’s social, political, and cultural outlook.
Ernst had studied with Loos in his Vienna workshop and parlayed Loos’s simple lines and unadorned surfaces into a community design for the clinic’s waiting room. In their therapeutic practice the Weimar psychoanalysts debated nontraditional approaches to treatment and, on the social plane, they advocated for penal reform, sexual liberation, gender equality, and the decriminalization of homosexuality.
But even in Berlin, where Eitingon’s wealth and Karl Abraham’s efficiency as the society’s director led to a simplification of Freud’s formula for allocating pro bono services, pledges were made and patients seen at home. The public’s demand for psychoanalytic treatment, which seemed to outpace any solution to the chronic inadequacies of time and space, was sensational. Neither in Vienna nor Berlin was psychoanalysis truly disengaged from the overall network of available mental health services.
Private health and mental health clinics, once restricted to the affluent or near affluent, now opened to all strata of society. But since at least 1916 governments had endorsed psychoanalysis as a form of psychotherapy to help shell-shocked soldiers returning from the front lines. And, while Alfred Adler had broken from Freud’s ranks in 1911, members of Adler’s highly popular Society for Individual Psychology staffed child guidance offices linked to Vienna’s municipal educational system.
With its uncompromising emphasis on human sexuality, psychoanalysis was only one of many treatments available in modern psychology, but it was, even so, the most complex and controversial. At the Vienna Ambulatorium on Pelikangasse psychoanalysis was practiced daily by clinicians closely linked to Red Vienna’s changing medical and sociopolitical agenda. And on Potsdamerstrasse in Berlin the Poliklinik offered the city’s psychiatric patients a compassionate alternative to the Charité Hospital’s institutional care, taking in those whom the medical and psychiatric establishments were ready to dismiss.
Although by 1938 the Nazis had so depleted psychoanalysis that one could walk through the academic centers of Berlin or Vienna without meeting an analyst, let alone a Jew, Otto Fenichel and his group of exiled colleagues argued their beliefs more fiercely than ever. The Berlin clinic was ended in 1933, Sex-Pol in 1934, the Vienna Ambulatorium in 1938. Even then Fenichel encouraged his former colleagues to preserve a critical, political attitude even though the Poliklinik had been aryanized (not technically closed) in 1933.
In the Rundbriefe, an extraordinary series of circular letters written to and among his circle of activist analysts, Fenichel articulated the confrontation between those who faithfully held to the humanist Freud and a new kind of clinician aligned with ego psychology. Over the next ten years Fenichel would come to view the ego psychologist Heinz Hartmann’s new theory of adaptation as neo-Freudian at best and, at worst, conformist and eerily pre-Freudian.
Fenichel’s group argued consistently, along with their colleagues in Ernst Simmel’s Association for Socialist Physicians, that the importance of psychoanalysis lay precisely in its social, even Marxist, dimension. “We are all convinced,” Fenichel wrote from Oslo in March of 1934, “that we recognize in Freud’s Psychoanalysis the germ of the dialectical-materialist psychology of the future, and therefore we desperately need to protect and extend this knowledge.”
That the history of political activism in psychoanalysis has been consistently withheld from public view is puzzling. The careers of the second generation of psychoanalysts were exemplary. Freud’s students were leaders in academia and medicine and even the military. Archival and oral history evidence, fragmented as it is, confirms that the early psychoanalytic movement was built around a progressive political core, closely allied to the cultural context of central Europe from 1918 to 1933, and that the free outpatient clinics were a practical implementation of that ideology.
This narrative comes into focus once psychoanalysis is located in relation to the twentieth century’s alternately reformist and conformist social movements of modernism, socialism, democracy, and fascism. Today Otto Fenichel’s 119 Rundbriefe survive as eloquent documentation of the historical link between psychoanalysis and progressive politics, as classical in their epistolary form as Fenichel’s benchmark psychoanalytic text, The Psychoanalytic Theory of Neurosis.
As of this writing they are fragile sheets of old typing paper attached by rusting paperclips. But the Rundbriefe tell part of the story of the psychoanalytic movement’s evolution from 1934 to 1945, of its active participants and their larger ideological struggles in Europe and America. Reconstructing other equally valid chronicles from personal memories, the few surviving documents, and widely dispersed archival fragments is a challenge.
Nevertheless, the actual political affiliations of prominent members of the psychoanalytic movement are a matter of record. Among the declared Marxists were Erich Fromm, Otto Fenichel, Karl Landauer, Barbara Lantos, Georg Gerö, Frances Deri, Käthe Friedländer, Steff Bornstein, and Wilhelm and Annie Reich. Bruno Bettelheim, Grete Bibring, Helene Deutsch, Ernst Simmel, Willi Hoffer, Eduard Kronengold (Kronold), Siegfried Bernfeld, and Heinrich Meng identified themselves as Socialists. Among the known Communists were Anny Angel-Katan, Edith Jacobson, Edith Gyömröi, Edith Buxbaum, Marie Langer, Ludwig Jekels, and Wilhelm Reich. Eduard Hitschmann, Paul Federn, Karen Horney, Josef Freidjung, and Sigmund Freud were Social Democrats.
Since then some of the analysts, like Erik Erikson and Karen Horney, have gained in stature while, for example, Helene Deutsch and Erich Fromm have faded from today’s cultural landscape and others, like Wilhelm Reich and Sándor Ferenczi, have since reappeared with surprising strength. Like the Rundbriefe, which have disappeared from public view, the clinics have suffered a historical fate in stark contrast to the elaborate psychoanalytic training standards and private practice model now prevailing in psychoanalytic institutes and exclusive offices worldwide.
With their culture fragmented by terrorism, obliged to rebuild professional lives in a foreign language, and beset by screeching postwar nationalism, most central European psychoanalysts fled. But they still assumed that the goodwill and compassion generated by psychoanalysis would ultimately triumph if they tempered the stories of their radical pasts. Ernest Jones had been a voice of conservatism all along, yet his 1926 pronouncements of social conscience had set the British society’s clinic on a course that, even today, continues to offer psychoanalysis free to London residents.
The Centre Jean Favreau still thrives under the Société Psychanalytique de Paris, founded in 1920 and led for many years by Marie Bonaparte; its psychoanalysts provide free consultation and treatment to residents of the city of Paris. Toward the end of World War 1, Ernst Simmel, who had served as an army doctor and director of a hospital for shell-shocked soldiers, wrote of the urgent need to participate in “the human economy . . . because of the waste of human life during the war years and for the preservation of all nations.”
He believed that community was the lifeblood of survival. For Simmel, as for Freud, the free clinics embodied collectivity within psychoanalysis. The psychoanalysts joined in Europe’s début de siècle struggle to build democracy without sentimentality and a better world. Helen Schur, a medical student at the University of Vienna in the 1920s and later wife of Freud’s personal physician Max Schur, summarized this well. “I think they saw that this would be the liberation of people. To really make them free of neuroses, to be much more able to work, you know, like Freud said, to love well and to work.”19 What follows is a history of that liberation.”
Dunker, Christian Ingo Lenz and Parker, Ian (2022) ‘Red Clinic: Accessible (Brazilian?) Psychotherapy for all’, Psy-Fi, link:
Katz, Ilana and Dunker, Christian Ingo Lenz (2019) ‘Care Clinic on the Banks of the Xingu River’, translation from Brazilian by Renata de Novaes Rezende, published in French in Recherches en psychanalyse, 2019/1 (N° 27), pages 49a à 58a
Parker, Ian (2022) ‘Red Clinic strikes Manchester’ (account of Red Clinic meeting in Manchester), Anti-Capitalist Resistance