Opening address for the launch of the special issue 24(3) of Psychoanalysis & History of December 2022, on ‘Psychoanalysis for the People: Free Clinics and the Social Mission of Psychoanalysis’, The Freud Museum, February 25th 2023.Â
For myself, this is an extremely exciting and satisfying moment. In my wildest dreams, I would never have imagined that my involvement and concern with various different low fee and free clinics in the last half of the 20th century would have led this far: to the innovative conferences in 2021 that Raluca Soreanu and myself organised with the Freud Museum, and then to such a publication as the special issue. And further to the funded FREEPSY research project. You might say, my dreams were not wild enough. ‘Wild’ has a special significance in the psychoanalytic vocabulary as a term that has been applied to various innovative and left field practices not accepted within the canon, including the many flexible and creative responses necessary in taking psychoanalysis out of its usual contexts and with previously excluded peoples.Â
This issue – and the forthcoming publication of further papers from the second clinic conference – are landmarks in the constitution of the free clinics in their totality as objects of psychoanalytic and psychosocial knowledge, the creation of a new area of thought about innovative and progressive psychoanalytic practices, many of which have long existed. The special issue represents the first stage in establishing a body of knowledge, the gathering together of some incredibly different projects with diverse approaches but also with similar aims, and also some new theorising. It is wonderful that the hard work of Matt ffytche, following Raluca’s suggestion, has managed to make it open access – really essential given the subject matter but unusual in the world of professional publishing. And I would also like to thank Matt as the editor of Psychoanalysis & History for his openness to different forms of articulation and writing.
We have learned how important histories are in providing the impetus and scholarship on which to base our present-day research and theorising of free clinics. I think we can all acknowledge the seminal role of Elizabeth Danto’s detailed historiography of the original European free clinics in establishing this as a field in its own right, and on which we are now building. Many of the issues she records the Berlin and Vienna clinics as struggling with are ones that recur now, for example the necessity to be flexible in the setting, duration and frequency of therapy sessions, the adjustment to the material constraints of people’s lives. There are also other histories to be told, from different times, and in different geographical locations around the world. This is one of the ways in which the collaboration between myself and Raluca has been so fruitful; she has brought a unique breadth of history, connections, theory and experience to our somewhat parochial shores. The special issue represents the beginning of this, and we have so much more to learn, to take just one example, from the Brazilian contributors, who place the impacts of coloniality and racism centre stage.
What has been my trajectory here? I have been involved, working and supervising, in several very different free and low cost clinics over the years, which I will describe below. As I was trying to make sense of all these and other experiences, and especially the role of ideological and political motivations in these practices, I became increasingly struck, particularly when writing Class and Psychoanalysis, (2017), on how unrecognised, unwritten up, not taught about, not learned from, the work that went on in these various clinics was. Essentially, hidden from history and forgotten. Of course, the harsh reality of social clinics is that they mainly exist under conditions of financial precarity, as do most of their clientele, and the struggle for existence can dominate. They are very hard to maintain and are often under threat from changes in the funding climate, as several of the papers make clear. This is all the more reason why it is so important to create frameworks where the challenges of their work, and the many innovative practices that they create, can be recorded, published and disseminated.
This is a crucial form of recognition and validation and may go some way to ameliorating the problematic legacy of Freud’s ambivalent metaphor of gold and copper alloy, when speaking about the future free clinics he imagined in 1918. This unfortunate metaphor, and its contemporary form of ‘pure’ and ‘applied’, has plagued subsequent discussions of more inclusive forms of psychoanalytic practice. It takes no account of how, although ‘gold’ may suggest greater value and status, alloys add many qualities not present in the pure form which add greatly to the utility of the material. Free and low-cost clinics not only enlarge the range of people who can access psychoanalytic thought and therapy but can also contribute in so many innovative ways to our psychoanalytic work, if we are prepared to learn from them.
In many instances when new clinics and projects are started up, they are often pioneered without reference to what has gone before, that is, to an extent, the wheel keeps being re-invented. While every clinic is importantly unique – and there is an astounding diversity – there are also some recurring themes and issues. I can tentatively identify some: the necessity for therapists to have some understanding of the historical conditions of social existence of the intended clientele, and some acknowledgement and adaptation to their material circumstances; flexibility and imagination in devising forms of therapy in these conditions; an ability on the part of the organisations and of the therapists within them to reflect on their own socio-political positions in relation to the forms of suffering and experiences involved, some of which may be very unfamiliar or disturbing to them. The challenge is that these factors, especially pertaining to poverty, social oppressions, discrimination and marginalisation are not usually included in mainstream trainings. Also, that at the conceptual basis of most psychoanalytic metapsychologies and methodologies is the notion of a psyche outside of power. Otto Fenichel argued strongly that the only way in which Marxism and psychoanalysis, that is variously left-wing politics and therapy, could be conjoined was in the free clinics, i.e. in practice. To rephrase it in more modern terms, with all the developments in psychosocial theorising that have developed, the free clinics are at the frontline of enlarging our psychoanalytic understandings of the constitution of subjects in their embodiment in the social world, and also of psychoanalysis itself. Freud, in that 1918 article, also argued that the future of psychoanalysis depended on the development of much wider and more inclusive access – and I think this is still true, politically, ethically and theoretically.
But this needs to go much further, also involving an expansion of our theoretical frameworks, geographical reach and political concerns, importantly to include the many ravages of coloniality and racism, in different sites, as much of the Brazilian literature is doing, as well as class and economic oppression. I also suggest that we need to include in our researches different historical periods, for example the flourishing of left-wing thought and practice in relation to psychoanalytic free clinics in the 1970s and 80s, where my feeling is there is much that is so far unknown or unrecognised.
To take a personal example, my first involvement was with Red Therapy, in the mid 1970s. We were a group of left-wing activists involved in community politics in East London, UK, with a particular approach to politics that emphasised people’s everyday struggles. We read Wilhelm Reich’s writings on psychoanalysis and Marxism, and on Sex-pol, the activist use of therapy in working class communities, where working from the material bases of people’s lives was crucial to establishing relevant forms of therapy. In Red Therapy we tried to understand how social structures interface with and often lead to particular forms of psychological symptoms, an abiding theme in all free clinic projects that have a political motivation. We had many critiques of the psychoanalysis of that time – and also of left-wing politics that did not address people’s psychological sufferings. Red Therapy was also a form of radical self-help for ourselves as political activists – we taught ourselves how to do therapy in groups, taking what we could from established practices and making them our own. There is a pamphlet describing Red Therapy in some archives. I don’t think at that time we were aware of Marie Langer’s contemporaneous work in Argentina, which we could have learned from.
What I want to draw out here is that our approach was framed if not guided by our politics. This is also true of the next free clinic I was involved in, Battersea Action and Counselling Centre, described in the special issue. Here the founding influence came from Sue Holland’s involvement with others in a particular form of Marxist politics, but also with Paolo Freire’s concept of ‘Conscientisation’. Something which at that point I was very ignorant of, though it has parallels with the widespread feminist use of consciousness raising of that time – all being attempts to understand the relation between the external world and the subjective one. The political nature of this clinic meant that when the local funding council changed to Tory, we got very quickly axed, bringing out what we also know from Danto’s history, how vulnerable free clinics are to right wing and fascist politics.
Political approaches to therapy, in a different way, framed the establishment of feminist therapy centres in many places – one of them was the Women’s Therapy Centre, in London, which I also tangentially worked for and which developed the use of workshops on specific topics to engage a large number of women who wouldn’t otherwise approach therapy. Another of them (which I think Lisa Baraitser worked in), was more specifically aimed at very disenfranchised women, and it still continues. The project I worked for in the 1990s was established in a different way, from – as it were – the centre trying to embrace the margins; that is, by established analysts with a social justice agenda, trying to widen access in an inner London borough. This clinic, unlike most of the others I have mentioned, still exists, but its non-political framing ran into trouble when I was there. Firstly, the left-wing local council criticised the centre for not adequately including the poorer and more marginalised sections of the local community and threatened to withdraw funding; this led to the establishment of a satellite centre in a poorer area of the borough. Secondly, the clinical supervisor of the time, who was extremely influential on us not very experienced therapists, took the theoretical line that if you needed help, it didn’t matter what colour, race, gender, creed etc you were. This brings out the problematic universalism of established psychoanalysis – progressive in its prioritising of individual suffering, but problematic in its lack of ability to incorporate the differentiated social world into its thinking, and practice, other than as a kind of added external extra.
We are at the moment in the creation of a new body of knowledge where disparate experiences, ideas and practices can be drawn together, put side by side, to create archives and networks, as the FREEPSY project will do, to identify recurring themes, to be frankly amazed by the commitment and creativity of so much that goes on, as many of the individual articles illustrate. This is not in any way to homogenise what is an extremely diverse field in all respects, but to provide a source of learning and inspiration that can be carried forward. Since Freud’s speech and the clinics of the 1920s, the kinds of social theories and political concepts available to us has enlarged enormously, and psychoanalysis has evolved in many directions. We also have the theoretical tools to understand psychoanalysis as a whole body of knowledge and discourse that can be seen as often embodying and enacting in its everyday practices and some concepts unmarked features of class, race, sexuality and gender. This is part of what the free clinics necessarily challenge and in doing so, these have not remained just as ‘challenges’, but have led to much fruitful, creative and new psychoanalytic formulations in these and other areas. Such multiple understandings, if adopted in teachings and trainings, could greatly enhance the reach of psychoanalysis and its theories and support the long-standing but sometimes ‘forgotten’ desires for a more socially informed and more equitable practice and profession.
