Freud's Free Clinics

1922
patients on the clinic’s waiting list suffered from medical conditions apart
from their already oppressive neuroses. The first patient was analyzed, the
second perhaps, but a third free patient could harden even the most altruistic
clinician. Imagine analyzing someone for a year and a half (a veritable
marathon in the 1920s), understanding his dreams and fantasies, his sisters
and brothers, without ever learning his name or address! This anonymous
patient became known as “the man with the cedilla under the ‘c’.” 21
When the Ambulatorium opened as a treatment center, its founders simply
intended to make psychoanalysis accessible to people who lacked the
means to pay for private treatment. The Ambulatorium was maintained by
limited private funds and functioned largely on a referral basis until 1926.
Whether flexible or simply naive, the analysts never really expected psychoanalysis
to become as lucrative as a traditional medical practice. For most Viennese
patients in the postwar inflationary economy, devaluation of Austria’s
currency meant that paying 30 shilling fees was just too difficult. But by now
many prospective patients and trainees came over from America, England,
and Holland, and these visitors, these Ausländer (foreigners), arrived prepared
to pay for their treatment and could do so in hard cash, dollars and
pounds sterling. Freud took these eager foreigners into treatment or training
analysis, and he was “terribly expensive and quite openly so,” recalled Grete
Bibring, because he lacked sentimentality and his conduct as a researcher
(not as a doctor) justified the price. 22 He charged the Entente patients for
missed sessions in order to repay friends for their wartime loans, to provide
for his family, and even to support the widening circle of adherents like Lou
Andreas-Salomé. But, like his Viennese colleagues, Sigmund Freud almost
never took money from an Austrian candidate once inflation hit.
After 1922 Viennese citizens of even the middle classes were largely exempted
from paying for the psychoanalytic treatment and training they
sought, whether at the Ambulatorium or in Sigmund Freud’s office. Generally
the analysts had little compunction about redistributing the large sums
they would charge the foreigners. In fact, Freud asked his friend Kata Levy to
forgive this bias and hold confidential the fact that even he “can no longer
make a living from Viennese, Hungarians, Germans. It is really no activity for
a dignified old man. C’est la guerre.” 23 But the larger political issue Freud was
navigating was really a form of local residency requirement. In Red Vienna,
as in almost any social welfare system, tax levies passed through a municipal
administration only to be apportioned back to the original local community
in the form of public housing, parks, health clinics, schools, and libraries.
Residency requirements distinguished between citizens and noncitizens by,
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