Freud's Free Clinics

1918–1922: SOCIETY AWAKES
commissioned Ferenczi to design an entire hospital-based psychoanalytic
ward in Budapest. Residential quarters would be adapted to treat men “brain
crippled [by the war with] organic injuries and traumatic neuroses,” modeled
at least in part on the therapeutic institute in Vienna of Emil Fröschels,
a colleague of the psychoanalyst Alfred Adler. 37 Thrilled that psychoanalysis
had achieved scientific respectability, Ferenczi shared with Freud his dream
of a “preliminary study [for] the planned civilian psychoanalytic institution,”
which would start with about thirty patients in 1918. 38 Istvan Hollós, a member
of the Hungarian society then running the psychiatric hospital in
Lipometzo, or Max Eitingon, now applying hypnosis with great success at an
army base, or both together, would make excellent assistant directors, Freud
suggested. Since 1915 Eitingon had supervised the psychiatric observation divisions
of several military hospitals, one in Kassa (Kachau) in northern Hungary
and the other in Miskolcz, a small industrial town in eastern Hungary.
Together at the Budapest conference for the first time since the beginning of
the war, Eitingon along with Ferenczi, Simmel, and Abraham began to set
down policies for their civilian practice, derived from experience in military
psychiatry. Of utmost concern was the threefold idea of barrier-free, nonpunitive,
and participatory access to psychoanalytic treatment. Sándor Ferenczi
introduced the technical concept of “active therapy” during these discussions
of war neurosis and initiated a clinical controversy that has lasted
even until today. Throughout the history of psychoanalysis, and indeed
much of modern mental health treatment, the debate between proponents of
the therapist’s direct verbal support of the patient, on the one hand, and the
therapist’s role as an interpretive facilitator of patient’s quest for inner
knowledge, on the other hand, has shifted from decade to decade. In all likelihood
encouraged by Freud’s interventionist speech on the role of the state,
Ferenczi’s own address proposed a psychoanalytic technique featuring time
limits, tasks, and prohibitions.
For Freud, war neurosis was a clinical entity largely analogous to “traumatic
neuroses which occur in peace-time too after frightening experiences
or severe accident” except for “the conflict between the soldier’s old peaceful
ego and his new warlike one.” 39 He was describing what we now call posttraumatic
stress disorder or PTSD, a cluster of psychiatric symptoms (depression,
hypochondria, anxiety, and hallucinatory flashbacks) experienced
by men and women exposed to trauma. The diagnosis required drawing a
necessary distinction between an involuntary psychological condition and
somewhat more deliberate actions like malingering, lying, desertion, and lack
of patriotism. For Simmel, who first articulated the concept of war neurosis,
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