Assistance for the Mind
Remembering and Rebuilding Radical Praxis in The Clinic
Jaice Sara Titus
To think about the history of psychoanalysis and its relationship to politics, whether political practice or institutions, is to think of a history of repression. How do we remember our stories, our positionalities, without losing sight of the political struggles that comprise the backdrop to our own individual and collective narratives? In Proust among the Nations, Jacqueline Rose writes that psychoanalysis “begins with the anguish of remembrance.” When we remember, our anguished memories are intermingled with political histories of states from above and of struggles from below, but what do we do with this material? Many socialist activists have approached the clinic thinking, “Will they understand me?” “Will my struggles make some kind of sense? Or will I be seen as a hopeless idealist at best and a deluded cultist at worst?” Such concerns express the anxieties of balancing one’s political commitments with psychoanalytic work, and of a desire for the analyst to understand, or at least to recognize, the tensions one carries when living under capitalism with revolutionary politics.
These anxieties in some ways reflect the generative, but ultimately uneasy, relationship between psychoanalysis and socialism and the tensions between the hows and whys of getting free, politically and psychically. The recent establishment of the Red Clinic, a “collective of communist mental health workers united for a radical psychotherapy, for the care of the oppressed, and for uniting the two in the service of communist politics,” offers the opportunity to reexplore this history and to consider how left politics and the clinic might sit together in the contemporary world.[1] The founders of the Red Clinic are acutely aware of this history and their relationship to the legacy of free clinics and other efforts at social provision of psychoanalysis, even if they see themselves as operating in a necessarily different way to what has gone on before.
From its earliest days, psychoanalysis contained the aspiration that it should be accessible to all. Elizabeth Ann Danto’s detailed research in Freud’s Free Clinics: Psychoanalysis and Social Justice 1918–1938 resurfaced the deep commitments of early psychoanalysts to free clinics in Austria and Germany. Freud’s suggestion in “Lines of Advance in Psycho-Analytic Therapy” that, in the future, psychoanalytic treatment for the masses “will be free” hauntingly echoes throughout Danto’s book. The idea would likely seem alien to the British and U.S. public, as well as to mainstream psychoanalytic communities today. Danto’s book highlights a period at the end of the First World War during which psychoanalytic treatment had a preoccupation with its social mission of helping not just the bourgeois population who could afford treatment. Her comprehensive text shows how the clinics were set up and establishes the political and radical ideologies of their founders.
In 1918, Freud called on psychoanalysts to be prepared to establish clinics where psychoanalytic treatment should be free to those who could not afford it. Invoking the social democratic spirit of the age, Freud asserted that, while the state would eventually recognize the urgency of such provision, in the meantime such institutions would be started by private charity. He insisted that “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.” Following Freud’s provocation, the Berlin Poliklinik was opened in 1920. One of its founders, Ernst Simmel, head of the Berlin Association for Socialist Physicians believed that the struggle for access to psychoanalysis was itself part of the class struggle. The clinic was extremely popular, with many applying to be patients, and fees were only required if patients could afford them. Members of the Berlin Psychoanalytic Society were required to donate free time or financial assistance to keep the Poliklinik running. In 1922, the Vienna Ambulatorium established itself against a backdrop of social upheavals and the rise of socialist politics, the period of the so-called Red Vienna.
Psychoanalysis was shifting to accommodate more radical members with progressive ideas. As Patricia Gherovici notes in Psychoanalysis in the Barrios: “Freud’s social activism and his commitment to the treatment of the poor and the working classes have been erased not just from the collective memory but, most importantly, also from psychoanalytic history. [...] About 20 clinics opened all over Europe, including Vienna, London, and Budapest. Other clinics followed in Zaghreb [sic], Moscow, Frankfurt, New York, Trieste, and Paris. They were free of charge like the municipal schools and universities of Europe. Analysts at the time saw themselves as brokers of change—individual and social.” Yet this historic moment was fleeting. The rise of fascism in Central Europe saw the end of this experiment in social activism. In Berlin, the Poliklinik was twisted into its grim and unrecognizable reflection, the Göring Institute, a center for the Nazis’ development of racialized forms of psychotherapy. “These were traumatic times,” recalled Martin Grotjahn, a Berlin-based analyst who fled to the United States, “and we talked little about them later.” In the wake of the Second World War, the concept of free or low-cost clinics was buried, and a much more conservative strand of psychoanalysis emerged, in which the poor and the oppressed were not only denied access to psychoanalysis but also in some cases were considered unanalyzable.
The Red Clinic is earnest about repairing not just in a psychic way, but also politically
Even as this neutralized psychoanalysis in the form of ego psychology developed in the postwar Western world, we also saw the rise of a significant counterculture that would challenge many of its preconceptions. This counterculture was interlinked with the radical social movements of the 1960s and 1970s that protested for civil rights and against the Vietnam War. As preoccupations with consciousness raising sat alongside an interest in consciousness expanding, figures such as RD Laing, the radical psychiatrist (and noted LSD user) who was associated with this New Left, grew in influence. The cross-fertilization of radical psychology and radical politics was such that even Lacan signed a manifesto in support of striking students during the May ’68 uprising in Paris. While the neoliberal revanchism that followed the ebb of the post-’68 revolts for a while seemed to bury the radical aspirations of psychotherapy, the cycles of protest that have followed the anti-capitalist awakening of Seattle 1999 have themselves been influenced by psychoanalytic ideas filtered through the likes of Žižek and Badiou, reasserting the affinities between radical politics and therapy in contemporary struggles.
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Efforts have been made by numerous historians, psychoanalytic activists, and theorists to keep alive the social link of psychoanalysis. For example, recently, analysts such as Patricia Gherovici and Daniel Gaztambide have worked in disadvantaged Latino communities in the U.S., establishing not only a desire for psychoanalytic treatment in the population but also its efficacy. In Britain, however, after a period of funding cuts and austerity, psychoanalysis is not widely popular and is difficult to access through the National Health Service. In recent years, there has been a major shift to cognitive behavioral therapy as part of the government’s Improving Access to Psychological Therapies program, now renamed NHS Talking Therapies. Yet, as Daniel Bristow and I have explained elsewhere, these services are closely linked to state-led interventions for making people employable.
Yet there have been attempts to reestablish the links between psychoanalysis and the social in Britain. Notably, the Department of Psychosocial Studies was founded in 2000 at Birkbeck University, which attempted to weave psychoanalysis with the social and which is currently facing the threat of restructuring and redundancies. Organizations such as the Centre for Freudian Analysis and Research (CFAR) and the Site for Contemporary Psychoanalysis have low-cost clinics, and there are also organic formations of networks to help people of color and working-class people access services, including the Radical Therapist Network, the Free Psychotherapy Network, and the Psychosis Therapy Project.
Between 2015 and 2019, a large section of the British public was stirred into action through the ideas and politics of a left-leaning Labour Party, symbolized by the general politics of its leader, Jeremy Corbyn. Many were inspired by his principled internationalism and his support for the liberation of Palestine. The 2019 manifesto pledged that Labour would “improve access to psychological therapies to ensure they deliver the quality care patients deserve” and to “ensure provision of 24/7 crisis services.” A vision for a National Care Service, similar to the National Health Service, was advocated after years of funding cuts and austerity. Such a service, in which “social care is a universally-available service, with personal care provided free at the point of use, and … all who need it can access,” was a welcome policy. By 2019, the British establishment had defeated any hope for such change. But many activists and people were galvanized around principles of social justice and redistribution.
After 2019, with Corbynism defeated at the election booths and the Conservatives back in power, the British Left was trapped in a period of mourning and overwhelmed by inaction. To top it all off, we were hit by a global pandemic, government lockdowns, and police lockups; we were locked in. It was during this closed-off period in which many were unable to escape the deadlock of either their political or personal lives that the Red Clinic was formed: a network of analysts, therapists, and counsellors from a broad range of clinical backgrounds, but with the same or similar political leanings—proudly anti-capitalist, with a redistributive agenda, unapologetically anti-racist, pro-queer, and pro-Palestine. In its formation, there is a sense of correcting what had gone on before it and repairing the defeated notion of radical change.
As Red Clinic board member Daniel Bristow explained, the Red Clinic requires “almost the inverse operation to the Free Clinics,” which developed from a central place before spreading out. The Red Clinic seeks to bring together projects that have emerged independently across the world to see what “solidarity and power between them can produce.” Yet the clinic’s founders are clear that they are still at a very early stage of the process of establishing what effect these political commitments will have in the clinic. As co-founder Luke Manzarpour explained, “what it means, say, to be anti-capitalist while working with a patient is one of the reasons for our existence. It is, as such, something we are working out/through.” However, their starting point is the wager that it matters to recognize the sociopolitical realities of capitalism, and such recognition can provide a stronger basis for treatment than that offered by what Luke calls the “bourgeois-liberal institutions and practitioners who, in convincing themselves and their patients that they have successfully bracketed out the social world, overlook its manifestations in the clinic.”
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In the wake of the Second World War, the concept of free or low-cost clinics was buried, and a much more conservative strand of psychoanalysis emerged, in which the poor and the oppressed were not only denied access to psychoanalysis but also in some cases were considered unanalyzable
The Red Clinic is earnest about repairing not just in a psychic way, but also politically. Co-founder Franck Magennis told me that the clinic “emerged as an attempt to forge a collective way of interrogating both the potential and limits of therapeutic practice from an anti-capitalist standpoint.” It is through overthrowing exploitation and injustice that we can achieve political freedom for all. Here begins the process of stitching back and repairing what was torn apart politically and psychically. Their mission statement landed during a time of racist police killings of Black people, of state-led mismanagement of the pandemic that led to the social murder of poor people of color, and of trans people’s lives being put in danger due to right-wing rhetoric and governmental policies.
Franck and Luke invited people to form a provisional committee to run the clinic. Their bold and concise mission statement aims for the collective to offer a “truly accessible and sustainable provision of psychotherapy for the working-class and the oppressed in the broadest senses of the terms, attentive to the interrelations between axes of oppression, and transcending national borders.” To get more clinicians from the Global South involved, the document seeks to attract people with similar politics and with an internationalist orientation. They understand the mission statement to function in a way that would exclude those who hold different politics to it. To an extent, then, it represents both a statement of intent and a program of action.
The Red Clinic is informed by a Marxist understanding of capitalism and is interested in the ways in which the personal and psychic become enmeshed. As Luke explained to me, “we draw inspiration from the works of liberation psychology, Frantz Fanon, the Freudo-Marxists, feminist psychoanalysts, and contemporary writers who incorporate consideration of the social and political into clinical work, such as Lynne Layton, Lara Sheehi, and Patricia Gherovici, among others.” One of the ways the Red Clinic reaches the public and fuses its political and psychoanalytic approach is through holding public events. Past events have focused on the abolition of the family, mental health in Palestine, labor conditions and mental health, and working with refugees.
The clinic’s operating model is simple and equitable: patients pay what they can afford, while clinicians are paid a fixed rate. Anything left over is used to subsidize treatment for those who cannot pay or can afford only a low fee. A flexible-fee model is the political basis for extending the clinic to those for whom psychotherapy wouldn’t ordinarily be accessible, chiming with how Freud described the Berlin Poliklinik: such endeavors “make our therapy accessible to the great multitude who suffer under their neuroses no less than the wealthy but who are not in a position to meet the cost of their treatment.” The therapy is often conducted via online platforms, a medium that attained wider prominence and legitimacy during the pandemic. Online platforms attract many who couldn’t otherwise attend sessions in person.
The Red Clinic is an upstart project run by a small group of volunteers. While they pay clinicians, they are not a hugely well-funded enterprise. In evaluating their funding options, they must consider how loans, grants, and equity can affect the operation and provision of the clinic. As the founders explained: “We of course recognise the limits to working as a capitalist enterprise, however cooperatively conceived. We are not exempt from the logic of capital and competition and are constrained significantly by their limits, which will only be overcome by revolution. However, while recognising these limits, we eschew a nihilistic fatalism, according to which the current conjuncture entirely prevents any form of meaningful anti-capitalist action in and beyond a professional context.”
While predominantly psychoanalytic, the Red Clinic has a mix of therapeutic orientations. Clinical supervision groups are led by Professor Robert Hinshelwood, a Kleinian. Supervisions are conducted together as a group, and in these meetings, the political and clinical experience of members is brought forward. Clinicians work together to understand their patients in their social and familial contexts. While maintaining privacy and confidentiality, the collective nature of the sessions means that the unconscious process in the analytic practice is collectively held together, as opposed to the privatization of the unconscious process to one clinician. The clinicians meet regularly to think through the transference of such a unique model. Luke explained to me that he believes that the clinic is “tentatively contributing to the development of a practice that will rediscover the links that early psychoanalysis had to the social and political in a manner adequate to the needs of our time.” Luke suggests that while the supervision sessions are similar to those that happen elsewhere, the focus on the social and the political in the clinical material is integral to “the process we are going through of developing a socially attuned psychoanalytic practice.”
The Red Clinic aims to build an international network, emphasizing the importance of solidarity between Marxists. While they acknowledge that much more work is to be done here, they have begun to develop associations with clinicians from Britain to Slovenia, India, Palestine, and the United States. As Franck explains, “Organizing with, and being organic to, the Global South is important because imperialism is a defining and fundamental feature of the capitalist totality. Class relations, and the mental health consequences that stem from them, operate differently between core and periphery. The members of our organization share a strong commitment to understanding and confronting imperialism.”
Franck told me that too many on the British Left have been unserious regarding anti-imperialism. The clinic, then, stands out in seeking in its own manner to remedy the disastrous ways in which imperialism, particularly as practiced by the British Empire, psychically and politically connects the exploitation and oppression faced by many. I am reminded of an adage from the late, British-based political thinker and activist, A. Sivanandan, “We are here because you were there,” emphasizing how migrants in the Global North are here because of the impact of colonialism there.
Tying these links up within the framework of the clinic is a powerful way forward when it comes to thinking through how capitalism and imperialism are felt on a psychic level. It is therefore significant that the clinic has a member based in India providing therapy, and that it has set up the Palestinian Clinicians Supervisory Group. A number of senior group psychoanalysts from Britain provide support for therapists who work in Palestine under conditions of apartheid and occupation, in Arabic and in English, to discuss the impact of the work. Through these psychoanalytic processes, the aim is, borrowing from Rose again, “to soften, rather than thicken, the contours of judgment—without losing sight of the dangers when memory is too brutally repressed, without diminishing the struggle for justice.”
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The members of the Red Clinic have set themselves lofty goals, though they approach them with some humility and a sense of the scale of the challenges they face. When asked about their ideal form, Franck told me that they would like to “create space for clinicians and comrades committed to anti-capitalist politics to organise and work together at a global scale to think about how therapeutic practice might contribute to revolutionary struggle.” Yet there are significant obstacles: “language and national barriers and the practical operational hurdles they present.” Perhaps even more fundamentally, the members of the Red Clinic recognize the challenges posed by money and financial pressures. As Franck went on to explain, they need to consider where they can get the resources they need, but also consider what impact getting such resources will have on “the politics and purpose of the organisation.” For example, one fear is that the clinic becomes reliant on volunteers, which might lead to a lack of consistency, burnout, or a shift in class composition toward those who can afford to give up their time freely. This is one reason why the clinic sees it as important to pay its clinicians.
Another challenge, very familiar to both socialist and psychoanalytic organizations, is a tendency toward fissiparity—they can all too often split acrimoniously over matters of principle, doctrine, or even simply ego. Franck suggests that “getting the right balance between political coherence and a degree of non-factional plurality has already proven challenging, and unavoidably involves conflict.” As the clinic develops, then, learning to constructively manage such conflict will be crucial to its longevity and productivity. While members of the board may be concerned that an institution such as theirs lacks the iron discipline of a revolutionary organization, perhaps the lack of a party line, or indeed of the requirement for one for a pluralist therapeutic organization, may turn out to be a blessing in this respect. It is hopefully much easier to stand by the motto of letting a hundred flowers bloom when the conquest of state power is not the uniting preoccupation of the membership.
The Red Clinic is in an early stage of its development, and it is perhaps too early to tell where it will end up. It is clear, however, that the clinic stands in the long traditions of seeking greater, more equitable access to psychotherapy for all, and of fusing psychoanalysis with radical socialist politics. So it is encouraging that Luke considers one of their key aims to be cooperating with individuals and groups with whom they are in solidarity. In addition to their work in Palestine and the Global South, the clinic is in discussion with trade unions about collaboration, hoping “to offer individual and group psychological support to those engaged in industrial action,” and they “would certainly welcome collaboration with others!” Such cooperation and collaboration could go a long way in reasserting those radical traditions for the betterment of activists and clinicians alike.
[1] I am grateful to Franck Magennis, Luke Manzarpour, and Daniel Bristow for taking the time to discuss with me the framework of the Red Clinic.