Broke Psychoanalysis
In memory of Harlem’s Lafargue Clinic
Kevin Duong
“Psychotherapy for the people.” This was the lovely phrase Freud crafted in 1918 at the Fifth International Psychoanalytic Congress to indicate the direction psychoanalysis should take after the war. It was an audacious prescription. Neuroses were commonplace, Freud reminded his audience, and nobody was spared. Why then should psychoanalysis be monopolized by “the well-to-do classes”? Why not render it according to need? What war-ravaged Europe required, and what analysts had to provide, were outpatient clinics provisioning free mental healthcare. Psychoanalysis’s institutional future, he suggested, might lie with the commons.
The ensuing years saw analysts across Europe improvise versions of psychotherapy for the people. Freud’s students in Berlin, Vienna, Paris, Budapest, and Frankfurt set up clinics stipulating no-cost treatment for a proportion of patients. In cities where the mood was socialistic, these clinics embodied an old and precious conviction of the Left: nothing is too good for the people. Neither luxurious public housing nor ostentatious culture, neither boredom nor beaches—and absolutely not psychoanalysis.
Harlem’s Lafargue Clinic was born into this tradition of free psychoanalytic clinics. It was run out of a parish house basement on New York’s 133rd Street from 1946 to 1958, and the clinic’s staff believed everyone damaged by the color line, and everyone poor, deserved treatment. Visits cost a quarter ($3.90 in 2023), but that ceremonial fee was waived if it was onerous. The staff worked for free. The basement space was furnished for free too, courtesy of St. Philip’s Episcopal Church. Patients were given spare change to cover their taxi fare home if that posed a problem. Framed on its walls and printed inside its brochures were sketches of the man to whom the clinic’s name paid homage: Paul Lafargue, the Cuban-born physician turned communist organizer and Karl Marx’s son-in-law. The Lafargue Clinic was a remarkable if idiosyncratic example of midcentury Freudo-Marxism in the United States. The staff dedicated itself equally to investigating the material bases of psychic disturbance and the alleviation of neurotic suffering.
In its own time, the clinic earned fame and notoriety that was atypical for a small psychiatric clinic. A labor of love, it commanded the respect of Harlem’s left-wing intellectuals. Richard Wright, in “Psychiatry Comes to Harlem” (1946), celebrated how the clinic brought “psychiatry to the masses, the turning of Freud upside down.” Ralph Ellison, in his 1948 draft of “Harlem Is Nowhere,” called the clinic “the most successful attempt in the nation to provide psychotherapy for the underprivileged.” The appraisal from Earl Brown, then at Time, was even more astonishing. He called the Lafargue Clinic “one of the most democratic places on earth. And this is not an overstatement.” To such praise were added weekly penny-sized donations from far-flung admirers who knew what it meant to be poor. Observers understood that a far-reaching experiment unfolded at Lafargue, and not only in terms of therapy. The clinic’s studies on racial alienation contributed to school desegregation by the U.S. Supreme Court. Concerning Brown v. Board of Education, Thurgood Marshall wrote to Fredric Wertham, the clinic’s director: “I hope that you and the members of your clinic will have satisfaction in knowing that your great efforts contributed significantly to the end result.”
This once-famous clinic has today become a bit obscure. This is true even among those who worship or administer pastoral care at St. Philip’s. When I visited St. Philip’s this past spring to chase down lingering documents, Charles, the organist, gave me a tour. A gentle, balding man with a careful gait, he pointed out the building’s magnificent stained glass before playing songs on his grand organ for my personal benefit. “It’s a beauty, but it needs some work.” When I related my interest in St. Philip’s, he responded, hesitantly: “Oh, I remember someone telling me about that. A clinic, right? I think it was a long time ago.” Charles’s memory could be exacting. He recalled, for example, who paid for the stained glass high up above the altar (a relative of the Astors). But the previous occupants of the basement beneath his feet remained just past his reach, as if names half-eroded on a gravestone.
Perhaps we shouldn’t be surprised that the Lafargue Clinic has ceased to exist as a memory, even among those whose proud history it is. “The transmission of knowledge across generations is more delicate than one would suppose,” Russell Jacoby wrote in The Repression of Psychoanalysis. “Familiar insights of one generation may become totally lost to the next.” The passing forward of knowledge, dreams, and collective capacities—a necessary dimension of democratic politics, I might add—requires sustained “human contact,” the felt enthusiasm between friends, students, organizers, lovers, teachers, and comrades. Without that contact, without that social link, the achievements of one generation do not become forgotten so much as they become irrelevant to the next, losing “the ability both to convince and to attract attention.” They become items of antiquarian interest. Jacoby had in mind psychoanalysis’s early connections to a radical political culture. Yet the same seems true of those segments of psychoanalysis’s history that do not link up to official institutions and certified analysts. Clinics like Lafargue have become dull curiosities in an era where the circuits responsible for metabolizing psychoanalysis’s history into memory have been privately enclosed by professional associations.
The transformation of the repressed into memory is rarely the crux of the cure. Even so, Freud always insisted it was a point of departure, a way to get going. “Getting going” isn’t actually a bad description for what the Left has been struggling to do for more than a decade now, at least in the Anglosphere. Maybe the time is ripe to find our way back to the Left’s historic wish for psychotherapy for the people. It is the case that Lafargue’s staff and patients made a promise we are still trying to keep seventy years later: psychoanalysis deserves to be communal luxury. It should never have been monopolized by any one group. Freud’s call for psychotherapy for the people in 1918 showed him at his most utopian, and for Lafargue’s staff, that utopianism is the correct yardstick for measuring what psychoanalysis needs to be and what it may someday do.
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The idea for the Lafargue Clinic arose during a conversation between Fredric Wertham and his friends Richard Wright and Earl Brown in 1945. A psychiatrist who had trained at the Kraepelin Clinic in Munich, Wertham emigrated from Germany to the United States in 1922 to work, first at a Massachusetts hospital and then under Adolf Meyer at the Phipps Psychiatric Clinic in Baltimore. He made his way to New York City in 1932 to take a job at Bellevue Hospital, eventually becoming senior psychiatrist for the New York City Department of Hospitals. Wertham first met Wright in 1941 when his cousin Ella Winter encouraged him to send along his book Dark Legend—an elegant psychoanalytic portrait of an Italian immigrant who had killed his mother. The book captured Wright’s interest, and the two men became close friends, exchanging notes on the psychoanalysis of violence. Subjects of race rule, concentrated anxiety, and thwarted libidinal sublimation, Black Americans were in Wright and Wertham’s estimation vulnerable to “catathymic crises.” These were bursts of violence that were premeditated yet whose motives were unconscious. Harlem was an enabling environment for such crises. On its streets reigned, Wright wrote, “an environment of anxiety and tension which easily tips the normal emotional scales toward neurosis.”
Wertham had spent a decade trying to create an outpatient psychiatric clinic in Harlem. The neighborhood desperately needed it. Until the Lafargue Clinic’s founding, Harlem had no dedicated mental healthcare facility of its own. Residents with severe mental health crises would be sent, usually involuntarily, to Bellevue’s Mental Hospital, which discriminated ferociously. Harlem Hospital would not enjoy its own psychiatric division until 1962. Treatment was more available for children than adults, though that treatment was frequently routed through the courts and juvenile delinquency systems. Despite this, philanthropists such as the Marshall Field Foundation rebuffed Wertham’s requests for financial support. “All gave excuses for not acting,” Ellison later complained, either because they assumed Black Americans did not need analysis or because they considered Wertham’s proposal an example of race-based special treatment. “One supposedly rich donor listened to [Wertham],” Ralph Martin of the New Republic later reported, “then smiled indulgently . . . By placing your clinic in Harlem, aren’t you actually practicing segregation?’” With philanthropists unwilling to help, Wertham was at a loss. Brown, who was then writing for New York Amsterdam News, suspected the hostility from the city’s liberal elite was intractable. And so Wright, echoing Wertham, finally suggested, in the fall of 1945, “Why not begin without money? . . . Let us see if we cannot shorten the long, drawn-out methods of psychotherapeutics.” Let us see, in other words, if we can adapt psychoanalysis around the fact that everyone is broke.
Let us see if we can adapt psychoanalysis around the fact that everyone is broke.
What does psychoanalysis look like when neither patient nor clinic has any money? What does psychic work, let alone repair, look like when scarcity is the rule? That isn’t a question that carries any weight within internal disputes of psychoanalytic theory. Compared to questions about analytic neutrality or “the unsayable,” censorship or acting out, “what do you do when you’re broke” seems hardly to qualify as psychoanalytic. But it’s actually a momentous question. It cannot but appear, in an imperative mood, out of conditions of social abandonment. Anyone committed to psychotherapy for the people must give an answer. That is true for analysands and analysts both. Wertham and Wright were proposing to treat Harlem residents who had no money, but it wasn’t like they had spare capital either. No state support was forthcoming, no benevolent Friedrich Engels eager to become a class and race traitor. Broke psychoanalysis was not what Wertham was taught to practice, but broke psychoanalysis was what needed figuring out. That was true in midcentury Harlem, and it is still true now.
Wertham’s breakthrough came when the rector of St. Philip’s Church, the Reverend Shelton Hale Bishop, offered him their parish house basement for free. With a space secured, Wertham gathered up friends, former students, and colleagues at Bellevue and Queens General Hospital to form the initial volunteer staff. The most important of these was Hilde Mosse, a child psychiatrist with Trotskyist leanings and soon to become Lafargue’s chief physician. More help came from exiled psychoanalysts that had fled Nazism. Ernst Jolowicz, a specialist of “personality analysis,” produced anti-Nazi propaganda for the radio department of France’s Ministres des Postes et Télécommunications from 1936 to 1939, until he was briefly detained in a concentration camp. He was forced to flee France in June 1941 with an emergency visa. He joined the Lafargue Clinic in 1947. There was also Bronislawa Langrod, who was born in Warsaw, trained as a psychoanalyst in Kraków, active in Polish antifascist cells, arrested by the Gestapo, and after the war made her way to New York City and the Lafargue Clinic. The list goes on, and includes both André Tweed and Charles Collins, among the very first African American psychiatrists to achieve full-time positions in mental health institutions in the United States. They were a proud, multiracial group, experts in their fields of psychiatry, social work, psychoanalysis, and office administration. Reverend Bishop was thrilled with this ensemble cast, which embodied psychoanalysis’s global itineraries and antifascist hopes. On March 15, 1946, several days after the clinic opened, the church newsletter celebrated the birth of this “Mental Clinic,” an experiment with “tremendous significance” for the neighborhood, the city, and maybe beyond too.
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Interested persons entering the Lafargue Clinic discovered no couch. They were greeted instead by tables, chairs, some lamps, and a few wooden screens. There was also a small desk Ellison donated. By 1952, the wooden screens partitioned the space into twelve booths, eight of which were considered operating rooms. In the center opened up a common space, where visitors queued for appointments. After eight o’clock, staff rearranged this center space into a seminar for everyone to debate challenging cases or share research. “Everyone” here must be taken plainly. “Every staff member,” according to an internal memo, “should get instruction in psychotherapy on all levels,” from analysts and social workers to psychologists and sometimes clerical staff, too. Provocatively, “everyone” included patients: most weeks a patient or two would attend, listen, and present their own case in as many of their own words as they could.
Some psychoanalysts will balk at this arrangement. The classical clinical encounter is a delicate and precious thing, and dispensing with it is not a trivial decision. Its power comes from its sheer incongruity with everyday life—its “radical unlikeness,” as Janet Malcolm put it in The Impossible Profession. There are good reasons why analysts have insisted on the one-to-one clinical encounter ever since Freud canonized it. Lafargue’s clinicians did not need reminding that their basement space failed to satisfy basic therapeutic expectations.
But at St. Philip’s, there was simply no question of private rooms for one-on-one analysis. The clinicians had to meet people where they were, literally; either psychoanalytic psychiatry could get going anywhere, with whatever was on hand, or all the idealistic references to “psychotherapy for the people” was cheap talk. It is true the clinic’s spatial arrangement started as a compromise formation, a half measure imposed by unchosen conditions. But Lafargue’s staff could not look at their basement space the same way a statesman surveys his kingdom. Psychotherapy for the people is not statecraft according to a heavenly pattern. It does not ask how given conditions—a land and its population—can be transformed in conformity with a legislator’s panoramic vision. When it comes to psychotherapy for the people, the point of view is closer to that of a political organizer: Given how things are, what can we do? If these are our given conditions, what can we transform these given conditions into given conditions for?
In truth, psychoanalytic psychiatry in this damp basement was no half measure, because the basement setting contained its own measure, its own immanent possibilities for therapy. Whether the staff liked it or not, the cramped space multiplied the transferential possibilities for patients and doctors. Having “not-enough” space forced a demonopolization of patients’ relationships with their doctors, of analysts over their cases, of staff ownership over the space, of universities and official institutes over technical education—and, above all, over clinical authority. Lafargue’s staff were crystal clear that psychoanalytic psychiatry required robust clinical authority. Their clinic was not an antiauthoritarian experiment, as no psychoanalysis can ever be. Analysands must be constrained by an authority to adopt an unusual posture of talking freely, to start transforming neurotic repetitions into memory. But nothing about this requirement suggests clinical authority has to be monopolized by any one person or class. At Lafargue, anyone could authorize or be authorized in turn. Anyone could suddenly find themselves in a clinical encounter. Sometimes, Wertham noted, patients formed transferential bonds with visitors waiting in the hallway who could “dispel . . . misconceptions better than a psychiatrist alone could have done.” All sorts of people can help us get going. We cannot know in advance with whom we will form transferential bonds. The impatient Polish woman sitting on the pew is as good a candidate for transference as the Dominican boy taking a Rorschach test or any clipboard-holding clinician. If a visitor to the clinic seemed unanalyzable to Mosse or Jolowicz, then maybe the desk staff stood a better chance; after all, given the cramped space, they were only ever a few feet away. Not the abolition of authority, but its multiplication, indeed the sheer abundance of transferential possibilities that any clinical setting brings into being: that wasn’t something the classical training of Wertham, Mosse, or Jolowicz taught them to prize or turn to their advantage. But that is what their cramped basement taught them to do by compelling them to do it.
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The clinic’s operation grew more complex over the years, and so too did its burdens. From 1947 to at least 1952, the clinic was designated by the Veterans Bureau as an official service provider for veterans of any color. In 1950, it finally received a license from the state’s Department of Mental Hygiene. Soon after, the clinic’s staff became involved with high-profile public battles: school desegregation and the “Trenton Six” in 1951, and then notoriously with comic book violence after Wertham’s 1954 Seduction of the Innocent. In each of these interventions, Lafargue’s clinicians tried to explain how psychodynamics of repression interfaced with social patterns of expropriation—how, that is, Freud intersected with Marx.
Can Marx and Freud be brought together? The question actually became somewhat urgent during the Cold War. Ben Kafka, in “Returning to the Repressed” (2019), writes of the Left’s historic pursuit of a “grand unified theory of unhappiness.” During the Cold War, bringing Freud and Marx together seemed to promise just such a theory. Hysteria had led Freud to psychoanalysis because it revealed there could be psychic disturbance without an organic lesion. Psychoanalysis was a revelation precisely for mainstreaming the fact that psychic reality was as real as practical reality, that the mind could injure itself even and especially in fantasy. Yet by the midcentury, the shadow of total war and global challenges to imperialism rendered the purely psychogenic origins of mental illness implausible. Mass poverty and racial domination seemed to cause mental disturbance just as much as the classic intrapsychic drama of assuming a sex. Surely social abandonment and spatial segregation activated and sometimes created neurotic debilitation. The conjuncture called on analysts to consider not just the psychogenic and neurological, but what—since Frantz Fanon—we’ve called the sociogenic origins of madness.
The Lafargue Clinic embodied Wertham’s lifelong goal to think Freud with Marx. As a student during the First World War, he was already studying Fabian socialism. He spent subsequent years wielding Marx and Freud against defenders of American capitalist democracy, notably at a 1947 Williams College conference where he squared off against Cold Warriors like George Kennan of “Truman Doctrine” fame. Wertham later spent most the 1960s placing Freud alongside Vladimir Lenin, György Lukács, Hannah Arendt, and then African socialists like Sékou Touré. In recognition of Wertham’s close relationship to Richard Wright, his daughter, Julia Hervé, sent Kwame Nkrumah’s books from Accra to Wertham for his study, much like how her father had once done from Paris with Paul Lafargue’s books. Hervé insisted Wertham focus on Nkrumah’s Neo-Colonialism: The Last Stage of Imperialism and its description of “the colonization of the mind.” He took her advice: Nkrumah features in his 1966 book on violence, A Sign for Cain. Like Wright, Wertham concluded that Harlem was an internal colony of the United States, a domestic factory for producing unique patterns of mental suffering among “mental DPs,” or mentally displaced persons. By the end of his life, Wertham had assembled hundreds of notecards cluttered with annotations for a book, never completed, on Marx and Freud: traces of a lifelong attempt to grasp how unconscious mental processes could move in tandem with capitalism’s unconscious laws of accumulation and contradiction. “Acc. to Marx man makes his own history without knowing it & acc. to Fr. he makes his own life without knowing it,” he scribbled.
Holding Freud together with Marx led the clinic to conclusions that challenged mainstream psychiatry. For one, the clinic determined the Oedipus complex presented a social fact. Though contemporaries often treated it as an intrapsychic drama, Wertham insisted otherwise. “The Oedipus complex is of course a crucial issue,” he wrote for the Scientific American in 1949, perhaps even the crucial issue. “It is a wedge that opens the door of psychoanalysis to the social factors in psychopathology.” That is because the renunciation of desire for the mother before the claims of the father—a castration in relation to which we become who are—is also the renunciation that submits us to social and symbolic life. Renunciation of desire is the pivot by which the psyche twists itself into society. We may have instincts because we are animals, but we have Oedipal complexes because we are animals becoming human, creatures whose psyches take shape by wrestling with the sexual prohibitions of a given society’s authority, its law. The Oedipus complex may be “structural” to the human subject and for that reason, as Claude Lévi-Strauss argued at the time, true in all times and places, transhistorically valid. But this Oedipal structure is also a guarantee that, universally, the psychoanalytic subject must come to terms with its historical location and so become a subject of history. We are all, universally, made particular by custom and sexual regulation. We are all, universally, made particular by our renunciations of desire before a specific society’s authority.
Wertham explained in the Scientific American how frustrating it was that “Freud, having opened this door, chose to pursue a different path, toward a strictly biological interpretation of mental illness,” leaving behind “the social . . . one is tempted to say, repressed.” Whether he was right about Freud or not, we should see the Lafargue clinic as Wertham’s attempt to take up this repressed path. To treat the Oedipus complex as a social fact, he and Mosse taught, meant rereading Freud’s Totem and Taboo in light of works like Friedrich Engel’s The Origins of the Family. Internal memorandums of clinic seminars offer detailed instructions for how to account for “the influence of social forces on our patients.” Indeed—and controversially—these memos enjoined clinicians “to consider the patient’s subjective wishes, but to give equal and sometimes greater importance to his objective position.” If the repression that thrusts each of us into bourgeois individuality is at once psychic and sociological, then analysis has to address both factors. It has to bring the material grounds of psychic life back into conscious play.
Lafargue’s staff were particularly attuned to what Jolowicz elsewhere called “situational neuroses.” These were neuroses anchored in sudden changes in a person’s social history—coming home from war, becoming a parent, or getting fired—that rendered a patient’s depth psychology maladaptive. Situational neuroses did not always require expensive, multiyear analysis. Sometimes what somebody needed was simply a stable job. People’s neuroses are usually more tolerable when they can work, enjoy their own efficacy, and experience some degree of self-management. In many cases, Jolowicz concluded in his numerous published papers, situational neuroses could be mitigated by another type of self-knowledge, the kind social theory supplies. “We must,” Mosse elaborated in her papers, “help our patients to recognize where they stand practically in society.” Patients needed to understand their location in the social totality. They needed help placing their suffering in a materialist and not only personal point of view. “Race” could not explain someone’s neuroses, even in Harlem; racial ascription was an existential situation in need of interpretation. To suggest otherwise—to believe in a special entity called a “Black psyche”—would be to indulge in ethnopsychiatry, an enlightened race science that Lafargue’s clinicians despised. Black psyches were no different than anyone else’s; it was their life in an internal colony that made them neurotic. And though it may be tempting to dismiss this prescription as class reductionism, that temptation must be resisted for its reductionist approach to class. “It is not class consciousness, but class unconsciousness” that afflicted Harlem residents, Wertham scribbled again in his private notes. “Can this be made conscious; yes, by the struggle.” It matters that Wertham wrote class unconsciousness and not false consciousness. The ascent from a class in itself to a class for itself is not about distinguishing true and false beliefs. It does not concern the recognition of hidden truths. It is more akin to the process of making a dream’s latent content manifest, the recognition of covert desire through the rearrangement of an individual’s psychic and social data. On this view, political organizing is a species of dream interpretation, an activity of rescuing repressed wishes that our everyday neuroses already whisper. Among a political organizer’s first tasks is to salvage these repressed wishes, to insist they are a secret measure for what the dispossessed deserve but do not get because history has betrayed them.
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It is hard to avoid the conclusion that if Harlem’s residents suffered from sociogenic mental illnesses, then the true “cure” lay in social revolution. The real conditions of life must change, too, if psyches are to be repaired. That was indeed the conclusion Lafargue’s staff reached in theory. One of the clinic’s difficult cases concerned a woman with delusions that her neighbors were “throwing fumes” at her to kill her. They would have been “just moving complexes around,” to borrow Wertham’s words, if they tried to analyze her without considering the fact that to without accounting for Harlem’s living conditions. The neighborhood was known for its overcrowding density; most buildings housed many more families than their designers intended.
Nevertheless, what is true in theory is frequently useless in therapy. Social revolution may be the real cure, but no clinic can design therapy around something like that. “We cannot wait for social and economic circumstances to change before we have to treat our patients,” Mosse lamented in one working paper. Analysts and clinicians “cannot change social conditions,” since “one cannot win it alone, individually. It can come about only through coordinated group work and action.” Analysis will never be a substitute for the work of politics. Its processes may condition it, and its success may depend on it, but therapy is not politics and it would be an outrageous symptom to confuse or conflate the two. The Lafargue Clinic had no choice but to fail the standard—their standard—of curing. Wertham and Mosse where honest and consistent on this point. The best they could do for their patients on this side of the social revolution was something humbler: they could protect in the meantime their patients’ “will to survive in a hostile world.”
The best they could do for their patients on this side of the social revolution was something humbler: they could protect in the meantime their patients’ “will to survive in a hostile world.”
The phrase “will to survive” is an arresting one. It appears several times in the memos and public-facing statements by the clinic’s staff. Sometimes, as Mosse liked to do, “hostile world” was qualified as “what is essentially (in the capitalist system) a hostile world.” The phrase is arresting because survival is not usually an explicit category of psychoanalysis, though of course it stands in half shadow behind almost all of it. When someone talks of trauma or self-sabotage, Eros and the death instinct, they talk about survival in an enlarged sense.
It would be easy to think of “the will to survive” as another of the clinic’s disappointing half measures. Lafargue’s clinicians certainly did not celebrate it or romanticize it. For them, protecting a will to survive was the best one could do in lieu of genuine curing—the overcoming of resistances raised and then resolved during a transference under conditions of social flourishing. It is not without significance that Jacoby emphasized survival in The Repression of Psychoanalysis. Speaking of Otto Fenichel’s emigration from Europe to the United States because of Nazism, he wrote of this interwar radical:
“For years, Fenichel stated, he had devoted himself to a psychoanalysis that was more than a private therapy; he had worked to develop a social and political theory. Now, these efforts belonged to history. ‘What once was is past.’ He felt that the overwhelming danger to life and liberty compelled theoretical modesty. The past hopes and plans had lost their urgency, even reality. ‘Many are oppressed; many are in need; and whoever thinks is threatened.’ A political psychoanalysis was no longer possible; survival itself was the watchword. The best one could do, Fenichel believed, was to preserve psychoanalysis and wait. The task was to ‘hold out.”
Jacoby emplotted political psychoanalysis as a tragedy. Psychoanalysis’s roots in radical political culture had to be muted the better to preserve it, and the lives of its émigré practitioners, in a new country hostile to Freud and Marx. Some of these analysts, like Jolowicz, ended up at Lafargue. But in depoliticizing psychoanalysis “in the name of personal survival,” Jacoby concluded that Fenichel and his circle actually helped killed it in the long run. Personal survival and political psychoanalysis were incompatible during the war; between the two, one had to choose, and in truth there was no choice to be made. Hence, in a cruel dialectic, though Fenichel and his circle survived, “today, it is no longer apparent that psychoanalysis was ever rebellious or that it was ever anything but sluggish and smug.”
This tragedy is a reminder that the utopian impulses of interwar psychoanalysis depended on propitious conditions that allowed analysts and analysands to hope for something more than mere survival. In places like Harlem, as during the war, such hopes receded. Lafargue’s patients were a mélange formed of migration inflows from disintegrating empires abroad and America’s own racialized surplus populations at home. Survival for them, too, was the watchword. That was the outrageous condition imposed on them and from which they needed to get going.
Yet, looking back, it may have been the Lafargue Clinic’s distinctive achievement to transform “the will to survive” into something more than what Fenichel was allowed to do. Because the more one reads the clinic’s case histories, the more protecting “the will to survive in a hostile world” looks like it was a kind of cure work—a different kind, naturally, than the one Lafargue’s clinicians were taught to do, but cure work nonetheless.
To see this, consider at last one of the clinic’s most challenging cases, someone we can call patient “M.” The clinic had been treating M., a repeat sex offender, throughout 1955. They thought he was making good progress. In February 1956, however, the clinic received a letter from the patient “to excuse himself for not keeping a Clinic appointment because he is in jail again.” He had relapsed and committed a sex offense. The letter reads:
“Please do not give up hope. This does not mean that I’ve failed. It’s just a long set-back. There are not enough Lafargue Clinics. I believe that I was about to approach the cure stage, had I not come to this. I’ll return there again some day, so don’t destroy my records please,—and don’t close the Clinic! We are not all hopeless cases. There are those who appreciate the sacrifice of your time, especially where there are other things all of you could do so much more recreational. Society is not a bad place to live in when you meet people like you. If I hadn’t been what I am I wouldn’t have met you. Though I wish I hadn’t been as I am. I’ll keep in mind that I have some place to come and somebody to come to.”
Where is the cure here? The harm M. has done toward (probably) women cannot be undone. These women will live with the consequences, and nothing can redeem that. Psychoanalysis cannot repair the past. M. did not get the cure he wanted, and now there are more broken people. This is a textbook case of failed treatment. What good is a vision of cure as strengthening “the will to survive” if that vision is neither what M. hoped for nor capable of repairing the wrong done?
Yet psychoanalysis enjoins an analyst to make room for a patient’s speech, to let the analysand bring their own questions to the clinical encounter. What is the question patient M. brings? There is no forgiveness to be given because none is requested. M. asks instead for Lafargue’s staff to not give up on him. “I was about to approach the cure stage,” “we are not all hopeless cases,” so don’t close the clinic. M. wants someplace to return to after jail. He is asking for another chance. He wants, like a compulsion to repeat, to try again after jail.
The compulsion to repeat, Freud teaches us, is a way of remembering unconsciously. We repeat because we cannot remember. But, in repeating, there is always a tacit hope for cure: the neurotic repeats because they hope they can repeat differently someday. Maybe this time, of all times, it will be different. That is one unconscious basis of the compulsion, and therein lies a therapeutic wish. We repeat because we want to change.
The Lafargue Clinic could not fix the past or prevent future harms. The only true form of mental prophylactic is a society where the color line and exploitation are abolished. What the clinic could do, and did do for M., even though it was not what M. wanted, was to instill a will to survive, a belief that he could still repeat differently someday. Fortifying this will to survive is not the kind of cure emphasized in classical analysis. But it is more than a half measure, too, something more than a cure compromised by the world it seeks to heal. It may also be the definition of cure most adequate to a broke psychoanalysis, a therapy for times and places where every resource imaginable is scarce—what was once 1950s Harlem and is everywhere now.