Adventures in the Orgasmatron (12 page)

The Ambulatorium had been two years in the planning not only because of Freud’s initial intransigence but because the psychiatrist Julius Wagner-Jauregg, a member of the conservative Christian Social Party and the head of the Society of Physicians, had blocked the proposals to launch a free clinic connected to the
Garrisons-Spital
(military hospital). Wagner-Jauregg, the director of the University Clinic for Psychiatry and Nervous Diseases, was then Vienna’s most celebrated doctor and one of Freud’s most notorious and sarcastic critics—“His whole personality,” his onetime assistant Helene Deutsch wrote in describing his resistance to psychoanalysis, “was too deeply committed to the rational, conscious aspects of life.”
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With the support of other psychiatrists who were not well-disposed toward psychoanalysis, Wagner-Jauregg, who took an entire year to examine Hitschmann’s proposal for the free clinic before he rejected it, argued that the clinic was an unnecessary supplement to existing ones like his own and constituted a breach of trade.

Reich would no doubt have been aware of Wagner-Jauregg’s efforts to block the Ambulatorium when he began a two-year stint of postgraduate work in neuropsychiatry with Wagner-Jauregg and Paul Schilder, the doctor to whom Reich had referred Lore Kahn’s mother. When Reich studied under him, Wagner-Jauregg was experimenting with electrotherapy and insulin shock treatments, and with inducing malaria to cure the dementia associated with the final stages of syphilis. It was found that the resulting fever could kill all pathogenic bacteria; the innovation would win him the Nobel Prize in 1927.

Wagner-Jauregg had been a friend of Freud’s when they were students. He once carried him to bed after Freud blacked out from drink, and he was one of the few to use the familiar
du
to address him. However, the pair fell out in 1920 when Freud testified against Wagner-Jauregg before a parliamentary commission. Wagner-Jauregg had been accused of excessive use of force in treating the military “malingerers,” as he called those he felt were feigning illness as a form of desertion. At the beginning of the war he had treated war neurotics with isolation and a milk diet, but he soon found that a strong dose of electric shock therapy was the best method of getting “simulators” to return to active duty, a feat he claimed to have achieved after as little as one session of torture. Freud accused him of having used psychiatry like a machine gun to force sick soldiers back to the front. In his autobiography, Wagner-Jauregg wrote that he considered Freud’s public statement a “personal attack.”
¹²

Reich received his first exposure to schizophrenic patients when he worked as an intern for a year on the “chronic ward” at the Steinhof State Lunatic Asylum in Vienna. There Wagner-Jauregg used bromides and barbiturates to sedate patients, which, Reich noticed critically, had no effect on their underlying psychotic symptoms. He wrote sympathetically of the inmates, “Each and every one of them experienced the inner collapse of his world and, in order to keep afloat, had constructed a new delusional world in which he could exist.”
¹³
His own analyst, Paul Federn, claimed some success in penetrating and curing schizophrenic fantasies using psychoanalysis. Reich liked Wagner-Jauregg’s “rough peasant candour” and admired his impressive diagnostic skill, but working with him created split loyalties.
¹⁴
Reich had already decided to give over his career to psychoanalysis, but to avoid being a target of his professor’s derisive wit, at Wagner-Jauregg’s clinic he made sure to exclude all mention of sexual symbolism from his patients’ case histories.

The Ambulatorium, which eventually opened at the General Hospital (where Felix Deutsch was a physician) just after Freud turned sixty-six, couldn’t have been more different from its sleek, modernist cousin in Berlin. Its shabby clapboard building was a carbuncle on the Beaux Arts architecture that surrounded it. The building was shared with the Society of Heart Specialists, whose physicians vacated it in the afternoons. The psychoanalysts used the emergency entrance for heart-attack victims as a meeting room, and the unit’s four ambulance garages made makeshift consulting rooms. A metal examination table with an uncomfortable springboard mattress doubled as a couch (patients had to use a stepladder to get onto it), and the analyst perched on a hard wooden stool. “After five sessions we felt the effects of so long a contact with the hard surface,” recalled the psychoanalyst Richard Sterba.
¹⁵
He had occupied both the stool and the table, having been analyzed at the Ambulatorium for free by Hitschmann and later, with Reich’s help, having gotten his first job at the clinic.

There was nothing elitist about psychoanalysis as Reich practiced it at the Ambulatorium. According to a report published by Hitschmann in 1932, 22 percent of the clinic’s patients were either housewives or unemployed, and another 20 percent were laborers. In its first decade, 1,445 men and 800 women were treated in the Ambulatorium’s improvised space, more than the 1,955 people treated at the Berlin Poliklinik. “The consultation hours were jammed,” Reich recalled, “There were industrial workers, office clerks, students, and farmers from the country. The influx was so great that we were at a loss to deal with it.”
¹⁶

These figures are especially impressive, considering the skeleton staff with which the institution operated, and show how accepted psychoanalysis was increasingly becoming among the general public. But they also show how far psychoanalysis was from providing what Eitingon ambitiously called “therapy for the masses.”
¹⁷
Eitingon himself regretted that the clinics couldn’t reach more “authentic proletarian elements.” Yet it was specifically the ambition of the second-generation analysts to do this—to universalize psychoanalysis with the aim of treating the social causes of neurosis rather than merely patching up the mental health of individual sufferers—that led to ruptures that almost destroyed the profession.

Freud, in launching the radical social project that was the free clinics, inspired the “revolutionism” of the second generation of analysts, as one of their members, Helene Deutsch, termed it (echoing Otto Bauer’s idea of a “revolution of souls”). They were, she said, “drawn to everything that is newly formed, newly won, newly achieved.”
¹⁸
These now legendary figures, who staffed the free clinics in Berlin and Vienna and came to believe that psychoanalysis could play a utopian role in liberating man from social and sexual repression, included Deutsch herself (who had been a lover of the socialist leader Herman Lieberman), Wilhelm and Annie Reich, Otto Fenichel, Edith Jacobson, Karen Horney, and Erich Fromm.

The year Reich joined the Ambulatorium staff, Fenichel instituted what became known as the children’s seminar for young psychoanalysts in Berlin, so called not because it was devoted to child analysis but because Fenichel liked to think of the rebellious analysts as “naughty children.”
¹⁹
In Vienna there was a similar generational gap, and a corresponding rebellion of values. It is notable that in a photograph of the Ambulatorium’s volunteers taken in the mid-1920s, there were only two gray-haired members: Ludwig Jekels and Hitschmann, who were both about thirty years older than Reich. For the young recruits, even more than for their superiors, psychoanalysis was, as the historian Elizabeth Danto puts it, “a challenge to conventional political codes, a social mission more than a medical discipline.”
²⁰

Swamped with patients at the Ambulatorium, Reich felt he was “‘swimming’ in matters of technique,” at sea in trying to apply psychoanalytic theory to an inundated practice.
²¹
He knew that he was supposed to break down the barrier of unconscious resistance with which the patient repressed any childhood sexual conflict so that the emotion-laden memory could break through and evaporate into consciousness, and he knew how to work with the transference so that it became a curative force in therapy. But what was one to do with uncooperative or catatonic analysands who refused to play the game of free association or did not want to have dreams? How to communicate with patients to whom the language of psychoanalysis was entirely foreign? When Reich told his uneducated patients, as he was supposed to, that they had a resistance or that they were defending themselves against their unconscious, they just responded with vacant stares.

There was no training institute or organized curriculum where Reich could discuss these practical problems. When he expressed his concerns to more experienced analysts, he said, “the older colleagues never tired of repeating, ‘Just keep on analyzing!’…‘you’ll get there.’” Where one was supposed to “get,” Reich added, no one seemed to know.
²²
Reich would take particularly puzzling cases to Freud, to whom he seems to have had privileged access. One of the cases about which he sought advice was that of his first analysand, the impotent waiter Freud had referred to Reich who was still not cured three years later.

Reich had managed to trace the origin of the man’s problem to his having witnessed, at the age of two, the bloody scene of his mother’s giving birth to a second child. This had left his patient, Reich noted, with severe castration anxiety, “a feeling of ‘emptiness’ in his own genitals.”
²³
However, though he had theoretically solved the case by unearthing the unconscious root of his problem, an epiphany to which the patient displayed no obvious signs of resistance, the waiter remained uncured.
²⁴
Freud warned against too much “therapeutic ambitiousness” and advised Reich to be patient and not force things; he also suggested, “Just go ahead. Interpret.”
²⁵
However, Reich declared a stalemate and dismissed the patient a few months later. His first case was a defeat that would plague him.

Freud told his disciples only what not to do in therapy, preferring to leave what one should do, as he told Ferenczi, to “tact.” Freud later admitted that his more “docile” followers did not perceive the elasticity of his rules and obeyed them as if they were rigid taboos. According to Reich, Freud deemed only a handful of analysts to have truly mastered his technique. At the Seventh International Psychoanalytic Congress, in Berlin in 1922, where Freud gave a lecture that was the germ of the following year’s paper “The Ego and the Id,” he looked out at all the people in attendance and whispered conspiratorially to Reich, “See that crowd? How many do you think can analyse, can really analyse?”
²⁶
Freud held up only five fingers, even though there were 112 analysts present.

Many psychoanalysts thought of themselves as passive screens for their patients’ unconscious projections and hardly intervened in their free associations. If their analysands were silent, they advocated matching these silences; they joked among themselves that they had to smoke a lot to keep awake during such unproductive sessions. (One analyst who had awoken to find an empty couch justified his having dozed off by claiming that his unconscious was able to dutifully watch over his patient even as he slept.) Reich experimented with this passive technique, but it did not suit his energetic character—he had been attracted to analysis by Freud, who was, as Reich saw it, a dynamic conquistador of the psyche. When Reich put up a blank façade, as some advised, he found that his patients “only developed a profound helplessness, a bad conscience, and thus became stubborn.”
²⁷

Soon after he joined the staff at the Ambulatorium, Reich suggested to Freud the establishment of a technical seminar to explore alternative techniques. When the idea received Freud’s blessing, the first-ever teaching program for psychoanalysts was launched. The technical seminar, initially led by Reich’s superiors, Eduard Hitschmann and Hermann Nunberg (Reich took over in 1924), was aimed at less experienced analysts, but senior analysts regularly joined the debate. It took place in the Society of Heart Specialists’ windowless basement; the “long room with a long table and big heavy chairs,” according to Helen Ross, a trainee who had made the pilgrimage to Vienna from Chicago, was made even more claustrophobic by the fact that it was clouded in cigar smoke.
²⁸
The seminar propelled Reich to the center of the theoretical debates then taking place within the profession. In this concentrated, heavy atmosphere, the analysts presented the stories of their therapeutic struggles (Reich offered his foundering case of the impotent waiter) and thrashed out possible solutions in the hope of forging a new, clinically grounded psychoanalytic technique.

When Freud had introduced the idea of free clinics, in Budapest in 1918, he had also spoken optimistically about “a new field of analytic technique” that was “still in the course of being evolved.”
²⁹
In the early 1920s there were two main areas of innovation to which Freud might have been referring: Ernest Jones and Karl Abraham were pioneering “character theory,” and Otto Rank and the Hungarian analyst Sándor Ferenczi (who made sure to attend the technical seminar when he was in Vienna) were pursuing what they called “active therapy.” Reich would ultimately try to fuse these two strands, but the former played a greater role in the birth of his theory of the function of the orgasm.