Onthesoci ogenesi sof thepsychoanal yt i c setti ngAbram
deSwaanThe Ratschlixge(1),or"Recommendationsto PhysiciansPractising
Psycho-analysis"by Sigmund Freud/containa perfectly clearandrather
complete designforthe practice ofpsychoanalysisand a sociologist
willfindinthese brief writings a blueprintforthenovelprofession
ofpsychotherapist.Yet thesefour articles,so easilyaccessibletothe
uninitiated reader,are relatively unknown outsidethe circleof
psychoanalytic practicians(2)andnever werethe subject
ofsociologicalinquiry.Fromthe beginning ofthiscenturysociologistsin
Europeand the United States have studied Freuds works,butthey were
mostlyinterestedin hisgrandideas,hisgeneralviewson human
psychologyand,foremost,in Freud'saDplication ofhis
theoriestosocialproblems,(3)or,onthe other hand,inthe application
ofpsychoanalyticideasinthe design of
sociologicalresearchandanalysis.(4)Althoughthe relationsbetween
Freud'sthought and hisownremained mostlyimplicit,Norbert
EliasinUbev denPvozessdevZivilisation(1936)brought about an
earlyand verythorough osmosisofpsychoanalytic thinkinginto
sociologicalanalysis:(5)"Esbr aucht dabei kaumgesagt zuwer den,
aber esmaghi er ei nmalausdr uckl i chher vor gehobensei n* wi evi
el di eseUnt er suchungden vor ausgehendenFor schungenFr eudsundder
psycho- anal yt i schenSchu-l ever dankt . Di eBezi ehungensi
ndfurj edenKenner despsycho- anal yt i schenSchr i f t t umskl ar ,
undesschi enunnot i g, anei nzel nen Punkt endar auf hi nzuwei sen,
zumal si chdasni cht ohneausf uhr l i che-r eAusei nander set
zunghat t et unl assen. Di eni cht unbet r acht l i chen Unt er
schi edezvi scbendemganzenAnsat zFr eudsunddemdervor l i
e-gendenUnt er suchungsi ndebenf al l shi er expl i ci t eni cht
her vor gehobenvor den, besonder sdasi chvi el l ei cht uber si
enachei ni gerDi skussi onohneal l zugr oszeSchwi er i gkei t enei
nEi nver st andni sher -! st el l enl i esze. "Another area of
confluence between psychoanalysisand thesocialsciencesoccurred
withtheadoption of sociologicaland ctnthropologica 1conceptsin
psycho-analysis,initiated and continued by Freudin Totem and
Taboo(1912-1913),Group Psychologyand Analysisof theEgo(1921)
,Civilizationand its Discontents(1930),and Mosesand
Monotheism(1939).381In those eighty yearsthefield of
psychoanalysisinsociology has been enormouslyextended,andso has,to
alesser extent,that ofsociologyin psychoanalysis,(7)but therere
mainsa surprisingscarcityofsociologyof psychoanalysis, and a
completeabsenceof psychoanalysisc/sociology.(8)Yet,Freudian
analysis hasbecome one ofthe
greatintellectualcurrentsofthiscentury(9)andthe study
ofthisdevelopmentrightfully belongstothesociologicaldomain.One
importantcourse ofresearch would concernthe emergence,development
and distribution of psychoanalyticideas:asociology of
psychoanalytic knowledge;(10)anotherlineofinquiry would followthe
waysin which peopleccme to experience and expresstheirtroublesin
psychoanalytictermsand even may cometo consider
themselvesas"suitablecasesfortreatment". (11)A third
pathofinvestigation wouldtracethe development ofthepsychoanalytic
movement and professionfrom the earlydaysin Viennatothe ongoing
establishment of a psychotherapeutic profession with
allitsramifications.(12)The lastapproach deservesheuristic
precedence:boththe professionalandintellectual body of
psychoanalyticideasandthe layman'snotionsabout symptomsand
complexesare best understoodin thecontext ofthe
earlycercle(13)andthelater psychoanalytic community wherethey
originated and evolved. (14)Tothispurpose
itisnecessarytoinvestigatetheconcrete,daily,practical aspectsofthe
psychoanalytictrade, whatisusually calledthe"psychoanalytic
setting"asit was first described and prescribedin
Freud'sRatschlageof1912, andtotrace backitsoriginsinthetherapeutic
practice of Freud's,and preceding,days.Thesubjectofthisinquiryisthe
gradualadoption by Freud inthe years1886-1912of certain
practicesthat,taken together,becamethe waysof the psychoanalytic
craft,and a craftit wasin the exercise of which Freud madehisgreat
psychological discoveries.Forasociologist,however,the
psychoanalyticsettingitself,.understood hereasa
particular,novel,form ofinteraction,which constitutedthesocial
matrixfrom whichsprangthe body ofpsychoanalytic knowledge,
representsasgreatan inventionasany other Freud made.Thispaper is
devotedtothe elaborationandjustification of thiscontention.It may
be summarizedinthefollowingfour
propositions:1.Thepsychoanalyticsetting wasin manyrespectsa
continuation of recently emerging customsin general medical orac-
tice.2.It was,however,a purified practice,in thesensethat all
formsofinteraction(or other occurrences)that could serve asan
alternative explanation ofthecontributions of the patient
were,asfar aspossible,and in principle, eliminated,analogousto a
naturalscience experimentin382which all variablesare controlled
sothattheresulting process may be explainedin termsof the agensand
reagens alone.3.Therecently developed practice of office
consultation ap- -/peared to Freud and hiscontemporariesto be aform
ofinteraction-devoid of allexchangesand othereventsthat... did not
immediatelyserve the businessto be transacted:a. "social
null-situation" .4.In;the RatschldgeFreud proposestwo
-complementary - groundrules,rulesof behaviorfortheanalysand and
the analyst:the rule offree association and the rule of
ab-stinence.These rulesconstitutethe very essence of
psychoanalyticpractice andtransform the office consultation' into'
an entirely new interactionalcategory which must - V count as
Freud's greatestsociologicalinvention.The remainder of this paperis
devoted to ajustification of these propositionsfrom
historicalevidence andfrom material in Freud's works,especiallythe
early technical works,first amongthem the Ratsehi'dge.In
theeighteenhundredeighties,when Freud established his neurological
practice,the medicalprofession wasbeingtransformed bya succession
ofscientific discoveriesandtherapeuticinventions It; wasthe
heroicepoch of medicine of Koch orPasteurand,yet,veryfew quick and
surefire cures existed atthetime.In neurology,Freud'sspeciality,a
number ofinnovations were beingintroduced,practicallyall of them
abandoned asineffectiveat present:Erbs electrothera-
pie,Faradization,Weir-Mitchell'srest cureetcetera;(15) the young
Freudtried his hand atall ofthem,(16)including the older-
therapiessuchas massages,vapours,purges,and baths,and
also,hypnosis,which,especially in France,was coming backinto
respectability.(17)One ofthe unintended consequences
oftheintroduction ofnew therapiesand the application of
allsortsofinstruments wasthat-physicians found it even harderto
travelto see their patients,even as roadsand. vehicles were
beingimproved.(18)Thetoolsof their trade had.becometoo heavy andtoo
bulky to carry alongin a carriage,letalone on horseback along
country roads.Many of the new treatmentscould only beadministered
inthe doctor's^office or evenin a clinic.Also,as physicians had
more remediesat theirdisposal,theirservices camein great- er and
more urgent demand amongsufferers.It became more necessary-that
doctorscould befound everydayat afixed place and a tan appointed
hour.Moreover,once doctors were widely known toachieve cures,their
prestige grew among their fellow-citizens.Butinthe earlynineteenth
centurythe doctor is rpictured and described asa man on the go,a
man about tpwn: (19)383J ehauf i ger der Ar zt auf derSt r
aszegesehenwur de, urn sogroszer schi ensei neKl i ent el , j egr
oszer di eKl i ent el , f ur umsoti i chti -ger undbel i ebt er gai
t der Ar zt . "In those early daysthat wasthe wayto win
patients,or,accordingto a satirist ofthe times:(20)"Fahr ei nuneri
nder St adt her um, vennesdi r auchanf angl i chan Pat i ent enf
ehl t , al shat t est Duvi el zut un*"Initially,ifthe
physicianreceivedat home,it wasduring hisAudiemstundeforthe poor
whocould not affordto pay the doctor'svisit,andforthe
maidsandvaletsofthe rich who cameto describetheir
patrons'illnessesandtotake back counseland medicine,often without
the doctor ever seeing the patient
himself.Thesearrangementschangedin the course of thenineteenth
century under theinfluences mentioned ofnew inventionsand the
prestige gained withthese remedies,and, in a broader
perspective,withtherise ofthe professionsin general,the improvement
of university education,theimposition ofstandardsof
practice,andthroughthe relative increase of bourgeoisoccupationsin
general.Asearlyas1829a doctor Hahnemann wasreceiving hispatienb,
regardlessoftheir worldly status,in consultation tor some five
office hoursa day.(21)"I kunser eedl eZei t zuspar enundunser er
Wur deni cht szuver ge-ben, di i rf en wi r bei kei nemchr oni
schKr anken, undwar eerei n Fi i rst, wenner( ni cht ) (22) zuunsi
nHauskoxamen kann, Besuche machen*Nur ei nakut en, bet t l ager i
genKr ankenmi i ssen wi r besuchen.Wer vondenendi eumher
gehenkonnen, ni cht Hat hbei I hneni mHausesuchenwi l l , kannvegbl
ei ben, ander sgeht ' sni cht , "Clearly,itisa matter of
bothefficiency(edleZeit)and prestige(Wurde)}and, interestingly
enough,the differentiationamong home and
officeconsultationisnolonger between poorandrich,but
betweenscientific,medicalcategories, between chronic
andacute,bed-ridden patients;"und ware er ein Fiirst:The
standardsofthe professionshould cut right acrossthe
boundariesofrank.But Hahnemann,knownfor his arrogance(asa
medicalpractitioner),wasahead of
hiscolleaguesandfoundlittleimitationfor sometime tocome.(23)Er st
sei t derMi t t edes19 .J ahr hunder t sbur ger t esi chdi e Spr
echst undei mHausedesAr zt esmehr undmehr ei n; vondensi eb-zi ger
J ahr enanwur desi e, wi edi eDi sser t at i onvonI ngr i dVi el
erzei gt e, i nder heut i genFor mgebr auchl i ch. Hoch1896r i et
al l er -di ngsder Ber l i ner J acobWol f f i nsei nemBuchi i
berdenpr akt i schen Ar zt undsei nenBer uf demAnf anger , zunachst
kei nebest i mmt en Spr echst undenan2uset zen, er st spat er konnt
eer si chei nensol chen Luxusl ei st en. "The Luxusof an office
hour wasapparently reservedfor those physicians who had achieved
the individualreDutation and prestigethat would make
patientscomenothem,rather than384them visittheir patients.Itisafair
speculationthatthe developmentsin Austria,and especiallyin
Vienna,weresimilar androughlysynchronoustothosein German
cities,documented here.Dr.Sigmund Freud,Privatdozent
Neuropathologie,opened his practice on Eastern
Sunday1886,(24)havingrecentlyreturne from hisstudies with Charcotin
Parisand from a briefvisit to Berlin.Freudsfirst yearsin
practiceform one ofthe least accessible episodesin
hislife,sincetherichcorrespondence with MarthaBernaysceased
uponthefinalreunifi cation ofthe couple withtheir marriagein
September1886*The equallyinformativecorrespondence with
Freud'sfriend Fliess,onthe other hand,went offto a slow
start,warming up onlygradually.(25)Nofamousand gifted peoplecame
yet to visit Freudsothattheir published recollectionscould en-
lightenlatergenerations.Freud's biographersarepreoccupied witha
differentthemeduringthesame period:thereception of Freud'sideas on
hysteriainthe VienneseSociety of Physicians. (26)Afterafew
monthsattheRathausstrasze Freud moved to an appartmentintheImperial
MemorialHouse.About thearrangementstherelittleisknown,(27)but
alreadyin 1891thefamily settled at19,Berggasse whereFreud
wouldliveandworkuntil1938,in1907movinghis working quartersfrom
thegroundfloortothefirstfloorwhere thefamilydwelt attheother side
ofthelanding.(28)Many descriptionsof Freudin his work
surroundingshavebeen produced by visitingauthorsand
colleagues,buteachtime^ thata sociologist would wish such a
witnesstostoop,beit onlyfor a moment,to more
mundanerecollectionsabout eti
quette,financialarrangements,timesandschedules,orservants,the
writerisstruck byanotherspark ofgenius,a flash ofinsight
which,indeed,deservespriority.The premises at Berggasse where
Freudsetup^practicehave variously beendescribed as"une maison de
mediocreapparence dansun quartier perdu deVienne"(A.Breton)(49)anda
largeapartmentin oneofthe bestresidential quartersin
Vienna."(30)But accordingtothejudgmentof afellow- Viennese
contemporary,a"pupilandfriend',HannsSachs,it was"in a quiet
andrespectable,ifnot exactlydistinguished,
neighbourhood."(31)Freud's working quartersconsisted
ofthreeroomsand an anteroom:a waiting room,astudy,housing thefamous
antique collection,which could be enteredthroughtheconsultation
room where Freud received hispatients.(32)Atfirst veryfew patients
cameto see Freud,paying patients evenless.Freud s ffciend and
mentor,Joseph Breuer,had advised him atthe start bfP.tiis
practice11 to takelow fees,treat a good many people jjE&tis,and
count on earningfivegulden a dayforthefirst i/ears."
(33)Threetimesa week Freud worked as director of the
neurologicaldepartment attheInstitute of Children's iifseiaSesof
hisacquaintance Kassowitz.He held an
office385hour{Ovdinationsstunde)dailyfrom two to three p.m.,seeing
patientsthat were often referredto him byfriendly colleagues
,suchasNothnagel,and,foremost,Breuer:(34)"In die Ordination die
beiden alten Patienten von Breuer,sonst nichts.Ich habein der
Regelfunf Personenin der Ordination: diezweizum Elektrisieren,einen
Gratis,einen Schnorrer und einen - Schadchen./matchmaker/"Freud
applied thestock in trade remediesof theneurological profession,but
hegradually became knownasaspecialistin hypnosis with an interest
in hysteria.Hehad,after allstudied withCharcot,lectured on
thesubjectof hysteria,translated and edited works by Charcot(35)and
Bernheim,(36)and made a visittotheclinic of Bernheim and Liebaultat
Nancyin1889.(37)Gradually, patients"with disordersthat had resisted
all attemptsat organictreatment and that werethought to beof
psychic origin" (38)were being referred to Freud.In tracing
thedevelopment ofthe psychoanalytic setting it issignificant that
Freud received veryfew ofthese patients at hisofficeand usually
wenttoseethem,wheretheystayed. Apparently,heconsideredthisa matter
ofno importance,if heconsidereditat all,since herarely even
mentions where thetreatment of a patienttookplace.Intheearliest
ca&e study(1892),thereaderfindshim making visitsto the homes of
hishystericalpatients:"farfrom being welcomed asa saviourin the
hourofneed,it wasobiousthatI was being received witha bad grace and
thatIcould notcount on the patient having muchconfidencein
me."(39)In theStudieson Hysteria(1895)Freud visits mostof his
patientsattheir homes,in nursing homesor clinics,butatleast
oneisreceivedin office consultation:Lucy R,"cameto visit me from
timetotimein my consulting hours."(40),and so,apparently did
Rosalie H . :"Onedaythe patientcamefor her session."(41)Daily
visits(42)to homesorclinicsseem to have been thenormal pattern in
the early nineties.Thus,aturning pointinthetreatment of
Elisabethvon R.occurred when duringthesession sheoverheard her
brother-in-law in the adjoining room,butthereaderisleftto
guessthatthis disturbance happened in the
patient'shouse.(43)Consultation in clinicsand rest
homessometimestook placeatthe bedside, but,especiallyinlater
years,italso happened in a special treatmentroom or office on the
premises.In1910,when the Wolf-Man,began
histreatment,itallapparentlystill wasa matterof
convenience,beit,atthattime of Freud'sconvenience: (44)Freud told
us he found my case suitable for psychoanalytic treatment, but that
he was at present so busy that he could not immediately take any
new patients. However, we might make a compromise. He was visiting
a patient every day in the Cottage Sanatorium, and following this
visit he would begin my treatment there, if I agreed to spend a few
weeks in the sanatorium."386k -.fe^Viwebkslaterthe Wolf-Man began
to bereceivedfor treatment.atthe
Berggasseoffice.Dne'mhyspeculateabout thereasonsthat brought
Freudand his;:;'pat.ientstogetherin hisoffice,rather than attheir
homes fvorl elsewhere.Itcertainly wasnot a matter of equip-
men^^lif^icult to be carried around,asin other medical
s-^eci^l^e's.Freud gaveup theuse ofone implement after an-
tyt^eriiajbi ;