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 ;