The Great War and the Fifth International Psychoanalytic Congress in Budapest: Psychoanalysis in the 1910s ❧

. Objective/Context: This article studies psychoanalysis in the 1910s and aims to understand the impacts of the Great War and soldiers’ neurosis on the psychoanalytic movement and knowledge through the Fifth International Psychoanalytic Congress in 1918 in Budapest. Methodology: In dialogue with cultural studies on the Great War and intellectual history, this paper investigates psychoanalytical spaces of sociability, such as the International Psychoanalytical Association and its congresses. Originality: A thorough historiographical review reveals few detailed publications on the Budapest Congress itself. This article fills the gap by synthesizing prior findings about the congress, connecting the historiographies of psychoanalysis and World War I. Conclusions: The congress in Budapest was a milestone for psychoanalysis, considering the first governmental recognition of psychoanalytical treatment, theoretical changes produced by war neurosis, and institutional modifications in the International Psychoanalytical Association, such as the expansion and democratization of psychoanalytical treatment.


Introduction
Since its birth, psychoanalysis was under attack by psychiatrists and neurologists, which demanded the firm resistance of psychoanalysts, repeatedly expressed in the correspondence between Sigmund Freud (1856-1939 and Karl Abraham (1877Abraham ( -1925 under the motto "Coraggio Casimiro!" 1 But in the pre-war period, psychoanalysis had its own conflicting internal policy, with the most remarkable of them being the resignation of Carl Gustav Jung (1875-1961) from the presidency of the International Psychoanalytical Association (IPA). Karl Abraham took over as president to ensure the organization of the IPA's 1914 congress-which, however, did not take place because of the outbreak of the Great War. Only in 1918 became feasible again a new congress. 2 Amidst the horrors of war, biomedical sciences played a strategic role for armies. Physicians used the battlefield experience to create new knowledge about war neurosis, blood transfusions, brain and facial surgery, and the development of prosthesis. 3 In German medical journals and congresses, an intense debate on war neurosis included discussions about physical and neurological traumas according to the organic approach, but also disagreement about psychological issues of hysterical manifestation. 4 In this intellectual context, psychoanalysts challenged the methods used in the treatment of war neurosis by "orthodox psychiatry." 5 Those contributions were presented at the Fifth International knowledge is built. 13 In our perspective, the IPA journals and congresses were an argumentative community with a common basis: Freudian psychoanalysis. According to Pocock, divergences can be found in an argumentative community while the common basis remains intact, since polyphony is always a characteristic feature. 14 Following cultural studies on the Great War, 15 our incursion into the field of the history of science seeks to understand the impact of the experience of a totalizing conflict on the psychoanalytic movement. The singularity of the Great War-a war with armies of national citizens-demanded governmental solutions of national scope for the victims of the conflict and, subsequently, the acknowledgement of psychoanalysis. We seek to demonstrate not only the importance of war for redefining the topic of trauma in psychoanalysis, but also, and particularly, the importance of the Fifth International Psychoanalytic Congress as a central event in the process of acknowledging trauma, the professionalization of psychoanalysis, and a public/governmental understanding of the need for new therapies for the treatment of war neurosis-a widespread medical condition caused by modern war.
For this purpose, first, we summarize the history of the International Psychoanalytic Movement before 1914, highlighting the main conflicts within the IPA during its first year. Second, we present the topic of war neurosis through a brief review of the Great War's historiography. Subsequently, we analyze the history of psychoanalysis during World War I, stressing the impacts of the war on the trajectory of Freud, Abraham, and Ferenczi. Similarly, we also explore the political context of Germany, Austria, and Hungary. Finally, we describe in detail the events of the Fifth International Psychoanalytic Congress in 1918, seeking to demonstrate why and how this congress was a turning point in the history of psychoanalysis.

The International Psychoanalytic Movement before 1914
To survive and consolidate its position, psychoanalysis needed to go beyond the Wednesday Psychological Society, founded in 1902, 16 and become international as medical science. Thus, the psychoanalytic movement first expanded within Europe and soon crossed the Atlantic. 17 Moreover, Freud needed to approach medical university professors. Zurich. Bleuler was the Chair of Psychiatry at the Zurich University and director of the Burghölzli Hospital, with Jung as his Privatdozent (lecturer) and Abraham, a new graduate in medicine, as his assistant. 18 Although Freud won the support of the Zurich physicians for the psychoanalytic discourse, the attacks and criticism to his "cause" did not cease, affecting his new allies as well. 19 The strategy of Freud's opponents was an attack on his theory of sexuality. Since 1905, Freud defended that sexuality is not limited to genital satisfaction and sex. 20 Misunderstandings, however, did not cease. Many German-speaking "organic physicians" not only rejected Freud's sexual theory and the unconscious, but also considered psychoanalysis being pure speculation. These attacks were so intense that Freud was led to express in a letter to Abraham on November 12, 1908, his wish to keep away from the "Vienna congress," as he considered a change among his critics to be unlikely. 21 After the constitution of local associations, new intellectuals were attracted to the psychoanalytic movement-and some of them became lay analysts (without a medical degree). By Freud's suggestion, Abraham returned to Berlin, where he became devoted to the dissemination of psychoanalysis and to clinical exercise in his private office. 22 In Berlin, Abraham exercised significant leadership in the local psychoanalytic association, which included names such as physician Max Eitingon (1881-1943), sexologist and prominent advocate for homosexual rights Magnus Hirschfeld (1868-1935), and physician Otto Juliusburger. 23 Between 1908 and 1910, fundamental steps were taken to strengthen the psychoanalytic argumentative community. In 1908, the first psychoanalytic congress was organized in Salzburg. Next came the foundation of a scientific journal for the publication of psychoanalytic writings and congress lectures. During the Salzburg congress, Abraham's lecture on hysteria and the sexual character of psychosis in a case of dementia praecox-known today as schizophrenia-was strongly criticized by Jung. Freud wrote about this in a conciliatory tone in a letter to Abraham on May 3, 1908, while also recalling being in favor of the argument defended by Abraham. 24 Regarding the divergence between Abraham and Jung, Renato Mezan considers Abraham's lecture to be an "intervention in the discussion that Freud had with Jung, to know whether psychoanalysis can be used to study psychoses or not." Mezan highlights that the answer was yes for Abraham, contrary to Jung's opinion. For Abraham, Freud's theory of sexuality could be applied to psychoses "if we consider that in this case the libido flows back from the objects to the ego"; therefore, Mezan suggests that Abraham has "anticipated Freud's notion of narcissism." 25 18  In 1910, the International Psychoanalytical Association was founded with Jung as its first president. Under his presidency, three congresses took place in Germany, which shows the importance of Abraham's Berlin group for the psychoanalytic movement 26 at that time: the Second International Psychoanalytic Congress in Nuremberg (1910), the Third International Psychoanalytic Congress in Weimar (1911), and the Fourth International Psychoanalytic Congress in Munich (1913). The agenda of the Nuremberg Congress had eleven studies. Freud addressed the "future prospects of psychoanalytic therapy," Ferenczi presented suggestions for a permanent international organization, and Jung presented a report on the trip he and Freud had taken to the USA. 27 Between 1908 28 Before the war started, there was a rupture in the international psychoanalytic movement, involving the local Zurich group and IPA members linked to Freud. 29 First, Freud and Stekel clashed. As a consequence, Freud withdrew from the Zentralblatt's editorial direction. In 1911, Alfred Adler (1870-1937) had begun to express ideas that clashed profoundly with Freud's theory of libido, as Freud explained to Abraham: "Adler's behavior is no longer reconcilable with our psychoanalytic interests; he denies the role of the libido, and traces everything back to aggression." 30 The breakup with Jung happened when he came back from the United States, where he defended ideas that were contrary to Freud's theory: "I found that my version of psychoanalysis has won over many people who have so far been reluctant to the problem of sexuality in neurosis." 31 The response was immediate. A plan by Ernest Jones, leader of the London group, Ferenczi, and Rank was put into practice, forming a secret committee to guide the direction of the psychoanalytic movement based on Freud's ideas. In addition to Freud, Ferenczi, Jones, and Rank, Abraham, and Hanns Sachs were immediately invited. In 1919, Max Eitingon joined the group. The secret committee was set to be the basis to rebuild the psychoanalytic argumentative community before and after World War I. The first official meeting was held on May 25, 1913 president without the secret committee's votes. 32 At that point, the possibility of the dissolution of the IPA was real. Freud even suggested it to Abraham who, however, disagreed with the idea. 33 The solution was to orchestrate a series of attacks against Jung, concluded by Freud himself with the publication of "The History of the Psychoanalytic Movement" in 1914. 34 As a result, Jung resigned from both IPA's presidency and the editorial direction of the Jahrbuch, being replaced by Abraham andEduard Hitschmann (1871-1957). Jung's resignation represented the dissolution of the Zurich group. Abraham accepted the interim presidency of the IPA by Freud's suggestion, until a new poll in the next psychoanalytic congress was possible. After confirmation of Abraham's name by local associations, Freud expressed his wish to have him as a permanent president. 35 A few months later, the Great War broke out, imposing new directions on the psychoanalytic movement.

War neurosis between medical and political conditions: A brief review of the Great War's historiography
For John Horne, the essence of World War I resides "in a totalizing logic, or potential." 36 We agree with this author and defend that this conflict may be understood as a "total war." Although, in this article, we do not intend to map out neither the term's origin nor its ideological dimensions-not even its broad appropriation by the far right-it is of interest to us, particularly as an analytic device. The idea of the Great War as "merely an important stage in the growing capacity of war to mobilize and destroy societies" 37 led us to review pre-war conditions, namely the capacity of control and mobilization at the mercy of nation-states. The multiple transformations that modernity brings forth are conditions of historical possibility for modern war, namely industrialization and its logic of human and material integration and mobilization; the nationalization of territories through bureaucratization, the creation of national armies, and political mobilization; the ideological galvanization of identity by governments, hegemonized by means of control. National unity governments based on states of exception, safeguarded by the politicization of the war effort, and on propaganda and censorship determined to assert the legitimacy of sacrifice, mobilize their war economy towards the absolute destruction of the enemy. War is represented "in absolute terms, as a crusade against a total (and often dehumanized) enemy in which great emphasis was placed on morale, opinion, and what amounted to the ideological capacity of each nation to sustain the war effort." 38 Thus, the experience of World War I went against all expectations of war propaganda: the war came to be fought against an invisible enemy, in a trench warfare that would grind to a halt for moments of agonized waiting, where civilians with little to no military preparation were driven 32 35 Freud and Abraham, Correspondencia. 36 Horne, "Introduction," 3-4. 37 Horne, "Introduction," 3-4. 38 Horne, "Introduction," 3-4.
to the slaughter. The effects would be dramatic for governments, societies, and, fundamentally, for those who fought in it-most of them under the condition of recruits in compulsory military services. For John Horne, the "politicization of warfare," transforming a nation into a source of mass armies, combined with technological innovation favoring firepower enhancement, "made the battlefield more destructive than ever before." 39 Hence the common view of veterans deeply brutalized by war among many historians, mainly those dedicated to German and Italian case studies. On the other hand, contrary to the idea of total opposition between times of peace and times of war, the theory of cultural continuity "emphasizes the moral and cultural continuity that underlies both the experience of peace and the experience of war." 40 Although war defies all categories of understanding, the mediation of experiences mobilizes existing categories. According to Leed, Freud, in his analysis of the uncanny, maintains that this experience is essentially the return of something already known and familiar (heimlich) that has become strange (unheimlich) through a process of repression. In a sense, Freud just adds the concept of repression, as a categorical activity, to Jentsch's notion that the experience of astonishment is usually caused by encountering something that goes beyond the categories considered definitive. 41 War neurosis is a central element in the Great War, because "trauma resulting from shell or mine explosions is the main cause of physical or nervous damage." 42 "Shellshocked soldiers were the first carriers of post-traumatic stress disorder in the twentieth century," 43 although war neurosis in post-traumatic stress disorder (PTSD) was only acknowledged as such in the 1980s. PTSD served as a culturally sanctioned diagnosis, which placing the origin of the pathology in an external device-war-would legitimize the claim for recognition and compensation from the government. 44 According to Fiona Reid, the Great War had an estimated 80,000 casualties related to war neurosis in the British Army, 200,000-300,000 among the German, and likely far more among the French. 45 As for the Austro-Hungarian Empire, Ferenc Erős estimates 180,000 cases in Vienna alone. 46 Although the pathology had been identified in previous wars, it grew into something nefarious in the Great War for the contingent of soldiers and for troop morale, demanding an urgent response from the medical services of national armies. With war neurosis, neurology and psychiatry gained more and more space within military medical services in the Great War, but they were far from resolving the dramatic impact of the conflict, even in the post-war period: not only were the diagnoses inaccurate, but treatments would often become violent for the patients themselves. The organicist explanation of war neurosis was also preferred by soldiers, as they could more easily be identified as wounded by war, being "genuinely ill." 47 Despite being gradually abandoned by neurology, the purely organic diagnosis remained prevalent due to "skepticism about some claims to war-related disability without evident physical injury; at times they believed such men were malingerers pretending to be disabled." 48 In the context of war, the number of casualties and the relatively new pathology led to an array of treatments. If the first treatments prescribed failed to heal physical and mental exhaustion, other more "proactive" therapies could be used, including re-education, hypnosis, intensive massage, hydrotherapy, among others. 49 The most controversial and violent therapy was known as the "Kaufmann Method" in Austria and Germany. Developed by Fritz Kaufmann, this method was called "overwhelming technique" and combined suggestion and electrotherapy with the rigor of military exercises, reproducing the terrors of the front. Several cases of medical abuse were reported and a series of debates about medical ethics emerged in the Central Powers. 50 Most physicians were likely acting in good faith. However, the circumstances of war, military standards, and societies themselves in which these cases occurred made it extremely difficult to identify such clinical phenomena. Jay Winter refers to the difficulties of medical practice in the context of a modern war, in which governmental demands for men at the front would prevent physicians from adequately responding to patients. In 1920, Julius Wagner-Jauregg, a physician who later won the Nobel Prize in Physiology or Medicine, was accused of mistreating a war neurosis patient using electroshock. Freud would defend him by claiming that he knew his colleague, who had no intention of mistreating the patient; however, he "claimed that Wagner-Jauregg was too quick to see malingering when there was a more complex story to tell-the story of neurotic hysteria." 51 Medical colleagues responded that psychoanalysis would be "too protracted a treatment and too expensive to use in a war crisis," to which Freud answered that it would be the result of a conflict between the physicians' duty to respond to the government and to meet the patients' needs. 52 In addition to therapies deeply conditioned by war demand, these men were pushed aside due to the inadequacy of treatments, socio-political support, and public acknowledgment.
In Germany, many physicians had an active role in diagnosing war neurosis. The Annual Meeting of the German Society of Neurology in 1916 in Munich debated this topic. The conference attracted 36 physicians, who were divided between the defense of the illness' organic character, mainly represented by Hermann Oppenheim (1858-1919), and those who reported its psychogenic character, such as Max Nonne. According to Nonne, by the end of the debate, Oppenheim 47  was isolated. 53 Karl Abraham reported his impressions to Freud in a letter on November 12, 1916: "It struck us during the discussion on neurosis how official neurology is gradually taking this and that over from us, without acknowledging the source either to themselves or to the world." 54 The circulation of ideas crossed the European borders of the war and disagreement was visible. Where the Allied Powers chose to create diagnostic and treatment centers on the front, the Central Powers sent their soldiers to the rear, with devastating effects on the civilian population. In particular, Austria-Hungary centralized treatment in the capital, with around 120,000 traumatized citizens in the city of Vienna by the end of the war, which is exceptional since most countries preferred to definitively disperse their "lunatics" in the most remote areas of the national territory. 55

Psychoanalysis and the Great War
World War I had a significant impact on psychoanalysis. Throughout the war, the psychoanalytic movement fractured along the lines of the belligerent blocs. Interpersonal contacts were constrained-and, at times, virtually impossible. The requirement to mobilize medical contingents, as part of modern warfare, led to the incorporation of psychoanalysts into national armies. As the war started, leading psychoanalysts lost many patients to the front. Freud saw his most loyal collaborators wearing military uniforms. 56 Given his old age, Freud was not enlisted. Initially optimistic about an early end of the conflict, he soon changed his mind and started to criticize the war. 57 Abraham, in turn, continued to be engaged and optimistic most of the time. 58 The war deeply hampered communications with Ernest Jones. 59 In a letter from August 29, 1914, to Freud, Abraham questioned the relationship with Jones: "Do you also find it such a strange feeling that he belongs to 'our enemies'?" To which Freud answered, "True, Jones is our 'enemy'". 60 Despite such statements, there was no animosities among the friends of the secret committee throughout the war: "I appreciate the pains you have taken as an expression of your friendship and feel sure that this affection is strong enough even to outlast the long isolation," said Ferenczi to Jones on May 15, 1915. 61  to the mediation of Dutch physicians-the Netherlands were a neutral country-it was possible to resume communication with Jones in 1915. 63 Considering nationalism that divided French and German intellectuals during and after the war, it is fair to say that the psychoanalytic movement did not let itself be contaminated by the hatreds of war.
Regarding the daily lives of psychoanalysts during this period, Karl Abraham was initially sent to a military hospital in Grunewald, located on the outskirts of Berlin. At first, he worked as a surgeon and only in March 1915 was transferred to the Allenstein Hospital, where he began to perform psychiatric functions and assumed its direction. Together with Hans Liebermann (1883-1931), Abraham was able to observe numerous cases of soldiers traumatized by the war. Such change was not sufficient to alter his state of mind. He felt frustrated because, since the beginning of the war, he had not been able to meet with Freud. In addition, his low productivity in psychoanalysis and the return of a disease from his childhood (asthma) led him to depression. 64 In the case of Ferenczi, the opposite occurred. He and Freud were closer than ever. This gave him, and the Budapest group, an advantage in comparison to Abraham and the Berlin group. 65 In addition to carrying out some analyses with Freud, the correspondence between the two grew considerably. As a military physician, Ferenczi was initially sent to the 7th Regiment of the Royal Hungarian Hussars. In January 1916, he became the head of the department of neurology at the Mária Valéria Military Hospital, 66 where he could occupy himself "with traumatic neuroses." 67 On May 27, 1916, he was awarded a prize for his psychotherapeutic work with soldiers with "war neurosis." One year later, he was transferred to a hospital in Újpest, where he worked at the department of neurology with Viktor Gonda (1889-1959), with whom he openly disagreed on the use of electrotherapy. In December 1917, he finally managed to fulfill his wish-a transfer back to the Mária Valéria Military Hospital. 68 Thus, Abraham and Ferenczi had the opportunity to closely observe traumatized soldiers. Abraham's first reference about the subject, in a letter to Freud, dates back to January 30, 1915: "I have seen a number of traumatic neuroses, well known to us from peacetime." And completed: "I have seen a lot of severe cases of hysteria in people knocked unconscious by an explosion. They generally have aphasia, abasia, and hysterical attacks." 69 This theme is resumed by Abraham in five letters. In the last one, on December 10, 1916, he reports 90 cases of neurosis and psychosis. 70 Ferenczi also informed Freud about his own experience with subjects. On August 12, 1915, Ferenczi wrote to Freud and informed him about a trip to Budapest, Graz, and Vienna, whose purpose was "to visit war psychosis and neurosis cases." 71 After his lecture at the Mária Valéria Military Hospital on war neurosis, he reported to Freud and received an invitation from him to publish in Zeitschrift what he had first published in the Hungarian journal Gyógyászat in 1916. 72 In Freud's correspondence, the topic is addressed again on February 17, 1918, when Abraham told Freud that he had met Ernst Simmel, a physician in charge of the Military Hospital of Posen, who published his experiences with war neurosis in a book. According to Danto, Simmel held two to three individual analysis sessions-considering the number of soldiers in treatment, it was impossible to allow more time for them-and employed the cathartic method, 73 combining hypnosis and suggestion. Danto highlights that psychoanalyst Max Eitingon also made use of hypnosis when treating his soldier patients. Abraham, on the other hand, would call the method he used in the Allenstein Hospital "simplified psychoanalysis." 74 Freud, in turn, had a different experience than his friends of the secret committee. During that period, he published five books and gave lectures at the University of Vienna. 75 In the last year of the conflict, he went through a period of difficulties and restrictions. In his correspondence with Abraham, Freud reported that the professional fees he charged were the same, but inflation corroded the value of the money. The cold weather and food shortage annoyed him. His groceries were obtained as gifts or at incredibly low prices, thanks to Ferenczi, Eitingon, disciples in Vienna, and families from Budapest who believed in psychoanalysis. 76 It was in this context that psychoanalysis received important financial support. Anton von Freund, 77 Freud's wealthy former patient of Hungarian origin, decided to support the psychoanalytic cause and made a significant donation 78 to fund the foundation of a publishing house and an institute of psychoanalysis in Budapest. 79 Freud told Abraham about this in a letter from August 27, 1918, stating that Budapest should become "the headquarters" of the psychoanalytic movement. 80 The values collected were left with the Mayor of Budapest and subsequently made available to Freud. 81 The idea was born during Freud's vacation in Hungary, which had been carefully organized by Ferenczi-a chapter of the rivalry between him and Abraham. 82 72 "Über zwei Typen der Kriegsneurose" (Two Types of War Neurosis); Falzeder and Brabant, The Correspondence, 113-115 and 127-128. 73 This is Breuer's method used by Freud in the 1890s that consists of shifting "the patient's attention directly to the traumatic scene in which the symptom had emerged" to "discover the mental conflict involved in that scene and release the repressed emotion therein." Sigmund Freud, "Historia del movimiento psicoanalítico," It is important to remember that Ferenczi was a founder of Hungarian psychoanalysis, mobilizing a group of followers that would later be called the Budapest School of Psychoanalysis. 83 He played a central role in spreading psychoanalysis among the Budapest intelligentsia and modernist avant-gardes. 84 In a 1912 letter to Freud, Ferenczi wrote that an "analytic fever hit Budapest." 85 Although World War I affected the work of the Budapest Psychoanalytic Society (founded in 1913), the suspension of activities was only apparent, as they gained new members during this period and resumed activities in 1917. 86 The organization of the congress in Budapest reflects not only a favorable pre-war environment around the discipline in the city, but also resonates with the political projects of social and cultural transformation in progress. 87 In October 1918, the Aster Revolution proclaimed the First Hungarian People's Republic. Members of the new government, concerned about the impact of the war on their men and interested in the possible contributions of the field, attended the congress, and recommended the creation of a psychoanalytic service in Budapest. 88 At the same time, the liberal government allowed that psychoanalysis enter universities. However, it took the Hungarian Soviet Republic, established in March 1919, to guarantee the creation of a Chair and a Department of Psychoanalysis. 89 The revolutionary government established an environment of important social and cultural transformations, with the involvement of Jewish intellectuals, to whom Ferenczi was close. 90 With Miklós Horthy's victory over Béla Kun starts a phase of persecution of the Jews involved in the liberal socialist and communist regimes, leading to the dismissal of Ferenczi. 91 The conservative nationalist government would reverse the avant-garde spirit that characterized the pre-war Budapest, although the 1920s and mid-1930s marked the apex of Hungarian psychoanalysis. 92 In Vienna, the end of the war was a relief to Freud, especially considering the survival of his three sons. According to Gay, Freud "was not saddened by the death of the Habsburg Empire." 93 Danto, in turn, states that he not only celebrated the social democratic Republic-a period known as Red Vienna-but also had old friends among the leaders of the new regime. 94 In Germany, days before the German Revolution of 1918-1919, Abraham said to Freud: "we are well," but "the political future seems grim." 95 Although the birth of the Weimar Republic was traumatic regarding the political and economic context, it was also the beginning of an extraordinary period in Germany in cultural terms. And psychoanalysis was part of it. 96 For Zaretsky, psychoanalysis was able to capture many means of the war hecatomb, as well as new dangers and possibilities, constituting "Freud's postwar readers." 97

The Fifth International Psychoanalytic Congress in 1918
The history of the Fifth International Psychoanalytic Congress has its first chapter in the pre-war period. Initially, it had been scheduled for September 1914 in Dresden, without the participation of the Zurich group and already under the presidency of Karl Abraham. With the outbreak of the war, it was canceled. During the last years of the Great War, Sachs suggested that Abraham should resume the organization of the Fifth International Psychoanalytic Congress. While war-induced hindrances to the circulation of people and ideas were a challenge for the organization of the event, in the eyes of Sachs and Abraham such limitations were a sign of the congress' urgency, a means to reactivate the psychoanalytic movement. 98 With the agreement of local groups, a committee was organized, which selected the city of Breslau in the German Empire as the venue for the congress, scheduled for September [21][22]1918. However, both the date and the location had to be changed due to "technical and travel difficulties." 99 In a communication transmitted by the organizing committee to local associations, when justifying the option of Budapest, "supply difficulties were also mentioned." 100 In Budapest, however, the situation was not different. The British naval blockade had a major impact on Hungary and on Budapest. Famine and other forms of deprivation were part of daily city life among different social classes. 101 The third reason for a change was the impossibility for Austro-Hungarian military physicians to obtain visas from the German government, which, according to Abraham, would have jeopardized the registration of 14 participants. 102 A similar topic can be found in Freud's letter to Ferenczi on September 17, 1918: "But Freund reassured me about that; according to his information, visits from outside the borders of the Empire will likely be facilitated." 103 Budapest was chosen by Ferenczi during Rank's trip to Hungary at the end of August without informing Abraham and Freud. As president, Abraham and the Berlin group were tasked with the organization, therefore, Freud's agreement was crucial. Everything was carefully and secretly planned by Ferenczi with the help of von Freund and Rank. At the end, the new congress' 95  location meant a defeat for Abraham's ambitions. 104 Only after the war noted Freud that the secret committee became "torn by rivalries." 105 The Fifth International Psychoanalytic Congress was held on September [28][29]1918, in Budapest, more precisely at the Hungarian Academy of Sciences. Rank and Sachs served as the event's secretaries-the latter being replaced on the day of the event for health reasons by Lajos Lévy and Sándor Radó. 106 The Ministries of War of the Central Powers sent their representatives. Military physicians Sándor Szepessy and Ödön v. Németh represented the Hungarian government; military physicians Adalbert Pausz and Friedrich Valek represented the Austrian government; and, finally, Professor Dr. Casten and military physician Dr. Holm represented the German government. 107 The list of authorities present at the event also included the Mayor of Budapest and a representative of the Municipal Chamber of Budapest. Altogether, there were 32 members of the IPA, eight representatives of the authorities, and 45 listeners, including Melanie Klein (1882-1960). 108 The president of the IPA, Karl Abraham opened the congress with a keynote on the importance of the event for the psychoanalytic movement, highlighting the presence of official delegates as well as the representatives of neutral countries, van Emden and van Ophuijsen of The Hague, referring to the newly founded local Dutch group. The event was divided into two parts. In addition to the main table about war neurosis, there was a diversified set of lectures: Jan van Emden talked about dreams; Elvin Morton Jellinek (1890-1963) analyzed the psychology of friendship; Johan van Ophuijsen (1882-1950) talked about "female frigidity"; Otto Rank discussed myths; Isidor Sadger (1867-1942) lectured on the "Castration complex"; Viktor Tausk lectured on the "function of judgement"; and Géza Róheim (1891-1953) presented a study on "The Self. A Psychological Study of Peoples." 109 Freud presented "Paths to Psychoanalytic Therapy," revising new directions for the therapeutic process: resistance against the analyst and the role played by Ferenczi's active technique 110 ; the abstinence principle regarding the patient's substitutive satisfactions (through habits or analytical transference); the reintroduction of hypnotic suggestion during the war. 111 For Montejo Alonso, these new directions must be associated with an "expansion and consolidation program for psychoanalytic psychotherapy" outlined during the IPA's 1910 congress in Nuremberg. 112 But Freud's talk also marked a turning point for two sensitive topics in the history of psychoanalysis: treatment fees and the introduction of psychoanalytic therapy in the public space. For Freud, the "the poor have as much right to assistance by the psychotherapist as by the surgeon" and "neurosis threaten public health no less than tuberculosis." 113 Thus, Freud's "social renewal" went in three directions: civil society, governmental responsibility, and social equality. 114 From then on, he began to support "free psychoanalytic clinics," "flexible rates," and "lay psychoanalysis" 115 against the monopoly of medical knowledge. 116 For the first time, Freud proclaimed the social responsibility of psychoanalysis to reduce inequality and to offer free therapy. He acknowledged, however, that such effort would still depend on private charity at first. 117 Before the war, Freud had considered that free treatment was probably useless for therapeutic purposes. Strategically, this was also about acknowledging the value of practice as it is "a known fact that the value of treatment is not enhanced in the eyes of the patient, if very low fees are charged," avoiding thus unpaid services, even for family members. 118 Until then, psychoanalysis was practiced mainly in restricted and private spaces: local associations, scientific meetings, IPA congresses, and private practices. For Freud, this organization was a result of the exclusion of psychoanalysis by the university. 119 One cannot neglect, in our view, the connection of the public dimension and free psychoanalytic therapy with wartime experience, specifically the integration of therapy to the care of soldiers of national armies 120 at the expense of governmental health systems, as well as the precarious conditions of war and post-war contexts.

War neurosis at the center of the debate
Despite the diversity of themes fueling the discussions at the congress, war neurosis was the central topic. The first psychoanalyst to speak about the subject was Ferenczi. 121 In his presentation, he focused on the failure of neurology and psychiatry to provide a diagnosis and therapy for war neurotics, introducing numerous authors. Among the psychoanalytic works, Ferenczi first highlighted Stern, who observed the relationship between militarism and repression in the onset of neurosis, considering that soldiers are forced to repress their emotions. Then he pointed out Mohr's use of Breuer's cathartic method, whereas Ernst Simmel applied the psycho-cathartic method. 122 Ferenczi also noted that Max Nonne, despite disagreeing with the sexual basis of the explanation of hysteria, stated that "the experiences of war provide interesting clarification and confirmation of Freud's theories on the elaboration of the unconscious." 123 In this regard, Ferenczi responded that "war neurosis belong to the group of neurosis, the development of which interferes not only with genital sexuality and ordinary hysteria, but also with a former stage, which was given the name of narcissism," both in dementia praecox and in paranoia. He concluded that "the sexual bases of war neurosis will reveal themselves," 124 where Freudian theory is well understood.
The sexual basis of these so-called narcissistic neurosis seems less obvious, above all, for those who assimilate sexuality and genitality and forgot the use of the term sexual in the old Platonic sense. However, psychoanalysis adheres to the old view when it integrates in the chapter of "eroticism" or "sexuality" all the affectionate and sexual relations of man with another sex and with his own, the affective mentions in relation to friends, relatives and human beings in general, including the affective relation to the "Ego" and the body itself. 125 After Ferenczi, it was Karl Abraham's turn to present his lecture titled "On the psychoanalysis of war neuroses." In his study, Abraham states that his experiences fully coincide with those of Ferenczi's. Trauma acts on sexuality, by giving "impulse to regressive changes that extend towards narcissism." 126 However, trauma is not manifested in all the soldiers, the reason why Abraham defends the need to consider the hypothesis of individual predispositions. Karl Abraham also observed a narcissistic illusion, through which subjects believe themselves to be immortal or invulnerable; the effects of an explosion and injury destroy such beliefs, leading narcissistic security to give way to feelings of helplessness, and causing the neurosis to set in. In many cases, there is regression, which leads the soldier to behave with an "expression of a child hardly two years old." 127 Abraham's concept of regression is related to the stages of sexual development (oral, anal, latent, and phallic) described by Freud. 128 In the text "Pre-genital stages in libido development," Abraham defended that the passage from one libido stage to another does not prevent a later regression. 129 For this study, Abraham received an award from Freud after the 1918 congress. 130 Ernst Simmel-who had not been a psychoanalyst until then-was the last speaker. In his lecture, he defended the psychogenic origin of war neurosis and psychoanalysis, while criticizing the various methods of psychotherapy that used force and restrictive actions, since these tended to produce new psychic damage. In addition, Simmel noted that eliminating the symptoms did not guarantee the cure; on the contrary, they would often resurface in different ways. This is the reason why he concluded that the methods used by physicians were merely palliative. For his part, Simmel employed individual analysis in a small number of cases, combining the hypnotic-cathartic method with analytic conversations. He also made use of dream interpretation to systematically investigate the symptoms of those patients. He stressed that he would not treat patients whose dreams he did not know. 131 He observed an "incongruity of the war experience and the lack of patient preparation," which would lead to the issue of predisposition. 132 Differently from Abraham and Ferenczi, Simmel declared not having tested the sexual nature of war neurosis, as his focus was on the symptoms of that phenomenon. He admits that, in some cases, the sexual content-such as a sexual trauma in childhood-is present. 133 Because of this study, Simmel was also selected by Freud to receive the award created with Anton von Freund's donations. After the war, Simmel became Abraham's analysand and an important name in the history of psychoanalysis in Berlin. 134 Although Freud did not give a lecture on war neurosis, the subject had an undeniable impact on him: new concepts (repetition compulsion and death drive, for example), theories on anxiety, adjustments in the method for psychosis and perversion cases, and, above all, a reinvestment in trauma. After Freud's seduction theory and the discovery of the unconscious phantasy, trauma did not disappear. Instead of focusing on external events, Freud preferred to explain trauma in economic, mnemic, and internal terms (psychological signification). 135 During the war and postwar years, the traumatic neurosis concept played a relevant role in Freud's texts, as well as theorical difficulties, considering the differences between trauma and neurosis. 136

IPA's administrative meetings and the congress' impacts
After the scientific program was completed, the IPA's administrative meetings were held. Ferenczi was elected president of the Association and Anton von Freund became the new secretary. It was decided that the following congress should take place in 1920 in The Hague-which shows the importance of the newly founded Dutch association. A report written by Ferenczi and von Freund about the congress' impact shows the dimension of the investment of public authorities in psychoanalysis in a time of shortages: "The city of Budapest had made available the Hotel Gellértfürdő" and "on the night of September 28, the participants of the congress were the guests of the city of Budapest at a banquet held at the Hotel Bristol in honor of the congress." 137 In a letter to Hans Sachs, Oskar Pfister highlighted the importance of the event: "It is magnificent that you organize a congress of psychoanalysis in a difficult time like this." 138 In this letter, and in a telegram sent later by Pfister about the well-advanced "establishment of a Swiss section of psychoanalysis," 139 it is noteworthy that the accomplishments of the congress had great importance for the reactivation of the psychoanalytic movement and the IPA in the context of war. The participation of renowned psychoanalysts who had served as military physicians during the war, as well as https://doi.org/10.7440/histcrit84.2022.01 military medical representatives reveals the centrality of the context of war and its consequences for the definition of the congress' agenda.
In a note sent by the IPA to ministries of war, thanking them for the participation of their representatives in the congress, the following remarks are noteworthy: We confidently trust that the psychoanalytic therapy method, particularly in the extremely important field of war neurosis, as well as in the further therapy of the disabled war neurotic, reaches significant success. The established association will be available, with great honor, to the Royal Prussian War Ministry through the president of our German group, Dr. Karl Abraham. 140 The sentence about "trust" and "success" of the "psychoanalytic therapy method" is repeated in a letter sent to the Ministry of War in Vienna. The documentation reveals the three ministries' concerns and the IPA's interest to help them with the issue of war neurosis. On October 8, 1918 Thus, the congress yielded a promise made by the military authorities jointly with ministries of war to build treatment stations (Nervenstationen) for traumatized soldiers diagnosed with war neurosis, where psychoanalysts would work. Such a commitment meant, for the first time, governmental acknowledgment and the admission of psychoanalysis into the public structure. Erős reminds us, however, that those treatment stations worked for the segregation of soldiers and medical treatment using occupational therapy, hydrotherapy, electrotherapy, mechanotherapy, as well as hypnosis, and suggestion. In cases of resistance to treatment, as a last resort, psychoanalytic work would be carried out. Nevertheless, the agreement placed psychoanalysis in the face of a paradox: humanizing and treating the souls of soldier, without questioning the political and military objectives of war. 142 Thanks to the experience with soldiers and the social "crisis provoked by the war," the Budapest Congress approved mass analysis ("publicly financed") and didactic analysis for every analyst, which would require an increasing number of analysts. 143 Moreover, other acknowledgments should be mentioned. First, the manifesto of 200 students in favor of teaching psychoanalysis at the university. 144 As a consequence, Freud wrote a text about psychoanalytical teaching at the university, highlighting the deficiency of "medical psychology" and medical education methods, which, for him, were very descriptive. Psychoanalysis could fill the gaps in the medical and psychiatric formation, as well as practice and the relevance of war neurosis, but also the reconstruction of the IPA on a Freudian basis. We also highlight the role played by Ferenczi and Abraham in this context, as well as many theorical changes and new directions for psychoanalysis discussed during the congress.
For Isabel Sanfeliu, there were three successes in the war period: Freud's new contributions, the acknowledgement of the war neurosis therapy, and the creation of the publishing house Internationaler Psychoanalytischer Verlag. 152 Nevertheless, this article tried to go beyond that. The Budapest Congress was also an important opportunity for new adherences to the psychoanalytic movement and the first Chair of Psychoanalysis at the University of Budapest-although only for a short time. Similarly, the presence of the Dutch representatives and the re-foundation of the Swiss association marked the event as well. Finally, the importance of the congress can also be understood by the presence of military authorities and the arrangement to open psychoanalytic treatment stations for soldiers. The experience of treating soldiers laid the foundations for the establishment of psychoanalysis institutes, based on the issue of free treatment, as well as mass analysis and actions for increasing the number of analysts. Thus, we sought to present the multiple impacts of the Great War on psychoanalysis, in a remarkable context for the whole psychological knowledge. The limits of strictly organic explications regarding war neurosis opened new paths for the field and the Budapest Congress was a central forum of these innovative debates.