You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Dr. Esman has elegantly and courageously presented many of the major issues confronting a psychoanalyst who attempts to treat elite affluent youth who are drug users. He clearly recognizes the heterogeneity of the population of drug users and the need for differential management, and he certainly understands that it is difficult to arrive at any meaningful guiding principles, much as one might so desire. Psychoanalysts and others yearn for such guidelines.
Many of the problems of the practitioner arise from the varying attitudes toward the drug user that have occurred historically. The drug user was long thought to be a criminal or a delinquent and is still thought so by many. More recently the notion of the drug user being a medical problem, particularly a psychiatric problem, has gained preeminence.
What is most difficult for many to comprehend is the concept that drug use may be an aspect of social behavior in youth today, not necessarily based upon psychopathology. In this sense, drug use is reflective of life style that varies from time to time and place to place. Even in the minds of many professionals, remnants of the view of the drug user as a criminal are mixed with the conviction of basic psychopathology.
However, while some drug users are schizophrenic and some are character disorders, there are some who are free of disease or illness. That makes for the difficulty. Of course all are part of a world which is “one world” rather than a subculture apart, as in heroin addiction. This world of youth is not necessarily a society steeped in deviants, but rather a series of membership groups requiring different assumptions about the world on the part of its members.