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A generation ago sexual promiscuity, delinquency, and alcohol and drug abuse were understood as symptomatic forms of acting out, forms of self-medication that were antithetic to psychoanalytic treatment. Clinical experience was persuasive: patients with impulse ridden character neuroses acted out their symptoms, rationalizing their conduct to defend against insight. Those who used alcohol and drugs added pharmacological insult to psycho-pathological impairment of ego functions since they biologically undermined reality testing in drug induced magical thinking.
A generation ago, in the years immediately preceding my child analytic training in London, and in the best tradition of Aichorn and Redl, I worked chaotic twelve-hour days with neurotic, delinquent, acting-out, working-class adolescent males. My retreat to quiet academic research and the elegance of training in analysis of (mere) symptom neuroses seemed a very reasonable trade-off for the fourteen-hour days that we who identified with Anna Freud shared with her at Hampstead.
In the early 1960s, Hampstead Heath's adolescent hangout, the Witch's Caldron, was haunted by some of London's more