The song title includes the parenthetical phrase "(1913-1938-197?)". The first two years refer to the years before the two World Wars broke out, and thus the third year reflects Bowie's belief at the time that World War III was imminent, a theme that is dominant throughout the lyrics of this song, and Bowie's songwriting in general at this point.
In 1999, at the Bridge School Benefit, an annual charity concert organized by Neil Young, Bowie played this song acoustically and said that it was "about young people, just before the two wars, wanting to go and screw girls and kill foreigners."
The title is a play on words "A Lad Insane." Bowie's previous album introduced the Ziggy Stardust character, and many people thought he was a little nuts.
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