Monday, September 15, 2008

Culture, Adolescent "Depression," and Nonverbal Signals

This 17 year old boy was brought to my office by his parents because they were concerned that he might be depressed. Tom (not his real name) came in looking very flat and listless.

His parents said that he had lost all interest in the things that he normally enjoyed doing. He did not want to go out, and stopped talking to his friends. His appetite was down to nibbles.

Tom was a solidly built, attractive looking teenage male who, I think, should have been enjoying life. His voice tone was flat, and he looked very sad. I took a history, and checked for suicidal ideation or actions (none on either count). There were no recent deaths in the family. He was appropriately oriented, and there was no psychotic process. The family history was generally negative for a history of emotional problems and learning problems.

I sent them home with a promise to speak to Tom alone during our next visit.

Tom arrived on time for his next visit. He looked as depressed as he had the week before and slumped down in his chair. I asked him if he had a girl friend (I assumed, correctly, that he was heterosexual). Tom had an unusual response, "How do you get one around here?"

I asked where he was living the last time he had a girlfriend and he said it was California. It was important to find out how one got a girlfriend in California, because large parts of that state are vastly different, culturally, from the Deep South where Tom was now living.

Tom reported that many girls would approach him in the street and put notes in his pocket with their name and phone number. Tom clearly did not have to work to find girlfriends where he lived. This was a time when the behavior that Tom described was not acceptable in Fayetteville, North Carolina.

He learned that girls here behaved differently at the time. He was concerned that if he approached a girl for a conversation and their phone number that they might reject him. Tom was unaware of the signs that he was being admired by a girl or girls.

We discussed some of the nonverbal cues that girls give when they are interested in someone. I then suggested a typical teen hangout (The Mall) and asked him to try out the "education" that I gave him. He made another appointment.

The following week Tom was a changed adolescent. He was smiling, laughing and generally his old self. His parents were happy. Tom came into my office. I didn't have to ask what happened, he announced, "It worked. I got hooked up." I told him to come back if he ever needed to talk again, and he promised that he would.

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