Wednesday, December 24, 2008

Hidden meanings

Adolescents are not the world's greatest communicators, and some of the things they say are almost unintelligible, even without their slang. Large portions of my humility have come as a consequence of realizing that just when I begin to think that I understand them, they remind me that I don't.

What the adolescent means is sometimes hidden from view and must be sought, because the real meaning can be quite revealing. Let me cite an exchange that took place between me and one of my patients on the adolescent ward one morning:

Dan, a 14-year-old boy who had been physically and emotionally abused in life, was brought to the hospital after a suicide attempt. He seemed to be responding positively to the security of his new environment. He let the nurses know that he liked feeling safe. However, he was distant with me, and, despite my efforts to get something going with him, he remained apart.

As I entered the ward one day, I spoke to several adolescents near the entrance. I turned to see Dan glaring at me. "You don't like me!", he declared in a most unfriendly manner. My first impulse was to feel offended. My second impulse was to defend myself against this unfair accusation, saying something like, "What do you mean saying something like that to me after all the hard work I've done to help you? Who do you think has been trying to make things better for you? Is that the thanks I get?" and so on.

Instead, I decided to seek the hidden meaning in his words. I was confused and said to him, "I don't understand." His reply was,"Yes you do, you don't like me!" I asked: "I don't? You believe that I don't like you?"

"That's right," he snapped. "Gosh, Dan, what is it that I'm doing that would cause you to feel that way?", I asked.

"You spoke to everybody else and didn't speak to me!", he informed me. "Oh, I see! I guess I'd feel the same way if I thought someone didn't want to speak to me. How does it make you feel thinking that your own doctor doesn't like you?" I inquired.

"It scares me. It makes me think that you might send me away," was his almost whispered response. "I'm not going to send you anywhere, Dan, not until you and I both think it's time to go," I assured him. I touched his shoulder and said no more.

Initially, I had been tempted to refute Dan's statement. Instead, I chose to find out what had prompted his statement. My obvious struggle to understand what was going on in this unhappy young man made a statement to him far more eloquent than a defensive denial of his charge. I didn't have to tell him I cared about him. He concluded that on his own.

I was fortunate that Dan was willing to give me bad news. Too frequently, children will misinterpret parental actions and feel hurt, but out of "respect" they keep it to themselves. If they tell us about it, we have a chance to put it right. Whether they are willing to bring unpleasant news to us depends upon how we ordinarily react to bad news.

......."Understanding the Adolescent" by George H. Orvin

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