Real Boys

by William Pollack

  2. Depleted or impulsive mood. The boy may act tired, dispassionate, bored, depleted. He may stop showing interest or taking pleasure in activities he used to seem to enjoy. If normally he is vivacious and talkative, he may become increasingly sluggish, less talkative, and less outgoing. Alternatively, he may act impulsively, unpredictably, or irrationally. He may seem more anxious or fearful than usual, perhaps reporting to you that he feels “nervous,” “worried,” or “tense.” It’s important for us to distinguish normal mood swings, especially during adolescence, from shifts in a boy’s moods that reveal deeper problems. This is a subtle distinction, so I suggest parents err on the side of asking a boy how he’s feeling rather than simply dismissing or ignoring his mood changes. Note that depleted mood is a common symptom of depression in boys of all ages; however, the occurrence of impulsive mood increases with age.

  3. Increase in intensity or frequency of angry outbursts. Even the smallest provocation may lead the boy to become full of rage and to verbally or physically lash out at others. What may at first seem to be a boy’s tendency to be “in a bad mood” may escalate into temper tantrums or frequent outbursts of anger or ongoing irritability. It’s important to remember that anger or “being mad” is one of the main ways boys indirectly express other feelings like grief, disappointment, and hopelessness. But when a boy becomes persistently angry or “grouchy,” he may very well be suffering a depression. Although the nature of a boy’s angry outbursts may vary with age, this symptom is significant for boys of all ages.

  4. Denial of pain. Even when questioned directly about difficult situations—a divorce, a death, an alcoholic parent, academic troubles—the boy may deny he’s feeling unhappy. His mantra may be something like “Everything’s fine” or “What’s the big deal?” or “Nothing’s wrong—why are you bugging me?” Behind these hardened responses may be a frightened, hurting boy. It’s important to probe behind the mask to help the boy express his authentic feelings. A boy in denial is often a boy in pain. He may also be severely depressed. Because this symptom is closely linked with the mask that emerges over time, it is unlikely to occur in preschool children; but with age, it may arise with increasing frequency.

  5. Increasingly rigid demands for autonomy or acting out. The boy may say things such as “Leave me alone.” He may resist adult authority. Younger boys may resist following rules at home or at school. They may act out in the classroom or at home. Older boys may come home late, take long drives alone, and resist participating in family events (even locking themselves in their rooms) or following family rules (such as curfew or “lights out”). While sometimes the boy may simply be rebellious or working through the normal process of individuation, he may in reality be isolating himself to cope with depression. Studies have confirmed that many boys who are depressed tend to develop conduct disorders. In 1986, Denise Kandel and Mark Davies, at the Department of Psychiatry at Columbia University Medical School, found that for boys, depressed mood was associated with minor delinquency and school absences. In 1990, Jeff Mitchell and Christopher Varley, at the University of Washington School of Medicine, found that 25 percent of preadolescent boys who were depressed also had a conduct disorder, whereas none of the preadolescent girls did. It’s important not to see boys who misbehave as “bad” or “toxic.” They may be sensitive, thoughtful boys who are actually depressed.

  6. Concentration, sleep, eating, or weight disorders, or other physical symptoms. The boy may find it difficult to concentrate on any one task without becoming quickly distracted or uninterested and might actually be diagnosed with attention deficit disorder. He may have trouble falling asleep, wake up abruptly in the middle of the night, or awaken prematurely in the morning. Alternatively, he may find himself tired a good deal of the time and sleeping too much each day. He may also suffer eating or weight disorders such as anorexia, bulimia, or obesity. These disorders do not happen only to girls. Also, he may have frequent headaches and stomachaches or report other persistent physical symptoms. Any of these problems with concentration, sleeping, eating, or maintaining body weight, or other physical symptoms should be discussed thoughtfully with the boy, as they are frequently associated with depression and/or may be connected with other serious medical disorders. In one form or another, these problems suggesting depression may occur in boys of any age.

  7. Inability to cry. The boy may appear unable to cry. Thus, for instance, if he is physically injured or is obviously in the middle of an emotionally traumatic experience, he may fail to shed a tear, appearing more stoic and hardened than usual. When any boy “shuts down” his emotions in this way, he may be trying to numb out what are actually symptoms of depression. Tragically, research shows that this symptom can occur in boys as early as elementary school.

  8. Low self-esteem and harsh self-criticism. The boy may seem very unsure of himself. He may utter self-effacing remarks such as “I’m such a jerk” or “Nobody cares about me” and focus on his failures more than on his successes. He may blame himself for things that clearly are not his fault. When offered compliments, he may deny them and try to persuade others of his weaknesses and shortcomings. Low self-esteem can be both a cause and a result of depression in boys. When you determine that a boy doesn’t feel good about himself, not only should you try to encourage and support him but you should also make sure that his low self-confidence isn’t linked to a more generalized sadness. Research has shown that this symptom can surface in depressed boys as early as the third grade.

  9. Academic difficulties. Often closely linked with low self-esteem, the depressed boy may have problems doing well at school. His grades may plummet, and he may get a bad report insofar as his conduct is concerned. These problems may stem not only from his lack of self-confidence but from his tendency to be distracted by his latent sadness. He may simply feel too unhappy to do his school work, much in the way that an adult who is depressed may begin to have problems focusing on work-related obligations. Also, when a boy is depressed, he may experience general difficulties concentrating on any given task, become withdrawn and tired, and thus find it very difficult to apply himself to his class work. This symptom can occur as early as the age when the boy leaves home to begin school.

  10. Overinvolvement with academic work or sports. The boy may become almost obsessive about his schoolwork or sports activities. He may spend all his free time on homework, studying compulsively, or out on the playing fields, avoiding contact with friends or family. While working hard at school or playing sports are obviously positives, some boys may use such activities to distract themselves from depressive states much in the way that men who are “workaholics” will use career-related work for such distraction. This symptom is more common as boys move toward adolescence.

  11. Increased aggressiveness. The boy may exude an overabundance of aggressive energy. He may act “wild,” become difficult to control, pick fights, or even intentionally injure others. His aggressiveness may actually spiral into sheer violence. Aggressiveness, like anger, is an approach boys take to cover up vulnerable feelings. Again, it’s critical that we not rush to the conclusion that an aggressive boy is merely a boy who is “bad” and doesn’t know how to behave. His rough behavior—especially if it becomes chronic and extreme—may actually be his way of calling for help. This symptom occurs in boys of all ages.

  12. Increased silliness. Perhaps to mask his genuine feelings of sadness, the boy may actually act silly or outrageous. He may, even as a very young boy, become the class clown at school or become the family comic at home. As his self-confidence deteriorates, he may also have a tendency to become the brunt of other people’s jokes. This is perhaps the most deceptive symptom of depression in boys. Not only does the boy seem to be doing all right, he seems amusing, entertaining, funny. But under the cheerful exterior may reside deep feelings of pain or desperation.

  13. Avoiding the help of others. The “I can do it myself” syndrome. When offered help on a task or given the chance to get emotional supp
ort from others, the boy will insist that he can handle things himself. This is another way in which the boy attempts to remove himself from the mainstream of his family and social circles and isolate himself. While a boy taking initiative should usually be encouraged, if he consistently or inappropriately protests others’ offers to help him out, he may be falling into a withdrawn or antisocial behavioral pattern not atypical of depressed boys. As a boy begins to be oppressed by the Boy Code—as early as the elementary school years—he may manifest this symptom of depression.

  14. New or renewed interest in alcohol or drugs. In older boys there may be a tendency to become more and more involved in alcohol or drug use. A boy who might have enjoyed a beer from time to time may begin spending time with friends who drink until they’re drunk. He may smoke marijuana regularly or begin experimenting with more serious drugs. Nearly one million eighth-graders say they have gotten drunk, according to a 1997 survey of 1,115 teens. This survey also found that 56 percent of those between the ages of twelve to seventeen have a friend or classmate who has used LSD, cocaine, or heroin, up from 39 percent in 1996. Sadly, many of these self-destructive behaviors are considered “cool” by teenagers and can confer social acceptance on a boy, a valuable benefit for a lonely, disconsolate boy. Such excessive use of drugs and alcohol is a classic sign of depression in boys and men and appears to be occurring in children of younger and younger ages.

  15. Shift in the interest level of sexual encounters. In older teenagers who are sexually active, there may be either a pronounced increase or decrease in his dating behavior or sexual activity. While obviously a healthy adolescent libido does not generally lead to depression, a boy who exhibits radical changes in his sexual behavior may be engaging in obsessive/compulsive behavior that reflects depression.

  16. Increased risk-taking behavior. During the teenage years the boy may begin to take inappropriate or unnecessary risks that show poor judgment. Examples include a new and unexplained tendency to engage in unprotected sexual activity, to drive at excessive speeds, or to engage in such sports as extremely risky skiing or bungee jumping that have high morbidity rates.

  17. Discussion of death, dying, or suicide. Especially during adolescence—but in some cases as early as the elementary school years—boys who are depressed may initiate discussions of or make casual or even joking references to death, dying, or suicide. While a child’s curiosity about his own mortality (or that of others) is only natural, it’s important to listen closely to any boy who talks about these issues. Especially if he’s exhibiting some of the other symptoms of depression, his reference to death, dying, or suicide may actually be an indirect way of letting others know that he’s not feeling good about himself, that he may be depressed. It’s always better to be wary, to question him about such a reference, even if turns out that he was simply curious or trying to be humorous.

  While it would be extremely rare for any boy who is depressed to exhibit all of these symptoms, it may also be unlikely that he’d exhibit just one. Typically, several of these symptoms will appear in a boy who is depressed. Yet because depression occurs along a continuum from “mild” to “severe,” I think it’s important to take immediate steps to help the boy as soon as any of the symptoms outlined above are detected. With depression, it’s better to be safe than sorry.

  ROBERT

  At the beginning of third grade, eight-year-old Robert started getting into trouble at school. He picked fights at recess, taunting other kids. In class, he seemed unable to concentrate. Full of restless energy, he couldn’t sit still or stay quiet. He began to be known as a troublemaker and his grades started to slip. Prior to this year, Robert had always been an easygoing boy who got good grades.

  If we analyze his behavior, we can detect several of the criteria from our diagnostic model: acting out, excessive aggressiveness, problems with concentration, and academic difficulties. Robert, whose father was a prominent banker who had been convicted for fraud, had been traumatized by his father’s abrupt departure from home. Now Robert was exhibiting symptoms that, in my opinion, constituted mild to moderate depression.

  PHILIP

  Fourteen-year-old Philip also showed dramatic behavior changes when he entered high school. He started hanging out with the tough kids and smoking pot. Soon, he was staying up late at night and was unable to get up in the morning. He skipped school often and started failing courses. He and his mother started fighting constantly, and Phillip would often shout at her loudly and inappropriately.

  Philip’s behaviors also fall directly within our diagnostic model—his use of drugs, problems sleeping, truancy, difficulty at school, excessive anger, resisting authority. Through discussions with Philip, I learned that his parents had recently divorced and that both he and his mother were having a difficult time coping with his father’s absence and dealing with life in a new and quite tense mother-son household. I diagnosed Philip as moderately to seriously depressed.

  PETER

  After Peter’s best friend, Brad, died in a car accident, sixteen-year-old Peter suddenly quit the basketball team and shut himself up in his room every afternoon, listening to loud music. He consistently refused to join the family for dinner, just saying sullenly, “I’m not hungry.” He started having thoughts of suicide.

  Peter, by seeking to isolate himself, refusing to eat, and thinking about suicide, satisfied several of the diagnostic criteria for boyhood depression. In fact, he was in the midst of a major clinical depression.

  Often as I consult with schools or talk to parents, I hear of boys like Robert, Philip, and Peter. It’s hard to think of depression when you first observe these boys’ problem behaviors. But armed with our list of diagnostic criteria, we can become more effective at knowing when the boy is actually depressed. Also, I find that if one has the chance to ask a few questions, it may turn out that the boy has suffered a recent unacknowledged difficulty that may have precipitated his symptoms. For instance, on further investigation it was uncovered that in Robert’s case, his father, a prominent banker in town, was indicted and sent to jail for fraud. Philip’s marijuana smoking started soon after his parents announced they were getting divorced. Peter lost his best friend in a fatal car accident when Brad and some other boys drove home from a party drunk.

  Underneath Robert’s restlessness and aggression, Philip’s marijuana habit, and Peter’s sullen withdrawal are sad, scared, and lonely boys. Though each is at a different stage on the continuum of depression, each has emotional problems severe enough to affect not only his present ability to function but also his future lot in life. These boys have suffered serious life crises, but not insurmountable ones. But what has made these boys unable to cope with their situations, and caused them to sink into depression, is that these boys, like most boys, do not know how to talk about their sadness or openly grieve over their losses and are not receiving the personal or professional help they may need.

  STEVE AND MARIJUANA: WHEN PARENTS MISS THEIR CUE

  To prevent boys from being trapped in the self-destructive spiral of depression, it’s important that parents and other concerned adults intervene early. One family I worked with missed several early chances to reach their son, Steve, and brought him to me when he was sixteen years old because he was by then a chronic marijuana user and in trouble with the local police. At this point, unfortunately, hostility and drug-induced numbness were Steve’s habitual ways of coping with the world. “Sure, I smoke pot every day,” he told me. “Sometimes once in the afternoon and once at night. What about it?” He also said he smoked two to three packs of cigarettes a week.

  I asked him when he started smoking. “I don’t know. Maybe three years ago for cigarettes. Two years ago for pot. Whatever.”

  After months of weekly meetings, he still doesn’t see his addictions as a problem. But he has begun speaking more openly—and with less hostility—about why he smokes.

  “It doesn’t matter what I do,” Steve says. “I used to get along with my mom. But I
don’t anymore. She just complains all the time. All she ever says is ‘Comb your hair’ and ‘Turn down your music’ and ‘Study more’ and ‘Clean your room.’ The other day, when my report card came, she said I’m ‘good for nothing’ like my father. I hate her.”

  “My dad doesn’t talk. He says like, one word a year. My sister just talks on the phone all day and all night. I have guys I hang with in school, but I never see them outside of school.”

  I asked Steve if his father really was good for nothing. “Yeah,” he says. “He has this lousy job so we can’t buy anything and he just watches TV every night. We’d be better off without him.”

  Is Steve like his father? “I don’t know,” he says. “Maybe. But at least I talk once in a while.”

  Steve is slow to acknowledge the cycle of disappointment and disconnection with his parents that has taken place over the years. But he did tell me about a formative event that happened when he was eleven years old, which clearly made an impression on him and set the stage for his hardened attitude toward his parents.

  “The day after school started, my dog got run over. He really was my dog, no matter what my sister says. My mom got him for me before she was even born. So anyway, my mother, sister, and I heard a car slam on its brakes and we ran outside. My sister started crying. My mom was talking to the lady in the car who hit Sam. I walked away and nobody even noticed. I went and hid in this old junk car we have in the garage. I kept feeling this lump in my throat, but I didn’t want to cry, so I swallowed the lump.”