Teenage depression: a cultural-interpersonal-intrapsychic perspective.

The "crossroads families" are caught between old value systems and American mainstream goals. Traditional family and sex-related roles and orientations conflict with those of the new social system. In turn, neither of the teenager's orientations--toward home or toward peer activity--is validated. In the clinical case presented, Anna, at adolescence, wants to relinquish many of her household chores and enter her social world more fully. She needs unconflictual support for such a move. If this does not take place, her autonomous movement represents an unconscious betrayal of her depleted and controlling mother as well as an abandonment of the parental coalition. This leaves her feeling resentful, guilty, and ultimately unlovable. Attitudes marked by helplessness and confusion are thus significant to the depressed affect that brings this teenager into family therapy. Teenagers of non-Hispanic background who enter family therapy reveal gross overlap with teenagers of the Hispanic "crossroads" family model. Here, the family gives mixed messages for homebound and intimate closeness as well as accomplishment in the societal mainstream. A primary difference between ethnic groups involves the freer expressions of anger and pain between husband and wife in the non-Hispanic families. This is not similar to the backgrounds of the more individuated Hispanic teenagers. While more open expressions of anger within the family do indicate higher levels of autonomy, the hostility that is expressed by the parents presents serious complications when this includes "triangulating" the child into the family tension. Here, as cited, the mother often uses her daughter as a confidant and ally at times of severe parental discord. This places additional strain on the child's conflict with separation. Importantly, the daughter experiences renewed rejection and betrayal when the mother "submits" to her spouse. These are significant family processes that heighten mixed messages around autonomy. Milagros, a depressed (more individuated) adolescent, is consistently entangled into her parent's abrasive relationship. Her interpersonal family struggles have become intrapsychic and, ultimately, transferential.