I never know how to respond to the generic, "How are you?" Once when I was in a vocational program, a counselor had asked me, "How are you?" So far, so good. This actually happened many times, but one day when I wasn't particularly fine, I hesitated when he asked me. Apparently my silence made him nervous, so he prompted further, "How are you -- fine, huh, fine?" I resented his manner because it was almost as though he was desperate to hear that I was fine. I doubt he cared what the true answer would have been.
Speaking for myself, sometimes when I'm asked that question in the morning (as in an office setting), I might reply that it's too early for me to know that yet. Still, I find that, "How are you?" tends to be a rhetorical question. No one is listening for an answer. I'm a cyclist, and once I replied to the asker that I'd been hit by a car a couple of days prior. The asker proceeded with the conversation as though I'd said, "Fine." Sometimes when I actually care how the person is doing, I might ask simply, "How's life?" because that can warrant a more thoughtful response.
This can be a tricky question: where I am from you will hear exactly from that person how that person is: but you might want to pull up a chair and look at numerous x-rays and doctor reports while this person will tell you exactly how he or she is.
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