Professional Documents
Culture Documents
3(3):321–341, 2002
Through a clinical case study, this paper explores the peak in
girls’ suicide attempts at ages 13 and 14 and offers a relational
interpretation of girls’ suicidal behaviors as symbolic and indirect
speech, ref lecting a language that is deeply encultured. In early
adolescence, girls learn that if they threaten to harm or endanger
themselves or actually do so, people take notice. Girls then
discover the communicative value of threatening or enacting
harm, danger, or violence against themselves. Thus they “learn
Carol Gilligan, Ph.D. recently moved to New York City, where she is
University Professor at New York University. Her latest book is The Birth of
Pleasure.
Lisa Machoian, Ed.D. is a Lecturer on Education in Human Development
and Psychology, Harvard University Graduate School of Education.
Earlier versions of this paper were presented at the conference of
Psychological Trauma: Maturational Processes and Therapeutic Interventions,
Boston University Medical School and Massachusetts Mental Health Center,
March 1998; and at the Biennial Peter Blos Lecture, Jewish Board of Family
and Children’s Services, New York City, December 1998. A version of the
case study is in the doctoral dissertation of Lisa Machoian (1998).
The authors thank, in alphabetical order, Blair Barone, Psy.D., Holly
Gelfond, Ed.D., Francis Pescosolido, Ph.D., Elizabeth Rice–Smith, Psy.D., and
Bessel A. van der Kolk, M.D. for their support of this work.
BACKGROUND RESEARCH
THEORETICAL FRAMEWORK
I learn from the shelter staff that Abby did not in fact run
away that night, but the next day after school she “ran away”;
that is, she walked home with her friend and spent the afternoon
with her. She returned to the shelter at sunset, indicating
perhaps that she took my concern about her safety seriously. I
continue to call her and leave messages for her when she refuses
to speak to me.
During her second week at the shelter, Abby is told once again
by the state agency that she will have to return home at the end
of the week. She writes a poem: “I want to be out of this horrible
pain/this horrible life/my spirit yearns to break free/soar free
out of this pain.” I receive an emergency call from the shelter
staff; they are concerned about suicidal thoughts and feelings,
and, in a hospital emergency room, a crisis evaluation team is
summoned to assess her danger to herself. When they conclude
that she is not a danger to herself, she is sent back to the shelter.
The crisis evaluation team does not think she should be returned
home and recommends an out-of-home placement. T he
adolescent shelter where she is currently residing recommends
a group home, an idea that her mother supports as well. Yet,
remarkably—although the crisis team, the shelter, my agency,
and Abby’s mother all request placement—the state’s child
protective agency maintains the plan that she must return home
at the end of the week because they do not think her situation
is serious enough to warrant removal from her home.
At this point, Abby becomes frankly suicidal. She writes a
note wondering if anyone knows how many times a day she feels
like killing herself. She also runs away daily and does not return
until well after dark. Abby and another girl ran down railroad
tracks one night, in the rain and got lost. The other girl was
frightened when Abby knocked on the doors of strangers’ houses
to ask for directions. At the shelter, the staff tells me she waved
a butter knife during dinner and later was seen hiding in a
nearby graveyard. The staff of the shelter calls an ambulance to
take Abby to the nearest hospital emergency room and decides
her behavior is too potentially dangerous for her to return to
their program. But the crisis evaluation team at the emergency
room determines that her behavior is not dangerous enough to
Learning to Speak the Language 331
Discussion
It seems clear that Abby had to escalate her self-destructive
behavior if she was to be effective in getting her needs met in
this treatment system. In our terms, she learned the language
that would be taken seriously and listened to—the language of
violence—a language that everyone understands and also a
language that is widely spoken in the society and culture in which
she lives. Neither my speaking on her behalf, multiple clinical
recommendations from various agencies, nor Abby’s speaking
plain language had any effect in changing the plan to return
her home. When she realized I was unable to protect her, she
became silent in our relationship, although perhaps the very
fact of the relationship gave Abby the courage to speak for
332 Carol Gilligan and Lisa Machoian
When a girl discovers that her voice is not being heard or not
taken seriously, or when her experience is unspeakable, that is,
that no one will listen, or, as girls say, “No one will believe me,”
we believe that creative resistance and a commitment to voice
remain possible if she can sustain a sense of hope about a
relationship. Relationship depends on voice—on the presence
of self—just as voice, or the sense of self, depends on relationship.
Abby’s suicidality can thus be understood as an active resistance
to disconnection; as an active f ight for voice, it becomes,
paradoxically, a sign of hope.
When Abby felt that I had left her in a dangerous situation,
she literally hung up on me and then proceeded to dramatize
her predicament by subjecting herself to the danger and
potential violence to which others had been willing to subject
her. Endangering herself, she communicated her knowledge that
she was in danger and was asking in effect if anyone cared. I
understood her suicidal behavior as ref lecting both her intense
need for recognition and her belief and hope for relationship.
I saw our relationship as supporting her resilience and
encouraging a healthy resistance.
It is important to recognize that young adolescent girls like
Abby are looking for a way to express themselves that will be
recognized. In middle and later adolescence, girls will often
protect a bruised and fragile sense of self-worth by “not caring”
or appearing not to care. “Not caring,” in our terms, means
giving up hope for connection. Here is an example:
Isabel, following years of chronic childhood sexual and
physical abuse, cut her wrists at the age of 14. She was
hospitalized and given the Thematic Apperception Test (TAT).
The stories she told all had people interacting in them, even
her stories in response to the two cards where no people are
pictured. Following her hospitalization, Isabel was sent to a foster
home. She ran away because for the first month she was not
allowed to see or speak with any people from her past with
whom she had relationships. Consequently, she stole a car,
crashed it, and then ran away to New York, where she survived
334 Carol Gilligan and Lisa Machoian
CODA
Later in our work, I asked Abby how it was that she talked with
me in therapy after she had been silent for over a year in her
previous therapy. “It’s because you talked about yourself. When
you asked me if I wanted to ask you questions, I was like yeah!
And, I asked you all those questions!” she tells me as she smiles
and laughs. When we talked about her stealing the teacher’s
grade book, Abby mused, “It’s like, I’m sort of like a rebel, I
guess.” She sat back in the chair for a moment, looked pensive,
and was quiet. Then, she said, “I think that I kind of like that
I’m a rebel.” I too liked Abby’s rebellion against being sent back
alone into danger, her willingness to risk relationships, her
insistence on being heard.
REFERENCES