It is one of the overlooked - even taboo - social problems in America: suicide. Each year, some 30,000 people - young and old, male and female - take their own lives in the United States.
Now, for the first time, the outline of a national strategy is emerging to deal with the problem. While some experts believe suicide is too complex to deal with as a national public-health issue, others note that the growing awareness and open talk about the problem are signs of significant progress.
On Oct. 20, US Surgeon General David Satcher announced the initial blueprint for a national initiative in Atlanta. The announcement came two days after a landmark conference in Reno, Nev., where more than 450 public-health officials, mental health providers, and educators met to develop strategies for preventing suicide in the US.
"We cannot afford as a nation to lose our children, our parents, our neighbors, our co-workers to suicide," said Dr. Satcher.
Some activists heralded the day as historic. "It's time for something from the government on the national level," says Eve Meyer, executive director of San Francisco Suicide Prevention. "We need centers that don't teeter on the brink of closing."
But others wonder if the issue is too complex. "People who have worked in the suicide-prevention world would be really challenged because it comes down to, can you put your ideas on a national scale?" says Jerome Motto, professor emeritus of psychiatry at the University of California San Francisco School of Medicine.
Suicide is the eighth-leading cause of death in the US and has often been a source of shame, guilt, and religious condemnation. In preliminary figures for 1997, the National Center for Health Statistics reports 29,725 suicides. But researchers believe suicide is unreported by as much as 20 percent. With 800,000 cases per year, the World Health Organization ranks suicide as the No. 2 cause of death worldwide.
A grass-roots suicide-awareness movement, especially in Georgia, has fueled efforts to remove the stigma and ignorance associated with self-inflicted death. In the past few years, this group has lobbied the government to do more to attack suicide as a preventable public-health problem. In 1998, Satcher declared suicide a major health problem and conceded that it had not been addressed adequately.
"This is all happening because of grass-roots efforts," says Iris Bolton, director of Link, an Atlanta counseling center. "Dr. Satcher's announcement is the beginning of big awareness for suicide, and legislators have finally decided to get involved."
Mrs. Bolton lost her son to suicide in 1977. Since then, she has dedicated her life to helping others cope. She enrolled at Emory University in Atlanta and earned a degree in suicidology, a term to describe suicide experts, regardless of discipline.
Bolton helped write the 80 recommendations to devise the national plan for suicide prevention.
Bolton has worked closely with Jerry and Elsie Weyrauch of Marietta, Ga., whose daughter committed suicide 11 years ago. The couple started Suicide Prevention Advocacy Network to push for a comprehensive national strategy.
"The connection between experts and survivors - those who have lost a loved one to suicide - is key to this succeeding," says Bolton.
The surgeon general's office says it could take five to six years to implement the strategy.
Suicide continues to rise as the cause of death in some segments of society, especially among African-American males. Last year, a Center for Disease Control study showed the suicide rate among African-American males had risen alarmingly. It said some had trouble coping with pressures of recently achieved middle-class status.
Roderick Conrad, director of Project 21, an African-American leadership network based in Washington, rejected that notion. He also hesitated about Satcher's stance.
"I just don't see how this can be done," says Mr. Conrad. "With suicide, unlike other illnesses, sometimes there are no signs."
Other experts have more hope. Many professionals think that if help is available during childhood and adolescence, suicides, especially among young people, could greatly decline.
Bill Barling, a social worker and a member of Arkansas's Commission of Youth Suicide Prevention, sees both young and older people battling depression and other suicidal contributors. "I think we need to look at suicide on the national level," Mr. Barling says. "We have to be willing to hear some painful stories and be touched by them in order to make this work."