FIGURE 1-1 Deaths from Suicide and AIDS and HIV-related Diseases. Based on data from the CDC (2001), NCHS (2001), and NCIPC (2000).

personal accounts of those who have completed or attempted suicide provide a glimpse of the psychological pain that culminates in a desperate act. A minority of those who kill themselves actually write suicide notes, and these only infrequently try to communicate the complex reasons for the act. Still, some consistent psychological themes emerge. Clearest of these is the presence of an unendurable heartache, captured in the simple phrase, “I can’t stand the pain any longer,” a phrase often seen in suicide notes or heard by clinicians after an attempt. One woman expressed it this way in her suicide note:

I wish I could explain it so someone could understand it. I’m afraid it’s something I can’t put into words.

There’s just this heavy, overwhelming despair—dreading everything. Dreading life. Empty inside, to the point of numbness. It’s like there’s something already dead inside. My whole being has been pulling back into that void for months.

Everyone has been so good to me—has tried so hard. I truly wish that I could be different, for the sake of my family. Hurting my family is the worst of it, and that guilt has been wrestling with the part of me that wanted only to disappear.

But there’s some core-level spark of life that just isn’t there. Despite what’s been said about my having “gotten better” lately—the voice in

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