According to an article on the ABC News website,[1] there is the "old Sherry" and the "new Sherry" -- the depressed girl who had electroshock treatment after two suicide attempts, and the woman who learned to make a commitment to living.

"It was a pretty amazing turnaround," said Sherry Pontosky, now a 35-year-old neonatal nurse from northeastern Pennsylvania.  When she was at her worst, she was so highly medicated on antipsychotics and antidepressants that she said she lost a whole year of her life.

"I never feared death," she said. "Even in the teenage years, I muddled through life. If I stepped off a curb and bus hit me, it was all right. I just thought that was how everybody felt and how people existed."

For years, before therapy helped to save her, medications didn't offer much relief and actually prevented her from getting to the root of her self-destructive behavior.

"I felt I wasn't worthy of happiness," she said. "I didn't know what that was."

According to the National Institute of Mental Health (NIMH), 500,000 Americans try to kill themselves each year, resulting in 30,000 to 40,000 deaths, but according to this article, far many more are living "on the edge," in what two psychologists have now labeled the "subtle suicide zone."

They may abuse alcohol and drugs, exhibit risky behavior or, like Sherry, sabotage their chances at happiness. Most of them are too afraid to actually kill themselves, but just don't want to wake up in the morning.

"It's not a formal diagnosis, it's a state of mind that can co-occur with other things," said clinical psychologist Michael A. Church, who has co-authored the new book, "Subtle Suicide: Our Silent Epidemic of Ambivalence About Living."

"We think those numbers pale if we can measure subtle suicide," said Church. "We think it's a portal to overt suicide."

Church and his collaborator, research psychologist Charles I. Brooks, both of Pennsylvania's King's College, have developed the concept of subtle suicide, which is often misdiagnosed as bipolar disorder or other psychiatric disorders.

Together, they have developed a preliminary diagnostic questionnaire to assist doctors and therapists to easier identify the characteristics of subtle suicide and to work to end the cycle of denial and self-anger that characterizes the behavior.

"Ultimately we want to measure it," said Brooks, a research psychologist.

"Why care about medications and psychotherapy if you don't care on a routine basis if you live or die," said Church.  

Sexual abuse, emotional deprivation, and trauma in childhood can turn anger inward, according to the authors. Those with low self-esteem seem more vulnerable to subtle suicide.