NEW YORK - Suicide survivors are leading a nationwide effort to prevent suicide through conversation and an end to anonymity.
They look intently at the camera, some impassively, some with smiles, all of them aware that they've just shared with an online audience a most personal story: Why they tried to kill themselves.
By the dozens, survivors of attempted suicide across the United States are volunteering to be part of a project by a Brooklyn-based photographer, Dese'Rae Stage, called "Live Through This" - a collection of photographic portraits and personal accounts.
It's one of several new initiatives transforming the nation's suicide-prevention community as more survivors find the courage to speak out and more experts make efforts to learn from them. There's a new survivors task force, an array of blogs, some riveting YouTube clips, all with the common goal of stripping away anonymity, stigma and shame.
"Everyone feels like they have to walk on egg shells," says Stage, who once tried to kill herself with self-inflicted cuts. "We're not that fragile. We have to figure out how to talk about it, rather than avoiding it."
Such conversations are proliferating.
In January, the American Association of Suicidology launched a website called "What Happens Now?" - described as the first sustained effort by a national prevention organization to engage survivors in a public forum.
It features a blog, updated weekly, with contributions from survivors sharing their experiences and often using their real names.
In one of the latest posts, the founder of a respite home for suicidal people writes powerfully about her own suicide attempt eight years ago, involving both pills and a kitchen knife, and about the contributions that survivors can bring to prevention efforts.
"Survivors have a unique perspective on what life's like down in the deep, dark hole," writes Sabrina Strong, executive director of Waking Up Alive in Albuquerque, N.M. "We found our way out... We're not afraid to crawl down in the dark hole with someone else."\
Seeking to encourage those types of contributions, the National Action Alliance for Suicide Prevention - a federally funded public-private partnership - has formed a first-of-its-kind task force comprised of prevention experts and survivors. It plans to issue recommendations this fall for how practitioners and organizations in the prevention field can "engage and empower suicide attempt survivors."
One of the task force co-chairs is psychologist John Draper, project director of the National Suicide Prevention Lifeline, a network of centers that field calls from emotionally distressed and potentially suicidal people.
According to studies cited by Draper, about 7 percent of survivors later kill themselves, a far higher rate than for other groups.
"Yet that means 93 percent go on to live out their lives," he said. "We've got to talk to them, engage then, find out what is bringing them hope and keeping them alive."
The other co-chair is Eduardo Vega, the survivor of a suicide attempt who is now executive director of the Mental Health Association of San Francisco.
"Nobody can speak to the issues, the sort of agony, even the decision-making that goes on when you're actively suicidal so much as somebody who's been there, and can relate to all that's going on in a nonjudgmental way," Vega says in a recent video. "That's the sort of magic that will make a difference."
In past decades, the stigma surrounding suicide was intense, and most people who tried to kill themselves avoided any public disclosures about their experiences. There was far more involvement in the prevention movement by bereaved relatives of people who completed a suicide.
Among them was Michelle Linn-Gust, whose sister killed herself at 17 and who, in her current role as president of the American Association of Suicidology, helped launch the "What Happens Now?" website.
"The bereaved, the people who've lost someone, like me, that movement has taken off," Linn-Gust said. "But the attempt survivors have not had a voice. Nobody has given them a home."
Over the years, individuals who had attempted suicide would surface occasionally, writing books or going on the public-speaking circuit to share their experiences. One such communicator is Kevin Hines, who became a prolific writer and speaker after surviving a jump from the Golden Gate Bridge in 2000. A survivor in Canada, David Granirer, has carved out a specialty as a stand-up comedian whose monologues address depression and mental illness.
Among Granirer's routines is a feigned phone conversation in which he unsettles a smarmy telemarketer. "I'm so depressed," he says. "If you hang up, I'll kill myself."
What's new in the past couple of years is a broader phenomenon - a surge of collective projects by survivors, corresponding with a keener and more systematic interest by prevention experts in their potential contributions.
"The voices of people who have thought about suicide and possibly attempted suicide have been largely absent from public conversations about suicide and what should be done about it," says Karen Butler Easter, president of National Association of Crisis Center Directors. "They know what hurts, and they know what helps."
One asset that survivors say they can supply is candor.
"We are willing to speak truthfully, even if others are afraid to," writes Sabrina Strong in her recent blog post. "We understand that we do others a disservice by providing generic and whitewashed advice from the school of magical thinking - 'Things will get better.' 'Everything's all right.'
"Sometimes things don't get better, at least not right away."
Historically, prevention specialists made relatively little effort to seek input from people who tried to kill themselves. Experts say treatment often was - and in some cases still is - condescending, and at times harsh and punitive.
"The attitude was that if a person tried to kill themselves, they were irresponsible, they were not people we could trust, and we knew what's better for them," said John Draper. "There also was some concern that they might kill themselves if we engaged them."
Those attitudes have evolved in recent years, with more interest in collaborative treatment. Yet prevention experts say many therapists lack specialized training in how to deal with survivors and balk at treating them because their above-average rate of eventually killing themselves prompts fear of malpractice suits by their families.
Among those serving with Draper and Vega on the new task force is Heidi Bryan of Neenah, Wis., who survived a suicide attempt in the 1980s and whose brother did kill himself.
Bryan, 55, has been active for more than a decade in suicide-prevention initiatives, and has observed notable changes in how experts view survivors.
"I remember sitting at a conference when speakers were talking about survivors - it was like we were lab rats," she said. "Now they're finally realizing maybe we should be brought in on this. We need to erase the misperceptions that people have about us, so we're treated with the respect we deserve."
Even amid the excitement over changing attitudes, prevention experts caution that many survivors are likely to remain wary of sharing their stories in public, notably for fear it might affect their employment prospects.
"There are still clear consequences for talking about your mental health history," said Jane Pearson, a suicide prevention expert with the National Institute of Mental Health. "It's getting better, but there are still challenges as to what that means for your life."
To help survivors think through the consequences of sharing their story, major prevention organizations recently teamed up to offer guidelines and suggestions. Their document urges survivors to be sure they and their families are emotionally prepared for such disclosures, and to be braced for the likely widespread dissemination of any personal accounts via social media.
In the two years she's been working on "Live Through This," Dese'Rae Stage says only one of her subjects has had a change of heart and asked not to be publicly identified. Meanwhile, she says she now has a waiting list of 200 suicide attempt survivors who want to participate.
Stage, 29, said she periodically tried to injure herself as a teenager, was diagnosed with bipolar disorder in 2004, and attempted suicide - through multiple cuts of her veins - in 2006 while struggling with an abusive relationship.
The attempt occurred not long after she graduated from East Tennessee State University, where her psychology studies included research about suicide.
Stage began taking photographs for "Live Through This" in 2011. She's ready to spend another year or more on the project, with the hope of visiting subjects across the country and eventually crafting the material into a book.
"The survivors who share their stories here are real people who have been through hell," Stage writes in a summary of the project. "They are also engaging, fascinating people whose voices deserve to be heard."
Stage notes that suicide, according to federal data, is the 10th leading cause of death in the U.S.
"I'm convinced that the simple act of getting people to talk about it will save lives," she writes. "It's a serious public health issue, and one we can do something about if we can just set our fears aside."
Among Stage's subjects is Caitlin Coleman, 30, who tried to kill herself with an overdose of pills 10 years ago while battling depression as a college sophomore in Columbus, Ohio.
"I didn't have a lot of friends, and felt increasingly isolated," she recalled. "It got to the point where it was a good day if I could get out of bed and go to Starbucks."
Her suicide attempt left Coleman hospitalized in a coma, and during a lengthy recovery she became frustrated at the lack of resources that included input from other survivors.
"I wanted to talk to people who went through the same thing I did and I couldn't find anyone," she said.
She heard about "Live Through This" through a friend, and was exhilarated when she checked out the website, thinking, "This is exactly what I've been looking for."
She is at peace with the fact that the project means her name, photo and personal story are now displayed on the Internet.
"I'm pretty open about my past," she said. "It's not something I'd say on a first date, but if the topic comes up I don't shy away from it. I don't believe it's anything to be ashamed of."
In college, Coleman was aspiring to a career in musical theater. For now, she's content with a job as a waitress in New York City, but she misses performing enough to be taking lessons in comedy improvisation.
"Now I feel like I'm at a really good, functional point in my life," she says. "Are there things that I'm still fearful of? Yes. But I want to speak to people."
American Association of Suicidology's "What Happens Now?" blog: http://attemptsurvivors.com/
Guidelines for suicide attempt survivors who want to share their story: http://bit.ly/10Bv8Db
Live Through This: http://livethroughthis.org/