"It was a pretty amazing turnaround," said Sherry Pontosky, now a 35-year-old neonatal nurse from northeastern Pennsylvania who, at her worst, was so drugged on antidepressants and antipsychotics that she said she lost a 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 psychotherapy saved her, medications offered little relief and 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."
Each year, 500,000 Americans try to kill themselves, resulting in 30,000 to 40,000 deaths, according to the National Institute for Mental Health, but far many more are living "on the edge," in what two psychologists have now labeled the "subtle suicide zone."
They may abuse drugs or alcohol, engage in risky behavior or, like Pontosky, sabotage their chances at happiness. Most are too afraid actually to kill themselves, but would have no problem if they didn't 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 or any number of other psychiatric disorders.
They have written the book for the average person and their families, but also as a "professional call to arms," said Church.
Together, they have developed a preliminary diagnostic questionnaire to help doctors and therapists better identify the characteristics of subtle suicide and work to end the cycle of self-anger and denial that typifies 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. "Just to call it bipolar or alcoholism is to miss the point."
Emotional deprivation, sexual abuse and trauma in childhood can turn anger inward, according to the authors. Those with low self-esteem seem more vulnerable to subtle suicide.
Many stay in the subtle suicide zone for years, not killing themselves for fear of the act itself, of being sent to hell, botching the attempt or hurting loved ones. The key is that they avoid facing their real issues.
Often, the behavior begins in childhood. The book finds common threads in the self-destructive lives of celebrities Anna Nicole Smith, Marilyn Monroe, Evel Knievel and Jim Morrison: separation from parents or lack of empathy.
Some have "numbed" their pain since they were young.
"The percentage of students on psychiatric medications is absolutely frightening," said Brooks, who works with many overmedicated college students.