"When they are 14 or 15, their parents get upset and they go to see the psychiatrists. They automatically put them on medication and everyone buys in to the belief. Sometimes it allays the symptoms, but the underlying problems are still there."
"They don't want to kill themselves, but they have an ambivalence, thinking, 'Would it be so bad if I die?'" said Brooks. "It goes back many years, to the way they were raised, their interactions with their parents. They get into a cycle, a habitual way of not dealing with the problem. It's like a whirlpool sucking them down farther and farther and they get in that suicide zone and they are trapped."
Church, who has treated more than 4,000 patients in his career, came up with the concept about 15 years ago after seeing self-sabotaging behavior in his patients.
The idea was not new. "Passive" suicide and had been described in other psychiatric literature, like Karl Menninger's landmark 1957 book, "Man Against Himself."
"I felt it was too important to put aside," said Church, after reading more books on the topic. He had seen the phenomenon in his own family: a relative who drove his motorcyclist too fast, "alcohol-ed up" and didn't take care of his health.
"I realized I have some unfinished business from my childhood and if I can't save my family, I can save others," he said.
Pontosky was one of them. In 2005, after her suicide attempts, she was referred to group counseling and met Church.
He discovered that Pontosky had suffered since junior high school with dysthymia, a mild depression that generally does not respond well to antidepressants.
Church likens it to "standing on one foot," where patients can be "more easily knocked down by the blows of life."
"They can go for years, have heightened feelings of anxiety and guilt, and avoid getting help," he said. "They go through the motions of life, underachieving. Sherry needed to want to live more."
Her first memory was of her parents announcing their divorce when she was age 3. Pontosky's father, unaffectionate and emotionally distant, remarried and had a child; her mother also remarried, then went back to school to become a nurse.
"She was working double shifts and didn't have a lot of time for me," said Pontosky. "I always had to have straight As and to be the star to gain some attention."
She went to college and married her high school sweetheart, an "unavailable man" much like her father, and resigned herself to being a submissive wife.
Pontosky was hospitalized and given electroshock treatment -- a "last resort" for those who repeatedly try to kill themselves, according to Church.
All memories from that year were wiped out by the electroconvulsive therapy.
A trigger for her depression had been a miscarriage after struggles with infertility. She was unable to work for nine months after her hospitalizations and couldn't face returning to the nursery at work, where she was surrounded by newborns.
All the while, her psychiatrist kept experimenting with her medications, which made things worse.