Over the last two decades, suicide has slowly and then very suddenly announced itself as a full-blown national emergency. Its victims accompany factory closings and the cutting of government assistance. They haunt post-9/11 military bases and hollow the promise of Silicon Valley high schools. Just about everywhere, psychiatric units and crisis hotlines are maxed out. According to the most recent figures from the Centers for Disease Control and Prevention, there are now more than twice as many suicides in the U.S. (45,000) as homicides; they are the 10th leading cause of death. You have to go all the way back to the dawn of the Great Depression to find a similar increase in the suicide rate. Meanwhile, in many other industrialized Western countries, suicides have been flat or steadily decreasing.
What makes these numbers so scary is that they can’t be explained away by any sort of demographic logic. Black women, white men, teenagers, 60-somethings, Hispanics, Native Americans, the rich, the poor—they are all struggling. Suicide rates have spiked in every state but one (Nevada) since 1999. Kate Spade’s and Anthony Bourdain’s deaths were shocking to everybody but the epidemiologists who track the data.
And these are just the reported cases. None of the numbers above account for the thousands of drug overdose deaths that are just suicides by another name. If you widen the lens a bit to include those contemplating suicide, the problem starts to take on the contours of an epidemic. In 2014, the federal government estimated that 9.4 million American adults had seriously considered the idea.
There’s an inherent lack of closure to suicide. Even when people write notes, they can reveal so little. Suicides often leave loved ones, acquaintances and co-workers to question themselves for the rest of their lives. And in their own grief, they, too, can entertain dangerous thoughts. “With suicide you have that added trauma to it,” said Julie Cerel, the president of the American Association of Suicidology. “The ‘why’ question of trying to search for meaning when there’s no meaning available—If I only had a note. If I only talked to the last person that they talked to. The ‘onlys’ can be torturous.’” Last year, Cerel published a study examining the consequences of suicide and found that each one could affect as many as 135 other people.
The fundamental mystery of suicide has long made it an object of fear and contempt within the medical establishment. Since the 1950s, public health officials have tried hotlines, individual therapy, group therapy, shock therapy and forced hospitalizations. Doctors have taken away people’s shoelaces and belts and checked in on attempt survivors every 15 minutes to make sure they are still safe. They have coerced patients into signing contracts swearing that they would not kill themselves. They have piled on psychiatric medications with ever-more invasive side effects, only to watch the number of suicides continue to climb.
Even now, most mental health professionals have no idea what to do when a suicidal person walks through their door. They’re untrained, they’re under-resourced and, not surprisingly, their responses can be remarkably callous. In an emergency room, an attempt survivor might be cuffed to a bed and made to wait hours to be officially admitted, sometimes days. Finding help beyond the ER can be harder yet.
“You take someone who is not doing well, shutting down, and throw them in a system that requires them to have the highest problem-solving abilities and emotional regulation,” said Jeff Sung, a psychiatrist colleague of Whiteside’s who works with high-risk clients and trains others to do so. According to federal data, the majority of those in need of mental health services do not receive it.
When confronted with the coldness of her colleagues, Whiteside grows exasperated. Because while the dead are invisible to most, she knows them. She gets how suicidal thoughts have their own seductive logic, how there is comfort in the notion that there is a surefire way to end one’s pain. She sees why people might turn to these thoughts when they hit a crisis, even a minor one like missing a bus to work or accidently bending the corner of a favorite book. That’s why suicidal urges are so much more dangerous than depression—people can view death as an answer to a problem. And she knows that many patients of hers will always feel vulnerable to these thoughts. She has described her job as an endless war.
Student ID of the therapist as a young woman.
Whiteside was born in Colville, Washington, 40 years ago, the first child of parents drawn to adventurous work wherever they could find it: building an oil pipeline in Alaska, raising cattle and conducting child health screenings in rural Washington, driving trucks through the Midwest. By the time she attended junior high, in Minnesota, Whiteside had enrolled in six different schools in three different states. But instead of turning her bitter or shy, all the moving seemed to sharpen her empathic powers. She became one of those canny little people who could intuit when those around her were in pain.
And she could be impulsive in her efforts to help. When she was in eighth grade, one of her best friends called her frantic and in tears. The friend didn’t go into detail, but said that she needed to escape her house immediately. So Whiteside planned a rescue. Shortly after midnight, Whiteside snuck out of a window in her family’s basement apartment and stole her mother’s sedan. She didn’t think about the fact that she couldn’t drive legally or that her friend’s house was 8 miles away or that the roads were icy and covered in snow. She didn’t care that she weighed only 80 pounds and could barely see over the steering wheel. She made it past the McDonald’s, down the hill, to the one-lane country road where her friend lived before crashing the car into a ditch in front of the house.
The older Whiteside got, the clearer it became that she was better at looking after others than herself. In high school, she struggled with her body image along with depression and anxiety. Like her future clients, she found it excruciatingly difficult to talk about what she was experiencing. The idea of asking for help was “the scariest thing I could imagine,” she said. During one point in college, she sent her mother, who had lost her own brother to suicide, a lengthy letter detailing her ups and downs. “I’m writing you this letter because I often have a hard time saying out loud what I mean,” she confessed. “I am just chicken.”
She wanted so badly to understand the mechanics of despair, including her own. “Everything I do has to be extreme,” she wrote in her diary. “I go through phases where I absolutely love myself—I go through others where all I can think about is knives and bridges.” At the University of Minnesota-Duluth, she read mental health textbooks and academic journals in her spare time. She was drawn to the field as a practical way of untangling life’s most intractable problems. “I took my first psychology class and I was like, ‘Oh my God, you can actually change things,’” she said. “It’s not magic.”
Before her junior year, Whiteside transferred to the University of Washington so she could learn from Marsha Linehan, a legend in the field of suicide research. Linehan had pioneered a powerful form of treatment called dialectical behavior therapy, or DBT, which trains patients how to reroute their suicidal impulses. It can be grueling, emotionally exhausting work that requires people to spend several hours a week in individual and group therapy, and therapists to do check-in calls as needed throughout the week. Linehan had a principle for all of her students: Clients came first, your own life came second.
It couldn’t have suited Whiteside better. “I’ve found some semblance of passion,” she wrote in her diary at the time. “I have to think of myself and I have to think of my soul and I have to remember those in most need, those experiencing suffering beyond my imagination.” In a letter of recommendation, Linehan wrote that Whiteside had “become unflappable.”
Text messages from Whiteside to a patient.
And then Whiteside sprinted nose-first into the wall of the modern-day behavioral health care system. She took a clinical internship in the psychiatric department of Harborview Medical Center in downtown Seattle, an under-resourced, grim institution. The main goal, she kept hearing, was triage. She was there to stabilize suicidal patients, nothing more, because no one had the time to do more.
Whiteside was tasked with probing patients for their treatment history and state of mind. There was the man who killed his dog and shot himself in the stomach. The immigrant who set himself on fire. The college student who had been found walking in the middle of a street clutching a teddy bear. Each one, she felt, was desperate for any form of help or kindness.
“I was absolutely insane, completely unconcerned with life,” one former patient from that era said. “They had no idea what to do with me. But Ursula was looking at me in a way where she was actually waiting for me to respond. … It wasn’t, ‘What are your symptoms? What medications are you on?’ It was, ‘Tell me a little bit about your story.’” Whiteside knew that people who leave the hospital after a suicide attempt are at a greater risk of harming themselves again within 90 days. And yet the doctors at Harborview were only providing referrals for clinics most patients would never visit or putting patients on waiting lists for therapists who might not be right for them. “These patients were basically at this critical juncture,” Whiteside said, “and we were fucking blowing it.”
After her patients left the hospital, she couldn’t stop thinking about them. So she began tracking them down, calling to see if they needed help or just to let them know they were on her mind. She handed out her phone number to patients before they left the hospital. On the back, she’d also leave a personal note. Anything to keep them tethered to the world. For six months, she called a woman who had made an attempt after a breakup. The woman took Whiteside’s calls for a while, until she didn’t. Whiteside still doesn’t know what happened to her.
“It was almost an existential crisis for her,” says Sarah Stuckey, one of Whiteside’s best friends from the clinical world. “She’s the velvet hammer in so many ways. She’s this beautiful woman talking in this soft voice about these horrible things. You lose people. That takes a toll. You have very close calls with people. That takes a toll.”
Whiteside was becoming so anxious about her work that she had days when she could hardly sleep or eat. One night after her internship was over, she uncorked a bottle of wine. She drank until she didn’t care if she ever woke up. This scared her. For just a few moments, she realized how it felt to be suicidal.
Months later, Whiteside met with her therapist to discuss how she could handle these feelings of powerlessness. Whiteside brought up the work of a long-retired psychiatrist and suicide researcher named Jerome Motto. He wasn’t well-known. But Whiteside’s mentor Marsha Linehan was enamored of him because he was the only American to devise an experiment that dramatically reduced suicide deaths. His technique didn’t involve a complicated thousand-page manual to follow or $1 billion in pharmaceutical research and development. All he did was send occasional letters to those at risk.
Right there in therapy, Whiteside found herself spouting out everything she knew about Motto’s approach and career. She began to cry. “Oh my God,” she said. “What if this is what we should be doing? What if it’s that simple?”