One spring day a few years ago, a man went into his garage and turned on the car. He sat there, in his car, with the garage door closed, waiting.

		Resources Contact Pittsburgh offers telephone help 24/7 from trained volunteers for those who may be suicidal, in emotional distress or in need of reassurance. It is free and confidential. Call 412-820-HELP. KidsLine Phone Pals, 1-800-578-5100 Reassurance for Seniors, 412-820-0100 Anti-Hate Hotline, 412-820-0111 National Suicide Hotline, 1-800-273-TALK

After decades of living with depression, after hearing from his wife that she wanted to leave, after knowing that things just weren't getting any better, he wanted to die.

As the carbon monoxide fumes gathered strength, he faded off to sleep, thinking about his life, and how unhappy he was, and how it all was finally over.

And then he woke up in a hospital, with doctors trying to save the life he was trying to leave.

The man, who asked that his name not be used to protect his privacy, is now 60 and lives in suburban Philadelphia. He participates in a Suicide Anonymous group in Radnor, Pa., but still grapples with depression and mental illness. Some days, he curses his luck that his wife came home early to find him.

Like the woman who tried to jump from the Smithfield Street Bridge a few weeks ago, he resisted all efforts to save him.

"When they started bringing me around, I started screaming at them, 'I want to die!'" he remembers. "I was very angry. I was not grateful. To be honest, I'm still not real grateful."

The survivors' paradox

The Philadelphia man and the Pittsburgh woman illustrate the puzzle that faces both society and the medical community when people survive suicide. In the immediate aftermath, mental health treatment is crucial, yet it is either not offered or not accepted.

A study published last week in the Journal of the American Medical Association found that about 1 in 5 people who attempted suicide over a decade did not receive any kind of medical treatment at all.

"It's just amazing to think that they can walk out of an emergency room and not be forced to see a therapist," said Ronald Kessler, lead author of the study and professor in the department of health care policy at Harvard Medical School.

The solution to the puzzle seems obvious: Care for those who have sent a clear cry for help. And the findings of two psychologists who have worked with those who have survived suicide attempts bear out that conclusion.

Richard Heckler, a California psychologist, interviewed 50 suicide attempters for his book "Waking Up, Alive." He found that in the period after the attempt, those who tried to get to the root of their suicidal tendencies and who had a strong support network to help them do so were the most successful in reclaiming their lives.

"It doesn't take a lot of medicine, but it does take helpers: psychologists, social workers, counselors, etc., who are really compassionate," he said.

Even some who were permanently scarred by their attempts were able to mentally recover from their deep depression. One was former University of Pittsburgh football player Ed Gallagher, who was paralyzed after trying to kill himself by rolling off the Kensico Dam in Valhalla, N.Y in 1995. He died of a heart condition last month at home in New York at the age of 48, two decades after his attempt.

Paul Joffe, a clinical psychologist and the chair of the Suicide Prevention Team at the University of Illinois, noticed in the 1980s that only 5 percent of suicidal students would seek help after their attempt.

So in 1984, he began a novel program to prevent students who attempted or threatened suicide on campus from trying again: They had to attend at least four sessions with a therapist or risk being suspended from school.

Out of 2,000 students who tried suicide over the next 20 years, only one person withdrew from school rather than attend treatment. The rest attended sessions, and none attempted suicide again.

Whose rights?

Yet bioethics come down squarely on the side of the person wishing to harm himself or herself.

"The law has been increasingly clear, it's too great an infringement on individual liberty" to hospitalize everyone who attempts suicide, said Alan Meisel, director at the Center for Bioethics and Health Law at the University of Pittsburgh. While suicide might hurt family members and others, the wishes of family members don't trump the desires of the individual.

"You walk a fine line there. You can't keep people against their own will," said Debbie Ramage, of Cranberry whose son, Matthew, killed himself in 2000 after convincing doctors at Western Psych to let him out of the hospital after a suicide attempt.

But even the feelings of people who have survived suicide attempts indicate that they could have benefited from intervention.

A 1975 study of six of the eight people who had survived jumping off San Francisco's Golden Gate Bridge found that virtually all of them regretted their decision as soon as they jumped.

One survivor, who had determined that he would not jump if one person smiled at him during his walk to the bridge, told the New Yorker magazine that his first thought was, "What the hell did I just do? I don't want to die."

"We need to come in as a community and say that we do see it as a problem, that you don't have a right to suicide," Joffe said.

Trying again

As many of half of people who attempt suicide will eventually try again, according to Dr. David Brent, a nationally known researcher on suicide in teens at the University of Pittsburgh's Western Psychiatric Institute and Clinic, another statistic that seemingly points to the need for intervention among those who survive attempts.

But even with treatment, life after a suicide attempt can follow an uncertain path. For some, surviving is a wake-up call.

It was for A. Kurjakovic.

"Oh man, I gotta live another day in this hell," was the first thought that went through her mind when she woke up after swallowing a whole bottle of Advil.

When her mother found out about her attempt, she forced her teenage daugher to seek treatment. It was the push she needed to begin to climb out of her depression. She moved out of her house and started a new life, and now studies architecture at the University of Pittsburgh.

And now she's a big advocate for seeking help; her step-brother killed himself this past winter, without have received any treatment for the manic depression he suffered.

For the Philadelphia man, life has continued to be a battle with depression and mental illness.

He tried to kill himself again a few years later by asphyxiating himself with a plastic bag. But he's still alive, he says, because of his own will to live, not the help of a therapist or any forced intervention.

"No therapist can prevent someone from trying again," he said. "People are going to do what people are going to do."

He has no children and is divorced, and while he says that sometimes he still wishes that his wife had not come home early that day to find him sitting in the garage with the car running, he still gets up every morning and goes to his therapist on schedule. He takes his medication every day. Auto racing holds his interest, and sometimes he'll even go to a Phillies game on a warm summer day.

"I would encourage people to try and hang in there because suicide is such a final answer," he said. "Once it's done, it's done."