Public health, health policy, and psychology

I’ve been a writer and editor on The Atlantic’s Health channel since November 2013, writing one or two stories per day.

Here are a few of my greatest hits:

The Evolution of Bitchiness: Women engage in indirect aggression and slut-shaming, even in clinical research studies. Why?

After Antibiotics, the Feces Pill Remains: Some people with potentially lethal gut infections find that the only effective treatment is an orally-administered fecal transplant. 

The Diet From God: The Daniel Fast is growing in popularity, often prompted by Christians’ desire for a deeper form of prayer.

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Education stories for the Washington Post

I recently wrote a number of stories for the education section of the Washington Post:

Charter school known for rigor comes to D.C.  [B1]

Most school leaders say they strive to reach high standards. A public charter school has arrived in the District with a distinctive brand of academic rigor.

Sixth-graders at the school, Basis D.C., take physics and Latin. Fifth-graders read “Beowulf.” After they wrap up their minimum six Advanced Placement classes, Basis high school students can tackle organic chemistry and game theory….

Alexandria school on a mission to improve  [B1]

Mount Vernon Community School got a new principal this year, and teachers were skeptical. Peter Balas is the third in five years to lead the Alexandria elementary school.

“When we found out we were getting a new principal, everyone was like, ‘Again?’ ” said Holly Rocchetti, a fifth-grade teacher….

For some D.C. youths, summer jobs look like school

Aniya DeVaughn thought she was signing up for a summer job when she applied for the D.C. Summer Youth Employment Program, which places young people in government and private jobs across the city. Instead, what she got is more school.

For five hours each day for the past several weeks, DeVaughn, a 14-year-old rising freshman, has reported to McKinley Technology High School in Northeast Washington to work on math problems, reading assignments and business-skills lessons, all led by a teacher in a classroom. But unlike during the school year, she makes $5.25 an hour for her trouble. After taxes, she’ll have made about $500 this summer….


Reporting for the Washington Post

As a reporter with the Washington Post’s small business section, I post multiples times per week on our On Small Business blog while also writing for the Sunday business section and our Monday business paper, Capital Business. My work has included deep policy analysis as well as short, SEO-friendly articles. In this role, I also edit user submissions, promote content through social media, and create slide shows, videos and other interactive elements. In my time with the paper, I have grown the section’s social media following from zero to 600 Twitter followers, and my stories have consistently reached the top of the daily leader-board for my section.

Here are a few recent articles:

New research reveals the reasons we shop on Black Friday 


(This was a Real Estate cover)
(This was a Sunday Business cover)

How the Holstee Manifesto became the new “Just Do It”

The enthusiasm gap between health start-ups and doctors

Boosted by regulations, a small business opens up its own lobby shop


LA Times: Employers tell workers to get a move on

My May 15 article for the LA Times:

Concerned about sedentary jobs, many offices find ways to add exercise to the workday. Some see it as an investment in workers’ healthcare.

May 15, 2011 | By Olga Khazan, Special to the Los Angeles Times

Between the sheet-cake birthday parties and hours-long, cookie-fueled management meetings, office work has a way of undermining all our plans to live healthfully. Americans spend nearly nine hours at work each day — and our sedentary jobs wreak havoc on our bodies.

Three-quarters of adults get little or no activity daily, according to Dr. James Levine, an endocrinologist at the Mayo Clinic in Rochester, Minn. Two-thirds of Americans are overweight, and obesity accounts for 63 million physician office visits each year. Even for active people, sitting all day increases the risk of heart disease and diabetes.

Many corporations are now encouraging employees to move more during the workday: In an April survey by the corporate benefits group Workplace Options, 36% of employees said their jobs offered perks such as wellness coaches, on-site health screenings and fitness programs. And 70% of Fortune 200 companies offer physical fitness programs, according to the National Business Group on Health, with many saving on healthcare as a result.

“We’ve reached the point where doing nothing is unacceptable because people are really sick,” Levine said. “It is bizarre and inexplicable that we’ve gravitated into this crunched up, chair-based way of living.”

Levine has become a cheerleader for workplace fitness. In 2007, he popularized the idea of treadmill desks that allow the user to burn calories while chatting on the phone or checking email. He now consults on corporate wellness with companies across the country. Money, he says, is the main consideration for corporate leaders deciding on fitness programs. But small budgets aren’t necessarily a limitation, he added: “A small company with a small budget can do well if the will is great.”

Some, Levine said, have adopted low-budget measures such as holding walking meetings or positioning printers farther from desks. Others have secured art gallery memberships so that workers can spend lunch breaks taking in Bonnard rather than the buffet.

In the intermediate budget range, options include hiring yoga teachers or fitness trainers to work with employees one day a week. More resource-rich organizations might have a few walking desks or an on-site health staff.

Geographically blessed companies are especially apt to weave hardcore physical activities into the workday. At the Ventura offices of the outdoor apparel manufacturer Patagonia, the company’s flex-time policy means employees can go running, biking or surfing in the middle of the workday, and nearly all of them do.

Showers and a wet suit rack make it easy for employees to clean up after a lunchtime surf. The “board room” is literally a room full of surfboards.

“These outdoor pursuits are a big reason why we all work here,” said Julie Armour, a textile designer with the company. “You make your own schedule and everyone agrees to be responsible for themselves.”

An outdoorsy spirit is to be expected given that Patagonia’s founder, rock climber Yvon Chouinard, wrote a book titled “Let My People Go Surfing.” But geekier industries are also making fitness a priority.

Rally Software in Boulder, Colo., has on-site yoga, reimbursements for health clubs and employee-organized groups for rock climbing and other activities. The company also provides bikes for employees to ride on nearby trails during lunchtime.

“People cherish their time to get out and blow off steam,” said company representative Lara Vacante. “A lot of our execs have time blocked off for their daily runs, and we don’t schedule over that time.”

At pharmaceutical giant GlaxoSmithKline, thousands of employees have enrolled in workshops targeting physical and mental health. The programs demonstrate workouts in the company gym and cover such basics as eating right and taking activity breaks away from the computer. More than one-third of employees surveyed three to 12 months after they complete the program say they’ve experienced “very significant improvements” in their physical performance.

“It’s made a massive impact for me,” said GlaxoSmithKline scientist Susan Barnes. “I take more walks at lunch. I have energy to do things outside of work.”

Employees at the pharmaceutical company are also encouraged to incorporate exercise throughout the day: After learning about Levine’s research, the company installed a bank of treadmill desks that allow employees to take turns walking while they work.

Treadmill desks, of course, are pricey: At more than $4,000 for the popular models, they can be too expensive for some businesses and workers, not to mention bulky. Wellness coach Dr. Cynthia Ackrill opted, instead, to outfit her office with the $230 FitDesk — essentially an exercise bicycle, attached to a laptop stand. She bought it for its relatively portable size, and generally rides it for spurts of about 15 minutes several times a day while she works.

“It doesn’t replace all the benefits of being outside on a gorgeous day on a bike,” she said, “but I can get into something on the computer and [find that] more exercise time has gone by than I realize.”

Another budget option is an ergonomic desk chair that has stretchy rubber bands attached and functions as a rudimentary weight machine, made by the Menlo Park company GymyGym. Producer Jonathon Stewart of Los Angeles-based Atticus Entertainment bought chairs for himself and his six employees. He said it helps combat stiffness in his back and shoulders — and that it’s something of a conversation piece.

“It’s funny to glance out over the office and see someone doing triceps extensions while they’re on a phone call,” Stewart said.

Even companies with tiny fitness budgets can enact schemes that see big health gains. Dr. Toni Yancey, a professor of health sciences at the UCLA School of Public Health, developed an exercise program that requires nothing more than structured 10-minute work breaks. During the workday, taking three such breaks — which involve moves such as marching in place and simple shoulder presses — adds up to the 30 minutes of activity recommended by the U.S. surgeon general.

Yancey has distributed DVDs with these “Instant Recess” exercises to about 150 small nonprofit and government organizations in L.A. over the last few years. She’s studying the effects of the program with these workers and will release her findings in 2013.

Yancey, like other wellness experts, emphasizes that the directive to get moving has to come from the company’s leadership.

“It’s about structure,” she said. “There needs to be a policy in place that every time we have a meeting that lasts an hour or more, we’re going to take a 10-minute recess break. The opportunity should be offered every day, day in and day out.”

Executives shouldn’t fear that physical activity would distract employees from work, experts say. A number of studies have shown that exercise breaks improve productivity.

Yancey lauds the retailer L.L. Bean for its policy of three stretch breaks a day, which add up to 15 minutes; the resulting productivity boon yields the equivalent of 30 minutes of work. In Britain, a 2008 study found that workers who exercised before work or during lunch on certain days reported a boost in mood and job performance.

And Levine’s number-crunching has found that the return on investment for employers funding comprehensive programs is roughly $5 for every $1 spent, thanks to ramped-up productivity, fewer sick days and lower healthcare costs. Other studies have found returns closer to $3 per $1 spent.

The trick is that the rewards don’t come one and two weeks after the initiation of the programs, which means employers must often put up a sizable sum with the hope of a long-term payoff.

“The rewards come one year later,” Levine said, “and that takes guts.”


The Way We’ll Live Next: Near Airports?

[From KCRW]

Of the many complaints often made about airports – the lines, the body scans, the baggage fees – one you don’t hear every day is that airports aren’t close enough to our houses. After all, LAX is across the city from downtown, necessitating a well-planned shuttle ride, an expensive cab or a kind friend to reach it. But Greg Lindsay, author of the new book “Aerotropolis,” believes we’ll soon see the end of hard-to-reach airports hanging on the fringes of sprawled-out cities. The future, according to Lindsay, belongs to dense, well-planned cities – with airports at their core.

On April 5 at the A+D museum, Lindsay shed light on his vision of a world in which cities sprout up around airports, rather than the other way around.

The term “aerotropolis” is a portmanteau that describes a major metropolitan area that’s anchored by a major airport. The term was coined in 2000 by John Kasarda, a professor at the University of North Carolina. Kasarda, a co-author of the book, predicted that successful 21st-century cities would do their best to build near and around airports, using them as major financial and distribution centers rather than banishing them to the outskirts of town.

The thinking is that major cities in history have flourished thanks to ports, railroads or other infrastructure by allowing people and goods to move freely. L.A. itself grew from 5,000 to 100,000 people within a few decades at the turn of the century after it connected to the Central Pacific Railroad. Much like it made economic sense for New Orleans to be at the mouth of the Mississippi and for Chicago to be connected to railroad lines, Lindsay argues, it makes sense for today’s big cities to be built around today’s major transport centers: airports.

There are plenty of examples of this phenomenon already taking place across the globe. Dubai, Lindsay pointed out, is

Globalization at work in Dubai's busy international airport. From ghada on Flickr.Globalization at work in Dubai’s busy international airport. From ghada on Flickr.

essentially a main hub on the “new silk road” between China, India and the West. Its success stems almost entirely from its development of Emirates Air, one of the fastest-growing airlines in the world.

Another example from abroad is Amsterdam’s Schiphol Airport, where rail lines connect office buildings to terminals, and business professionals are never more than a few-minute train ride from their flight to a trans-continental meeting. Think airplane noise would scare off prospective tenants? Rents nearest to the airport are some of the highest in the Netherlands.

In L.A., we see examples of communities that have grown around airports in Santa Monica and Burbank, both of which owe much of their residential development to the presence of airports nearby. (However, some of these residents are not as thrilled to be living near air traffic as the Dutch might be.)

The idea of an aerotropolis is also becoming more important from a commercial standpoint as the economy continues to globalize: Medical tourism has become increasingly more popular among Americans looking for affordable surgeries. Apple products continue to be produced in Chinese factories and shipped to the U.S. as fast as American consumers can snap them up. London has a “phantom suburb” of hundreds of thousands of workers who fly in on weekdays via RyanAir and other inexpensive European airlines.

Lindsay doesn’t see this air-centric trend relenting any time soon. In fact, it is expected to progress as non-stop workdays and overnight shipping become expected in today’s economy. But in order for these airport-cities to succeed in the global marketplace, there would need to be some major changes in the way we plan cities.

First, in order to sustain air and other types of travel without depending on oil, we need to develop more biofuels, Lindsay said. And not just the corn variety – yeast and algae apparently can be used to make energy as well.

Second, “automobile-driven sprawl has run its course,” Lindsay said. (Sorry to all you content supercommuters of L.A.) Instead, we need denser cities constructed around walking, biking and public transit. Essentially, we would live and work in mixed-use development, and we would take trains to get to the airport.

“Cities are the engines of innovation,” he said. “And dense cities will do better than others.”

If that’s the case, then L.A. has some work to do.


Industry-Backed Congressional Reps Target EPA

[From KCET]

With the federal government looking for places to cut spending, Republicans in Congress seem increasingly intent on targeting climate legislation.

The GOP-controlled House just last week passed a budget that would, among other things, greatly limit the Environmental Protection Agency’s ability to regulate greenhouse gases.

And recently, Sens. James Inhofe (R-Okla.) and John Barrasso (R-Wyo.) each introduced legislation that would tie the federal government’s hands when it comes to carbon pollution, while Fred Upton (R-Mich.), the Republican chairman of the House Energy and Commerce Committee, introduced a companion bill shortly thereafter.

Perhaps it should be no surprise then that all three — Inhofe, Barrasso and Upton — received a large chunk of their campaign contributions from the oil and gas industry.

For Inhofe, who has publicly said that global warming is “the greatest hoax ever perpetrated on the American people,” the oil and gas industry is his largest contributor, giving more than $1.2 million since 1989. His third-largest individual donor is Koch Industries, the Wichita oil and gas giant that has been recruiting Congressional Republicans to stand up to greenhouse gas regulations.

For Wyoming’s Barrasso, oil and gas are the fourth-largest industry contributor, giving nearly $180,000. Foundation Coal, which has since merged with Alpha Natural Resources, is Barrasso’s largest individual backer.

Upton used to support stricter environmental regulations. In 1990, he backed the Clean Air Act amendments. But he has since moved in the opposite direction, accepting more than $250,000 from the oil and gas industry, and he recently hired an energy aide with a ConocoPhillips past.

What’s more, Politico reported that Upton and Inhofe staffers in January met behind closed doors with lobbyists from the American Petroleum Institute, the National Mining Association, the National Rural Electric Cooperative Association and others who were seeking an “all-out push to block federal and state climate rules.”

The resulting legislation is the “Energy Tax Prevention Act of 2011,” which would “amend the Clean Air Act to prohibit the Administrator of the Environmental Protection Agency from promulgating any regulation concerning, taking action relating to, or taking into consideration the emission of a greenhouse gas due to concerns regarding possible climate change.”

According to an analysis performed by Rep. Henry Waxman (D-Calif.), the Energy Tax Prevention Act would also “repeal California’s authority to regulate vehicle emissions, hamper EPA’s efforts to offer amendments to the Montreal Protocol, and prohibit EPA from limiting carbon emissions from stationary sources, cars and trucks,” Reuters reported.

But while deregulating CO2 emissions might satisfy some oil industry donors, the move would do nothing to abate global climate change, which most scientists agree stems largely from man-made carbon pollution.

“It is clear that impacts in the United States are already occurring and are projected to increase in the future, particularly if the concentration of heat-trapping greenhouse gases in the atmosphere continues to rise,” wrote the United States Global Change Research Program in 2009.

So how would climate change impact the home states of these three congressmen?

In the Midwest, Upton’s home turf, heat waves would become more severe and longer-lasting, Climate Science Watch reports. When it rains, it will likely rain harder, and flooding will become more common.

“The June 2008 Midwest flood was the second record-breaking flood in the past 15 years,” the report noted.

Inhofe’s home state of Oklahoma is projected by 2100 to see the average yearly temperature climb 10 degrees if current emissions levels remain constant. Droughts will become more common and soil will become less productive, according to reports.

“In the southwest United States, water resource issues will become a major issue,” said Michael Wehner, one of the authors of the Global Climate Change Impacts on the United States report, in a press release.

Barrasso’s home state of Wyoming might see a fate similar to Oklahoma’s if carbon emissions remain constant — severer weather and harsh dry spells.

“Pests will spread northward and milder winters and earlier springs will encourage greater numbers and earlier emergence of insects,” the report noted.

“The good news is that the harshest impacts of future climate change can be avoided if the nation takes deliberate action soon. This can be done through a balanced mix of activities to reduce greenhouse-gas emissions and adaptation to the otherwise unavoidable impacts,” said Evan Mills, a Berkeley Lab scientist who worked on the Global Climate Change Impacts report, in a statement.

When all is said and done, it’s not members of Congress or their staff working in offices on the Hill who would have to face the brunt of a changing climate. It’s the children of their constituents who will know whether it was all just a great hoax.


Will Revolving Door Staffers Influence Planned Parenthood Funding?

[From KCET]

With its federal funding already threatened and congressional budget negotiations still under way, Planned Parenthood, an organization that provides health care and abortions at reduced prices, faces an uncertain future.

The organization came under fire last month with a House budget proposal that would have withdrawn its federal funding. Although the Senate defeated the resolution on March 9, Congress may press forward with the issue in the next version of the budget.

“We’ve gained a lot of momentum. We expect that in whatever budget measure comes up next, defunding Planned Parenthood will be in it,” said Wendy Wright, CEO of Concerned Women for America, a socially conservative organization that has been lobbying for federal defunding of Planned Parenthood.

Wright has at least one reason to be optimistic. Michael Schwartz, the former head of government relations at Concerned Women now serves as the chief of staff to Sen. Tom Coburn, R-Okla. Although he hasn’t yet taken sides in the current budget battle, Coburn is a staunch conservative who serves as one of the “Gang of Six,” a group of Democratic and Republican senators who are involved in long-term budget negotiations. Coburn is also an influential Republican and member of the Senate Finance Committee who many Washington observers say has significant sway within his party leadership.

All this comes at a time when reproductive rights are being restricted in many states around the country. Since January, more than 800 reproductive health bills have been introduced in various state legislatures, according to findings by Regional News Network, and more than half of them aim to limit access to abortion. In Congress, both the pro- and anti-choice sides now count among their staffs former lobbyists who once fought fiercely on one side or another.

Schwartz, for instance, had an illustrious lobbying career before his job as a Congressional aide. Now, he and his boss, Coburn, seem made for each other.

Both men have a history of taking social conservatism to the extreme. Coburn once said he supports the death penalty for doctors who perform abortions, and Schwartz has said that pornography leads to homosexuality.

“Homosexuality is inflicted on people,” Schwartz said at a 2009 panel discussion for the Family Research Council. “All pornography is homosexual pornography because all pornography turns your sexual drive inwards.”

Throughout his career, Schwartz has bounced between conservative pro-life organizations and stints on the Hill. He was already a pro-life advocate when he joined Coburn’s House staff in the late 90s. He went back to work as head of government relations at Concerned Women for America from 2000 to 2004. After that, Schwartz returned to work with Coburn as administrative director in his Senate office.

Planned Parenthood also has a former lobbyist serving on the Hill. Laurie Rubiner, who was Planned Parenthood’s vice president of policy and advocacy, in 2010 became chief of staff for Sen. Richard Blumenthal, D-Conn., who has long been an advocate of abortion rights and was endorsed by NARAL Pro-Choice America’s PAC.

Rubiner may be better known to some as legislative director for Sen. Hillary Clinton, a position in which she helped develop the New York senator’s health care reform proposal for a 2008 presidential campaign. Before that, Rubiner held policy positions at the National Partnership for Women and Families and the New America Foundation.

“Sen. Clinton is 150 percent committed to universal health care coverage, and so am I,” Rubiner said in a 2007 profile in The New York Times.

House Resolution 1, the budget provision that would have defunded Planned Parenthood, was introduced by Congressman Mike Pence, R-Ind., who is chairman of the House Republican Caucus and has a staunch pro-life record.

Both Pence and Coburn received campaign contributions from the Club for Growth, a conservative PAC primarily focused on fiscal issues that has recently joined the struggle against federal funding for Planned Parenthood.

If conservatives are successful in defunding Planned Parenthood, the organization’s representatives say its ability to provide health services will suffer.

Approximately one-third of Planned Parenthood’s $1 billion budget comes from the federal government. By law, federal money cannot be used for abortions, but the organization does use taxpayer money to provide cancer screenings and contraceptives to women without health insurance.

“We estimate that nearly 2 million patients participate in the federally funded program,” said Tait Sye, a Planned Parenthood spokesman. “If we are defunded, America’s emergency rooms will be overrun.”


Reporting on money in politics

As a News21 fellow, I’m involved in a semester-long project on money in politics. As part of it, I’ll be writing regularly for KCET, an independent LA news organization.

So far, I’ve covered:

The strange bedfellows when it comes to opposing healthcare reform

The anti-EPA congressional Republicans, and what climate change has in store for their home states

The surprising rainbow coalition behind stopping the LA oil tax

Stay tuned…


What’s Behind LA’s Foreclosure Crisis?

It’s not exactly surprising that much of California, including L.A., has been ravaged by foreclosures. What is surprising is that many of the homeowners who are now facing foreclosure were originally targeted for subprime loans because of their race. What’s more, many trouble homeowners are now unable to secure mortgage modifications despite their best and repeated efforts.

Last week I wrapped up another series, this one about the problems that L.A.’s troubled homeowners face when trying to save their homes.

The first story focused on foreclosure prevention in South L.A.

The second was an infographic about the areas and banks with the most foreclosures in L.A. County.

The third was a look at one homeowner’s 5-year struggle for a mortgage modification, which he took all the way to the governor’s office.

The last story examined the six biggest problems with the mortgage modification process.

Along the way I made a javascript glossary to help readers understand the complex banking terms I discussed.

I also made a video to go along with the package:


Can Social Networks Save Lives?

This story is about the suicide-prevention function of social media, and how its limitations can literally be deadly.

[Neon Tommy]

In August, a suicidal man with the username Diefex logged into the social news site and posted a comment asking for “just one good reason to live.”

“DO IT FAGGOT,” said one comment on the post.

“You’re a history major; I’d commit suicide too,” said another, who had determined Diefex’s college major from one of his other comments on the site.

Others left more helpful advice, reminding Diefex about the earthly pleasures of good food, orgasms and mountains.

Two hours after his post, Diefex, a 24-year-old college student named Robert Duncan, hanged himself in his Philadelphia apartment.

Duncan was one of more than 4,000 people who have turned to the sprawling social network for help when they were contemplating suicide. The site has 200,000-plus forums dedicated to everything from politics to porn, and several of the forums, like Suicidewatch, allow commenters to vent their troubles and await responses from other so-called “Redditors.”

The recent death of New Jersey college student Tyler Clementi, whose dorm-room trysts were Web cast by his roommate, raised questions about the Internet’s role in prompting suicide. In Duncan’s case, the taunts from others on the site may have pushed him over the edge – a thought that still haunts his father.

“It certainly didn’t help,” Richard Duncan said. “It probably put him over. But we’ll never know for sure.” A few days after his son’s death, he posted a message on Reddit begging its users to be more sensitive to people who seem suicidal.

Duncan doesn’t blame Reddit. But Diefex’s death does raise chilling questions about online forums, where just one post can be the only warning of a brewing suicide attempt, but where the only available counselors are anonymous Web surfers.

And while some researchers say social networks can be effective in preventing self-harm, others fear Reddit and similar sites are the wrong outlet for the desperate cries of the distraught.

Suicidal thoughts are an extreme side -effect of crippling depression, explains Dr. Adam Kaplin, an assistant professor of psychiatry at Johns Hopkins School of Medicine.

When Kaplin meets grieving families desperate for an explanation for a loved one’s suicide, he tells them to picture this scenario:

“Imagine you were stricken with boils all over your body, you were in the hospital, you were alone, you were in terrible pain, and life had lost all of its fun.”

Depression takes people to that place emotionally. “It robs you of the ability to see where you are in reality, or that it was ever not like it is now,” he said.

If a brain without depression provides an accurate read-out of life’s events, a depressed brain has a “thermostat that is stuck,” Kaplin said.

At the root of depression is a short-circuit in the brain’s ability to absorb serotonin, a chemical that helps regulate mood and impulsiveness.

“When serotonin is low, people tend to make riskier decisions,” said Dr. John Mann, a professor of psychiatry at Columbia University. “If someone is feeling depressed and having suicidal thoughts, it’s hard to that person not to act on it.”

Genetic differences make suicidal tendencies more likely by reducing the amount of serotonin the brain produces. In 2004, scientists at Duke University discovered that a variant in just one enzyme can cause a brain to produce 50 to 70 percent less serotonin than normal.

Countless environmental factors can also trigger a suicide. In Duncan’s case, a recent breakup and an increasingly bleak economy made him anxious about his post-college future. For Tyler Clementi, it was being unwittingly outed on the Internet.

Even when genetic and environmental factors are stacked against them, suicidal people usually feel some degree of ambivalence about wanting to die, which means there’s a crucial window when counselors and friends can intervene.

“Part of them wants to die, but part wants to live,” said Lisa Firestone, head of the Glendon Association, a suicide-prevention nonprofit. The challenge, then, for doctors, friends and even Redditors is, “How do you connect with that part of them that wants to live?”

It’s a difficult task because people who have suicidal thoughts often feel guilty and reluctant to come forward. That’s because even the most severely depressed recognize, on some level, that one person’s death affects everyone else they know, Kaplin explained, and killing oneself is equivalent to tearing the fabric of society.

“People are very ashamed by it, and they will reach out in anonymous ways,” he said.

Sometimes, the anonymous way might be the only way they reach out. A 30-year-old Finnish man, whose Reddit monicker is Restlesssoul, had already been thinking about killing himself for several days when he posted one final, desperate plea online:

“I’m trapped, no good options left.”

In a two-paragraph post, he explained that he’s stuck in a loveless marriage. “This all hurts like hell, the pills don’t help,” his post continued. “I’m really contemplating suicide.”

“Which do you think will hurt your children more?” asked user G3R4 in response. “You committing suicide, or you divorcing your wife?”

“Talk to someone -– even if the start is just a suicide hotline,” said another.

Restlesssoul thanked the Reddit community in a later post he wrote from a hospital, where he was being treated after he talked to a psychiatrist about his suicidal thoughts. In an interview, he said the Reddit community encouraged him to make the initial doctors’ visit.

“I’m a faceless nobody on Reddit,” he said. “I can say things that are true but that I’m too ashamed to say out loud. [The people on Reddit] managed to put things in a different perspective.”

Reddit isn’t the only social network with sections dedicated to suicide prevention. Sex columnist Dan Savage started a YouTube channel called the “It Gets Better Project,” which targets gay teens with encouraging video messages and has been viewed more than 1.5 million times.

In June, a Canadian woman started a Facebook page called “Please don’t jump.” It gained 20,000 members overnight.

“So many people go on and they say, ‘I need help,’” said Katelyn Roberts, an administrator with the Facebook group. “Within a few hours, they have at least five people commenting on their status.”

She says the site can, in some ways, be more accessible than a professional would because the commenters on Facebook aren’t social workers or people who “have to be there.” Instead, they appear to be there because they genuinely want to.

But some psychiatrists warn that it’s dangerous for novices to do the work of professionals when lives are on the line.

“It’s like getting onto Facebook and asking someone if they can fix your car engine,” said John Mann, the Columbia University professor. “The best thing someone can do is to tell you to take it to a mechanic.”

Suicidewatch moderator Aenea, who also asked that only her Reddit name be used, said the forum does try to be the link between users and the “mechanics,” or psychiatrists. She said the six Suicidewatch volunteer moderators perform research for users and send them messages with the phone numbers of psychiatrists or free clinics in their areas. The moderators also patrol the site’s comments once an hour, deleting anything offensive.

“Of course it’s better to be dealing with a qualified mental health professional,” Aenea said. “But we want people to talk to us rather than not talk to anyone.”

But although it may be good to get suicidal people talking, it’s also important to make sure they’re hearing the right things in return – and that’s where the Internet can pose a problem.

“In general, people aren’t assholes to each others’ faces,” Aenea said. “But someone saying ‘Do it, do it, do it!’ –- that’s more common online.”

Granted, in the Suicidewatch section of Reddit, it’s rare to find commenters like those who encouraged Duncan to kill himself. Duncan posted his request in a different Reddit forum, “Ask Reddit,” where moderator policing isn’t as strict and where the comments can be much more vile.

And beyond the deplorable comments of so-called “trolls” lies another problem with the online medium: It’s hard to tell exactly what someone means or if they’re being sincere. You can’t hear a desperate sob or see a tear-streaked face on the Internet, and the lack of person-to-person interaction creates gaping holes in the online suicide safety net.

Like many suicide victims, Duncan left his own version of a goodbye note – in a three-word Facebook status message: “See you Philly.”

Giving it the most literal reading possible, a friend of his responded, “Where are you going?”

“I wouldn’t have thought anything of it,” Duncan’s father said. “On the Internet, you can’t hear people’s voices.”

However, that might be the very reason people seek help there in the first place.

To be sure, on social networks people can misconstrue or ignore what are essentially suicide notes, and “trolls” can urge suicidal people to give in to a dark and final temptation.

But hotlines and therapists come with their own unfortunate drawbacks. People usually don’t think of themselves as mentally ill, even if they are. If you’re suicidal, picking up the phone to call a suicide hotline requires a massive cognitive leap – one that takes you from denying suicidal tendencies (as suicidal people often do) to admitting that you’re one of the “people who need help.”

But Suicidewatch and other networks find people where they already are – debating in forums, watching YouTube videos or perusing friends’ Facebook profiles. Those anonymous communities are often where people feel safest confessing. And when it comes to depression, hearing those confessions can mean the difference between life and death.

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