Editors' Note: This is the second of three ABCNews.com stories featured during National Suicide Prevention Week to explore not only what motivates people to kill themselves, but to highlight those who survive suicide attempts, witness them or work to prevent them.
When Jan finally got psychiatric help for her depression at 34, she had been hospitalized twice for cutting and purging and had made multiple suicide attempts.
She held many dark secrets, including sexual abuse as a child, a violent husband and a "difficult" daughter that she couldn't manage to love.
After a variety of treatments failed, she plunged into despair so deep, she held a gun to her head, ready to pull the trigger.
"I was completely numb and in so much emotional pain," said Jan, who did not want to use her real name. "I had so many flashbacks that seemed so real to me, and I wanted them to go away. I thought my life was totally worthless."
But that rock bottom was soon to be her turning point for recovery when Jan's psychiatrist, Dr. Joseph Shrand, demonstrated his respect and trust for her.
"I see myself as a survivor," said Jan, who is now 54, remarried and living in Kentucky.
Though she has "good days and bad days," Jan is no longer on medications and the suicide urges have waned. And when the dark moments come, she seeks help.
Broadly speaking, a federal study shows, 8.3 million Americans -- 3.7 percent of all adults -- have serious thoughts of suicide each year; 2.3 million make a plan and 1.1 million attempt suicide, resulting in an estimated 37,000 suicide deaths each year.
Jan credits Shrand, who teaches at Harvard Medical School, for helping her to survive on that critical night when she was ready to take her life.
"The best thing you can give someone is trust and to believe in them," she said.
His novel approach, called Imax, is based on a simple theory that, "It all starts with respect."
Shrand said that studies find that two-thirds of those who think about or attempt suicide never seek help because of the stigma of mental illness.
"They are resistant because they worry about being judged as sick," he said.
The "unpredictability" of mental illness makes people nervous, he said: "It scares us."
From a biological standpoint, Jan's depression can be seen as a coping mechanism to external influences, or domains, over which she has no control, such as her abusive home life and marriage.
"It is always remarkable that people are not doing worse," Shrand said. "The imax approach truly sees people doing the best they can."
Shrand, who today works as medical director for the CASTLE, a treatment program for at-risk youth, met Jan when she was struggling to raise her daughter, a "feisty" 10-year-old.
Her own mother brought them in for a consultation, but Shrand's attention immediately turned to Jan, who was sullen and didn't seem to have much interest in her daughter.
Jan told him that she had a history of cutting, as well as binging and purging her food and admitted she was tormented with "emotional pain."
She was institutionalized in a locked ward after her first suicide attempt. Shrand wrote about Jan in a story, "Lady With a Gun," which is part of a future book: "Jan may not have been mistreated in the hospital, but she did feel very, very alone," wrote Shrand.
There, she fell in love with another patient, but when they were discharged and later married, he beat her and forced her to have sex, once at gunpoint. Eventually, he abandoned Jan and their daughter.
The girl shared her father's blond hair and blue eyes, as well as his temper. Jan could barely summon up the emotion to love her daughter, who was a reminder of the violent and disrespectful relationship.
Eventually Jan became Shrand's patient and after 18 months, they built a trusting relationship, meeting once a week at 9 a.m. As her emotional state worsened, he put her on antidepressants and antipsychotics.
"I was a walking drug store then," admits Jan, who continued to have flashbacks. Her cutting also escalated from just her arms to her thighs and abdomen.
She was briefly admitted to the hospital after a cutting incident took her to the emergency room again. As a result, Jan decided to give up custody of her daughter to her mother.
'Lady With a Gun'
That seemed to quell the suicidal episodes for a while, as she entered a day treatment program. But months later, she paged Shrand to cancel her next day appointment -- and all of her therapy sessions.
"I don't remember a lot of it," Jan told ABCNews.com.
In therapy, Jan had promised she would call Shrand if she ever felt the urge to use the razors again. But now, on the phone, she told him she had a gun.
"You can't live with a gun, Jan," he responded. "It's too quick, too permanent. You changed the rules. I can't live with that either."
Shrand struggled with whether to call the police or 911. But he remembered they had a trust, and the fact that she had called "meant something."
"A promise is a nebulous agreement between two people," writes Shrand, telling the story. "But in therapy, it represents trust: A patient who trusts their therapist is one thing, but when a therapist has trust in a patient, it lets them know of that bond, that attachment, remarkable things can happen."
Shrand told Jan she could not be his patient if she had a gun and he expected to see her (and the gun) at therapy the next morning. No shots went off and she showed up the next day.
It was a turning point, according to Jan.
"He chose not to call the cops," she said. "He said, 'I trust you and see you in the morning.' It made me feel like I am OK, that I matter to someone. He didn't flip out and call 911."
The next day, all the secrets poured out -- her military officer father had sexually abused her and so had her brother. Jan was even able to confront her mother -- and her estranged brother -- and tell the truth.
The healing, over a decade of therapy, began and today, Shrand counts Jan as one of his biggest success stories.
Humans are social creatures, according to Shrand, and they need to trust each other for survival.
"In our heart of hearts, we just want to feel valued by another human being and if you think about the evolutionary perspective, it makes enormous sense," he told ABCNews.com. "If I don't feel any value to the world, I might as well not exist."
Listening to the person with suicidal thoughts and acknowledging their emotions, rather than telling them to "pull themselves up by the bootstraps," is also important, Shrand said. "It doesn't mean we condone it or like it, but we have to respect it."
When a person trusts another, the hormone oxytocin, which promotes bonding and attachment, is released, he said. "You feel that pleasure again."
And so did Jan. She moved to Kentucky in 2002 where she now has a large support group of friends and co-workers to keep an eye on her.
"I am in great shape and people love me," she said.
She has forgiven her brother.
"He's my only living relative," said Jan. "Why hold grudges over things in the past. I know a lot of people couldn't understand that, but I could relive the horror. I realized I had to stop the wheel [of anger] to go on."
Jan still has a "rocky" relationship with her daughter, who is now 24 and back living in Boston. But she knows now she loves her unconditionally.
She finds joy in caring for her five dogs -- at one point she had 11. She attends a "big old" Christian church she laughingly calls, "Six Flags Over Jesus," and says she loves her work as a parts manager for a tractor company: "I put 200 percent into my job."
"I have learned a lot about myself," she said. "I am a good person. I am working. I can do good and I can help people."
A co-worker was recently injured and has been depressed.
"I am blunt with him -- I say what is in my heart," Jan said. "I learned I need to be honest and blunt about my feelings. ... They were stuffed so way down deep, I didn't know what a feeling was."
Twice, close to the holidays, she slipped into a depression and checked herself into the hospital.
"I survived hell," Jan said. "My brother and father put me through hell, and I am still alive. And yeah, I'm glad to be alive."
For help or to report a suicide, contact the National Suicide Prevention Center Lifeline at 1-800-273-TALK (8255).
The following are signs that might indicate the risk of a suicide attempt:
Talking about wanting to die or to kill themselves;
Looking for a way to kill themselves, such as searching online or buying a gun;
Talking about feeling hopeless or having no reason to live;
Talking about feeling trapped or in unbearable pain;
Talking about being a burden to others;
Increasing their use of alcohol or drugs;
Acting anxious or agitated; behaving recklessly;
Sleeping too little or too much;
Withdrawing or isolating themselves.
Showing rage or talking about seeking revenge.
Displaying extreme mood swings.
- Mental Health