WASHINGTON - For many years, Gregg Loomis hid the attempts from others. He worried about the effect on his insurance business. He had seen people's view of him change once they found out. He had lost friends that way.
So two days before his trip to Capitol Hill, Loomis sat in his office in a New York City suburb, agonizing over what he might say. How do you explain to total strangers the most painful, private moments of your life - the moments you tried to end it.
A suicide prevention group had sent notes to him and other volunteers to prepare for the trip. He wouldn't be talking with actual lawmakers, but with their legislative aides. He'd have 10 minutes, 15 at most, to tell his story and plead for funding and legislation.
"That's not a lot of time," a worried Loomis, 61, said as he went over the notes.
Until recently, the suicide prevention movement has been driven largely by family and friends of those who died. But in recent years - as suicide rates have climbed to historic levels - survivors of suicide attempts have been "coming out," determined to combat the problem even if it means speaking out about their own, often-hidden pasts.
Their emergence in unprecedented numbers in the past five years has transformed the suicide prevention world. Clinicians who once hid their own attempts for fear of having their objectivity and work questioned have started revealing their history to peers. Researchers trying to understand suicide, who previously focused on post-mortem data and environmental factors, are starting to embrace the relatively new idea of reaching out to people who experienced it directly. And advocates are harnessing those voices to raise awareness of suicide as a public health issue and win sorely needed funding and attention.
The new momentum comes at a time when suicides in America have hit their highest levels since World War II.
Since 1999, suicide rates have climbed 33 percent. Roughly 130 Americans now die by suicide each day, making it the country's 10th leading cause of death. And yet, government funding for research and prevention has lagged far behind all other leading causes of deaths. Funding for it is regularly dwarfed by ailments with only a fraction of the death toll regularly - despite the profound trauma and costs of suicide, including more than $50 billion lost in work productivity each year.
"We are where cancer was in the 1960s, or AIDS was in the 1970s, or Alzheimer's 10 years ago. We haven't pierced the national consciousness," said John Madigan, head of public policy at the American Foundation for Suicide Prevention. "We haven't put a face on the problem."
As an exercise, the suicide nonprofit had asked volunteers to boil their stories down to 150 words - an elevator pitch to advocate for crisis call centers, medical research and expanded access to mental-health care.
As he packed for Washington, Loomis thought about the darkness he felt the first time he had tried to kill himself, while in college - the all-consuming pain and his desperation to escape it. He thought about his last attempt, in 2008, when the hospital forced him to leave after five days, while he was still mentally fragile, because that's all his insurance would pay for.
He thought about the first time he talked about any of it publicly at a suicide awareness event four years ago, and how he had teared up and had to pause to gather himself.
"It's not like this is some badge of honor you want to wear in public," he said. "It's not something I'm proud of. But if there's something I can do to help. "
The field of suicide research and prevention is only four to five decades old. For most of that span, those who survived suicides were considered too ill or too disturbed to contribute.
"Survivors were seen as people to be studied, rather than partnered with," said Ursula Whiteside, a researcher with the University of Washington. "It was an 'us and them' approach. The 'us' were people helping and the 'them' were people who needed help."
Implied was the concern anything could send such people over the edge. Until recently, for example, clinical drug trials for mental illnesses routinely removed all patients with any suicidal thoughts. As a result, researchers note, little is known today about what medicines might reduce suicidal thoughts and impulses.
"Even among suicide researchers, when someone comes out, there's a fear people will start questioning their competency and work," said DeQuincy Lezine, a researcher who is open about his suicidal past. "You hear questions about whether they should be answering calls on prevention lines, or working as clinicians."
That began to change in 2011, when Marsha Linehan - a towering figure in the field who developed a treatment called dialectical behavior therapy that can be effective on illnesses such as borderline personality disorder - revealed publicly that she struggled with suicide throughout her life.
Others soon followed suit.
"Once you see someone telling their story, it's less hard to tell your own," Whiteside said. In 2017, more than 47,000 Americans died by suicide, but the number who attempted it was almost 30 times that - meaning 1.4 million survived such incidents,according to federal statistics.
Suicide experts now use the term "lived experience" to describe what such survivors offer their field. Their insights have led to new lines of research and pilot programs deploying survivors to counsel other patients at risk.
The National Action Alliance for Suicide Prevention launched a task force made up of attempt survivors. The American Association of Suicidology created a special division and a seat on its board of directors for attempt survivors.
A day before their appointments on the Hill last month, 250 volunteers gathered in a hotel basement for a crash course on lobbying.
Most in the room had suffered loss of some kind - a sibling, spouse, child had died by suicide. But about a fifth of them, more than in any year past, were themselves attempt survivors.
The group in charge, the American Foundation for Suicide Prevention, had lined up meetings with congressional offices from each volunteer's home state.
The volunteers got a yellow packet crammed with stats: How suicides have risen especially sharply among teens and young adults and is now their second leading cause of death. How 90 percent of people who die by suicide have a diagnosable mental condition, suggesting treatment could have saved their lives. How researchers have barely scratched the surface in understanding what's happening in the brains and bodies of people who kill themselves and why suicide is increasing at such an alarming rate.
But more important than any statistic, organizers told the volunteers, was making the message personal.
You are fighting for not just money but attention in a crowded arena, said former Rep. Patrick Kennedy, D-R.I., in a final pep talk to volunteers. Use your stories to break the cycle of shame, he urged them. Use your stories to reveal suicide for what it is: a national crisis.
Listening from a table in the back, Sumer Anelli said she had been bracing for weeks for the conversations ahead.
"It can be emotionally draining," said Anelli, 38, of Nashville, Tennessee. Last year, she started crying in the hotel lobby before she visited a single congressional office. It had taken eight years - since the day she swallowed every pill in her medicine cabinet - before she could share that experience.
"I finally got to a place where I was OK with others judging and talking about me," she said. "I got over it because I know others need help."
Even now, Anelli said, she is deliberate about how and with whom she shares her past.
It comes up when someone asks about the tattoo on her forearm - the flatlining beat of a heart-rate monitor, interrupted by a semicolon. The semicolon, she said, represents the moment when she, as the author of her life could have ended the sentence, but did not.
Coming with Anelli from Nashville was Shannon Geames, 50. Geames has incorporated her experience into her job with the Tennessee Highway Patrol. After convincing her bosses that suicide prevention training should be mandatory, Geames helped teach classes for the state's 848 troopers and cadets.
Sometimes after mentioning her own attempt, Geames said, those who lost someone close come up afterward with urgent questions. Mostly, they want to understand why.
"You're not thinking about your kids or parents or job," she said she often tells them. "All your thinking about is the unbearable amount of pain. It's like being in a burning building and feeling like you either have to jump out, or burn to death."
The next morning, as Anelli and Geames scurried between offices, they took turns making their pitches.
At Anelli's first meeting, the legislative staff member clicked his pen and nodded impatiently. Every few minutes, his eyes flicked to the clock above. Anelli rushed through her talking points, but as soon as her 10 minutes were up, the staff member gave a curt thanks and showed her out.
"You can't take it personally," Anelli said afterward. "As a society, we hate talking about death, much less this kind of death."
Do you know the suicide warning signs? pic.twitter.com/9dcD0ucBtu— American Foundation for Suicide Prevention (@afspnational) June 17, 2019
Loomis - the Port Chester, New York, insurance salesman - was having slightly better luck. After refining his story all weekend, he reduced it to a single short sentence, introducing himself as "an attempt survivor and someone living with bipolar illness."
He explained his careful word choice in a meeting with a staff member for Rep. Nita M. Lowey, D-N.Y.
"I don't say, 'I'm bipolar.' I say, 'I have an illness,' because that's what it is, like cancer or any other illness," Loomis told the staff member. "The stigma around suicide is huge. We say someone 'committed suicide' because it used to be considered a crime and sin. Churches wouldn't even let people who did it be buried in their cemeteries."
The idea seemed to resonate with the aide, who jotted notes as Loomis explained the need to enforce laws requiring insurers to provide people with mental ailments the same resources they give to those with conditions like heart disease.
By the end of the day, Loomis had visited five offices. Anelli and Geames had split up to cover all nine of Tennessee's congressional offices and its two Senate offices.
As Anelli walked along the Mall, exhausted and fighting a cold, she wondered aloud whether they had made a difference.
"There are times in this fight when it can feel pretty lonely," she said softly. "But if we changed anyone's minds or saved even one life today, it's worth it."
For help dealing with suicidal thoughts or loss from suicide:
This article was written by William Wan, a reporter for The Washington Post.