Like many college freshmen in the early 1970s, Peter Kramer sometimes thought of suicide as an existential, vaguely romantic response to an absurd world – a notion that his later training disabused him of. "One function of socialization into psychiatry is to lose all romantic notions about suicide," says Kramer, the author of Listening to Prozac and a clinical professor of psychiatry and human behavior. "Suicide today is seen as the end point of a medical illness."

Yet despite new developments in diagnosing and treating major depression and suicidality, the rate of suicide, Kramer notes, has changed very little. Better psychotropic drugs, refined psychotherapies, and more carefully controlled electric shock treatments have had little statistical effect. The suicide rate still increases with age, and drops noticeably only during wartime or some other event linking people with a common cause and interest. Recent studies in Scandinavia, where rates of depression are higher, suggest that antidepressants can have a mitigating effect on the rate of suicide, Kramer says, but such studies have yet to be conducted in the United States.