I had floated for hours in a warm mineral spring in Florida, interviewing Eastern Europeans in Speedos and floppy hats. For a reporter, it was an idyllic kind of day. Back at the office late in the afternoon, gritty and sun-bleached, I sat down to look through email. I had just published an article about a Spring Hill woman named Gretchen Molannen. For 16 years, she had lived with an embarrassing genital arousal disorder that had left her destitute and in pain. An email from her boyfriend caught my attention. "She committed suicide this weekend," he wrote. "The story won't help her now." My mind took off at a gallop. It's a joke. He's angry about the story. He's wrong. Is it true? What if it is? How sad. It's my fault. She killed herself because of my story. Wait, this could affect my career. Stop thinking about yourself. Think about her. I knew I needed to tell someone, but I sat frozen. Can I get away with not telling my editor? I sighed. Hands shaking, I called him into a private office. Soon I sat in another office surrounded by important editors with sympathetic faces. They had questions. When had I last spoken to her? What did she say? Had something happened? At that moment I only knew that Gretchen, who was 39, had been found two days earlier in her home. My brief story about Gretchen's suicide spread across the Internet quickly. It was translated into Turkish, Hungarian, Vietnamese and countless other languages. In response, I received hundreds of supportive emails from colleagues around the United States. But there were other comments. A controversial St. Petersburg blogger said Gretchen's suicide had left "blood on the Times' hands." As interest in the story grew (the video and stories were viewed about 1.2 million times that first month), Tampa Bay Times managing editor Mike Wilson suggested I revisit how the story was reported and edited, to better understand Gretchen's suicide — and what we had to do with it, if anything. The idea felt risky. A journalist did not report on herself. A year has passed. A year in which I tried to put the episode behind me. A year in which I worried repeatedly that it would happen again. A year in which I realized I still had questions about what happened with Gretchen. A month or two ago, I pulled out my notes and my recorded interviews with Gretchen. I listened to her voice. I pored over her medical records, autopsy report, disability documents. I called suicide experts and journalism ethicists. I tracked down people who knew her. I was searching for answers. Could I have done more to help her? Or more to the point, should I have avoided telling her story altogether? NEWSPAPER REPORTERS prowl for story ideas. We scan bulletin boards. We eavesdrop. We strike up conversations with strangers in bars. I was browsing Craigslist in July 2012 when I found this: "PSAS sufferer seeking help from a neurologist . . ." I did some research. Persistent sexual arousal syndrome (PSAS, though it is now called persistent genital arousal disorder) was first identified in 2001. Women who had it were "physically but not psychologically aroused." Most masturbated for hours to achieve seconds of relief. The disorder had struck thousands of women of all ages, from a 36-year-old mother of three who had to stimulate herself to orgasm in sets of six to an 81-year-old woman whose symptoms began six years before, after a hysterectomy. Sufferers were isolated and ashamed. They also had difficulty getting people to take the condition seriously. On July 5, I sent an email to the woman who posted anonymously on Craigslist, asking if she would talk to a reporter. I heard back the same day. Hi, Leonora. Thank you for your reply and your interest in my condition. I've been wanting to do a news story about this for years! . . . I look forward to hearing from you again. Thank you for caring! Gretchen HER PHONE HAD BEEN SHUT OFF, so the basics of her story came to me over the next few weeks in dozens of long emails, sometimes up to eight a day. Her condition had emerged for no apparent physical reason soon after she graduated from the University of South Florida with a degree in Spanish in 1996. She loved learning languages and also spoke French, Japanese, German and a little Greek. She had hoped to be a translator, but her condition made that impossible. Over the years, she had sought medical help from counselors, a psychiatrist, gynecologists, a reproductive endocrinologist, a neurosurgeon, a hypnotherapist, two urologists. She underwent MRI scans and took countless medications. She got some relief from a sleeping aid. She had tried to work in the early years — as a receptionist, a jewelry saleswoman, a tanning salon clerk — but she couldn't concentrate and spent a lot of time in the bathroom. By 1999, she stopped trying to work. She spent most days at home. Her boyfriend paid her bills. She had tried to win disability twice and lost. She had attempted suicide twice and survived. I presented Gretchen's story to my editor, Bill Duryea. He had questions. What caused it? Was it psychological or physical? When I told Bill about Gretchen's suicide attempts, he saw it as an indication of the seriousness of her condition. I asked Gretchen for her phone number. She answered quickly by email: Most of the time, reporters who do stories on women with PSAS sensationalize the condition for "ratings" or they tend to "mis-describe" the condition and "put words" in the sufferer's mouth. I explained I wanted to do something more meaningful, to document her life in words and pictures. "I'm worried about my acne," she said. "I don't look very good right now. But sure." I WAS NERVOUS as I drove to Spring Hill on a muggy Tuesday in late September. Gretchen had asked me in advance to avoid certain words that might trigger her arousal. I had to spell out O-R-G for orgasm. M for masturbation. It was unnerving. I didn't want to inadvertently cause her pain. She lived in a neighborhood of stucco homes with smooth lawns and pool cages. But her house was obscured by a stand of shaggy oak trees, as if she were hiding in a tiny forest. I had expected her to be homely based on her description of herself. But the woman who opened the door had pretty green eyes and reddish-brown hair pulled back in a barrette. She wore a fuchsia top and white capris. I saw no signs of acne. As we settled in for the interview, she perched gingerly on a dusty black daybed and looked at me expectantly. She apologized for the mess. I looked around at the clutter and sneezed over the dust and thought it all rather paradoxical. She was a virtual shut-in, but she was fastidious and self-conscious enough that she had had breast implants and permanent eyeliner. Over the next 3 1/2 hours, I was struck by how easily she told me about herself. She didn't cringe or hesitate, as I imagine I would have. Nothing was off-limits. She spoke easily and directly about rapes she had suffered by a neighbor as a child in Wisconsin and her limited sex life with her boyfriend. Her candor and humor emboldened me to ask more difficult questions about her condition. Hours of "abusing herself," she said, had caused carpal tunnel syndrome and joint pain, and urinary tract and bladder problems. She had been diagnosed with obsessive-compulsive disorder and borderline personality disorder. She couldn't work, so she had no medical insurance. She had lost her Medicaid, apparently because she owned her deceased parents' house. Even if she could have afforded treatment, doctors didn't understand the condition well enough to help her. At the time, I was focused on understanding her condition, but listening almost a year later to recordings I made of the interviews, I see just how much we talked about her precarious psychological state. She had told me in an earlier email that she had attempted suicide, but that day I learned that both of her attempts had taken place six months before. She was fed up with the agonizing symptoms. It didn't help that her boyfriend had gotten a job at a home improvement store, leaving her alone more often. "A lot of women with PSAS try to commit suicide," she said, "and the lucky ones succeed." I'd never talked with someone so matter-of-factly about suicide. She detailed her attempts — how she set up photos of her parents nearby and put an episode of Three's Company on her DVD player. "I was dying for entertainment," she said, joking. Listening to a recording of that interview recently, I can't detect a trace of judgment in the questions I asked. The reporter-source relationship is a complicated one that defies easy description. It borrows a little from the salesman-buyer relationship, the therapist-patient relationship, the police officer-witness relationship, sometimes even the growing intimacy of a friendship. We work hard to gain access and trust, and generally we avoid doing anything that stops a source from talking once she gets started. "How are you now?" I asked at the time. "I'm suffering horribly . . . but I'm not suicidal," she said. "It's a soothing thing. I don't really want to do it. But it helps me calm down, it helps me sleep to think about the possibilities to end the suffering." If I had possessed some sort of device that could peer inside her brain and pick up some biological trace amongst the billions of nerve cells and circuits that would indicate she was likely to commit suicide, would I have stopped the interview? I don't really know. I just know that we were both in deep at this point and proceeding toward publication of an article that might help her and other women with her condition. Quite simply, she said she wanted to live and I believed her. THE CHALLENGE in telling Gretchen's story was to make readers empathize with her rather than snicker or wince. I examined her medical records, interviewed sex therapists, medical researchers, other women suffering with the condition. It was time consuming and for Gretchen exhausting. Nevertheless, Gretchen agreed to a video interview in early October. It was an example of her determination and it added measurably to the power of her story. Then, one Friday night in late October, Gretchen called. I took the call on the sidewalk outside a restaurant. She was distraught. Her boyfriend, who had encouraged her to work with me, was advising her to pull out. She thought he was worried about his family finding out. "I really want to do the story," she said tearfully, "but I can't lose him. I just can't." I told her to take her time, think about it. But I'll be honest. I felt pressure to produce this story. The Tampa Bay Times was launching a new magazine in December and Gretchen was to be the first cover story. We talked about pulling the story if we had to, but a few days later, Gretchen called back. She wanted to go forward. I was relieved to know that four months of work had not been for naught. But my seemingly endless questions — What was she thinking as she headed into her disability hearing? Did the judge look at her while she told her story? Was she in pain? — had begun to wear on Gretchen. Monday, Nov. 5, 2012 If I had known how painful and drawn out this process would have been, I might not have gotten involved. I know it's your job to get the facts and verify them but I'm not getting paid for this like you are. This isn't fun or profitable for me — it's a daily hell and constant mental and physical struggle. I'm sorry but this process is really hurting me. I want to get the word out and also stand up for myself to my mom's friends but not be examined under a microscope. I'm exhausted. I hope you can understand and I appreciate your work. I called her and apologized. I'd been so wrapped up in getting the story right that I'd missed how it was affecting her. I told her I'd leave her alone until the story was written. IN LATE NOVEMBER, about a week before publication, I read Gretchen the whole story over the phone. Many journalists blanch at the thought of giving up that kind of control. If sources control content, they say, the truth might get lost. But I do this with nearly all my stories. It's important for me to get my facts right. It's also an act of good faith with someone who quite often would never have entered the public realm if not for my interest in her. Still, I'm firm at the outset that I retain control over the finished product. Gretchen had no complaint about the accuracy of the story. She asked that we delete that she had met her boyfriend on Craigslist and that she had once been involuntarily committed under the Baker Act. My editor wanted to keep how she met her boyfriend because we had done the same with her other boyfriends. We removed the Baker Act reference because we felt the story was sufficiently clear about her mental health issues. Gretchen said she was fine with this compromise. Two days later, on Wednesday, Nov. 28, she sent me an email: Thank YOU for taking an interest in doing a story for me! I am flattered that you cared so much to want to help. I just hope this will educate people that this (condition) is serious and really exists, and that other women who are suffering in silence will now have the courage to talk to a doctor about it . . . Thank you for your patience with me and for devoting so much time to this . . . I'm excited to see my own story online. Gretchen's story went online on Friday afternoon, Nov. 30. It appeared in print in Floridian on Sunday, Dec. 2, under the headline "The Agony of Gretchen M." I learned of her suicide from her boyfriend on Monday, Dec. 3. Some readers would conclude that seeing the story published prompted her to take her life. But authorities think she killed herself either late Thursday, Nov. 29, or early Friday, Nov. 30 — before the story ever went online. AT FIRST, BEFORE I LEARNED that Gretchen was dead, my in-box began to fill with offers to help her. I heard from doctors who wanted to treat her for free, lawyers who wanted to help her with her unsuccessful disability claim. Someone started a petition to add genital arousal disorder to the list of conditions meriting government disability claims. I heard from a 71-year-old ordained minister in Hawaii who said, "This article is a godsend because I didn't know what I had." But then, as news of her suicide spread and the criticism began, I was quickly overrun with requests for interviews. There was debate among media critics about whether I should have read the story to her before publication, whether I'd caused her death, whether the story was anything more than sensationalism. Gretchen's last email to me and the knowledge that she had died before the story came out provided some comfort, at least initially. But my mind swung back and forth between sadness, guilt and confusion. I cared about Gretchen, but was I supposed to be devastated? I didn't know. I felt overwhelmed. A co-worker suggested I see a counselor. J.A. BOOKER'S YELLOW LABRADOR, Sally, nuzzled me as I sat down on the dark leather couch in his office. A replica of a tall ship sat behind glass on his desk and a marble chess set sat on a coffee table between us. Booker, a licensed clinical social worker, had read about Gretchen in the Times. He told me he thought I had done everything I could with the information available. "I should have taken all her medical records, all the disability reports and handed them over to a psychologist or a psychiatrist," I said. Booker nodded. "What would you have done with that information?" he asked. "Well, we might not have run the story." "It's just as likely she would have killed herself if you had not run the story," he replied. I felt my perspective shift. Looking back, I realized that the moment Gretchen and I connected, this was how things might end. No matter what I did. A FEW WEEKS LATER, I sat at a Perkins in Tampa drinking coffee when he slipped in across the booth from me. Bill Dwyer, 44, had been Gretchen's boyfriend. A messy thatch of brown hair hung down his forehead. He was unassuming and quiet, almost awkward. He had called me. He wanted to make sure everyone knew that Gretchen was a good person, not a freak. She had been desperate and lonely and afraid. Sometimes she got depressed and would talk about taking her life, but her tone was always "goofy" or "sarcastic." Every time he visited her, though, he worried what he might find. "It was stressful," he said. "She felt like such a burden and an outcast." He worried that if he called anyone about her precarious mental state, it might cause her to kill herself. Gretchen had told both of us that she feared ending up behind a locked door at a hospital, unable to take care of her problem. "My hands were tied," Bill said. "Talk about the last time you saw her," I asked. "Thursday night. She came over late when I got off work," he said. "We watched a movie and then I said, 'I'm getting tired, I have a long day tomorrow,' and she went home around 11:30." The timing of her suicide was so perplexing that I wondered if something had happened at the last minute. "Did you argue at all?" He shook his head. He said that she was relieved that the interviewing was over. She had seemed okay with the story. The next day, Friday, Nov. 30, he went to her house, fetching her mail from the box at the street. But she didn't answer her door, so he set the mail in her car. He stopped by on Saturday and still couldn't reach her. He called two of Gretchen's friends, who lived nearby. Together, they entered the house through an unlocked sliding door in the back. They found Gretchen on the same daybed where she and I had talked two months before. The medical examiner determined she had asphyxiated herself by inhaling helium. When Gretchen had attempted suicide in the past, she'd always left a note. This time she didn't. "It just didn't make sense," Bill said. The story was about to come out and might garner help. "She had something to look forward to." I MOVED ON TO OTHER STORIES. A man and woman wading through a particularly contentious divorce. A computer engineer who refused to cut his grass for fear of killing the insects it harbored. A half-dozen veterans who had been sexually assaulted while in the military. I didn't change the kind of questions I asked or my fact-checking method. But I worried about some people. I called one female vet after a particularly grueling interview, asking if she was all right. Long after the stories ran, I checked on my subjects. I began to wonder, would I ever stop worrying? I felt as if I'd handled Gretchen to the best of my ability. So why was it still gnawing at me? I did some research on suicide. One study by the Centers for Disease Control and Prevention estimated that in 2008 more than 8 million Americans had suicidal thoughts. Of those, 2.2 million made suicide plans; 1 million attempted suicide; and 36,035 took their lives. Deaths by suicide, particularly those of people in middle age, have accelerated over the past decade and now surpass deaths by car crashes. This past May, the CDC called suicide "an increasing public health concern." Worldwide, suicide rates have jumped 60 percent in the last 45 years, according to the World Health Organization. Julie Phillips, a sociologist at Rutgers University, attributes the changes to a morphing society: More of us are living alone with deteriorating health conditions and financial problems. Florida State University professor Thomas Joiner has developed a theory on suicide. Joiner, whose books include Why People Die By Suicide and Myths About Suicide, believes three conditions must be present: The person must feel she is a burden; the person must feel alone; and the person must be capable or fearless enough to do it. All of this sounded a lot like Gretchen. She felt she was a burden. She was alone much of the time. She was depressed. She'd tried before, so she was capable. This got me thinking. Should I have done more, given that I knew of her previous attempts? She'd even mentioned during one of our final conversations that she had tried again a third time a few weeks before. She told me that she had stopped herself because she didn't want to do it. I made another appointment with Booker, the counselor. I wanted to better understand what happened, what I did or didn't do. "Suicidal behavior is extremely complex, so there's no real rule of thumb," Booker said. We were sitting in a clattery coffee shop, away from his office, a reflection that he wasn't counseling me. I was interviewing him for this story. "For a reporter confronted with a source who is suicidal, it's unrealistic for you to expect that you would know how to deal with that," he said. "Quite frankly, it's inappropriate for you to try to fix their irrational beliefs." In other words, assessing Gretchen's risk was over my head. If I was concerned, I could have asked if she was seeing a counselor and asked to talk to her counselor, he said. I thought back to my discussions with Gretchen. Because she had no regular insurance, she'd seen doctors who were available at walk-in clinics. With her permission I had tried to call some of those doctors but they hadn't responded. I'll be honest, though. My goal was to confirm her disorder rather than assess her psychological condition. But I kept coming back to one thought: Gretchen had never appeared unstable. "Everything seemed normal when I talked to her," I said to Booker. "Well, you have to consider the possibility that Gretchen was intending to kill herself all along," he said. "And a suicidal person who has committed to acting on it oftentimes experiences a great deal of relief. "They know there is an end to their suffering . . . they don't feel anxiety because it's taken care of in their minds, so an individual with those thoughts might present as having it all together and being okay." Recently, Heather Dearmon, a South Carolina woman with persistent genital arousal disorder whom Gretchen met online in a support group, shared some emails she received from Gretchen shortly before her death. They showed someone who was feeling pressure from all sides. A doctor had told Gretchen he would no longer prescribe a sleeping aid, the only medication that provided her relief. She didn't know how she would pay her property taxes. "I have everything ready for when I'm depressed and brave enough to do it," Gretchen wrote to Dearmon, 40, on Nov. 23, six days before she took her life. "I have no friends and no family — no one would miss me if I weren't here anymore. I smile so rarely now, usually not even once a day, that my entire face hurts from sagging." I asked Booker to explain the contradiction between what Gretchen said to me and what she wrote to Dearmon. "A person who intends to kill themselves understands that if other people know that, they are going to try and stop them," he said. "So if you're committed to that idea, the last thing you want to do is behave in a way that tells people that's what you were going to do." Dearmon wrote back, as she had other times, begging Gretchen to hang on and "pray that God will bring us relief soon." Dearmon told me that Gretchen had grown comfortable sharing her suicidal thoughts. Dearmon knew the pain of genital arousal disorder. She had considered suicide herself. And Gretchen had made her swear not to call the authorities. Dearmon kept her promise. SUBJECTS OF NEWS STORIES don't often kill themselves. But when they do, they are often public officials who are under investigation. In May 1996, Navy Adm. Jeremy Boorda shot himself while Newsweek was looking into whether he had earned two Vietnam combat medals for valor he wore on his uniform. Here in the Tampa Bay area, Hillsborough County State Attorney Harry Lee Coe III shot himself in July 2000 soon after WFLA investigative reporter Steve Andrews revealed that Coe borrowed thousands of dollars from two employees to cover gambling debts. On the phone recently, Andrews said Coe is not the only one who died by suicide during one of his investigations. There were two others. "I do sometimes worry about certain people," he said. "But I can't say it changed the way I go about doing investigations or stories." But what about nonadversarial stories like Gretchen's? Given the rising number of suicides in the United States and the prevalence of psychological problems among military veterans, reporters are apt to confront subjects in crisis more and more frequently. Ignoring them is not an option. I got on the phone with David Finkel, a Pulitzer Prize-winning reporter and editor for the Washington Post and author of Thank You for Your Service, which is about veterans returning from Iraq. Men with psychological trauma, some with suicide on their minds, populate the book. Finkel said he worries about his subjects even now, but he would not have backed away from their stories. There was a point, however, during an interview that Finkel realized one soldier, who just days before had held a loaded shotgun to his chin in the basement of his house while his wife begged him not to do it, was not getting any help. "No one in his life who he listened to or respected had said he needed help," Finkel said. "I put my notebook down . . . and I told him he needed to get some help, and the point is that when I did that, I did it with the understanding that I was jeopardizing the journalism. But I didn't care at that point." Booker suggested that the Times might introduce a protocol for dealing with someone who has exhibited mental illness or suicidal behavior. There should be more discussion among reporters and editors if someone presents with that kind of history. "Contact with the media is an extremely emotionally powerful experience for people," Booker said. "You are touching their lives and you can't predict how that's going to affect them ultimately." Kim Walsh-Childers, a professor who specializes in journalism ethics at the University of Florida, wasn't sure a set of rules was in order. But if there are red flags, it might be worth calling a psychologist or a psychiatrist. "I don't necessarily believe that we can never write stories about people or never use people as sources who are potentially suicidal," she said. "But if I was going to do that, I would want to know I got as much information as possible." JUST BEFORE HALLOWEEN this year, Times photographer Eve Edelheit and I drove to Spring Hill and stopped by Gretchen's house. There were Halloween decorations in the yard, including pumpkins and ghosts and tombstones that said Rest in Peace. We had heard her brother lived there, but no one was home. We made one more stop — the mother and daughter who had helped find Gretchen's body. Susan and Mary Ann Schulz lived a mile away in the same subdivision. The police report on Gretchen's death said they had known her all her life. I was nervous as I knocked on their door. Would they be angry with me? There was a muffled voice and someone peeked at me from behind a curtain. I explained who I was. Susan Schulz, 66, opened the door. "Come on in," she said. Susan and Mary Ann, 37, knew that Gretchen had tried suicide several times before, but they were surprised she went through with it this time. Both women said they knew she was working with a newspaper reporter. I wondered why Gretchen hadn't told me about them. Then I got my answer. Gretchen had not revealed the true nature of her condition. "She said it was obsessive-compulsive disorder," Susan said. "She was trying to tell me what it was, but I couldn't understand it until I read your article." I asked them if they blamed the story for her suicide. "I think it was a brave thing for her to come forward and do," Susan said. "I think she had a bad problem with depression and she might have had second thoughts once it hit the public. But no, I think it was a combination of things. She had tried before to do it and she couldn't find the right medication for her condition and she didn't have any money to get treatment or to live." Mary Ann said she admired her friend for coming forward. "There's not enough known about this disorder, and more research needs to be done by scientists," she said, "and I'm glad that Gretchen did this story, because it brought it to the front for a lot of people." SHE IS RIGHT. TO A DEGREE. Since Gretchen's death, I have heard from dozens of women around the world who were touched by her story. In September, a man from Brooklyn, N.Y., sent me an email. He said his 30-year-old wife had PGAD. "Please help us," he wrote. Researchers at Rutgers and Johns Hopkins universities are testing one theory that could help a group of women who have cysts on their genital nerve, but not all women with PGAD have the cysts. Many women, like Gretchen's friend Dearmon, have tried everything and continue to struggle. I don't regret that I wrote Gretchen's story. My editor and I thought that as long as we treated Gretchen sensitively and fairly, if we got people to take her condition seriously, she would be all right. That was, as my editor called it, "a blind spot." Given that one in four U.S. adults has some diagnosable mental disorder, we are not going to stop writing about people who are in crisis. But perhaps we need to take extra care with sources who are mentally ill, who may have the means to kill themselves at hand, who feel burdensome and alone in the world. Maybe we need to consult a psychologist or a psychiatrist about those concerns as readily as we consult with lawyers about libel and public records access. I recently spoke to a psychiatric nurse practitioner, John Femenella, who saw Gretchen for free in May 2012, just two months before I first started talking to her — but after she had attempted suicide in March. Femenella, who prescribed an antidepressant for her, looked at his notes from his appointments with Gretchen. "She was frustrated by the (disability) system, that she kept getting turned down," said Femenella. "But she was never suicidal." The point is that someone who intends to kill herself won't always yell it from the rooftop. Whether Gretchen intended to kill herself all along, or did it at the last moment because she was scared, or did it accidentally we will neverknow. What we do know is that she taught us an awful lot about depression and suicide, which are far more common than persistent genital arousal disorder. Times researcher Natalie Watson contributed to this report. Leonora LaPeter Anton can be reached at [email protected] or (727) 893-8640.