The NewsA comparatively quick treatment for post-traumatic stress disorder, in which a patient writes about traumatic experiences in five supervised 30-minute sessions, is as effective as the therapies most recommended by federal agencies, according to a study published on Wednesday.The treatment, called written exposure therapy, involves asking clients to write down the thoughts and feelings that occurred during a traumatic event, and then speak with the therapist about the writing process. In later sessions, they are asked to write about how the event has affected their lives.In the new study published in JAMA Psychiatry, 178 veterans with PTSD received either written exposure therapy or prolonged exposure therapy, which consists of eight to 15 therapy sessions that are 90 minutes long in which the patient vividly imagines the terrifying situation, and then, between sessions, confronts real-life reminders of it.iStock/Getty ImagesThe two therapies were found to be equally effective, and only 12.5 percent of subjects dropped out of the written exposure group before completing a course of treatment, compared with 35.6 percent in the prolonged exposure group. In 2018, a study by the same team found that written exposure therapy was as effective as cognitive processing therapy, another first-line, or most highly recommended, PTSD treatment.Writing down traumatic memories may be easier for some people, if they feel shame or embarrassment about what happened to them, said Denise Sloan, a psychologist who helped develop the treatment and is an author of the study. She said patients were asked to write by hand, which takes longer and allows them to engage with the memory.“It’s a slower process, that allows them to better think through ‘what happened next, and who was there, and what did they say,’ because they’re writing about it,” said Dr. Sloan, associate director of the Behavioral Science Division of the National Center for PTSD. “It slows everything down, versus just saying it out loud.”The therapy was inspired by the work of James Pennebaker, a Texas psychologist who, in the 1980s, began experimenting with what he called “expressive writing,” and found that people who regularly wrote about negative life experiences had stronger immune systems and paid fewer visits to the doctor.The first study of written exposure therapy as a treatment for PTSD appeared in 2012. It works, Dr. Sloan said, much the way other trauma-focused treatments do: by allowing the client to confront the traumatic memory, lessening their fear and avoidance, and allowing them to identify misconceptions like self-blame.Why It MattersCognitive processing therapy and prolonged exposure therapy, the two treatments most highly recommended by the Departments of Veterans Affairs and Defense, have been in widespread use since the 1980s and are backed up by abundant research. A newer method, eye movement desensitization and reprocessing, is rapidly growing in popularity.But all three are time-intensive, requiring sessions of 60 to 90 minutes for three months or more. A large number of patients — an average of 20 percent, and sometimes as high as 50 percent, studies have shown — drop out before completing a course of treatment.Written exposure therapy, Dr. Sloan said, seems to achieve similar effects in fewer sessions.“We have a lot of people that need mental health treatment, and we can’t accommodate the demand,” she said. “We need to revisit what we’re doing and how much is necessary for a good outcome. Because most people can’t go to treatment for 12 to 16 sessions.”What’s NextData on the effectiveness of written exposure therapy is still emerging.The studies comparing it to cognitive processing therapy and prolonged exposure therapy are non-inferiority trials — devised to demonstrate that a newer treatment is not worse than an established one — and “not as scientifically stringent” as trials devised to determine superiority, said Dr. Barbara Rothbaum, one of the developers of prolonged exposure therapy. She added that dropout rates at her clinic, at Emory University, were around 10 percent.There is a reason, she said, that talk therapy has such a strong record of success in treating PTSD.“There is something inherently healing about saying out loud the worse, most scary, most embarrassing, most shameful moment of your life to another human who is trying to be helpful,” she said. “Does it have to be that? No.”Written exposure therapy was not endorsed as a first-line intervention by the Departments of Veterans Affairs and Defense in its most recent clinical practice guidelines, largely, Dr. Sloan said, because of the small number of published studies examining it.That is likely to change over the next two years, she said, as a number of larger trials are completed. Clinicians, too, are going to have to get used to the idea of using writing, in addition to speech, to engage with patients on painful topics.“Some people, they feel threatened by this, because it kind of challenges the crux of what they generally do,” she said. “It flies in the face of what they think is important in treatment.”

A study of adults who were mistreated in childhood found that those who did not recall it showed fewer psychological aftereffects.For generations, our society has vacillated about how best to heal people who experienced terrible things in childhood.Should these memories be unearthed, allowing their destructive power to dissipate? Should they be gently molded into something less painful? Or should they be left untouched?Researchers from King’s College London and the City University of New York examined this conundrum by conducting an unusual experiment.Researchers interviewed a group of 1,196 American adults repeatedly over 15 years about their levels of anxiety and depression. Unbeknown to the subjects, 665 of them had been selected because court records showed they had suffered mistreatment such as physical abuse, sexual abuse or neglect before age 12.Not all of them told researchers that they had been abused, though — and that was linked to a big difference.The 492 adults who reported having been mistreated and were in court records substantiating the abuse had significantly higher levels of depression and anxiety than a control group with no documented history of abuse, according to the study, which was published last week in JAMA Psychiatry. The 252 subjects who reported being abused without court records reflecting it also had higher levels.But the 173 subjects who did not report having been abused, despite court records that show that it occurred, had no more distress than the general population.The findings suggest how people frame and interpret events in their early childhood powerfully shapes their mental health as adults, said Dr. Andrea Danese, a professor of child and adolescent psychiatry at King’s College London and one of the study’s joint authors.“It goes back to almost the stoic message, that it’s what you make of the experience,” he said. “If you can change how you interpret the experience, if you feel more in control at present, then that is something that can improve mental health in the longer term.”In a meta-analysis of 16 studies of childhood maltreatment published in 2019, Dr. Danese and colleagues found that 52 percent of people with records of childhood abuse did not report it in interviews with researchers, and 56 percent of those who reported it had no documented history of abuse.This discrepancy could be partly because of problems in measurement — court records may not have all abuse history — and may also reflect that self-reporting of abuse is influenced by a person’s levels of anxiety and depression, Dr. Danese said.“There are many reasons why people may, in some ways, forget those experiences, and other reasons why others might misinterpret some of the experiences as being neglect or abuse,” he said.But even considering these caveats, he said, it was notable that adults who had a documented history of having been abused but did not report it — because they had no memory of the events, interpreted them differently or chose not to share those memories with interviewers — seemed healthier.“If the meaning you give to these experiences is not central to how you remember your childhood so you don’t feel like you need to report it, then you are more likely to have better mental health over time,” he said.Traumatic childhood experiences have been the subject of some of psychiatry’s most pitched battles. Sigmund Freud postulated early in his career that many of his patients’ behaviors indicated a history of childhood sexual abuse but later backtracked, attributing them to subconscious desires.In the 1980s and 1990s, therapists used techniques like hypnosis and age regression to help clients uncover memories of childhood abuse. Those methods receded under a barrage of criticism from mainstream psychiatry.Recently, many Americans have embraced therapies designed to manage traumatic memories, which have shown to be effective in the treatment of post-traumatic stress disorder. Experts increasingly advocate screening patients for adverse childhood experiences as an important step in providing physical and mental health treatment.The new findings in JAMA Psychiatry suggest therapy that seeks to alleviate depression and anxiety by trying to unearth repressed memories is ineffective, said Dr. Danese, who works at the Institute of Psychiatry, Psychology & Neuroscience at King’s College.But he cautioned that the results of the study should not be interpreted as endorsing the avoidance of distressing memories, which could make them “scarier” in the long term. Instead, they point to the promise of therapies that seek to “reorganize” and moderate memories.“It’s not about deleting the memory, but having the memory and being more in control of that so that the memory feels less scary,” he said.Memory has always posed a challenge in the field of child protection because many abuse cases involve children below the age of 3, when lasting memories begin to form, said David Finkelhor, the director of the Crimes Against Children Research Center at the University of New Hampshire, who was not involved in the study.In treating people with histories of having been abused, he said, clinicians must rely on sketchy, incomplete and changing accounts. “All we have is their memories, so it’s not like we have a choice,” he said.He warned against concluding that forgotten maltreatment has no lingering effect. Early abuse may emerge through what he described as “residues” — difficulty in modulating emotions, feelings of worthlessness or, in the case of sexual abuse victims, the urge to provide sexual gratification to others.Elizabeth Loftus, a psychologist at the University of California, Irvine, and a prominent skeptic of the reliability of memories of abuse, noted that the study stops short of another conclusion that could be supported by the data: Forgetting about abuse might be a healthy response.“They could have said, people who don’t remember in some ways are better off, and maybe you don’t want to tamper with them,” she said. “They don’t say that, and that, to me, is of great interest.”

CAMBRIDGE, Mass. — In the fall of 1994, the psychiatrist Dr. Judith Herman was at the height of her influence. Her book “Trauma and Recovery,” published two years earlier, had been hailed in The New York Times as “one of the most important psychiatric works to be published since Freud.”Her research on sexual abuse in the white, working class city of Somerville, Mass., laid out a thesis that was, at the time, radical: that trauma can occur not only in the blind terror of combat, but quietly, within the four walls of a house, at the hands of a trusted person.More than most areas of science, psychology has been driven by individual thinkers and communicators. So what happened to Dr. Herman — as arbitrary as it was — had consequences for the field. She was in a hotel ballroom, preparing to present her latest findings, when she tripped on the edge of a rug and smashed her kneecap.“Just, wham,” she said. “Smack.”On and off for more than two decades, Dr. Herman groped her way through a fog of chronic pain, undergoing repeated surgeries and, finally, falling back on painkillers. The trauma researchers who surrounded her in the Boston area moved on with their work, and the field of trauma studies swung toward neurobiology.“She is a brilliant woman who lost 25 years of her career,” said her friend and colleague Dr. Bessel van der Kolk, whose 2014 book, “The Body Keeps the Score,” helped propel the field toward brain science. “If you talk about tragedy, that is a tragedy.”At the age of 81, Dr. Herman has rejoined the conversation, publishing “Truth and Repair,” a follow-up to her 1992 book “Trauma and Recovery: The Aftermath of Violence — From Domestic Abuse to Political Terror.” During that period, trauma has gained broad acceptance in popular culture as a way to understand mental health.But the dominant idea now comes from Dr. van der Kolk, who argues that traumatic experiences are stored in the body and can best be addressed through the unconscious mind. “The Body Keeps the Score” has appeared on the best-seller list for an astonishing 232 weeks. TikTok bulges with testimonials from members of Gen Z, identifying all manner of habits and health conditions as trauma responses.Dr. Herman does not want to use this flush of attention to debate her old friend. But in “Truth and Repair,” she picks up where she left off in 1992, arguing that trauma is, at its heart, a social problem rather than an individual one.Drawing on interviews with survivors, she lays out a theory of justice designed to help them heal, centering on collective acknowledgment of what they have suffered. Her approach is frankly political, rooted in the feminist movement and unlikely to go viral on TikTok.This does not seem to trouble her at all. “In my own life, I feel like I’m in a good place,” she said. “On the other hand, I think psychiatry will have to be dragged, kicking and screaming, into any kind of progressive future.”A pledgeDr. Bessel van der Kolk, Dr. Herman’s friend and colleague. “We noted that people in academia were often very cruel to each other,” he said, “and we made a pledge to have each other’s back.” Kayana Szymczak for The New York TimesWhen Dr. Herman and Dr. van der Kolk met in the 1980s, she was treating the daughters of working-class Irish and Italian families, who were coming forward with stories of sexual abuse. He had been treating veterans who seemed trapped in the past, exploding with extreme rage at minor frustrations.She was reserved; he was expansive. Dr. Herman likes to call herself “plain vanilla,” doggedly faithful to psychodynamic psychotherapy; Dr. van der Kolk is “flavor of the month,” always exploring new treatments, first Prozac, then body work and eye movement desensitization and reprocessing.They had this in common: The patients they treated had been routinely dismissed by the psychiatric establishment as malingerers or hysterics. “We were in explicit agreement,” Dr. van der Kolk said. “We noted that people in academia were often very cruel to each other, and we made a pledge to have each other’s back.”The diagnosis of PTSD was brand-new, having first appeared in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1980, and the Boston area, Dr. van der Kolk said, “was to trauma what Vienna was to music.” A trauma study group convened monthly in the elegant stretch of Cambridge mansions known as Professors’ Row.Passing around glasses of sherry and cups of coffee, they argued, Dr. Herman said, about “what counted” as trauma. “The guys who worked with the vets, we had some back and forth, shall we say,” she said. “We had some knockdown drag-outs, calling out the sexism of the men who thought combat trauma was trauma and everything else was just whining.”Dr. Herman is widely credited with putting this question to rest. “Trauma and Recovery” addressed a general audience in “measured, gripping, almost surgically precise” language, as the Times review put it, and with the authority of a Harvard psychiatrist.Her ideas also radiated into the communities where she practiced, said Rosie McMahan, whose family worked with Dr. Herman and her colleague Emily Schatzow to confront sexual abuse by her father.“She did this remarkable thing — ‘Wait a minute, the same things that were happening to those soldiers, in a sense, happened in families,’” said Ms. McMahan, whose book, “Fortunate Daughter,” describes her family’s reconciliation. “They recognized that it was trauma and called it such. They behaved as if it was.”Their ideas were gaining ground. In 1994, the editors of the DSM expanded the definition of PTSD, dropping the requirement that the traumatic event be “outside the range of usual human experience.” Dr. Herman and Dr. van der Kolk began lobbying for the inclusion of complex PTSD, the result of recurring or long-term traumatic events.Dr. Herman at the 130th meeting of the American Psychiatric Association in Toronto in 1977.via Judith HerhamThen came what’s known as the “memory wars” — a pushback from leading psychiatrists against therapy that encouraged patients to unearth memories of sexual abuse. The criticism often zeroed in on Dr. van der Kolk, who served as an expert witness in high-profile cases, and Dr. Herman, whose work on dissociation was regularly cited by defenders of repressed-memory therapy.Dr. Herman shrugged off this critique as “predictable,” the same resistance that Vietnam War veterans and rape victims had encountered when they came forward. “You know, history is a dialectical process,” she said. “When you have a movement that challenges the power structure, you’re going to have a backlash.”Some clinicians did go overboard, Dr. van der Kolk said. They “started talking about satanic ritual abuse, kids being sacrificed in altars,” he said. “It got a little bit weird. Judy and I never went with that crowd. But they were part of our crowd.”By the time the debate faded, his laboratory at Massachusetts General Hospital had been shut down, and he lost his affiliation with Harvard Medical School. “Almost all of us bit the dust in the memory wars,” he added.Since the mid-1990s, the editors of the DSM have consistently opposed further expanding the definition of PTSD. The original definition was “intentionally strict, meant to avoid the possibility that all mental disorders are simply caused by trauma,” said Dr. Allen Frances, who chaired the task force for the DSM’s fourth edition.While stress contributes to most psychiatric problems, he said, PTSD diagnoses can be made quickly and carelessly, without pursuing underlying mental disorders, such as anxiety and depression. Taking that leap, he added, means “all the rest of the knowledge ever accumulated about mental disorders goes out the window.”Dr. Frances was similarly skeptical of “trauma-informed therapy,” which he said provided “a misleadingly reassuring explanation” to complicated psychiatric problems. He added that proponents of the idea, like Dr. Herman and Dr. van der Kolk, had succeeded in winning over a large part of the general public.“You can write best-sellers on this because it’s an appealing model for people searching for an explanation for the distress in life,” Dr. Frances said. That avenue was closing. But that wasn’t the only thing that happened.Pain of unexplained originA page from Dr. Herman’s personal journal from 1976, around the time she started writing her first book.Kayana Szymczak for The New York TimesOn the day she broke her kneecap, Dr. Herman was preparing to deliver a workshop on her latest findings, and was carrying a carousel of slides to a projector. She was distracted and did not see that a binding had come loose from the rug.Dr. Herman has offered vague explanations for the 30-year gap between her books. “Life intervened, in the form of illnesses and a move to an assisted-living community,” she writes in a forward to “Truth and Repair.” In an interview, she flicked away the question, calling it “a very long, sad tale which I won’t bore you with.”But there is a story. Her kneecap healed, but nerve tumors had formed in her leg, and the pain grew steadily worse. For long stretches, daily life became a challenge. There were remissions, but there were also times she could not get out of bed, where even changing positions was “extremely, extremely painful.” At one point, she was so desperate that she asked a doctor if he could amputate her leg.“All you could think about was pain,” she said. “It wasn’t even thinking about pain. It was being pain. One’s existence was just pain. It’s like being in a tunnel.” Like “your whole existence is pain, and nothing exists outside of it,” she added.There was a subtext in her doctors’ response, early on, which she, as a fellow physician, was uniquely qualified to identify: They did not quite believe her. “I was a middle-aged woman with pain of unexplained origin,” she said. In the jargon of medical residents, she said, she was a “crock,” or a female hypochondriac.Eleven years and three surgeries later, her doctors said there was nothing more they could do. This was the worst of it, when there was no hope of reprieve. “It made me not want to live,” she said. “That is literally what happened.”“Judy’s fall had a gigantic impact,” Dr. van der Kolk said. “When you talk about suffering, that was suffering. She was really suffering physically. A large part of the joy and triumph of publishing a great book she did not get to enjoy.”He also said the injury had created a distance in their relationship. He was on fire with the ideas that would later become “The Body Keeps the Score,” among them a view that chronic pain may be an expression of suppressed trauma. He thought he could help. But she was, he said, “too injured to be all that curious.” After that, he said, “Judy and I started to go in different directions.”“It really was the source of sadness on my part, as I was entering this body world, that Judy did not go in the same direction,” he said.Dr. Herman had little recollection of this exchange. But she did not see any larger meaning to her pain; it was just pain, a bunch of malfunctioning neurons, and it preoccupied her entirely. She was fitted with a brace and crutches, and managed to continue teaching and supervising trainees by taking a large doses of fentanyl, applied through a transdermal patch.Asked what the experience taught her, she paused and said, “I guess I just had more empathy for people who go through various forms of torture.”A remedy appeared in 2019, almost by chance. She had gone to see a surgeon about arthritis in her hand, and instead, he peered at her knee. After she left, he emailed her an article about a surgery that had been developed at Walter Reed National Military Medical Center to treat amputees, war veterans from Iraq and Afghanistan.Later that year, surgeons removed the damaged nerves, sutured them to a motor nerve harvested from her quadriceps and then implanted them into her muscle. She weaned herself off fentanyl, set aside the brace and the crutches. She compared the relief she felt to the sensation women have when childbirth ends.“I mean, it’s really heavenly,” she said. “I’m in a permanent state of gratitude.”And that, she said, was why she had the energy to finish another book.“It’s a totally crazy story,” she said. “I owe it all to the forever wars.”The queen of traumaDr. Herman’s new book, her first in 30 years.Kayana Szymczak for The New York TimesWhen Dr. Herman walked into a launch event at the Harvard Book Store last month, wearing orthopedic shoes and multiple shades of purple, there was an intake of breath from the audience, largely made up of older women in mental health professions.The store offered books on healing trauma through weight lifting, quitting one’s job or blocking the nerves known as the stellate ganglion; books on trauma in the music of Dolly Parton, polyamorous families and the Indian caste system; and, of course, “The Body Keeps the Score,” one of those books that, the store’s buying manager said, “even people who aren’t necessarily readers have heard about.”This did not escape Dr. Herman’s admirers, who waited in folding chairs, grumbling discreetly about the authors who rode on her coattails. “All the noise around trauma is all about white men,” remarked Mary Gorman, a psychiatric nurse specialist. “It’s like she’s the forgotten stepchild.”Dr. van der Kolk, who has been helping Dr. Herman to publicize her book, was acutely aware of this dynamic. “The Body Keeps the Score,” he said, benefited enormously from its focus on neurobiology. “In the culture right now, if it’s based on the brain, it’s real,” he added. “Everything else is woozy stuff.”As his book neared publication, he said, he worried that it would supplant Dr. Herman’s as the best-known title on trauma. “She must have known that, to some degree, I would bump her to second position,” he said. “I wondered how she would deal with it.”Considering the whole story, he sounded stricken. Were it not for her injury, he said, “Judy really would have been the queen of trauma.”Dr. Herman, in contrast, sounded cheerful as she looked back on it all. For a woman of her generation to become a full professor at Harvard was a big deal, she said. As for the years lost to pain, she said that the work she had done in her 40s and 50s had already helped to launch a generation of younger scholars.“It wasn’t so much of a cult of personality,” she said. “The field is haunted by all that. But in my case, once ‘Trauma and Recovery’ came out, I wasn’t the only messenger.”At 81, she has the aches and pains of old age, but cannot shake the feeling of having been reborn. In the Black Lives Matter and the #MeToo movements, and in the psychiatric residents she supervises, she sees a return to the politics that shaped her as a young doctor. “I’m back in that exploring kind of moment,” she said. “It’s quite exciting. I just wish I had a 40-year-old body instead of an 80-year-old body to be able to keep up with it.”

Hospitalizations for pediatric suicidal behavior increased by 163 percent over an 11-year period, an analysis of millions of hospital admissions in the United States found.The portion of American hospital beds occupied by children with suicidal or self-harming behavior has soared over the course of a decade, a large study of admissions to acute care hospitals shows.An analysis of 4,767,840 pediatric hospitalizations by researchers at Dartmouth, published on Tuesday in the medical journal JAMA, found that between 2009 and 2019, mental health hospitalizations increased by 25.8 percent and cost $1.37 billion.The study did not include psychiatric hospitals, or reflect the years of the coronavirus pandemic, suggesting that it is a considerable undercount.Especially striking was the rise in suicidal behavior as a cause: The portion of pediatric mental health hospitalizations involving suicidal or self-harming behavior rose to 64.2 percent in 2019, from 30.7 percent in 2009. As a proportion of overall pediatric hospitalizations, suicidal behavior rose to 12.7 percent in 2019 from 3.5 percent in 2009.Though the rise in suicidal behavior among American youths is well-established, the study underlines the gaping inadequacies in our health system, said Dr. Gabrielle A. Carlson, director of child and adolescent psychiatry at Stony Brook University medical school, who was not involved in the new study.“You have got a whole system failure here that is registering itself in suicidal kids,” Dr. Carlson said. Parents seeking care for children, she said, encounter a series of frustrations: Clinicians who don’t take insurance or aren’t taking new patients; crisis interventions staffed by low-paid, poorly trained workers; insurers that don’t reimburse well.“The hospital ends up being the place you go when all else fails,” Dr. Carlson said. “Could you have nipped it in the bud earlier? That is a systems-of-care problem.” She added, “This is playing itself out in an attention-grabbing way.”The study analyzed the Kids’ Inpatient Database, the largest nationally representative database of pediatric acute care discharges, which includes patients under the age of 21. Mental health hospitalizations rose significantly in children between the ages of 11 and 14, but they declined in younger and older age groups during the same 11-year period. Girls became a larger portion of mental health hospitalizations, rising to 61.1 percent in 2019 from 51.8 percent in 2009. Hospitalizations for suicidal behavior rose to 129,699 in 2019 from 49,285 in 2009.The study did not examine what caused the trends, but Dr. JoAnna Leyenaar, one of the paper’s co-authors, pointed to “a growing, growing use of social media among children and adolescents and in particular, growing use among younger adolescents,” which she said had been shown to increase symptoms of depression.Whatever the reason, she added, “we don’t have the magic formula to figure out how to dial this back and make things better.”Dr. Leyenaar said the research was informed by her personal experience as a hospital pediatrician: Though her training included no formal mental health experience beyond a six-week rotation in medical school, children hospitalized after a suicide attempt or self injury are now a central focus of her working life.“Five years ago, my care for these patients didn’t look very different from my care for children with respiratory illnesses,” said Dr. Leyenaar, an associate professor of pediatrics at Dartmouth’s Geisel School of Medicine. Her team has added trainings on safety planning and cognitive behavioral therapy, in the hope that younger doctors “leave residency better equipped to care for youth with mental health conditions than we did.”The findings should spur policymakers to place more mental health care services in school and community settings, which “may well result in decreased hospitalizations,” said Mary Arakelyan, a research project manager at Dartmouth Health Children’s and another co-author. Meanwhile, she said, hospitals should confront their increasingly central role as mental health providers.“For so long, the culture has been, in the hospital, that medical emergencies are the true emergencies,” said Dr. Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center, who was not involved in the study.Mental health training, she said, should be given throughout the hospital, “kind of like how everyone in the medical staff is trained on how to do CPR.” And, she said, hospitals need to be incentivized to add inpatient psychiatric units, which, because of reimbursement rates, “hemorrhage money.”The study traced a major shift in the kinds of mental health problems being treated in hospitals, with depressive disorders rising to 56.8 percent in 2019 from 29.7 percent in 2009. Hospitalizations for bipolar disorders, conduct disorders and psychotic disorders like schizophrenia decreased, which could reflect better outcomes due to early intervention programs and more wraparound care.Rates of suicidal behavior are a “marker of distress” among children who lack coping skills to manage stress and “big emotions,” said Dr. Crawford, who is also an assistant professor at Boston University School of Medicine.“When you actually talk to kids who engage in self-harm, who impulsively ingest the Tylenol, they oftentimes talk about an argument that they had with a peer, or a disagreement that they had with an adult,” she said.In most cases, she said, these children have suffered from diagnosable depression for “many, many months” without being treated. “The kids we’re seeing in the emergency room are doing this rather impulsively in the context of some argument,” she said.

Los investigadores han creído durante mucho tiempo que el cerebro controla nuestro sentido del tiempo. Un nuevo estudio sugiere que el corazón desempeña un papel importante.Es una perogrullada que el tiempo parece expandirse o contraerse según nuestras circunstancias: cuando tenemos miedo, los segundos se pueden estirar. Si pasamos un día en soledad, puede pasar lento. Cuando queremos entregar algo a tiempo, las horas transcurren con rapidez.Un estudio publicado este mes en la revista Psychophysiology a cargo de psicólogos de la Universidad Cornell descubrió que, cuando se observa al nivel de microsegundos, algunas de estas distorsiones podrían ser generadas por los latidos del corazón, cuya duración es variable de un momento a otro.Los psicólogos sometieron a estudiantes universitarios a electrocardiogramas para medir la duración de cada latido con precisión y, después, les pidieron que estimaran la duración de tonos de audio breves. Los psicólogos descubrieron que tras un intervalo más largo de latido, los sujetos tendían a percibir que el tono era más largo; los intervalos más cortos llevaron a los participantes a evaluar el tono como más corto. Tras cada tono, los intervalos de latidos de los sujetos se alargaban.Saeedeh Sadeghi, una doctoranda en la Universidad Cornell y autora principal del estudio, mencionó que un ritmo cardiaco más bajo pareció ayudar a la percepción.“Cuando necesitamos percibir cosas del mundo exterior, los latidos del corazón son ruido para la corteza cerebral”, explica. “Puedes asimilar más el mundo —es más fácil procesar cosas— cuando el corazón está en silencio”.Sadeghi indica que el estudio brinda mayor evidencia, después de una era de investigación enfocada en el cerebro, de que “no es solo una parte del cerebro o del cuerpo la que lleva registro del tiempo, sino toda una red”. Y añadió: “El cerebro controla el corazón y el corazón, a su vez, impacta al cerebro”.El interés en la percepción del tiempo ha tenido un auge desde el inicio de la pandemia de la COVID-19, cuando las actividades fuera del hogar se detuvieron en seco para muchos y personas de todo el mundo se enfrentaron a tramos de tiempo que no podían diferenciar.Un estudio de la percepción del tiempo realizado durante el primer año de confinamiento en el Reino Unido halló que el 80 por ciento de los participantes reportaron percibir distorsiones en el tiempo, en distintas direcciones. En promedio, la gente de mayor edad y más aislada de contextos sociales reportó que el tiempo se ralentizaba; mientras que gente más joven y activa reportó que se aceleraba.“Nuestra experiencia del tiempo es afectada de maneras que se asemejan, en general, a nuestro bienestar”, explicó Ruth S. Ogden, catedrática de Psicología en la Universidad John Moores de Liverpool y autora del estudio durante el confinamiento: “Las personas con depresión experimentan una lentificación del tiempo y esa ralentización se percibe como un factor que empeora la depresión”.El nuevo estudio de Cornell aborda algo diferente: cómo percibimos el paso de los microsegundos. Odgen señaló que entender esos mecanismos podría ayudarnos a manejar el trauma, en el que experiencias instantáneas son recordadas como prolongadas.La académica manifestó que, cuando se intenta evaluar la importancia de una experiencia, “nuestro cerebro simplemente hace una retrospección y dice: ‘Bueno, ¿cuántos recuerdos generamos?’”.Y añadió: “Cuando tienes un recuerdo muy vívido, más intenso del que normalmente obtendrías de un periodo de 15 minutos de tu vida, tu mente puede hacerte creer que fue muy largo”.Hugo Critchley, un profesor de Psiquiatría en Brighton and Sussex Medical School que ha estudiado cómo los latidos afectan nuestra forma de recordar palabras y responder ante el miedo, afirmó que, hasta hace poco, la investigación sobre la percepción del tiempo se había enfocado en distintas áreas del cerebro.Critchley, quien no estuvo involucrado en el estudio de los latidos de Cornell, aseguró: “Creo que ahora se aprecia mucho más que las funciones cognitivas están vinculadas de manera íntima, tal vez incluso cimentadas, en el control del cuerpo, mientras que la mayoría de los estudios de psicología hasta la década de 1990 ignoraron el cuerpo desde el tronco encefálico”.El catedrático opinó que las investigaciones previas han explorado cómo la excitación física está conectada con el procesamiento del estrés y estados emocionales como la ansiedad y el pánico. El nuevo estudio ahonda en eso al centrarse en el papel del corazón en una función no emocional, la percepción del tiempo, que puede vincularse a distorsiones más grandes en el pensamiento.“La función cognitiva no se puede examinar en aislamiento”, añadió. “Incluso al entender cómo el cerebro se desarrolla y comienza a representar estados mentales internos, la gente ve la preeminencia de la información interna indispensable que se debe controlar para sobrevivir”.Adam K. Anderson, un profesor de psicología en Cornell y coautor del nuevo estudio, aseveró que una razón por la que el cuerpo podría estar íntimamente involucrado en la percepción del tiempo es que el tiempo está muy relacionado con las necesidades metabólicas.“El tiempo es un recurso”, concluyó Anderson. “Si el cuerpo fuera una batería o un tanque de gasolina, intentaría averiguar en tiempo real: ‘¿Cuánta energía tenemos?’. Percibimos que el tiempo corre más lento o más rápido según cuánta energía corporal tenemos”.Ellen Barry cubre salud mental. Ha sido jefa del buró del Times en Boston, corresponsal internacional jefa en Londres y jefa de los burós en Moscú y Nueva Delhi. Fue parte de un equipo que ganó el Pulitzer al Reportaje Internacional en 2011. @EllenBarryNYT

Researchers have long assumed that the brain controls our sense of time. A new study suggests the heart plays an important role.It is a truism that time seems to expand or contract depending on our circumstances: In a state of terror, seconds can stretch. A day spent in solitude can drag. When we’re trying to meet a deadline, hours race by.A study published this month in the journal Psychophysiology by psychologists at Cornell University found that, when observed at the level of microseconds, some of these distortions could be driven by heartbeats, whose length is variable from moment to moment.The psychologists fitted undergraduates with electrocardiograms to measure the length of each heartbeat precisely, and then asked them to estimate the length of brief audio tones. The psychologists discovered that after a longer heartbeat interval, subjects tended to perceive the tone as longer; shorter intervals led subjects to assess the tone as shorter. Subsequent to each tone, the subjects’ heartbeat intervals lengthened.A lower heart rate appeared to assist with perception, said Saeedeh Sadeghi, a doctoral candidate at Cornell and the study’s lead author.“When we need to perceive things from the outside world, the beats of the heart are noise to the cortex,” she said. “You can sample the world more — it’s easier to get things in — when the heart is silent.”The study provides more evidence, after an era of research focusing on the brain, that “there is no single part of the brain or body that keeps time — it’s all a network,” she said, adding, “The brain controls the heart, and the heart, in turn, impacts the brain.”Interest in the perception of time has exploded since the Covid pandemic, when activity outside the home came to an abrupt halt for many and people around the world found themselves facing stretches of undifferentiated time.A study of time perception conducted during the first year of the lockdown in Britain found that 80 percent of participants reported distortions in time, in different directions. On average, older, more socially isolated people reported that time slowed, and younger, more active people reported that it sped up.“Our experience of time is affected in ways which mirror, generally, our well-being,” said Ruth S. Ogden, a psychology professor at Liverpool John Moores University and the author of the lockdown study. “People with depression experience a slowing of time, and that slowing of time is experienced as being a worsening factor of the depression.”The new Cornell study addresses something different: how we perceive the passage of microseconds. Understanding those mechanisms may help us to manage trauma, in which instantaneous experiences are remembered as drawn out, Dr. Ogden said.When trying to assess the importance of an experience, she said, “our brain just looks back and says, Well, how many memories did we make?”She added, “When you have this really rich memory, richer than you would normally get in a 15-minute period of your life, that’s going to trick you into thinking that it was long.”Research into perception of time has focused, until recently, on different areas of the brain, said Hugo Critchley, a professor of psychiatry at Brighton and Sussex Medical School who has studied how heartbeats affect memory for words and fear responses.“I think there’s much greater appreciation that cognitive functions are intimately linked, perhaps even grounded in, the control of the body, whereas most of the psychology up to the 1990s dismisses the body as being something controlled at the level of the brain stem,” said Dr. Critchley, who was not involved in the Cornell heartbeat study.Previous research has investigated how physical arousal is connected to stress processing, and emotional states like anxiety and panic, Dr. Critchley said. The new study expands on that by focusing on the role of the heart in a nonemotional function, the perception of time, which can be linked to larger distortions in thinking.“You can’t look at cognitive function in isolation,” he said. “Even understanding how the brain develops and starts representing internal mental states, people are looking at the primacy of the inescapable internal information you need to control to keep alive.”One reason that the body may be closely involved in the perception of time is that time is closely related to metabolic needs, said Adam K. Anderson, a professor of psychology at Cornell and a co-author of the new study.“Time is a resource,” Dr. Anderson said. “If the body was a battery, or a gas tank, it’s trying in the moment to say, How much energy do we have? We’re going to make things seem shorter or longer in terms of time based on how much bodily energy we have.”

Suicide increased among younger Black, Hispanic and Native American people, and declined among whites and older people, the C.D.C. reported.A two-year decline in yearly suicides ended in 2021, as suicide rates rose among younger Americans and people of color, according to a new report from the Centers for Disease Control and Prevention.For decades, suicide rates among Black and Hispanic Americans were comparatively low, around a third the rate recorded among white Americans. But a gradual shift is underway, as suicide rates rise in populations most affected by the pandemic.Between 2018 and 2021, the suicide rate among Black people increased by 19.2 percent, from 7.3 to 8.7 per 100,000. The swiftest rise took place among some of the youngest Black people, those ages 10 to 24. The suicide rate in that group rose by 36.6 percent, from 8.2 to 11.2 per 100,000.Among people ages 25 to 44, suicide rates rose 5 percent overall, and even more significantly among Black, Hispanic, multiracial and American Indian or Alaska Native people. The suicide rate remained highest among Native American and Alaska Native people, increasing by 26 percent, from 22.3 to 28.1 per 100,000, in that period.The only racial group that saw a decrease in suicide rates across age cohorts was non-Hispanic white people. That population saw a decline of 3.9 percent, from 18.1 to 17.4 per 100,000. Suicide deaths in the white population numbered 36,681, more than three-quarters of the total number.Tips for Parents to Help Their Struggling TeensCard 1 of 6Are you concerned for your teen?

Chilling details emerged at an arraignment of Lindsay Clancy, accused of strangling her three children. Her lawyer argued she was mentally ill, but prosecutors outlined methodical planning leading to the deaths.DUXBURY, Mass. — Lindsay Clancy lay paralyzed in a hospital bed on Tuesday afternoon, occasionally blinking or shutting her eyes, unable to do anything but listen as lawyers told two narratives about how she had strangled her three children.The prosecutor said it had been meticulously planned: She had concocted an errand that would keep her husband, Patrick, out of the house for about 25 minutes, just long enough so she could do it.And she had then strangled each of her children with an exercise band, an act that would require holding each of them down for at least four minutes. Then she leapt from a second-story window, a fall that fractured her spine.“The defendant stated that after he left the house that night, she killed the kids because she heard a voice, and had, quote unquote, a moment of psychosis,” Assistant District Attorney Jennifer Sprague said during a virtual arraignment via Zoom.“She heard a man’s voice, telling her to kill the kids and kill herself because it was her last chance,” Ms. Sprague said.The defense lawyer told a different story. Since the birth of her youngest child, eight months ago, he said, Ms. Clancy had repeatedly sought help for postpartum depression, eventually being prescribed 13 psychiatric medications in a four-month period. But suicidal thoughts kept surfacing, culminating in a break on Jan. 24.“This is not a situation, your honor, that was planned by any means,” said Ms. Clancy’s lawyer, Kevin Reddington. “This is a situation that clearly was a product of mental illness.”In the last two weeks, since Mr. Clancy arrived home to a horrific scene, this community has been trying to make sense of it. Ms. Clancy, 32, worked as a labor and delivery nurse. She was known as a generous friend and a doting mother. She had no criminal record, nor any reported history of abusing her children — Cora, 5; Dawson, 3; and the baby, Callan.Ms. Clancy has received a good deal of sympathy, much of it from women who have experienced postpartum depression and psychosis. Online supporters have adopted the hashtag LAOL, which stands for Lindsay’s Army of Love. Mr. Clancy appealed to the public to “find it deep within yourselves to forgive Lindsay, as I have.”But Tuesday’s arraignment made it clear how difficult it would be to untangle Ms. Clancy’s mental state from her actions.Tips for Parents to Help Their Struggling TeensCard 1 of 6Are you concerned for your teen?

Her simple idea, for patients to write down a plan that would help them weather a suicidal crisis, rapidly spread in clinical settings.Barbara H. Stanley, a psychologist and researcher who developed a simple, effective tool for suicide prevention, died on Wednesday in a hospice in Scotch Plains, N.J. She was 73.Her daughter, Melissa Morris, said the cause was ovarian cancer.Dr. Stanley, a professor of psychology at Columbia University and the director of suicide prevention training at New York State Psychiatric Institute, helped propel a major shift in the field of mental health as researchers began to view suicide as a distinct problem that could be directly addressed, rather than as a symptom of another disorder.Her most prominent contribution was an idea that is deceptively simple. The Stanley-Brown Safety Planning Intervention asks patients struggling with suicidal urges to compose a written plan that lists coping strategies, as well as sources of support or distraction that could help them weather a suicidal crisis.The idea of a written document was not new. For years, clinicians had asked patients to sign a “no-suicide contract,” effectively promising their doctors not to engage in self-harm. But there was little evidence that these agreements had much effect, said Gregory K. Brown, Dr. Stanley’s research partner and the director of the Penn Center for the Prevention of Suicide at the University of Pennsylvania.In 2008, when they first tested the written safety plans, Dr. Stanley and Dr. Brown envisioned them as a short-term measure to tide adolescent patients over while they waited for slow, labor-intensive courses of therapy — the real treatment — to have an effect.But patients right away singled out the written safety plan as so helpful that the team developed it as a free-standing intervention. The researchers often compared the written plans to “stop, drop and roll” fire-safety training, or to the safety cards distributed on airplanes — a way to provide very simple instructions to help people make sound decisions in the midst of overwhelming emotions.“There is something about this kind of intervention,” Dr. Stanley said in a 2019 interview, “that helps them get through that period of time.” Patients, she said, “actually really like the piece of paper.” She recalled hearing from two separate patients who, while standing on bridges considering suicide, changed their minds because they pulled out their safety plan and read it. Even years after composing a safety plan, she said, “almost everybody could tell you the exact location, where it was at that exact moment.”“Over two-thirds of the people had used their safety plan at least once,” she said. “So it was a living, breathing document for them.”Clinicians treating veterans showed immediate interest, and the researchers were inundated with requests for training programs, manuals and handouts, even before the technique’s effectiveness could be demonstrated in randomized controlled trials.Research did eventually bear out their enthusiasm. In 2018, a study of 1,200 suicidal patients at Veterans Affairs hospitals around the country found that two simple interventions in emergency departments — a written safety plan combined with follow-up phone calls — reduced suicidal behavior by 45 percent. The patients were also twice as likely to receive mental health treatment in the six months following their visit.Dr. Stanley’s work helped shift the focus of suicide research toward practical, concrete and timely interventions, said Paul Nestadt, an associate professor of psychiatry at Johns Hopkins School of Medicine who studies suicide and access to lethal weapons.“Whether someone dies of suicide comes down to that act,” he said. “Intervening in those most important few minutes, between the decision to die by suicide and the act of suicide, is key. It is one of the few things that makes a difference. She knew that.”Dr. Stanley went to great lengths to support young scientists, said Kelly L. Green, a senior research investigator at the University of Pennsylvania Perelman School of Medicine.She recalled being overawed when she met Dr. Stanley for the first time, at an academic conference in Baltimore. Later, when they ran into each other at the railroad station, Dr. Stanley insisted that the two ride the same train back together so they could have time to talk.“She took such an interest in me, and she didn’t have to,” said Dr. Green, who went on to collaborate with Dr. Stanley for years. “No one else at that conference would have gone up to the ticket counter and said, ‘No, I need her on my train.’”Dr. Stanley wrote more than 200 papers. She was president of the International Academy for Suicide Research and served on boards and committees of many professional organizations. She also continued her clinical practice, treating patients who struggled with suicidal feelings.Ms. Morris, Dr. Stanley’s daughter, said that her mother was modest about her professional success but was always thrilled to hear from clinicians in far-flung places who had used the techniques she developed to help patients.“She was deeply touched by that, no doubt,” she said in an interview. “She found it very, very, very meaningful and very passionate. The work was so fulfilling to her, both on a personal level and on a larger level, to have been of service.”Barbara Hrevnack was born on Aug. 13, 1949, in Newark. Her father, John Hrevnack, worked as a tool-and-die maker, and her mother, Marie (Wnukowski) Hrevnack, worked in the claims department of an insurance company.She earned a bachelor’s degree at Montclair State College and a doctorate in clinical psychology at New York University.She married Michael Edward Stanley, a neuroscientist, in 1970, and the two published a number of research papers together on such topics as informed consent and borderline personality disorder. He died in 1993.In addition to her daughter, Dr. Stanley, who lived in Chatham, N.J., is survived by her son, Thomas Stanley, and her siblings, John Hrevnack, Michael Hrevnack and Joanne Kennedy.

Late Monday morning, two police officers drove up a gravel driveway to a mobile home in Benton, Tenn., a tiny town in the foothills of the southern Appalachians, to question Susan Meachen, a 47-year-old homemaker and author of romance novels.She had been expecting them. For a week, she had been the focus of a scandal within the online subculture of self-published romance writers, part of the literary world sometimes known as “Romancelandia.”The police wanted to talk to Ms. Meachen about faking her own death. In the fall of 2020, a post announcing she had died had appeared on her Facebook page, where she had often described her struggles with mental health and complained of poor treatment at the hands of other writers.The post, apparently written by her daughter, led many to assume she had died by suicide. It sent fans and writers into a spiral of grief and introspection, wondering how their sisterhood had turned so poisonous.But she wasn’t dead. Last week, to the shock of her online community, Ms. Meachen returned to her page to say she was back and now “in a good place,” and ready to resume writing under her own name. She playfully concluded: “Let the fun begin.”Other writers, seeing this, were not in the mood for fun. Describing deep feelings of betrayal, they have called for her to be prosecuted for fraud, alleging that she faked her death to sell books or solicit cash donations. They have reported her to the F.B.I. cybercrimes unit and the local sheriff and vowed to shun her and her work. Some have questioned whether she exists in real life.Ms. Meachen does exist. In a series of interviews, she said the online community had become a treacherous place for a person in her mental state, as she struggled to manage a new diagnosis of bipolar disorder.“I think it’s a very dangerous mix-up, especially if you have a mental illness,” she said. “I would log on and get in, and at some point in the day my two worlds would collide, and it would be hard to differentiate between book world and the real world. It was like they would sandwich together.”A text message from Ms. Meachen to Samantha A. Cole, another romance writer in her Facebook group.via FacebookWhen she was first introduced to “the book world,” as she calls it, she was alone at home for long stretches while her husband, a long-haul truck driver, traversed the country.She read romance novels, sometimes plowing through more than one a day. She had always been a reader, despite dropping out of school in the 9th grade to marry. The online romance community was a revelation to her, “like an escape, a timeout, a break from everyday reality,” she said.Over time, though, it began to feel more like quicksand. Over the next three years, she self-published 14 novels and maintained a near-constant social media presence. She was also diagnosed with bipolar disorder, a disease characterized by periods of manic activity that can alternate with deep depression.The book world made her disorder worse, she said. Writing often sent her into a manic state, and conflicts on the fan pages left her seething. She knew she should walk away, and she tried. But she said it was “an addiction”; every time she tried to log off for good, her phone would ping.Dead people don’t postRomance writers’ groups can be fizzy, exhilarating places. There is sexy cover art. There is snappy industry jargon, like HEA (Happily Ever After), Dubcon (dubious consent) and Reverse Harem (a female protagonist with multiple male love interests.)At their best, the groups are a fountain of support for “indie” authors, who self-publish their work and help each other with covers and marketing, which is known as “pimping.” At their worst, they can be “epicenters of nonstop drama,” said Sarah Wendell, the co-founder of the romance blog Smart Bitches, Trashy Books.Ms. Meachen’s fan page, The Ward — a humorous reference to a psychiatric hospital — went in that direction. She complained bitterly about colleagues who, she said, she had helped but had failed to help her in return, and threatened to leave the indie world.“Every day it got to the point I’d rather be dead than to deal with the industry and the people who swear they are friends,” she wrote in September of 2020. “I’ve had some dog eat dog jobs in my life but this one is by far the most vicious with the least amount of money.”Ms. Meachen lives in the tiny town of Benton in the Appalachian foothills in southeastern Tennessee.Jessica Tezak for The New York TimesShe described her psychiatric treatment and alluded to past suicide attempts.“Dear Scary people in my head, I truly understand we’ve been doing your story for over a year,” she wrote. “Waking me up with muscles screaming at me to get up and finish does not motivate me.”Ms. Meachen’s psychiatrist, Dr. Niansen Liu, confirmed, with her permission, that she is under his treatment for bipolar disorder and that she has been prescribed medications for anxiety, depression and psychosis. He would not comment further on her case.Her online friends worried about her, and some reached out to express their concern, but there was a limit to what they could do, said Kimberly Grell, who became friendly with her through writing groups.“She was becoming pretty chaotic,” Ms. Grell said. “It just seemed like every problem that surfaced with her she was in the middle of, and it turned to where she was the victim of it all.”She sympathized with Ms. Meachen’s frustration, though, as it became clear that she might not be able to earn money with her writing.“A lot of people get into this type of business thinking they’re going to make their millions, like Stephen King or James Patterson,” said Ms. Grell, who exited the romance industry last year to sell beaded jewelry. “The reality is, it’s a money pit. You are literally tossing your money into a pit hoping someone will find you.”Ms. Meachen’s husband, Troy, said he came to see the “book world” as a danger to his wife’s welfare.When she sent out samples of her work to other authors, the responses she got were often “really brutal,” he said. When writing, he said, she had periods of mania and psychosis; sometimes, he would come home and “she would talk like a character from a book, like she was the individual she was writing.”He worried that it was too dangerous to leave her alone during the day. “It got to the point where it was like, enough is enough,” he said, comparing the community’s effect on her to a whirlpool. “She was going round and round,” he said, “and the bottom was just right there.”This reached a climax in the fall of 2020, according to Mr. and Ms. Meachen and their 22-year-old daughter, who described the episode on the condition that her name not be used.It had been a rough few weeks. In August, someone had called police because they feared she would harm herself. On September 10, Mr. Meachen was away, hauling a shipment of chemicals. Their daughter stopped by to check on her mother, and found her semiconscious.Ms. Meachen had taken a large dose of Xanax, enough to make her “like a limp noodle,” and was “not cognitive or responsive,” Mr. Meachen said. He instructed their daughter to announce her death online, he said.“I told them that she is dead to the indie world, the internet, because we had to stop her, period,” he said. “She could not stop it on her own. And, even to this day, I’ll take 100 percent of the blame, the accolades, whatever you want to call it.”The post on Meachen’s page said she had died two days earlier. “Author Susan Meachen left this world behind Tuesday night for bigger and better things,” it said. “Please leave us alone we have no desire in this messed-up industry.”A follow-up post appeared on Oct. 23. “Sorry thought everyone on this page knew my mom passed away,” it said. “Dead people don’t post on social media.”Ms. Meachen and her husband of 27 years, Troy. He said he came to see the “book world” as a danger to his wife’s welfare.via Susan Meachen‘I feel majorly gaslit’The news of Ms. Meachen’s death radiated out through the fan pages. Ms. Meachen was well known in the community, and had often reached out to new authors, volunteering to provide cover art or help with marketing.“Susan, I will never, ever forget how kind you were to me,” wrote Sai Marie Johnson, 38, the author of “Embers of Ecstasy,” at the time.“I only wish you would have known I would have talked you through the night, I’d have defended you against your bullies,” she wrote. “I will do everything I can to make a difference so your death is not in vain.”Ms. Johnson, who lives in Oregon, was so upset that she reached out to Ms. Meachen’s daughter online and offered to edit her mother’s last book for free, as a tribute. But the damage had been done, she said: Over the months that followed, many members, disgusted by the Mean Girl-ness of it all, migrated out of the community or deleted their accounts.“It caused a huge shift in this community,” Ms. Johnson said. “There was a lot of drama, but this was the tidal wave. Nobody before had gotten so abused that they wanted to commit suicide.”The subject receded, replaced by other dramas, until Jan. 2, when Ms. Meachen reappeared on her fan page with the news that she was alive.Ms. Meachen did not see it as a particularly big deal. Eager to resume writing under her own name, she had been considering such a move for about a year, she said. She sat down at the computer, she said, and “hit enter before I could talk myself out of it.”“I debated on how to do this a million times and still not sure if it’s right or not,” the post read. “There’s going to be tons of questions and a lot of people leaving the group I’d guess. But my family did what they thought was best for me and I can’t fault them for it.”For the first few hours, the response was muted. Then, as she put it, “all hell broke loose.” Her post was widely shared by Samantha A. Cole, a romance writer from the suburbs of New York City, along with a seething commentary.“I was horrified, stunned, livid, and felt like I’d been kicked in the gut and the chest at the same time,” wrote Ms. Cole, who previously worked as a police officer, and asked to be identified by her pen name to avoid the notice of people she had arrested.More than anything, Ms. Cole said, she was hurt. She had gone into a “major funk” for months over Ms. Meachen’s death, worried that she had not been a good friend. Worse, in the recriminations that followed, Ms. Cole was accused on one fan page of bullying Ms. Meachen, something both women said was untrue.Ms. Cole, who describes herself as “naturally suspicious,” set about documenting Ms. Meachen’s false claims in a series of screen shots and DMs.An excerpt from Ms. Cole’s Facebook page.via FacebookShe provided screenshots showing that Ms. Meachen had appealed to the group for financial help in medical emergencies and noted that she returned to the fan page under a new identity, T.N. Steele, effectively eavesdropping on her own mourners.“It was important to me because the people that had grieved for her death for so long had a right to know that the whole thing was a hoax,” Ms. Cole said. “That’s what led me to do this, my anger and the sense of betrayal. I needed a way to vent.”Many authors who are angry say it is because they know so many people struggling with mental illness themselves, and that it is despicable to falsify suicide for any reason.”“I feel majorly gaslit,” said Ms. Johnson, who, last week, filed a report about the incident to the cybercrimes unit of the F.B.I. She added, “It doesn’t seem like she is apologetic, and she is trying to cast blame on people, trying to get them to accept that she had a mental illness.”As the scandal drew the attention of mainstream media outlets to the romance industry, many of its senior figures drew a weary sigh.“I do not think it is going to help the romance industry’s persona of being a bunch of overly emotional women,” said Clair Brett, the president of the Romance Writers of America.A twinge of remorseMs. Meachen watched from Benton while the online backlash made headlines in Greece and Britain and France; reporters from various countries were appearing in her DMs, which stressed her out.This meant, among other things, that her real-life neighbors might read her novels, which fall on the racier end of the genre’s spectrum. For years, she has carefully separated her two identities — the romance writer and the homebody — but now they were smashing together.She had not heard again from the police and sounded confident that she would not face charges, saying the family had not received substantial donations after her online death announcement; she had offered the detectives access to her bank accounts to prove it. She did admit feeling remorse for the fans who had grieved her loss.“I’m sorry for their mourning, but from a legal standpoint, I did nothing wrong,” she said. “Morally, I might have done something wrong. But legally, there’s nothing wrong.”If Ms. Meachen was on the edges of a literary world before, she is now cast out of it. Her fan page has gone silent. Her inbox is full of angry messages from former friends. Looking back on the whole story, she said she regrets it all, starting with entering the romance groups.“It wasn’t good for me,” she said. “No, it wasn’t. I wish I had never met the book industry whatsoever.”She has set aside her plans to resume writing fiction, for now, to deal with more immediate concerns. Someone is impersonating her on social media, issuing comments about the scandal, she said, and hoax Susans were bouncing around the internet saying God knows what.“That’s what’s so funny about it,” her husband said. “You can be anybody you want to be on the internet.”