Like many people who commit suicide, the 17-year-old boy was a perfectionist unable to cope in an imperfect world. Two months before the death, his father had bought him a shotgun, ostensibly for sport. By all accounts, this was a nice, average American family. On the night of the suicide, the father and son had argued.

The night of the tragedy's first anniversary, the father's guilt and grief overwhelmed him. At 2 a.m., awakened in a panicky sweat, he reached for the gun he kept under his bed. His confusion became a mantra: "I am going to kill myself."

But the gun was not there.

There would not be another suicide in this house.

This family was being watched, or more precisely, studied, by Mohammad Shafii and his team of University of Louisville researchers. They wanted to understand the aftermath of suicide as well as the familial and other factors that can lead to it. The researchers knew that suicide can be contagious. Survivors often blame and punish themselves for what happened.

The reseachers had asked the family to remove the guns from the home before the observation began.

"We got the call on our answering machine at 8 in the morning," Shafii says. "The father called one of my researchers and told us, 'You and Dr. Shafii were so right. Last night was the anniversary of my son's death and I woke up so despondent and guilty, I went to reach for the gun and it wasn't there.' "

"He just kept saying, 'Thank you, you saved me.' "

Shafii's work was spurred by an ominous upward spike in youth suicides in the late 1970s, he says.

"We noticed a significant increase in actual child and adolescent suicide in this community and nationally.

But even as late as 1980 when Shafii and his U of L research team began their studies, not a lot was known about the pathology of child and adolescent suicide, or youth violence in general.

Shafii, professor of psychiatry and director of the child and adolescent residency training program at the Bingham Child Guidance Center, says a lot of myths about youth suicide and violence persisted until recent years, even among mental health professionals.

Mohammad Shafii and his book "School Violence"

He set out to dispel those myths by investigating suicide and youth violence with the same rigor that a pathologist or a detective would use to investigate a murder or a medical researcher would use to trace the course of a disease.

Shafii says his studies have helped to prove that young people who lash out, either by taking their own lives or the lives of others, typically leave plenty of clues in advance-telling friends, parents or others of their intentions.

It seems like common sense, but Shafii says the connection was not always accepted, even in academic circles.

"Even in clinical discussions and meetings (among child psychiatric professionals), people would say, 'Kids who talk about suicide don't commit suicide. If they really meant it, they would have done it and succeeded.'

"This was the thinking at the time."

The spate of recent cases of killings and murder-suicides by armed teens at schools bears out the findings of Shafii and others: that talkers are also doers.

"There is still a lot of denial out there. Parents and teachers say, 'Oh he

doesn't mean it; he's just joking' about killing himself or others. But when anybody begins to actually verbalize thoughts about suicide or homicide, the risk of it happening increases significantly-especially when they provide specific plans.

"If they say something like, 'I am going to bring a gun to school or bring a bomb,' then the risk of something actually happening increases tenfold."

"We said, 'Let's check into it, let's do qualified, careful database research,' " Shafii adds. "Let's take the same scientific method used in medicine to find the physiological cause of illness and apply it to psychiatric issues; let's use an autopsy model and apply it to behavioral, psychiatric and psychological problems."

Anatomy of a Suicide

Shafii came to U of L in 1974 from the University of Michigan. He began his "psychological autopsy" studies in 1980 with the boost of a small grant and support by Jefferson County, Ky., coroner Richard Greathouse.

"We contacted families with children who had committed suicide, offered our condolences and told them that we don't really know enough about why youths are losing their lives. We asked if they could help us," Shafii says.

"Amazingly, 85 percent agreed to open their hearts and their homes to us."

During the study, Shafii's team created life histories of youths at various points in time prior to their suicide, from one year to the day before.

"We noticed that friends had a lot of information about the youths that the parents and school personnel did not know," he says.

The studies also helped disprove another myth about suicide: that it's an impulsive act sparked by bad grades, breakups with boyfriends or girlfriends, or family arguments.

"That was not the case," Shafii says. His studies of children up to age 19 showed that violent acts by youths, including suicide, are often symptoms of undiagnosed or untreated long-term psychiatric problems.

Shafii says 95 percent of suicidal youth have psychiatric problems, with threefourths of them suffering from major depression. In addition to suicide, the depression often leads to other problem behaviors such as alcohol abuse, truancy and petty crimes.

"Researchers in Pittsburgh and at Columbia University in New York repeated our studies and pretty much confirmed them," Shafii adds.

"We now feel it's a very natural evolution from underlying depression and other psychiatric disorders toward suicide and the recent school violence we've seen."

Another major finding by Shafii's researchers was that about 85 percent of young people who committed suicide made known their intentions to somebody at least once during the prior year.

"Most of them gave indications more than one time," Shafii says. "And 45 percent did more than just say they were going to kill themselves, but how they would do it, as well."

Shafii says that early diagnosis and ongoing treatment are essential to stopping youth violence and suicide.

"In my experience, up to 95 percent of kids who are depressed or suicidal can get better with treatment, with medication and psychotherapy."

The teenagers who committed two of the most notorious school shootings of recent years bear out many symptoms identified in Shafii's work.

In May 1998, 15-year-old Kipland "Kip" Kinkel shot his parents to death in Springfield, Ore., then opened fire at his high school, killing another two and wounding 26 others. In 1999, he was sentenced to 111 years in jail.

During the trial, it was learned that Kinkel either had been misdiagnosed, undertreated or both. He briefly was placed on the anti-depressant Prozac, which improved his anti-social demeanor. But he became angry and depressed again when the treatments stopped.

Many of Kinkel's antisocial outbursts, including shouting in class and writing morbid murder fantasies in the margins of his homework, were either ignored or not taken seriously.

Only after the killings did psychiatrists assess Kinkel as psychotic and delusional.

In another well-known case, the Columbine High School murder-suicides that occurred in Littleton, Colo., in April 1999, 18-year-old Eric Harris and 17-year-old Dylan Klebold killed 15 people, including themselves, and wounded many more.

As with Kinkel, warning signs of their intentions were ignored, including Harris' personal Web site, which was filled with angry, hate-filled diatribes.

Just prior to the Columbine shootings, Shafii helped organize a symposium on school violence as part of his duties as a member of the scientific committee of the American Psychiatric Association.

An outcome of that meeting was a book, "School Violence: Assessment, Management, Prevention" (American Psychiatric Publishing, 2001), co-edited by Shafii and his wife Sharon Lee Shafii, a psychiatric nurse. The book features diverse articles by Shafii and other noted practitioners in the field of child and adolescent psychiatry.

"The book was written because there is not very much systematic, clinical information presented in a comprehensive way available to clinicians and other professionals who work on the front lines with children and adolescents who have a potential to commit school violence," Shafii says.

"The book is geared toward professionals, child and adult psychiatrists, pediatricians, nurse practitioners, social workers, school counselors, teachers, principals and school psychologists. But it is written so that interested parents, PTA members and so on can benefit also."

The Shafiis have co-written or edited six books together, but Shafii is particularly proud of "School Violence" because, he says, "The American Psychiatric Press probably is the most prestigious press in the world in that field."

More importantly, by getting the word out though his publications Shafii hopes to save lives, just as he has through his psychiatric practice.

"Almost 80 percent of my practice deals with depression," he says.

Many patients have done well with long-term treatment and follow-up.

"Many of my patients have grown up to become teachers, doctors, lawyers, business people and professionals of all kinds. And they are doing fine."