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This answer may contain sensitive images. Click on an image to unblur it.There are a lot of important answers on here. I am going to take a different tack for those who stumble on this post and have decided not to use the obvious skills of those trained in such critical matters.Having been suicidal a couple of times and having my brother intervene, I now know just being rational won't work. In addition, I have seen quite a few people who were suicidal in my practice now and used a number of processes others have posted on this site to help them. I am still in contact with the first guy I was able to help.Generally, suicidal thoughts come from an existential crises, because some event has brought a belief, so into focus, the person feels trapped. There doesn’t seem to be another way to see it, after running through all the options the person can come up with. Checking-out seems like the best option.Credit: Disney-Alice in WonderlandI have a model I developed when I was a probation officer to help the guys get a handle on their life before it completely slipped away to the prison system. A lot of them were saying, "I'm getting it together." I started asking about what getting it together was and did they know anybody who had it together?Most didn't and when they did, I'd ask them what the qualities were. They'd come up with stuff like; "He's rich", or "He doesn't have anyone telling him what to do. Of course, after walking them through known celebrities who had been in that predicament and failed, it came clear; they really didn't have very good handles for what "getting it together" was.I came up with what I called the "Together person diagram" to help visualize what was happening in their life. My wife never like the name, so I changed it to; “The Wheel of Life”.Eight items, each as a spoke in a wagon wheel. The person would rate each quality on a numerical value of 0 to 10, representing how well that item functioned in their life. 10 being excellent, out to the rim. We would put a dot on the spoke indicating how well that particular quality was operating at that time in their life.1. Work: is about being productive It is what you do for society, that society pays you for. It doesn’t mean it is fulfilling. It is enough to have a functioning lifestyle with. People see it for what it is. Most people in the world are not doing the kind of work they would prefer. It is the kind of work they can survive with. To be good at it; you need to be dependable, reliable, have veracity, follow through, and follow up. People need to have the pride in, I did it myself.2. Intimate: is about being vulnerable and lovingBeing open both physically and mentally, Naked. Someone to share the rainbow with and them you. Where you enhance each others joy and listen to their woes.It is being honest and treating them with dignity and respect even in times of conflict. This encompasses communication and empathy.3. Learning: is about your intelligenceIt doesn’t seem to matter whether it is formal or informal. After school, most people seem to educate themselves on their work, sometimes hobbies. But it would seem, few do on relationships, human growth, and even history. To grow intellectually in all areas of life is important.4. Creative: Is about using your talentEveryone needs to make things that didn’t exist. “I made it myself!” It doesn’tseem to matter what it is, just as long as it gives a sense of pride to its creator. Find your sense of innate gifts and shape them to express yourself in some way. At least get a hobby such as gardening, sewing, photography, model building, cars, computers, but something. Watching things and consuming things doesn't count. Getting through a computer game or crossword puzzle doesn't count. Those are other peoples creativity. Some people are fortunate enough to work at something that they can create too. It is a rarity in the world. I noticed from working with professional artist and musicians, they always have the consumer version of stuff and when they get the chance, they work on their own creations.5. Social Is about being popularIt is about friends, real friends. People who are willing to risk thefriendship to tell you, you are making a mistake. You can share who you are andthey with you. It is keeping a confidence. When friends trust you with theintimate details of their life, they are expecting you to honor that, even whenyou get angry, and not use it against them. It is Learning tobe aware of and empathies with other people.6. Physical: is about your Health in two ways.Our bodies are on loan. They all get factory recalls. Take care of it and it should last a hundred years. We have a friend right now who is a hundred and four,…. still works,…as a federal judge.What you ingest, turns into and becomes a part of you. Learn what food, drink, and mood alterants really do. You only need enough food to get to the next service station, otherwise you body stores it for the supposed coming drought. More than likely, it isn’t the last time you’re ever going to get to eat oneExercise keeps the energy flowing through so you don’t stagnate and putrefy. Similar to when water is dammed up and it sits. Medical says 20 minutes a day, every other day is minimum. The astronauts say they would have to exercise around 21 hours a day just to keep the muscle mass we get with walking around with one G. Learn a routine for aerobic functions to metabolize your intake and stabilize your output.7. Community: is about being ResponsibleWhen people connect with community, it is to expand their belonging to more than themselves and family. It is realizing they are a part of greater thing. They contribute and give back for the betterment of that community. Most do it in a volunteer aspect but there are other ways. It is a sense of being able to respond to the needs of the community. My wife was run over by a drunk as a kid and spent a number of years in a handicapped school. She said one of the basic things taught was to help others and pay attention to how you could help. It was a big shock when she went to a regular school and it seemed it was everyone for themselves.8. Play: is about having FunHow to get off the clock and just play naturally. Down time, So many people Isee have learned to use artificial poisons to relax enough in order to havefun, They haven’t learned how to stop the harangue in their head and not feel guilty. Poisoning your rational-self with drugs to quit harassing you, says you have not learned how your internal systems work and they definitely are not working as a teem.Now connect the dots and it gives a visual as to just how well rounded a person has been running their life.The Rim. and Tire.These are where you use the resources of time, energy, money, and affiliations. Resources are all finite things which connect the outer part of the wheel, Where the rubber meets the road is where all the myriad of things are utilized in your life.such as decisiveness, cooperation, trust, respect, loyalty, discipline and others.THE HUB:.This is what keeps it all together, rather like the glue. It is who we believe we are. Our meaning in life, our purpose. It also creates our compelling future, why we get up in the morning, why bother with anything. This is our spiritual center. What we believe is our truth as to what it is all about. It feeds meaning to the spokes.No one can take your belief from you; you have to give it away. Your spokes, on the other hand, can be taken from you against your will. You can lose your job or your health. When people have a deep sense of who they are, they realize the event is a predicament or situation they are dealing with.You can lose a number of spokes and if your hub is okay, then you can weather it through. But if you lose the hub, then the whole thing (life) falls apart.Where it goes wrongCredit: Disney-Alice in WonderlandWhen people don’t have the hub identified and developed for them when they are growing up, one feels shame they are not good enough. They didn’t measure up to some standard for just being. They then learn they have to be liked to be loved. To be liked, they must behave a certain way. The hub has to be filled with something.Once the spokes tend to get identified as what will get the child liked, they start performing in whatever format that is. They have to get value by doing something, instead of being. When that occurs, the child tends to have shame if they behave otherwise. They can’t make mistakes because they now believe it will expose; they are a mistake. It becomes what we believe in our heart of hearts about ourselves.In order to fill the empty in their hub, the person tends to make what I have called a "Golden-Calf-God. That is, put a spoke in its place. They will sacrifice everything; friends, career, family, children, health, even their own life, to feed their form of security. It is a substitute reason for living.Performance becomes everything. For most men, it becomes work. That is, who they are. It can be a woman whose children grow and now she has empty nest syndrome. A sports figure blows out his knee, A man has his wife tell him she wants a divorce. A woman gets breast cancer. The company downsized and you lost your job. A large number of people have to be perfect (right) at whatever their particular spoke is.When this happened and the spoke was substituted in the place of who you are, you became vulnerable to having the rug pulled out from under you. Something has been taken against your will. It feels like it is who you are and you’re suffering a loss with out any hope of replacing it. Most people start obsessing as to ways to get the issue resolved. When it cannot be, despair can set in and it is a hop skip and a jump from suicide.All the people I have known to commit suicide had a spoke in place of the hub. They bet their life on something which could be taken away without their consent. Even people who said they had a deep religious conviction would commit suicide if say, their child died and they thought it was Gods punishment. Most religious suicides are from getting caught with sexual or financial improprieties, which betray their real behavior. Their shame is exposed and they have to leave.You are suffering as the great Buddha was suffering when he was in his own great depression.Suicidal Thoughts:Credit: Disney-Alice in WonderlandOnce the awareness sets in and concludes; “there is no way to get the old status back”, people get depressed. After all the other options are exhausted, most people’s minds start looking at "checking out", as a final solution. They can start using that as a purpose for awhile because it is a focus on the future and something one can work on. That is why when some people have been depressed and suddenly perk up, they convince people who notice, they are really getting better. The reality is, they have a door out of their predicament and are working on executing it now.When the obsessing starts and moves to depression, medication is almost always called for. The persons own biology is normalizing the process even though it is a negative one and can lead to death. It kind of reminds me of the movie “What Dreams May Come” when the Tracker tells Robin; “In Hell, the real danger is losing your mind. Hell will feed despair and you can’t think enough to get out.”“Every time you make a choice, you are turning the central part of you, that part of you that chooses, into something a little different from what it was before. And, taking your life as a whole, with all your innumerable choices, all your life long you are slowly turning this central thing either into a Heavenly creature or into a hellish creature -- either into a creature that is in harmony with Spirit, and with other creatures, and with itself, or else into one that is in a state of war and hatred with Spirit, and with its fellow creatures and with itself. To be the one kind of creature is Heaven: that is, it is joy, and peace, and knowledge, and power. To be the other means madness, horror, idiocy, rage, impotence, and eternal loneliness. Each of us at each moment is progressing to the one state or the other.”C.S. Lewis: The Chronicles of Narnia.A Native American elder was walking with his grandson around a lake and forest. They heard some wolves in the distance. The elder said to his grandson: "There are two wolves that live within me. One is content and happy, and roams around at peace with nature and its surroundings. The other is hungry and ravenous, never satisfied and always looking to destroy and conquer." The boy looked at his grandfather and asked: "Which wolf is stronger, Grandpa?" The elder answered: "It depends on which one I feed."Anonymous ancient Native American story.Sometimes people use affirmations as an attempt to heal themselves and although it can help a little, it never really works because again, rational mind can't access that unreasonable spot in your heart, in your hub. Some people just want you to pull yourself up by your own bootstraps but if you have what you considered your purpose in life taken from you, “what’s the point” can flood your mind. When a spoke has been put as a hub and has been taken against your will, all the sacred questions that the blessing was supposed to give you as truth, have evaporated. Those can't be fixed.... It has to be healed... Because we are living beings, not mechanical computers.Alice in wonderland.“Oh, Cheshire cat! It's you!Whom did you expect? The White Rabbit perchance?”Credit: Disney-Alice in Wonderland“Oh no. I'mthrough with rabbits I want to go home! But I can't find my way.”“Naturally. That's because you have no way.”“To get out of Tulgey wood, some go this way, and some go that way. But as for me, myself, personally, I prefer the shorT...cuT!”Credit: Disney-Alice in WonderlandGo find a Cheshire cat to get you out of Tulgey Wood. If you don't know one of your own, utilize ones posted on this site.Repair of an empty hubYou believe as you have been taught, you are a failure of some sort. That part of you has it as a truth. That part believes if you look into who you truly are, there will only be some kind of ugly. That part already feels ugly, so the fear is; it seems like confirmation. That is the problem with self diagnosis at this point. Touch the tip of your finger with the tip of the same finger. You can’t be subjective and objective at the same time.The spoke must get back to being just that, one of the supports for your life. It isn’t truly who you are, it just seems that way because of your background. You have to find something that is higher than you original parent-Gods messages which put it in there. The new message doesn't matter what form it comes in. It has happened for people in dreams and even a throw-away comment made by a complete stranger. Some people realize it reading a passage from a book and others from watching a movie.This is a basic existential crises and I have used all kinds of things for the individual to find their true personal self. I prefer transpersonal psychology for this because it is focused on the persons inner-truth. One of the better methods, Core Transformation, a delightful process created by Connie Rae Andreas from NLP Comprehensive in Colorado, addresses this beautifully. “To unstick yourself, organize your resources–spiritual, psychological, physical, sexual, emotional–so that they are in a balanced matrix.”Core Transformation by Connirae and Tamara Andreas"http://coretransformation.org/books_tapes.htmAnd a taste of the process:http://www2.hawaii.edu/~lady/archive/core-transformation.htmlOne other site for similar ideas:http://www.pathwaytohappiness.com/writings_falsebeliefs.htmAnd a couple of songs from Goose Creek symphony:Confusionhttp://mp3.xalo.vn/mp3new/85355/4e4ac6b7/094/confusion.mp3A Statified Mindhttp://mp3.xalo.vn/mp3new/85354/4e4ac796/e11/a-statified-mind.mp3Written by: Charles GearheartHow many timeshave You heard someone sayIf I had his moneyI could do things my wayBut little they knowThat it's so hard to findOne rich man in tenWith a satisfied mindOnce I was waitin'In fortune and fameEverything that I dreamed forTo get a start in life's gameThen suddenly it happenedI lost every dimeBut I'm richer by farWith a satisfied mindMoney can't buy backYour youth when you're oldOr a friend when you're lonelyOr a love that's grown coldThe wealthiest personIs a pauper at timesCompared to the manWith a satisfied mindWhen my life has endedAnd my time has run outMy friends and my loved onesI'll leave there's no doubtBut one thing's for certainWhen it comes my timeI'll leave this old worldWith a satisfied mindHow many timeshave You heard someone sayIf I had his moneyI could do things my wayBut little they knowThat it's so hard to findOne rich man in tenWith a satisfied mind

According to his daughter, yes:How My Father Steven  Levenkron killed Karen  Carpenter    My father is a very bad man.     Gabrielle Levenkron    Copyright © 2017 by Gabrielle Levenkron. All rights  reserved.   No part of this book may be reproduced in any form or by  any electronic or mechanical means including  information storage and retrieval systems, without  permission in writing from the author.   This book is a work of fiction. Names, characters, places,  and incidents either are products of the author’s  imagination or are used fictitiously. Any resemblance to  actual persons, living or dead, events, or locales is  entirely coincidental.     For Dad    I hope you rot in prison till you die     Karen Carpenter Was Killed by An Over-the-Counter  Drug that was given to her by my father Steven  Levenkron.   My father Steven Levenkron is an American  psychotherapist and writer known for his research into  anorexia nervosa and self-injury. He lives in New York,  where his practice is based .     Steven Levenkron   American psychotherapist    IMC'IC IX PMV77   l h# imtini w^wl  ii> rW bf« wllmg   novel I Kt BfcSl  urtu c.mi  is the world   Tl»» motto* *<•   •n«|Mrin«   iM a toang wnnun  tirnggling ig«MM  he* iltvfwil Cttrt and  ilk* wh w w iu a ikil      I was on cover on one of his books.    At the point when Karen Carpenter crumbled at 32 from  heart disappointment in a closet storeroom of her folks'  Downey, Calif, home two years back, the acting Los  Angeles coroner, Dr. Ronald N. Kornblum, said she kicked  the bucket of difficulties from anorexia nervosa,  particularly "cardiotoxicity" expedited by the substance  emetine. What he didn't indicate was the means by which  the emetine arrived. Specialists now concur there was  just a single way that could be available: She had abused a  typical, over-the-counter medication called ipecac.    A noxious, golden shaded medication, syrup of ipecac has  been sold in drugstores for a considerable length of time  to actuate spewing in harm casualties. General experts  have since quite a while ago prescribed having a  container in the solution chest as a shoddy antitoxin; a  one-ounce bottle costs just about $2. In any case, the  truth of the matter is that ipecac, in vast measurements,  may make irreversible harm the heart, and if taken more  than once, is a deadly toxic substance. One month after  Carpenter's passing, Deborah Mae Mellon, 32, a mother of  two, kicked the bucket of emetine harming. Two  Philadelphia legal advisors, Thomas E. Mellon Jr., Mrs.     Mellon's brother by marriage, and Michael B.L. Hepps,  have recorded a claim charging the various producers of  ipecac with inability to caution people in general about  the medication's dangerous threats. The suit, started in  the interest of Mrs. Mellon's domain, looks for $5 million  in compensatory harms and $10 million in reformatory  harms. "Nobody can know from taking a gander at this  toxic substance remedy that it is a toxin itself," says  Mellon. "Like Karen Carpenter, Debbie thought ipecac  was safe. She was a cheerful, solid lady who essentially  was urgent to get more fit." Mellon says if the reason for  Karen's passing had been uncovered promptly, it may  have spared Debbie's life. "What's more, it would have  prevented other ladies from taking ipecac, as well. They  would have said to themselves, 'This is the thing that  slaughtered Karen Carpenter. I'm not going to take it.' "    Presently a few specialists fear a pandemic of ipecac  abuse among an expected 150,000 anorectics and two  million patients who experience the ill effects of bulimia,  gorging and cleansing. A gathering of psychotherapists  who have some expertise in treating the two sicknesses  has chosen to announce the genuine reason for Karen's  passing. Boss among them is Steven Levenkron, a     psychotherapist and creator. It was Levenkron who  treated Carpenter for anorexia— effectively, he  thought— for right around a year prior to her passing.  "Similarly as Karen snuck past our fingers, so are  numerous other ladies," he says now. At a hearing later  this spring in Washington, D.C., Levenkron and his  partners will request that the FDA pronounce ipecac a  physician recommended medicate. "Ipecac ought not be  promptly accessible," he says. "It ought to be controlled  instantly."    When she kicked the bucket, Karen had been  experiencing anorexia for a long time— evidently since  perusing a passing reference to her tubbiness in an audit.  In the wake of seeing a few advisors in California, she  moved to Manhattan to start working with Levenkron. He  in the end place her in the healing center, where she  raised her weight from a skeletal 83 to 108 and defeated  her dependence on diuretics. In November 1982 Karen  concluded that she could go home. Before long, as  indicated by Levenkron's reproduction of her last  months, she more likely than not started gulping a few  teaspoonfuls of ipecac consistently after supper and in  the long run expanded her admission to a jug or two. The     medication, which causes sharp spasms took after by  vicious regurgitating, bit by bit debilitated her and drove,  on Febuary 4, to her sudden demise.    Levenkron says he was stunned to discover that his  patient had kicked the bucket from ipecac harming. "I  contemplated her." During telephone discussions, he  reviews, he had asked her, "Would you say you are  shedding pounds? Are you taking purgatives?" and she  had dependably replied, "No." "Ipecac was something that  never jumped out at me to get some information about,"  he says. "I accept Karen thought this was a safe thing to  do," to eat consistently yet keep up her weight at 108.    In an official statement for his post-mortem examination  investigate Karen, the L.A. coroner neglected to say  ipecac. The discharge in truth expressed that "research  center tests had precluded medication or pharmaceutical  overdose as a reason for death." Says Dr. Kornblum now,  "It never struck me to specify ipecac. In my brain,  emetine and ipecac are a similar thing."     Since Karen passed on, Deborah Mellon's has been the  main revealed demise from ipecac harming. However, a  few spectators presume that many eating routine fixated  young ladies may have passed on from abusing the  medication. "We believe that numerous anorectics and  bulimics who've kicked the bucket of baffling heart  disappointment may have really passed on of ipecac  mishandle," says Levenkron. Dr. Alan Adler, a  Philadelphia doctor who in 1980 treated the principal  revealed casualty of ipecac passing, a 26-year-old lady,  clarifies, "Individuals don't confess to taking ipecac, most  doctors aren't mindful that it's cardiotoxic, and as far as  anyone is concerned just a single lab in the nation tests  for emetine harming."    Ipecac originates from the base of the ipecacuanha plant,  a bush that develops in South America. It is the main  nonprescription medication known to contain emetine.  Until the late '70s, when investigations of ipecac harming  began appearing in therapeutic diaries, many specialists  never considered that ipecac may be abused. "None of us     had taken the inconvenience to research this medication,"  says Levenkron, "in light of the fact that who might  mishandle a medication that produces awful agonies,  queasiness and retching?" Dr. John Adams Atchley, a  Manhattan specialist who is leader of American  Anorexia/Bulimia Association Inc., answers the inquiry:  "In the event that you heard [bulimics] discuss the  considerable euphoria they get in wiping themselves out,  you'd comprehend why they're willing to take ipecac.  They'll endure a wide range of things to get that  practically otherworldly high."    Anorexia is self- starvation coming about because of one's  very own irritated feeling self-perception. Bulimia is  repetitive gorging, trailed without anyone else actuated  spewing or cleansing by intestinal medicines and  diuretics. Bulimics are sticklers and fanatical  compulsives, with exclusive expectations and low  confidence; they are fleshier than anorectics, whose  squandered look marks them as casualties of an odd  illness, and their number is developing. "In eight years I  saw our gatherings in New Jersey change from gatherings  of gaunt young ladies to gatherings of field hockey sorts  who were gorging their heads off, taking intestinal     medicines and tossing it up," says Dr. Atchley. However,  on more intensive look there are indications: puffiness  around the eyes and a swelling of the organs on the sides  of the jaws. Endless vomiters once in a while have facial  rashes, harmed teeth and untimely cheek wrinkles— like  columns of brackets on the sides of their appearances.    Despite the fact that bulimics appear to be sturdier than  anorectics, they are frequently in reality less strong.  Gorging itself can be lethal. As of late a 23-year-old  model, who had starved herself down to 84 pounds,  passed on in London in the wake of picking up 19 pounds  amid one fling. As indicated by a letter in the British  medicinal diary, Lancet, the lady's lethal admission  comprised of liver, kidneys, steaks, eggs, cheddar, bread,  mushrooms, carrots, an entire cauliflower, 10 peaches,  four pears, two apples, four bananas, two pounds of  plums, two pounds of grapes and two glasses of drain.    A few vomiters end their gorges with a few containers of  eating routine pop. This influences the sustenance to  buoy to the highest point of their stomachs and sparkles     the stiller reflex. Some basically will themselves to hurl.  Others— 300,000 by a few appraisals— take ipecac.    Regardless of the awfulness of Karen Carpenter, not  every person concurs that ipecac ought to be made a  physician endorsed sedate. Dr. John Schlegel, leader of  the American Pharmaceutical Association, recommends  that rather, "We embrace naming changes on the item  that will all the more enough caution customers about the  potential perils of utilizing ipecac mistakenly." Says Ron  Williams, APhA's executive of expert undertakings,  "Consistently ipecac spares 150,000 lives. Everybody  ought to have a container in the pharmaceutical chest if  there should arise an occurrence of inadvertent  poisonings." To balance certain toxic substances, ipecac  must be taken inside a half hour.    Dr. Atchley contends that requiring a remedy won't risk  harm casualties. "A mother could approach her  pediatrician for a remedy and keep a jug in the  pharmaceutical chest," he says. His position is supported  by previous clients of the medication. One of Levenkron's     patients, a 14-year-old young lady, said she purchased  ipecac at a drugstore subsequent to perusing about it in a  book about bulimia. She took it a few times despite the  fact that it influenced her regurgitation to blood and bile.  "Would you have utilized it regardless of the possibility  that it had a skull and crossbones on the name?"  Levenkron asked the young lady. "Truly," she stated, she  would have.     Returning to Los Angeles in November 1981, Karen filed  for divorce. Leaving behind the pieces of her broken  marriage, she set out on a year-long recovery mission,  relocating to New York City's Regency Hotel in January  1982. Manager Jerry Weintraub arranged for Karen and  Itchie Ramone to share a two-bedroom suite. Cherry  O'Neill, the eldest daughter of singer Pat Boone who had  herself recovered from anorexia, had recommended  Karen consider coming to the northwest and seeing the  doctor who helped her. But in Karen's world, one name  was synonymous with anorexia treatment, and that name  was Steven Levenkron. He was a psychotherapist  specialising in eating disorders and his successful book  The Best Little Girl in the World had become a highly  acclaimed television movie, which aired in May 1981.  Levenkron agreed to treat her. He received £100 for each  hour-long session five days a week, totalling $2,000 a  month. "I liked Levenkron, at least in the beginning,"    Itchie Ramone says. "No one really knew why someone    would get the disorder or how to treat it, so we were    really looking to him to 'save' her."    Arriving at Levenkron's office at 16 East Seventy-Ninth in  Manhattan, Karen weighed in at an alarming 5st 81b. A  week into their daily sessions, Karen admitted to     Levenkron she was taking a large number of laxative  tablets - 80-90 Dulcolax a night. This did not surprise  Levenkron. In fact, it was a common practice for many  anorexics. "For quite some time, I was taking 60 laxatives  at once," admits Cherry O'Neill. "Mainly because that was  how many came in the box... I would ingest the entire  contents so as not to leave any evidence."   What did stun Levenkron was Karen's next casual  disclosure. She was also taking thyroid medication - 10  pills a day. He was shocked, especially when she  explained that she had a normal thyroid. Realising she  was using the medication to speed up her metabolism,  Levenkron confiscated the pills. This was the first case of  thyroid medication abuse he had seen in his dozen years  in the field.   According to Levenkron's 1982 book, Treating and  Overcoming Anorexia JVervosa , the patient must become  totally dependent upon the therapist. Once the patient  has transferred their dependence on to him, he tries to  teach them how to create their own sense of identity, and  he helps them disengage from their dependence on him  with new behaviours, habits, and thought patterns.     Karen took advantage of the beautiful spring weather and  began a new exercise routine - to and from her sessions  with Levenkron - a brisk two -mile round-trip walk. This  was yet another method to burn extra calories. Outwardly  Karen seemed committed to the idea of therapy, but as  evidenced by her daily walking regimen, she was not as  committed to making actual changes that would result in  real progress. "She was still walking a lot, and she was  exercising," Carole Curb says. "And then she was into  throwing up and taking pills that make you lose  water-weight. Debilitating things like that."   Several months into his sessions with Karen, Levenkron  began to suspect that she had fallen off the wagon. He  invited the Carpenter parents and Richard to a  90-minute family therapy session at his office. "They did  come to New York -finally," Itchie Ramone recalls, "and  only after a lot of nudging. By then, Karen seemed to be  starting to turn the corner a bit emotionally."   The stigma surrounding mental illness and a need for  therapy was frightening for the family, especially Agnes,  who felt Karen was simply going overboard as far as  dieting was concerned. If only she would stop being so  stubborn and just eat. Over the years the family tried     every possible approach to get through to her and make  her eat. "Everyone around her did everything that they  could have humanly done," Richard said in 1993. "I tried  everything - the heart-to-heart, the cajole, the holler... It  can just make you crazy. Obviously it wasn't about to  work, and I was upset."   Levenkron explained that the family's attempts to  threaten or bribe Karen out of her behaviours would  never make them go away. According to his book, "Failure  of the family to understand this produces division within  the family that in turn results in feelings of anger and  guilt. The family atmosphere is chaotic, reinforcing the  anorexic's belief that she and no one else knows what is  best for her." Levenkron suggested to the family that  Karen was in need of a more tactile, demonstrative kind  of love. Karen cried uncontrollably during the meeting.  She told them how sorry she was for having put them in a  situation where they felt a need to defend her upbringing,  and she went so far as to apologise for ruining their lives.  "I think Karen really needs to hear that you love her,"  Levenkron told the family.   "Well, of course I love you," Richard told her  unreservedly.     "Agnes?" The therapist tapped the mother's shoe with his  own.   Rather than address her daughter, Agnes explained how  she preferred to be called Mrs Carpenter. "Well, I'm from  the north," she continued. "And we just don't do things  that way."   "Agnes couldn't do it," says Itchie Ramone, who discussed  the meeting with Karen and Levenkron after the family  left. "She couldn't do it... In therapy you're basically stark  naked. Then your own mother can't reach out to you?  And the way she doted on Richard. Most children would  try to dance as fast as they could to make their parents  love them, but it was at that point that I think Karen  decided it was time to take a step back."   After the meeting with Levenkron, Richard became angry  with the treatment plan, which he thought to be  worthless. He was upset that Karen had not checked  herself into an inpatient facility as one would do to  conquer substance abuse. He and his parents returned to  California and chose to keep their distance after this  painful encounter. They made no further attempts to  contact Karen's therapist. "What I find interesting,"     Levenkron stated in 1993, "is that in the entire time Karen  was in New York, I got zero calls from the family. I have  never treated anyone with anorexia nervosa whose family  didn't call regularly because they were concerned."  Likewise, Richard claimed to have never received a call  from Levenkron.   Karen and Itcliie were surprised to learn that Levenkron  was not an actual doctor. "We used to call him Dr  Levenkron’ all the time," Itcliie explains. "Then we found  out that he wasn’t even a real doctor. Any medical issues  she had, we had to go see this other doctor at Lenox Hill  Hospital."   According to Evelyn Wallace, "Karen picked the wrong  guy to go to. He wasn’t even a doctor. It seemed like  Levenkron was simply trying to talk Karen out of having  anorexia, but she’d talk to him and she’d go hack to the  same routine."   By the autumn of 1982 Karen showed no real signs of  progress. In fact, her walks to and from sessions with  Levenkron kept her body weight beneath the six stone  mark. Itchie Ramone called Levenkron and voiced her  concerns. "Look, Karen's getting thinner and thinner," she  exclaimed. "Plus, it's obvious she doesn't have her usual    energy anymore. When do you expect this turnaround?  She's just skin and bone."   The therapist agreed that Karen seemed extra tired and  was not responding as quickly as he had hoped, and  vowed to try another approach. After her next session  with Levenkron, Karen asked Itchie if she could borrow a  swimsuit. "What?" Itchie asked. "There's no pool in the  hotel. Besides, it's cold out!"   "No, I have to wear it tomorrow for Levenkron," Karen  answered. The two stopped by the Ramones's apartment  to pick up a size 2 light green bikini belonging to Itchie.  Karen changed into the bikini and emerged smiling.  Itchie was mortified and unable to hide her reaction.  "What's the matter?" Karen asked. "It fits."   "Uh, yeah, it fits," she said hesitantly. "You can use it  tomorrow, I guess."   Returning to Levenkron the following day, Karen was  asked to change into the bikini and stand in front of the  office mirror. He urged her to survey and evaluate her  body. "She didn't really see any problem with how she  looked," Itchie recalls. "In fact, she thought she was  gaining a little weight. But she was 791b."     In mid- September Karen phoned Levenkron and told him  her heart was "beating funny". She was quite upset,  anxious, and confused. She complained of dizziness to an  extent that she was unable to walk. Despite not being  medically qualified, he recognised her symptoms as those  of someone suffering extreme dehydration. Karen was  admitted to New York's Lenox Hill Hospital on 20  September 1982 to begin hyperalimentation, or  intravenous feeding.   The next morning she went into surgery to have a  small-bore catheter implanted within the superior vena  cava (right atrium of the heart). An unexpected  complication was discovered later that day when she  complained to the nurse of excruciating chest pain, and  X-rays revealed the doctors had accidentally punctured  one of her lungs in their attempts to insert the tube.   As her lung began to heal, Karen's body quickly  responded to the artificial means of feeding. The  hyperalimentation process completely replaced all of her  nutritional needs, and a precise daily calorie intake was  dispensed through the catheter. This loss of control was  known to often spark fear in patients, and doctors who  oppose hyperalimentation argue that it does not teach the     patient to eat properly. However, Karen went along with  it and gained i2lb in only a few days. Solid foods were  slowly reintroduced as the level of assistance from  Karen's IV lessened, and she continued to gain weight  steadily. Unlike many other patients she seemed pleased  and excited to show visitors her progress. Richard flew in  to visit on 25 October and, like most who saw her there,  was shocked and saddened. She was still horribly  emaciated and barely identifiable by this stage. "You see  how much better I look?" she asked.   Richard nodded in agreement but only to appease his  sister. In an attempt to divert the attention away from  herself, Karen told him of other patients who were much  worse off. But he was not sidetracked. "Karen, this is  crap," he said suddenly. "Don't you understand? This is  crap! You're going about this all the wrong way. This guy  isn't getting anything accomplished because you're in a  hospital now!"   By November Karen was eating three meals a day at  Lenox Hill, and trying to stay positive about the weight  gain, by then approaching the 3olb mark. The return of  her menstrual cycle, which had ceased during the  previous year, seemed to signify an improvement in  emotional and physical wellbeing.     On 16 November Karen visited Steven Levenkron for the  last time and presented him with a farewell gift, a framed  personal message in needlepoint. The large  green-threaded words "you win - I gain" served as  tangible proof of the long hours Karen had spent alone in  the hospital. Learning of her plan to leave, Levenkron  reminded Karen she was abandoning the program much  too soon, and that treatment takes at least three years. He  suggested a therapist in Los Angeles so that she might  continue a routine of some sort upon her return home,  but she declined. She promised to call him and swore she  would not take any more laxatives or diuretics. Agnes and  Harold (Karen's father) met up with her at Levenkron's  office that day. The couple had flown to New York City to  bring their daughter and her 22 pieces of luggage home. It  was obvious to most that Karen's treatment was  inadequate and ending too soon.   "She tried to get help," says her longtime friend Frenda  Franklin. "She went to New York to try. It just wasn't the  right way to do it. If this had happened in today's world I  think Karen would have lived. I think we would have had  a good shot. They know so much more. We were dancing  in the dark."     Karen ate heartily on Thanksgiving Day, much to the  delight of her family, and she even called Itchie Ramone  that night to tell her of all she had eaten. "She said to me,  'I ate this and that and all my favourite things,'" she  recalls. "She was very proud of herself then. We were all  very proud of her. It seemed like progress."   In the weeks following her return to Los Angeles Karen  went back to shopping and socialising without delay.  Although others felt she was still quite fragile and thin,  Herb Alpert, who had first signed the Carpenters to A&M,  saw Karen shortly after the New Year and recalled her  looking terrific. She bounced into his office saying, "Hey,  look at me, Herbie! What do you think? How do I look?"  Alpert agreed that she looked happier and healthier than  he had seen her in some time, and felt she appeared to  have won the battle. "I am so happy," she told him.   "I'm ready to record again, and Richard and I have been  talking about getting the group together and performing."   Despite her high spirits, she was taking more naps than  usual and sometimes lying down by seven in the evening.  Richard did not believe she was well, and he told her so.  On Thursday 27 January Florine Elie drove to Century     City for her weekly cleaning of Karen's apartment at  Century Towers. There the housekeeper made an  unnerving discovery. "When I was working up there I  found Karen," Elie says. "She was lying on the floor of her  closet." She gently shook Karen who awoke but was  groggy. "Karen, is there something wrong?" she asked.   "No, I am just so tired," she replied.   "Maybe you better go lie on your bed," she said, helping  Karen up and tucking her into bed.   Florine checked on Karen again before leaving. By then  she was awake and adamant she was OK.   Tuesday 1 February found Karen dining with her brother,  this time at Scandia on Sunset Boulevard. They were  joined by stage producer Joe Fayton, and the trio  discussed plans for the Carpenters' return to touring.  Karen ate with enthusiasm and after dinner returned to  Century Towers. This was the last time Richard would see  his sister alive.   The next day Karen spoke with Itchie Ramone, who was  pregnant with her and Phil's first child. Karen shared her  plans for the week. She would sign the final divorce     papers on Friday and then prepare to leave for New York.  "That weekend, 6 February, she was going to hop on a  plane and be there for the birth," Itchie recalls.   Shortly after midnight, staying overnight with her  parents, Karen went over her to-do list with Frenda  Franklin by phone, and finalised plans for the next day.  "OK, I am going to drive in. There shouldn't be a lot of  traffic," she said. According to Frenda, Karen enjoyed  keeping up with traffic reports. "Then we're going to go  get the red fingernail polish." The two had a noon  appointment for a manicure in celebration of her divorce.   On Friday morning, 4 February, Karen awoke and went  downstairs to the kitchen, where she turned on the  coffeepot her mother had prepared the night before. She  went back upstairs to get dressed. When the coffee was  ready, Agnes dialled the upstairs bedroom phone, but its  ring, heard faintly in the distance, went unanswered.  Agnes went to the foot of the stairs and called to her  daughter but there was no response. Entering the room,  Agnes found Karen's motionless, nude body lying face  down on the floor of the walk-in wardrobe. Her eyes  were open but rolled back. She was lying in a straight line  and did not appear to have fallen. "She had just laid down  on the floor and that was it," Agnes recalled.     The autopsy report listed the cause of death as "emetine  cardiotoxicity due to or as a consequence of anorexia  nervosa." The finding of emetine cardiotoxicity (ipecac  poisoning) revealed that Karen had poisoned herself with  ipecac syrup, a well-known emetic commonly  recommended to induce vomiting in cases of overdose or  poisoning.   Levenkron claimed to know nothing of Karen's use or  abuse of ipecac. In their phone calls she assured him she  was maintaining her new 7st lolb figure and had  completely suspended use of all laxatives. He never  suspected she was resorting to something much more  lethal.   In a radio interview taped shortly after Karen's death,  Levenkron discussed the autopsy findings: "According to  the LA coroner, she discovered ipecac... and started  taking it every day. There are a lot of women out there  who are using ipecac for self- induced vomiting. It creates  painful cramps, tastes terrible, and it does another thing  that the public isn't aware of. It slowly dissolves the heart  muscle. If you take it day after day, every dose is taking  another little piece of that heart muscle apart. Karen,  after fighting bravely for a year in therapy, went home     and apparently decided that she wouldn't lose any weight  with ipecac, but that she'd make sure she didn't gain any.  I'm sure she thought this was a harmless thing she was  doing, but in 60 days she had accidentally killed herself. It  was a shocker for all of us who treated her."   In one of Levenkron's most recent books, Anatomy of  Anorexia , the author boasts of his above-average recovery  rate in working with those suffering from eating  disorders. "In the last 20 years I have treated nearly 300  anorexics," he wrote. "I am pleased to state that I have had  a 90 per cent recovery rate, though tragically, one  fatality." That was Karen Carpenter.     I have read most if not all of Steven Levenkron's books. I  used to admire him a lot because he seemed very  insightful and caring. But as I've gotten older and had my  own experiences with a therapist and in getting social  work training myself, I started to see him as  condescending and egotistical. I have no doubt that he's  helped many people with eating disorders, but I no longer  see him as a "guru". Maybe Richard was turned off of him  because he saw the same things in him that I see.    As to whether or not Karen got substandard care from  Levenkron, I would guess she didn't. I think there's a  good reason why Levenkron is so successful. In fact,  Karen had set a goal to "kick" anorexia in a year.  Levenkron reportedly told her that it would be  impossible to do that, even if she got therapy every day.  Karen went back to L.A. after a year in New York anyway.  Even if she hadn't done that, I doubt Levenkron would  have been responsible. She died of medical issues— she  didn't purposely take her own life. And even if she had  committed suicide, any therapist will tell you that a  person who really wants to kill themselves will find a way  to do it eventually.     I think it's my father Steven Levenkron's fault that Karen  died. He was working a lot of things with a client who  was used to getting her own way. And he was in charge  of the medical side of her treatment.  Full text of "How My Father Steven Levenkron Killed Karen Carpenter"