The car, parked on a deserted mountain road near Tokyo, had its windows taped shut from the inside. In the car were small charcoal burners — and the bodies of seven people.

Within a few miles of the scene, another car held two more bodies.

The suicide victims were five men and two women ranging in age from 34 to 20. They came from all over Japan. What drew them together was an Internet posting from the 34-year-old woman offering a suicide pact.

On Nov. 28, four men were found dead in a Tokyo apartment where they had gassed themselves. The next day, two men and two women were found dead in a car parked near a dam outside Tokyo. Police suspect the two unrelated groups met over the Internet.

Could it happen outside Japan? Psychiatrist Sundararajan Rajagopal, MD, thinks it might. His editorial in the Dec. 4 issue of the British Medical Journal sounds the alarm. Rajagopal is with the South London and Maudsley NHS Trust in London.

"In recent years there has been concern about the role of the Internet in normal suicide — solitary suicide, people who take their lives on their own," Rajagopal tells WebMD. "There is evidence that the Internet can influence people to take their own lives. The term coined is 'cybersuicide.' What we are seeing in Japan may occur sporadically in other countries. We cannot rule out the possibility that people, who might otherwise have taken their lives on their own, will meet on the Internet to form suicide pacts."

Suicide Sites Easy to Find

Web sites dedicated to suicide are easy to find on the Internet. Here are some excerpts from one suicide chat room:

—"I somethings [sic] think I'd prefer myself dead. And then other times I do as well. And sometimes, I think I'd prefer myself dead. And rarely I don't not think I'd prefer myself dead.

—"You really want to die but on the good days you programmed yourself to know that on the bad days when you really want to die you don't really want to die and that you are thinking irrationally. But i want to die."

—"Now if you'll excuse me, i have a bus to catch."

"Catching a bus," on these web sites, is slang for killing oneself. Don't try to log on to save anyone. Those leaving antisuicide messages are banned from the sites.

Perhaps it was just talk and nothing serious. But psychologist Gerald Goodman, PhD, professor emeritus at the University of California in Los Angeles, says it's important to take talk of suicide seriously.

"Suicide oftentimes involves some sense of isolation," Goodman says. "Theorists say that the heart of it is meaninglessness. Meaninglessness without hope. When you look at why people do it, there are several things that add up: isolation, meaninglessness, and self-loathing — disgust with oneself."

The Wrong Kind of Community Support

If isolation is part of the recipe for suicide, wouldn't a community — even an Internet chat room of suicidal people — keep people from killing themselves?

No, Goodman says. In fact, suicidal patients often tell him in chilling language that other people's suicides gave them "inspiration" or "courage" to kill themselves. It comes, ironically, from the human need to be known.

"The suicide wants company. The suicidal person thinks, 'I want to be known by you, and if you truly empathize with me there is no question you will want to talk me out of it – because if you know me you know it is the right thing to do,'" Goodman says. "So the empathy on these web sites is not saying, "Oh, I really understand you.' Instead, they demonstrate that they know how you feel by adding to it. It is collaborative. It is mutual support for suicide."

Goodman notes that there are many more web sites dedicated to mental health, support, and professional help than there are to suicide. But the suicide sites offer something enormously powerful.

"Mutual support is more powerful as a change agent than psychotherapy," Goodman says. "Psychotherapy is one-way intimacy. But with mutual support, we are both in it together. You aren't going to try to talk me out of it. We want the same thing. I've heard the word inspiration twice in this context. Inspiration for suicide."

Since young people are at particular risk of Internet-supported suicide, Goodman suggests that parents monitor teens' Internet use. And Rajagopal suggests that doctors and psychologists should ask depressed patients about whether they have used the Internet to obtain information about suicide.

The good news, Rajagopal notes, is that very few suicides — only about one in 100, even in Japan — are linked to the Internet.

"Suicide pacts are a very small proportion of suicides, and the number of Internet-linked suicides is still very small," he says. "I don't want people to be unduly alarmed."

By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

SOURCES: Rajagopal, S. British Medical Journal, Dec. 4, 2004; vol 329: pp 1298-1299. Sundararajan Rajagopal, MD, South London and Maudsley NHS Trust, Adamson Center for Mental Health, St. Thomas's Hospital, London. Gerald Goodman, PhD, professor emeritus, University of California, Los Angeles.