In January 2003, Suzanne Gonzales wrote to an online messaging group: “I cry for no reason, and I can’t help but feel that I’m bothering others with my whining. I’m sorry to everyone. It would just be best if I would go away.”

She had been suffering from depression and, in the following months, she often went to this website to talk about suicide. It was a place where suicide was normal, or even encouraged. Anonymous users told her it was okay to kill herself, lending her detailed advice on how to do it.

In March, Gonzales checked in to a hotel room and drank a cup of poison, according to news accounts. She was 19 years old when she died.

The death of Gonzales is a frightening tale about dark corners of the Internet and the role it can play in the lure of suicide. While suicide has long been a public health issue in the United States, leading to more than 40,000 deaths each year, mental health experts are just coming to grips with how the Internet influences suicide risk and prevention.

[Can exercise cure depression and anxiety?]

Suicide-related information is readily accessible online. Using the Internet to read about suicide can provide a beacon of hope, as much of the available content promotes prevention or resources for those in distress. Yet a number of studies have raised concerns about websites that may encourage suicide and self-harm. One site, for instance, advertises itself as “a place where people who are interested in suicide methods come together and discuss about suicide methods.”

In a study published in 2008, researchers put phrases related to suicide (e.g., “How to kill yourself”) into search engines and examined the first 10 sites from each search. The authors found that about 1 in 5 of these top hits were sites encouraging suicide or describing suicide methods. A more recent study compared the top suicide-related search results from 2007 to 2014, and found the proportion of sites providing factual information about suicide methods had tripled.

Research suggests these websites draw people, particularly youths, who are in distress. In a survey of 1,500 young people living in the United States, browsers who visited pro-suicide sites were 11 times as likely to report thinking about self-harm and seven times as likely to report having suicidal thoughts as were young people who hadn’t visited the sites. A 2015 study found that 20 percent of young adults with a history of suicidal self-harm had visited sites containing information on how to kill or hurt oneself, compared with just 3 percent of young adults more broadly.

What’s less clear is the motivation behind these websites: Why would someone encourage others to kill themselves, often providing detailed instructions on how to do so? The relative anonymity of the Internet makes this question challenging to study. Some academics have speculated that pro-suicide sites may serve as forums for commiseration, community or even rebellion, but there aren’t much data to make firm conclusions.

After Suzanne Gonzales died, her parents, Mike and Mary Gonzales, decided to take a stand against people who promote suicide online. Working with them, Walter Herger, then a Republican congressman from California, introduced a bill that would criminalize using the Internet to promote suicide. The bill was named the Suzanne Gonzales Suicide Prevention Act of 2007, or “Suzy’s Law.”

Plenty of state laws make it illegal to knowingly assist in suicide, particularly as it applies to physician-patient situations. But the legal implications of using the Internet to encourage suicide are murky.

For starters, websites and users may be based in different states or overseas. Also, it could be hard to prove that online posts directly led to another person’s self-harm.

Our aversion to cracking down on free speech online also comes into play. The United States ranks among the top countries for Internet freedom, and American courts have tended to side with protecting freedom of expression online.

But regulating content and activity that promote suicide online isn’t impossible. In 2011, William Melchert-Dinkel was convicted in Minnesota of assisting suicide via the Internet. A nurse, he had encouraged people he met online to kill themselves and offered detailed methods; two of them, a Canadian man and a British woman, eventually died by suicide. The case has stirred multiple legal battles, at one point finding its way to the Minnesota Supreme Court, but Melchert-Dinkel eventually served jail time for assisting suicide.

In 2006, Australia became one of the first countries to criminalize pro-suicide sites. After dozens of people in Japan killed themselves in 2008 using a gas method described online, national police asked Internet providers to take down online content spreading the information. South Korea and Russia have taken similar steps.

Suicide remains difficult to predict, and we’re just beginning to understand the role of the Internet in mental-health outcomes. Still, the rise of pro-suicide activity online poses tough questions about the boundaries of free speech and what constitutes acceptable online use. In particular, do we want the Internet to be a place where people can learn about — and even be drawn into — killing themselves?

A decade has passed since Suzy’s Law was first introduced, but it has yet to gain traction in Washington. The Gonzales family has tried to keep the bill alive by getting it reintroduced every few years, including in 2009 and 2011.

Mike Gonzales recently told me that he felt the country had made important strides in talking about mental health, but he hopes that more will be done to stop pro-suicide activity online.

“I’m all for free speech,” he told an interviewer shortly after his daughter’s death, “but once you start telling young impressionable kids how to kill themselves, that’s crossing the line. Someone’s got to be held accountable.” He said he still believes that.

If you are in crisis or you know of someone who is, you may want to call the National Suicide Prevention Lifeline at 800-273-8255 or visit suicidepreventionlifeline.org. Morris is a resident physician in psychiatry at the Stanford University School of Medicine.

[Read more:]

[I live in fear that my daughter will inherit my depression]

[Man streamed murder on Facebook]

[‘13 Reasons Why’ depicts a graphic suicide. Experts say there’s a problem with that.]