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When Robin Williams' death was announced, much of the media in the UK and elsewhere speculated wildly about what might have caused him to take his own life. US-based journalist Cara Anna was following the coverage closely. However, unlike other reporters, her interest in the subject was more personal than professional. As someone who tried to take her own life twice and has since gone on to campaign for better support for people who have attempted suicide and lived, another high-profile death served as a stark reminder of how much still needs to be done in the area of suicide prevention.

Since trying to take her own life in 2010 and 2011 while working as a foreign correspondent in China, Anna, 41, has become known as one of a rapidly expanding and increasingly vocal cohort of suicide-attempt survivors in the US who are "coming out". They have been arguing that the time is long overdue to address the taboo surrounding the "hidden" suicide-attempt survivors who all too often feel shunned and left without adequate support while they recover.

"Is [attempted suicide] just so terribly shameful that we all have to walk around in silence after something so traumatic and dramatic?" she asks. "We're just supposed to zip it up and pretend it never happened?"

The dearth of tailored support for survivors in the US and other countries, including the UK, is serious not least because previous suicide attempts are a major risk factor for eventual death by suicide, she says. And she finds this all the more bewildering in the light of the fact that an estimated 1 million people in the US alone attempt suicide annually. "This is not a small group," she says.

While people living with a mental illness have been speaking out in greater numbers in the US and UK in recent years, Anna points out that, by contrast, suicide-attempt survivors remain largely in the shadows. She is an admirer of Alastair Campbell who, after Williams' death, wrote about his recurring suicidal thoughts, and of the UK's anti-stigma campaign, Time to Change, for featuring attempt survivors in its projects.

However, it is the rarity of examples of people with first-hand experience of suicide attempts being given a voice or supported that has driven Anna over the past three years to speak at public events and lobby on behalf of survivors.

It was her own fruitless searches for support groups online that spurred her to action. The vast majority of "survivor sites" and support groups she found were for people who had been bereaved by a suicide.

"I thought, surely there are organisations just for people like me. But there was this growing sense of amazement to find that there was nothing out there. You can find support groups for anything online, so to have this big echoing nothing was really startling. Do we no longer exist after an attempt?"

On a guest blog on Campbell's website last year, Anna wrote: "Anonymous suicide forums were shadowy and focused on feeling bad, not feeling better. I tried joining a depression forum or two, only to be solidly told that 'we don't talk about that here'."

In response, she launched her own support website, talkingaboutsuicide.com. The site harnesses her journalistic skills through blogging and by hosting interviews with other survivors. It soon made an impression and led to her being asked by the American Association of Suicidology (AAS) to manage a site for them, attemptsurvivors.com, on which she mostly curates the contributions of other survivors. Both sites point visitors to established organisations such as Samaritans that help people in crisis, and Anna makes it clear she is not an expert, therapist or counsellor.

She has recently joined forces with other outspoken survivors on a range of projects, including a documentary due for release in 2015, The "S" Word, which features another resourceful survivor, Dese'Rae L Stage. Her website, livethroughthis.org, uses photography and first-person stories of survivors to demystify the subject. Anna has also contributed to an online documentary released this year, A Voice at the Table, and to a report, The Way Forward, published in July as part of a taskforce set up by the US National Action Alliance for Suicide Prevention. The report proposes sweeping changes for the way suicide-attempt survivors are addressed and included.

The AAS, "after decades of nervousness" about involving attempt survivors in its activities, has this year created a specific division and hosted a "new voices" panel at its annual conference.

Anna says the reticence of survivors, wherever they live, to speak about their experience is often due to fear that it will come to "define" how they are seen or lead to discrimination. "It's such a heavy subject," she says, adding that being unable to talk or find the right support can exacerbate feelings of isolation - something that is another risk factor for suicide. Describing her own experience she adds: "[You think] 'What if everybody backs off? What if nobody wants to talk to me any more?'"

She is keen to work with survivors and prevention organisations in the UK as part of a burgeoning international advocacy network. Says Anna: "I am doing my best to break open a long-held and really dangerous taboo - dangerous in the sense that people are dying because they are too scared to talk about it."

Curriculum vitae

Age: 41.

Lives: New York.

Status: Single (divorced).

Education: Beech senior high school, Western Kentucky University, BA journalism.

Career: 2005-present: reporter/editor, global wire service; 2004: English teacher, Pakistan; 2000-02: technology and business reporter, Austin American-Statesman; 1999-2000: copy editor, Shanghai Daily; 1997-99: features writer, Palm Beach Post; 1995-97: Africa volunteer, Peace Corps.

Public life: Founder, Talking about Suicide website; National Action Alliance for Suicide Prevention attempt-survivor taskforce; co-chair, attempt-survivor taskforce, American Association of Suicidology.

Interests: Hiking, pizza, urban exploration, more pizza

* In the UK, the Samaritans can be contacted on 08457 90 90 90.
Topics

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'Is attempted suicide just so terribly shameful?'

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When Robin Williams' death was announced, much of the media in the UK and elsewhere speculated wildly about what might have caused him to take his own life. US-based journalist Cara Anna was following the coverage closely. However, unlike other reporters, her interest in the subject was more personal than professional.

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With her "multivalent" sex life and curious choice of subject, the American photographer was certainly odd - but not half as strange as the picture we've built of her since her death

In 1945, Diane Arbus sent a self-portrait to her husband, who had been posted to India during the war. She wasn't yet a photographer, but she knew how to use the huge Deardorff camera her father had bought for the couple in the hope that they might start a fashion and advertising business. Reflected in the bedroom mirror, Arbus is naked except for a pair of boyish white briefs, and she is pregnant. The camera stands next to her at shoulder height; her leg is draped around the tripod as if the apparatus were her partner and she were about to dance with it. Her eyes are directed at herself, not at the lens, which gives her a slightly faraway look, and her head is tilted as if in inquiry.

For all the difficulty of some of Arbus's future subjects, this is, to my mind, her most heartbreaking image. What took her from this moment, when she was about to produce a new life, to the day in 1971 when she ended her own?

"When I point my camera at something, I am asking a question," said Lisette Model, who taught Arbus at a critical point in her career, "and the photograph is sometimes an answer." Sometimes, but not always. Model taught Arbus to walk around with no film in her camera, just so she could practise seeing. That Arbus took photographs seriously only for the last 15 years of her life - and that those that made her famous were taken in the last nine - makes sense when you realise that for so much longer, she was looking.

It's easy to dislike Arbus's photographs. Dwarves, nudists, transvestites, looming faces lit by flash, identical twins who seem poised for horror: they are the opposite of discreet, and can feel like a provocation. But who is provoking whom? Is the photographer challenging the viewer? Is the subject confronting the photographer? Is there a victim in this scenario?

Susan Sontag cemented the fury of those who saw Arbus as an exploitative voyeur when she wrote against her in 1973 (the essay was later published in Sontag's seminal book On Photography). Arbus, she contended, sought out pain for her own purposes - and what's more, her suicide was the culmination of this strategy: it seemed "to guarantee that her work is sincere... as if it proved the photographs to have been a danger to her".

How Sontag could know this from looking at the pictures was never made clear, but that wasn't unusual. Arbus muddies the water: the link between her apparently friendly method and its apparently brutal result was so hard to trace that everyone looked to her life for clues. Her quest for outcasts, her appetite for group sex, her overdose: all seemed to offer themselves up in the service of her images. Thanks to the gatekeeping of Arbus's daughter, Doon, no biography of Arbus has ever contained any of her photos, a situation that makes the books seem embattled from the start.

Arbus's work first came to public attention in 1967, in a group show at the Museum of Modern Art in New York. The grouping was a little spurious: Lee Friedlander and Garry Winogrand were street photographers, and Arbus was a portraitist, but her subjects may have been too strange to be seen that way at the time. Entitled New Documents, the exhibition was based on the idea that the new documentarians were not recording the world with a view to changing it but simply in order to know it. "Their aim has been not to persuade but to understand," wrote the curator, John Szarkowski.

Key to all of this was an understanding of the photographic act as a transaction. The photographer wasn't stealing souls - far from it; she must give something of herself, too. Doon later described her mother's photographs as the result of "a kind of mutual seduction".

Unlike Walker Evans, who hid his camera in his coat, or Paul Strand, who attached a fake lens to the side of his so no one could see what he was really aiming at, Arbus considered her portraits to be collaborations. "Actually, they tend to like me," Arbus said of her subjects. Though she admitted, too, that "I think it does, a little, hurt to be photographed." The syntax of that sentence is typical of Arbus: "a little" being not so much a qualification as a brief delay before the final punch.

The latest blow to be dealt to Arbus herself is a hefty unauthorised biography by Arthur Lubow, a New York Times journalist with excellent credentials and meticulous methods, which makes his insensitivity all the more dispiriting.

Lubow is interested - as any thorough investigator would be - in what he calls Arbus's "multivalent" sex life. As a signal, he drops an early bomb: not only did Arbus experiment sexually with her brother, Howard Nemerov, when they were children, but the siblings continued to have sex throughout her life. The last occasion, Lubow asserts, was two weeks before Arbus's death.

Lubow is categorical about this. Even William Todd Schultz's 2011 An Emergency in Slow Motion, a much more speculative book whose main claim to publicity was interviews with Arbus's psychoanalyst, wasn't as certain as Lubow on that point. So what is Lubow's source? It's an interview with the very same analyst - Helen Boigon - conducted by Patricia Bosworth, Arbus's original biographer, in 1981. Lubow found it among Bosworth's papers and must have had her permission to use the material. So why didn't she?

Bosworth's biography never mentions Boigon by name. At the time, Boigon was still alive and so was Howard Nemerov, the American poet laureate, among other things (they died in 2009 and 1991, respectively). But who's to say whether the claim of incest is true: whether Arbus really said it, and whether the sort of analyst who would share this information after her suicide is a reliable witness? Could Arbus have been trying to outrage a therapist to whom she was in many ways already averse? It wouldn't have been out of keeping with the contemporary effect of some of her photographs, which Boigon professed to dislike.

Despite - or perhaps because of - her omissions, Bosworth's remains a much better book. It stays close to Arbus's eyes, if not taking on her point of view then at least looking outwards at the world from somewhere nearby. Lubow pins his subject under a microscope, and enlists as his helpers acquaintances who found Arbus exasperating and are finally prepared to say so.

This is, perhaps, an effect of the passing of time: as with Marilyn Monroe, whose death also involved barbiturates and whose doctor also saw fit to talk, would-be witnesses are bound to crawl out of the woodwork. But in the biography of a photographer, outlook is not irrelevant. Arbus was famous for the way she saw, not for how she was seen.

A far more interesting contribution is Diane Arbus: In the Beginning, a book published to accompany a Metropolitan Museum exhibition of her early work. It's often possible to trace the evolution of an artist's style, but it's rare to watch a photographer actually sneaking up on her subject before your eyes. The book and exhibition contain photographs Arbus made between 1956, when she left the studio she shared with her husband, and 1962, when she starting using a Rolleiflex and producing the images for which she is known.

Here, we find Arbus exploring worlds she would come to know better, but everything about the result is tentative. Her images are grainy, imprecise and haphazardly exposed; she hides round corners to get her shot; she takes photos in the dark, where she can't be seen - in cinemas, at night. Her subjects are fire-eaters, sword-swallowers, contortionists, female impersonators; she's fascinated by murder but stays safe by photographing a notorious recreation of one in a wax museum. She is protected by the artifice, and you can feel her distance.

In one significant contact sheet, a woman on a bus is photographed unawares, then photographed again, looking at the camera. What's striking about the shift is not just that the subject has redirected her gaze, but that Arbus has become emboldened too. The difference is subtle, but it's clear that Arbus has sat up, and aimed eye to eye.

In 1962, Arbus started to work with a twin-lens Rolleiflex. It seems silly to say that the camera was the making of her, but if Lisette Model's teachings held true, then what Arbus saw through that ground glass must have transformed her view of the world.

Her camera no longer covered her face, so she could engage with her subjects undisguised. The world in the waist-level viewfinder was symmetrical, yet backwards - a twist she might have enjoyed. The lens was a wide angle, which placed her at an intimate distance but made the background seem to swirl around the person she was portraying. Everything was close, a little distorted, and contained. All her best pictures - her engagements and insinuations into her subjects' lives - were taken this way.

In the last months of her life Arbus tried a new camera. It was heavier, and not square. Although she liked it, she told friends that her work had got "out of control". More specifically, she said her work was giving her "nothing back".

When she died she left no note. Doon got together with Arbus's lover, Marvin Israel, and they designed her legacy. It may or may not have been complicated by the fact that Doon and Israel were also lovers long before Arbus's death. All we can really know is what the photographer left behind. A photograph, she said, is "like a stain". "You can turn away but when you come back they'll still be there looking at you."
Diane Arbus: In the Beginning by Jeff L Rosenheim in published by Yale (£35). Diane Arbus: In the Beginning is on at the Met Breuer in New York until November 27. Diane Arbus: Portrait of a Photographer by Arthur Lubow is published by Cape (£35)

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Incest, suicide - and the real reason we should remember Diane Arbus

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With her "multivalent" sex life and curious choice of subject, the American photographer was certainly odd - but not half as strange as the picture we've built of her since her death In 1945, Diane Arbus sent a self-portrait to her husband, who had been posted to India during the war.

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