"Often it's a desperate plea for help," says Oliver Razum, a physician and professor of health science at the University of Bielefeld in western Germany. "But if someone jumps from a tall building, they intend to succeed."
Razum is a tall, thin man with thin glasses and a boyish haircut. The view from his seventh-floor office is of a concrete wall. He used to work as a district doctor in Zimbabwe, but now that he is a professor he spends his time writing equations like: "R = Number of cases in a period of time : population at risk in that period of time x 1000." Nowadays, he only addresses human suffering in the form of statistics.
About 20 percent of people in Germany come from immigrant backgrounds. Unemployment among this group is twice as high as it is among ethnic Germans. In Sema's neighborhood, 60.8 percent of residents are foreigners or of foreign origin. Of that number, 32 percent are Turks.
"The sick immigrant?" Razum asks from behind his desk. He smiles and says that this is not an accurate picture.
In fact, immigrants are generally not sicker than Germans. On the contrary, they are less likely to suffer from cardiovascular disease and intestinal cancer, and if they reach the age of 80, they tend to live longer than their German neighbors.
Are immigrants more suicidal?
"Not really," says Razum.
In fact, immigrants in general are three times less likely to commit suicide than Germans. But it's a different story with women, says Razum. Young women of Turkish origin, between the ages of 18 and 35, are particularly at risk.
Razum, the numbers man, was one of the people who had sent his statistics to Berlin physician Schouler-Ocak when she was doing her research. He has even more statistics in his records, including numbers that describe how immigrant women commit suicide: 43.3 percent hang themselves, 16.3 percent jump from tall buildings and 13.5 percent take pills.
When Sema tried to commit suicide, the doctors advised her to stay in the hospital for a few days longer. But her parents took her home and said nothing.
By then, more and more Turkish families were moving to the neighborhood where her family lived. In some cases, entire families had moved from their villages to the German city, where they lived together in their insular Anatolian community, living by the same rules and pressures that had applied at home in Turkey. Sema's parents didn't tell anyone what had happened.
"And that was that," says Sema. She also didn't speak with her parents, because her parents generally spoke very little with each other. Even today, when she is asked questions that relate to her parents, her answer always ends with the words: "As far as I know."
She says that she wanted to get out of her insular life. She didn't want to live the same life as her parents. Instead, she wanted a real profession.
That was the first time Sema tried to break out -- not backward, in the direction of death, but forward in the direction of life.
She began by picking up her little brother from kindergarten and babysitting. She cleaned toilets -- 30 a day -- to save money for a driver's license. She applied herself and did well in school. She attended a Realschule, the middle-level high school in Germany's three-tier system, and managed to get a high-school diploma after 10th grade. She was encouraged to continue her education at a university-track Gymnasium high school. There, she entered 11th grade with the intention of earning the qualification that would allow her to go to university. She wanted to become a doctor.
"A doctor?" her mother asked.
"A doctor?" her father asked. He said nothing and left the room. He refused to take her life seriously.
Fiancé Treated Her Like a Prisoner
Sema wanted to help herself and be a good German. Her parents wanted Sema to help herself and be a good Turkish woman. Somewhere between those two worlds, her strength ran out.
Sema left school soon afterwards and completed a training program as a dental assistant in a dentist's office in the neighborhood. Sometimes she would meet up with a young man who was also Turkish. They had known each other for a few years.
They were happy and they wanted to get married, and they told everyone about their plans. But things changed after they got engaged. The man started hitting her. Sema doesn't explain how or why.
She says that he took everything away from her, including her mobile phone and her keys. He locked her into the apartment and treated her like a prisoner, making sure that she couldn't escape.
"The women are always oppressed," says Sema.
"The men often keep the role-playing going. They do what their fathers did, but perhaps in a different way," says Schouler-Ocak, the doctor from the Charité hospital in Berlin.
Sema's father, concerned about his honor, tried to hold onto everything, his business, his family, his plan for life. He felt threatened when Sema broke away, just as her fiancé felt threatened when she told him that this wasn't the way she wanted to live, and that she wanted a different life, a more German life.
When Sema asked her Turkish aunts for advice, they said: "It's not so bad."
At some point Sema was convinced that she had no choice but to get married. Otherwise the people in the coffee shop would talk. They would look askance at her father and say that his daughter had refused to get married.
Sema didn't want her father to feel ashamed when he walked through the Turkish village in the middle of Berlin. She still craved his approval, but ever since they had returned from Turkey, he had never looked at her in quite the same way as he had during those weeks, when she could be a child.
A Second Suicide Attempt
She got up on a chair and tried to throw herself out of the window of her parents' apartment. She was 19 when she tried to kill herself the second time, a few weeks before the wedding. But her parents held her back.
Sema told them that everything was OK, and that she wanted to sleep for a while. When she was alone, she got up and swallowed every pill she could find. She took four bottles of pills this time, her mother's sleeping pills and antidepressants.
When Sema opened her eyes again, she was in the intensive care unit. She had been under for two days. Now she was disappointed that it hadn't worked.
After four days in the hospital, Sema went back home and married the man who locked her up. She wore a white dress with a corsage and spaghetti straps.
The couple moved into a small apartment. They had no work, but Sema found cleaning jobs and saved enough money to buy a couch. She had her first daughter at 24 and her second daughter soon afterwards. Everything will be OK now, Sema thought.
She took care of the children while her husband watched TV, played with his mobile phone or went to an amusement arcade. Sema felt alone, just as she had felt alone when she was a little girl.
Then she became sick. She heard voices and smelled things that didn't exist. A doctor prescribed medication and diagnosed her with a severe depressive disorder. At 26, Sema had hit rock bottom for the third time.
"Many don't even know who to turn to," says Schouler-Ocak. "Or they do know but don't go, because other people could see them."
Seeking counseling could mean being seen as crazy, and many young Turkish women are afraid of gossip. In their families, it's important not to attract attention.
There is a particular sentence that kept cropping up in the interviews she conducted, says Schouler-Ocak: "Berlin is a big place, but everyone knows everyone else."
The project Schouler-Ocak heads continues until the end of September. After that, a decision will be made as to what happens next. The Berlin crisis service will take over the hotline, at least for one day a week, because so many women have been calling in.
'I Want to Have a Life'
Sema is still in psychological treatment, and she is taking her medication. She walks around in the streets a lot these days, she says. "I want to have a life, too," she says.
"It's not so bad," say Sema's aunts whenever she asks for their opinion.
Sema says that she has an image in her head. In it, the mother, the father and the child are standing next to each other. The mother and the father go to work. The mother and the father save money and go on vacation.
It's an image of a German family.