'13 Reasons Why': When it comes to suicide, not all ‘conversations’ are equal.
With the second season of Netflix's '13 Reasons Why' releasing soon,
medical experts are still concerned that the series glamorizes suicide.
USA TODAY
Netflix's popular show '13 Reasons Why' promotes a problematic picture of suicide and doesn't encourage those affected to seek help.
In the past month, our two research teams independently published separate studies examining suicide deaths in the U.S. following the first season of "13 Reasons Why."
Although
there are nuanced differences between the study designs and findings,
most particularly that the rise in deaths was more prominent in young
women than young men when ages 18 and 19 were considered “youth,” the
underlying conclusions are the same: Suicides increased suddenly
above and beyond what was expected given preexisting trends and only in
youth in the months following the show. Although not definitive proof,
this pattern of an abrupt, significant rise in suicide has all of the hallmarks of a media contagion event.
In response to these findings, a Netflix spokesperson wrote,
“ '13 Reasons Why' tackles the uncomfortable reality of life for many
young people today and we've heard from them, as well as medical
experts, that it gave many viewers the courage to speak up and get
help.”
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Although
some Season 1 viewers surveyed in research studies reported benefits,
including improved mood and decreased participation in bullying, we
think it is important to highlight that this assessment of benefits from
the show paints an incomplete picture. The argument that "13 Reasons
Why" might improve the lives of young viewers positions the series as a
public health intervention of sorts. And like any other health
intervention, it must be evaluated not only based on its benefits but
also its harms.
Read more commentary:
'13 Reasons Why' should have featured resilience
Netflix’s
statement disregards the now growing evidence that the series, which
wanted to start a conversation on suicide, might have contributed to
suicidal thinking, attempts and even deaths in some youth. Researchers
found an increase in pediatric emergency visits after Season 1 was
released as well as copycat suicide attempts and gestures in youth who
watched the show. Most troubling, the increases in suicide rates that we
found are entirely consistent with the possibility that some of those
copycat acts tragically ended in death.
Netflix has
responded to the data in a way that would be logical if "13 Reasons
Why" were just any show. They note that they have received feedback from
viewers who say they like it and derive benefit from it, and
that anyone else doesn’t have to watch.
The problem is that the stakes make the "conversation" about suicide
different. Public relations efforts that fail to acknowledge the very
real possibility of harm can at best be viewed as misguided and at worst
a reckless abdication of responsibility.
The
conversation about suicide is not like other conversations. While we
know that certain content can make the problem of suicide worse,
research over the past decade shows that portraying suicide can be done safely and responsibly.
Stories that do not present suicide as the only feasible option to cope
with life adversity, and that feature people who have managed to be
resilient in the face of suicidal crises, have a powerful potential to
start a conversation about suicide that is both engaging and safe.
Suicide is fundamentally a public health issue. We know that its underlying causes are complex, but mental illness commonly plays a major role. Most suicidal crises are short-lived,
especially in young people, and there are numerous evidence-based
treatments and competent providers able to help those in need to develop
effective strategies to manage suicidal thoughts. Almost everyone with
thoughts of ending their life finds a way to be resilient, and the cases
where youth do die by suicide should be understood as preventable
tragedies that do not serve as a means of "enlightening" or
"educating" those left behind.
Sadly, these truths
are all missing in the first season of "13 Reasons Why," replaced by
the exact opposite, popular myths and inaccurate information. Rather
than providing valuable information about ways to cope with suicidal
thoughts and behavior, the show glorifies its protagonist’s death, including a graphic depiction of how she died. Most important, the show portrays getting help for suicidal thoughts as absolutely futile, even counterproductive.
This is a dangerous message to vulnerable teens who could benefit from
mental health treatment. Ultimately, the show violated the majority of
expert recommendations for safe portrayals of suicide in the media.
Entertainment can help prevent suicide
We
should note that we do have an agenda here — a desire for fewer suicide
deaths — although there is no agenda against the entertainment
industry. We would have been pleased to report that a television show
had been accompanied by a reduction in suicides had that been the case.
However, any objective analysis of this particular "conversation" would conclude that there is reasonable evidence
showing that the harms have clearly outweighed any benefits, which is
no surprise given its content. In the end, the creators of "13 Reasons
Why" have started a different conversation than the one originally
intended about the responsibility of the entertainment industry when it
comes to depicting suicide. Given that suicide is a health issue, a good
starting point would be to think about how other health issues are
treated in TV and film.
For example, we no longer see portrayals of young identifiable characters enjoying a cigarette
or talking about how it helps them lose weight. It’s true that some
youth viewers exposed to such a show might still find smoking
unappealing, but evidence from our past suggests that smoking rates
might rise overall.
Efforts by the entertainment industry in the early 1990s to educate people about HIV, perhaps most famously the movie "Philadelphia,"
are another example. We no longer see media depicting people with HIV
as dangerous or frightening. It may be that some viewers would respond
to that with empathy but, again, we know that many would probably take
harmful myths about HIV seriously and could stigmatize sufferers.
Importantly,
these trends in the entertainment industry did not arise through
censorship. No one said producers are forbidden from creating that
content, nor are we suggesting that the entertainment media have no role
in educating the public on the topic of suicide. In fact, conversations
about suicide that confront this issue compassionately, accurately and
productively are an important part of global efforts to prevent suicide.
Sensational portrayals of suicide are deadly
We
desperately need the entertainment industry to take a greater interest
and to feel a greater moral obligation to present suicide as it really
is — including, most important, that suicide is never the only option.
Pointing to some evidence of benefit does not and cannot negate or
outweigh harm in terms of suicide attempts and deaths. Certainly, we
should not accept that sort of reasoning in the case of "13 Reasons
Why." In fact, when the negatives seem to be worse than the positives,
there is a strong argument that it may be better not to have that
particular conversation at all.
We must insist that
when tackling the topic of youth suicide, the entertainment industry,
at a minimum, avoids contributing to one of the world’s most concerning
public health issues. Sensationalized portrayals
of suicide that send the message that help is not available for those
in distress undermine this critically important conversation. Like it or
not, in today’s society we have to have an open and direct conversation
with our kids about mental health and suicide. Let’s make it a good
one.
Suicide Lifeline: If you or someone you
know may be struggling with suicidal thoughts you can call the National
Suicide Prevention Lifeline at 800-273-TALK (8255) any time of day or
night or chat online. Crisis Text Line provides free, 24/7, confidential
support via text message to people in crisis when they dial 741741.
Dr.
Mark Sinyor, Dr. Thomas Niederkrotenthaler, John Ackerman and Jeff
Bridge are researchers from the University of Toronto, the Medical
University of Vienna and the Abigail Wexner Research Institute at
Nationwide Children’s Hospital, respectively. They authored research examining suicide deaths following the release of "13 Reasons Why."
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