Could 13 Reasons Why Spur an Increase in Teen Suicide? Research Supports the Possibility

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“Why did the show depict Hannah’s suicide in such a graphic manner? Was it necessary?  And could it actually spur copycat suicides?”

Netflix’s newest sensation is sparking a larger conversation around suicide, rape, and bullying.  In our multi-part series on 13 Reasons Why, one mental health professional will explore the psychological aspects presented in the show.  Next up, a psychological Analysis on teen suicide and the threat of contagion.

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources. 

Warning:  The following article contains spoilers for the Netflix television series 13 Reasons Why.

Warning:  The following article contains graphic descriptions of suicide.  Please be advised this may trigger some folks who struggle with mental illness or have any personal experience of, or connection to, suicide.

teenLast Sunday evening my wife and I finished watching the penultimate episode of 13 Reasons Why.  We were both tense, uncomfortable, and a bit ambivalent about watching the last episode.  We were captivated by the show and wanted to know how things played out for all the characters still alive and reeling from Hannah’s suicide.

But my wife and I also felt uneasy about the last episode.  We knew it included Hannah’s suicide.  The trigger warning at the beginning of the episode reminded us that it would be included in the show.  I had already read articles alerting me to the content.  Everyone involved in the creation of the show has relentlessly advocated that the suicide needed to be depicted in a drawn out, gory scene.  Their thinking is only a realistic depiction of suicide could deter young viewers from contemplating or attempting suicide.

Sociologists have long known that individuals who have strong social bonds have less risk in killing themselves, but sometimes the opposite is true.  Research supports that one person’s suicidal behavior can spur another’s, and one death can lead to more deaths.

All of this information compels me to question – why did the show choose to be as gruesome and graphic in showing Hannah’s suicide?  And could it actually lead to an increase in teen suicides?

Why Did 13 Reasons Why Show Hannah’s Suicide?

In the final episode, the show depicts in a graphic manner Hannah’s method of suicide.  The camera doesn’t look away, leaving it to the viewer to decide whether or not to watch Hannah’s suicide.  This decision to show the suicide in such gruesome fashion has sparked a larger conversation about sensationalizing suicide, the risk of glamorizing it, and why it was necessary.

Screenwriter and show creator Brian Yorkey said, “We’ve had a number of people ask us along the way why we had Hannah kill herself in the way we did, and why we showed it,” Brian said. “We worked very hard not to be gratuitous, but we did want it to be painful to watch, because we wanted to be very clear that there is nothing in any way worthwhile about suicide.”  The showrunners wanted it to be a difficult scene to watch. The intention was to send viewers the potentially life-saving message that suicide is never a glamorous choice.

But was it the correct call?  Did mental health professionals sign off on this decision?  And does it achieve its intended hope?

Teen Suicide is a National Crisis!

As a mental health professional, I support raising awareness and increasing support and resources to decrease suicides in the US.  I’m all for it, because our country has a serious suicide problem.

Suicide rates for teens and youth have been increasing for the past 12-14 years.  Teen suicide rates increased 25% from 1999 to 2014.  Suicide is the second leading cause of death for ages 10-24.  It is the second leading cause of death for college-age youth.  It is the second leading cause of death for children ages 12-18.  While other causes of death are on the decline, suicide keeps climbing – and it’s doing so for every age group under 75.

There is one age group that really stands out — girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over a 15-year period.  More than three times as many teens are killing themselves now than in the 1950s.  And with an increase in teen suicide comes a greater risk for copycat suicide.

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What is Suicide Contagion?

Suicide Contagion or “Copycat Suicide” occurs when one or more suicides are reported in a way that contributes to another suicide.  Evidence supports that suicidal behavior is “contagious” in that it can be transmitted, directly or indirectly, from one person to another.  The evidence to support the threat of Contagion comes from three bodies of research:

  • Studies of the impact of media reporting on suicide
  • Studies of suicide clusters
  • Studies of the impact on adolescents of exposure to a suicidal peer.

Data from the National Longitudinal Study of Adolescent Health found that “teens who know friends or family members who have attempted suicide are about three times more likely to attempt suicide than are teens who do not know someone who attempted suicide.”

So one of the biggest contributors to copycat suicides is how suicide is reported and portrayed in the media.  Given how 13 Reasons Why decided to tackle the topic, what are the recommended guidelines and how closely did 13 Reasons Why follow them?

Who’s at a Greater Risk for Contagion?

All the research points to the highest risk population being individuals with a recent history of suicide attempt and/or a concurrent severe depression are more likely to attempt suicide in the wake of a media report.  But an adolescent’s mental health history is a bigger predictor of future suicidal behavior than any relationship to a suicide victim.  Adolescents and teens with mental health struggles are the most vulnerable to contemplating suicide after hearing about it from friends, from the media, or in entertainment.

Guidelines for Suicide Reporting in the Media

More than 50 research studies worldwide have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals.  Media coverage of real-life suicides can have real-life implications.

That is why the American Foundation for Suicide Prevention, along with dozens of medical, educational, and religious organizations, created specific guidelines for media and online coverage of suicide.

An example of the guidelines and recommendation would be:

  • Instead of big or sensationalistic headlines, inform the audience without sensationalizing (“Kurt Cobain Used Shotgun to Commit Suicide” vs. “Kurt Cobain Dead at 27”)

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When Marilyn Monroe died in August 1962, the nation reacted to the cause listed as probable suicide.  The coverage was relentless and the suicide rate in the U.S. jumped by 12 percent compared with the same months in the previous year.

However, when Kurt Cobain of Nirvana was found dead in 1994, local coverage of his suicide was closely tied to messages about treatment for mental health and suicide prevention, along with a very public discussion of the pain his death caused his family.  In the months after Cobain’s death, calls to suicide prevention lines in the Seattle area surged and suicides actually went down.

Can Suicide Depiction in Fictionalized Shows Impact Suicide Rates?

Most of the research on the impact of media reporting on suicide has addressed nonfictional reporting, which has been shown to have a more powerful effect.  However, research does show an increase in suicide rates after fictional stories about suicide.

Data shows a correlation of lower suicide rates and risk for countries where reporting tended to portray the suicide victim and the act of suicide in terms of psychopathology and abnormality, and to describe the negative consequences of the suicide.

One study gathered data the leading before and after a suicide was depicted in a weekly television show.  Emergency rooms across the country reported a 17% increase of suicide by the exact same method the week after the episode aired and an additional 9% increase in the second week.  The specific type of poison used doubled after the episode aired.

Fictional portrayals of suicide can have a dramatic impact on suicide attempts.  A recent meta-analysis found youths are particularly at risk of suicide suggestion via fictional suicides.

Following the media guidelines for suicide coverage and reporting has proven to dramatically decrease the effects of suicide contagion.  And given the reality that fictionalized depictions of suicide can contribute to copycat suicides or a contagion effect, does the suicide depiction in 13 Reasons Why follow the guidelines?

Why 13 Reasons Why Ultimately Failed

Did 13 Reasons Why sensationalize suicide?  In my professional and personal opinion – YES.  Yes, the show depicted a graphic and gratuitous suicide.  One interesting fact about 13 Reasons Why is that in the original book, it’s only implied that Hannah dies after overdosing on pills.  And the early version of the book didn’t originally end with the main character dying of suicide. But the novel’s author, Jay Asher, said his editors wanted a death instead.  And then the showrunners switched her method of suicide so that it would be more graphic – how is that not sensationalizing suicide?

If the hope of the showrunners was they wanted to depict that there is nothing in any way worthwhile about suicide, wouldn’t that be a message intended to those who might be struggling or considering suicide as a viable option?  Folks who are not at risk for suicide don’t need the message that suicide with a senseless tragedy.  Kids who may see it as a solution need that message.  And this is not a show that will help those folks.

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Guidelines recommend against “any photo or video of the method of death.”  13 Reasons Why disregarded the guidelines.  But it wasn’t only the depiction of suicide where 13 Reasons Why failed.  Suicide is more than just an act.  The setup and entire premise of the show fails one of the key recommendations for reporting on suicide.  It is advised against reporting the content of a suicide note.  The entire show and source material centers around the 13 specific reasons that Hannah Baker killed herself.  The show is essentially focusing on 13 suicide notes.

Perhaps the creators were not familiar with recommended guidelines for depicting suicide.  Perhaps they disregarded them.  Although they had mental health professionals consult for the show, perhaps not all of their recommendations were followed.  It’s difficult to know how much 13 Reasons Why consulted mental health professionals to help with the show, vs. they consulted with them to be able to publicly declare that mental health professionals were involved with the show.

Additional Steps They Could Have Taken

Some coverage of suicide may contribute to contagion while other characteristics may help prevent suicide.  Only time will tell if 13 Reasons Why indeed contributes to contagion.  In my professional opinion, the showrunners and Netflix could have done more increase positive awareness and decrease the possibility of contagion.  It’s impossible to know what the mental health consultants advised, but some easy steps that could have been taken include:

  • More specific trigger warnings at the beginning of episodes containing sensitive topics
  • Advising folks NOT TO WATCH specific episodes that depicted sexual assault and suicide if they have a personal history with the subject matter
  • The creators could have invested more time into supplementary content after each individual episode where folks involved with the show and mental health professionals could discuss the subject matter. AMC’s Talking Dead is a full hour-long show that breaks down each episode of The Walking Dead.  The show instead created one, 30 minute companion show.

I mostly believe the show had good intentions.  I believe they genuinely wanted 13 Reasons Why to spark more awareness and conversation about suicide, mental health, and getting help.  But you don’t really achieve this by showing how gruesome and painful suicide is.  A person contemplating suicide is already in pain.

No, you help suicidal people by showing them that there are people who genuinely love and care about them.  You show stories of folks dealing with their pain, getting help, and overcoming trauma.  You tell them and show them that things can get better for them.  You show things getting better for folks like them.  You give them hope.  This show really offered no hope.  13 Reasons Why did not positively portray any of the above scenarios.

Neither my wife nor I could make it all the way thru the suicide scene.  My wife looked away before it began.  And as the scene played out for an unbearably long time, I couldn’t bear to watch.

As a piece of entertainment, 13 Reasons Why did not fail me.  I was riveted by the story, and I was impressed by the casting and performances.  But I’m afraid the show failed in its hope to be a strong advocate for suicide awareness and prevention.  And my biggest fear that they failed the very people who need support, those who are at the greatest risk for suicide.

Should Teens Watch 13 Reasons Why?

I strongly urge parents to talk with their teens about the show, regardless if they want to watch, plan to watch, or have already viewed it.  I’m confident they’ve heard of 13 Reasons Why.  The show is the “buzziest ever show” after it generated more tweets in its first week of release than any of the streaming service’s other original series.

I would recommend against adolescents and teens watching the show if they have any recent history of mental health struggles, especially; self-harm, sexual assault, suicide history, and major depression.

If they plan to watch it, I recommend they watch it with a parent or an adult.  I recommend they do not watch it alone or binge-watch several episodes in a row.  Parents and teens would be wise to talk about each episode and process their thoughts and emotions about what is depicted.

And I strongly recommend talking with someone if you, or someone you know, is struggling with mental illness or suicidal thoughts.

Stay tuned in my multi-part series where I will explore:

  • The unrelenting anguish of suicide
  • Current trends in teen culture, specifically around mental health and other topics addressed in the show
  • 13 things the show gets right about mental health
  • 13 things that are problematic about the show

And next up: The character of Hannah and her mental and emotional state

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources. 

http://www.shrinktank.com/psychological-analysis-of-13-reasons-why-the-unrelenting-anguish-of-suicide/

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Jonathan Hetterly, LPC

Jonathan Hetterly is a licensed professional counselor. He specializes in helping teen and young adult men navigate the challenges they face in life. Jonathan is also a writer and his articles are regularly featured on ShrinkTank.com. He has also contributed material to several books that explore the intersection of pop culture and psychology, including The Walking Dead Psychology, Star Wars Psychology, and Game of Thrones Psychology. Follow him on Twitter @jhetterly.

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