Teen suicide has been in the spotlight since the release of Netflix's controversial new show 13 Reasons Why, based on Jay Asher's popular book of the same name. Although the show's producers aimed to raise awareness about suicide, mental health professionals, parents, and school officials have argued that the show glamorizes suicide and does little to guide teens who are struggling with suicidal thoughts.
Suicide is the second-leading cause of death for youth aged 15-24 years and takes the lives of more teenagers and young adults than cancer, heart disease, diabetes, congenital birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.
Madelyn Gould, PhD, MD, professor of epidemiology in psychiatry at Columbia University in New York City, is an expert on teen suicide and the impact of the media on mental health. She sat down with Pablo Goldberg, MD, and Mirjana Domakonda, MD, both child psychiatrists at Columbia University, to discuss her concerns about the show and thoughts on what physicians need to know about how the show may be affecting their patients and their families.
Dangers of Depiction
Drs Goldberg and Domakonda: By now we know you have heard about the show 13 Reasons Why and have been part of the conversation surrounding its controversy. Have you seen the show; and, if so, how do you feel about it? Do you agree with the show's depiction of suicide?
Dr Gould: I first read the book several years ago on the urging, actually, of child psychiatrists in our division whose patients were starting to come in talking about it. When I read it then, I was really concerned. I then watched the series [based on it], and not only am I still concerned, but my concerns have amplified. The concerns I had with the book and the series are that they present teen suicide in a way that is likely to reinforce the behavior, and they also present help-seeking as a pointless endeavor, ultimately reducing the likelihood that a troubled young person will seek out an adult for help.
For at least a few decades, there has been extensive research on the impact of the media on subsequent deaths by suicide. Whether it is nonfictional stories about suicides or fictional depictions of suicide, how you present the information or the story can have a very different impact. If you sensationalize suicide and portray it as a behavior that yields rewards such as revenge, that has been associated with subsequent deaths by suicide. If you discuss suicide, but your protagonist does not engage in suicidal behavior but rather adaptive coping strategies, there is new research that shows that such stories yield a significant decrease in completed suicides. The site reportingonsuicide.org has a resource that anyone can download about how to safely portray suicide in the media. The media has a lot of power to influence young individuals, and I think in this case that the show's producers were careless with their representation of suicidal youth and their options.
Drs Goldberg and Domakonda: Why do you feel that 13 Reasons Why is particularly harmful for teens?
Dr Gould: The series does a number of things that are potentially harmful. First, as I mentioned, it presents help-seeking as a somewhat fruitless activity, painting both parents and school guidance counselors as useless. Second, Hannah is a very appealing character, and many teenagers can identify with her problems. By having her die by suicide, it not only reinforces the behavior but glamorizes suicide as a solution. The vast majority of young people who experience depression or similar life stressors do not go on to die by suicide. It is very unfortunate that the producers chose to show that the only way to cope with these problems and open up lines of communication is to kill yourself.
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Cite this: New Show 13 Reasons Why Reinforces Dangerous Teen Suicide Myths - Medscape - Jun 15, 2017.