New Show '13 Reasons Why' Reinforces Teen Suicide Myths

Revenge vs Regret

Drs Goldberg and Domakonda: The show's producers, among them Selena Gomez, felt that it was important to show the graphic nature of Hannah's suicide to raise awareness about the issue. Do you agree? What do you think about how Hannah's suicide was depicted?

Dr Gould: I have heard people complain about the depiction of her death. I am not as much upset by its graphic nature as I am by the fact that it shows a romanticized version of suicide. Hannah's expression suggests some pain after she cuts herself, but it is short-lived, and the next scene is of her falling asleep peacefully in a warm bathtub. This image of the warm bathtub, usually associated with something soothing and comforting, is a far cry from our understanding of how suicide survivors usually feel in the moment—terrified, hysterical, and riddled with extreme regret.

Kevin Hines, who jumped from the Golden Gate Bridge in 2000, has since become a suicide prevention advocate and speaker and talks quite forthrightly about his mindset during his attempt. He says that as soon as he jumped, he realized that all of the problems he thought were so serious in his life—while they existed—were not nearly as serious as the major mistake he made by jumping off of the bridge. He talks to young audiences about that sense of regret and has been very influential in people thinking, "Oh, my God, I don't want to end my life thinking this is the biggest mistake I've made."

I would rather have seen Hannah do that—cut her wrist and go, "Oh, my God!" or try to stop the bleeding or get help. That way, even if she ultimately died, it would not have reinforced the idea of suicide as a peaceful way out of your problems.

I think that one of the worst parts of the show is that Hannah narrates the story after her death, which feeds into the fantasy that you can take revenge on people and see how events unfold after you die, like watching your own funeral. Regarding suicide prevention, I think it would have been much more effective for the producers to show Hannah survive her suicide attempt and re-emerge 20 years later as a famous poet. Or to show up at her high school reunion as someone famous—that would have been a better revenge.

Drs Goldberg and Domakonda: Art has always brought up similar examples of struggles and suicide. For instance, literature has the example of William Shakespeare's Romeo and Juliet or J. W. von Goethe's The Sorrows of Young Werther and innumerable movies and plays. Is 13 Reasons Why any different?

Dr Gould: It is very similar to The Sorrows of Young Werther. In fact, the impact that the media has on subsequent suicides is actually called the "Werther effect" after The Sorrows of Young Werther. The book was actually banned in Europe after publication because young men were dressing in the same style that was depicted in the book and dying in the same way, holding the book.

On the other hand, more recent research has shown that when the media portray suicide as something surmountable, and a suicidal person who, despite their depression, remains hopeful and engages in healthy coping strategies, youth may be more apt to do the same. This converse effect has been termed the "Papageno effect" after Mozart's The Magic Flute. There, the main character is suicidal but doesn't engage in suicidal behavior. That term was a spinoff of the "Werther effect." So overall, I do not think 13 Reasons Why is much different, although it is much more easily accessible.

Drs Goldberg and Domakonda: Should the book or the show be banned?

Dr Gould: I do not support banning literature. (As you know, The Sorrows of Young Werther was banned in Europe.) I think, as Americans, we are particularly averse to that idea, and it can be a slippery slope.

So given that we have the show, as physicians we now have an obligation to counterbalance whatever negative impact the series is likely to have by enhancing resources for teens, parents, school, and providers. The goal now is for mental health professionals and others working with children and teens to have an armamentarium of resources for the populations who are bound to be affected by the series.

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