Discussing 13 Reasons Why With Patients
Drs Goldberg and Domakonda: How do you recommend that physicians approach the series, and its potential consequences, with their patients? Should physicians be preemptively discussing the show with children and teens?
Dr Gould: Yes. Primary care physicians should be proactive with the teens and parents in their practices and not wait for children and teens to bring it up. Just as they are hopefully doing some psychosocial assessments or screening for depression and suicidality, they should be inquisitive about what teens are watching.
I do not recommend bringing up 13 Reasons Why specifically because that may trigger otherwise unaware teens to seek out the show. But providers might ask about time spent on social media, popular TV shows, or the latest music trends. They could also ask their patients if they have seen anything lately that their peers are buzzing about, or if something has recently been very controversial or upsetting. This way physicians can explore what their patients are viewing in an unbiased manner and address things as they come up.
Drs Goldberg and Domakonda: Has the show resulted in suicide contagion—in other words, more adolescents attempting suicide as a direct result of the show?
Dr Gould: There have been decades of research describing contagion and the impact of the media on suicidal behavior. But I generally do not like the idea of "copycat" suicides because this term suggests that the show was the only cause of the suicide. We know that when people die by suicide, they typically have an underlying vulnerability or other mental illness. But a series like this can definitely give them the wrong impression about how to cope with the problems they have.
It is too early to tell if the show will have a direct impact, but I have heard from colleagues about teens binge-watching the show and presenting to the emergency department after a suicide attempt. Time will tell about the broader impact of this far-reaching series.
Drs Goldberg and Domakonda: Do you feel that the show improves or adds to the stigmatization of psychiatric illness? Do you think it distorts the scientific/real facts about mental illness?
Dr Gould: I think the series could add to the stigmatization of psychiatric illness by presenting youth suicide as an inevitable consequence of psychiatric problems. Yes, the rates of youth suicide have unfortunately been increasing over the years, but we know that the vast majority of adolescents with psychiatric illness do not engage in suicidal behavior. Furthermore, most adolescents who attempt suicide do not reattempt or commit suicide. The majority go on to recover but with help with proper treatment. Overall, the show brought awareness about suicide, but it did so in a way that reinforced stigma by not highlighting treatment and recovery.
The series also failed to show any coping strategies for dealing with bullying behavior, including cyberbullying. The association between cyberbullying and suicide is complicated. They are associated, but it is inaccurate to say that cyberbullying, or even sexual assault, is the only reason someone dies by suicide. If the show had changed the narrative in subtle ways and focused on recovery, it could have had the potential to do a lot of good. Suicide was presented as an option, and it should never be an option.
Medscape Psychiatry © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: New Show 13 Reasons Why Reinforces Dangerous Teen Suicide Myths - Medscape - Jun 15, 2017.