Suicide Contagion and “13 Reasons Why”

I don’t really want to read one more thing about suicide in 13 Reasons Why, let alone add to the mix. But I think it’s necessary. Many articles and essays I read about the show are based on emotion, without acknowledging the very well-researched phenomenon of suicide contagion. The more that people understand the facts about this phenomenon, the better. Here goes.

Is Suicide Really Contagious?

Suicide contagion is real, with four decades of research to back up its existence. It is a tricky issue. On the one hand, researchers know that asking people if they are thinking of suicide does not trigger suicidal impulses. On the other hand, we also know that news articles, TV shows, and movies about suicide can lead to an increase in suicides. Contagion doesn’t happen all the time, but it happens often enough to cause tremendous concern.

The contagion effect is also called the Werther effect, so named for the novel The Sorrows of the Young Werther. Written by Goethe in 1774, the novel’s central character, a young man, dies by suicide. Following the book’s publication, waves of suicide reportedly occurred among young men in Europe, where the book was published, and authorities in Italy and Copenhagen banned the book entirely.

Some people also refer to suicide contagion as the copycat effect. Researchers have found evidence of copycat suicides after the deaths of celebrities such as Marilyn Monroe. Especially relevant in the case of 13 Reasons Why, researchers also uncovered suicide contagion after a 6-episode TV series ran in the 1980s.

The 1980s series showed the suicide of a 19-year-old man, who intentionally got hit by a train. In the 70 days following the series, railway suicides increased, according to this study. Tellingly, the contagion effect was strongest among those who were the same age and gender as the character who died by suicide. Among 15- to 19-year-old males, the rate of railway suicides went up 175%.

It’s not that someone who’s healthy and happy would watch a TV show or, say, a Netflix series and suddenly become suicidal. It’s that someone who already has suicidal tendencies, depression, and other vulnerabilities could watch a show about suicide and then be moved to act on those thoughts. These things certainly are not a show’s fault directly, but the producers have a responsibility to keep in mind the research on suicide contagion and take protective measures accordingly, such as providing hotline numbers or other information to help vulnerable people.

The Dangerous Failures of “13 Reasons Why”

The producers of 13 Reasons Why ignored the enormous responsibility they had to help deter vulnerable people from acting on suicidal thoughts in response to the series. Whether or not you think that the show is constructive in some ways or that it should never have been made, there indisputably are things the producers could have done to head off copycat suicides.

After Kurt Cobain died by suicide in 1994, many suicide prevention advocates feared that his death would inspire copycat suicides among vulnerable youth in the Seattle area. To help prevent this from happening, suicide prevention advocates, crisis centers, and others did a massive outreach to the local media. This led to newspapers and television stations providing numbers to crisis hotlines with each story about Cobain’s death.

Researchers looked at suicide rates in the months following Cobain’s death. It turns out that the suicide rate did not increase in Seattle and nearby. But guess what did increase substantially? Calls to the local crisis hotline. The awareness campaign had worked.

In the same way, the producers of 13 Reasons Why had the opportunity – and obligation, I believe – to help prevent tragedies.

Potential Remedies to Suicide Contagion

So, what could the show’s producers have done instead? First, the producers could have looked to these guidelines for media portrayals of suicide.

One thing these guidelines call for is not providing graphic information about suicide methods. The graphic scene of Hannah’s suicide has inspired passionate debate. Some say it triggers and traumatizes vulnerable youth, while others say its brutality can steer people away from suicide. For example, this is from one of the show’s writers, Brian Yorkey: “Many people are accusing the show of glamorizing suicide and I feel strongly — and I think everyone who made the show — feel very strongly that we did the exact opposite. What we did was portray suicide and we portrayed it as very ugly and very damaging.”

I choose not to see the scene, so I will say only that I think there are other ways to portray suicide as “very ugly and very damaging” without exposing vulnerable people to traumatic images. The American Psychiatric Association acknowledges in the DSM-5, the diagnostic “bible” in the mental health field in the U.S., that watching a movie with traumatic material can lead to PTSD when the person is required to watch it for their job. In this case, nobody was required to watch the suicide scene, but once you see something, you cannot un-see it.

Another media guideline calls for providing information about how to get help whenever portraying suicide in television, newspapers, or shows. This is where the 13 Reasons Why folks failed terribly.

How hard would it be for the show’s producers to provide numbers at the end of each episode for the National Suicide Prevention Hotline (988 or 1.800.273.8255), the Crisis Text Line (text 741741), and other resources such as To Write Love on Her Arms, a group that is popular with young people?

How hard would it be to have someone say at the end of each episode that, generally speaking, suicide is preventable and mental illness is treatable? This same person or voice-over could also give information about ways to recover from the traumas of sexual assault and bullying.

How hard would it be for the show’s producers to sponsor a social media campaign on Facebook, with Selena Gomez at the forefront, detailing all the reasons why – and there are far more than 13 – Hannah’s suicide need not have happened?

There is a 30-minute show, Beyond The Reasons, where Selena Gomez and others discuss suicide, bullying, sexual assault, and mental illness, and they provide resources for getting help. That is a good contribution, but it requires viewers to wait too long to receive the information. Again, why not flash the numbers to the hotline and text line?

To their credit, the show’s creators hired mental health experts to provide guidance for the show. At first, I thought those experts failed either at providing truly expert advice based on decades of research, or at persuading the show’s producers to do the right thing.

Then I read this article, in which one of the “experts” states the research about suicide risk isn’t definitive. Little to no research in the social sciences is 100% definitive, but the evidence is definitely overwhelming that contagion can occur. In particular, the study of the 1980s series I mentioned above provides compelling evidence that a TV series can trigger suicides. To say that the study was not definitive is a cop-out.

What Are the Consequences?

Now I keep hearing of suicides that supposedly are linked to 13 Reasons Why. An 8-year-old girl and, separately, a male teenager who killed themselves after binge-watching the show. A teen boy in Denver who killed himself after making tapes for those who he blamed for hurting him. Whether these stories are true or apocryphal, I cannot know. Time will tell.

And if the suicides did occur, we can’t know for sure that the show bears true responsibility. Even before 13 Reasons Why came out, about 7 children and adolescents a day were dying by suicide in the U.S. Perhaps the suicides that occurred after the show’s release were part of that same, as-yet unstoppable pattern. In time, to figure out if the show truly triggered suicides, researchers will look at suicide rates before and after the show and compare them with suicide rates at the same time periods in previous years.

Even without those empirical findings, it’s clear that the show’s producers ignored readily available evidence that their show could create contagion among vulnerable young people.

They ignored well-researched guidelines for how to most safely portray suicide.

And they ignored basic compassion and decency, both of which call for taking steps to help prevent suicide contagion, especially when it is easily in one’s power to do so.

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Copyright 2017 Stacey Freedenthal, PhD, LCSW. All Rights Reserved. Written for Speaking of Suicide. Photo purchased from Fotolia.com