Mental Illness and Suicide: What “13 Reasons Why” Leaves Out

By Caroline E. Graham, MSW, LMSW

Yahoo! News recently reported the death of a 23-year-old Peruvian who has completed suicide (Lindsay, 2017). The 23-year-old had reportedly seen the Netflix show, 13 Reasons Why and had left behind tapes for people in the same style as the popular show (Lindsay).

While the show cannot singularly be blamed for copy-cat completed suicides, it has been notoriously popular and controversial among Netflix viewers and throughout media sources, which raise awareness about mental health issues. Many sources have spoken about the show prior to the recent report by Yahoo! News on the 23-year-old Peruvian, Ciario Clarin. Concerns raised about the show include that the show is likely viewed by
vulnerable youth who could be unduly influenced by the show (Scudder & Breuner, 2017). Moreover, part of the controversy is that the show does not speak enough about the personal nature of the act of taking one’s own life. While traumatic events and the people who are involved in them do have an impact on the mental health of others, self-injury and taking one’s life are never the full responsibility of perpetrators.

While 13 Reasons Why addresses the personal nature of suicide attempts and/or completions, it does so too late in the series (13 Reasons Why, 2017). By the point at which the show addresses the personal nature of the decision to take one’s own life, viewers have become entranced in the blaming of 13 individuals for the suicide. Additionally, while the show purports to bring awareness to an important issue through trailers, cast members, and producers speaking out on the issue as an addendum to the
show on Netflix, these statements fall short for Netflix’s vulnerable viewers. In today’s technologically advanced age, there is no way to fully protect viewers, which features graphic depiction of rape and suicide. Though Netflix offers parental controls, youth with less involved parents may be at increased risk for negative reactions after viewing the show.

Too often the media falsely portrays mental health disorders. In the case of 13 Reasons Why, this isn’t just an issue of a specific mental health disorder. This is life or death:  It is the portrayal of the end result of too many untreated mental health disorders. Suicide is the second leading cause of death for youth aged 15-24 (American Association of Suicidology, n.d.).—the age demographic which is more likely to watch 13 Reasons Why. The show itself fails to recognize that suicide more often is the end result of mental health difficulties rather than the impact of traumatic life events. 13 Reasons Why trivializes the role of mental health and puts at-risk individuals at even greater risk.

As a psychotherapist, crisis intervention and researcher, I know that suicide is incrementally more likely in instances where pre-existing, untreated mental health disorders are present (Hjorthoj et al., 2014). Individuals with pre-existing mental health
disorders are 90% more likely to attempt or complete suicide (O’Connor & Nock, 2014). The total exclusion of addressing the likelihood of mental illness of the main character in 13 Reasons Why, omits one of the most likely risk factors for suicide. This exclusion is detrimental in raising awareness for the cause, which is purportedly one of the main goals the producers had (Holmes, 2017). Exposure to the suicide of a close other increases that risk by reducing sensitization to the idea (family member, friend) (American Foundation for Suicide Prevention, n.d.). It is also known that witnessing suicide through an alternate means, such as the media exposure in 13 Reasons Why, increases the likelihood of suicidal ideation, suicide attempts or suicide completion in individuals who are suffering from depression and severe or persistent mental illnesses (schizophrenia, bipolar disorder, major depression, eating disorders) and those with certain personality disorders (Franko et al., 2013; Tidemalm et al., 2014; Isometsa, 2014; Lineman et al., 2015).

Recommendations
for parents of youth:

  1. Parents or caregivers watch 13 Reasons Why with children, allow for an open discussion about the plot and effects of the show on the children.
  2. Parents have the ability to set parental controls on Netflix based on four maturity
    levels. With parental controls, access to shows above each maturity level are
    disabled.
  3. Option on Netflix to set a 4 digit pin, where shows above a set level cannot be viewed without the pin number.
  4. See Netflix parental control guidelines at https://help.netflix.com/en/node/264

 

For
adults:

  1. Watch 13 Reasons Why at your discretion. If you have ever had thoughts of suicide, have been diagnosed with a mental illness or have been sexually assaulted, watch the show with a safety plan in place. Include coping strategies to deal with upsetting thoughts or feelings.
  2. Make a list of trusted close family or friends who you can speak to when in
    crisis. If you have an existing mental health provider, contact them or follow
    your provider’s set protocols for emergency situations.

 

If you or anyone you know are struggling with thoughts or plans to end your life or if you are struggling after viewing 13 Reasons Why, please contact:

Behavioral Health Response Crisis Line 314-469-6644.

National Suicide Prevention Line 1-800-273-8255.

Call your existing mental health care provider.

Call 911 or go to your nearest emergency room.

 

 

References

American Association of Suicidology. (n.d.). Infographics. Retrieved June 14, 2017, from http://www.suicidology.org/resources/infographics

American Foundation for Suicide Prevention. (n.d.). Risk Factors and Warning Signs — AFSP. Retrieved June 14, 2017, from https://afsp.org/about-suicide/risk-factors-and-warning-signs/

Franko, D. L., Keshaviah, A., Eddy, K. T., Krishna, M., Davis, M. C., Keel, P. K., &
Herzog, D. B. (2013). A longitudinal investigation of mortality in anorexia
nervosa and bulimia nervosa. American Journal of Psychiatry, 170(8),
917-925.

Hjorthøj, C. R., Madsen, T., Agerbo, E., & Nordentoft, M. (2014). Risk of suicide according
to level of psychiatric treatment: a nationwide nested case–control study. Social
psychiatry and psychiatric epidemiology
, 49(9), 1357-1365.

Holmes, L. (2017, April 21). ’13 Reasons Why’ Promised To Raise Awareness About Teen Mental Health. That Backfired. Retrieved June 14, 2017, from http://www.huffingtonpost.com/entry/13-reasons-why-mental-health-portrayal_us_58f65f6ae4b0bb9638e70390

Isometsä, E. (2014). Suicidal behaviour in mood disorders—who, when, and why?. The Canadian Journal of Psychiatry, 59(3), 120-130.

Lindsay, K. (2017, June 08). A 23-Year-Old Allegedly Copied The 13 Reasons Why Suicide And Left Behind Tapes. Retrieved June 14, 2017, from https://www.yahoo.com/news/23-old-tragically-copied-13-151500880.html

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., …
& Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high
suicide risk in individuals with borderline personality disorder: a randomized
clinical trial and component analysis. JAMA psychiatry, 72(5),
475-482.

Scudder, L. E., & Breuner, C. C. (2017, June 14). Should Kids Watch ’13 Reasons Why’? Advice From a Pediatrician. Retrieved June 14, 2017, from http://www.medscape.com/viewarticle/881253

Tidemalm, D., Haglund, A., Karanti, A., Landén, M., & Runeson, B. (2014). Attempted suicide in bipolar disorder: risk factors in a cohort of 6086 patients. PLOS one, 9(4),
e94097.

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