My last suicide attempt was over twenty years ago, but it feels like yesterday. Even though I’ve found many reasons to live since then, the girl I was at those most despairing moments of my life will always be a part of me. For this reason, I binge-watched “13 Reasons Why” and closely observed the avalanche of coverage and commentary that followed. The series has generated a firestorm of debate about why and how to depict suicide in the media, with much of the reaction bordering on hysteria, including a petition and calls to yank the show off of Netflix.
Based on the 2007 young adult novel of the same name by Jay Asher, “13 Reasons Why” centers around the events leading up to and aftermath of the suicide of fictional high school student Hannah Baker, who faced bullying, social exclusion, sexual harassment, and rape before making the decision to end her own life. Baker leaves behind cassette tapes addressing the 13 people she says contributed to her decision to die.
One of the primary complaints is that the show went too far in its graphic on-screen depiction of Hannah’s suicide. I believe in the importance of adhering to public health guidelines when it comes to suicide, and we should never exploit, glamorize, or sensationalize it. When artists and journalists take on this subject, they have an ethical and moral responsibility to endeavor to do so in a way that will not cause further harm.
But to play Devil’s advocate, I see too many tightly-controlled, sterile suicide prevention narratives and messages that get little to no traction with the youthful demographic that has clearly been reached by this show. Whatever it is that we’re currently doing to reach this demographic, I’m not sure that it’s working so well. Suicide remains one of the leading causes of death among young people in America. And the suicide rate among adolescent girls has tripled in the last 15 years.
There has also been much concern about the suicide “contagion” that could potentially be caused by the series. I get it: copycat suicides can and do happen following media coverage of suicide deaths. But the contagion fears about “13 Reasons Why” appear to be largely unsupported by science. According to a recent article in Scientific American, the research evidence is mixed at best as to whether fictional portrayals of suicide lead to contagion in the same way that, for example, coverage of celebrity suicide does.
I want to discuss some of the things that this series does well, whether intentionally or accidentally. Like it or not, “13 Reasons Why” is the most-watched series in Netflix history, and has been renewed for a second season. Beyond decrying the problematic aspects, suicide prevention advocates can and should push for policies and practices that address the real-life concerns it raises.
What “13 Reasons Why” gets right:
1. Exposes the correlation between sexual assault and suicide. The show clearly demonstrated the connection between traumatic experience — sexual trauma, specifically — and suicide. This link is rarely talked about, despite evidence showing that girls and women between the ages 12–34 are at the highest risk for rape and sexual assault, which also happens to put them at considerably at greater risk for suicide. According to the Rape, Incest, and Abuse National Network (RAINN), 33% of women who are raped contemplate suicide, and 13% of women who are raped attempt suicide. And a USA Today essay entitled “13 reasons why a conversation about rape culture is as important as one about suicide,” underscores the importance of addressing this major factor increasing suicide risk among adolescent girls. We need to broaden our lens of what “suicide prevention” means and what it looks like. To be more effective in addressing suicide, we need to take on the most toxic aspects of our culture — including rape culture — that contribute to it. If we continue to ignore root causes and conditions, I believe we will never move the needle.
2. Highlights the importance of social connectedness. Some reviews have argued that Hannah’s character was too quick to blame others for causing her suicide. But it also brings up another important link — students who are bullied are at increased risk of suicide. According to a Yale University study, youth who are bullied are between 2 to 9 times more likely to consider suicide than non-victims.
What if we are more responsible for each other’s well-being than is comfortable for us to acknowledge? The show made a strong statement about the life-saving power of friendship and social inclusion. This concept is not just a fuzzy-wuzzy one, but is based in solid public health and neuroscience concepts. We are hard-wired to bond with others; connection is among our deepest human needs. Research clearly indicates that social isolation is a killer, in more ways than one. And the Centers for Disease Control and Prevention (CDC) specifically names “connectedness” as a critical protective factor against both suicide and interpersonal violence. Programs and policies that promote empathy and social connectedness in our schools and communities are a vital part of suicide prevention.
3. Avoids simplistically equating suicide and mental illness. Another source of criticism is that “13 Reasons Why” doesn’t have any scenes or dialogue about mental illness. The complaint is likely based on the widespread — but false — statistic that 90% of people who die by suicide suffered from an underlying mental health condition. This statistic is based on the flawed methodology of “psychological autopsy” — highly subjective interviews with the friends and loved ones of people who have died by suicide. As suicide law and policy expert Susan Stefan notes in her book Rational Suicide, Irrational Laws, the limitations of psychological autopsy have been acknowledged by Dr. Edwin Shneidman, the founder of modern Suicidology, as well as many experts since.
By continuing to spread the bogus “90%” figure, suicide prevention experts create a closed loop: “mental illness causes suicide which is a symptom of mental illness.” Worse, by insisting suicide is nothing more than a symptom of a psychiatric disorder, we medicalize and depoliticize the suffering and oppression that so often leads up to the decision to die by one’s own hand. We shut ourselves off from understanding the reasons why. And if we want to actually be effective at prevention, comprehending those reasons means everything. When you talk to actual suicide attempt survivors, they always have reasons why, and mental health issues are rarely the only reason, or at the top of the list.
4. Realistically portrays our poorly trained mental health workforce. Another critique is that the show discourages help-seeking behavior due to its portrayal of a spectacularly unhelpful encounter between Hannah and her high school counselor, Mr. Porter. In this scene, Mr. Porter either misses or chooses to ignore Hannah’s fairly obvious hints at having suicidal thoughts. He doesn’t ever directly ask her if she is thinking of ending her life, a basic best practice in suicide prevention. He also says that if she is unwilling to name her rapist, then she may need to “move on.”
Some critics have argued that this scene was unrealistic. But sadly, while there are plenty of competent and compassionate counselors out there, the portrayal of this interaction may be more accurate than any of us would like to admit. Top suicidology experts have stated that as many of 50% of mental health professionals are not adequately trained to respond with confidence to suicidal persons in their care. This lack of competence and confidence, coupled with liability fears and concerns, can lead to disastrously judgmental, shaming responses, or even outright refusal to work with suicidal people. And rape culture can lead not just counselors, but law enforcement and other first responders, to shame, blame, or flat-out not believe rape survivors. What more can we do to better ensure that when young women seek help, whether for suicide or for sexual assault, that they will be met by adults who are compassionate and competent in their response? To me, that’s the critical question here.
I’m not saying “13 Reasons Why” was the best or most responsible program ever to cover the topic of suicide. Many of the critiques, whether from a creative or public health standpoint, are more than valid. But the show gets some important things right that have been unfairly maligned or downplayed. The series is getting schools, parents, and youth to discuss suicide prevention proactively, rather than only responding after a suicide death. And some youth are reacting in exciting and hopeful ways to the show. (For example, check out this “13 Reasons Why Not” program taking place at one high school.) Educators and others working with youth can and should be supporting more of these kinds of youth-driven creative responses to the issues raised by show.
Perhaps most importantly, “13 Reasons Why” has gone farther to emphasize the vital, life-saving importance of kindness, friendship, and compassion than any other series I’ve seen on this topic. In the current era we’re living in, these kinds of messages are needed more than ever.
If you’re feeling suicidal, please talk to somebody. You can reach the National Suicide Prevention Lifeline at 1–800–273–8255 or Trans Lifeline at 1–877–565–8860. If you’d like to talk to a peer, warmline.org contains links to warmlines in every state. If you don’t like the phone, check out Lifeline Crisis Chat or Crisis Text Line. If you’re not in the U.S., click here for a link to crisis centers around the world.