IMPORTANCE OF OFFERING HELP,
Show’s impact raises concerns, but it’s also a reminder of the importance of help, Erin O’Loughlin says.
I had never heard of the book 13 Reasons Why when I pressed “play” to binge watch the TV adaptation. It took me three days to watch the 13 hours, the content of which caused sleep deprivation that has continued weeks later (the suicide scene is horrific).
To say that the show is controversial is an understatement. Google “13 Reasons” and you will discover a plethora of reactions from parents, adolescents, psychologists and people with mental health issues.
Some argue that the show creates awareness by stimulating important dialogue, and bringing a difficult subject out into the open.
Others say 13 Reasons Why glamorizes suicide, and could prompt vulnerable young people to think about it (suicide ideation), and in some cases even act.
Concerns about a possible link between “media” and suicide date back at least to 1774, when a book describing a suicide was banned because of “copycat” suicides. More recently, researchers have noted that suicides sometimes cluster in time, which indeed suggests social learning of suicide-related behaviours.
Like it or not, though, the show is out there, and it has opened the door to debate.
In Quebec, where we already have one of the highest suicide rates in Canada, it is all the more crucial that our responses to this series be informed, sensitive and responsible.
The transition from adolescence into young adulthood, when many suicides occur, is characterized by upheaval, when youth leave home, join the workforce, attend university, engage in new longterm relationships and start families. These changes can create high levels of stress in anyone, but even more so among those with a predisposition to mental health problems.
Our research team recently compared mental health diagnoses, substance use, use of health services and medication use among 785 young adults in Montreal with and without persistent suicide ideation (thoughts of suicide), over four years (from age 20 to 24). We found that about one-third of those with suicide ideation at age 20 continued to report suicide ideation four years later. (Because we were measuring ideation and not suicide itself, our data do not reveal how many of the original respondents in fact committed suicide during those four years, however ideation is certainly associated with self-harm, including suicide attempts.)
Those with persistent suicide ideation were more likely to smoke cigarettes, and use marijuana and other illicit drugs as well as to binge drink, all of which are viewed as unhealthful coping strategies. There is good reason to presume that similar proclivities would be found among a younger age group, as well.
While preventing suicide is obviously the biggest concern, the fact that suicide ideation is also often accompanied by self-harmful behaviours is an additional reason to address the underlying issues.
While 13 Reasons Why has a positive anti-bullying message, the show does little to teach the audience about depression or anxiety, and it leaves viewers with a sense of powerlessness.
Importantly, as we learned from Hannah in 13 Reasons Why, youth with suicide ideation must feel there is a place or person they can go to with their thoughts. If one in three people with suicide ideation experiences ongoing thoughts about suicide four years later, it’s clear that for all too many people, suicide ideation is not a passing “phase.”
Clinicians need to routinely inquire about suicide ideation, assess substance use and mood and anxiety disorders and if needed, refer these individuals for psychological or psychiatric care.
As 13 Reasons Why alludes to and as the experts tell us, parents, friends, educators and employers should take suicide ideation seriously and extend help to those with this issue by helping them reach out to appropriate resources including the Quebec Association for Suicide Prevention, Suicide Action Montreal and the Canadian Association for Suicide Prevention.