For Families of Teens at Suicide Risk, ‘13 Reasons’ Triggers Concerns

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As a mom who lost her son to suicide in 2013, a Houston nurse became concerned when she heard about the popular Netflix show “13 Reasons Why.” By then her 15-year-old daughter had already binge-watched it.

In the series, the character Hannah Baker kills herself in despair, leaving audiotapes for the people she holds responsible, among them, her rapist, fickle friends and bullies. The tapes are part justification for her suicide and part vengeful accusation of her peers.

But in the month since the show’s release, a rising chorus of mental health experts contend that too many of the show’s messages on suicide are inaccurate and potentially dangerous. Superintendents and school counselors around the country have issued warnings to parents that “13 Reasons Why” glorifies suicide and could lead to an increase in copycat behavior and self-harm among vulnerable students. “We are concerned about our children watching this series without adult supervision because it romanticizes and sensationalizes the idea of suicide,” Lisa Brady, superintendent of schools in Dobbs Ferry, N.Y., wrote in an email to parents.

Its creators have defended the show, saying they aimed to make the drama helpful to struggling kids.

But for the nurse’s family, the show has been devastating. Her daughter, who found her brother’s body, has been working through depression and trauma ever since. With treatment and regular therapy, things got better — until she watched “13 Reasons Why.” Now the show has triggered new thoughts of despair and suicide in her daughter, she said.

“If I’d known about the show beforehand I would have monitored her Netflix account a bit more,” said the nurse, whose name is being withheld to protect her daughter’s privacy. “If kids have a history of depression, self-harm or suicidal thoughts, I don’t think they need to watch it.”

On Friday, in a letter to parents, Robert Avossa, superintendent of Palm Beach County schools in Florida, reported that his employees have seen an uptick in self-mutilation and threats of suicide among elementary and middle school students since the show began.

The Netflix series, which may be renewed for a second season, is based on the 2007 young adult novel “Thirteen Reasons Why,” by Jay Asher. It includes a graphic scene in which Hannah kills herself with a razor. Its creators say it’s an unglamorous death, and they worked hard to make sure it wasn’t gratuitous.

Netflix has created an accompanying 30-minute documentary “Beyond the Reasons,” that includes the cast, producers and mental health experts discussing some of the show’s more difficult scenes. In the documentary Brian Yorkey, the creator of the series, said, “We did want it to be painful to watch because we wanted it to be very clear that there is nothing — in any way — worthwhile about suicide.”

In a statement, Netflix said the writers sought the advice of medical professionals while writing the script, and the show carries a TV-MA rating as well as a warning about graphic content. “Our members tell us that 13 Reasons Why has helped spark important conversations in their families and communities around the world,” the statement said.

Some parents have defended the show. Dawn Zawadzki, a paralegal from Fort Mill, S.C., said she watched part of the series with her 16-year-old daughter. “Everybody is saying ‘it glamorizes suicide,’ but I don’t think it does,” she said. “It’s making us wake up and look at it.”

Not everyone agrees. Just before its March 31 release, a producer sought the support of the JED Foundation, a teen suicide prevention group. “I think they were looking for us to say, ‘It was a great educational tool,’” or that “they handled the issues in a psychologically helpful way,” said Dr. Victor Schwartz, a psychiatrist and the chief medical officer at the JED Foundation.

Ultimately, he could not support what he called “one long revenge story.” The group issued a guide about the show, advising people who choose to watch it to view it with someone else and to take breaks between episodes rather than binge watch.

“It’s complicated, because they got a lot of important issues out on the table,” Dr. Schwartz said. But he’s concerned that students could think of suicide as a way to get back at people and worried that showing the specific way Hannah died would spur imitators. “The missteps are high stakes,” he concluded.

The problem, suicide prevention experts said, is that even an ugly suicide can beget copycats. Research has shown that “someone else’s death by suicide can reinforce a vulnerable person’s motivation to die by suicide,” said Madelyn Gould, a professor of epidemiology and psychiatry at Columbia University.

On Instagram, Paris Jackson, a 19-year-old model who has tried to kill herself in the past, called the series, “extremely triggering.” “Please only watch this show with caution and keep in mind that it may put you in a dark place,” she wrote in a post that got more than 20,000 likes.

The National Association of School Psychologists has advised teenagers, who have had suicidal thoughts, to avoid the series entirely. They recommend that any teenager should watch with a parent who can make it clear that suicide is not a solution to problems.

The show’s fatalism leaves the impression that suicide can’t be stopped, experts said. In one concerning scene, a character agonizes that he could have done more to help his friend. A school counselor tells him: “If she wanted to end her life, we weren’t going to stop her.”

The statement runs counter to the advice given to teachers and peers about how to help at-risk teens.

“For kids, that action is staying with your friend, not keeping it a secret, and telling a trusted adult,” said Richard Lieberman, who coordinated suicide prevention for Los Angeles Unified School District for 25 years. Another option is to call the National Suicide Prevention line, 1-800-273-8255, or text HOME to 741741.

Often suicidal children are scared to tell adults, for fear they won’t be taken seriously, said David N. Miller, the author of “Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention.” He said, “the way adults are portrayed as incompetent or clueless” is a major problem in “13 Reasons Why,” because he thought it would dissuade students from seeking critical assistance.

Hours before her death, Hannah goes to see the school counselor, hints that a senior assaulted her, and cryptically says, her eyes welling with tears, that “I need everything to stop, people, life.” He hands her tissues, but doesn’t conduct a suicide-risk assessment or consider hospitalization.

“That was gross negligence,” Dr. Miller said, and it sends “a dangerous message” that adults don’t care.

Although the creators of “13 Reasons Why” aspired to educate, the show itself never mentions a critical point: most children who die by suicide have a mental health disorder like depression that’s treatable.

And throughout the series, as other characters talk of suicide, little is done to address their struggles. “The series is actually depicting suicide contagion, and at the same time, it’s denying the suicide contagion exists,” Dr. Gould said. It’s “so upsetting to me on so many levels.”