13 Reasons Why: Warning Label

The new Netflix series 13 Reasons Why is generating alarm among many mental health professionals and suicide prevention experts, who are concerned about the risks of glamorizing suicide and the possibility of contagion.


Netflix kicked up a controversy with the series released on March 31 about a high school junior named Hannah who takes her own life. The series received a 91 percent critics approval rating and an 88 percent audience rating on Rotten Tomatoes. Critics praised the cast’s performances and the “authentic,” “sensitive,” and “hard hitting” portrayal of teenager angst.

However, 13 Reasons Why needs a warning label. The National Association of School Psychologists cautions that the series should not be viewed by vulnerable young people who experience any degree of suicidal ideation. NASP warns:

“Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies. They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character. Unfortunately, adult characters in the show, including the second school counselor who inadequately addresses Hannah’s pleas for help, do not inspire a sense of trust or ability to help.”

NASP has problems with the accuracy of how mental illness and suicide are portrayed in the series. For example, it is concerned that the series does not emphasize that common among most suicide deaths is the presence of treatable mental illnesses. And that suicide is not the simple consequence of stressors or coping challenges, but rather, it is most typically a combined result of treatable mental illnesses and overwhelming or intolerable stressors.

Despite the strong misgivings, some see the widespread publicity around 13 Reason Why as an opportunity at least to spread greater awareness about suicide and suicide prevention. NASP says that the controversy is an “opportunity to better understand young people’s experiences, thoughts, and feelings,” educate parents, teachers, and students alike about suicide risk warning signs, and reinforce the message that suicide is not a solution to problems.

NASP advises that school psychologists and other school-employed mental health professionals can assist stakeholders such as school administrators, parents, and teachers to engage in supportive conversations with students as well as provide resources and offer expertise in preventing harmful behaviors. NASP published “Considerations for Educators,” guidance on 13 Reasons Why. Download it here.

Experts say if you’re thinking about the safest and best way to lead a discussion with teens about 13 Reasons Why and suicide, read the tip sheet co-authored by Suicide Awareness Voices of Education (SAVE) and the JED Foundation. Click here to download the tip sheet.

Some recommended reading from experts on the subject of suicide contagion:

Preventing Suicide With A “Contagion Of Strength” (National Public Radio February 25, 2015)

The Science Behind Suicide Contagion (New York Times, August 14, 2014)

Teen suicide: Prevention is Contagious, Too (Christian Science Monitor, December 8, 2013)

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

Robin Williams’s Story

The widow of Robin Williams has written a detailed account of the brave struggle with an undiagnosed brain disease called Lewy Body Dementia that preceded the comedian’s suicide in 2014.


Headlined “The terrorist inside my husband’s brain,” Susan Schneider Williams’s essay in Neurology reports that “the massive proliferation of Lewy bodies throughout his brain had done so much damage to neurons and neurotransmitters that in effect, you could say he had chemical warfare in his brain.”

Susan Schneider Williams used the platform of a medical journal to specifically address her words to medical researchers, saying she hoped the “personal story, sadly tragic and heartbreaking,” would further inspire them to persevere in the quest for a cure. Given the initial media frenzy that dwelled on the actor’s past struggles with depression and substance abuse, the essay also helps expose the harm of stigmatizing suicide through simplistic stereotyping.

Listen to a podcast with Susan Schneider Williams here.

Excerpts from her essay:

My husband Robin Williams had the little-known but deadly Lewy body disease (LBD). He died from suicide in 2014 at the end of an intense, confusing, and relatively swift persecution at the hand of this disease’s symptoms and pathology. He was not alone in his traumatic experience with this neurologic disease. As you may know, almost 1.5 million nationwide are suffering similarly right now. …

Although not alone, his case was extreme. Not until the coroner’s report, 3 months after his death, would I learn that it was diffuse LBD that took him. All 4 of the doctors I met with afterwards and who had reviewed his records indicated his was one of the worst pathologies they had seen. He had about 40% loss of dopamine neurons and almost no neurons were free of Lewy bodies throughout the entire brain and brainstem. …

Not until after Robin left us would I discover that a sudden and prolonged spike in fear and anxiety can be an early indication of LBD. …

I will never know the true depth of his suffering, nor just how hard he was fighting. But from where I stood, I saw the bravest man in the world playing the hardest role of his life. …

Robin was losing his mind and he was aware of it. Can you imagine the pain he felt as he experienced himself disintegrating? And not from something he would ever know the name of, or understand? Neither he, nor anyone could stop it—no amount of intelligence or love could hold it back. He kept saying, “I just want to reboot my brain.”…

After months and months, I was finally able to be specific about Robin’s disease. Clinically he had PD [Parkinson’s Disease], but pathologically he had diffuse LBD. The predominant symptoms Robin had were not physical—the pathology more than backed that up. However you look at it—the presence of Lewy bodies took his life. …


Memo to “Good Morning America”

“It’s the top of our morning show. We don’t want suicide on the brain.”
That’s how ABC’s Good Morning America asked a group of dedicated, t-shirted, poster-holding suicide prevention campaigners to scram during GMA’s live broadcast on September 8. That’s according to one of the group’s leaders, Jill Harkavy-Friedman, a Columbia University professor and head of the American Foundation for Suicide Prevention’s research program.

When the No. 1 morning show (four million plus daily viewers) flinches from this subject during National Suicide Prevention Week, we know there’s a lot more to be done in raising awareness about mental illness—even among the journalists whose mission is to educate viewers about issues of public interest.

Memo to GMA: Suicide is the tenth leading cause of death in the United States, and the second leading cause of death among Americans between the ages of 15 and 24. A fact sheet from the Centers for Disease Control describes suicide as “a significant problem in the United States,” pointing to data:

—41,149 people killed themselves in 2013.

—Suicides result in an estimated $44.6 billion in combined medical and work loss costs.

—Over 494,169 people with self-inflicted injuries were treated in U.S. emergency departments in 2013.

After her experience with Good Morning America, Harkavy-Friedman recalled in The Mighty:

We were in such good moods, standing there in our colorful shirts: far from a dour image that would have brought any early morning viewers down. We were ready to happily answer questions like, “What can we do to prevent suicide?” and, “How can you start a conversation with someone you’re worried about?” Simply giving people the answers to these questions saves lives.

The Violence Myth

A new study published by the leading health policy journal Health Affairs says that the news media’s misrepresentation of the connection between mental illness and violence may undermine public support for mental health policies.

The study, “Trends In News Media Coverage Of Mental Illness In The United States: 1995–2014,” sampled 400 news stories about mental illness, and found that 55 percent of them mentioned violence. By contrast, only 14 percent described successful treatment for or recovery from mental illness.

The study provides some context to the media reporting on whether mental illness was a factor in the mass murder of 49 people at an Orlando gay night club on June 12 by a 29-year-old man, Omar Mateen. In the New York Times, security expert Peter Bergen writes that a New America study found that only one in ten terrorists—below the incidence in the general population—had mental health problems.


Here’s the full abstract of the study:

The United States is engaged in ongoing dialogue around mental illness. To assess trends in this national discourse, we studied the volume and content of a random sample of 400 news stories about mental illness from the period 1995–2014. Compared to news stories in the first decade of the study period, those in the second decade were more likely to mention mass shootings by people with mental illnesses. The most frequently mentioned topic across the study period was violence (55 percent overall) divided into categories of interpersonal violence or self-directed (suicide) violence, followed by stories about any type of treatment for mental illness (47 percent). Fewer news stories, only 14 percent, described successful treatment for or recovery from mental illness. The news media’s continued emphasis on interpersonal violence is highly disproportionate to actual rates of violence among those with mental illnesses. Research suggests that this focus may exacerbate social stigma and decrease support for public policies that benefit people with mental illnesses.

The Atlantic has a good review of the study here.

An extract:

…[A] consistent and dangerous narrative has emerged—an explanation all-too-readily at hand when a mass shooting or other violent tragedy occurs: The perpetrator must have been mentally ill.

“We have a strong responsibility as researchers who study mental illness to try to debunk that myth,” says Jeffrey Swanson, a professor of psychiatry at Duke University. “I say as loudly and as strongly and as frequently as I can, that mental illness is not a very big part of the problem of gun violence in the United States.”

The overwhelming majority of people with mental illnesses are not violent, just like the overwhelming majority of all people are not violent. Only 4 percent of the violence—not just gun violence, but any kind—in the United States is attributable to schizophrenia, bipolar disorder, or depression (the three most-cited mental illnesses in conjunction with violence). In other words, 96 percent of the violence in America has nothing to do with mental illness.

Sadness of Depression

The Mighty is an online community for people facing serious health conditions—and it offers a lively platform for sufferers of mental illnesses to share their experiences. According to The Mighty’s Who We Are page: “We’re creating a safe platform for our community to tell their stories, connect with others and raise support for the causes they believe in. We are stronger when we face adversity together, and we know it.”


Read a recent post, “What the Sadness of Depression Really Feels Like”:

Imagine you wake up in the morning and you feel as though, overnight, your heart has sunk into the pit of your stomach and stayed there, throbbing, until it becomes a dull but persistent ache that has spread to your entire body. Maybe it’s raining and you have a dentist appointment later that day, or maybe it’s a warm sunny day and you have plans to spend it in your favorite place with your best friends: it doesn’t matter. The entire world looks ominous through the lens of the depression. Whatever lurks beyond the door of the bedroom doesn’t feel safe. Sitting up and swinging your feet out of bed feels insurmountable, not because of the mind-numbing fatigue you feel but because it just hurts inside. Just pushing yourself up to turn off your alarm makes your insides clench with discomfort and fear.