My professional opinion? In the media there’s sometimes a fine line between working to “end the stigma” and romanticizing mental illness, but the controversial teen series “13 Reasons Why” isn’t one that walks that line. It crossed it from the day the ads first appeared:
Hannah Baker: “I’m about to tell you the story of my life – more specifically, why my life ended. And if you’re listening to this tape, you’re one of the reasons why.”
My colleagues and I work with highly suicidal teenagers every day. We are Dialectical Behavior Therapy (DBT) providers—you know DBT, it’s the therapy that executive producer of “13 Reasons” (Selena Gomez) claims to love. As DBT clinicians, there were no words to express the face palm feeling we got when hearing about “13 Reasons.” Why? Here’s 13 dangerous (and misguided) implied messages:
1. If I kill myself, then they’ll be sorry!
Do not take me for granted. Not again. -Hannah
Ahh, the “scorched earth policy” for solving relationship issues. This can be one of the juiciest fantasies in contemplating suicide for anyone lacking assertiveness skills and/or the power to intervene on their own behalf. This “then they’ll pay” thing gets perpetuated ad nauseum in adolescent social mythology. Ok, so the first problem is, you aren’t alive to experience the glorious revenge anyway…cause you’re dead. The second problem is that YOU’RE DEAD and those bastards who contributed to your earthly suffering are most likely going to continue in their self-centered ignorance, perhaps considering you long enough just to use your funeral as an excuse to miss class. Not to mention the fact that if your last dying desire is to harm someone else, it doesn’t bode well for your karma in the afterlife. Better to stay alive and figure out a way to stick it to them. As they say, the best revenge is success.
2. If I’m dead, THEN people will listen.
Is it you? What did you do? How did you end up on these tapes? Maybe you did something cruel. -Hannah
There’s a pretty famous song that also touts this claim. At the time, I thought THAT was bad, but it appears we now have a clear winner in the “Most likely to incite a rash of teen suicides” competition. The deceased girl leaves a macabre “escape game” of audiotapes for classmates, essentially holding them hostage with fear and guilt tactics in order to communicate her messages beyond the grave. Not so noble when you put it that way? Yeah, it’s also seriously wishful thinking because human beings are wired to be self-absorbed most of the time (i.e. “how will this impact ME?”) Yes, the majority of us have the capacity for empathy and the drive toward relationships is strong, but the human default is to be self-protective. Our brains work really hard to filter information to fit our limited, personal understanding of the world, the future, and ourselves. You know why people really listened to those tapes and why you watched? Because Hannah used the universal teaser: “…and if you are listening to these tapes, you are one of the reasons why” a.k.a. “how is this about me?” People wanted to find out what her suicide meant about them. Am I to blame? Could I be to blame? Me? Me? ME? Here’s another gem to ponder…what us therapists find is that when people misunderstand you alive, they are just as likely (perhaps more so) to misunderstand you when you are dead. How pissed would you be then?? Hauntings anyone? Why not hop a bus to anywhere else instead, leave the tapes (minus the suicide, of course), and stand back to watch the carnage from a warm beach somewhere? Find a good DBT therapist who can help sort out how to create a life worth living, and find a way to make meaning out of the pain. Death is inevitable anyway—why not eliminate all other possibilities first? (See Message #1)
3. If you don’t do what people want when they are dying, dead, or suicidal, you are a bad person.
This is not obsession. It’s respect. I’m living out her last requests. -Clay
Malignant manipulation, anyone? People are more or less susceptible to the idea that they are obligated to carry out the wishes of the dead depending upon a number of factors, including their spiritual and cultural upbringing, as well as their propensity toward purchasing a ticket on the old “guilt-trip express.” But for someone contemplating suicide who is angry and feeling marginalized with little ability to control their environment, it can be a very tempting benefit to consider when weighing the pros and cons. To be able to live on after death?! Again, a huge problem is, if we have trouble getting someone to come back from the grocery store with the right item, how well do you think they would do with our postmortem directives? This message is a version of the “then they’ll listen” myth. At the point in the tape that it became clear that Hannah was blaming poor Clay for her suicide, if I were his therapist, I would have recommended shutting it off, walking away, and refusing to ever listen to such garbage. But that wouldn’t make for much of a story, would it? I once treated a sweet older woman who’s husband had been using suicidal threats and ultimatums to control her behavior and emotions for over 20 years. Despite her attempts to help him, he ultimately killed himself and left a note blaming both her and his children (HIS CHILDREN). Not. Ok. I fully supported her decision to keep the note a secret from the children as it could do nothing but bring them pain. I was so glad that therapy had helped her to realize that she was not responsible for his choices in the end. Just because someone is dead doesn’t mean they weren’t a jerk.
4. if someone (does really hard things for you, can’t sleep because of you, gets depressed because of you, etc) they really care.
Alex Standall shot himself in the head last night. -Principal Gary Bolan
Clay and the others apparently HAD to listen to the tapes, despite the fact that the scathing audios seemed to be intolerable for him to bear. Why did he put himself through it? Well, because he cared, right? He proceeds to scramble all about town, risking physical danger and enduring significant emotional distress, ostensibly to carry out the wishes of the young woman who chose to take her own life. But let’s get real—Clay was an anxious guy from the start. His fumbling, bumbling intensity was more about his Generalized Anxiety Disorder/Social Phobia than about her. She basically triggered her “friend” by becoming his worst fear! He was susceptible to having a full blown mental health crisis to begin with and she just added gas to the flame. Let’s think about the relational part now… If Clay cared about her, shouldn’t his caring be equivalent whether she was alive or dead? If her death made him care more, wouldn't that kind of make him an #%^hole ? Worry isn’t caring, depression isn’t caring, and suicidal thinking isn’t caring—they are clinically significant symptoms that often require treatment. People grieve in their own ways. People care in their own ways. If your are truly concerned that people in your life “don’t care” then address it with them, get new friends, or both.
5. Teens are responsible for identifying classmates who are suicidal.
If I hadn’t moved away…she would still be alive today. - Kat
*Retch* This one is just mean spirited. In a nutshell, no one can reliably predict suicide, but if they could, it most certainly should not be considered the responsibility of untrained minors. But then again, there’s nothing that can brighten a day more than “saving” another suicidal peer!! For adolescents that lack a sense of meaning and purpose, feeling like a Suicide Superhero can unfortunately be tempting. Why? Because if they lack meaning and purpose, there's already a problem, then we’re compounding it by suggesting that they are responsible for something as serious as being the difference between life and death. In doing therapy with adolescents who have their own mental health demons, my clinicians struggle to challenge this myth. We see kids so busy worrying about "friends" who might kill themselves that they can’t focus on their own recovery. To perpetuate the ridiculous idea that they would be responsible for the death of a peer because they didn’t sit with them at lunch or weren’t “there for them” enough is completely irresponsible. Combine this one with #4 and you end up with suicide pacts. Yes, we should teach kids to be kind, to work to be inclusive, and to practice empathy, but not to walk around cloaked in the cape of anxiety, staying up all night with a “friend” who has counted out a lethal dose of medication and who claims that she would be dead “if it wasn’t for you!” What happens the next night? What about the next? I tell parents and kids that they aren’t trained in how to handle suicide risk and therefore, should defer to someone who is. Of course, it doesn’t mean we can stop it either, but at least there's no risk of lifelong unjustified guilt for some poor kid . And by the way--did you know that there are ways of responding in a seemingly “supportive” way that can actually increase a person’s risk for going through with suicide? Yeah, so I wouldn’t recommend it for the layperson.
6. Parents (and adults in general) are clueless about, don’t listen to, and can’t help depressed and/or suicidal kids.
Do adults understand how friendships work? -Hannah
Adding insult to injury, even if they DO know and try to help, they will apparently respond in some idiotic manner (cue random breakfast med refill) thus driving the kid further into the depths of depression. Even my teen daughter was put off by what she viewed as a serious case of “stereotyping adults.” What is a kid supposed to conclude from this show when considering whether to open up to their parents? Does this show really convey the message that they should have hope for a conversation with a school counselor? Nope. It says there’s no use anyway because “they” don’t get it…and since they’re generally lame-o, so you should either just test out a same-aged peer's ability to “care enough” or just cut to the chase and go ahead and kill yourself. Am I the only one who thinks this is ludicrous? At our practice, we receive the majority of referrals for adolescent therapy from adults—parents, teachers, and other mental health providers who recognized that a kid was struggling. Implying that adults could never help is yet another barrier to them reaching out. Don't forget that if they do reach out (and god-forbid it helps) it must mean they were never that bad to begin with (see Catch-22 #10). Parents buy into this myth far too often and instead of asking questions, might instead, bring an 8 year-old to therapy for us to “fix.” While I don’t want to suggest that parents should ever feel that they are expected to tackle their child’s mental health issues on their own (see #12), I also want to applaud the fact that caregivers around the world successfully “treat” kids every day.
7. If it’s “really bad,” then a person will be suicidal.
The other night I almost threw myself over a cliff -Clay
It is a mistake to think that if a person is not clinically depressed or suicidal, then they must not be “that bad.” But there wouldn’t be much of a story if Hannah had been traumatized and then simply suffered with pervasive depression for years, now would there? Nor would there be much of an audience for her just working through things. Why not??? The resilience of the human spirit is incredible. Why can’t we glorify that? But I digress. It’s important to know that people can experience crippling levels of despair without seeking to kill themselves. We are actually equipped to cope with terrible levels of emotional pain. The show implies that suicide is a natural go-to in times of extreme emotion and traumatic experiences. Unfortunately, this serves to normalize what is actually an abnormal response and increases the likelihood that contemplating taking your own life is super normal. It is not. It is cause for alarm and you should treat it as such. Multiple characters seem to use suicide as a superlative—a way of communicating how bad it is and to show they care. One of the characters goes so far as to attempt to kill himself in response to Hannah’s suicide (he cared that much!). Apparently, people are not taken seriously unless they intend to kill themselves. Threatening suicide seemed to be the trump card in the game of “see, I really DO care.” Even though Jessica was struggling through the discovery of her own rape and the death of her friend, her pain was upstaged by Justin’s claim to have almost killed himself, ”I was going to jump or shoot myself or something.” Not nice. It was her turn, but he pulled a “checkmate” that thankfully, she didn’t buy into. It pains me to think about the number of people watching who probably felt like Jessica was “being mean” when she didn’t back down from expressing herself. Good for you, Jessica, his emotions are not your responsibility. As for you Justin, go see a good therapist and allow Jessica her space to be pissed.
8. If people really care, they will know if I’m suicidal or depressed.
A lot of you cared, but just not enough -Hannah
Sorry—no one can read your mind. Not even those who are closest to you and not even if you are “obviously” struggling. It’s also pretty unhealthy to equate worry with caring (See #4). Playing the “he loves me, he loves me not” game with a life (both yours and someone else’s) isn’t cool…nope, not at all. It also isn’t fair to another person who may care so much that they give you space and trust that you will let them know if you need something from them. If you are wondering whether someone cares about you, then use a less lethal and permanent method of finding it out. Don't be passive-aggressive and “test” them. Usually, if you get real with yourself for a minute and truly ask yourself the question, you will know the answer. If they do care, great, then tell them if you want them to try to help. If they don’t, then work on finding someone who does. Or *gasp* maybe even work on being a person that other can care about. The main character was so busy pushing people anyone away who let her down and proving to herself that no one cared she neglected all of the people who actually did care. Oops! You were wrong about that whole “no one cares” business, huh? Too late! People are fallible and only human, after all. I hate to be such a therapist, but you know, you weren’t such a great communicator either, Hannah.
9. Mental health professionals should know when someone is suicidal.
She hoped you’d come after her, but you didn’t -Clay
Sorry—we can’t read minds either. Would it frighten you to know that my profession is no better at predicting whether someone will kill themselves than tossing a coin would be? It’s true. In 2016, the American Psychological Association (APA) cited a major study which suggested that not only do trained professionals fail at recognizing when someone is going to kill themselves, but we haven’t even improved in our omniscience capabilities in the last 50 years. I can promise you that this inability to reliably predict does not stem from of a lack of effort on our part. Therapists are often so afraid of being blamed for a client suicide that they refuse to take on suicidal clients at all (aka “referring to a higher level of care”). When they do treat risky clients, they are more likely to insist on hospitalizing against the client’s will, to call mobile crisis unnecessarily, and to do more “policing” than they do therapy. They can get so hung up on trying to guess whether someone is going to kill themselves that they aren’t able to actually listen to what the problem is that suicide is supposed to solve. In supervising new therapists terrified of working with chronically suicidal clients, I remind them that they can only do their best to help and the rest is up to the client. IMO, this myth is one of the more dangerous ones because it reduces the number of therapists willing to even try to help. In the end, no one (sometimes not even the client!) really knows until it actually happens. In fact, suicide research suggests that many of these deaths occur within hours of the person making the actual decision. Not days, but HOURS. In typical therapy, seeing a mental health professional once a week is considered pretty “regular.” When hours make the difference between living and dying, it can make reliable prediction close to impossible.
10. Silent suffering means that a person is really depressed, suicidal, etc.
I think a lot of times people feel paralyzed by: "I don't know how to talk about this. Maybe it'll go away.” -Dr. Hu
Ah, the long-suffering martyr type. This message basically says if you are really suicidal you won’t ask for help…you’ll just hint about it and use your non-verbals to communicate like a “real” depressed person. Did you notice that not one single character approached someone directly for assistance with depression or suicidal thoughts? Oh sure, multiple characters skulk around moodily or casually toss a suicidal comment at whomever they are trying to get a point across to, but none actually asking for direct assistance from anyone. The quieter and more angsty they were, the more likely the audience imagines that they must be really bad off. And don’t even try to claim that Hannah’s cryptic exchange with the school counselor counts as confessing any suicidal thinking. She outright denied it and stormed out, but not before playing her own version of Russian Roulette waiting to see if the counselor would chase her. Actually, believe it or not, depressed and/or suicidal people often DO ask for help directly. There is another pervasive myth that people who are truly going to kill themselves don’t tell anyone, instead, they just do it. Here’s a shocker: Research shows that more often than not, people who attempt suicide told someone of their desire to do so. The character Hannah did not. When asked directly, she implied both in her response and her body language that her comment about wanting “life to stop” was simply a figure of speech—she even apologized for saying it. Let’s not perpetuate the problem of silence by buying into this crap that people who are really suicidal don’t say anything, yet someone somehow could crack the secret code if only they would utilize their magical caring powers.
11. Depression and suicidal thinking are caused by negative events such as trauma (or being suicidal means you’ve had a negative event or trauma occur).
Every single event documented here may never have happened had you, Alex, not written my name on that list. It’s that simple. -Hannah
This is more common of a misconception than you might think. Even some mental health professionals make the mistake of presuming a “trauma” when a someone presents with a certain collection of symptoms. In truth, Depression and suicidal thinking can actually come “out of no where” and when we make the mistake of presuming that “they must have trauma,” we can inadvertently do more harm than good. In the 80's, there was outbreak of “Multiple Personality Disorder” diagnoses that, as it turns out, was actually CAUSED by mental health professionals who were “helping” patients “remember” traumas that didn’t exist. Not good. In addition, I have treated countless people who compound depression further with the guilt of believing they have “no reason” to be depressed. I can imagine nothing more invalidating than being depressed and having someone then judge whether there is a good reason for it. A true Major Depressive Episode is a Major Big Deal and stands on it’s own as a reason for suicidal thinking.
In short, one size does NOT fit all, especially when it comes to suicide. The soapbox that Clay gets up on in the last episode suggests that he KNOWS what would have prevented Hannah’s death. I sure wish I was ever that certain. There were several characters who fancied themselves professional suicidologists, confidently citing how they or someone else could have “saved” her. Spare me.
12. Women (and suicidal people) are fragile and should be treated as such.
[Interview after the show remarking on teaching sexual consent language for boys] That’s actually incredibly sexy, and that makes any girl feel really taken care of, and I think if we can better program them with the right things to say, and teach them the impact that their actions have on people are actually very real, and have, potentially, very serious consequences, maybe we could do something about preventing it. -Alexis Jones, "activist"
Ugh. How paternalistic can you get?? It is incredibly sexist to imply that women need to be “taken care of” and that males are the only perpetrators of sexual assault. What a progressive idea, Alexis! I can't even begin to address all of the male bashing that happens in the show and the dangerous messages about young men. As far implying that suicidal people are fragile, there was plenty of that type of thinking as well (see #8, #9, & #10) When I’m training therapists, I remind them that patients have often been through a lot in their lives and it’s insulting to imply that one comment or sideways look from you will break them. Nothing will make someone feel crazier than being treated like they're crazy. Have you ever had someone talk softly and tiptoe around you because they thought you were on edge? Yeah. Patronizing. In addition, we train parents of chronically suicidal children how an extended period of doing this actually leads to an increase in suicidality as it can be highly reinforcing. If the family has a history of doing so, they actually MUST have some assistance in breaking the pattern because of a drastic (but time-limited) increase in their child’s suicidal risk…something referred to as an “extinction burst.” If it was a simple as being warm and fuzzy, listening, and avoiding hurting someone’s feelings, we wouldn’t have the rate of suicide that we do. Family members, friends, and therapists alike have tried that approach, but it just isn’t enough. Not to mention there’s the other problem of maintaining your own autonomy. No one deserves to be held hostage. Just do the best you can within your limits, and the rest is up to the other person.
13. It is your fault if I kill myself and if I kill myself, it means you didn’t do enough.
He failed and my fate was sealed -Hannah
No, no, no. Just no. In case someone you know has committed or attempted suicide and you have never heard anyone say it before, let me make it clear that in no uncertain terms are you responsible. No offense, but you are not that important or that powerful. There are a multitude of factors that contribute to a person taking their own life. While involuntary suicide is possible (during a psychotic or intoxicated state, for example), most suicides are a very personal decision. To presume that we are able to “cause” someone to kill themselves is both presumptuous and paternalistic. Now, they may blame you outright and you may have even been the primary source of emotional pain in their lives, but here’s the thing… suicide is NEVER the only option. Not even the guy who raped her is to blame for her suicide. Yes, he’s to blame for her rape, but not her suicide. As therapists, we work really hard at moving people toward recognizing and then take ownership of their choices. We would never let anyone with suicidal urges get by with blaming someone or something else entirely—that is essentially like saying “Of course! Go ahead and kill yourself Your life is basically over!” Sure, we would empathize and validate the pain, but we would want to quickly be moving toward a mindset of taking personal accountability…of their emotions, of their thoughts, and of their decisions. Recovering addicts cite the Serenity Prayer, reflecting this idea, “Lord grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Blaming others gives away power just at the time when you need all the power you can get.
PS: I'm not going to put the patronizing, obligatory, CYA "if you or someone you know" thing at the end. You get the idea. We're here if you need us.