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Thirteen Reasons to Be Concerned About "13 Reasons Why"

by Sansea L Jacobson, MD, director of the Child and Adolescent Psychiatry Residency Training Program at Western Psychiatric Institute and Clinic at the University of Pittsburgh School of Medicine

Netflix recently announced its intention to release a sequel to 13 Reasons Why, the controversial series that depicts a fictional teen suicide. As a child and adolescent psychiatrist at ground zero of the adolescent suicide problem, I feel compelled to share my concerns about this influential and concerning program.

The sensitive topics raised (e.g., bullying. sexual assault, substance use, suicide) are important and should not be ignored. After having watched the entire series, however, I became concerned.

Just one month after its release on Netflix, I binge-watched the first season of 13 Reasons Why. I was inspired to do so after several parents asked me whether they should be allowing their teens to watch the series. From an artistic perspective, undeniably the characters and narrative of 13 Reasons Wily are compelling, and it is understandable that teens are drawn to it. Furthermore, the sensitive topics raised (e.g., bullying, sexual assault, substance use, suicide) arc important and should not be ignored. After having watched the entire series, however, I became concerned.

13 Reasons Why You Should Be Concerned

What follows are 13 reasons why you should be concerned, too:

  1. The series romanticizes suicide, which places youthful viewers at risk for suicide contagion. We know from research that dramatized portrayals of suicide on television and in movies can lead to increased rates of suicide and suicide attempts using the same methods displayed on the screen. Furthermore, this impact is intensified when suicide is presented in the absence of information about mental illness.
     
  2. It focuses on blaming others, as opposed to recognizing that greater than 90 percent of individuals who complete suicide actually struggled with mental illness.
     
  3. It downplays the cognitive distortions of depression, and instead repeatedly suggests that suicide was the protagonist's rational "choice” in order to escape the emotional pain caused by others or perhaps, more provocatively, to take revenge on those who wronged her.
     
  4. The imagery of self-injury and the suicide itself are disturbing and extremely graphic. This is known to increase the risk of imitation. Fortunately, most youth will not become suicidal after being exposed to suicide. That being said, we know that a small subset of more vulnerable teens, especially those struggling with mental health issues, are at increased risk.
     
  5. There are prolonged rape scenes (yes, more than one, and from multiple perspectives) that are frankly unnecessarily detailed and potentially traumatizing for those with a history of sexual assault.
     
  6. There are fights and beatings that are gratuitously violent and likely emotionally distressing, especially for bullied and traumatized youth.
     
  7. The school's post-suicide intervention strategy doesn't come close to following national evidence-based guidelines or standards. For instance, allowing Hannah's locker to become a long-term mini-shrine inadvertently creates an emotionally charged reminder of the suicide, which experts warn could be internalized by particularly vulnerable youth as a means to gain recognition.
     
  8. It portrays the school leadership as villains primarily concerned about the legal implications of the suicide, as opposed to recognizing that teachers and school administrators are not only a potential resource for support, but also very much part of the bereaved community.
     
  9. It mocks the role of the counselor, once again suggesting that adults are somehow incapable of really listening to youth at risk.
     
  10. It is too dangerous a topic to use for entertainment, and yet, that is its primary purpose. Hannah was supposed to be an outcast, but she was strikingly beautiful, perfectly coiffed, envied by peers, always quick with sarcastically winy retorts -and only starts to show slight signs of disturbance (darker circles, tousled hair, irritability, hopelessness) on the day of her completed suicide.
     
  11. It undermines the role of the concerned parent. Parents need to know that there are mental health resources to support families when youth are struggling and that mental health interventions are evidence-based and effective.
     
  12. The way the series is produced and publicized, teens are clearly the target audience, and yet the content is presented in a way that is very adult. Netflix responded to concerns of mental health advocates by updating the trigger warnings to carry additional advisories, Unfortunately, in all likelihood, many adolescents are watching the show unaccompanied by the adults needed to reinforce these warnings.
     
  13. This series had real potential to make a difference--to reduce the stigma of mental illness, promote mental health care, and inform the public about the signs and symptoms of adolescent depression. But it fell short, and we need to do better. Child mental health professionals need to help our communities understand that there is no single right way to talk to teens, that what is most important is to make time and space for the conversation to happen. In talking with adolescents about a serious topic like suicide, it's crucial that adults be open and honest, follow their lead, and really listen. We know that talking to teens about suicide does not increase the risk of suicide. It is silence that is dangerous.

More Information

This article was originally published in The Brown University Child and Adolescent Behavior Letter.