The danger of "glamorizing" death by suicide

Talking about suicide is a cornerstone of prevention. All organizations and individuals involved in reducing suicide rates worldwide agree on this point. According to the World Health Organization, suicides claim more than 700,000 lives annually, as do suicide attempts. But how should we talk about it? How should the topic be addressed in the media and in audiovisual cultural products?

Much has changed since the publication of Goethe's "The Sorrows of Young Werther" in 1774, which triggered a wave of copycat suicides. Two hundred years later, sociologist David Phillips coined the term "Werther effect" to describe precisely this imitative phenomenon associated with suicidal behavior.

This effect has been observed over the years and has guided the guidelines published to offer advice on appropriate media coverage. The aim is to highlight the preventative role that communication platforms can play – the Papageno effect – and to mitigate the harmful influence they can also exert – the Werther effect.

Guidelines for parents and friends facing the risk of suicide in adolescents and young people

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Numerous guides, such as the one prepared by the Ministry of Health, comprehensively outline key recommendations for responsible reporting . These include the importance of avoiding mentioning methods or locations that are easily imitated, as well as not glorifying the individual, portraying suicide as normal, or presenting it as a solution to problems or a way to cope with them.

The media apply these ethical standards with varying degrees of success. The problem arises when we enter the realm of creativity, free artistic expression, and the audiovisual industry.

The burden of "13 Reasons Why"

Four years have passed since Netflix released the series "13 Reasons Why," based on the novel of the same name by Jay Asher. The story revolves around a student who dies by suicide after a series of personal events detailed in tapes that are narrated throughout the series.

From its very premiere, thousands of experts in health and education warned that this series could do more harm than good, and subsequent studies confirmed the copycat effect it was having among American teenagers. The studies were conducted in the United States, but the series' impact is global, considering the 190 countries where Netflix is available for streaming .

But did the series really have a contagious effect?

The first published study, "13 Reasons Why: Viewing Patterns and Perceived Impact Among Youths at Risk of Suicide" (Hong et al., 2018) , revealed that approximately half of the adolescents reported that watching the series increased their risk of suicide due to a strong identification with the female protagonist. Furthermore, the young people at high risk of suicide watched the series alone and without discussing any of the themes addressed with their parents or other adults.

In the days following the release of "13 Reasons Why," internet searches for terms like "how to commit suicide" and "how to take one's own life" increased by 26%, while searches for helplines rose by 21% and searches for suicide prevention increased by 26%.

Another study (Bridge et al., 2019) confirmed a 29% increase in suicides among American teenagers aged 10 to 17 following the release of the first season. In April 2017, one month after the 13 episodes aired on Netflix, the suicide rate in this age group reached its highest level in 19 years. This trend remained high throughout the rest of the year, with 195 more suicides than expected.

Figure 1: (Bridge et al., 2019) - Association between the release of "13 Reasons Why" and suicide rates among children and adolescents aged 10 to 17 in the United States. Note: Blue circles indicate observed suicide rates between January 1, 2013, and December 31, 2017. The solid orange line indicates the adjusted values that best represent the underlying level, trend, and seasonal variation prior to the release. The shaded solid line indicates the initial airing of the "13 Reasons Why" trailer. The line following the shaded area indicates the release date of "13 Reasons Why." Orange triangles indicate predicted suicide rates; curved orange dashed lines indicate the upper and lower 95% prediction intervals. Observed suicide rates in March, April, June, and December 2017 were significantly higher than the corresponding predicted rates.

According to an article in La Vanguardia , other studies "revealed that students who watched all the episodes of the second season had fewer suicidal thoughts and more concern about helping someone with plans to take their own life compared to those who had never seen the series; however, researchers also discovered that some students who watched some of the episodes of the second season had a higher risk of suicide and less optimism about the future."

All studies conclude that caution is needed when exposing children and teenagers to this fictional series, and in any case, viewing should be supervised.

The criticism is not of the topic itself, but of how it is addressed.

The main problem with the series lies precisely in its narrative approach. The first episode already depicted the protagonist, Hannah Baker, taking her own life, wrapped in a narrative that glamorized or "beautified" the act itself. Throughout the series, it disregards all recommendations advising against presenting suicide as a means to achieve certain ends, such as revenge or recognition, and against glorifying suicide or those who die by suicide.

Netflix responded to the criticism on these issues by activating various measures:

• It activated warning messages at the beginning of each chapter.
• In July 2019, two years after its initial broadcast, it removed the suicide scene from the first season.
• The content warning was complemented by an online information space about violence and sexual abuse, mental health, self-harm, and suicide, accessible from the platform itself and with resources for teenagers and their families.

It will be difficult to know the full extent of this series' impact and influence on vulnerable individuals at risk of suicide. Although Netflix never releases viewership data, Nielsen published an estimate of views in 2018 when the second season premiered. According to this company, the second season was watched by 6 million viewers in the United States during its first three days, with 75% of the audience under 34 years old. If we extrapolate these figures to a global market over four years, we are talking about millions of people exposed to a message that can have a harmful effect, especially on those at risk.