The show can be a catalyst to help adolescents struggling with depression and suicide.
“13 Reasons Why”, a Netflix-original drama that boasts Selena Gomez as one of the executive producers, is a series that focuses on Hannah, a young high school girl who has recently committed suicide. She leaves behind carefully orchestrated narratives on cassette tapes in which she names individuals whom she alleges all had a role in her death. The show, and the book on which it is based, is a stunning demonstration of the raw emotion that ensues from bullying and rumors, rejection and isolation, and the everyday stressors and tribulations of adolescence.
Some argue that the show glorifies suicide — and in fact, shows a very real and jarring suicide scene — potentially glorifying life after death. When initially released, Netflix failed to include trigger warnings and helpline numbers, though they’ve since corrected that. And of course, there are worries and concerns about copycat suicides and that the show does little to capture the context of mental illness.
As a licensed clinical psychologist, I have the privilege of working with young adolescent women. I use the word “privilege” deliberately and purposefully. I’m acutely aware that youth confide in me, entrusting me with their deepest and most intimate secrets, fearing judgment and embarrassment. So when I win over the trust of one of my adolescent clients, I treasure it, knowing just how difficult it can be for them to trust an adult to listen and not talk at them, to validate their issues without dismissing them as silly or “dramatic,” and to not be visibly distressed by their comments or remarks about suicide and self-harm so much so that they fear opening up.
Amidst the controversy of “13 Reasons,” I binge-watched the show, fearful that I would have an influx of suicidal ideation and threats. But as I became more immersed in the show and formulated my own ideas and thoughts, and as my clients subsequently approached me in practice in the weeks that followed, I discovered that the show was more valuable to me as a clinician, and more valuable to them as individuals, than I may have given it credit for. Here are some things that I took from the show through my lens as a mental health clinician:
1. Talking about suicide does not lead to suicide. Talking about suicide gives a voice to the feelings underlying the suicidal ideation.
The show may give rise to suicide contagion (aka copycat suicides which are suicides that are catalysts and triggers to further suicides). And in fact, my work in a residential treatment facility for eating disorders corroborates this concern. When one adolescent patient would come forward in reporting that they had been self-harming, a floodgate would open and give rise to handfuls of other girls self-harming. For the majority, this was not a newly learned behavior, but rather, a vehicle with which to communicate to us their feelings of loss of control, anger, and desperation.
We have a misconception that mentioning the “s” word can lead someone to act on it, when in fact talking about suicide and giving it a name, can reduce shame and stigmatization around the topic.
The fear of mentioning certain taboo topics reminds me of when Papa Roach came out with the song “Cut My Life Into Pieces” and there was a frenzy of worry that youth would begin self-harming in response. Or when Christina Aguilera’s music video for “Beautiful” came out which encompassed a young woman with an eating disorder, amongst other youth with mental health issues. The lyrics and images give voice to thoughts, feelings, and ideas that adolescents are taught to view as socially unacceptable and shameful. These songs, videos, and shows tell our adolescent clients very little that they do not already know — rather, it gives them a language with which to communicate their deepest woes and struggles. My clients will often tell me that they are reading books like “Prozac Nation” or “Girl, Interrupted”, or they may even share a famous quote, because it gives them a language to communicate the abstract sense of despair and hopelessness that they may feel, but are unable to express or convey themselves.
2. There is no one size fits all description of mental illness.
Ninety percent of all completed suicides are in individuals who had some form of mental illness, according to the Substance Abuse and Mental Health Services Administration. Suicide is a behavior, a response, a reaction to mental illness. The American Psychiatric Association specifies various criteria for Major Depressive Disorder (what is colloquially referred to as depression). To the layperson, these are jargon-filled specifications that are all too easy to overlook or miss.
Depression does not always look like, well, depression. “13 Reasons” concentrates its efforts not on going by the books, but showcasing the experiences and little nuances of depression, the “warning signs” so to speak, that we’re all apt to see in everyday life. For example, the show highlights how depressed teens may present as more irritable and angry, with mood swings and impulsivity in reactions. Isolation, secrecy, and a retreat inwards are also key indicators. Depression may even manifest in an inability to concentrate or focus attention, mimicking the signs of ADHD. Subtle indicators of low self-worth and poor self-esteem are also highly evident across the show (for example, Hannah asks Clay if she could “ever be as pretty” as one of her friends). Nearly all of the parents I’ve worked with have told me that in hindsight they recognize their child was depressed, suicidal, eating disordered, anxious, and so on, but that they failed to see it unfolding in real time. They note that they’re taught to look for glaring red flags, and often miss the continuum of symptoms in which depression, and other forms of mental illness, may manifest.
3. The show is shown through the lens of a teen, capturing their ideas and worldview and is not meant to outwardly debunk myths, but rather, more indirectly call attention to them.
When we talk with teens, we often do so at a level they simply cannot comprehend. While the adolescent brain is maturing at an exponential rate, several areas of the mind implicated in decision-making, emotion regulation, and inhibition remain underdeveloped.
“13 Reasons” is from the perspective of teens themselves, showcasing their belief system and way of viewing the world. It’s emotional, intense, painful. Characters’ behaviors are impulsive and reckless, with no seeming understanding of consequences. For Hannah, she is consumed by the short-term consequences of her death with her final days marked by anger, revenge, and the hope that these infamous tapes will linger in the lives and minds of the individuals whom she blames and holds responsible for her pain. But she fails to evaluate the long-term consequences: her mother’s heartache and pain, Clay’s despair and confusion, even the impact it might have on others facing similar difficulties like Skye, Clay’s ex-girlfriend who exhibits similar warning signs as Hannah. She fails to see the events unravel leading to what could be Season 2’s hook for a school shooting.
The series does not beat adolescents over the head with this information, warning them and talking at them. Instead, it weaves in these intricacies every so carefully.
My task as a psychologist is to listen to my clients and hear their pain, to validate it, to be there in the moment with them as they experience it. I try not to sugar coat things with shallow statements of “it will be better soon” or “there are great things that await you.” I never purport to know the future. But what I do tell them is that I know of other ways to cope, to deal, to live. I know the unhealthy ways just as much as the healthy ones. The great thing about unhealthy coping skills is that they act quickly. The unfortunate part of it is that these effects rarely last. Sooner or later, we’re left to confront the long-term consequences of our actions.
I believe it’s our job as adults to help our young clients, students, and children with the decision-making process.
And I do that without judgment or manipulation by using Socratic questioning to help them come up with the answers themselves, so that they are more inclined to hear it, and subsequently, believe it.
4. We are all doing the best we can and we can all be doing a little bit better.
Hannah faces barriers to reaching out for help that may send the wrong message to teens — telling them that help is not available or that it may not be worthwhile to ask for support. The school counselor in ’13 Reasons Why’ is distracted by his own personal life and lacks an educated understanding of rape and the harmful effects of victim-blaming. This is not representative of therapists as a whole.
But we are a profession that is notoriously overworked and underpaid. We are often multitasking different cases, navigating the political systems within which we work, and fighting through the administrative processes that often bogs us down with hours upon hours of paperwork. We are a profession that requires a number of continuing education credits per year in order to renew our licensure by the state boards, but simultaneously have jobs that fail to give us paid time off (or paid conference fees) to seek out said workshops.
The show highlights that this can be a barrier for kids seeking help. Not the norm, but certainly a possibility and far too common than any of us would like to admit. Teachers, counselors, or coaches who are too busy to focus or watch for the kids “falling through the cracks.” A system that is preoccupied with standardized test scores to secure government funding rather than providing adequate social and psychological support. A society that stigmatizes mental illness, shaming and blaming individuals because that is easier than addressing the larger school culture.
We are targeting a show’s failure to portray the availability of resources, when in actuality we should be lamenting the fact that our society and systems repeatedly fail our youth.
This is our opportunity to acknowledge our limitations and work to be better: to listen more, to judge less, to intervene quicker. We should be actively advocating for improved psychological services in the school system — both in number (more counselors) and in quality (more continuing education opportunities available to counselors). We should be rallying for preventative efforts — posters that give out the national suicide hotline (1–800–273-TALK) before suicides occur, not afterwards. We should be advocating for mental health issues and lobbying at Capitol Hill to destigmatize the shame surrounding mental health issues so that it will trickle down to our youth and pave the way for them to reach out for support.
5. Suicide is the final act, but it starts much earlier than this.
While we often see suicide as the last act, the show depicts the various events that led to Hannah’s final moments. Beyond that, we can see into the lives of her peers, all facing issues of their own (unstable family environments, sexuality and sexual orientation concerns, rape). There are instances upon instances of events, small and large, that take place leading up to the characters acting in the way that they do. It seeks to give context to the act of suicide, rape, bullying, and so on, rather than simply focus on the ultimate end.
A large portion of my clinical psychology private practice encompasses adolescent and young adult women with depression, anxiety, eating disorders, and substance abuse, to name just a few. Across the board, every single client that I work with has experienced some trauma — whether it’s in the form of sexual or physical abuse, neglect, emotional abuse, bullying, complicated bereavement and grief, car accidents, and natural disasters.
My clients have come in with various takes on the show. For some, the portrayal of bullying and social exclusion resonates. For others, it’s the way the show depicts suicide and the anger, pain, and hopelessness that they once felt. And for others still, it’s their hope that the show can communicate what they have been unable to do — a sense of visceral emotion that at times can only be felt, not spoken.
In short, the series is an opportunity for us as parents, clinicians, counselors, teachers, school systems, and youth to begin a dialogue. It is a jumping off point and should not speak for itself. We should be mindful of our own histories and the feelings that the series drudges up in us. Perhaps our reluctance to accept the series for what it is, is our own fear of death, depression, and a sense of hopelessness. These are the very things we should be talking about, not ignoring or shutting down.
Originally published at medium.com