Why Not Thirteen Reasons Why?

From the Editor

There has been tremendous media coverage of Thirteen Reasons Why, this spring’s new fictional Netflix series (based on a book of the same name published about a decade ago) about the aftermath of the suicide of a 15-year-old girl. For those of you who either haven’t seen the series or haven’t heard media coverage about it, the 13 reasons are a series of 13 audiotapes made by the character, Hannah Baker, to be listened to by the 13 people she felt in some way contributed to her decision to kill herself.

The media coverage of the show has ranged from critiques about the script, the acting, the initial one-dimensional portrayal of many characters, the series ploys to keep the viewer watching, and the content. Other reviews have lauded the portrayal of the insecurity, alienation, shifting loyalties and relationships, and labile emotions many viewers will either remember from their own high school days, or feel speaks to their current experiences.

Individual mental health clinicians as well as organizations, in press releases and interviews, have criticized the series as somehow glamorizing or romanticizing suicide. They have expressed serious concerns that vulnerable adolescents who watch the series may be influenced to commit suicide.

And some critics have suggested the series communicates an unrealistic message that suicide can be prevented if people are simply nicer to each other, though I think this reflects an incredibly simplistic and superficial reading of the scripts. My own take on this is similar to that of one of the protagonists-especially in the last episode-who expresses his hope for more self-reflection and empathy toward schoolmates and friends.

To me there was no implication that this would be adequate to stop suicide on a broad scale, but I’m sure we’d all agree that it might have some beneficial effect on the atmosphere resulting from the social media harassment and verbal and physical aggression that seems epidemic in some school settings, and which clearly stresses all-not just the most vulnerable adolescents.

I’m not here to serve as a TV or movie critic, although I am very familiar with the legitimate fears about the potential for an increase in adolescent suicides among those exposed to the show due to the effects of a social contagion. This phenomenon has been well described following other spikes in adolescent suicide. Some will remember, in this regard, the repeated episodes of group suicides by Japanese teenagers some years ago. There is, actually, an indication that this even occurs within the series itself to one of Hannah’s former friends after her suicide.

The adolescent suicide rate had tripled between the early 1970s and 1990s, and today almost 20 years later we know there has been little change since then. Even worse, it isn’t even much of a topic of public discourse.

On the other hand, after having watched the entire series, I think some of the critics must have watched a different show than I did. Yes, the series uses the usual plot trick of cliff-hanger endings to maximize the likelihood you’ll come back for the next episode, but I most often found the show compelling, tense, sad, and heart-wrenching. I think some of the hyperbole in the media is misplaced.

At the end of the series, we actually know very little about Hannah Baker beyond her suicide. We know she was bullied, subjected to public humiliation, and raped, but know little else about who she is as a person beyond these horrific experiences. We actually find out more about a number of the other characters as we learn how they are coping with the aftermath of her suicide and the presence of the tapes. Hannah’s significant depressive symptoms are relayed through the various episodes, and up to almost the last moment, we learn she still has ambivalence about killing herself and is looking for a lifeline she finally concludes isn’t coming.

Implicitly, we know she has had significant anger, although there is no overt portrayal of her venting it. If anything, a straightforward conjecture is that, as Freud hypothesized in Mourning and Melancholia, her suicide in part reflects aggression turned against herself. And, clearly, the tapes themselves, directed to be listened to by those she feels have hurt her, are geared to induce significant pain, hurt, and guilt in those left behind.

I don’t think my view is an isolated one, and I do have some other opinions that share my perspective, though I have no polling data to support it. I’ve been directing our third-year medical student clerkship for this semester, and in a meeting with the students, one of them asked me what I thought of the show. I had been aware of it at that time but hadn’t seen it yet, though I mentioned I was aware of the controversies I’ve mentioned here. I asked them, and the current group, what those who had seen it thought. Not a single one, and this is a group generally in their mid 20s, thought it somehow painted an even vaguely positive picture of suicide. In fact, they thought it showed both the extremely difficult antecedents and the horrors of the act itself (shown explicitly in the final episode, apparently a taboo to some suicide experts).

The medical students thought it was probably not suitable for 12- to 14-year-olds to watch without an adult, but they didn’t think anything portrayed would be foreign information or feeling states for most teenagers. One student, insightfully showing you don’t have to be a psychoanalyst or a Freud scholar, did express a concern that Hannah’s suicide could be seen as a way of getting revenge on those who had hurt her and might influence some kids in that way. Not one of the 40 students thought this show should be off limits even to early adolescents, including the 10 of the group who said, in response to my question, that they personally had known someone who committed suicide.

The students also felt, and I completely agree, that this series highlights several other problems, which have been tied to suicide risk but that also need significant attention in addition to increased suicide risk. I’m referring to the problems faced by Hannah before she committed suicide and by other high school characters in the series-and clearly by many children and adolescents in real-life school settings. These include social media harassment, sexting, sexual assault, alcohol and other drug abuse, and other forms of emotional and physical harassment.

When Dr. David Satcher served as President Clinton’s Surgeon General, one of his major national public health priorities was adolescent suicide prevention. As a pediatrician, he was well aware that the adolescent suicide rate had tripled between the early 1970s and 1990s, and today almost 20 years later we know there has been little change since then. Even worse, it isn’t even much of a topic of public discourse.

If Thirteen Reasons Why does nothing more than bring back to public consciousness this terrible problem of adolescent suicide, to me that’s enough. But with the growing body of information that informs us that a large number of adolescent high school and college students have suicidal thoughts in a given year, we know much more needs to be done than the momentary experience of watching or talking about this TV series. If you have kids in the right age group who are still living at home, watching the series together might provide a stimulus for some important conversations. And also, consider calling your kids’ schools and offer either to come yourself or arrange for a colleague to come to the school to talk with the teachers and parents about adolescent suicide and the other important concerns raised by the show.