13 Mental Health Questions about “13 Reasons Why”
The realistic portrayal of mental illness in television and movies can be an effective way to reduce stigma around psychiatric issues. But it can be troubling if those portrayals do not show options for treatment. A new Netflix show, 13 Reasons Why, has a large following on social media and has garnered media attention for its stark depictions of bullying, rape and suicide. It has also caused some to express concern that the show is “at odds with the way experts say we should talk about suicide,” a Washington Post article reports. Suicide prevention advocate MollyKate Cline told Teen Vogue, “my problem is that the audience is shown what not to do without examples of what they actually should do.”
What should you do when faced with issues of bullying, depression, trauma and suicide? Seeing these issues in pop culture can help to reduce stigma and shame around mental health, but it is just as important to learn the facts about mental health issues and seek reliable treatment.
1. How can you prevent depression and anxiety?
Depression may impact up to one in four teens by the end of their adolescence. Important parts of prevention include recognizing the signs of depression (in yourself and in others), knowing that effective treatment is available and creating a supportive culture in which it’s encouraged to ask for help. Signs of depression can include changes in sleep patterns and appetite, social withdrawal, decrease in school performance or motivation, changes in concentration and energy level, and having worsening mood (this could be sad moods with crying or persistent irritable moods).
2. How common is teen suicide?
Suicide is the second leading cause of death in 15-24-year-olds, second only to accidents. That said, suicide itself is a relatively rare occurrence. In 2014, a little more than 5,000 people aged 15-24 years old died from suicide in the United States, while nearly 12,000 died from accidents. Sometimes youth suicides can cluster together in a community over a short period of time, which highlights how important it is to provide support on the individual, school and community levels in the aftermath of a teen suicide.
3. What are warning signs of suicidal behavior?
In some cases, there are few warning signs of an imminent suicide attempt, making it important to watch for the signs of depression and distress discussed above. However, some warning signs to take seriously are the onset of self-injurious behavior, abrupt social withdrawal, increased high-risk behaviors (such as drinking, drugs, reckless driving), writing goodbye letters (either in person or on social media) and giving away possessions to others.
4. What are contributing factors that make a person more likely to have suicidal thoughts and behaviors?
There are a variety of factors related to genetic background, temperamental makeup, as well as life experiences, that are risk factors for self-harm and for suicidal thoughts or acts. Risk factors include exposure to trauma or neglect, loss of a parent or parental discord, having a family member who has attempted suicide, use of alcohol or drugs, impulsivity, low self-esteem, exposure to bullying, hopelessness and perfectionism. Adolescents in the LBGTQ community who face anti-gay sentiment have also been shown to be at increased risk. Suicide attempts in adolescence are usually related to conditions like major depressive disorder, anxiety disorder or substance abuse, which are treatable once recognized.
5. Is it anyone’s fault if someone dies by suicide?
While bullying can be a risk factor for developing depression, it interacts with a variety of other factors (like underlying severity of depression or anxiety, drug use and level of parental support and involvement) in complex ways. Medical and psychiatric professionals can treat depression and suicidality effectively, so suicide prevention may be best driven by supportive, informed and caring communities working together to identify teens who are at risk or in crisis and to help them access medical care. Good resources include the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), the Crisis Text Line (text TALK to 741-741) and mental health crisis resources in your state.
6. Can friends and family prevent suicide?
Friends and family may be the first ones to see the “warning signs” that a person is depressed and may become suicidal. Sometimes, these signs show up long before a friend/loved one is in crisis. Take advantage of this time—the earlier the person can get help, the better the outcome may be. Practicing mentally healthy behaviors like using problem-solving and conflict resolution skills, creating easy access to a variety of clinical interventions and maintaining strong, positive relationships can be protective factors against suicide.
7. What should I do if a friend seems to have suicidal ideations?
Talk openly and honestly and listen without judgement. Your role is not to “fix” them, but to get them to someone who can help. Let them know you care and they are not alone. Encourage them to seek help immediately from a mental health professional. Don’t leave them alone. An immediate method of support for yourself and your friend is to call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
8. What will happen to my friend if I tell an adult that my friend is suicidal?
Your friend will not get in trouble, they will get help. Things that are discussed with a counselor or doctor are confidential. While it can be hard to talk about these issues, the outcome can be far worse if symptoms are ignored.
9. What should I do if I’m thinking about suicide?
Asking for help is the first step in treating these negative feelings and getting better. If you feel suicidal or have thoughts of suicide you should talk to a responsible adult or call the National Suicide Prevention Lifeline immediately at 1-800-273-TALK (8255), where you can talk anonymously with someone about your feelings and find a mental health provider in your community. It is important to talk openly about these feelings with someone as soon as possible even though it may feel uncomfortable. Even if you don’t feel you are in crisis at this moment, save the phone number to your cell phone contacts in a place that you can get to it easily in case of an emergency, perhaps saving it with a different name if you’re worried about someone seeing it.
10. Why do people self-harm?
Self-harm is a form of coping with or escaping overwhelming negative emotions. Self-harm can provide a way for those who have trouble feeling emotions to feel something “real” to replace numbness; it can help turn internal psychological pain into external physical pain. People also self-harm to punish themselves and the shame and guilt of self-harm can lead to further self-harm, causing a downward spiral. Injuring yourself can release endorphins or pain-killing hormones, raising mood momentarily; self-harm can thus become addictive. Self-harm is sometimes a physical sign or cry for help, but more often performed privately to dispel negative emotions, then hidden from others.
11. Is self-harm always a warning sign of suicidal thoughts?
The relationship between self-harm and suicidal thoughts is complicated. While people who engage in self-harm usually do not intend to end their own life, it is a symptom of underlying emotional pain that increases their risk for suicide. Sometimes, people may cause more harm than intended, resulting in medical complications or death. Also, in severe cases people may become desperate over their lack of control in self-harm, leading to suicide attempts.
12. What can I do if I know someone is being bullied?
If you’re afraid someone is being bullied, always be proactive and let them know you care and they can talk with you; simply knowing they have someone to talk to can help them speak openly. When someone confides in you about being bullied, focus on listening to what’s happened and ask them how they feel, versus rushing to suggestions like “just ignore them!” or “fight back.” Always report bullying and if you see someone being bullied, stand up for them politely and firmly; bullies are much less likely to bully if others confront them.
13. Does bullying contribute to suicidal ideation?
We don't know if bullying directly leads to suicide, but it greatly increases the risk of victims having thoughts of or attempting suicide. This risk is in both victims of bullying and bullies, and is especially high in youths who are both victims and perpetrators of bullying. This risk is further increased if the victim is suffering from depression or anxiety, or is part of an at-risk population, including ethnic minorities and LGBTQ youth.
- Jennifer B. Dwyer, M.D., Ph.D., APA/APAF Child and Adolescent Psychiatry Fellow
- Swathi Krishna, M.D., SAMHSA Minority Fellow
- Chandan Khandai, M.D., APA/APAF Leadership Fellow