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Days after the death of Kate Spade, and hours before Anthony Bourdain's suicide, Reed Hastings, CEO of Netflix, announced the renewal of a third season of the hit show “13 Reasons Why.” This compelling teen drama follows the story of a teen girl's death by suicide and the aftermath among her high school peers. Despite the controversy over its content, and numerous reports that episodes have served as a trigger for teens' own episodes of self-injury across the country, Hastings justified its renewal by declaring that “'13 Reasons Why' has been enormously popular and successful… It is controversial. But nobody has to watch it.”
As a clinical child psychologist and federally-funded investigator examining adolescents’ self-injurious behavior and popularity for the past 25 years, I know exactly why the renewal of this show will increase the risk for teen suicide—even among those who choose not to watch the show.
The Centers for Disease Control reports that suicide is currently the second leading cause of death among adolescents and young adults. In the U.S., about one out of every four high school teens report that they have seriously considered attempting suicide and approximately 8 percent do so, far exceeding the rate of almost every other developed nation on the planet. In addition to the risk of death, adolescent suicide attempts inflict remarkable pain and suffering on loved ones, cost the United States billions of dollars in emergency health care, and increase the risk among attempters for future death by suicide at least ten-fold. Suicide is a public health crisis that is woefully understudied, perhaps explaining why as compared to cancer, HIV, and cardiovascular disease, it is one of the only leading causes of death that has not diminished in frequency in the US over the past fifty years.
These sobering statistics may offer one reason why “13 Reasons Why” deserves to be on TV. Its bold and vivid depiction of non-suicidal and suicidal self-injurious thoughts and behaviors offers a spotlight to a topic that affects far too many families, yet has been neglected in mental health care policies, funding for scientific research, and education dollars to expand the mental health workforce.
Yet, this spotlight creates a dark, dangerous shadow through its particular narrative style, the glamorization of self-injury, and the inadequate depiction of available resources. Indeed, it is the very “popularity” of this show that makes it most dangerous to developing teen brains that are biologically susceptible to influence.
Research in human neuroscience reveals that the adolescent brain does not mature uniformly across all regions as puberty unfolds. It is the ventral striatum—a region with the brain’s primitive limbic system, and highly sensitive to opportunities for social reward—that is among the first to develop. If you have ever wondered why adolescents suddenly become so averse to attention from their parents, and so addicted to opportunities for popularity around the age of 11 or 12 years old, it is this unique characteristic of our neural development that is likely responsible.
Typically, teens' penchant for popularity guides them to talk incessantly about the cafeteria seating plan, to crave “cool” clothing and music, and to create inventive ways to torment the class nerds in an effort to gain more social rewards—in other words, to produce a surge of dopamine and oxytocin in the brain’s ventral striatum.
Yet, the media can be instrumental towards these aims as well. The University of North Carolina sociologist Jane Brown suggests that the media represents a “super-peer” to teens, with magnified influence over adolescents’ own attitudes and behavior. The special power of the media occurs through two avenues. One is the use of well-known personas to communicate emotionally evocative messages, leveraging celebrity status—the epitome of modern popularity—to influence thought. The second is through the viral nature of popular media, creating opportunities for high school locker conversation about the motives, intentions, and importantly, teens’ identification with each character.
So when a relatable teen uses self-injury to reduce emotional distress on a popular TV show, it is as if adolescents have been thrust into a new, large social group in which cutting and suicide has become suddenly more normative, more “cool,” and unwittingly associated with adolescents’ sense of reward at a neural level they do not recognize consciously. When these same characters forgo mental health resources, remain furtive in their desire to hurt themselves, and use suicide as a vengeful act to retaliate past social wrongs, these too become paired with “reward” and approval in a region of our brains below our awareness.
Research suggests that the power of popularity is remarkably strong. In recent work, investigators revealed that simply telling participants within an experimental lab-based study about the popularity of ideas or preferences was sufficient to produce remarkable changes in adolescents’ and young adults’ neural responses, changing their own stated preferences and values just moments later. In related research, learning about the popularity of images depicting dangerous, illegal, immoral, and harmful acts was associated with diminished activity in teens’ prefrontal cortex—the region designed to inhibit our most impulsive acts when under duress.
Netflix, and its celebrity producer Selena Gomez, have been modestly responsive to concerns raised by numerous parenting groups, as well as many national scientific and professional organizations such as the Society of Clinical Child and Adolescent Psychology, and the National Association of School Psychology by offering additional resources to vulnerable teens. Yet, any parent who understands how the popularity of “13 Reasons Why” surreptitiously affects their children’s attitudes towards one of our nation’s top killers knows that this is not sufficient.
I wrote this piece not because I want people to send hate mail to Netflix or to Ms. Gomez, but rather to ensure that parents are aware that their teens' exposure to their peers who do watch this show may well be sufficient to change adolescents' values and beliefs towards self-injury and suicide, without them even realizing it. Parents and teachers should speak directly with their teens about this show, and about suicide. There is no evidence whatsoever that broaching this discussion with teens will create greater risk, or somehow "put the idea into their heads," yet substantial evidence suggests that talking with vulnerable teens about suicide can reduce the likelihood they will ever attempt.
Ask teens:
- "What do you do when you are most upset?"
- "What would you do if you couldn't think of any way to solve a problem in your life that felt extremely important to you?"
- "Who would you talk to if you started to feel really depressed, started to think about hurting yourself, or started to wish you were not alive anymore?"
- "What are some of the best things to do if you hear a friend was feeling that way?"
For more information about suicide, visit the American Foundation for Suicide Prevention, call the National Suicide Prevention Helpline at 1-800-273-8255, and make sure all teens know about the Crisis Text Line which helps teens using the type of communication style they prefer. To find a mental health professional near you, visit the Psychology Today Therapy Directory.
© Mitch Prinstein, 2018
