Suicide, Mental Health, and the Media: Can it be done right?
Over the past year, suicide prevention and mental health have received a tremendous amount of attention in the media. Much was written about the potential mental health impact of the COVID pandemic and more recently, Naomi Osaka’s withdrawal from the French Open Tennis Tournament again brought heightened attention to how mental health challenges can impact elite athletes-an issue that received substantial attention around the NBA and WNBA bubbles last year and is similarly a source of concern as we anticipate Olympic Games in Japan taking place largely in a “bubble” again.
It is well established that the way suicide is portrayed by the media-whether in journalistic contexts or in fictional accounts-can raise or lower risks of suicide for vulnerable populations-especially vulnerable youth. And while these impacts are not robust (in the sense that only a small percentage of consumers of the media are likely to be put at risk), the consequences are, obviously, potentially dire (increased suicide attempts and suicides). It is also important to consider that even a very low incidence event over a very large population can still have lots of impact. If something affects “only” 1 in 10,000 people (0.01%) but is consumed by 1 million people-it will impact 100 individuals. One of the current challenges in relation to safe messaging and media is the fact that online media might be easily consumed by 100’s of millions of people or more. So even small risk events can have substantial impact.
We also know that the way mental health is portrayed by the media can impact attitudes about mental health- and peoples’ comfort or preparedness to ask for help- in ways that can be helpful or harmful.
How does this work?
Let’s focus on safe messaging and suicide for a moment. Examine the guidelines for safe messaging and you will notice several themes emerge. First when coverage portrays the person who dies by suicide or the suicidal actions in detailed ways that allow someone consuming this media to emotionally connect with the person or the suicidal act (the technical term is “identification”) or when coverage portrays suicide as a way to solve problems or as a commonplace or uncontrollable act, these things all potentially slightly lower the barriers to suicide for some small group of people consuming the media. They seem to induce thoughts like “I’m just like him/her/them (this conveys the identification) so if this was the “solution” to their problems then maybe it makes sense for me as well”. The more complete a picture of the person or act that is drawn the easier it is to make a mental connection to it. Further, the more suicide is portrayed as a potential solution to problems: a way to be loved or receive attention, a way to get revenge etc., the more appealing it becomes. Again, these are small but empirically demonstrable effects. (For a more detailed discussion of these ideas see my presentation in the 2018-19 NYU Grand Round series on 13 Reasons Why and Suicide Contagion: https://med.nyu.edu/departments-institutes/psychiatry/education/continuing-medical-education/grand-rounds)
What about mental health?
It goes without saying that mental health is a deeply complex topic and is often portrayed in such broad strokes that people are left with misunderstandings and troublingly problematic views. In popular media, mental illness is often used as a scare tactic in a plot line-psychotic killers, multiple personality disorder, other florid manifestations of mental illness. Even when portrayed well, often there is a lack of nuance-only the most profound and chronic types of mental illness are typically presented. These portrayals often lead viewers/readers to conclude that mental illness consists of the most serious, intense, and chronic manifestations of illness. This would be like suggesting that being physically ill only consisted of having serious cardiovascular disease or cancer. Of course, if that were the case the idea of becoming physically ill would be terrifying. In fact, we all realize that physical illnesses occur across a range of seriousness, intensity and chronicity-you can have a brief injured muscle or stomach ache or a cataclysmic stroke or heart attack which are both “illnesses”- and the same is true of mental illnesses, but we rarely see this portrayed or well explained in media coverage.
Why is this so hard?
Consider what I suggested regarding reporting or portraying suicide or suicide attempts. If you present information in a way that induces people to have a stronger mental image of the person who attempted or died or of the method, you are raising the risk of copycat behaviors. But it is in the nature of news reporting or storytelling in books or films to do just this. Journalists, novelists, and filmmakers are trying to move us emotionally by having us feel a connection to the subject of the article, story or film. In fact, the first known episode of copycat suicide precipitated by a work of art was a flurry of suicides among young men who appeared to be emulating a character in the novella, “The Sorrows of Young Werther”, by Goethe. The spate of young men dressing like the lovelorn title character and killing themselves led to the book being banned in several cities. As a result, copycat suicide has also come to be known as the Werther Effect. The very nature of news reporting and storytelling appears to increase risk for copycat suicide.
In relation to reporting or portraying mental illness, the problem is similar-journalists and artists are drawn to dramatic and compelling stories. Stories about someone having a mild and self-limiting episode of gastritis or arthritis in their knee or a moderate anxiety disorder that is problematic at some times, but at other times causes no trouble and goes away-is not that interesting. This is why most medical shows focus on ER’s and inpatient hospital care-this is where the dramatic stories happen-even though most medical problems and medical care happen in fairly boring outpatient medical practices or even without professional medical care (how often do you see your doctor for a stomach or headache?).
In light of this, we are left to question whether it is indeed possible to portray suicide and mental illness in ways that are compelling, accurate and safe?
In fact, while difficult (and infrequent), suicide and mental illness can be portrayed safely and in compelling ways in documentary/journalistic settings and in fictional/artistic settings.
Over the past several years, some of the most impressive and effective efforts in this domain have been overseen by Shelia Nevins, multi award winning film maker and longtime president of HBO documentary films (and an advisor to Mind Strategies). Nevins’ production of Liz Swados’ brief animated autobiographical film, My Depression, in which Swados describes her experience of and treatment for depression over the course of her life is engaging and informative. Nevins also produced two excellent shows taking on suicide. The first, Every Brilliant Thing, is an extraordinary one man show by Duncan Macmillan discussing his mother’s experience of episodes of suicide attempts and long history of depression and the impact these had on him. It is funny, witty, compelling, sad, moving and stays completely within the bounds of safe message. It is brilliantly done. Her newest documentary, released by MTV, Each and Every Day, is a serious and sensitive exploration of nine young adults who have struggled with suicidal thoughts and impulses and how they have received care and support. It also is emotionally engaging while being safe and informative.
The Broadway and multi-Tony Award winning hit, Dear Evan Hansen, explores mental health and suicide from an artistically creative and engaging perspective while remaining well within safe messaging guardrails. The show is moving, thoughtful and inspiring.
And just a few weeks ago, Harpo Productions (Oprah’s production company), Prince Harry and Apple TV (along with Radical Media Productions) released the excellent series The Me You Can’t See. This 6-hour series takes up a wide swath of topics related to mental health: the range of problems, different approaches to treatment and challenges to finding adequate care-and it does so with accuracy, sensitivity and depth.
I have had the distinct pleasure and honor to have worked as an advisor on several of these projects (Each and Every Day, Dear Evan Hansen, and The Me You Can’t See) but this brief list shows that, while challenging, with careful planning, thought and consultation, safe, accurate and compelling discussions and depictions of mental illness and suicide-related topics can indeed be produced.