SIO432: How 13 Reasons Why Killed Kids

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:16 Thomas: Hello and welcome to Serious Inquiries Only. This is episode 433. I'm Thomas Smith and making a triumphant return is Dr. Stormy Decisis, Alan Smerbeck himself. How are doing?

0:00:28 Alan: I am splen-tacular.

0:00:30 Thomas: Good to hear it. Yeah, it's, uh, you've been, you've you Been busy. You've been working. We've missed you sorely. We thought, you know maybe maybe you hated us, but no, you've just been really busy.

0:00:39 Alan: I am delighted to be back, but yeah, I mean, it was personal. So So, you know, just letting you know.

0:00:44 Thomas: Oh, sorry. Okay. It was personal. He told me off air was, that that it wasn't, but I think he's saving the truth for the listeners. So yeah. Okay, it was personal grievance.

0:00:51 Alan: Yeah, no, I wanted to just let you know now it's frankly, it's your your body odor is really just the issue. I don't want to be in the same Zencaster room with you.

0:00:56 Thomas: Wow, it's coming through that far. Jeez. Great to have you back. I am looking forward to this. This is one that, you know, know, we've kind of talked about you wanted to do for a while. And I've said, yeah, absolutely. Because when this show came out, 13 Reasons Why, which is like 2017, I want to say, it's been a while, right?

0:01:20 Alan: Yeah.

0:01:20 Thomas: This seemed awful. And, uh, I think you're here to tell us that science also maybe concludes that this is awful.

0:01:28 Alan: So we first talked about in the it patron only bonus when we were talking about Hunting and Robin Williams death by suicide. And that was an example of a case where there was what we call suicide contagion, where after a suicide, more people die by suicide than would otherwise be expected. And that doesn't have to happen. Is predicted by the way the suicide is discussed and reported on. So in Robin Williams' case, the news media did a lot of things that you really aren't supposed to do. In particular, they speculated a lot on the cause, and they gave graphic details about the method and the body position and the exact injuries. One story literally gave a detailed description of the exact object that was used. And you'll notice that I'm not saying which object is used because it's, generally speaking, a bad idea to do that. And so in the five months after his death by suicide, there were 1,800 more suicides than would be expected.

0:01:38 Thomas: That's right. Yeah.

0:02:35 Thomas: Wow. This is, wow. Okay. That's a lot. Wow. That is way more than I would have thought. So this is not a minor thing.

0:02:40 Alan: Yeah. So start off, one of the biggest reasons is that, and I say this and it's going to sound flippant, but I mean it in the nicest possible way, suicidal people are lazy. Severe depression makes it hard for you to have motivation, to be a problem solver, to be flexible. And so if is difficult, lot of people are protected by that fact. They give up, not because they want to live, but because it's too hard. And later, they're glad they didn't die by suicide. But in the moment, they give up because it is difficult. And so talking and showing an explicit method makes it easier, because now you don't have to think of a method. And now we've explained these particular tools lead to this outcome.

0:02:53 Thomas: Yeah. Yeah, yeah, yeah.

0:03:24 Thomas: Since This whole thing is about talking about suicide, possibly responsibly. How do we make sure we're doing that today? Is there anything we need to be doing

0:03:36 Alan: So the very first thing is providing people with resources. So I'm going to talk later about suicide the hotline, but I will say right off the bat, the number is 988 in the United States. You can call them, you can text them. If you are deaf and use a video phone, you you can use a video phone and communicate with them through ASL. And having access to that resource is important. I will say to any listeners, some of the information I'm going to provide, there's really no way to describe it without being a little bit graphic. I'm not going to be any more graphic than I need to be. But if you are someone who is sensitive to this kind of information. I would suggest just not listening. You You need this podcast in your life generally, but you do not need this episode. And I am not in a position to monitor your health and be responsive to it because I don't know you, listener. So I would say that if you're someone who feels, you know, very vulnerable to that, probably your best bet is to skip it.

0:04:09 Thomas: Yeah.

0:04:38 Thomas: All right, well, that said, uh, yeah, I'm amazed by how big that effect could be, but also, yeah, it was so visible. And I said in the episode, um, I struggled with that, you know, because at the time when Robin Williams died, it was, yeah, everybody was speculating, there's this stupid trope about the sad clown, and everybody decided that's what it was.

And I, you know, I know, like, me, me and my brother, who suffered from depression, a really hard time with it, like harder than maybe if someone doesn't suffer from depression than you might think. But I guess that's not exactly related per se, because it wasn't about like specifically being motivated to commit suicide or anything. But it just, it's a visibly sad thing. And then, like you say, I've been there where, you know, severe depression, it is incredibly difficult to do anything. Thing. And so it's, I never thought of it from that angle that like, oh, just giving people that little bit of like motivation and information is enough to kind of break through that, depression spiral enough to do it, which is, I didn't know that. That's, wow. That's really shocking.

0:05:38 Alan: Well, that's why there's a very, very strong link between firearms and suicide, because firearms make it easy. I always bring this up and tell as many people as possible, because whenever we start talking about gun control, everyone's thinking about homicide, but more than half of firearm deaths are suicides. So if anyone's talking about a good guy with a gun and a bad guy with the gun, in more than a half of cases, The shooter and the victim are the same person. And that's because it's super easy. You don't have to plan and really work out exactly how to do things. It's a single brief motion.

0:05:43 Thomas: Yeah. Yeah, yeah, Yeah and not only that, I mean, I've talked about about a long time ago. It's why men commit attempt suicide at similar rates or maybe even lower rates than women, but are more successful because they use guns more.

0:06:24 Alan: I'm going to just let you and the listeners know some preferred terminology.

0:06:27 Thomas: Oh, please.

0:06:28 Alan: So we would say suicide or died by suicide for someone who made a fatal attempt. And then we would see a non-fatal attempt or just an attempt for rather than like an unsuccessful attempt because we don't want to suggest that that was a failure. But it's also the case that the more we give sort of a dramatized view of the person's life, of the, the person who died by suicide, the easier it is to identify with them. And what you just said, you and your brother felt after Robin Williams' death, the media coverage talking about his mental state and his life was so, so extensive. It really invited people to identify with him. And while it's generally good to be empathetic and identify with others, when you're identifying with someone who just died by suicide, that could increase your risk of suicidal behavior. And so in general, media guidelines recommend that you do not give a ton of details about a person's life and their mental state, not immediately after their suicide, not to the public,

0:06:31 Thomas: Okay. Mm-hmm. Uh-huh. Good point. Yeah. Yeah,

0:07:33 Alan: Because that tends to make people feel like I am the same as this person, like similar. And that is going to increase the risk of suicidal behavior.

0:07:44 Thomas: Know any of the history of this? When anybody noticed this or any famous cases where this kind of developed? Oh, or

0:07:50 Alan: The answer is yes, but I don't know how to pronounce all the things. So in fact, name for this is the Werther effect, and that's W-E-R-T-H-E-R, and it comes from a German novel called The Sufferings of Young Werther, which is just about a guy who's miserable and he kills himself.

0:08:07 Thomas: I think I've heard of this, yeah. Yeah.

0:08:09 Alan: And then the opposite is something called the Papageno effect, which is, I think of an opera, So,

0:08:14 Thomas: Papageno? Yeah, that's, that's from Papageno's from, uh, oh, no, it might just be called that, or is it a character in operas?

0:08:17 Alan: No. It is, it is. The Papageno, the

0:08:22 Thomas: Called Papageni.

0:08:22 Alan: So Yeah, but this basically you know, it's about someone who, who is suffering and reaches out for help, so they're modeling good coping, coping behavior, whereas were their models bad coping behavior? That's as far back as we've identified it. But

0:08:23 Thomas: Yeah yeah okay wow I feel like I've read this Wikipedia page before, and it's like there's, well, people thought that everyone was like jumping out a window because of a thing. It's like, well, we don't know if that's actually true, but it might. So, who knows? But still.

0:08:46 Alan: No, but I will get to that because it's a really important point, which is that external stressors can be the immediate trigger, but they're not the long-term cause of suicide. And 13 reasons why it gets that wrong. So I will add that other deaths by suicide have not led to the same increase as Robin Williams' suicide. Kurt Cobain is a pretty famous example. The media was much more limited in its descriptions. The method was not publicized. And they were very careful that every time they brought up his death that they had intensive suicide prevention messaging. And so So there really wasn't an increase in suicide after his death. So it's not inevitable. Let's start with the good news. Talking about suicide can be a good thing. Asking people if they have suicidal ideation does not induce suicidality. There's really extensive evidence that bringing up suicide in a therapeutic manner is good. Favorite example of this is the rapper Logic had a hit song 1-800-273-8255, which is the number for the suicide hotline.

0:08:50 Thomas: Okay. Yeah. Yeah, that's a relief.

0:09:57 Thomas: Was that before they did the three digit thing or something?

0:09:59 Alan: Right, so Congress very wisely passed a bill to devote the number 988 to the suicide headline, and now that works all around the United States, which Which is good because, again, suicidal people aren't thinking very clearly. We want to make it as easy as possible for them to get help. But this song, the song is about someone who's suffering and then reaches out for help and ends up not making a suicide attempt. And the title of the song and the refrain were the number of the suicide hotline.

0:10:12 Thomas: Yeah.

0:10:28 Thomas: Which so cool. Like, it's amazing.

0:10:31 Alan: The month after the release, as well as, they checked the month after the released and the month after attention was drawn to it, it won two major awards, it got a Grammy and an MTV Music Award, calls to the suicide hotline went up by about 7%, and in young adults suicide went down by about 5.5%. That was 245 deaths that were prevented.

0:10:46 Thomas: Wow.

0:10:54 Alan: Yeah.

0:10:54 Thomas: That's amazing, yeah.

0:10:55 Alan: So there are ways to talk about suicide that, I mean, literally that song saved hundreds of lives making it easier to remember the number, by prompting people to call it. So it. It's absolutely, there are good ways to talk about suicide. It is not the case that we shouldn't talk about it, but are bad ways to talking about it. And that's both in talking about actual behaviors as well as fiction. So the most famous example of this is in the 1980s, there was a German television show called Death of a Student, well, it was in German, in which a young man's exact method of suicide, and I am going to say it, was jumping in front of a train. And after that, the number of young people, particularly young men, jumping in front of trains doubled. You gave them the method.

0:11:46 Alan: You told them how to do it. And it's not that that isn't kind of obvious, but it's kind of of obvious to someone who's not depressed. Yeah.

0:11:53 Thomas: Is there a way to separate? I'm curious if in this, it sounds like this has been studied a lot, is there a way to separate the effect of just the method with also the glorification kind of thing where it's like, you making we're making a TV Show where it kind of glorifies it in a way. Is there any way to seperate those effects?

0:12:09 Alan: So Both of those things happen. This particular study didn't look at that. Um, it's harder to detect the method because jumping in front of a train, which the reason I mentioned that is because jumping in front a train is a relatively rare method. So it's one can disagree with with fact that this show influenced that particular behavior. Whereas if we saw an increase in behavior in general, it would be harder to attribute it. But the stuff with 13 Reasons Why, we see both a general increase in suicidality and suicidal behavior, and a specific increase in the behaviors modeled in the show. So both of those things are present.

0:12:26 Thomas: Yeah. Yeah.

0:12:50 Thomas: So it failed on every count. Yeah, yeah, can all agree. Fuck this show but

0:12:54 Alan: It almost almost could not possibly have been worse. So really, really important not to romanticize suicide. I used to work with a guy who was in an adolescent psych ward, and some adolescents have a very romanticized view of death. You'll be a pretty corpse, you'll be young forever kind of thing. And one of his favorite things to say was, you shit yourself when you die, which is true. True, you'll lose control of your sphincters, feces come out, and you, and know, he was saying, like, you're not going to leave a pretty corpse, you're not going to be young and beautiful forever, you're going to be a bloated, you know, death, your is ugly, let me show you how. He'd like take them down to the morgue, you know, because some young adolescents really, they have like a Romeo and Juliet version of, you know, they're going tobe beautiful forever in death. And so romanticizing suicide is really dangerous, it's really important to look at the motives that are shown, and not, the most important thing is not to show suicide as effective, don't show suicide as having solved a problem.

0:12:55 Thomas: Yeah My god. Hmm. Yeah yeah

0:13:55 Alan: Um, your real world example of this, I, this wasn't a school that I worked at, but a nearby one, and I knew some of the people there. An adolescent, um, died by suicide. He, he was gay, and he had taken a lot of comfort in Lady Gaga's music about, you know, accepting yourself for who you are and themes like that. It'd been like, like a, the local Lady Gaga fan club or something. And I, I want to emphasize that this speaks incredibly well, Lady Gaga actually offered to do a benefit concert, this person's name, to raise money for suicide prevention, and also to spread an anti-bullying message. This child had been bullied. And again, this speaks terribly well of her. I don't know how much on earth that would have cost for her to put on this concert. It was a huge, huge, generous offer. But the right thing to do is to turn it down, and that's what they did. Because otherwise, it would send the message that suicidal behavior gets your favorite pop star to pay attention to your problem.

0:14:52 Alan: So let's talk specifically about 13 Reasons Why. So I'm going to give a very brief summary of the plot. So, I guess, spoiler alert, learn, but I'm going to give you three named characters, I'm not going to go into all of them. So there's Hannah, who is the girl who kills herself, the narrator of the book is a boy named Luke, who had a crush on her and, you know, was kind of friends with her, but just a normal adolescent, like, you know, I kind of want to talk to you, but I'm scared. Um, and then a boy, boy named Tony, who was not friends with Hannah or Luke, and just is kind of a peripheral guy, and Hannah draws him into this. So Hannah suffered terribly in terms of being mistreated by her classmates. She decides to kill herself in a way that punishes the 13 people, actually 12, who hurt her or failed to help her.

0:14:44 Thomas: Yeah gets Yeah. Yeah, exactly

0:15:41 Alan: So before she dies by suicide, she records 13 tapes, each describing one event that she blames for her suicidal behavior. She mails the tapes to the first person on the list with the demand that he listen to them, and then mail them to the next person. Before she did all this, she gave a second copy of the tapes to Tony, told Tony to basically follow them around and make sure they listen. And if they don't, Tony is supposed to release a copy of the tapes to the public. The author has been very clear that the central message of the story, at the kind of people who received the tapes, tell them that your actions are profoundly hurtful, have very terrible consequences, so stop doing those things, as well as to bystanders who could have reached out but didn't, to send the message that, know, notice when people are hurting and reach out.

0:16:38 Alan: Those are good messages. But vulnerable viewers and readers identify with Hannah. They don't see themselves in the bad guys. They see themselves in the victim, and the victim models unhealthy unhealthy behavior. So has several goals over the course of the story. As the So story goes, Luke gets the tapes. Now it turns out that Luke is not one of the bad guys. He's the one person on the list of 13 that Hannah just wants him to understand what's happening, but not blame him for it.

0:16:44 Thomas: Yeah yeah yeah it's Kind of a shitty thing to do, but yeah, okay.

0:17:16 Alan: Point is that these tapes are blaming 12 out of the 13 people. Now, some of the people did truly reprehensible things. Others did things that are bad, but are kind of within the realm of adolescence being shitty. So the first one is a boy that Hannah kissed, and then he went and bragged to his friends that she let him feel her up. And that was the start of a rumor that she was easy or sexually promiscuous. That's bad.

0:17:46 Alan: Don't do that, but bragging to your friends and exaggerating what happened in a makeout session, don't feel like he deserved to be told that he is to blame for someone's death.

0:17:46 Thomas: Yeah yeah Lifetime of Trauma is a little rough for that, but okay. Okay.

0:17:56 Alan: Yeah so The narrator, Luke, it keeps giving his reactions to the tapes, and that's really important because he keeps echoing and affirming Hannah's message that these people are, that they caused her suicide. And so the reader is not given a contrasting approach, that this is Hannah's perspective, but Hannah is deeply distraught and her perspective might be skewed. All they hear is Luke saying, yeah, well, this is what caused this event, because Luke's a high schooler and he doesn't know any better. So Hannah has several goals. She wants to be understood, very normal adolescent feeling. And in particular, she wants the people around her to listen and know that these rumors about her are false. Understandable. She wants to convey to other people just how badly they hurt her.

0:18:45 Alan: She wants to punish them for their actions. Understandable. She wants positive relationships, she wants people who she cares about to like her. And in particular, she wants others to see how badly she's hurting and she wants them to want to save her. These are all very normal experiences, and these are all things that people who are in her position do feel and experience. And in particular, that last one of wanting help, but some people have this sense that if I directly ask for it, then that doesn't prove that you care about me.

0:19:19 Thomas: Yeah, yeah, yeah.

0:19:20 Alan: And again, that is a very real thing that people experience. But that's not a great thing to model.

0:19:27 Thomas: Yeah. Yeah, I can relate to that so hard as a teenager. You know, I felt that really hard. I think it was a lot to do with how my parents, dad was, but it is, I think, really important to kind of try to grow past that a little bit and just take this, I've taken this idea that like, you know, people are busy. Honestly, they might really care about you, but they're not going to do exactly what you need them to do every time.

0:19:40 Alan: Again, I to be very clear that when I'm saying these things, I'm not judging Hannah and people like her. I'm judging an author who chose to write this book.

0:19:56 Thomas: Sure. Yeah, of course. And then a studio that chose to make a whole show about it. Right.

0:20:03 Alan: Desire to be saved is a real normal feeling. Of course we want that. We all want that. Particularly an adolescent who's terribly suffering. But we have the problem that sense that you need to be saved is antithetical to taking steps to help yourself, to get that help. So if you feel like, well, it's only people really showing they care if they reach out to me, then you're not going to reach out to them. Hannah has all these goals. And the central point about what is wrong with this book and this show is that her Her suicide accomplishes them, and nothing else she does accomplishes these goals. Her suicide gets her what she needs, except it doesn't because she's dead.

0:20:47 Thomas: Yeah. Right?

0:20:57 Alan: But the story, the way it's set up, lets her appear to live on. So the viewer or the reader gets the sense that she has finally been understood. She has finally dispelled these rumors. She has finally punished these people, some of whom really do deserve to be punished. She has finally gotten the attention and affection of this boy Luke. She's finally gotten other people to see how badly she's hurting, and people now really want to help her and regret that they didn't.

0:21:28 Thomas: Yeah.

0:21:28 Alan: So she gets everything she wanted through suicide, and that's a really, really bad message. Hannah tries to accomplish these goals before planning her suicide, but none of her efforts work. And so the message again is that non-suicidal coping behavior is ineffective, but suicidal behavior works. She never in, or in the book, talks to her parents. They're non-entities, even though there's nothing in the story to suggest that they're bad people or they have a bad relationship.

0:21:31 Thomas: Yeah right. Not a great message.

0:22:04 Thomas: Right

0:22:04 Alan: The parents show up twice. Once they ground her when she's been skipping school, seems like reasonable parental behavior, and the other time is a story about how, because her room was on the first floor, her dad went outside to check that people on the street couldn't see in through the window. That's it. That's the only time her parents show up in the story.

0:22:04 Thomas: Huh.

0:22:22 Thomas: That's weird.

0:22:26 Alan: So again, when you're, lots of teenagers have a sense that their parents can't understand them, and you know nobody understands anyone perfectly, but sending the message, don't even try. Um, changes her appearance as a sign of how distraught she is. And she even talks about how they'd learned in school that a change in your appearance is a warning sign of suicide. And both she and Luke bemoan, why oh why didn't anyone pick up on my distress? Well, because adolescents change their appearance for lots of reasons.

0:22:36 Thomas: Yeah right.

0:22:57 Alan: And also her appearance change was from one kind of pretty to another. She cut her hair very short. And I don't mean to sound flippant, but when I think of alarming appearance changes, if a person who was previously well-groomed has clearly not showered in a month, that is a very strong sign of severe mental illness.

0:23:18 Thomas: Yeah I I knew somebody who had a really bad mental mental health episode. And I saw like, all of sudden they had a bunch of pictures on their Facebook that were like a total, I think it was like a wig or something. And it was just like, it was just eerie, you know? It was just something's not right here. I don't know how to put my finger on it exactly or how to say it, yeah. But Is it that kind of thing?

0:23:40 Alan: There's a couple of things. So a bizarre change in appearance could indicate a severe mental health problem. Maybe a bipolar disorder or a psychotic illness.

0:23:49 Thomas: It WAS bipolar. So you nailed it, yeah.

0:23:50 Alan: Yeah. But just a complete loss of hygiene. That is very consistent with severe depression, sometimes schizophrenia. Cutting your hair short is, is a significant change, but there's a lot of reasons to cut your hair. They're short. So persistently, Hannah expresses her distress in indirect and ineffective ways. And again, that's a real thing. Lots of people do that because they don't have the social and psychological skills to express themselves directly.

0:23:56 Thomas: I like depression, yeah, yeah.

0:24:21 Thomas: But if the story reflected that better, you know, that that wasn't, yeah.

0:24:22 Alan: Right, the story is not Luke, the narrator, going and saying, Hannah, why didn't you do this? Why didn't you tell me? Why didn't you ask clearly? The story is Luke saying, God damn it, why didn't anyone notice that her haircut meant she was distressed? And that's a really harmful message. So she uses an anonymous note to request a class discussion on suicide in a class where they discuss important important life issues, and she's disappointed when her classmates fail to, you take effective action to help her. Understandable, she would feel hurt, but not reasonable to expect that that would have worked.

0:24:26 Thomas: Yeah yeah Just sounds like a whole lot of externalizing, like, it's, what I mean, not, not, obviously this is a fictitious story, right, it's not based on anything per se, yeah.

0:25:15 Alan: It's fictitious.

0:25:16 Thomas: It sounds like it, whole, not of, why didn't everybody else fix this, which is, you know, obviously we can look at what can be done, but geez, I don't know if that's the best way to present the message to teenagers.

0:25:25 Alan: Yeah, well, so that's, it turns out that life stressors definitely increase the risk of suicide, but but not on their own. For example, during wartime, very few suicides, even though people are experiencing all kinds of terrible stress. You don't see an uptick in suicide during war. What we see is that people who have longstanding mental illness, a negative event can be the trigger that kicks off an immediate suicidal crisis. It's the proximal trigger. But you had to have had all these prior vulnerabilities. Media in general, and especially fictional media, portray suicide as driven by those stressful life events, that's easier to understand. You

0:25:34 Thomas: Huh. That's interesting.

0:26:13 Thomas: Yeah, yeah.

0:26:14 Alan: Know, you can say, you know, Bloggar the Viking killed himself because his wife was killed in battle. That's a story. If you say Bloggard the Viking killed himself because he had a long predisposition to depression, that's not a story, but that's a lot more realistic.

0:26:31 Thomas: He actually didn't care that

0:26:33 Alan: Fantastic.

0:26:33 Thomas: His wife died. He's kind of an asshole. No, I'm kidding.

0:26:34 Alan: Well, But no, but like his wife's death might have been the trigger for that thing. He hadn't had the predisposition to depression, it is very unlikely that that would have happened. So but the whole message is that it's it's all these other people's fault. We certainly don't want to be, you, assigning blame, we don't wanna blame her, we don't assign blame, that's not how that works. But if we're looking at causes, it's really rare for external causes alone to be the the to ultimately lead to death by suicide.

0:27:08 Thomas: And that makes sense. I mean, honestly, evolution wants us to keep going for the most part, so for the most part, I feel like a lot of bad stuff happens and people are pretty resilient, and you might look at two people and the same thing happened, and one person who doesn't have that history, I mean, they get through it, someone else might not.

0:27:25 Alan: There's a number of factors that have to be in place before a person makes a suicide attempt. And emotional distress is only one of them. There has to be, um, generally you have to feel that sense of hopelessness that things won't get any better. A stressful event, even a terrible one, say losing a loved one in a traumatic way, generally isn't enough to create that sense of helplessness because it's really unlikely that that loved one was the only source of joy in your entire life. It's terrible to think about, but most, but people lose loved ones, and very few of them become miserable for the rest of their lives over it. Have to feel like you're not a part of any community or any kind of positive relationships. And Hannah might have been feeling that, but were people who would have formed those relationships, But she didn't seek or embrace them. In fact, in multiple points, people are nice to her. They just aren't the exact kind of nice and helping she wanted or needed, because she would have had to meet them halfway.

0:28:13 Thomas: She was Wrong about That Right Right Hmm.

0:28:29 Alan: And she wasn't able to do that. She eventually, the 13th tape is her talking to her guidance counselor and she says she's sick of life. Okay, that's pretty alarming. If someone came into a clinic and told me they were sick of living, but then he questions her and she only vaguely indicates that something happened at a party.

0:28:51 Thomas: Wow.

0:28:51 Alan: Bad, she won't tell him what, and she mentions that she has some kind of reputation and that's upsetting, but she won't tell them anything more, he tries to reach out to her but he can't magically figure out what's going on or solve the problem, and so he's one of the people she blames for her death. Only person she approaches in a way that I would consider 100% alarming is Tony. So remember, Luke is the boy who's attracted to her. Tony is the guy she gave a second copy of the tapes to and said that he should monitor people.

0:29:07 Thomas: Yeah.

0:29:20 Thomas: He's The enforcer, yeah.

0:29:26 Alan: Right.

0:29:26 Thomas: Weird.

0:29:27 Alan: But Tony wasn't her friend, nor was he one of the bad people. He was just a guy, he didn't, he barely knew her, so He approaches, she approaches him and gives him her bicycle. Now that, that is a pretty serious concern if someone just gives you, giving away their things, important things like that. She lies about why she's doing it, and she asks to borrow his tape recorder and she lies about why. How the hell is he supposed to know what's What's going on.

0:29:36 Thomas: Yeah. Yeah. Hmm.

0:29:57 Alan: The message to the viewer is it's bad that these other people didn't figure out what was wrong and give her the exact assistance she wanted when she needed it, and Luke reaffirms this message throughout, because he keeps reacting like, hey, why didn't you see that this was happening, why didn't you fix it. As he's listening to the tapes, he's begging the characters in them to help Hannah or to stop Their harmful behavior. So the message is non-suicidal coping doesn't work. They never show her, like, reach out for help and get it, or Persist a little bit, like someone helps you but not in quite the right way, so you keep trying.

0:30:21 Thomas: Yeah. Yeah. Yeah. Or, I mean, they never show her reach out for help in the right way, but the other person actually sucks. It sounds like, that still probably wouldn't be great, but at least it would be better, maybe.

0:30:48 Alan: I mean, her talking to the guidance counselor and saying, you know, she's sick of life, is is kind of getting there, but She gives up very quickly when he doesn't. Immediately, so what happened at the party is that she witnessed a rape. He asks her, like, did someone hurt somebody, and she says yes, was it a boy, she says yes, and he says, like, do you want to press charges, says no, and then he's kind of not sure what to do because she hasn't told him what happened and she won't give him any more information, and so he, he gives kind of a suboptimal response because he doesn't know whether this is an assault or someone saying something awful, or there's all kinds of possibilities, and so he says, like, you know, do you want me to, you, this person, and either talk to them or, you know, some kind of referral for discipline, no, I don't want that, then he says, well, like, how can I help you move forward, and she takes that as being very dismissive of, like, I'm just supposed to get over it, and again, real people feel this way.

0:30:54 Thomas: Yeah,

0:31:50 Alan: Doesn't know, persist, you, and say, wait, I can't get over, and I witnessed a rape, this, I'm extraordinarily upset, she just walks away at that point, she doesn't do anything else. And so message is that non-suicidal coping techniques don't work. And there's never a message saying, Hannah should have tried something else. And again, we don't want to shame people who are suicidal for not behaving optimally. They're unwell. But the author, who was not suicidal at the moment, one assumes, is sending the message that non-suicidal coping does not work, but suicidal behavior will accomplish your goals. Hannah gets to force 13 people to listen to her story and really understand her.

0:32:31 Alan: She Gets to tell all the people who hurt her just how bad their actions were, get revenge on them, and really make them feel as guilty as they deserve. Serve, she gets boundless attention and understanding from the cute boy she's liked, and she gets lots of people to really wish they'd, they'd only listened and help her, so it's a sort of like, when I kill myself, you'll be sorry.

0:32:31 Thomas: It sounds like it failed on pretty much every metric. Every way that you can accidentally or negligently encourage people to kill themselves that sounds like this show did.

0:33:04 Alan: It would be like if I made a show about someone who started using heroin and it turned out great, then they're like, yeah man, ever since I've used heroin, I've lost weight, and I got a new job, and my relationships are awesome. It's not a very realistic portrayal of suicide. It is something, again, these are things that real people feel.

0:33:13 Thomas: Yeah, well, yeah, yeah!

0:33:23 Thomas: Yeah. Well, what's interesting is, I I can see a certain amount of this clashing with art, like, I think that's a concern some places, because it's not as though, reality is always like, obviously reality isn't such that it prevents suicide the best, like, we know that. So, and it does have a certain feel of like, well, in order to be an authentic storyteller, or to, or to be an authentic artist, it feels a little weird to like, yeah, but when it comes to this thing, you have to do like the afterschool special, you know, you have to turn into the, like, the more, you know, and do the right, you know, there's a little bit of attention there, but I feel like with something this dangerous, like, I feel like you got to make that effort, you know?

0:34:01 Alan: Yeah, so I'm not suggesting that the book should be banned. You know, I'm not suggesting that. I do think it shouldn't have been written. But it exists, and that's fine. But I definitely think that if people are going to read it, if they're going to let their teenagers read it if they can hold their teenagers watch the show, they should read or watch it with them and discuss it. Oh, yeah, it's a young adult novel. It's specifically for teenagers.

0:34:24 Thomas: I didn't think about that. Yeah. Is this specifically a book that teens are reading? Okay. Yeah, that's. Yeah. No, that that's bad.

0:34:33 Alan: Yeah, and so I can tell you that if it were my kid, I would almost certainly instruct them not to read it. If they really wanted to, I Would insist on us reading it together. Other. In the same way that there are books, there's a very famous book that I'm not going to give the title of, that is giving people advice on how to euthanize themselves. And it's specific, the book is very clear that it's specifically for terminally ill people. And it tells you exactly like what medications and how to get them, like what lies you should tell your doctor and how you get the medications and exactly what you do with them.

And matter how you might feel about terminally ill people doing that, it's a mass market book. Oh, Yeah, no, it's... I I find it in bookstores all the time. I look for it. It's so... Like the question was, was it responsible to write this and to write it in this way, like even if you wanted to show Hannah having some kind of terrible outcome other than suicide, that would have been considerably... Or, like you said, if you showed her reaching out in a persistent, effective way, but somehow it just didn't work, like one of these people was truly evil, that actually would have been better.

0:35:06 Thomas: Wow. It is. Jeez.

0:35:30 Thomas: Yeah. Yeah.

0:35:46 Alan: But thing is, when it comes to realism, it's actually fairly common for people to feel this way and engage in some suicidal behavior, but it's not very common for this to describe a completed suicide. Suicide. Completed suicides are actually somewhat different from non-fatal attempts, to some extent. For example, non- fatal attempts are much more often young people. Compluted suicide is much more often older people. The ratio of attempts to completions in young people can be as high as 100. In older people, it goes down to between 10 and 30. So suicide in Hannah's story is shown as having an external cause. There's no discussion of mental illness playing a role.

0:36:27 Thomas: Wow.

0:36:28 Alan: No.

0:36:28 Thomas: I didn't think about that. There's none. Really? I just assumed there was.

0:36:31 Alan: They never say. They never

0:36:32 Thomas: Oh, it's all just these things that happened to her.

0:36:33 Alan: Right. And And the things that happen to her are terrible, and they talk about her being distressed, but they don't talk about her as having depression or other kinds of things like that. Suicide in the story is shown is a rational act. It's shown as something that she planned and very carefully decided upon, and that the viewer is shown that it was sensible as a decision, when in reality, suicidal crisis involves tunnel vision. Suicidal crisis, the time period where you are actually considering doing the act, first of all, it's usually quite short. It's hours, usually not not weeks and months, of the the acute period where you're really, really considering it, as opposed to it just being kind of in the back of your mind. But in that point, people have incredible tunnel vision. People who work in emergency departments or a suicide hotline, you'll talk to people all the time where they seem to have just Just forgotten.

0:36:38 Thomas: Yeah. Yeah.

0:37:35 Alan: You'd be like, what will happen to your dogs if you die? My what? Your dogs. Oh, I didn't think about that. Have this incredible tunnel vision. Hannah is shown as making a rational, carefully planned decision that she's really thought out, in a way that most suicidal people... That's not how they're thinking.

0:37:53 Thomas: I didn't realize there's no discussion of like actual mental illness. This is, wow. What a bad book.

0:38:00 Alan: In the book, Hannah's method of death is not discussed extensively. It's implied that she OD'd. This is where, for listeners, I am going to be a bit graphic, because that's kind of the only way I can think of to explain exactly what was wrong with the show. The show portrayed her suicide in a much, much, much worse way. So first of all, her suicide is not an actual scene in the book. Book starts after she has died, and this boy Luke is obviously aware she died by suicide, but it's never actually shown. In the show, the actual suicide scene was shown. You see her engage in the behavior and you see her dying. And then you see she's dead. Her body. That is exactly what you are not supposed to do.

0:38:16 Thomas: Okay.

0:38:48 Thomas: In the beginning, it was like sometimes showing the graphic nature or just the gross nature of death seemed to be maybe a counter message, passage

0:38:57 Alan: That was very specifically showing the kind of gross nature of death to de-romanticize it. But this scene doesn't show, like they don't show. So she slits her wrists in a bathtub. They don't show that there's shit in the bathtub with her. If they did that, that would actually be an improvement. But instead, you see her just looking angelic and peaceful lying there. But in general, showing methods, showing materials, showing the event itself is a really, really bad idea. Yeah. A brief discussion of the gross outcome is helpful for a very small group of usually younger people who have a real romanticized version of death. But that's not showing the event itself or anything. Clinician I told you who would take them down to the morgue, he wasn't showing them suicides.

0:39:15 Thomas: Right. Yeah. Oh,

0:39:47 Alan: He was just showing them dead bodies just showing Showing them like, look, this is not a beautiful little angel. This is a kind of bloated looking corpse. Method was graphically displayed. They showed her pick up the sharp object. They show her handling it for almost a minute, which for you people who know film stuff, that's a really long time. Again, they show her actually cutting her wrists, again, for about a minute. And then are showing exactly how to do it. They're showing the exact thing you need to do to make that lead to death. She cries out in pain, but then very quickly, within just a few seconds, she looks relieved. So suicide is shown as effective in relieving her pain, whereas a refrain constantly in people who work to prevent suicide is, so the most common reason people attempt suicide is they want relief from their pain. The refrain we always tell them is, relief is a feeling, and you have to be alive to feel it. No longer have this suffering, but there's no you to be relieved anymore.

0:40:05 Thomas: That's A Long Time It

0:40:52 Alan: And so what we see is Hannah still alive, experiencing relief. Leaf in fact, in the the show, she first attempts to OD, which is a a method that has a lower rate of lethality than violent methods, than methods that involve injury. And so again, you're you're teaching the audience, well, don't do this thing that we would be more likely to be able to save you. Do this other thing. Um, results were disastrous. Um, This has been studied repeatedly. There have been multiple studies. One thing I think is really interesting is subjective things, where you asked people, like, hey, how did watching this show make you feel, show more mixed results. But objective studies, where we looked at the actual rates of suicidal behavior, attempts, completed suicides, hospital admissions, um, show that suicide rates went up by about 25% in

0:40:58 Thomas: Really feels like they were going out of their way to try to do a bad job at this.

0:41:18 Thomas: Dude, oh, My Gosh Wow Was this studied?

0:41:53 Thomas: Is

0:41:54 Alan: The month after the the first season was released.

0:41:57 Thomas: That where, like, in the Country And

0:41:59 Alan: The United United States, as well as I think there have been studies in other English-speaking countries.

0:41:59 Thomas: Um, Jeez. In the entire country it went up 25%.

0:42:08 Alan: Well, that is in youth 10 to 17, who are the ones who you would expect would be the most affected by it. So there is a statistically significant increase in self-harm-related emergency room visits. There were an increase in online in Google for things like how to commit suicide. Some studies have found about 200 more deaths by suicide the 10 to 17-year-old age group. So this is a show that had a body count. Review of charts of people who were in the hospital for suicidal behavior or depression found that, were substantial numbers that specifically referenced the show that the person said, you

0:42:11 Thomas: Still, I mean, that's a lot.

0:42:50 Thomas: Wow.

0:42:50 Alan: Know, I was watching this and this had an influence on me. Mean, now people's perception of influence isn't always correct, but 40% of hospital admissions found that there were young people coming in, engaging in behaviors that were directly copied from the show. They cut their hair like the main character. Some of them were making tapes.

0:43:11 Thomas: This is, wow.

0:43:12 Alan: Yeah, it is truly outrageous this happened. Now, just in general, reading a book is less intense than watching a Movie. And of course, as I said, the movie amped it up in harmful ways, but the fact that someone chose to make this a... a streaming, a television show, was homicidally stupid. Again, to me it would be like making a show where someone just does heroin and it's awesome.

0:43:13 Thomas: Not good. Not good.

0:43:25 Thomas: Sure.

0:43:42 Thomas: Yeah. And I just pulled it out. I mean I, my memory of it was this came out and I think the circles that we run in socially are probably like, wow, what a bad idea. And then I didn't really hear from it. It says it went four four seasons.

0:43:54 Alan: Did so, the... the first season is, you know, where we have the most research because the first season follows the story of the book, and so it... Hannah died at the beginning of It but it follows the tapes until Luke gets to the point in the tapes when she kills herself. Then there was a huge backlash from mental health organizations saying this was an absolutely terrible idea. The second season put a little... made its own story and put a little more emphasis on the mental health messages. And then the third and fourth, fourth seasons, I guess, were not very popular, and they kind of went in completely different directions. But again, the fact that they gave it a second season was not great.

0:44:02 Thomas: Oh, did they try to fix it at all?

0:44:35 Thomas: Yeah.

0:44:36 Alan: Entirely predictable that this would increase suicidal behavior in young people.

0:44:38 Thomas: Yeah. This isn't like patient zero, case zero. Like this science, Stormy was around. You were around then, right? You could answer some questions.

0:44:51 Alan: And there are lots of things where the effect is not like, I think Romeo and Juliet, I think we should be very careful how we teach that. You don't want to teach that as a beautiful love story with a tragic but kind of romantic ending. You want to treat to teach it as these two kids were fucking stupid and they did a stupid thing.

0:44:58 Thomas: Yeah, yeah, yeah. And we do teach that to exactly the age group of kids that's like probably most vulnerable.

0:45:12 Alan: Exactly. Because, I said, we see more attempts than completions at all ages, but especially in adolescence. Adolescents are more likely to in much more impulsive suicidal behavior. If you ask them, like, how long were you thinking of this before you made this attempt, it's a much shorter time period, and they're more likely to in that in response to a short-term event, again, you have to have had those long-term risk factors as well. But a depressed adolescent whose significant other breaks up with them is more likely to make an attempt than a depressed 40-year-old whose significant another breaks up with them. But even something like Romeo and Juliet, which I think doesn't send a great message, it doesn't sound one good message. You don't have all of these terrible messages piled on top of each other and shown in the most graphic way way possible.

0:45:50 Thomas: Right. Yeah.

0:46:04 Thomas: Yeah, no kidding.

0:46:08 Alan: I do just want to end this by reminding your listeners that if you are having any thoughts or concerns about suicide, there are lots of places you can go for help. But if you're not sure how to access any of them in your local area, 988. You can text it, you can call it, there's people available 24 hours a day.

0:46:27 Thomas: I'm glad Congress did one good thing to make that three digit number. That's nice.

0:46:32 Alan: By the way, that number number is not just for suicidal crisis. If you're having any other kind of mental health crisis, you're hearing voices, you're not sure what's real, you feel paranoid, you feel like you can't stop your substance use, 988 will help you locate appropriate resources. So if listening to anything about this made you feel distressed or you're just worried about things in general, that's a great starting point to figure out where you need to go.

0:46:36 Thomas: Hmm.

0:46:58 Thomas: Absolutely. Wow. This is a every bit as bad as advertised stormy. That is a really irresponsible. I hope that people don't do that again. That's awful. Thanks so much for that breakdown. Again, 988 is the number. And yeah, thanks for speaking to us today. Oh, you normally have a little call to action. Do you have one of those this time?

0:47:17 Alan: Yeah, so I still have my banned books project at shareband, B-A-N-N-E-D, books.com, but my new assignment for everyone is to go to vote.org, Which is a nonpartisan voter registration site. You can check your registration, make sure you haven't been sneakily purged from the voter rolls. You can find out like, for example, to get an absentee ballot, you can sign up to get election reminders, well, they'll send you reminders when deadlines are approaching. And what I would like to encourage all your listeners to do is there are resources on there for how to share this link. Put It on your bio and social media. What I do where I work is I actually just printed out little tabs that just have the URL on them and attach them to candy and hand them to people. But I would like all of your viewers to commit to telling three people to check their voter registration or register to vote. Evidence shows that there's quite a lot of people who will register if you just remind them.

0:47:56 Thomas: Yeah, good stuff. Vote.org, you said?

0:48:25 Alan: Vote.org.

0:48:27 Thomas: Vote.org. All right. Dr. Alan Smerbeck, thank you so much.

0:48:31 Alan: Thank you for having me.