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13 Reasons Why; A Discussion Amongst Professionals

13 Reasons Why; A Discussion Amongst Professionals


(spoiler alter!)
13 reasons

Please introduce yourself:

JULIA FOX, LPCC: My name is Julia Fox. I am a LPCC and currently practicing at a DBT outpatient clinic, as well as in private practice. Many of my clients have struggled, or are currently struggling with forms of anxiety, depression, PTSD, personality disorders, suicidal ideation and self-injurious behavior. Much of my work consists of skills-based therapies such as DBT and CBT, safety planning, and goal setting.
 quintin QUINTIN HUNT, LMFT: My name is Quintin Hunt, I am a Marriage and Family Therapist and pre-doctoral research fellow at Drexel University in Philadelphia, PA and soon-to-be Assistant Professor of Counseling at University of Wisconsin-Superior. I have studied and worked in suicide prevention field for approximately 15 years. Currently I run a large clinical trial that tests Attachment-Based Family Therapy with suicidal and depressed adolescents.
 adam ADAM ARNOLD, LMFT: My name is Adam Arnold. I am an LMFT in private practice, working mostly with adolescents.

 

Have you used or thought about using the Netflix series Thirteen Reasons Why in your work with adolescents or families?

JULIA FOX, LPCC: One of the main reasons I decided to watch 13 Reasons Why was because I was getting phone calls from parents regarding their adolescent watching this show and whether or not I thought it was appropriate. I watched the show with an assessment hat on, and not once did it cross my mind to use this as a therapeutic tool with my current clients and their parents. While I believe that the intention behind the show was to open up communication about bullying and teen suicide, I do believe that the representation glorified the act of suicide and raised more questions than it answered. If I were required to use this series as a teaching, or therapeutic tool, it would be focused on what Hannah could have done differently, what skills she could apply, how she could cope with the distress she was experiencing, and what we could do to help stop bullying. In speaking to parents, I would use this as a tool to get parents to talk to their kids about emotions, to make sure they are checking in with their child even if everything seems “fine”.

QUINTIN HUNT, LMFT: I have thought about using the Netflix series, yes. Have I? No. The clients I work with are largely already very depressed and suicidal. I have followed their lead on how they approach the series. I’ve found it has been a much bigger deal for the parents. However, I have encouraged some parents to watch the show to potential understand what it might feel like to for their kid that is thinking about wanting to die and feels let down by friends and even teachers or counselors.

ADAM ARNOLD, LMFT: I made a point to process the series on some level with all the teens (and their parents) with whom I work.  Even if they had not seen it I assumed, given its widespread popularity, that most all American teens would likely see the series eventually, or at the very least be influenced in some way by its themes and messages.

I made sure to note that I categorically do not recommend the series due to its misleading and sometimes dangerous messages. Though, like many things with teens, we can’t control what they do – we can only control how we respond to what they do. Creating an open and safe forum to process this potentially volatile series thus became my approach.

 

The feedback on social media outlets and in schools has expressed mixed feelings about this series. What are your feelings?

JULIA FOX, LPCC: I remember sitting down at my kitchen counter and beginning the series. I watched the first three episodes back to back and my immediate reaction was that of disappointment and frustration. Initially, it appeared to give off the interpretation that Hannah’s suicide was a “blame game”. As I continued to watch, those thoughts were still present but I also felt myself getting pulled into the drama of the show, as if it was just another original Netflix series to binge watch after a long week. As I sat back to reflect on that feeling, even as I write that now, it is incredibly disheartening.  This show, about a subject that is so real to so many of my clients on a daily basis, is being dramatized and pulling me in for entertainment. When communicating my thoughts about the show to my co-workers and friends, I described it as  “A Pretty Little Liars with Suicide”, a “Who-done-it”. This is frustrating to me because the issues in this show– the subject of suicide is not a murder mystery, and it is not a source of entertainment.

Many teens experience similar events to what Hannah went through. Unfortunately these experiences are not uncommon. My biggest frustration in the show was the emphasis on “blame”, “guilt”, and the statements said multiple times by individuals in the show “we all killed Hannah”. While the external environment has a role in shaping our behavior and influencing our thoughts and emotions, ultimately it is the individual and their current mental health struggle (this could be completely biological in nature too) that makes the decision to end their life. Now, I do believe that there is a lack of resources for teens, and that teens (as well as adults) feel like no one is listening. There might be fear, denial, anxiety, lack of motivation, hopeless and a number of other factors that might be a barrier for an individual to ask for help and reserve the services they need.  There is a sense of accountability that one needs to take related to their mental health and their decision to end their life. I do not believe that 13 Reasons Why did a good job getting to this point. Instead, it placed more of an emphasis on what role others had.

Did the show do a good job at portraying bullying? I think we could make a supportive case for that. Did it do a good job at portraying the issue of suicide? I would disagree here. In one last note, the final scene where Hannah takes her life is unnecessarily graphic. I had to fast forward through it myself. Many of my clients are easily triggered by such depictions of self-harm and suicidal behaviors. When I think about who is going to binge watch Netflix, especially a teen series, it will be teenagers- and I could guess that many of those teenagers struggle with things themselves, and I believe that this show portrayed triggers that were more harmful than helpful.

QUINTIN HUNT, LMFT: I’d say the feedback in the suicide prevention field has been very one-sided and critical against the show. I, however, LOVED it. I laughed, I cried, it connected with me on a lot of levels. I do have a lot of mixed feelings about showing the suicide attempt itself and that there is no encouragement about whom to speak with when difficult feelings arise.

ADAM ARNOLD, LMFT: 13 Reasons Why is a well-done series from an artistic standpoint: excellent acting, high production value, and it had that binge worthy what’s-going-to-happen-next quality which led so many teens (and adults like myself) to have great difficulty looking away. I finished the series in about four days. I know some teens who got it done in two.

However, on the whole, my feelings are negative on the messages of the series. 13 Reason Why presents a hurting teenage girl who has an on-screen, sensationalized suicide. This kind of presentation cannot only be traumatizing for viewers (this is in addition to the two graphic scenes of sexual assault in the series), it can also lead to suicide contagion among teens (see the work of Madelyn Gould, a professor of Epidemiology in Psychiatry at Columbia University). Additionally, the notion that a person’s suicide is someone’s (or 13 someone’s) fault is misleading at best, profoundly cruel at worst. As the Center for Disease Control states:

Suicide is never the result of a single factor or event, but rather results from a complex interaction of many factors and usually involves a history of psychosocial problems. Public officials and the media should carefully explain that the final precipitating event was not the only cause of a given suicide. Most persons who have committed suicide have had a history of problems that may not have been acknowledged during the acute aftermath of the suicide.”

 

What do you think was accurate about mental health from the series? Was there anything missing that you wish would have been included?

 

JULIA FOX, LPCC: This show was lacking on the emphasis of mental health. There was very little, if any, forward discussion of anxiety, depression, self-injurious behavior, suicidal ideation, and other mental health issues. The show did a good job with illustrating the symptoms of these diagnoses and issues, but did not outwardly discuss them to the audience. What would have been helpful from a teaching perspective, would be if at the end of each episode there was a discussion of the symptoms we were seeing and a screen shot of crisis lines and mental health resources. You can’t increase awareness of a subject as fragile as this without providing resources and help to those who are struggling.

QUINTIN HUNT, LMFT: This series did not talk about mental health or mental illness at all.  Many people are critical about this series for not talking about mental illness (as up to 90% of people that attempt suicide have a mental disorder). However, this statistic is highly debated and I have a hard time calling the experiences of Hannah mental illness.

ADAM ARNOLD, LMFT: The series  was accurate from the standpoint that many teens are hurting, and out of that hurt many teens will make poor, unsafe choices that can have tragic results. However, mental health diagnoses nor mental health in general had prominent parts in the script. The girl who committed suicide, Hannah, is not depicted as having specific mental health concerns, i.e., depression, PTSD. She is mostly depicted as being forced into suicide due to the cruel actions of others. Hannah’s suicide has been interpreted by many as a heroic act. It was a tragedy and should viewed as such. As Dan Reidenberg from SAVE explains, “Suicide is not a common response to life’s challenges or adversity. The vast majority of people who experience bullying, the death of a friend, or any other adversity described in 13 Reasons Why do not die by suicide. In fact, most reach out, talk to others and seek help or find other productive ways of coping. They go on to lead healthy, normal lives. “ The series appears to suggest that Hannah had only one way out of her pain, which is an accurate representation of the perspective of a suicidal person: there is no hope of things getting better. However, professional treatment can help to empower persons to shift this perspective, and understand that they have options beyond ending their lives.

 

Do you think this series portrayed teens accurately? What about their portrayal stood out to you?

JULIA FOX, LPCC: I would like to be careful about the overgeneralization of “teens”. There are some accurate portrayals of teen qualities. For example, the attention placed on relationships, the struggle with identity, the influence of certain peer groups, the focus on sex and drugs. The show did do a good job at portraying how cyber bulling can happen through text messages and apps on the phone.   I think that there are also some teens that don’t know the implications that their bullying can have, or that they are even participating in bullying at all.

What we don’t see is that there are a lot of teens that don’t fall into the categories laid out in the series and who might take steps to stand up against bullying and reach out to help Hannah. The camera spent more time on the kids that were “troubled” or who were “bullies”. The character of Tony seemed very over-dramatized as the “keeper of the tapes”. There were also stereotypical representations of Bryce and Tyler; what if these character roles were reversed? What if the individual that was part of stalking/camera photos was of the same-sex as Hannah? What if Bryce was the “good guy”, etc.  Just a thought.

QUINTIN HUNT, LMFT: The series portrayed troubled teens very well. I’d hope hat the ease of getting drugs and alcohol and those unsupervised parties might be exaggerated, however looking back I don’t think so. The experience of feeling alone and misunderstood hit the nail on the head for many teen experiences. Certainly was mine. Certainly was like a lot of the kids with whom I work. Sof the hesitance to speak with adults about issues going on in teens lives speaks to the experience of being a teen. (I do like to think that adults can be great sources of guidance and comfort for youth but something prevents many teens from doing so). I don’t think Hannah’s parents’ reactions were quite understandable. I think they would have been much, much worse.

ANDY ARNOLD, LMFT: It certainly portrays the deep sadness and pain many teens are carrying around inside of them. You could feel their pain leaping from the screen just in watching the first episode. However, we do not see much joy or humor in these teens. There are storm clouds that permeate every nook and cranny of their lives. Yet, when one spends time around even the most hurting of teenagers and you’ll absolutely experience some silly, zany, genuinely happy moments.

 

What are some important lessons you hope teens and families learn from this series? What are some of your concerns?

JULIA FOX, LPCC: A couple important takeaways from this series:

  1. Suicide is real and something that many individuals have struggled with on a daily basis their whole lives and there are ways to get help, even if you feel completely alone.
  2. Suicide is not to be glorified, dramatized, or part of a mystery game. While individuals and our external environment might influence our emotions, thoughts, and behaviors, it is ultimately our decision to end our life (unless otherwise influenced by medication side effects) and telling individuals “this was your fault” is an ineffective way to view the subject.
  3. Check in with your child/teen. We did not see the parents check in very often with Hannah about how she was feeling, and this is an important thing to do because often your child/teen might not be the one to approach you. Talk to your child and teen, even if appear like nothing is going on. Educate them on suicide and that there are resources and help out there. Let them know they are not alone.
  4. Suicide is not just the result of bullying. While bullying can definitely lead to an increase in suicidal ideation, suicide is often related to mental health concerns. There are individuals that struggle with different intensities of suicide based on a number of different mental health diagnoses and life histories- the series did not address mental health concerns accurately, if at all.

One of my biggest concerns is that teens might be vulnerable to modeling similar behavior as Hannah.  I have worked with many teenage girls who struggle with very similar issues as Hannah did in 13 Reasons Why, and some of these clients are young and easily impacted by the things they see. I worry that they might go about creating tapes themselves or sending letters to everyone that has impacted them and then carrying out the suicide in a similar way. I know that we can’t protect children and teens from everything, but I do believe there is an appropriate way to go about illustrating topics.

QUINTIN HUNT, LMFT: The biggest things I hope teens and families learn from 13 Reasons Why:

  1. As Tony said, everyone is at fault (and no one is at fault). It’s not just one thing that made Hannah want to kill herself. Not just being bullied, or the inappropriate pictures of her, or her fight with her parents, or her rape. It was a combination of everything.
  2. It really messed up her friends and “frenemies”. Alex attempted suicide afterwards. Almost all the kids with tapes showed some pretty self-destructive and self-harming behavior in their grief and regret. This is part of the hurt that continues on.
  3. Hannah’s parents wanted to sue the school. The school’s refusal to say I’m sorry and admit there was a mistake made things worse. This is also typically the case with therapists after a suicide. Families WANT to know that someone loved and cared about their kid. They also want to know that they were not the only ones that missed the signs. Interestingly, therapists that reach out to families after a suicide are less likely to be sued than ones that don’t.
  4. Feeling like a burden is one of the main mechanisms of adolescent suicidality. Feeling like people would be better off if you were not around (because you are a liability) is one of the things that takes people from depressed and not suicidal to depressed and suicidal. Hannah experienced this with her family when she lost their money. When her friend died because of the stop sign. Her friends experience it after Hannah’s death. This feeling of responsibility is pretty normative after a tragic loss like this—but it is not anyone’s fault (to directly contradict myself). Yes, all things had a role, but none of it is one person’s fault. Those feelings of being a liability are powerful and I think that is one of the things we should be talking about that we largely are not.

ANDY ARNOLD, LMFT: It’s my hope that parents and teens will use the series as a launching pad to discuss together some of what we know to be true about suicide:

  1. Death is final, and we will not get to experience the memorials, nor the taped messages, we leave behind after we die.
  2. Memorializing someone after a suicide can lead to suicide contagion in a given community. Mourn the loss, feel your intensely sad feelings, and then honor the deceased by moving forward in life in a positive way.
  3. Treatment for suicidality can help prevent suicide. Processing suicidal thoughts and feelings with a professional will not make the act more enticing. Talk about it, ask about it, seek out treatment.
  4. Giving teens the message, “If you’re nicer people will commit suicide less – and if you’re meaner people will commit suicide more,” misrepresents what we know about the causes of suicide. It’s also a fear-based intervention, which is in the long-run likely to increase tension and fear. Teens should be encouraged to be kind for its own sake, and those still prone to cruelty towards others would do well to be seen as hurting within themselves; and would do well to receive professional treatment for what is influencing their cruel behaviors.