A semicolon in the arts

There have long been established guidelines for discussing suicide in the news media. But how can artists navigate this difficult topic without compromising their truth?

Content warning: This article discusses suicide

It’s almost an understatement to say that violence is prevalent in our storytelling. It’s consumed on a large scale every day through the news, books, TV shows, movies and music. It’s so pervasive, that many of us are desensitised to it, at least to some degree. But not all violence has the same effect on consumers, and it would be easy to imagine that depictions of violence towards the self would be no more harmful than violence towards the other. As it turns out, research suggests that representations of suicide are a whole different ball game in terms of their effect on the audience.

This is a very real issue for the current generation of pop culture-savvy young people, who are known to be dealing with high levels of stress, depression, and anxiety. Members of minority groups are particularly vulnerable. In 2013, the National LGBTI Health Alliance noted that “LGBTI people have the highest rates of suicidality of any population in Australia”. Suicide rates among young Indigenous Australians can reach figures as high as four to five times that of the non-Indigenous population. There are a lot of vulnerable people out there.

Suicide in the media

You need only consider that anxious feeling when it’s been a bit too long between social media sessions to know that the media has great influence over us. In a similar vein, the way that suicide is represented in the media can have a profound effect on how vulnerable people think, and in some cases how they behave.

Studies suggest that harmful representations of real-life cases of suicide can influence people who are at risk, and in some cases cause them to imitate what they read and see. Marc Bryant, Program Manager of Mindframe, an Australian media initiative that promotes sensitive and responsible representation of mental illness and suicide, said that “research from more than 100 international studies suggests that reporting about suicide deaths has been associated with increased rates of suicide and suicide attempts following reporting.”

Irresponsible reporting can contribute to suicide contagion, a phenomenon where direct or indirect exposure to suicidal behaviours influences others to follow suit, usually within a short timespan and within communities affected by the original death. When reporting on stories involving suicide, journalists can decrease the likelihood of contagion by carefully choosing the language they use, the specific information they include and the way they frame the story.

There are certain clear-cut things to avoid that have been shown to be triggering for some people. “Glamourising, glorifying or simplifying suicide can lead to vulnerable people believing suicide is a viable solution,” said Bryant. “Repeated and prominent reporting can suggest that this solution is common or a norm. Depicting method and location can provide information for vulnerable people, which can allow them to conduct ‘copycat’ behaviour.”

This is particularly an issue when reporting on the deaths of celebrities. John Ackerman, suicide prevention coordinator at the Center for Suicide Prevention and Research, said while speaking with CNN: "Especially when you've got high-profile people who are successful and who the world views as having a lot going for them and they die by suicide, it can generate feelings of hopelessness."

On the other hand, there is reason to think that the media can be a power for good. A Vienna study suggested that widespread uptake of mindful reporting guidelines led to a more than 80% decrease in suicide contagion in 1987. And researchers are fairly unanimous on one point: that talking about suicidal feelings helps, on both the level of interpersonal conversations and what we perceive in the media.

Bryant suggests that, ideally, “the powerful influence of mass media [would be] used to highlight suicide as a tragic and avoidable loss, focusing on the devastating impacts on others, or exploring an individual’s experience of overcoming suicidal thinking.”

Experts suggest that the news media should report responsibly in order to minimise harm to vulnerable audiences. Pexels (CC0) — *Experts suggest that the news media should report responsibly in order to minimise harm to vulnerable audiences.* Pexels (CC0)

To help content producers navigate this delicate terrain, organisations in countries around the world have developed guidelines for journalists in reporting on suicide. The Mindframe guidelines are designed to help Australian journalists report on instances of suicide while minimising potential for suicide contagion. A well-known rule is to omit details about the method and the location, which reduces the risk of ‘copycat’ behaviour.

Another recommendation in the Mindframe guidelines is to consider the message that is being sent to vulnerable readers through the framing of the story. By glamourising or sensationalising the act, it may suggest to a person who is experiencing suicidal thoughts that taking their own life will allow them to escape their pain. Messaging that reinforces stigma and bias against mental illness, like that suicidal people are acting selfishly or simply seeking attention, is also advised against.

In New Zealand, similar guidelines have been developed for the media, where irresponsible representation of suicide is considered a criminal offence. In the US, the American Foundation for Suicide Prevention have released their own recommendations. The World Health Organisation and the International Association for Suicide Prevention also partnered to develop guidelines to be taken up by journalists globally.

However, while there is strong evidence to support a causal link between positive reporting practice on suicide in the news media and safer experiences for vulnerable people, there is limited research to confidently suggest the same effects are at play in fictional stories, leaving artists in an uncertain position.

The case of 13 Reasons Why

The limited understanding in this area became very apparent recently, with the conversation playing out on the international stage. In March 2017, the first season of Netflix’s original series 13 Reasons Why was released. The show, which is a retrospective account of a young woman’s lead-up to taking her own life, was widely criticised for its graphic and allegedly glamourising depictions of sexual assault and suicide. One scene in particular, where a main character takes her own life on screen in vivid detail, was regarded by some as potentially distressing for vulnerable viewers.

At the time, headspace, the national help service for young at-risk people in Australia, issued a warning about the show’s potentially harmful content. One study in the US found that in the two weeks after the show’s release, Google searches for potentially alarming content were dramatically increased. For example, the phrase “how to commit suicide” was found to be 26% higher than expected over this period.

However, the cast and crew of the show were adamant that they were trying to represent issues of bullying, sexual assault and suicide in an unflinching and realistic manner. Bryan Yorkey, Executive Producer of the show, said in a special episode which plays automatically at the end of season one: “We worked very hard not to be gratuitous, but we did want it to be painful to watch, because we wanted it to be very clear that there is nothing in any way worthwhile about suicide.”

The special episode argued that the crew worked to represent these issues with care. They sought help from counselors when writing and developing the show, and made a conscious decision to go to places they viewed as typically off the table in mainstream television, which they perceived as beneficial for the audience.

Following wide online controversy after the the first season’s release, Netflix organised a study with the Center for Media and Human Development at Northwestern University to “examine whether media can promote parent-child conversation about difficult topics”. The study involved surveys with 5400 adolescents, young adults, and parents of adolescents from the US, the UK, Australia, New Zealand, and Brazil.

Interestingly, the study found that 63-74% of adolescents and young adults across all four regions felt that the intensity of the show was appropriate for them, and 63-79% felt that the graphic nature of the suicide scene was necessary to show how painful suicide is. However, due to the focus of the study, it did not allow for thorough understanding of how particularly vulnerable viewers felt during and after watching the potentially problematic segments in the show.

To Netflix’s credit, they took the discussion they had sparked seriously and the show applied what they’d learnt. In season two, which was released in May 2018, actors from the show address the audience directly in short videos to talk about issues raised, and detailed online resources have been made available. Bryant from Mindframe notes that “the result was a second season that proved safer for viewers, and the creation of new supporting material for young people and parents/carers (including schools) to engage with.”

A short video series ran alongside season two of 13 Reasons Why, including cast members addressing issues raised in the show.

The showrunners worked hard to present the argument that they were aiming to start difficult conversations by being unflinching. The logic was that if they placed barriers around the portrayal of the character taking her own life, the audience would not be able to appreciate the full extent of her pain. However, this goes against current recommendations for media, in particular omitting details about method. It appears there is a genuine difficulty in representing suicidal impulses faithfully in creative works without putting viewers at risk.

What does this mean for artists?

While some artists may be concerned that using content guidelines could limit authenticity, this is a risk to be mitigated against potential harm. This doesn’t mean that depictions of suicidal behaviour should never be shown; in fact, young people are more likely to seek help for mental health problems if they have some knowledge of mental health issues.

So far, the effects of fictional stories have not been as heavily studied as those of news stories when it comes to this topic. However, despite the equivocal evidence within some individual studies, Bryant states that “critical reviews on suicide and the entertainment media as well as suicide and the news and information media come to the same consensus.”

Mindframe have developed specific guidelines for artists working in stage and screen, which highlight the importance of discussing these tough issues responsibly in creative works. “I encourage artists not to be afraid to reach out to experts to enhance their understanding of the complexities of suicide, to understand how to ensure their portrayal is safe,” said Bryant.

An Australian TV series has become an example of how this topic can be handled mindfully. In 2016, Josh Thomas’s black comedy television show Please Like Me was praised by critics for its sensitive portrayal of mental illness, self-harm and suicide. Research suggests that portrayals of non-suicidal self-injury can have a similar contagion effect if handled inappropriately. The showrunners were careful to consider the impact of their content when designing the program.

There is no doubt that artists can use their voice to bring attention to the topic in a healthy way. Hip-hop singer Logic released his song 1-800-273-8255 in 2017 as a direct appeal to vulnerable people. The title of the song is the phone number of the National Suicide Prevention Lifeline in the US, and the song encourages those who are struggling with suicidal thoughts to reach out for help.

Promisingly, according to official statistics provided by the rapper in a tweet, calls to the lifeline dramatically increased the day after Logic performed at the MTV Video Music Awards with featured artists Alessia Cara and Khalid. Nearly three months after the performance, the Lifeline reported that since the release of the song the organisation had received a new baseline of 25% more phone calls to their service.

Logic’s performance at the 2017 MTV Video Music Awards included many suicide attempt survivors on stage wearing white t-shirts. (2:45 onwards)

Ideally, artists will strive for a depth of understanding and regard for the bigger picture when it comes to the issue of suicide. “We support artists to be well informed of suicide to enable portrayal of its complexities, its impact on the community following a death, and the avoidable and tragic loss that it is,” said Bryant.

“I recommend that artists assume that every person viewing and involved in their work have some level of lived experience of suicide, and that all those involved in the work understand the impact of portraying suicide, based on evidence from up-to-date research. This can help in remembering to prioritise safe portrayals, as you never know whom may be vulnerable.”

However, Bryant also warns artists to keep themselves safe while engaging with such potentially dangerous content. “Creating works related to this topic can be distressing for artists, especially if they have lived experience. It is therefore important that artists ensure they prioritise their own self-care and seek help if required.”

It is worthwhile for artists who are exploring suicidal themes to try to fully understand the research that does exist so they can strive to make artworks that are safe and supportive for their audience. Only by doing so will artists be able to create work that aids rather than hinders a healing process that is so desperately needed.

Edited by Deborah Kane

For youth and parents, key national youth support services include:

Youth 24/7 Crisis Support - Kids Helpline 1800 55 1800 www.kidshelpline.com.au
Online Clinical support and information - headspace 1800 650 890 www.headspace.org.au
Mental Health Information for young people and families - Reachout www.reachout.com

For digital mental health