The Problem of Suicide and How We Talk About it

After the recent spate of heart-rending, very public teen suicides, Alexandra Kimball navigates the murky channels of suicide, its coverage by the media, and the contagion effect.

Alexandra Kimball is a writer living in Toronto. Her work has appeared in The Walrus,...

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In 2011, I was re-assigned from my editing job at Kids Help Phone, a national distress line for kids and teens, to a communications post at the company’s suicide project. There had been a highly-publicized spate of teen suicides in Canada, and we were overrun with media requests.

While the need for a media liaison was acute, the task was quite rote. Like all mental health institutions, Kids Help Phone believed firmly in the “contagion effect,” the phenomenon whereby reports of suicide tend to beget more suicides, especially among young people. On my desktop, I kept a PDF of a document from the Canadian Psychiatric Association, which advised media on how to minimize contagion. It urged, among other things, that reporters avoid repeating the word “suicide,” especially in large-font or headlines; publishing admiring descriptions of the deceased; and relating details of the deceased’s method of death.

When a reporter came knocking—is there a teen suicide epidemic?—I’d zap them this document, and then wait for the big splashy story that would inevitably feature the word “suicide” in 18-point font above paragraph-long descriptions of the lost kid’s beauty or talent. “Put it away,” said a staff social worker, brusquely, when I showed her a headline about teen suicide in a Toronto daily. “I don’t want to see that.” She went into our “quiet room,” a soundproofed cubby set aside for emotionally taxed counsellors, and shut the door.

Privately, I was more ambivalent. I was writing freelance for magazines on the side, and shared the journalists’ disgust at any protocol that seems to censor the press, as well as a belief in the therapeutic effects of dialogue. The assumptions behind the contagion effect seemed to me the worst kind of logic, the thinking that would blame Marilyn Manson for Columbine or video games for gun violence. At the same time, it was hard to dismiss the objections of the psychologists, social workers, and counsellors I worked with—all educated professionals who had worked with young people for years.

In the years before mass communication, when people heard about suicide directly, the threat of copycat behaviour was real, but contained: waves of suicide would roll through small communities and then pass. As the mass press developed in the 18th and 19th centuries, however, and with it a vast increase in literacy, the networks for contagion expanded. In 1774, Goethe’s novel The Sorrows of Young Werther was banned after a rash of shooting-suicides among young male readers in Europe.

Professionally, I was smack in the middle of a new area of conflict between news media and the mental health industry. Since the contagion effect had first been publicized in the late 1980s, media had observed a rule of silence around suicides, reporting them only in cases where the death was of public interest (for example, when it was the death of a high-profile figure). But since around 2008, arguably the year social media began to displace newspapers as the primary source of public information, established media began to defy these guidelines. Silencing reporters had always seemed tantamount to censorship; now that deaths were being reported on Twitter, it was impossible for journalists to stay silent.

More compellingly, the body of knowledge on suicide had grown since the guidelines were first developed. Studies showing contagion appeared dated and unreliable, especially in light of what we now know about the positive effects of mental health awareness, which provokes policy change and helps people who are suffering feel less alone. In 2012, the Globe and Mail announced it would be replacing the conventional phrasing, “committed suicide”—a term derived from a time when suicide was a crime against God and country—with the more neutral term, “died by suicide.” It was ironic, I felt, that the media was bringing the public increasingly in line with the psychiatric ethos.

My professional conflict didn’t last long. A few months after I was assigned to the project, I paid off my student debt and left the job to write full-time. Like everyone else, I heard about teen suicides through newspaper headlines and Facebook status updates, and I sensed that media’s focus had shifted since I’d left the job—from college students suffering from depression to high-school-aged victims of bullying. One afternoon, I clicked on a Facebook link to a Youtube video posted by BC teen Amanda Todd, whose death had been all over the news, thinking it was some document of her life in happier times; to my shock, I saw it was a type of suicide note, told via scrawled cue cards, each itemizing an abuse she’d suffered at the hands of an online predator and her classmates.

At the sidebar were a number of “response” videos, mostly from other young women, told via the same cue-card narrative format. I watched a few, then snapped my browser shut as quickly as I shield my eyes during a bloody scene in a violent movie. I’m not sure why—though I think, shamefully, that I did not want to be contaminated. I was beginning to understand the concerns of my former colleagues.

*

In the years before mass communication, when people heard about suicide directly, the threat of copycat behaviour was real, but contained: waves of suicide would roll through small communities and then pass. As the mass press developed in the 18th and 19th centuries, however, and with it a vast increase in literacy, the networks for contagion expanded. In 1774, Goethe’s novel The Sorrows of Young Werther was banned after a rash of shooting-suicides among young male readers in Europe (Goethe’s young male protagonist shoots himself after he is romantically rejected).

Still, it wasn’t until the latter half of the 20th century that mental health experts identified what came to be known as “media contagion.” From 1967–1968, a newspaper strike in Detroit was linked to a decline in local suicides; when the strikers returned, experts noted, the suicide rate rose again. In 1987, researchers in Vienna counseled journalists to restrict their coverage of suicides on the city’s subway system. Within six months, the number of subway suicides and attempts in Vienna had dropped by over 80 percent, and the city’s overall suicide rate had lowered, too. By 2008, over 50 studies from various countries had confirmed media contagion, the World Health Organization had issued press guidelines, and policies that restricted suicide coverage were in place at media companies across the globe.

In the 2000s, however, a counter-approach to media contagion began to emerge. A 2007 study by Gerard Sullivan analyzed the current research on contagion, and found much of its data too selective to prove that media reports affect suicide rates. Others in the mental health field pointed out that the highly publicized suicide of Kurt Cobain in 1994 had failed to produce the expected copycat behaviour. Once social media enabled suicide survivors, witnesses, and family members to blog and tweet about their experiences, it began to seem ethical for reporters to provide accurate, up-to-date accounts of events that were already public.

“[Editors] are reacting to social media—where online memorials pop up instantly and friends and family members talk openly about suicide whether the mainstream media are doing it or not,” wrote Steve Ladurantaye in a 2010 Globe and Mail feature identifying a “new ethos” in journalism, partly fuelled by this shift in technology. Indeed, 2009–2010 saw the biggest jump in suicide coverage in Canada’s history. Unlike the carefully-phrased reports of the past, this coverage used the word “suicide” prominently, freely discussed details of the deceased’s life, and sometimes included information about the method of death. “Maybe the taboos are finally being shattered,” wrote Globe public health reporter, Andre Picard, in a 2009 op-ed. “Burying our heads in the sand and self-censoring our stories certainly has not worked.”

Liam Casey was a journalism student working part-time for the Toronto Star when he decided, in 2010, to write in favour of reporting suicides. “Suicide Notes,” his essay for the Ryerson Review of Journalism, is a stunning piece that examines the flaws behind contagion theory from the perspective of a writer who has lived through depression and thoughts of suicide. Now working full-time for the Star as a reporter, Casey takes time out of a busy news day to talk to me by phone. “I believe there’s a contagion effect among high schoolers—I’ve always believed that,” he clarifies. “What doesn’t make sense is that the contagion effect would be caused by media.” When he started research on his RRJ piece, his suspicions were intuitive at first—“I can’t think of any problem that improves by not talking about it”—but when he tried to probe these concerns with the country’s suicide experts, he came up against what he saw as psychiatric dogma. “I didn’t get any satisfactory answers,” he says—just the same party line, over and over, “like they all learned it in the same class at med school.”

The empty rhetoric, Casey tells me, made him doubly skeptical. “Remember Belak?” Casey asks. (Wade Belak, an ex-NHL player, died by suicide in 2011.) “That was a top news story, front pages, tons of coverage. So of course, experts came back, criticizing media for sensationalizing the story, because supposedly that causes contagion. OK, well, I followed that. [If contagion is accurate], you’re supposed to see a spike in suicides, a short term rise, a week after the exposure. But there was no spike.”

When Casey looked for studies to explain cases like Belak’s—high exposure, with no contagion—he found nothing. “The studies are 30 years old. They’re correlational studies, which are fraught with problems.” There’s a link between exposure and contagion, but less evidence that one causes the other. Moreover, Casey adds, the bulk of research was done in “a much different landscape: there was no Internet; people got their news off TV. The contagion effect is specific to young people, but young people aren’t getting their information from old media. It’s conversation, texting each other, Facebook memorial groups. To point a finger at the media, and say, ‘you have blood on your hands,’ that’s simplistic. Suicide is more complex than that.”

After the publication of “Suicide Notes,” Casey tells me, he encountered overwhelming support, not only from media, but from readers who had themselves struggled or survived the suicide of a friend or family member. “I don’t get responses to anything I write more than when I write about suicide,” he says. “The sense is always the same: ‘Oh thank god, no one talks about this.’ There’s an appetite for this. It’s a common problem that’s not reflected in the news.” Or, in the words of Werther, “nothing is more dangerous than solitude.”

[pagebreak]*

Dr. Jitender Sareen, one of the sources quoted in Casey’s piece, is a prominent figure in the national debate on suicide coverage. A suicide expert, Sareen is the chair of the CPA Research Committee; as such, he’s responsible for promoting the media guidelines. When I talk to him by phone, I sense in his speech those sound-bite tendencies Casey discussed with me, but also the frustration of repetition. “This isn’t stuff psychiatrists have made up,” he says. “Around the world, studies show there is a contagion effect, specifically that there’s a contagion effect for youth, and around the world there are guidelines for media that advise them on how to minimize [that effect].” Seeing reporters flout those guidelines infuriates him.

The current emphasis on bullying in teen suicides is particularly problematic, Sareen says, because it reduces the complex phenomenon of suicide to a simplistic narrative that downplays other factors. In 90 percent of suicides in all age groups, there is advanced mental illness. Marginalized social groups, including the elderly and ethnic minorities, are at higher risk than those in the dominant culture. And “poverty is a major risk factor,” Sareen tells me, as corroborated by US studies showing increased suicide during periods of high unemployment and falling median incomes.

Amanda Todd seemed aware that her life was potentially an object for public consumption, and the video is, in part, an attempt to control how her story gets consumed. I decide that I am disturbed by the Todd video not because it’s a suicide note, but because it’s a kind of pre-mortem obituary. I see Todd as a girl who felt loathed and ignored, and the video as an attempt to change the official story of her life, by recasting it in the redemptive language of bullied-teen suicide stories. Maybe her suicide was the same kind of gesture.

Even when bullying is indicated in a suicide—and indeed, it appears to be a powerful trigger for young people—there are invariably other parts of the story that the current narrative disallows. (The 2010 death of Phoebe Prince was at first attributed to bullying; a reporter’s digging turned up a history of mental illness and a previous suicide attempt.) The risk of these simplified narratives, Sareen informs me, is not only that bullied kids might identify with them; they also mislead the public about suicide, defeating the purpose of reporting about it in the first place.

But aren’t suicide stories already distorted and simplified in the age of social media? As I was writing this piece, someone on my Twitter feed RTed: “Jesus Christ, I just saw someone kill themselves by jumping off the Dragon City Mall in Chinatown.” Someone else responded: “WHAT.” A couple more RTs, and that was it. Any newspaper report, no matter how splashy or sensational, strikes me as preferable to this sort of flippancy. I ask Sareen if, under these circumstances, it seemed necessary for journalists to step in. “I don’t buy it,” he replies. “Old media take the perspective that with social media, [the public] are going to see reports of suicide regardless [so they have to report]. They’re saying ‘we’re not doing any harm.’ [But] what’s in social media depends on what’s in the regular media.”

I’m not sure about the causal logic here. Non-journalists break stories on Twitter and Facebook all the time (that suicide I heard of on Twitter? Citytv reported it six hours later). But implicit in Sareen’s comment is a refusal to see social media stories as sui generis phenomena, which strikes me as key. Pick your Facebook memorial group, or your standard Twitter “RIP,” and you’ll notice familiar conventions: the tone of shock, the search for a reason, the late-game admiration of the deceased. The way we discuss suicide is shaped by the stories we’ve read about suicide, chiefly in newspapers and magazines. Social media may have changed how these stories are transmitted, but it hasn’t changed the narrative codes—and that’s the problem.

I go back to the Amanda Todd video. Again, I find it too visceral to watch; the words “too much” keep coming to mind. I think it has to do with how she keeps her face out of frame, training the camera instead on her hands, delicate fingers curled around the cue cards’ edges. There are woven plastic bracelets on her left wrist—a token of normal girlhood that is devastating in this context.

But there’s something else that strikes me, too: her wording. “I then got anxiety, major depression, and panic disorder,” one of the cards reads. Another: “I then got into drugs and alcohol.” No desperate kid who has not been reading about desperate kids talks like that. This is the language of social work, or more accurately, the language of social work as it appears in countless stories on bullied, suicidal teens. Amanda Todd seemed aware that her life was potentially an object for public consumption, and the video is, in part, an attempt to control how her story gets consumed. I decide that I am disturbed by the Todd video not because it’s a suicide note, but because it’s a kind of pre-mortem obituary. I see Todd as a girl who felt loathed and ignored, and the video as an attempt to change the official story of her life, by recasting it in the redemptive language of bullied-teen suicide stories. Maybe her suicide was the same kind of gesture.

*

What gets lost in the discussion of suicide coverage is the logic behind contagion—why news of one suicide might cause a domino effect, especially in young people. On a sunny day in May, I returned to Kids Help Phone to interview my old boss, Alisa Simon, VP of counselling services, and the new director of Program Development, Carolyn Mak. “Young people have specific vulnerabilities,” Simon tells me; contagion jibes with what we know about adolescent psychology and the way young people process stories. Young people tend to identify with prominent cultural narratives, to position themselves in the stories they hear most often. And “developmentally, [young people] don’t necessarily understand what the outcomes of their [actions] might be,” Mak explains. “Do kids understand the finality of death? Do they really get that?”

Think about it, Simon says: you’re young, “you’re struggling with significant challenges, and part of that is feeling like nobody cares, you’re not noticed. [Then], you see that another young person has taken an action that is getting them attention, and the attention you potentially want… Their picture is all over the place, there are thousands of people expressing grief and making admiring comments.” When enough stories about teen suffering end in suicide, she says, death begins to seem like a natural solution. “One of Rae’s pet peeves,” wrote Leah Parsons on a Facebook memorial page for her daughter, Rehtaeh, “was that when someone passed away, suddenly they were liked and people cared.” The risk is that readers will understand suicide as a type of redemption.

Suicide contagion is often called the “Werther effect,” after the rash of suicides that followed the publication of Goethe’s novel, but there is another phenomenon named after Papageno, a character in Mozart’s The Magic Flute. In the opera’s final act, Papageno is dissuaded from suicide by three spirits who invoke images of the future. Clinicians use the term “Papageno effect” to describe how stories about people who choose against suicide can actually reduce the suicide rate.

Sareen sends me links to a number of recent studies, the most interesting of which is a 2005 Austrian study that compared how different kinds of suicide narratives link up with suicidal behaviour. Repeated exposure to traditional kinds of media suicide coverage, including stories that focused on suicide epidemiology or expert opinions, were positively associated with suicide. But one type of suicide story was negatively associated with suicide, meaning people who consumed it were less likely to take their lives than people who heard nothing: the “mastery of crisis” narrative, which describes people who think about suicide but, like Papageno, decide against it. Understood thusly, the tendency of young people to identify with dominant narratives can be harnessed for good.

*

In the late 1980s and early ’90s, Washington, D.C.-based journalist Amy Alexander observed a spike in the suicide rates of black American men aged 18–34. Her 2000 book, Lay My Burden Down: Suicide and the Mental Health Crisis Among African-Americans, co-authored with psychiatrist Alvin F. Poussaint, explores the myriad and deep-rooted factors that led to that statistical spike—everything, she tells me, from African-Americans’ historical distrust of health care institutions (itself a result of abuses of black citizens by those institutions), to a lack of affordable treatment for people from low-income communities, to a dearth of research on mental health issues specific to people of colour. As she tells me over the phone, the book provoked a long-overdue discussion of mental illness and suicide among both the psychiatric community and African-American readers.

Alexander, like most journalists writing on mental health, believes that more, not less discussion of suicide and mental illness in media is an effective way to reduce stigma, provoke policy change, and encourage people who are struggling to seek treatment. But she knows from her own research that simplifying suicide narratives runs the risk of sensationalizing and distorting the real story. “The trope of bullying in suicide, if you will, is a popular one,” Alexander says. “It’s important to discuss bullying, it’s good that this conversation is happening. But suicide requires reporters that are sensitive to the broader context in which it happens. When I see a story on suicide, for example, or a suicide cluster, I’d like to see some stats. Is this part of a trend, and if so, is it regional? National? Are suicides, overall, up or down?” (Contrary to what media coverage seems to imply, she points out, the group with the highest-rising rate of suicide in the USA is men and women age 45–64.)

It’s unfortunate, Alexander says, that media companies began to greenlight suicide stories around the same time that newspapers started to lay off staff reporters in large numbers. Among the first positions to be cut, she says, were the social services reporters traditionally assigned to the mental health beat, which left newsrooms ill-equipped to deal with the issue: more likely to over-simplify and sensationalize their reports.

In the Canadian data, a standout statistic is that suicides among Aboriginal youth are five to seven times higher than suicides for non-Aboriginal youth; suicides among Inuit youth are among the highest in the world (11 times the national average). “Our attention is often on white, middle-class Canadian young people who have taken their lives by suicide, which of course is an incredible tragedy,” says Simon. “But we don’t pay as much attention to the First Nations communities, where 50 percent of residents have had a friend or a relative die from suicide.”

As with the suicides Alexander examined, which were rooted in the political, social, and economic histories of black America, suicides among Aboriginal youth are impossible to divorce from the context of colonization, poverty, and ongoing oppression. This makes Aboriginal suicide ill-suited to the conventions of media narrative, where stories are sum-uppable in 1000 words, tragedies “caused” by some external antagonist, and solutions condensable in a sidebar.

“It’s a misdirection in focus,” Simon adds. “That’s understandable—you hear about these cases and they’re unbelievably sad. But why haven’t we talked about the fact that schools aren’t equipped to deal with bullying? Or the lack of affordable pre-natal care, or the [stress of] transitioning from high school to university? There are so many pieces that come together to form that tragedy.” We take solace in stories that allow us to shift the burden of guilt onto a singular villain. Mak mimes the typical response: “Oh we have a bully, or a sexual predator, and he’s awful!” A more accurate story, she explains, would discuss “not just poverty, but the social-historical oppression of certain groups.” Of course, this kind of complexity “would mean that we all have a stake in it, we all contributed to it.”

The attention on bullying in teen suicides, then, not only misrepresents the complex nature of suicide but also reveals the limits of traditional reporting. I wonder if the problem is not that media broke the silence around suicide, but that this happened without a concurrent transformation of media narratives. “Suicide is an event of human nature, which, whatever may be said and done…in every epoch must be discussed anew,” wrote Goethe in his autobiography. In ours, it’s not surprising that the typical suicide narrative is the one that exculpates the reader—that makes us feel good for paying attention, as if this were the same as awareness.


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