13 Reasons Why: Guest Blog Post with Dr. Elizabeth Dexter-Mazza

Posted on Posted in Digital Parenting, Elementary Age, high school age, Middle School Age, Parenting, Screenagers, Teens & Screens

I speak and write a lot about the pros and cons of living and parenting in the digital world. Through this work, I often connect with amazing professionals and their work. As a child psychologist, the Netflix original series, 13 Reasons Why, has become a major, albeit controversial, topic in my office, home-life and Facebook wall. Controversial because parents of young children (9 or 10 even), ask me how to handle that their children have already watched the series on their iPad without the parent’s knowledge.

In previous posts and comments, I have highlighted the Digital Parenting Pioneer perspective that 13 Reasons Why represents the dangerous trend of blurred boundaries regarding the targeted audience for content found online whether on Netflix, Google, YouTube, or App store. When children and adults have access to the same content, the danger and risk of harm to children rises as they are exposed to and interact in the adult digital world. In the case of 13RW, the tragic subject matter is important and I am thrilled that the public conversation has been sparked. However, as stated in a letter sent home by my local school district: “13 Reasons Why” carries a TV-MA (for mature audiences and may be unsuitable for children under 17) rating because it is not intended for viewers younger than 17″… yet many young children are watching it without the knowledge, supervision or safe place to process the disturbing content. So we have ‘mature’ content watched on adult-devices by young viewers who are, at best, simply not developmentally equipped to manage the content.

Yes, Digital Parenting is TOUGH stuff.

Remember those amazing professionals? Well, I am fortunate to introduce to you, Dr. Dexter-Mazza, a brilliant clinical psychologist and co-author of the DBT Skills in Schools (DBT STEPS-A) a social emotional learning curriculum, who shared her expertise with her Facebook friends and I urge you all to share it with your wall to increase the dialogue about this dangerous digital trend that has gone ‘viral’.



Elizabeth Dexter-Mazza, Psy.D.

 

Dr. Elizabeth Dexter-Mazza:
Why I think every parent needs to watch 13 Reasons Why (13RW)…

So I typically don’t write posts like this, I like to stick to pictures of my family, my food and occasionally share someone else’s posts. Sorry, this is going to be a long one…All week, I have been thinking about 13RW, and need to say something as a parent and professional. This became even more clear when a few friends and family members asked me about it and what to do with their own teenagers. I am clinical psychologist who specializes in therapy for adults and adolescents who are at high risk for self-harm (e.g., cutting) and/or suicide. Additionally, I spend a lot of my time teaching mental health practitioners how to work with high-risk clients.

Suicide is the 2nd leading cause of death for 15-24 year olds.

When I teach about suicide risk assessment and management, I discuss factors that impact suicide risk. I tend to spend a significant amount of time talking about the contagion effect, an imitation effect that occurs after a suicide. The American Association of Suicidology media recommendations state: “Risk of additional suicides increases when the story explicitly describes the suicide method, uses dramatic / graphic headlines or images, and repeated / extensive coverage sensationalizes or glamorizes a death.” This is especially important true for young people. Research has repeatedly identified this effect, and some studies have found that young females are at the highest level of risk for imitation or contagion effect. But what I want to tell you about is one study in particular that I always use as an example when I teach about suicide risk factors and contagion. In 1981, there was a 6-episode soap opera in Germany where the main character, a 19-year-old male, dies by suicide (method=railway). The show tells the story from family and friends perspectives. In 1982, the same series was shown again. The results showed there was a significant increase (up to 175%) in the number of young male suicides by railway after the series compared to a period of time before the first showing, before the second showing, and several months after the final episode aired (ABABA design). This shows the imitation effect – sometimes called the Werther effect. The impact of publicizing deaths by suicide, is often related to an increase in suicide rates, and even moreso for individuals that have similar characteristics to the person who died by suicide. (Schmidtke & Haffner, 1988).

So here are my concerns with 13RW. There are two models of suicide in this show, and possibly even a 3rd. This show covers a wide range of characters and multiple methods of suicide.

  • Hannah Baker, a high school aged female, dies by suicide cutting her wrists. The last episode shows an over-detailed depiction of how Hannah killed herself. It comes across as a “how-to” in my opinion.
  • Alex Standall, a high school aged male, attempts suicide with a gunshot wound to the head.
  • Tyler Down, is shown purchasing a gun and hiding it in his bedroom.
  • There is a 4th character who is shown with scars on her arms indicating that she engages in cutting behaviors.

I watched the entire series and was frustrated most of the time. The intention of the series was to show the potential impact of bullying, teasing, slut-shaming, rape, rape –culture, and rejection. These are all important issues we need to talk about with teenagers, so I agree with that. However, the importance of these issues gets lost in the story line, because the story focuses on how Hannah gets revenge on all the people who hurt or failed her, ultimately causing one other character to make a suicide attempt and two others to think about it. First, the show does not provide any information about what to do if you are thinking about suicide, such as the number for the National Suicide Prevention Lifeline (800-273-8255) in the 13 episodes. It is not until the 14th behind the scenes episode called Beyond the Reasons, do they provide a website with access to resources. I am not sure how many teenagers are going to watch that episode in order to get information about help available. At a minimum, the show could have provided resources with every episode. Additionally, the show highlights how the school has a memorial set-up for Hannah at her locker and in the hallways of the school, which goes against the media and school guidelines established by national suicide prevention agencies and the National Association of School Psychologists (NASP) guidelines. From NASP (partial excerpt):

Contagion. Suicide contagion occurs when suicidal behavior is imitated. The effect is strongest among adolescents: they appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. Guilt, identification, and modeling are each thought to play a role in contagion. Sometimes suicide contagion can result in a cluster of suicides. Studies indicate that 1-5% of all suicides within this age group are due to contagion (100-200 teenage cluster suicides per year).

Suicide prevention strategies designed to minimize contagion include avoiding sensationalism or giving unnecessary attention to the suicide, avoiding glorifying or vilifying of suicide victims, and minimizing the amount of detail about the suicide shared with students.

Memorials. Memorials in particular run the risk of glamorizing suicide and should thus be implemented with great care. Living memorials are recommended such as making donations to a local crisis center, participating in an event that raises awareness about suicide prevention, or providing opportunities for service activities in the school that emphasize the importance of student’s taking care of each other.

What does this all mean and what should I do as a parent?

So, if you are still reading this, thank you. I strongly believe, as a parent and professional, that every parent needs to watch this show. At some point, your child may watch it or YouTube the suicide and/or rape scenes. You need to know what they are watching and be able to discuss it with them. Even if they decide not to watch it, it is important that you can have a discussion with them about the reasons they are choosing not to watch it. Several suicide prevention organizations have worked together to develop discussion guidelines regarding the show. As parents, we have to get ahead of this; we don’t always know what is going on inside our children’s heads. One thing that show is doing, it is starting conversations about suicide. I hope those conversations are going to be effective ones. Asking someone about suicide is not going to give them an idea, it is going to give an opportunity to talk and know you care. My children are too young and haven’t watched the show, but they do know what the show is about (in a general sense) and why Jim and I think it is problematic. At some point we will watch it with them if they want to.

Additionally, I have started watching parts of the show and discussing it with my psychotherapy clients. I have been told that “all the kids are watching it and talking about it”. Teens are making comments to each other when feeling attacked or rejected, such as “XXX this is your tape” imitating the show, suggesting that hurtful behaviors are a joke or that it makes the person want to die by suicide. I watched the detailed suicide scene with one of my clients since she hadn’t watched it yet and I didn’t want her watching it alone. We discussed her suicide and self-harm urges before, during, and after the scene while also preparing for how she was going to skillfully manage those urges without hurting herself. We then had a discussion with her parents about the show, shared the guidelines, and encouraged them to watch it together. My goal is to get in front of this, showing my clients and my own kids that I am willing to have difficult conversations about difficult topics, and even more so that I care. I suggest you do the same; you don’t need to have a degree in psychology to show you care.

Finally, it is important to communicate to your kids that there is always an option other than suicide and help is available. Let your children know if they don’t want to talk to you, you can help them identify people at their school and within the community who they can talk to. The show depicts an unhelpful school counselor who failed to identify the warning signs and do a proper assessment of Hannah, while also making assumptions about the rape being her fault or that her only two options were to report it or get over it. It also shows how Mr. Porter tries to cover-up his mistakes, rather than being a model of how we can make mistakes and own up to them by repairing. Not all school counselors are like Mr. Porter. Most school counselors and school psychologists receive training on how to recognize warning signs properly assess, and effectively intervene.

I know this was long and thanks again for reading. I needed to get this off my chest as I have been thinking about this show all week. Now I will go back to posting pictures of my kids and my food.

Elizabeth Dexter-Mazza, Psy.D.
Licensed Psychologist
Certified DBT Clinician, DBT-Linehan Board of Certification
Mazza Consulting and Psychological Services, PLLC
www.mazzaconsulting.com