Medical experts say Netflix and creators of the second season of 13 Reasons Why — streaming Friday — aren't doing enough to curb the increase in teen suicides and may be encouraging copycat cases.
Data show the teen suicide rate rose by more than 70% between 2006 and 2016 with black teen suicides increasing far faster. The renewed criticism comes despite the series' new embrace of suicide prevention, which includes a collaboration with the American Foundation for Suicide Prevention (AFSP).
Some critics of the series, which showed a suicide and sexual assault in graphic detail, blame the first season for glamorizing suicide. The proportion of visits involving suicidal thoughts — known as "ideation" — jumped by more than 40% last April and May compared to the weeks before the release of the series' first season on March 31, 2017, according to a study of millions of doctors’ visits by 14- to 20-year-olds.
Netflix responded by including extensive resources and an "after show" on prevention that airs after the final episode in each season. But executive producer Brian Yorkey said Thursday that Netflix "stands by" the first season.
While medical reports disagreed with the portrayal of suicide, Yorkey says Netflix felt it was the "most truthful portrayal" they could do.
"I believe we did the right thing," he said Thursday.
It's not enough to try to educate, says emergency doctor Paul Kivela, president of the American College of Emergency Physicians.
"My concern with this whole show is the kind of glorification of suicide," says Kivela, who is based in Napa, Calif. "The problem here is that the producers of the show may not understand the unintended consequences of their show.
"They may be trying to educate but may be having the opposite effect," he says.
The new season also introduces a second black female teen, played by Samantha Logan, which helps illustrate the universality of mental illness and trauma. Logan, like actress Alisha Boe, was sexually assaulted, but chooses to downplay the trauma in an unhealthy way.
"It's important for viewers of all different backgrounds to see themselves in this," says Yorkey. "They might have some different cultural pressures in how they deal with some things."
To underscore that the actors are only playing troubled teens, Netflix is releasing a set of videos starring cast members out of character addressing many of topics in the show. This "discussion series" will be available in the Netflix “Trailers and More” section and on 13ReasonsWhy.Info starting Friday. The series includes information on how to spot depression, understanding sexual consent, drug and alcohol abuse, bullying, and self harm.
The new Beyond the Reasons after show featuring actors and experts in suicide prevention, sexual assault and other problems will play automatically after the last episode of the second season. Rhode Island child psychiatrist Karyn Horowitz, a Brown University associate professor, says it should run after every episode and questions whether teens will view the online resources.
Psychiatrist Christine Moutier, AFSP's chief medical officer, collaborated with Netflix on a resource page and discussion guide. AFSP, Netflix, and other organizations created public service announcements with cast members.
AthenaHealth and researchers on the doctor visits study acknowledge the increase for suicidal ideation visits could actually show that more teens are seeking help after viewing the show, which is a positive development.
Some of the criticism of the series highlights disagreement over the effect publicity has on behavior - and the level of accountability the media and entertainment should have for actions stemming from their work. But Horowitz, who heads outpatient child psychiatry and behavioral health services for the Rhode Island health system Lifespan, cites research showing teens exposed to suicidal behavior were at least three times more likely to attempt suicide.
"With fear of talking about suicide in the name of protecting against contagion, do we also bring stigma and shame?," asks Yorkey.
Horowitz says the attention shouldn't be on the act, but rather the prevention of suicide.
Non profits and medical groups have guidelines for how the media reports on suicide, which includes not disclosing or showing where the death occurred or how it was done.
In Washington, Judy Davidson welcomes the attention to suicide, especially in the African-American community. Still, she hasn't been able to bring herself to watch the series. Her son, Alvin Conrad Layne II, nicknamed “Momo,” died by suicide in 2016, a year after he was robbed on the street, shot twice and became paralyzed.
And African Americans supposedly didn't kill themselves, or so the thinking goes. In fact, some people even told Davidson that her son would go to hell because suicide is a sin, something experts say leads to a code of silence that worsens the problem.
"It’s like a sign of weakness," says Davidson. When talk turns to suicide, "People will say, 'Give them a shower and a nice clean shave and pray about it.'"
She felt ostracized when she first wore an "RIP" tee shirt for her son as people suggested she should quickly get over the his death as it was suicide.
No wonder many people don't want to talk about it: "They’re shamed and they’re ashamed," says Davidson.
"It's worse in the African-American community," says motivational speaker Willie Jolley. "They don’t talk about mental health and very rarely admit to getting therapy."
Suicide, he says, stems from hopelessness, adding that he tells audiences, "Some of you are struggling in life and you need therapy, you need help."
That's a message Horowitz hopes anyone who watches season 2 of 13 Reasons Why will heed if they are suffering from mental illness, self harm or suicidal thought. Most of all, she says she's one of the "many child psychiatrists who are disappointed there is a season 2 because of the negative impact of season 1."
Contributing: Reginal Payne II, a fellow with the Urban Health Media Project, which O'Donnell co-founded.