How should we talk about suicide

Yesterday was annual World Suicide Prevention Day, which, given the recent high-profile suicide of the actor Robin Williams – a death that has generated a huge amount of media and professional debate on the subject – has an added layer of poignancy this year.

Although it may be disappointing that it requires the suicide of a much-loved celebrity to engage the media and public in such intense debate on the issue, as this feature investigates, the relationship of the media, celebrity suicide and suicide in the general population is fraught and complex.

First, some statistics. Last week, the World Health Organization (WHO) released some sobering data on suicide prevalence. According to the latest figures, one person commits suicide every 40 seconds.

“Suicides are preventable,” states WHO Chief Margaret Chan, who describes each suicide as an avoidable tragedy, and that suicide as a public health concern fails to grab attention because of taboos and stigma.

She adds:

“Every suicide is a tragedy. It is estimated that over 800,000 people die by suicide and that there are many suicide attempts for each death.

The impact on families, friends and communities is devastating and far-reaching, even long after persons dear to them have taken their own lives.”

The WHO report is the result of a decade of research involving 172 countries. It found that, in 2012, high-income countries had a slightly higher suicide rate than low- and middle-income countries, accounting for a quarter of the global toll.

The global rate was found to be 11.4 suicides among every 100,000 people, with men about twice as likely as women to complete suicide.

tributes to Robin Williams
Examining the outpouring of grief over Robin Williams’ death, we can see how seemingly innocuous statements may still present a violation of the established public health standards.

The report mentions that the most frequently used suicide methods are pesticide poisoning, hanging and firearms, with the exception of urban areas of Asia, where jumping from buildings is a common method.

However, the report castigates the media and users of social networks for providing lurid details of suicides and the methods used in reports of both celebrity suicides – such as Robin Williams – and unusual suicides by non-celebrities.

“Inappropriate media reporting practices can sensationalize and glamorize suicide and increase the risk of ‘copycat’ suicides,” the report states.

“Media practices are inappropriate when they gratuitously cover celebrity suicides, report unusual methods of suicide or suicide clusters, show pictures or information about the method used, or normalize suicide as an acceptable response to crisis or adversity.”

“Coverage of the recent suicide of Robin Williams was problematic,” Prof. Silvia Canetto, from the College of Natural Sciences-Psychology at Colorado State University, told Medical News Today.

“The reason,” she elaborates, “is that many journalists are not aware of the guidelines, and that training of journalists needs to be consistent, across generations of journalists, and with booster training opportunities.”

Media guidelines on suicide reporting

The “guidelines” she speaks of are perhaps not well known to the general public. In 1989, the Centers for Disease Control and Prevention (CDC) for the first time published recommended guidelines for news organizations on how to report on suicide.

newspaper printing press
In 1989, the CDC for the first time published recommended guidelines for news organizations on how to report suicide.

These recommendations were followed by similar guidelines from the National Institute for Mental Health (NIMH) and WHO.

What the guidelines are striving to prevent, is what experts term “suicide contagion.” Suicide contagion is a measurable phenomenon whereby sensationalized reporting of high-profile suicides is directly followed by a spike – on either a regional or national basis – in suicide attempts and/or completed suicides.

In the CDC’s own words, suicide contagion is “a process by which exposure to the suicide or suicide behavior of one or more persons influences others to commit or attempt suicide.”

The CDC’s position is that while suicide is often newsworthy and therefore likely to be reported, it is incumbent upon reporters to “understand that a scientific basis exists for concern that news coverage of suicide may contribute to the causation of suicide.”

For the CDC, this involves avoiding presenting simplistic explanations for suicide, sensationalizing or excessively repeating coverage, or reporting “how-to” details of suicide. Their guidelines also warn against glorifying people who commit suicide or “presenting suicide as a tool for accomplishing certain ends.”

The NIMH guidelines recommend that in media reporting on suicide, reporters should offer hope to readers, adding statements on the many treatment options and resources available for the psychiatric or substance abuse problems that they claim are present in 90% of people who have died by suicide.

Suicide contagion has been a public health concern since at least the 18th century, when the novel The Sorrows of Young Werther by Johann Wolfgang von Goethe was banned in much of Europe. Goethe’s titular lead character commits suicide following a failed love affair. The powers that be in these countries were worried that young romantics would take the character’s dilemma to heart, potentially sparking a wave of what are now known to the media as “copycat suicides.”

Despite this, there have been relatively few studies to comprehensively investigate suicide contagion. Some studies had found that – overall – suicide rates rise following an increase in media reporting on suicide, and that the greater the amount of coverage is, the greater the rise will be.

Corroborating the stance of the CDC and NIMH, these studies also suggest that media reports portraying suicide negatively are less likely to be followed by a rise in suicides. Goethe may be vindicated here, as studies have not yet reported a link between a rise in suicide and fictional accounts of suicide in the media.

However, the same studies have shown that reporting of the suicides of political or entertainment celebrities is followed by a rise in suicides.

‘Cluster suicides’ and suicide contagion

When a spike in suicide incidence follows a high-profile suicide, it is known as “a suicide cluster.” Teenagers are considered to be particularly at risk for cluster suicides.

depressed teenager hugging his knees
Teenagers are considered to be particularly at risk for cluster suicides.

Earlier this year, Medical News Today reported on a study in The Lancet Psychiatry that set about addressing the paucity of evidence on cluster suicides with an analysis of 469 American newspapers published between 1988 and 1996 and their relationship to 48 identified suicide clusters.

In each of these clusters, between 3 and 11 victims aged 13-20 killed themselves within 6 months of the first suicide.

The study – conducted by researchers from New York State Psychiatric Institute – reported that significantly more newspaper stories were published in the aftermath of a suicide that was closely followed by another suicide than those with no additional suicides within 6 months.

Also, the association was strongest for news stories about teenage suicides.

“Although we cannot show causality,” lead author Dr. Madelyn Gould explained, “our study indicates that media portrayals of suicide might have a role in the emergence of some teenage suicide clusters.”

This suggests that perhaps the CDC guidelines, which were first published at the start of that study’s investigation period, were not effective during their first 7 years of implementation. But have journalists and editors taken up the recommendations in following years? Evidence suggests not.

A 2010 study by Prof. Canetto, published in the journal Suicide and Life-Threatening Behavior, analyzed 968 local and national newspapers published in 2002-03 and concluded that American newspaper coverage did not follow the CDC’s updated 2001 guidelines on media reporting of suicide.

In particular, 56% of stories broke with the recommendations by describing the suicide method and 58% described location. Further contravening the guidelines, only 1% provided information about warning signs and risk factors for suicide, 4% highlighted the role of depression, 2% the role of alcohol, and only 6% recommended prevention-related resources.

The study by Canetto and colleagues could only find one instance of a high-profile suicide where these recommendations had been followed – the death of Nirvana singer Kurt Cobain, back in 1994.

How do the suicide reporting recommendations apply to modern media?

Since then, the media landscape has changed in ways that no one could have predicted, and so a new approach to how such guidelines might be applied to modern media may be required. Examining the outpouring of grief over Robin Williams’ death, we can see how seemingly innocuous and off-the-cuff announcements may still present a violation of the established public health standards.

screengrab of Robin Williams twitter tribute
A moving, appropriate epitaph, or irresponsible public statement?
Image credit: Twitter

This is perhaps best illustrated in the minor controversy over a tweet published by the Academy of Motion Picture Arts and Sciences following the announcement of Williams’ death. Posting a screengrab of the Williams-voiced genie character from Disney’s Aladdin, the Academy’s elegant 19-character tweet – “Genie, you’re free.” – seemed a moving, appropriate epitaph for a man who had been publicly plagued by mental health and addiction problems.

And it struck a chord with Williams’ fans – the message had been retweeted 361,624 times by the point the American Foundation for Suicide Prevention were quoted as saying the Academy’s tweet may contravene the guidelines by implying that suicide is an option.

With Twitter and other social media – increasingly people’s first stop for news and consensus views – beyond the scope of regulation, and with even trained journalists and editors not heeding the recommendations, to what extent are these guidelines either relevant or enforceable?

Silvia Canetto told MNT that the guidelines are still relevant but points to studies that show American journalists are “generally unaware that imitation suicide was a potential consequence of certain suicide reporting.”

For Canetto, the answer to preventing suicide contagion being spread by the media in the aftermath of high-profile suicides is to work with institutions responsible for training journalists and include education on suicide coverage as a component in their curriculums.

Secondly, Canetto argues that the awareness of and response to the guidelines by the media should be tracked to avoid the guidelines being disregarded if they come into conflict with “marketing journalism priorities.”

To what extent any lessons have been learned from the huge response to Williams’ death remains to be seen, but certainly – whether it is the American Foundation for Suicide Prevention’s response to the genie tweet, or recent newspaper think pieces on media complicity in suicide clusters – the issue of how we should talk about suicide is now being vigorously debated in mass media for the first time in 20 years, which can only be a good thing.

Written by David McNamee

on line mental health support community @ http://www.bipolar4lifesupport.co

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