Rebutting the Hysteria: More Thoughts on “13 Reasons Why”

Last week it seemed like I was bombarded by articles on the impending doom descending upon our adolescents due to the Netflix series 13 Reasons Why. Pretty much every article cited a study done by San Diego State University Graduate School of Public Health associate research professor John W. Ayers just published in the scientific journal JAMA Internal Medicine.

Ayers and his team of researchers focused on United States internet searches between March 31, 2017 (13 Reason Why‘s release date) and April 18, 2017 (so queries wouldn’t coincide with the April 19 suicide death of former Patriots football player Aaron Hernandez). Every search phrase included the word “suicide,” omitting the word “squad” so searches for the film Suicide Squad wouldn’t contaminate the results. Then they compared those results with searches and daily trends between January 15, 2017, and March 30, 2017 to get a baseline sense of what those searches are like generally.

The findings showed that after the release of 13 Reasons Why, which follows the events surrounding a fictional teenager’s eventual suicide through a series of tapes she leaves behind, all suicide-related searches were 19 percent higher than expected.

While awareness-related phrases like “suicide hotline” and “suicide prevention” were up 12 percent and 23 percent, respectively, “how to commit suicide” increased by 26 percent, “commit suicide” by 18 percent, and “how to kill yourself” by 9 percent.

That said, it’s unclear if these specific internet searches were definitely related to the show. It also isn’t clear whether those searches actually led to suicide attempts or deaths. But Ayers noted that previous research has found a correlation between increased searches for suicide methods and actual suicides. In other words – Ayers is extrapolating his interpretation to what he thinks is causation – but can’t really show anything but what he wanted to show in the first place.

Studies like this are clickbait shrouded in an academic cloak. First correlation doesn’t prove causation. And second nothing, especially teenagers, operates in a bubble. There is no experiment group vs. control group to compare. Also, even more importantly, one would assume there would be an uptick in internet searches associated a popular teenage series (no matter the content and especially if it has weight). To think this curiosity will cause additional action where there already has been action – is far from conclusive.

In my May 12 blog piece, “13 Reasons Why” … And Why It Matters To Your Community, I made a case why I thought the series was a good thing for our communities, including both adolescents and adults. But I’m not one who thinks we need to shelter our youth from the “monsters under bed.” On the contrary, I firmly believe we should empower our teenagers to develop the skills and self-efficacy to fight back against the aforementioned monsters. For there will alway be monsters under every bed well past the teenage years. The better our children get at fighting them early on … the better off they’ll be later on in life.

What I stressed in my previous piece, and what the pieces based on Ayer’s research didn’t (anywhere) – was what is the role of the community and adults who run them. What role can those living with and around teenagers, not only parents – but mentors, neighbors and civic leaders, play in their mental health? What are these people doing to create environments that dissuade our young from getting to the point of such extreme disenfranchisement in the first place.

In “Why People Die By Suicide” (2005), Thomas Joiner, a professor of psychology at Florida State University, drew on the testimony of survivors, stacks of research and the loss of his own father to upend minds. He recognized the myriad pressures on a suicidal mind — substance abuse, genetic predisposition to mental illness, poverty — but identified three factors present in all of those most at risk: a genuine belief, however irrational, that they have become a burden to those around them; a sense of isolation; and the ability, which goes against our hard-wired instincts of self-preservation.

The question we should be asking ourselves is how should we combat this sense of isolation that breeds within our young people. Whatever the reasons why, the best way of combating destructive behavior, including suicide, is refocusing energy by providing positive outlets and alternatives. If your life has a purpose, you’re much more likely to spend your time and attention on that purpose rather than on self-annihilation. It’s hard to feel sorry for yourself and escape in a bottle of vodka if you’re too busy helping those in an even worse space than you. For example, studies have shown volunteering often helps the person doing the volunteering more than the person being helped.

Even after we’ve addressed the reasons why and created positive outlets to focus on, we still don’t live in a Perfect World though. The human psyche is vulnerable. The monsters will always be there and no matter how much we try to ignore them … they’re still going to find their way out from under the bed into our minds. Or in the words of John Milton; “turn our heaven into hell.” The question ultimately becomes … how do we deal with them when they do. Do we dive into the bottle or the medicine cabinet – or do we shake it off and put the haze of gloom behind us? How much can we, or in the case of “13 Reasons Why” our kids – take? 

Salutogenesis and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes a health approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. When fighting adversity, self-efficacy is your tool chest. It’s your ability to fight the monsters under the bed. One of the most potent defenses we have is engagement. This engagement can be with ourself, through our minds and bodies, or with those around us in our communities and neighborhoods. “Doing” is a prescription for well-being. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and self-efficacy.

Now as the supposed adults in this discussion (that is highly questionable at times though), isn’t our responsibility to step in and do something other than playing Chicken Little running around screaming the sky is falling. Our kids are fragile, as we are. Sheltering them is not the answer though. Empowering them and giving them access to engagement to boost self-efficacy is.

In the last couple decades we decided that the effective way to bring up our children is to strip them of opportunities to express themselves in benign ways as they wish. At the earliest age possible we relegate them to organized academic activities pounding reading instruction down their throats even in preschool rather than letting them flourish in unstructured play where they self-learn coping and socialization. It’s no wonder when they get into situations later on, outside of the constructs of the classroom, they don’t adapt well.

Even though our adolescents are exposed to the same information we adults are due to technology, we still often view them as less than people. Our teenagers are not the way we were. No matter how much we want to shelter them – we can’t. What we can do is help them acquire the tools to successfully cope and excel. And this responsibility extends well past the walls of our classrooms and even our homes. It lies open with everyone in our communities.

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” Wendell Berry

The world we all live in is charging ahead at a speed no one could have envisioned. While we can pull from our experiences of the past – we can’t take them verbatim as the answer for the problems we face today. Our mission must be to use the past and mold the positive value it bequeaths us and let it evolve to a more relevant time of today and tomorrow. And central to this social inheritance is the Middle Ring of our neighborhood and community relationships.

Introducing the ‘Middle Ring”

A few years ago Marc Dunkelman wrote an excellent book on the evolution, or should I say the de-evolution of the American neighborhood, “The Vanishing Neighbor.” In his book Dunkelman introduces the concept of the Middle Ring. The Middle Ring is what Dunkelman calls our neighbourly relationships. This is in contrast to the inner-ring of family and close friends, and the ever-expanding outer-ring relationships fostered by the digital age and social media. Unfortunately the ‘middle’ is not holding, collapsing from pressures on both sides. Social media sites have brought our closest contacts closer and expanded our reach to include ‘weak ties’ that we know only through cyberspace. Compound this with the proliferation of politically and interest segregated cable and internet news outlets, we have little time or attention for anyone else, physically or philosophically. And what suffers are our neighborhood acquaintances, our communities and the memories of what they used to stand for.

There’s been much discussion in the last decade about the decay of the American community as we like to remember it, or as Hollywood portrays it. But really it’s the loss of the Middle Ring we’re seeing. We still have communities, they’re just not inhabited by ‘our neighbors.’

It’s the loss of these neighbors who were physically around that could be counted on (often without even asking) that’s creating a social divide in America. In the past, before World War II, our neighbors were our support. They were the doctors, the midwives and the handymen. They were where we could go to get food when we needed it. It’s what got America through the Great Depression.

We didn’t have to agree with them politically, socially or otherwise, but we knew them and they were still our neighbors. And we could count on them.

But with Roosevelt and the New Deal, the government became America’s support system. The help of your neighbor wasn’t as important. That worked fine, but that reliance on the township, the community, the neighborhood and in turn the nurture of our Middle Ring began to wane. It wasn’t so evident at first. But the chinks in the armour, so to say, were beginning to show, even back then.

And now it seems as if we’ve all but lost our Middle Ring. Maybe not physically. There’s still people who live next door and down the street, but we don’t know them. Maybe we’ve never even met them. We don’t know where they’ve been or where they want to go. And it kind of makes it hard to help them get there.

As a result our neighbors don’t seem to have identities – and neither do our communities. It’s hard to tell one from another. Maybe it’s due to the prevalence of homogenized big box stores like Wal-Mart and Target. Maybe its the MacDonald’s or Starbucks on every corner rather than Joe’s Diner or Martha’s Koffee Klatch. Maybe it’s the gated communities where unless you live in one … you don’t know who or what does. Maybe it’s all of it. But regardless, everywhere kind of seems the same. It’s like there’s planned communities everywhere, except they’re not intentionally planned.

It’s time to re-examine this way of life we’ve created – one that increasingly resolves around isolation not engagement. It this the world we want our children to have? Do we want their only access to the answers they need to grow up being on the other end of the screen of the iPhone? Our lack of attention to the communities we have socially and civically abandoned has given them no other option. It’s no surprise some of the most desperate see suicide as the only option.

Also last week the sentence came down on the “death by texting case.” Michelle Carter received sentence of only 15 months, while the prosecution wanted seven years. The mother of Conrad Roy, the boy who committed suicide at the encouragement of Carter is calling for new legislation to invoke mandatory sentences for future offenders in similar cases. As Bill Clinton once famously said, “you can’t legislate morality.” no politician is going to come to our rescue. Only we, the ones who live in our communities, can create them as we want to.

Since we’ve let our civic and social relationships, especially across generations, decline to the extent it has – shouldn’t we take responsibility, own up to the problem and make efforts right at home in our neighborhoods to fix them. Calls for mandatory penalties are not going to repair the social fabric of our communities, deter anti-social behavior or bring back a troubled loved one – no matter how impassioned they are. Only we, the leaders of our communities, can affect change by encouraging an embrace of empathy and compassion that jumpstarts a collaborative dialogue with our teenagers.

Whether you believe it or not, our children are more capable than we ever were at their age. We just don’t give them the avenues to express themselves to create environments around them to better fit the their social needs to handle the demands of the daily stresses they encounter in a over saturated world. And we’re sure not doing it for them.

“To learn is to accept that one’s growth—the endless process of becoming who they will be—depends on engaging the strangeness within themselves (the part that is perpetually open, unpredictable) as much as interacting with a strange world of knowledge that they can absorb but never know in its entirety on their own.” Maximillian Alveraz

The summer job at the gas station down the street or the pick up baseball game in the vacant lot are gone. We, the adults, have let them go away. We replaced them with Wal-Mart and volleyball summer camps (for our benefit more than theirs). What ever summer jobs might be left are filled by retirees too actively young or financially needing to retire. Cross-generational interaction isn’t based on physical collaboration – it’s from a spectator perspective. Distrust because of unfamiliarity extends up and down the age spectrum.

Our answers lie in inclusion and engagement across all lines. Our young people are assets if we treat them that way. Help them build their own futures rather than create barriers because we think they should act like we did (whether we even did or not). After all the world we’re living in will soon be theirs – and we will be the ones needing their help. The more successful the transition we provide … the better off we all will be.

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“13 Reasons Why” … And Why It Matters To Your Community

I watch Netflix – as I’m sure quite a few of us do. A couple of months I was looking at their original section and I noticed “13 Reasons Why.” I had read about it and thought about watching it … but no matter how intrigued I was, I couldn’t get myself to dive into a series about adolescent suicide. On the surface it looked too much like the plethora of other young adult series you find on Netflix … only with a more ominous premise.

But then after a few weeks I noticed “13 Reasons Why” was starting to get a lot of buzz in the mainstream media, but not because it so good – but because many parents and the mental health profession considered it too controversial. The book it was based on was even appearing on banned book lists. This peaked my interest. 

A few years ago, Harvey Weinstein and his brother, Bob, of the acclaimed Weinstein Films produced a topical film about teenage bullying aptly named “Bully.” While not entering the territory of being banned, the Motion Pictures Association of America (MPAA) gave it an R rating; even though its target audience was high school kids and it confronted an issue too often ignored in our schools. Apparently the colorful language of real life in high school was just too much for the virgin ears of teenagers to hear on the screen. Outraged and standing behind their film and its significant societal benefits, the Weinstein brothers circumvented the MPAA and re-released with no rating (NR), leaving it up the each individual theatre to make the call who could see it.

I couldn’t get “Bully” out of my mind every time I thought of diving (or not) into “13 Reasons Why.” Much of the exact things overprotective parents, however well-meaning they may be, want to shelter their kids from are the exact things they encounter everyday at school. As with bullying – suicide, whether carried through on or just contemplated, is real their real world. And our reluctance as parents and adults to see this and confront it head on can have catastrophic consequences.

“13 Reasons Why”

“13 Reasons Why” revolves around a high school student, Clay Jensen, and his friend Hannah Baker, a girl who committed suicide after suffering a series of demoralizing circumstances brought on by select individuals at her school. A box of cassette tapes recorded by Hannah before her suicide details thirteen reasons why she ended her life.

As I mentioned above, the series was not without controversy. It seemed to initiate a united global front from psychology and psychiatric organizations. The outcry centered on the series’ over-simplification of the reasons behind suicide. Much of the focus of “13 Reasons Why” was put on the bullying Hannah had to endure. This reaction is not surprising. After all, the value of their profession is predicated on the assumption that our psychological maladies are rooted internally – and not fixed simply through external adjustments.

In Montana where I live, the state legislature meets for one three-month session every two years. Being heavily conservative, they don’t really do much of anything that involves spending money. They’re big on trying get more guns everywhere, restrict abortion and rid the state all that evil liberal stuff like environmental regulations. But spending money … not so much.

About only thing that both parties could agree on was a mental health and suicide prevention bill. Or at least that’s what they called it. The legislation established that insurance companies that operate in the state must cover mental health on the same level as physical health (welcome to the 21st century). It also dedicated a whole $1 million for local communities, school districts and tribes to develop their own suicide prevention programs. $1 millions doesn’t go far. That’s about one dollar for every person in the state – what a MacDonald’s double cheeseburger on the dollar menu used to cost when there was such a thing.  I suppose we should happy in the Big Sky Country they even did that, since about their only other accomplishment was to add a couple extra judges to deal with all the meth cases that have been piling up.

However well-intended this legislation is, it’s still after-the-fact. Granted, maybe more counseling will help persuade a disenfranchised kid to not take that final step; but anyone who has or has had teenagers knows, probably one of the last places they’re going to go to talk about suicide is to an office that sits down the corner from the principal. The risk of being on the principal’s radar, for whatever the reason, is too much  of a deterrent. School architects don’t think about these things. However, aside from where the counselor sits – too much of the time, the effort is put in is still after-the-fact.

Suicide is an effect of the circumstances thrust upon us by the current society we live in. For the most part it’s a reaction one has to the stresses of their lives, like doing drugs or drinking alcohol – only much more extreme. Granted some methods of coping are a lot more self-destructive than others – they are still all ways to psychologically vent, opening our steam valve. Releasing this pressure is going to have to happen one way or another. The question is how.

I believe how and when this release happens is a function of three components. These act in concert and the result of this interaction can often dictate whether someone lives or dies. Our goal as communities must be to sway these factors in as positive direction as possible.

  • What are the external factors that contribute to the pressures one undergoes in their lives (financial issues, bullying, academic pressures, etc.)?
  • What outlets are available, adolescent or adult, to release this pressure (sports, work, drugs, hobbies, etc.)?
  • How mentally strong is the person (level of self-efficacy) and how much pressure can they take?

It’s easy to simplify the phenomenon of adolescent suicide, as “13 Reason Why” was criticized of – by saying much of its root cause is bullying. Or we can blame parents – whether being over-protective, demanding of even just being indifferent. Or we can blame it on society as a whole by saying it’s just damn unjust and too many of our kids have poverty ridden upbringings (even though poor kids don’t kill themselves any more than rich ones do). Regardless, pinning the blame on external factors, whatever those may be, address only one of the contributing components. Unfortunately, no matter how much we try, there are always going to be reasons why; there’s always going to be monsters under the bed – no matter how well-feathered that bed may be.

Whatever the reasons why, the best way of combating destructive behavior, including suicide, is refocusing energy by providing positive outlets and alternatives. If your life has a purpose, you’re much more likely to spend your time and attention on that purpose rather than on self-annihilation. For example, it’s hard to feel sorry for yourself and drown yourself in a bottle of vodka if you’re too busy helping those less fortunate than you are. In fact volunteering often helps the person doing the volunteering more than the person being helped.

“The mind…can make a heaven of hell, a hell of heaven.” ― John Milton

Even after we’ve addressed the reasons why and created positive outlets to focus on, we still don’t live in a Perfect World. The human psyche is vunerable. The monsters will always be there and no matter how much we try to ignore them … they’re still going to find their way into our minds. Or in the words of John Milton; “turn our heaven into hell.” The question ultimately becomes … how do we deal with them when they do. Do we dive into the bottle or the medicine cabinet – or do we shake it off and put the haze of gloom behind us. How much can we, or in the case of “13 Reasons Why” our kids – take. 

Salutogenesis and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes a health approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. When fighting adversity, self-efficacy is your tool chest, or for those in Montana, your ammunition stockpile. It’s your ability to fight the monsters under the bed. One of the most potent defenses we have is engagement. This engagement can be with ourself, through our minds and bodies, or with those around us in our communities and neighborhoods. “Doing” is a prescription for well-being. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and self-efficacy.

Now back to “13 Reasons Why.” Let’s assume that the story of Hannah was not fiction; what could those thirteen people have done that would have changed the outcome? But even more so, since the reasons why are just one variable, one factor in the suicide equation – should this even be the question we’re asking? Ultimately suicide is still a personal decision. If there’s a complaint I have with the show, it’s that it portrays Hannah too much as the victim; just a pawn of the external circumstance swirling around her, the poor girl at the peril of the “monsters under the bed.”

That being said, external factors can’t ignored. In fact external factors play prominently into all three of the components I’ve referenced above. What could have these thirteen people have done to create a community that was designed around positive engagement opportunities for young people so they their reaction to stress wasn’t addictive substances and self-destruction? What could they have done to nurture their young people so they could weather storms like these – because there will alway be storms in their lives, whether it be today or in the future? These are the questions we should be asking ourselves. We can’t restrict our focus to efforts after-the-fact … after the damage is so severe that whatever hole is plugged today is only going to reappear tomorrow or the next day. 

We have to wake the hell up otherwise our kids are going to kill themselves. It may not be one thing, but the accumulation of things that add up that gives them the feeling of inescapable hopelessness. Engagement refocuses and helps them break free of the downward cascade. It’s a positive release … and with this release comes hope.

Confederate flags
Livingston, Montana High School

The Failing of a Town and Creating Hope in Yours

Last year I wrote about a suicide that occurred in Livingston, Montana – down the road from me here. In The Failing of a Town, seventeen year old Deon Gillen committed suicide after years of being bullied. His plight was no secret though. On numerous occasions his mother brought it up with school administrators. When a Billings Gazette article came out detailing the incident, the public outcry was harsh – so harsh that the high school shut down their Facebook page, attempted to discredit the report and enacted a locked door policy during school hours. Just the time they have should embraced taking responsibility … they circled the wagons. This was not unexpected though.

I wish that was the end of the story however. It wasn’t though. Not even two weeks after Deon’s tragedy, two more people in Livingston (pop. 7000) committed suicide. This time it was two adults and they received barely a footnote in the paper. Not only had Livingston failed its youth, it failed its adults as well. In a separate article, I read that Park County, of which Livingston is the county seat, has the highest suicide rate in the state (in a state that has the highest rate in the country). And this was calculated before the latest rash of incidents. This dubious distinction is no small feat, but probably not one they’ll include in Livingston Chamber of Commerce’s next promo brochure. What the hell type of a place is this that access to engagement and positive outlets to stress release is so limited that the accepted alternative is to kill yourself.

“Leave every person, every place and everything better off from you being there.”

It’s everyone’s responsibility to make their community better for all its residents. We can’t push off this responsibility to only politicians and social workers. And that doesn’t mean just low taxes and more box stores. It’s up to all of us to contribute – not just take and lobby for our own interests. Helping others is not only the right thing to do … in the long run it’s a prudent economic strategy for a community to take. Going around proclaiming how great your town is when people have few opportunities to engage, reach out and be touched is hypocritical and will eventually be self-defeating.

Too much of the time we assume legislation is the only way to fix our societal ills – like here in Montana with the suicide prevention bill. In reality it’s just the easy way out for us adults to say we’re doing something – giving us an excuse to say we’re actually doing something for our kids. Bill Clinton once said “You can’t legislate morality.” No truer words have been said.

For two years I’ve stood on my soapbox and preached the need for us to rebuild the relationships with those around us in our physical neighborhoods. I’ve stressed focusing on our commonalities not our differences. These Middle Ring neighborhood relationships and the actions that come from them are what are going to determine the personality of where we live. It will determine what we do when someone, say one of our children like Dion, is in trouble. It’s how we raise them and whether we teach them to be empathetic and compassionate. It’s whether we view hardened ideology as a virtue or an obstacle. It’s whether NIMBYism is the norm or a condemnable exception. It’s whether we confront someone for bigoted talk and attitudes … or we just let it slide. These are the socially accepted attitudes and norms that determine what we do when it matters most. They determine our communities’ character.

It’s not easy to make the effort to do the right thing – especially if runs contrary to community norms.. It’s easier just to go with flow and expect someone else will take the chance and do it. But normally no one does. Be the one that does. And who knows … maybe someone else will start doing the right thing too.

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Melvin is a customer engagement platform that enables small businesses to combine their loyalty marketing efforts with messaging designed to improve the well-being of their community. This messaging is designed to combat mental, physical and social isolation through community and civic based engagement and volunteer activities. You can find out more about the Melvin Initiative and Community 3.0‘s efforts to improve the human condition at the initiative’s dedicated site here.

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