Doctors' Notes: A Toronto psychiatrist weighs in on what’s wrong with Netflix show 13 Reasons Why

The show’s producers have defended its bleakness, saying they wanted to be very realistic. But I think they’re naïve about how teens think — especially teens with underlying depression or other mental illness who are vulnerable to suicidal thoughts.

It’s also a wake-up call to parents, because most adults are portrayed as inept, even stupid. On the show, too many assume everything is OK, or blame serious depression and anxiety on “normal” teen moodiness. Too few bother to check in with their kids, or put in the time to build trust.

As a psychiatrist who works with vulnerable teens, I’ll be the first to acknowledge there are some good parts to the show. It brings very difficult topics out of the shadows and into the open: bullying, both in person and cyber; sexual assault, and teen suicide. The series is certainly stimulating conversation about these topics, which is great. My patients tell me the show makes them feel less alone and not as badly off as Hannah.

But school bans on discussion of the show are ill advised and not practical — forbidden fruit just becomes more attractive. Kids watching this program need dialogue to challenge its inadvertent message that suicide is a good option, and a way to get revenge on bullies.

Certainly, a lot of people experience high school in these dark terms, and there’s a place for exploring that. But in 13 Reasons, the pain vastly outweighs the hope. It shows Hannah having no way out of her suffering. And this is simply not realistic — almost every teen has at least one adult in their lives they could turn to for help, or if not, there are resources like KidsHelpPhone.ca.

But here’s the problem: Suicide is very often an act of despair and hopelessness, not just anger and revenge. This show not only portrays suicide as a valid, logical option, but it shows suicide as a highly effective way to get even with people who’ve hurt you. Kids don’t realize that, if they’re dead, they won’t be around to watch their tormenters suffer.

In the show, Hannah kills herself and leaves behind 13 tapes, one addressed to each of the people who contributed to her anguish. It focuses on how badly everyone feels and how much they suffer as a result of her death, and realizing their part in it.

There’s been a lot of buzz about the graphic nature of the show — the rape scene, and especially the suicide, when Hannah slits her writs in a bathtub. Frankly, I don’t think this scene is graphic enough. She’s depicted as dead after just a few minutes. She has a smile on her face. In reality, if you cut your wrists, you would bleed to death slowly and painfully. You would not be at peace and calm. You don’t look like you’re at the spa.

When we inadvertently give power, even glamour, to suicide, it’s doubly dangerous because of the copycat effect, which is very real in suicide. Already, I’m starting to hear anecdotal reports about a higher volume of teens taken to Toronto hospital emergency departments than usual this spring. Recently, a colleague at a Toronto hospital told me six young people taken to the ER for suicidal behaviour on a recent weekend specifically cited 13 Reasons as part of their motivation.

Although I wish the show were much different, I do think it’s very difficult to stop kids from watching it. For that reason, it’s essential that schools take leadership and open discussions of it. I’m not seeing schools make any effort to do anything other than warn parents about its dangers. The story is such a morality tale — I think it would be good for English classes to compare it to Lord of the Flies, because both show that bad things happen when adults aren’t around.

The first thing parents and educators need to understand is that many teens, unfortunately, do experience bullying and sexual assault but very few kill themselves. That’s because in 80 to 90 per cent of teen suicides, there’s a pre-existing mental illness — usually untreated depression. And when you’re in the midst of a depression, you often can’t see a way out. It’s essential to identify those kids. I ask suicidal teens if we could remove your pain, or make it tolerable, would you still want to die? They always say no.

Parents need to create an environment in the home where it’s safe to talk about tough things.

If your teen confides in you, listen without judgment. Empathize (i.e. “that must have been very hard for you”).

If your child is watching the show, try to watch it with him or her. Ask questions like: “What do you take from the show? How did it make you feel? Do you think it’s realistic? Have you ever felt this way? Have you ever been bullied? Please don’t ever hesitate to tell me about it.”

For Hannah, I would have suggested she switch schools and get treatment for her depression. But every kid is different. Consider your own teen’s temperament and what solutions might work best for them.

Sometimes it’s good to bring the school in. But if they’re terrified of that option, talk to them about options that don’t involve contacting the school. Demonstrate you care about them, and promise to do your best.

With a show like 13 Reasons out there, now is the time to check in with your kids, look for signs of depression and open dialogue about their emotional health. Depression and trauma are highly treatable, but only if you ask for help.

Marshall Korenblum is an associate professor in the Faculty of Medicine’s Department of Psychiatry and Psychiatrist-in-Chief at the SickKids Centre for Community Mental Health (formerly the Hincks-Dellcrest Centre). Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email [email protected] .