Monday, May 1, 2017

13 Reasons "Mental Health" Advocates Need to Watch 13 Reasons Why

Controversy erupted quickly around the release of 13 Reasons Why, a Netflix series based on the 2007 novel of the same name. This comes as no surprise, considering the story revolves around suicide. Not only that, the show (and the novel, but those don't get nearly as much attention in pop culture) disrupts the standard expected narrative in which suicide is typically portrayed.

The premise of the story is that a high school student, Hannah Baker, killed herself, but first left a series of audio tapes for and about all the people who contributed to her suicidality. The idea of a dead person leaving messages behind isn't new, but what does stand out is that a person who attempted suicide, and succeeded, still gets to tell her story. This premise allowed the script to offer a perspective that isn't found in other suicide narratives, and is much closer to reality.

The objections to the show seem to mostly fall into two categories: 1) People who have actually had suicidal thoughts or even attempted suicide, who understandably refuse to watch the show for fear of being triggered or re-traumatized. 2) People who advocate for "mental health awareness" and are very offended that suicidality is portrayed as a natural life experience and not a chemical imbalance. Where these two groups overlap, the label for that section of the Venn diagram is "internalized ableism". Here's an example (WARNING: auto-playing music) which seems to be the most popular "don't watch it!" post floating around multiple social media sites, and the inspiration for this rebuttal.

Evidence on comforting the afflicted is inconclusive, but 13 Reasons Why definitely brings affliction to the comfortable. "Mental health" advocates need to see this show. No, it's not for "everyone" - it's highly triggering (for example the act of suicide is shown on screen, as well as multiple sexual assaults) and more than a little problematic. As said most elegantly by my colleague Leila Yoder, there are definitely aspects of the script to be critical of, but "it's not pathology paradigm enough" isn't one of them.

13 Reasons Why is an important cultural commentary that more people should see. Here are 13 reasons why:


1. Bad consultants were mostly ignored.


The creators of the show consulted with the American Foundation for Suicide Prevention, an organization which advocates in favor of force and coercion, including locking people up in psychiatric prisons and pacifying them with medication. Can you guess how the Foundation justifies this? All human rights violations are a necessary means to the exalted end of recovering people from their mental illnesses. What a unique and original thought. While it's impossible to know whether the final script was molded by ethics, marketing, or storytelling, it's clear to me is that the screenwriter had a chat with a very bad organization, then went directly against most of their bad advice.

2. The dead girl tells us what didn't work.


In real life, we can't ask someone what went wrong after a successful suicide attempt. Therefore we don't know how realistic Hannah's perspective is. Nevertheless, it disrupts the standard narrative: Suicide attempt survivors, both real and fictional, get paraded as tokens by "mental health" advocates to talk about how great the "treatment", usually being locked up and medicated, worked for them. This narrative is not scientifically justified. In fact, it's propaganda.

The most well-known example of this problem was recognized during World War 2, when the U.S. Navy studied returning planes and reinforced the most damaged parts in the next design. The mistake was that those were the parts which could get heavily damaged and still return. The parts that never return damaged are the ones that bring the plane crashing down, never to be studied. In psychology, this cognitive error is literally called survivor bias.

In a society where every suicidal person is forced, coerced, or at least pressured into some kind of "treatment" program, you either never get identified as suicidal and never get hit with a psychiatric intervention, or you get identified and you get an intervention. There is no identified-but-not-intervened control group to verify that the "treatment" should actually get the credit. We do on the other hand have research suggesting that locked facilities make people more suicidal, not less.


3. Hannah was killed by other people.


Another part of the standard narrative is that suicidality, without a verbal acknowledgement, is undetectable. Therefore it's no one's fault when someone dies. 13 Reasons Why straight-up says no to this narrative, instead placing the blame firmly on those who hurt Hannah and those who failed to reach out. The show demonstrates the simple causal link between suicide and traumatic events such as bullying and sexual assault. The other main character, Clay, wasn't a direct assailant but has to come to terms with his complicity.

4. Hannah is neurotypical.

 

You can't deflect the blame to a "mental illness" or "chemical imbalance" either. Not for the character any more than for real people, unless being gay also causes a "chemical imbalance" the same way excessive melanin in the skin exerts a gravitational force on police bullets.

Hannah is portrayed as a normal, mentally healthy person (at least until she racks up a few traumas), not as a list of diagnostic criteria or LOL RANDOM CRAZY. It was her experiences that caused her to become suicidal, not spontaneously manifested brain chemicals.

This is a breath of fresh air for people who have been falsely labeled as mentally ill... which is everyone who's been labeled as mentally ill...

5. Hannah is able-bodied.

 

Though I'm rarely thankful for this, disability is not represented at all. Hannah does not have one. She does not kill herself because it's so tragic and burdensome to exist in the world as a disabled person. Another break from one of cinema's most offensive and harmful clich├ęs.

6. It's not just a choice.


I usually go out for vanilla ice cream on the weekends, but this time I think I'll try rocky road to see if I like it. And I usually enjoy being alive but I think I'll try killing myself today. That's what has to be going through the heads of people who say suicide is just "a choice".

Suicide is what people are driven to when they're pushed past their breaking point. This reality is reflected in the portrayal of Hannah Baker. She is bullied and abused and injured and broken, until eventually she can't think of any other option. If seeing the truth makes people uncomfortable, good.

7. Reaching out backfires.


When Hannah tries to reach out to other characters - friends, parents, school counselor, they are at best unhelpful and unsupportive, if not making the situation even worse. This is realistic, if perhaps a bit relentless in its cynicism. "Don't reach out" may be a dangerous message, but so is "reach out to anyone and everyone." Some people will invalidate, re-traumatize, or even call the cops. This warning creates the appropriate balance, supporting the reasonable message to be selective.

8. Self-harm gets a spotlight too.


One of the characters (not Hannah) explains her self-harm by saying "it's what you do instead of killing yourself." This isn't the true reason for everybody who self-harms, but it is for some. In a non-coercive way, this line offers an alternative to suicide. Because the rationale is so difficult to argue with, it also helps to de-stigmatize self-harm, and yes, self-harm absolutely does need to be de-stigmatized. Not the "treatments" for it, but the act itself.

Self-harm and suicidality are both natural parts of the human experience. Turning them into taboo subjects does no good for the people experiencing them. In fact, it often creates shame, which makes both of them more attractive. 13 Reasons Why has got people talking.

9. Hotlines are not the answer.

 

Another major complaint against the show is that it doesn't offer resources. For example, there is not a list of phone numbers for suicide hotlines in each episode's end credits.

I don't believe that this was an oversight. I believe it was a deliberate choice, because promoting suicide hotlines would undermine the central message of the show.

The real reason people get uncomfortable with the lack of resources is not moral outrage at irresponsible triggering, it's because they are yet again trying to find a way to make suicide the sole responsibility of the suicidal person and not anyone else. If calling a stranger on the phone is a magic pill to cure suicide, then every death is the fault of the dead person for not reaching out. By not inviting this supposed solution into the show, it was not invited into the conversation. The focus is kept instead on other people's responsibility in causation or prevention.

10. Medication is not the answer.

 

Medication actually does come up in the show, not for Hannah but for Clay. His incompetent mother can't think of any other way to relate to him, because she's internalized the idea that his grief over a dead friend is a mental health condition, and the way you deal with those is by taking drugs, not, you know, being human together.

Hannah does not take any medication, because that would give the audience freedom to rationalize however they see fit: Either the medication caused the suicide so it's not other people's fault, or it was the wrong medication for her mental illness so it's not other people's fault. Clay explores medication but doesn't get any benefit from it, which is also the most common outcome in real life.

11. Prison is not the answer.

 

None of the characters, least of all Hannah herself, ever suggest that what she really needed was to be locked up in a psychiatric prison where she can be somehow healed by additional violence against her. Not only would such a statement have been patently untrue, it would have once again undermined the apparently controversial message that people are responsible for each other's well-being. If suicide prevention is the responsibility of some professional psychologist in some hidden facility, then it doesn't have to be yours. You have permission to ship people off and wash your hands of it. Out of sight, out of mind.

12. Permanence is powerful.

 

If Hannah really wanted to send a message, why didn't she power through and tell her story while still alive? Isn't that more powerful? No. It isn't. Sticking around gives other people the chance to apologize, to offer help, to give lip service and feel good about themselves, without doing anything to actually improve the victim's quality of life.
 
13 Reasons Why is not a warning to suicidal people not to kill themselves. That was never the intent. It's a warning to friends and family of suicidal people, that if you fuck up, if you're not present and caring and supportive, that's it. They're dead. You don't get a second chance. You don't get closure.

13. Suicide awareness can kiss this show's ass.


I have a confession to make: I have never been suicidal. And I don't think I ever will.

Yet suicide awareness campaigns still affect me personally, and my community. I won't soon forget the inherent dehumanization in habitually cutting the strings off my shorts, because I'm expected like all other interchangeable mental patients to somehow kill myself with them while pinned down on a four-point restraint bed. I haven't forgotten that suicide was the big justification no one wanted to challenge, when we first decided that you could detain people in so-called "hospitals" instead of mainstream jails. Every time I see a therapist, I'm reminded that if I so much as express a thought about killing myself, that she not only has the option to legally commit violence against me, she's expected to and can get in trouble if she doesn't.

As someone who has been subjected to traumatic and abusive human rights violations in the name of misguided attempts at suicide prevention, and who knows the stories of other people who can say the same, I am thankful that an item of cultural influence promotes a different message. Even if I believe for a second that the point of 13 Reasons Why is to "glorify suicide", I'll take that over awareness.

Image description: Promotional photo of the characters Clay and Hannah, with additional text around the title so that the image says "There are thirteen reasons why I killed myself and not a single one of them is a chemical imbalance."