THURSDAY, May 4, 2017 (HealthDay News) -- It started as a bestselling novel aimed at teens.
In 2007, Thirteen Reasons Why, by first-time novelist Jay Asher, outlined the story of a 16-year-old named Hannah Baker. In the book, Hannah recounts -- from beyond the grave -- the high school gossip, humiliation, bullying, invasion of privacy, betrayal and sexual assault that led her to suicide.
In the spring of 2017, "13 Reasons Why" became an even more popular 13-episode series on Netflix.
How popular? Netflix doesn't provide ratings. But in the month since it began streaming in its entirety, evidence of the series' wide reach can be seen in the young binge-watchers who've swamped social media to discuss the show.
Twitter, for one, has already been deluged with 11 million series-related tweets. And that, says Variety magazine, makes the Netflix hit "the most tweeted-about show of 2017" so far.
According to the U.S. National Institute of Mental Health, suicide remains the third leading cause of death for Americans between the ages of 10 and 14. For those aged 15 to 34, it's the number two cause of death.
And a new study released Thursday found the rate of teens with suicidal thoughts or self-harm seen in U.S. emergency departments doubled between 2008 and 2015.
So what's wrong with "13 Reasons Why," which focuses on this issue?
Plenty, say teen suicide experts, who worry that a series aimed at discouraging child and teen suicide might have the opposite effect.
Dr. Victor Schwartz is chief medical officer of the New York City-based JED Foundation, an advocacy group dedicated to preventing suicide among teens and young adults. He believes Netflix was "sincere" in its hopes that "13 Reasons Why" might curb youth suicide, but underestimated the complexity of the issue.
"The problem is that I'm not sure that a 12-year-old kid will really take this in as a cautionary tale," said Schwartz. "One concern is that the character of Hannah is extremely appealing in many ways. You can see young viewers identifying with her, but at the same time there are real problems with her psychological profile," he explained.
"For example, there isn't any ambivalence or overt distress [over her situation]," he noted. "The only emotion that comes out is a kind of anger at all those people who have wronged her."
And Schwartz feels the series goes one dangerous step too far.
"Her suicide is portrayed explicitly in the last episode," he noted. "I wouldn't say that her suicide is romanticized or glorified, but she actually shows you how to kill yourself. And that's absolutely problematic in terms of messaging, because there is considerable evidence that the way a suicide is portrayed in the media can potentially raise the risk for suicide among viewers," Schwartz said.
And, he added, "the more detail you offer -- about the means, the settings, the circumstances -- the greater the risk for suicide contagion and 'copycats.' "
The suicide scene takes up about three minutes of screen time, during which Hannah is shown going through the motions of preparing her suicide, before she actually takes her life. The footage depicts exactly what she does and how she does it.
"The other problematic piece of the storytelling is that in the same episode, Hannah goes to the student counselor for help, and he clearly mishandles the situation," Schwartz noted. "And not in a subtle way -- he completely botches it up. And you have to ask what the impact of seeing that might be on the propensity of a teenage kid to reach out for help when he or she needs it?"
In that scene, Hannah confides that she was sexually assaulted. The counselor clearly says he believes that "something happened." But when Hannah hesitates to identify her attacker, the counselor advises her that in the absence of being willing to provide details and press charges, her "only other choice is to move on."
The counselor meeting is depicted as something of a pivot point; a moment when a cry for help goes unmet and Hannah decides to take her life.
That scene is also troubling for Phyllis Alongi, clinical director for the Society for the Prevention of Teen Suicide.
"What kids need to know is that what happens to Hannah is not the norm," she said. "The inadequate and ineffective assistance she gets from the school counselor is not the norm. And it's irresponsible to suggest that it is, because kids who struggle do get help. Suicide prevention works."
According to Alongi, the show also fails to address any of the mental health concerns that often fuel suicide risk.
"There is no point in the series where anyone ever addresses depression, or discusses any kind of mental health diagnosis. Not to mention treatment," Alongi noted. "And not doing so actually contributes to the ongoing stigmatization of mental health."
Reacting to mounting criticism from mental health experts, Netflix said on Monday that it would add a warning to viewers at the start of "13 Reasons Why," as an extra note of caution to viewers.
"While many of our members find the show to be a valuable driver for starting important conversation with their families, we have also heard concern from those who feel the series should carry additional advisories," Netflix said in a statement.
Discussion and change
Is there any "silver lining" to the series and its popularity? Perhaps, the experts said.
"I would say that if we can use the series to increase awareness and education, that's something," Alongi pointed out. "The show is not what we would want it to be, but it's provocative and it's sparking open conversation. So now the dialogue is open."
That dialogue could be a starting point for change, she added.
"We should take this opportunity to help parents and educators get in tune with bullying and stalking, and all the difficulties that children have to deal with," Alongi said. "Get parents to access the resources they need, so they have the tools to look for warning signs, and to discuss suicide with their kids, and teach them help-seeking skills."
The series "has the capacity to bring up conversations and get kids talking to their parents -- and hopefully even to each other -- about how to handle similar situations," he said.
But he stressed one important caveat.
"If kids are going to watch, then parents should watch with them," he suggested. "And kids who watch it and find themselves shaken up or not sleeping or distraught, should stop."
Finally, "kids who have a history of anxiety or depression or suicidal thoughts probably should not watch it at all," Schwartz believes.
The National Association of School Psychologists has issued a statement echoing that advice, cautioning teens who have considered suicide to steer clear of the series altogether.
Experts strongly urge anyone contemplating suicide to immediately contact the National Suicide Prevention Lifeline at 1-800-273-8255. The line is open 24/7, and calls are both confidential and free.
There's more expert advice and discussion on "13 Reasons Why" at the JED Foundation.
Click here for online access to the National Suicide Prevention Lifeline.
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