Suicide Coverage: Caution is Warranted If We’re Serious About Prevention

Posted on 13 Nov 2010 at 6:44pm

(Trigger warning: If you're in tender space related to suicide, grieving, recovering, or feeling vulnerable, feel free to move on.)

Cindi E Deutschman-Ruiz published a well-researched article in 2003: Reporting on Suicide.  One of the resources she used was a World Health Organization document, from which she drew these points:

  • Suicide is never the result of a single incident.
  • Details of the method or the location a suicide victim uses may lead to copycat suicides.
  • It's vital to use statistics and mental health information very carefully.
  • Suicide coverage is an opportunity to provide the public with information and resources that could save lives.

Of particular interest in the context of youth suicides after bullying, from the WHO doc (emphasis mine):

Overall, there is enough evidence to suggest that some forms of non-fictional newspaper and television coverage of suicide are associated with a statistically significant excess of suicide; the impact appears to be strongest among young people.

Repeated and continual coverage of suicide tends to induce and promote suicidal preoccupations, particularly among adolescents and young adults.

 A couple of quick points here:

  • I detest the term copycat suicide.  To me, it marginalizes the very real pain a suicide victim experienced, implying that they just wanted to be trendy. The more accurate term is suicide contagion.
  • I lost my partner Dale to suicide a decade ago, so the lessons learned which inform the following are borne of real, raw experience.

What does this mean to us as we grieve the loss of too many young lives where bullying has contributed, and press for bullying and suicide prevention?  I have more questions than easy answers, after the jump.

Never the result of a single incident

The WHO expands on the concept:

[Suicide] is usually always caused by a complex interaction of many factors such as mental and physical illness, family disturbances, interpersonal conflicts and life stressors.

This certainly isn't the way we've often acknowledged youth suicide lately where bullying has been a factor, right?

  • GLSEN refers to [name redacted by me]'s suicide due to bullying.
  • Equality Forum's press release yesterday: It is estimated that about 500 gay teens each year or 40 gay teens per month take their lives as a result of homophobia. 
  • Karen Ocamb: Another Teen Commits Suicide Because of Bullying
  • Americablog Gay: …the horrible suicide of gay teenager [name redacted] due to bullying…

I'm not picking on these good folks, as much as noting that bullying-triggers-suicide seems to be an accepted, little-questioned meme.

I'm also not denying that bullying has been a significant contributor to the deaths of youth and young adults by suicide.

But we need to ask ourselves, Is suicide after bullying distinct from other suicide?  Is there evidence to suggest that bullying is a more unitary cause or a more direct trigger than other contributors?

Checking in with experts on the evidence.

Slate.com's Emily Bazelon published an in-depth piece about a young woman lost to suicide that I won't link to out of personal discomfort with investigative reporting on suicide victims.  Public health social worker Elana Premack Sandler has written about the Slate piece, though:

The truth about bullying and suicide
Why suicide is never simple

She had earlier quoted a parent whose son died in 2003:

“I want to be very clear. I don't blame Ryan's suicide on one single person or one single event. In the end, Ryan was suffering from depression. This is a form of mental illness that is brought on by biological and/or environmental factors. In Ryan's case, I feel it was the ‘pile on effect' of the environmental issues mentioned above that stemmed from his middle school life.

“We have no doubt that bullying and cyber bullying were significant environmental factors…”

While she noted:

We can't say, empirically, that bullying causes suicide.

Discussing the Slate piece, Premack Sandler concludes (emphasis mine):

As much as it's been beneficial to have [name redacted]'s story in the media as a way of raising awareness about teen suicide prevention [...] and as much as linking bullying to suicide helps both kids who are bullied and kids who are suicidal, the simplification – that bullying was the cause of [redacted]'s death – has been a problem for suicide prevention. Suicide as an outcome is never simple.

The evidence-based answer

So, we've got a painful, uncomfortable, answer to the question: Suicide after bullying is not something set apart, simpler, or more easily prevented than suicide in general.  In fact, while increasing awareness of bullying and suicide is helping, some of the most vulnerable in our families and communities may be harmed by the use of an oversimplified bullying-causes-suicide meme.

My perspective as a layperson

I wrote yesterday from a more personal, less evidence-based POV at my blog.

One of my observations as a SOLOS (Survivor Of a Loved One's Suicide) is that distorted thinking seems to be an essential contributor to suicide.  And, one of the common distorted thoughts of suicide victims is that dying by suicide will serve a greater good than living would have.  It strikes me as essential, when we're talking about suicide and bullying, to call this out as false. As Deutschman-Ruiz wrote in 2003:

Suicide is not a rational act.  It is an act of desperation, carried out after a monumental struggle.

In the middle of the monumental struggles of many more than those we have lost to suicide, it seems to me we need to be thoughtful about how we memorialize victims.  (I consider suicide victims to be primarily the victims of mental illness, complicated by other factors.)  While we do everything possible to honor them and draw strength and motivation to eliminate bullying and promote good mental health, it's crucial that we're not inadvertantly contributing to the already-distorted thinking of other folks of any age who are suffering or living with despair.

One layperson's language preferences

Where do we go from here?   I don't have easy answers.  I'm not a journalist or a suicide expert.  I don't want to see a new wave of politically-correct language police rise up and nitpick writings on suicide.

So, my preferences don't carry any more weight than the thoughts of one guy who has a heart for youth and adults who are struggling.

But, here they are:

  • De-couple bullying and suicide.  At best, describe suicide as following bullying, or where bullying appears to have been a factor. Retire the word bullycide permanently.
  • Minimize/downplay suicide methods.  The death indicates severe desperation was at play; the choice of method neither adds or subtracts, and talking it up may contribute to contagion.
  • Drop “committed.”  People commit to jobs or relationships, or commit crime or heroic acts. Saying that my partner Dale died by suicide states the fact without judgment.
  • Honor the victims' lives: We needed you with us longer. We would change it if we could.  Speak to them as we would those who are still with us but struggling.
  • Empathize with families and loved ones: We cannot imagine your pain.
  • Take responsibility: We, as your community, may have failed you in some fashion, given the collapse of your mental health.
  • De-couple memorializing and advocacy: Use limited photos and details when expressing condolences or memorials; swap in statistics and evidence whenever workable while pressing for change.

LGBTQ communities have a terrific opportunity related to suicide.  Like awareness of HIV and open, nonjudgmental discussion of sexual health issues has exploded because of our communities' legacies, we have an opportunity to promote awareness of comprehensive mental health. Coming out, surviving, and thriving had propelled a lot of us to get evidenced-based mental health care.

It's time to continue dismantling stigma and stereotypes by promoting the fact that comprehensive mental health care saves lives.

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