When Netflix came out with its 13 Reasons Why series this spring, many parents didn’t even know about it until their children had already seen it. We turned on the radio or TV and heard about this show in which a girl commits suicide at the end, or got a concerned email from the school warning about the program. The young people had already seen it, however. The suicide appears to be revenge against the 13 people the fictional girl blames for her suicide, detailed in 13 separate tapes.

As Sansea L. Jacobson, M.D., writes in the commentary of this month’s issue (see p. 8), there are a lot of good reasons to be concerned about how the show will affect teens.

The problem, according to many, is not that the program existed, but that teens binge-watched it without any parental guidance. The series includes a lot of real problems: bullying, rape, drunk driving, and more. What could have been opportunities for guidance and assistance and open communication instead was a journey the teens took on their own.

Parents of young people who are already in treatment for psychiatric disorders should be particularly cautious. “We do not recommend that vulnerable youth, especially those who have any degree of suicidal ideation, watch this series,” the National Association of School Psychologists (NASP) said in a statement. “They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character.”

One of the individuals “blamed” by the girl was a school counselor who did not respond adequately to the girl’s plea for help. This in itself could make viewers think their counselors at school can’t help, according to NASP. Even the girl’s parents are seen as not helpful, because they know nothing about the events that led to her misery.

Many youth know that it’s fiction and not real life, and are capable of talking about the show. You should do that.

If your child is isolated, struggling, or “vulnerable to suggestive images and storylines,” it’s particularly important to help them process the series, according to NASP. “Research shows that exposure to another person’s suicide, or to graphic or sensationalized accounts of death, can be one of the many risk factors that youth struggling with mental health conditions cite as a reason they contemplate or attempt suicide,” NASP said.

Guidance for families

Below is guidance from NASP for parents.

  • Ask your child if they have heard or seen the series 13 Reasons Why. While we don’t recommend that they be encouraged to view the series, do tell them you want to watch it, with them or to catch up, and discuss their thoughts.
  • If they exhibit any of the warning signs above, don’t be afraid to ask if they have thought about suicide or if someone is hurting them. Raising the issue of suicide does not increase the risk or plant the idea. On the contrary, it creates the opportunity to offer help.
  • Ask your child if they think any of their friends or classmates exhibit warning signs. Talk with them about how to seek help for their friend or classmate. Guide them on how to respond when they see or hear any of the warning signs.
  • Listen to your children’s comments without judgment. Doing so requires that you fully concentrate, understand, respond, and then remember what is being said. Put your own agenda aside.
  • Get help from a school-employed or community-based mental health professional if you are concerned for your child’s safety or the safety of one of their peers.

Social networking

“The horse is out of the barn,” said Cora Collette Breuner, M.D., professor in the Department of Pediatrics at Seattle Children’s Hospital at the University of Washington, and chair of the committee on adolescence at the American Academy of Pediatrics.

“We can either ignore this and hope it goes away or take it on and be mindful of the dangers,” Breuner told me. She does not recommend that a youth who is actively depressed watch it. But she blames social media and the fact that teens have phones and watch whatever they want, without their parents’ knowledge.

“We give them these phones and all the data they want, and they can do whatever they want with it,” she said. It might be different if families were sitting together watching it on a screen. But be prepared to talk openly and to give guidance, interpreting some of the messages with a critical perspective. And don’t be afraid to make rules.

“Caring parents need to take on social networking,” she said. “We can demonize this show or we can be more aggressive about social media,” she said. “It’s as if we had no self-control, and the kids are autonomous and completely in charge.”

Breuner watched the entire series, and said that early on the show depicts one of the very real events that happens: a photo is rapidly shared on social media.

There are other problems with social media, even if it’s just showing off how happy you are, said Breuner. “Yes, it can be sad to watch someone who is really depressed hurt themselves,” she told us. But for some teens, it is just as sad to “look at how happy everybody else is and see what food they had for dinner.”

At this time of year, there are always more bouts of suicide and self-harm, said Breuner. The reason is usually that school is transitioning — some youth are anxious about summer, and others, even if they didn’t like school, are worried about losing the structure.

The show is definitely not appropriate for anyone who is depressed, or for anyone under 15, said Breuner. Finally, if you as a parent can’t sit through the series with your children, you should recommend that your children not watch it. “Are kids going to sneak around and watch it without their parents? Yes. Times are going so fast. We’re trying to keep up. Parents also need to practice some self-forgiveness.”

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