​how do you safely depict self-harm, suicide and mental health problems in the mainstream media?

With 13 Reasons Why putting teen suicide in the spotlight, we spoke to Jamie Tworkowski -- best selling author and founder of non-profit mental health charity To Write Love on Her Arms -- to discuss the difficulties of adequately portraying such issues.

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May 2 2017, 7:55am

It's a hot-button issue, the depiction of depression, self-harm and -- most importantly -- suicide. Last year we asked the question, can you direct depression on screen? It's tricky, in short, with more questions than answers. How does the mainstream media depict mental health? What's a responsible depiction? What's an irresponsible depiction? How do people who struggle with these things -- the most important people in this debate -- view such depictions? And what sort of impact can the depictions have on them?

It's an urgent debate right now. And it's happening largely in the wake of the Netflix show 13 Reasons Why, a show that, in its final episode, graphically depicts the suicide of a 17-year-old girl. Since the airing of the show -- which has received both positive and negative reviews- - more and more people have expressed concerns. Shannon Purser (Barb from Stranger Things) tweeted: "I would advise against watching 13 Reasons Why if you currently struggle with suicidal thoughts or self harm/have undergone sexual assault." Others have argued that it glorifies suicide, prompting the show's writer Nic Sheff to defend himself: "the most irresponsible thing we could've done would have been not to show the death at all."

And yet, the show is not the first to depict teenage suicide on screen. There was The Virgin Suicides of course. And what about Romeo and Juliet? Do these films prettify/romanticise suicide? When is the line crossed? I called up Jamie Tworkowski, best-selling author and founder of To Write Love on Her Arms (a non-profit organisation dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury and suicide), to talk about the thorny issue of depicting these things.

Do you think it's important to see issues like depression and self-harm depicted on screen?
Man, that's a tricky one. There's such an element of stigma and I think the stigma has so much to do with silence. When you look at something like 13 Reasons Why, it's kind of fascinating because the conversation is good, and breaking the silence is good, but how it's portrayed matters too. I think this is an interesting moment in television and popular culture, because here's a show that tens of thousands of people are talking about, but there's certainly the debate: did it go too far? I'm a big fan of talking about these issues, in general, but I've also come to believe that how they are presented matters. If you're going to tell a story, you have to care about the audience and you have to care about the needs of the audience. And the audience that I care about the most is people who struggle. And that's not something that the average person knows or thinks about, like: what are the unique needs of someone who struggles with depression or self-harm, or someone who has attempted suicide?

In depicting suicide, specifically, part of the debate seems to be: to show or not to show.
Yeah, but I think it goes further than that, where it's like: what do you show? Then it can literally come down to seconds of footage and angles, so I think there's more to it. I do think -- if we're talking about 13 Reasons Why specifically -- they went too far. I think you're not just talking about one person, I think you're talking about thousands and thousands of people for whom this show might be more harm than good. And the flipside is, I think they could have told the exact same story and been more careful with a couple of scenes; it would still tell the same story, while being more sensitive to people who struggle.

Talking specifically about how shows like this can risk prettifying or romanticising suicide, is it the music, the lighting, the camera positioning? I think that stuff is secondary. I think there are questions like, 'Hey, is this romanticising suicide?' And I think that's an important question, but for me that takes a backseat to triggering -- even specifically the suicide scene itself… I think there is a really healthy debate, in terms of the story overall. I've heard there's some people who feel like this show presents suicide as a really powerful position, that this show is essentially narrated by a girl who, after her death, is in complete control and getting revenge. And I think that's a really scary message to present to young people. 

Have you read the show's writer's defence of depicting the suicide? He said, "The most irresponsible thing we could've done would have been not to show the death at all."
Again, I don't buy that. So here's an example I've been thinking about. That same logic tells me that the only way to care about the Middle East is to watch videos of people getting their heads chopped off. It's like, I went to Iraq, I sat in refugee camps and met people who have lost loved ones to ISIS, and so the idea that the only way to know or care about something is to see the worst of it, even physically, I don't buy that. I think that's false. The reality is that, there are people way smarter than me, experts in this field that are straight-up saying [the show] got it wrong, and I haven't heard them address that at all. The writer's statement, to me -- and I certainly respect his point of view -- but just because you choose to go there doesn't mean you got it right; you don't get a hall pass just because you were honest. 

Have you seen The Virgin Suicides? It's less explicit but again you do see the bodies of the girls who've committed suicide.
It's been a while. For me, I don't think you have to show every detail of an awful moment to make it clear that it's awful. With 13 Reasons Why, I watched the whole thing, I enjoyed a lot of it, I came to care about the characters. But in the end I can't take off my hat where I'm thinking of this on behalf of people who follow the work that I do… And I've been sharing some things on Twitter and Instagram, and there's so many people responding, saying that the show was really hard for them or they've had to choose to stay away from it, out of making their own recovery a priority. And even people that said they relapsed as a result of the show. And so my hope is that, whether it's the folks who made 13 Reasons Why -- there's talk of a season 2 -- or even other filmmakers, my hope is people can learn from these mistakes. But if they're not willing to call them mistakes, at least learn from this debate and this conversation. 

Lastly, what are the things you can do to help someone you think is struggling? How can you help them feel less alone?
I think a lot of times we feel like if we don't have the perfect thing to say or if we don't know exactly what someone's dealing with we end up saying nothing. So I like to encourage people to start somewhere, just to be honest… and I think when you really know someone, you know when they're off, when they're down, when they're sad. More than anything, the hope is that you can encourage that person to get help. Because while there is real value in the help and support of a group of friends, to me nothing takes the place of professional help. There are really simple examples. I sometimes talk about the idea that if you break your arm you go to the hospital, because they know how to fix broken arms. If your car won't start, you take it to a mechanic because they know how to fix cars. When it comes to mental health I think we need to treat it the same way, where there's experts in this field who understand how these things work.

Find out more about the work of To Write Love on Her Arms

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Text Oliver Lunn