Redefined Bipolar

To be short and sweet: I’m closing the chapter in my life that is Redefining Bipolar.

But don’t panic. For me this means I’m moving toward a redefined Redefining Bipolar. The person who started this blog and the person I am now are two very different people. After many months of not understanding why I couldn’t write, I realized that I actually can — I just can’t write under the idea of “Redefining Bipolar” anymore. And, for me, it has always been an idea. It was the question of what bipolar disorder could be, and weirdly enough I feel like I’ve stumbled upon an answer (for now).

For the last year or so, especially near the end of my Master’s degree, I have struggled specifically with calling bipolar a “disorder.” I have written, on many accounts, of the positives bipolar has brought me. But, I have always held back because of the fear of having rose-tinted glasses, or minimizing the struggles of others, or being too politically incorrect. Ironically, I ended up minimizing my own experiences because of these fears. So I’m not going to do that anymore.

For me — and I am speaking very personally — my bipolar is not a disorder. If anything, “bipolar” is the umbrella word that others have used to characterize an enormous amount of experiences in my life. So I journey to step beyond that curtain to find something that resonates with me more. I have always stressed the importance of language and it is with this spirit that I journey forth. There are many other words I want to find.

I don’t expect any of this to be relatable. But it will explain why you won’t see any more posts from me at this particular location.

Oh, I forgot to mention: I’m starting a new blog. Follow my twitter for updates on that. What, did you think I would just leave like that?

Where I’ve Been and Where I’m Going

For the last three months I’ve struggled to open my dashboard and start writing a post for this blog. In August, I was immensely depressed to the point of suicide. In September I was ecstatic, but quickly fell into the grasp of stress and reality. Now it’s the middle of October and I have to admit I’ve been functionally ill.

Times of transition are difficult for everyone. Ending my Master’s degree was both a huge success but also a bittersweet goodbye. In the midst of searching for a job, I was left with nothing to guide me to my next step in life. It was devastating to feel like I had left a life behind and fallen into a void, and that darkness seeped through me like a sponge soaking up water. I was convinced that my life had come to an end. I started planning who I should give my belongings to. I had a plan.

For the longest time, I never thought I would live to see my 25th birthday. I was convinced I would end my life by then and follow in my brother’s footsteps. And yet every time I find myself about to shake death’s hand, I feel a tug in my stomach that tells me something isn’t quite right. For reasons I can’t quite explain, I keep moving on. I trudge through the black, ichorous swamp in darkness; eventually I find land. I can’t explain my resiliency, but I hope one day I can.

When I woke up on my birthday, I realized I would have to keep going. My window of opportunity was over. It was time to move on. But to what? So ensued several more weeks of that numbness that chills to the bone. I didn’t ask for help. I just curled up into my depression and stayed there for a while. And then I got a job and immediately had to try to smile.

The funny thing about working in mental health is I keep thinking people will — at the very least — have the tools for maintaining their own mental health. Sadly, I keep having to remind myself this is not true. So while I was extremely enthusiastic to land a job in my line of expertise, I was also thrust into an environment that is still ignorant when it comes to mental illness. Thus my stress continued.

It’s difficult wanting to write about mental health and mental illness when I go to work and have to be an advocate for myself and others. I feel like I’ve been fighting stigma on a daily basis, and it’s been completely draining. So when I look at Redefining Bipolar, my mind has just said, “I can’t today. As much as I want to, I just can’t.” As I write this, I have a headache that I’ve been trying to manage for the past couple weeks. It’s been taking a huge mental and physical toll.

But, it’s not all doom and gloom. I’ve managed to submit a PhD application and I truly enjoy working with the individuals I have the privilege to care for. I stopped keeping everything inside my head and reached out to friends and professionals for help. I started journalling and found it inside me to write this very post you’re reading now. I’m finding my inner strength to make change in the workplace and looking forward to hearing about whether or not I can return back to school.

So that’s a little of where I’ve been and where I’m going. I’m not sure how active this blog will be for the time being. But hey, I’m here.

Fighting Depression, Fighting Myself

I feel like I’m fighting myself. And how could it be otherwise? Depression is a condition beyond my control, and yet it is part of who I am. It doesn’t define me, but it still is me.

Even after a decade, this kind of pain still feels like a fresh cut. It’s the feeling of being filled with cement. It’s the ache in my chest and my abdomen that tells me I’m freezing up. Every movement is a fight against gravity; every step is a resistance against the thought telling me to lay down and stop. Every body gesture is heavy with the shackles of depression. Yes, I know its name. It is my familiar. It saturates my fluid and coagulates without killing. And I have to sit here with it and wait for it to run its course.

My self-care list is strong. Exercise? Check. Good diet? Check. Social support? Check. Hygiene? Check. Check. Check. Check. I’m doing everything right. Medication change? Check. So why do I feel so responsible for being depressed? Why do I continue to fight myself, to blame myself for these experiences? Overcoming the self-stigma of mental illness has been a love-hate relationship. I know this is not my fault, and yet paradoxically I still think it is.

It’ll pass, they say.
Yes, I know.

Just focus on getting better.
Rent doesn’t pay itself.

Don’t worry, things will work out.
Can I get that in a notarized document?

Fighting depression isn’t just a battle with myself — it’s a battle with society. Could I use a month to figure this out? Absolutely, but I have bills, deadlines, the pressure of work and the reality of not having money if I don’t. There isn’t a “no strings attached” government bailout package for a high-functioning person not sick enough for hospital but not well enough for daily life. I have forever been in the gap of care.

As I sit and write this, I want to maintain that message of hope. Because I do know it will pass, despite not feeling like it will. But it is these experiences make salient the great changes we need to conjure in society. We need a new culture of health that better supports people living with mental illness. I need this. We all need this.

For anyone else who finds themselves relating to this point, obviously you’re not alone. As strangers, perhaps we can take comfort in knowing we fight ourselves — we fight depression — alongside visible and invisible support.


Photo Credit: Stocksnap (CCO License)

3 Suggestions for Navigating Medication and Body Image Issues

Something I’ve struggled with for most of my life, like many others, has been my (mostly negative) relationship with how my body looks. When it comes to body image and taking medication, this can make matters worse. Some medications to treat mental health conditions cause weight gain — sometimes dramatically so. Sometimes that has made me feel like I’m being kicked when I’m already down and trying to get up. I still wrestle with accepting my body for what it is today, but I’ve discovered a few techniques and perspectives that have helped. Most of what I offer is for those who are cisgender women, as that’s my experience. So there are some specifics in here, but I hope some of it translates to others who this is not necessarily intended for:

It’s That Time of the Month

It was a recent realization for me that there are certain times of my menstrual cycle when I’m most likely to think negatively about my body. Turns out I’m not alone: One study of adolescents found a link between certain phases of the menstrual cycle and viewing one’s body negatively, after controlling for a variety of factors. When I was in attendance at the International Society for Bipolar Disorders conference, someone remarked to me how little female-specific (as in XX chromosomes) health issues are included in bipolar research. Often the abstracts I’ve found for this topic have been clinical in terms of “how does menstruation affect symptoms” or “what medications change the menstrual cycle.” Personally, the most meaningful information would come from a question like this: “How does the menstrual cycle affect a woman who has bipolar in everyday life, and what can we do to help her cope with those thoughts and feelings?” I’m sure there are better ways of putting it, but the essence points to quality of life. On the ground level, I already know medications influence my body image. What I need is help not feeling like I have to avoid mirrors.

One tool I’ve found helpful is an app called Clue, which is available for both Apple and Android users. I’ve been using it for years and it’s not perfect for the mentally extraordinary mind, but it provides a useful way to monitor one’s period. What I’ve been doing recently is making correlations between my pre-menstrual symptoms and — for the lack of better words — how much I dislike my body. There are definitely trends that I didn’t think about before, but of course make sense now. For example, when I’m bloated and gassy, obviously I’m less likely to think I’m attractive. Even though being aware of that hasn’t completely whisked away my worries, it does help me implement some CBT strategies so I don’t linger on these thoughts too long.

There are, of course, many studies on body image, the culture of “thin,” and other intersecting issues. But the medication, menstruation, bipolar, and body image connection? Someone please point me in that direction.

The Obvious: Exercise!

Sometimes this is a loaded word when it comes to mental illness because of the different “places” people are at in their journeys back to wellness. Exercise is helpful at every point in one’s journey. A meta-analysis (a study of many studies) of university students found that exercise greatly improved symptoms of depression; another large study of studies found that people with bipolar have improved quality of life when exercise is thrown in the mix; and there is a greater than ever push to see exercise as part of treatment. While there can be barriers to exercise, or to exercising regularly, it is a top health priority for whole-body health.

In terms of body image, I know I feel better about myself when I have a regular exercise routine. On average, I work out 5 days a week and spend time outdoors if weather permits. I can afford a studio membership that gives me access to many classes at many times of the day, so I don’t have a lot of excuses not to exercise. However, there was a time when I didn’t have that. At one point in my life, a thirty minute run in the neighbourhood was all I had. But sometimes that’s great — it takes away potential anxiety from going into a gym environment. And even when I didn’t have money for group classes, I used online videos like Do Yoga With Me, which offers free yoga classes in the form of recorded videos. Sometimes, it just takes a little bit of creativity to find an exercise regime that works for you.

Where does the self-loathing come from?

Since I started taking medication, I’ve noticed a steady increase in weight gain. There are some reasons for this: Depression makes exercise pretty difficult, medications can mess with metabolism, an erratic exercise schedule, and an injury all contributed to my current state. That being said, this year I made it a point to get in better shape, which I’ve been fairly successful at. I wish I could say that I’m at peace with my body that’s physically stronger and in better shape than it’s ever been — but it’s simply not so. For me, “self-loathing” is how I describe my feelings; it will surely be different for others. Ironically, it fuels my motivation for exercise — almost like I’m running away from myself. What I really need to do is run toward myself and give myself a hug, because these feelings really do hurt.

In Western culture, we are seeing a movement to body positivity — accepting our bodies for what they are. Yet, there is still a huge emphasis for women to be thin and sexy, and sexy is a fairly narrow category. From a young age, girls are exposed to these standards and taught to believe in these range of ideas. So there’s a large cultural component to the body image conversation — large enough to warrant books and many heated debates over it. What’s important for me in adding this in is to contextualize my feelings in the bigger picture. I’m not alone in thinking and feeling these things. This is not just a mental illness issue (though it certainly could use more research). This is a worldwide issue.

There are certainly mental illness-specific tips and suggestions for navigating body image issues, and the last one I’m presenting is, for many, the tough one. Facing myself, my feelings of inadequacy — these are difficult realities to face. This needs to be done with the proper supports; if possible, with a caring healthcare professional. At the very minimum, with loved ones who will listen non-judgmentally, or even peer support groups. Talking about the effects of medication on one’s well being is a proper conversation to have in a psychiatrist’s office. The take home message is this: Just because someone with a mental illness needs to take medication, that doesn’t mean the medication should impede on quality of life. Medication is a negotiation, not a life sentence.

Why I Don’t Hide My Self-Harm Scars

In helping people who self-harm through peer support, I’ve listened to a variety of perspectives of one particular type of self-harm: Skin tissue injury. Typically, people think of this as cutting, but it’s more than that; it can be picking at the skin, plucking hairs, scratching, hitting body parts against hard surfaces, and other methods that have the consequence of hurting “superficial” (anatomical term) tissue. And even when thinking about cutting, often there is a narrative that includes razor blades that someone uses on their forearms.

I find it interesting that this has become the stereotype of self-harm. For example, my self-harm used a specific tool — a thumb tack. And I would always cut on my thighs because that was the body part I hated the most, and was significantly easier to conceal than other locations. There’s an interesting logic to my self-harm behaviours. When I first started self-harming as a teenager, I found a thumb tack on my shelf in my bedroom and I began wondering what it would feel like to drag it across my skin. I began by just using it to scratch the skin, often not drawing blood. But eventually I cut a little deeper, and now all these years later I have these fine, white vertical lines on my thighs.

Thankfully, it’s been a few years since I hurt myself like that. A few weeks ago, I was walking in my dining room with shorts on and the evening light was beaming from the window; as I stopped to put something on the table, I noticed the light caught my legs in a peculiar, and somehow beautiful way. The small ridges on my legs, the usually unnoticed whiter parts, stood out like I hadn’t seen them before. I’ve always referred to them as my battle scars, but in that moment — seeing them in that light — they had a luminescent quality about them. They weren’t ugly, flaws, or even scars. They just were. It was a peaceful moment.

For many years I felt a deep sense of shame about my self-harm scars. I tried every method in the book to try to get rid of them — or at least lessen their appearance. And I was moderately successful; it’s hard to see them now unless you’re really staring at my bare thighs. Part of me regrets going through that process. It was a tedious and felt miserable hiding my scars and always being conscious of what I was wearing — especially for dreaded events like swimming.

If I happened to have a self-harm relapse today, I wouldn’t go out of my way to conceal the wounds. I know from personal experience that self-harm wounds and scars tend to make people feel uncomfortable. To all those who do feel uneasy around people who have visible self-harm scars, just imagine what it takes to show those scars. I’ve had people stare at me like I’m a dangerous, wild animal. I see the stories such people begin to fabricate in their minds. And it leaves me at the disadvantage of not being able to explain the pain, trauma, and turmoil that resulted in those scars forming. It is another form of objectification, and it can be particularly vicious in that we the self-harmers tend to have few allies.

The percentage of people who self-harm in Canada and the United States is an educated guess at best. When we look at the research, the prevalence of self-harm has been plagued by many problems in accurately measuring how many people self-harm, and what self-harm is even defined as. But on a day-to-day basis, knowing that doesn’t matter. What we do know is that people do intentionally inflict harm on themselves and we need to care for these people with compassion even when we don’t quite understand what we’re dealing with.

There are various messages to elaborate on, which I think can be summarized in short (for now):

For those who feel uncomfortable with self-harm and have never self-harmed:

If you can’t understand why someone self-harms, you can certainly try to understand the person who self-harms.

For those who feel uncomfortable with self-harm and do self-harm:

It’s okay to hate yourself, to feel ashamed, to be depressed, to be angry, or whatever else you feel about self-harming. I’m not here to tell you how to go about your process or healing journey. I’m just here to say someone out there understands and wishes you wellness.

For those who want to be allies to people who self-harm:

It’s scary and you’ll probably make mistakes, but that’s okay. Education is key. Continue listening and asking, “How can I help you?” (Also read here and here for other stories I’ve written about my self-harm.)

For those who self-harm and don’t hide their scars:

I admire your decision to do so.

In breaking down the myths of self-harm, I always look to others. I am only one story out of many, and I think it’s crucial to remember that if we want to break down walls to authentic human connection.

Common Things I Hear as Someone Who Has Bipolar

It’s been about three years since the inception of “Redefining Bipolar” and everything that coincided with the creation of this website. I’ve done many speaking engagements, a lot of questioning and answering, and generally being out and about as someone who lives with mental illness. So over the past few years, there are some common questions and remarks people have posed to me; I thought it might be neat to put a few down in a post for some weekend food for thought. Let’s dive right in with the big one:

“You’re so brave.”

To see gratitude in someone’s eyes and hear it in their words warms my heart. I don’t mean to take away from that sentiment, as it is indeed something I respect and find comforting to see in others. What I do want to add is my thoughts on this phrase and how I view myself in relation to it. The concept of being “brave” doesn’t resonate with me as much as other adjectives might. Part of the definition of brave does include facing danger or pain; when I do public speaking, I’m not putting myself in a position that would cause me pain. I’ve never had any negative repercussions from being public about my bipolar. I have privileges in life that secure my position in it, such as being an academic and having a safety net of people who could rush to my aide at any sign of structural or social threat. I certainly didn’t always have this, so being “brave” was at some point relevant. But it’s not anymore. I’m not brave. In an abstract way, I’m basically just secured and insured to some degree. I enjoy public speaking immensely and I have privileges others in my position don’t always have. No, it’s not without risk — but the risk is much smaller to me than it is for others. So I see this as a moral obligation. At one presentation I had recently, someone in the audience asked me why I am so open when I speak. My answer was simple: Someone has to, and I seem to have the skills to do so.

“What can I do to help my friend/colleague/etc. who has bipolar?”

When people ask me this question, I understand where they’re coming from. But, what always goes through my mind is, “Well, I don’t know — who are they?” While there are some general skills that you can use to navigate the realm of bipolar — like active listening and generally being empathic — every person is different. It’s also a loaded question, because what exactly does that person need help with? Or do they even need help at all? Even with my having bipolar, I still need to be mindful that I’m not seeing problems that don’t exist in my friends who also have bipolar. But, there’s a simple solution here: Talk to the person and see if they need help. Engage in a dialogue while being mindful of emotional boundaries.

This is more nuanced in situations where symptoms may be appearing or escalating quickly. Depending on who you are in that person’s life, it may not be appropriate to intervene even if your intentions are good. For myself, I wouldn’t want anyone helping me unless we have an existing relationship where we’ve talked about my bipolar and that person’s role in my life. There are some people I wouldn’t want helping me under any circumstances, and there are specific people in my life who know how to help me in all the different emotional/cognitive/behavioural states I can be in. I can’t speak for anyone but myself, so my best answer for this is always to talk with that person and get to know them — you know, as a person, not just someone who has bipolar.

I have a draft I’ve been working on for a long time about helping someone with bipolar, so when that’s finally done I’ll link it here.

Scenario: Self-validating audience members.

This is a particularly interesting phenomenon to observe as a speaker. I’ve gone to many events where there’s a q&a portion of the presentation, and sometimes the following happens: Someone asks a question to confirm something about bipolar that they really need to have confirmed. For example, take someone who asks a question about the genetics of bipolar. I’ll explain that studies have shown it can run in families, but we don’t have the knowledge about genetics to point to any causal relationship, and there are still many psychosocial factors to analyze. And yet said person will respond with something like, “I knew it was a biological condition.” These self-confirming biases are predominant in society, so it’s not a surprising scenario to run into.

What makes me so curious about these situations, though, is what’s going on in that person’s life that they’re so badly looking for answers. Sometimes I get the opportunity to follow up with people after the presentation, as I find many people get some sort of relief by expressing their circumstances. For me it brings up the ache of knowing I could whip out resource after resource and sometimes it’s just not about knowledge. Sometimes I listen to people and there’s such pain in their hearts that’s leaking out. It’s difficult knowing all I can do is listen, but I hope it does help in some capacity. Speaking of being brave — to me it’s the audience members who often hold this quality. Since it is a stigmatized topic, it’s not always easy showing up in a room full of strangers not knowing what to expect.

So those are some thoughts for now.

If you have any questions, there’s now an option to ask anonymously! Just look at the navigation bar for ways to contact me. I’m happy to answer anything.

 

13 Reasons Why: When Research and Lived Experience Mix

Trigger warning for suicide, sexual assault, bullying, and spoilers galore. One thing I also want to begin with is that it’s taken me over a month to write this article, as I was patiently waiting for others to respond to this show and observe how everyone has been reacting.

There has been a great amount of controversy surrounding the Netflix TV series 13 Reasons Why since the show was released. There was some chatter on my facebook feed about the show being extremely insensitive to mental illness, so of course I had to watch the show to see what all the fuss was about. Little did I know I would end up watching a show that not only feels like parts of my own life, but actually has a solid foundation on research. Initially, I thought I would be critiquing the hell out of 13 Reasons Why, but I’m genuinely blown away by how realistic the show is. I’m happy to announce I even took notes while I watched it; this is key because there are some extremely significant trinkets that you could miss if you’re not paying attention or don’t know what you’re looking for. Instead what I’m finding is critiquing the people who have/have not watched it.

So let’s talk about bullying.

Many focus their arguments about this show on suicide and mental health. While I agree, there is a HUGE lack of conversation about bullying and how it has the biggest role in this story.

I recently finished a doctoral seminar on school violence, and I found myself wishing this show had been available earlier so I could have discussed it in that seminar. The Handbook of School Violence and School Safety: International Research and Practice is where I’m mostly drawing my arguments from, just so it’s clear that I’m not pulling facts out of the air. Though I haven’t read the entire tome that is that book, I had the chance to research scenarios like Hannah’s to figure out what exactly goes on in situations like hers. The short of this is Hannah’s situation is a sad reality many have endured and continue to endure.

The one thing that stuck with me throughout the show is how teenagers will not break their code of silence. I made some comparisons to real life cases like Reena Virk and Amanda Todd. In looking at instances like Reena Virk, who was brutally murdered by her peers, it took well over a week for anyone to come out with information regarding her disappearance, despite most people knowing what had happened under the bridge that night. This is a toxic problem that researchers, teachers, administrators, and parents alike have all tried to get around. It’s even more intriguing in Hannah’s case because of the tapes she made that essentially indicted those she felt had wronged her. But the fact that those who received the tapes did not pass them onto adults (except for Tony and Clay at the very end, weeks after the fact) goes to show that this code is held in high regard and mirrors real life instances. While Reena Virk’s case wasn’t about suicide, it still elucidates important aspects of the influence of peers in Hannah’s life.

There were several “gems” in 13 Reasons Why that told me a greater story of what Hannah had experienced beyond what her tapes were saying. In a later episode, her parents are talking about their failing business and her mother gets the idea that they should move “again;” in one sentence she glosses over the fact that Hannah had been bullied by “vicious” girls at her previous school. This is similar to Amanda Todd’s story, in which she went from school to school to escape bullying without reprieve. Sometimes moving schools can help the victims of bullying start anew, but often patterns repeat themselves for various reasons. In Amanda Todd’s case, it was because of her cyberbully and other in-person bullies continuing the legacy at her new schools. It was one sentence in the show, but it is a large piece of Hannah’s story that we don’t see despite its significance. Amanda Todd ended up taking her life, and she made a video online documenting it. Is that different than tapes? I would be interested to know what Amanda Todd’s family thinks of the show.

Many have mentioned that Hannah was not only bullied, but became a bully via her tapes. I thought about this for a while and I lean in the direction of addressing the tapes as a suicide note. Can one posthumously bully others? Definitions of bullying always include the bully having perceived power or status over the victims, and this is not the case for Hannah when she is alive. If we are to think of the tapes as bullies, as having power over those being bullied, then I think we’re missing the point. The tapes are Hannah’s story of how she was bullied, raped, her feelings about her interactions with others, and her deep depression. By conventional definitions of bullying, this is just the story of a victim. If anyone is the bully in the scenario, it would be Tony because he enforces everyone to listen to the tapes; he especially holds Clay responsible, but at the same time Tony is emotionally supportive for him. In other words, not technically a bully.

This leads into the idea that those on the tapes will be “exposed” if they do not listen to them and pass them on. I fail to see the victimization in this scenario considering the tapes are addressing what all the teenagers (and school counsellor) actually did. It’s merely holding them accountable for their actions. What’s interesting and accurate here is how every teenager is thinking about the consequences of him/herself being exposed and not holding a greater sense of right and wrong in the world. This is in line with various theories of moral development, of how teenagers in Western society are biased to think in terms of how events relate to themselves alone. Only a couple of them, at the end, want to come forward with the information after weeks of struggling with keeping it a secret and saving face. Ultimately, some of them want to honour Hannah by outing Bryce as a rapist (and bully) and making amends for the perceived wrongs they did not only to Hannah but to others around them.

13 Reasons Why is only partially about suicide.

The claim that it glamorizes or romanticizes suicide seems to me to be a coverup for how uncomfortable the suicide scene at the end is. Hannah, the protagonist who kills herself and whom the stories surround themselves around, slits her arms in a bathtub. Many people have made a good point in noting that these scenes should be uncomfortable. If watching someone die is ever comfortable, it’s time to get a mental health assessment (and this applies to all film and TV, so think about that too while we’re at it).

There are also claims that this is a “revenge” suicide. If she didn’t hate everyone who bullied her and the men who sexually objectified her and raped her, then I’d be concerned. But she didn’t kill herself because she wanted them to suffer. She killed herself because she was suffering. This is notable in her anonymous letter she wrote in her communications class, in her discussions with the school counsellor, and in other what we call “micro” aggressions between her and her peers. She was severely depressed and suicidal and she didn’t have to say it. Calling it a revenge suicide only stigmatizes someone who is hurting in many deep ways. But more on that later.

To bring the focus back to bullying, there’s a scene earlier on in the series during their communications class where the teacher brings up the idea of “social learning theory.” I think this should actually be social learning theories as more of a blanket term, but it was Albert Bandura who came up with social learning theory in the 80s. Albert Bandura is a social psychologist and is famous for his work in understanding behaviour — and aggression specifically — in a social context. It’s one of those gems I mentioned earlier, because it’s said in one sentence and yet it is critical in understanding this TV show. I’d even go as far to say as the writers may have intended it to be the foundation on which to set the plot and its characters. It’s one theory that tries to explain the very plot we’re presented with in 13 Reasons Why.

From a Film Perspective

A lovely article by the CBC points out the myriad of issues I’d also like to address, but one point in particular stands out about the nature of filmmaking. It reads, “The main character is able to make her voice heard after she’s dead…” which brings up some food for thought: Does the show have reliable narrators? The concept of “reliable” refers to characters who may or may not be telling you the whole story, or may be misleading the audience. In a meta sense, this also reflects the reality of teenage bullying; the truth is hard to find, with multiple versions always coming to the forefront. We see the show mostly through Clay’s listening to the tapes. Even though we hear Hannah’s voice as a narration, it’s still Clay’s perspective. Is he omitting or emphasizing parts of the tapes?

Logistically, cassette tapes can play 30-120 minutes to content per side. In the show we see that every tape is played through in its entirety on each side; this means that there is potentially 60-240 minutes of content of Hannah’s story per 50 minute episode. Because the show isn’t just Hannah’s voice all the time, it’s reasonable to conclude that Clay is cherry picking information that is significant to him. As an audience, we’re probably hearing only key points that Clay thinks are important. This is a critical facet of the show to consider, especially given the third person omniscient voice. Who is really telling the story?

After my analysis of the show, I feel bad for the filmmakers who obviously put a lot of thought into crafting the story. No, this story doesn’t follow mental health 101 — that’s not the point. So this leads us to the question of social responsibility on the part of the filmmakers. Was it a good idea to make this TV show? That there seems to be a split between people who think 13 Reasons Why is damaging and those who relate to the story because it actually happens makes me say yes — we need to be having this conversation, and the story of 13 Reasons Why has been a vessel for this topic. We need to remember that 13 Reasons Why is a drama; we can’t confuse the distinct goals of the art of storytelling with formal education.

The fuss about this show makes less and less sense considering how many other films and TV shows have portrayed mental health. Just the other day I watched a new release called Lights Out where the mother ends up shooting herself in the head to make the plot go away; it was her fault because she didn’t take her meds and invited her evil psych ward friend into her head. It used mental illness as a spectacle plot device. But no one’s complaining about that. Why? If the sole argument against 13 Reasons Why is its lack of social responsibility in portraying mental health then we’re severely misleading ourselves. For example, one of the most famous horror movies is called “Psycho.” Compared to most other film and TV, 13 Reasons Why is setting a higher standard for the rest of the industry to follow.

Suicide Contagion

Yes, it exists, but research suggests it exists primarily for people who are considered “at risk,” which is a debated term on its own with a history in several disciplines. Further, there’s no causal relationship between having a peer kill themselves and other people then taking their own lives. Suicide contagion studies are all correlational and fraught with measurement problems, such as the problems researchers encounter with self-reporting questionnaires. Also, the contexts in which this research is done varies immensely, from celebrity deaths to news articles — and context is key because otherwise generalizability can be called into question. A more recent article noted “suicide contagion” as an entire concept needs to be clarified. The best way to know if 13 Reasons Why does produce a suicide contagion effect would be to study those who watched it and see if suicide rates go up. And it would have to control for many, many other factors — such as school climate, parental warmth, community safety, preexisting conditions (not just mental illness), and so forth. We need to proceed with a healthy dose of skepticism on this issue.

Also in the aforementioned CBC article…

The show has a TV-MA rating (may not be suitable for those under 17) and provides a warning to viewers before the episodes with particularly graphic content.

Yup, there are trigger warnings. If suicide, bullying, and sexual assault are triggering, it’s up to the viewer to know where to draw the line.

“I think it’s showing, like, what’s really going on out there in the high school world and it wants to show us we shouldn’t treat others like that,” 15-year-old student Ashley Rosales told CBC News, sitting with six other friends at a Los Angeles mall, all of whom watch the show.

Because as I’ve stated, this is indeed a reality for many.

 “The series is very intense and romanticizes the story of Hannah and her suicide.”

How? I’m now accepting evidence-based answers.

Many schools in Canada —including in Ottawa and around B.C.— have since sent out their own advisements to parents. One Edmonton elementary school has prohibited students from talking about 13 Reasons Why on school grounds.

The most dangerous part of this entire argument is NOT talking about it. In all the suicide training I’ve taken in my life, this is the exact opposite of what you’re supposed to do. As someone who has talked strangers down from suicide and who has taken people to the ER when they’ve been suicidal, you NEED to talk about suicide as directly as possible. This feeds into the stigma that talking about it only makes people want to kill themselves more. Not talking about it is one reason why suicide is a public health issue.

“Adults are portrayed almost across the board as being disengaged, uninformed and almost uncaring and, therefore, not a source of help or support around any of these issues,” she said. “It sends a message ‘you’re in this on your own.’ The adults can’t help you.”

Yeah, that was my reality as a teenager. And many teenagers don’t see adults as people they can trust and go to for support. On the topic of suicide, many adults are uninformed. Ask yourself if you’d know what to do if a teenager told you they were suicidal. You can have all the knowledge in the world about suicide; when someone comes to you actively suicidal, there are just some things you can’t anticipate without having already been there either yourself or with someone else.

Helen Hsu, a clinical psychologist in Fremont, Calif., whose work involves suicide prevention in schools, helped shape some of the 13 Reasons Why scripts. She said not showing Hannah’s suicide would be almost “coy and avoidant” and that medical studies aren’t definitive about the risks of suicide contagion.

See my previous notes on the problems of suicide contagion research.

“The more I think I have a picture of that person, the greater the chance that there’s going to be this connection and imitative behaviour,” he said, citing research from world-renowned suicide contagion expert Madelyn Gould. “We know that this contagion effect exists.”

That cited research isn’t bad research — citing social learning often — but it has its drawbacks. When there seems to be an instance of suicide contagion, it’s important to look beyond the individuals. It would be more accurate, in these instances, to take a bioecological perspective that accounts for social learning, but also for an individual’s ecology (community, home life, cultural norms, history over time, etc.). Again, see my previous comments.

What others have had to say…

I’ve read a mix of opinions and the ones that bother me the most are those that argue against the show while either not having seen the show or not giving reasons as to how it’s detrimental to various aspects of mental illness. One article mentioned thinking the show isn’t “safe” for anyone who has a mental illness, despite some not overtly dealing with mental illness themselves. This is a concerning perspective for me because it taps into the idea of being what I call a misleading advocate; in a way, it’s being offended for people and offering advice that is not informed by lived experience. After my critique, I would strongly recommend that people without that lived experience do watch this show because it can help them understand the reality many people have experienced. While of course trigger warnings are needed, they are indeed provided. I question if this idea of not being “safe” actually means avoiding content that is uncomfortable. Suicide is not a comfortable topic and 13 Reasons Why can be a tool to help us become more comfortable with the subject.

Another article grievously misunderstands the “takeaway” message of the show. The author says the tapes are meant as revenge to inflict on those around her — the “causes” of her suicide. Suicide is a multifaceted issue, but there are certainly events that can be the tipping point. I can definitely point out several people who were the reasons why I tried to kill myself. My high school counsellor was useless; she even told me that I would never make it to a four-year university. So “in reality,” as the article makes a point of describing, what happens in 13 Reasons Why are situations that do in fact happen. It’s literally reality for some people. No, it doesn’t have a happy ending and it doesn’t provide any resources for people struggling — that’s not its purpose. It’s a TV show, not a educational video. The art of film depicts the world and a story in novel ways, and it did just that. It’s our job to be critical consumers and to think more carefully about what is being shown to us and what goes into the making of media. I will say that I’m glad the show has sparked controversy because we do need to start understanding suicide as a multifaceted, multi-causal issue.

One of the writers of the show spoke out about why various aspects of the show were displayed as such. He used his own suicide attempt and others’ to help craft the scene in which Hannah kills herself. The best thing we can ask for in TV and film is having it co-written by people with lived experience of the issues being handled. When people say 13 Reasons Why glamorizes suicide, I always ask “how?” and never seem to get a concrete answer other than “it shows a suicide scene.” When a suicide scene is written by people who have tried to kill themselves, that’s not romanticizing — that’s reality. He even alludes to why tapes were included as a means of storytelling and how showing the suicide scene allows us to break down myths surrounding it. I agree; part of destigmatizing suicide is dealing with how raw that act is. I can’t emphasize enough how much I related to that scene and how close I came to becoming Hannah. It was certainly uncomfortable to watch, but that’s the point. If we truly want to help people and understand suicide, we have to face it in its raw form. This is, in part, why peer support is so effective; speaking to someone who “gets it” is extremely validating and can be that lifeline that people like me sometimes need. Suicide trainings like ASIST echo the sentiment of needing to be more comfortable with suicide through exposure to it.

A registered nurse and professor spoke out about the show in suggesting that we use it as an educational opportunity. This nurse brings up two interesting points: 1) The push for mental health literacy starting with young children has sparked the same concern about “promoting” suicide, and 2) the suicide scene (and others in the show) are no more graphic than other shows. I hadn’t thought of that in my initial reaction, but it’s a really good point. If seeing Hannah cutting her own wrists is too “graphic,” then there are entire genres of film and TV that are far, far worse. It again speaks to the autonomy of the audience to decide what they can and cannot handle in a movie and parental discretion/guidance in allowing minors to watch graphic content. After all, it’s practical makeup effects, just like any other movie. As real as that can look, it’s still just makeup.

Yes, teenagers will get their hands on this and it’s not something we can control. But if that’s the argument we want to tackle, then what about things like online pro self-harm communities? Compared to a show that’s available on Netflix, there are far more disturbing and damaging online phenomena that deserve much more attention than a mainstream TV show.

The Irony Behind My Dissent

Many people critique the show via Hannah’s suicide and how she went about it. Let’s think about this: Are we blaming her for killing herself? It’s what one CBC opinion article seems to suggest by saying it “normalizes suicide” and saying it’s unfair to say others contributed to someone’s suicide. But by doing this, we’re simply perpetuating the stigma that suicide is a selfish act. By claiming that Hannah’s tapes were part of her “revenge” suicide plan, we fail to see them as her suicide note and disrespect her story in its entirety (if we are actually exposed to a reliable narrator).

At the end of the show, many of the teenagers in the tapes acknowledge the stories as true. Think about how many teenagers were bullied that ended up killing themselves. I was almost one of them; I wrote about how much pain my bullies had caused me, listing their names and their wrongdoings in the journal I kept at the time. If I had succeeded in taking my own life, someone would have found that journal. I probably would have made sure someone did. Would you call that a revenge suicide? Or would you look more closely and understand it was merely a byproduct of the immense pain and suffering I was failing to fight? Note failed suicide. I could have been Hannah.

Don’t blame Hannah for wanting the truth behind her death to be known. Don’t insist that suicide is always the person’s action that has nothing to do with social circumstances. See 13 Reasons Why as something that has happened and will continue to happen until we start looking at suicide from other perspectives. Better yet, how about we talk about the real issue at hand — bullying and the violence that happens in peer groups and at schools. If there’s a conversation we should be having, bullying is it. School violence and peer group violence are the neighbours next door we’ve been ignoring and seeing as normal for far too long.

It’s the viewer’s job to know the limits of what they can emotionally digest when watching shows like this, and have informed conversations about suicide and its prevention. Better yet, let’s delve beneath the controversy of one suicide scene to look at thirteen episodes of a TV show that shows bullying and violence many teenagers are subject to every day. Be angry that we’re not talking about suicide enough. But be even more angry with all the reasons people end up killing themselves.

My only sibling killed himself. So I know what it feels like not to get a reason why.

And yet I knew why — there were many reasons why, some of which were people. I saw a video on Facebook that I can’t seem to track down again, but I’m sure it’s out there somewhere; it was a woman talking about why she didn’t need to see 13 Reasons Why because her best friend killed herself when they were teenagers. Just because someone you cared for deeply took their own lives doesn’t suddenly make you an expert on suicide and excuse you from learning more about the subject. I mentioned earlier that people without lived experience need to expose themselves to suicide through story and more formal education; this stands for people who do have lived experience as well. My brother killed himself, I tried and failed, but that alone doesn’t mean I know a lot about suicide — I just have lived experience of it. Despite the years I’ve spent studying suicide, I still know there is much more to learn. Having the lived experience perspective enriches research and helps me navigate it more realistically, but I’d never approach someone who is suicidal with assumptions based on my own experiences. That’s not only disrespectful of that individual’s story, but could be damaging in preventing further suicidal ideation and/or intention.

So here’s what you can do to become more comfortable with suicide:

  • Listen to personal accounts of suicide survivors; don’t speak, just listen. This account, for example.
  • Research media portrayals of suicide — were they written by people with lived experience? Are we seeing the full perspective? Be curious in your investigations.
  • Seek out education rather than assume knowledge; suicide prevention starts with an open mind.
  • Say “suicide” out loud to yourself. Say “Are you feeling suicidal?” out loud to yourself. Make it feel like a normal question to ask.
  • Take a local suicide prevention training. QPR, for example, can be done in an hour. The next suicide prevention training I’m doing is two days long, so look at what’s available in your area.
  • However, don’t be formulaic about suicide prevention. Every person’s situation is different, which is why suicide prevention can be difficult.
  • If you are mentally well to do so, watch shows like 13 Reasons Why and think critically about them. Suicide is not a black and white issue. There are reasons why people kill themselves. Many, many reasons.

Like it or not, 13 Reasons Why is what happens when you mix research and lived experience into a visual art form. And many people must have enjoyed it enough because Netflix renewed it for a second season. So I look forward to critiquing the next season and hopefully seeing a different conversation about bullying and suicide surface when it comes out. I welcome informed discussion on this topic and hope that, unlike many discussions I’ve seen online, we can be civil in engaging in an intellectual debate. Because, ultimately, this isn’t about which opinion is right or wrong — this is about understanding the nature of society and how it contributes to suicide. This is about opening a conversation to help people through evidence-based resources.

If you or anyone you know is feeling actively suicidal right now, here are some ways to get support:

Click here for an international list of crisis lines.

Suicide Prevention help in Canada.

Download a pamphlet on quick tips about suicide prevention.

More resources on my website for Canadian and American residents.

You’re not alone.