The Sorrows of Young Werther: How Werther Effect Can Affect People

In 1774, the success of Johann Wolfgang von Goethe’s novel, The Sorrows of Young Werther, and the perceived string of suicides that followed became a famous instance of suicidal ideation from popular media in Europe. One of the novel’s characters, Karl Wilhelm Jerusalem, is in love with a married woman who does not reciprocate the feelings, and he later shoots himself in the head. It is said that due to the novel’s popularity, people across several countries who found themselves unlucky in love killed themselves in the same manner that Jerusalem does. There is no conclusive evidence that a significant number of copycat suicides occurred; however, at the time, the possibility of imitations was great enough that the book was banned in several places, including Italy, Copenhagen, and Leipzig (Jack 2014).

Fast forward to 2019, the phenomenon seen after the publication of Goethe’s novel—known as suicide contagion, suicidal ideation, suicidality, or the Werther effect—is still being discussed. In the United States, a recent work to come under scrutiny for potentially eliciting the Werther effect is the highly streamed Netflix series 13 Reasons Why. The show, based on a novel of the same name by Jay Asher, follows the lives of the students, parents, and staff of Liberty High School following the death by suicide of Hannah Baker. In the thirteenth episode of the first season, Baker dies by suicide in a scene where she is shown getting into a bath, slitting her wrists, and bleeding to death. She leaves behind a series of cassette tapes detailing how each of her peers played a part in her death, and the content of the tapes makes up the primary plot of the show. As in the case of Werther, the show is wildly popular—especially among viewers of an impressionable age—making it is essential to determine whether there is a causal link between 13 Reasons Why and rising teen suicides or suicide attempts.

The way Baker’s death was portrayed incited outrage even before the show aired. Professionals advised Netflix against airing the show, but the streaming service ignored this advice to protect the creators’ artistic vision. “Our creative intent in portraying the ugly, painful reality of suicide in such graphic detail in Season 1 was to tell the truth about the horror of such an act, and make sure no one would ever wish to emulate it,” said showrunner Brian Yorkey (Gilbert 2019). After the show premiered, the general public was as concerned with a potential Werther effect as experts were. People took to social media to criticize Netflix for the portrayal of suicide, which many took issue with because the depiction broke guidelines on how suicide should be handled. The guidelines, set by the World Health Organization (WHO), state that media outlets should educate the public about suicide, avoid presenting suicide as a solution to problems, avoid explicit description of the method used in a suicide, and provide information about where to seek help (World Health Organization 2008). 13 Reasons Why fails to follow all of these guidelines. Baker dies after barely attempting to seek help from the school guidance counselor, making the depiction one where suicide is seen as the only option to escape one’s trauma. The elaborate plan to distribute the tapes to everyone she perceives as being at fault for her death establishes Baker’s suicide as an action taken to enact revenge. Additionally, the show includes the manner in which Baker died in explicit detail and failed to provide mental health resources for the first season. However, Netflix is not bound to WHO guidelines because the guidelines are suggestions and not laws, and they are meant for news outlets rather than entertainment outlets.

Despite not being legally required to follow said guidelines, Netflix recently decided to edit Baker’s death scene so that the audience does not see her slit her wrists and only sees her parents grieving as they discover her body. The show has since moved on to its third season, but the decision was made because of the fact that all episodes of the show are available for immediate, unlimited streaming on Netflix’s platform, and the creators felt that, after analyzing the feedback they’d received, it was important to edit the scene so that new viewers wouldn’t be potentially harmed by it. “We believe this edit will help the show do the most good for the most people while mitigating any risk for especially vulnerable young viewers,” said Yorkey (Gilbert 2019). While the effect of the edit has yet to be determined, it is definitely a step in the right direction as it follows WHO guidelines of not showing the manner of suicide and instead gives due consideration to those grieving the lost individual. Before the edit, Netflix added warnings to the beginning of episodes and a series of short videos where the show’s actors encourage viewers to seek help if they need it; the platform also created additional content to accompany the show, including 13 Reasons Why, a resource regarding suicide prevention and mental health, and 13 Reasons Why: Beyond the Reasons, a show with one episode per season where the actors discuss the sensitive topics touched on in the show.

In the 19 days following the release of season one, researchers used Google Analytics to track the trend in searches related to suicide. They found that searches related to suicide rose 19% during the period studied, which is 900,000 to 1.5 million more searches than expected Some of these searches included “how to commit suicide,” “commit suicide,” and “how to kill yourself” (Ayers et al. 2017). Researchers also studied engagement with the show on social media, focusing on the platforms most popular among American teens, Twitter and Instagram. Between April 1st and June 30th of 2017, Thomas Niederkrontenthaler, MD, Ph.D. and his team gathered 1.4 million tweets and 26,322 Instagram posts that mentioned 13 Reasons Why. They found that social media attention for the show peaked in April and faded after June, a period that overlapped with a 13.3% increase in suicides among those aged 10-19.

In addition to taking to the internet regarding suicide, teens went to their doctors about suicide more after the show was released. After the show’s first season, Victor Hong, MD, medical director of Michigan Medicine’s Psychiatric Emergency Services, noticed that the number of teens coming in with suicide-related issues was rising. The trend revealed “30% to 50% more than we would have expected,” he said. Hong also noted that the issue was seen nationwide as the topic came up on a listserv for the American Association for Child and Adolescent Psychiatry (Voelker 2019). In Minnesota, pediatricians Margot Zarin-Pass, Phillip Plager, and Michael B. Pitt noticed that, following the release of the show’s second season, patients began exhibiting the same behaviors as Baker, making lists of 13 reasons why they wanted to kill themselves and even altering their appearance to resemble Baker. A search of their hospital’s records revealed that in the six months after its release, 13 Reasons Why was mentioned by name 60 times among 31 patients. Over 75% of the recorded incidents were related to attempted suicide, and more than 50% of patients in the population expressed concerns that the show worsened their mental health (Zarin-Pass et al. 2018). The Oklahoma City Children’s Hospital also saw an unexpected increase in the number of admissions for attempted suicide following the show’s release. The projected number of admissions for May 2017, one month after the show aired, was 12, but the actual number was 31.

As one might expect, with thoughts and attempts of suicide on the rise, the number of deaths by suicide among teens also increased following the show’s debut. Using data from the Centers for Disease Control and Prevention (CDC), Niederkrontenthaler analyzed trends in deaths by suicide between 1999 and 2017 among 3 age groups—10-19 years, 20-29 years, and 30+ years. The study showed that in the three months following the show’s release, the number of deaths by suicide among those aged 10 to 19 years was 13.3% higher than expected, which amounts to approximately 94 additional deaths. Jeffrey Bridge, Ph.D., director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio, conducted a similar study using the same CDC data but a more narrow timeframe of January 1st, 2013, to December 31st, 2017. Bridge found that in April 2017, the month following the series debut, the number of deaths by suicide was 29% higher than projected for those aged 10 to 17 years. This amounted to an estimated 195 additional deaths among the age group. In both studies, there were no significant increases in deaths by suicide among the older age groups, which were made up of individuals outside of the show’s target age range (Voelker 2019).

The aforementioned evidence would suggest that the show elicits suicidal ideation in young viewers; however, there is also evidence to suggest that 13 Reasons Why may actually be helpful. In the two weeks following the release of season one, there was an increase in messages to the Crisis Text Line. In a cross-sectional study conducted by Alexis Lauricella and her colleagues, respondents reported that the show was beneficial to themselves and their peers because it encouraged them to be kinder, seek out information about the difficult topics the show discusses, and made them more willing to help someone struggling (Mueller 2019). A similar survey conducted by André Zimerman and his colleagues showed that 59% of respondents with pre-existing suicidal ideation reported a decrease in suicidal thinking. It also yielded findings that a majority of the 41% of study participants who had previously been bullies reported decreased bullying behaviors after watching 13 Reasons Why (Campo & Bridge 2018).

After the success of the first season, Florian Arendt and his team conducted a study of how watching all, some, or none of the second season—the season Netflix introduced the pre-episode warnings, short videos, and 13 Reason sWhy —affected viewers. Of the 729 individuals aged 18-29 surveyed, those who watched all of the second season had lower levels of suicide risk than those who watched some or none of it. The data also showed that current students who watched the entire second season exhibited a reduction in self-harm that those who stopped watching or did not watch at all failed to exhibit. Additionally, watching only some of the second season was linked to increased suicidal ideation in students, while students who watched the entire season reported less ideation than those who did not watch it at all (Arendt et al 2019).

It’s not clear why the same show can elicit such wildly different reactions among its viewers. There are many fundamental issues with the present data on whether or not fictional media elicits a Werther effect. Studies examine the association between exposure to media that features suicide and population-level suicide rates, but it cannot be determined whether the individuals who died by suicide following the popularization of the media in question were even exposed to it. There is also the issue of the fact that researchers are unable to account for important individual risk factors for suicide that may be the true causes of an individual's death. In the specific case of 13 Reasons Why, many of the studies conducted only included participants who watched the show. This limits researchers’ ability to understand why people watch the show and the ways in which fans of the show may be inherently different from those who choose not to watch the show. Arendt's study attempts to address these methodological limitations by collecting longitudinal survey data and including individuals with different levels of exposure to the show (even those who had not watched it at all). Still, the study is limited in that it focuses solely on suicide and doesn’t touch on the show’s other themes, which is significant because the graphic sexual assault scenes rather than the suicide content may be the reason viewers didn’t finish season two and negatively impacted their mental health. Additionally, while Arendt and his colleagues found an immediate decline in some viewers' mental health, the study cannot determine how long these harmful effects last; it may be that the effects are only short-term and not as concerning as they initially seem (Mueller 2019).

For Joyce Deithorn, a mother whose 19-year-old daughter, Emily Bragg, imitated Baker’s death by suicide, the effects are anything but short-term. She blames 13 Reasons Why for her daughter’s death, the same way Mrs. Baker blames Liberty High for Hannah’s death (Yandoli 2019). The fact is that there is no evidence to suggest that any one thing is to blame. As previously noted, current research into the Werther effect can’t determine whether exposure to a piece of suicide-related media causes individuals to commit suicide. The most that can be determined is a correlation, which is definitely present in regard to 13 Reasons Why. However, this correlation, tragic as it may be, is not enough to ask Netflix to pull the show because correlation does not prove causation. In addition to the fact that there is no proven causal relationship between 13 Reasons Why and teen suicide, the show’s creators have done a lot to help the vulnerable members of its audience. Along with the previously mentioned changes, like the editing of the death scene and the creation of 13 ReasonsWhy, the series page also has a list of trigger warnings to alert viewers to the potentially upsetting content. Viewers who choose to watch the show regardless of the warnings can always choose not to watch the scenes they may find upsetting.

As a viewer with prior mental health issues, I did not experience any suicidal ideation or other negative mental health impacts as a result of 13 Reasons Why. I watched in moderation and skipped any graphic scenes that I did not want to see, which made viewing the show a positive and helpful experience. I discussed its themes with my mother during episodes, and, while writing this paper, I discussed the themes amongst my peers and got a greater understanding of them through my peers’ experiences.

Though the show and the media attention surrounding it may focus on Baker’s death, 13 Reasons Why is about more than suicide. It speaks to teens’ unfortunate experiences like bullying, sexual assault, school shootings, mental health issues, drug abuse, homelessness, and more. Its mere existence is helpful to those dealing with suicidal thoughts because it has sparked a conversation between teens, parents, and educators and helped people become more aware of what their children or peers may be experiencing. While there is no evidence to say that 13 Reasons Why caused a rise in teen suicides, there is definitely evidence to suggest that the show started a conversation—one that will hopefully lead to better research and a greater understanding of methods of suicide prevention.