A Tale of Two Portrayals: Suicide and Eating Disorders on Netflix

Two recent projects by Netflix, 13 Reasons Why and To the Bone, have attracted attention among public health officials for their portrayals of serious issues – rape, suicide and eating disorders.

13 Reasons is based on the popular novel by Jay Asher and involves a teen who commits suicide (in a heart-wrenching, four-minute wrist-cutting scene) after sending cassette tapes to 13 people she ‘blames” for her troubled life. The film has come under fire for what critics say are depictions of youth suicide and rape in graphic ways that could influence vulnerable teens. A study last week in the journal JAMA Internal Medicine reports there were between 900,000 and 1.5 million more suicide-related searches overall in the 19 days after the show’s release than would normally be expected during the same period—many of them searching for information about suicide methods.

To the Bone delves into the world of anorexia. It is a semi-autobiographical account of writer Marti Noxon’s battle with the eating disorder as a teen. The leading actress Lilly Collins lost 20 pounds to prepare for the role, and has openly discussed and written about her own battle with an eating disorder.  Some health experts voiced concern for the actress and the possibility of the experience triggering a relapse for her, and others commented that the real horrors of the disease were not shown in enough graphic detail.

But in comparison to 13 Reasons, this film was more widely acclaimed for portraying a nuanced look at the underlying issues of eating disorders and raising awareness. Further, the creative team involved consulted with other survivors as well as public health groups such as Project Heal, and were able to weave some educational messages into the script. Project Heal offers a To the Bone advice and discussion guide for viewers who want to explore the issues in the film.

Producers and writers of both projects stand by their choices. Both projects creative teams appear committed to exploring their respective issues, and they did so in ways that only could be done through narrative storytelling – placing us inside the minds and bodies of two young women and helping audiences to experience their pain. Both teams sought to tell serious and important stories and both wanted their projects to start a dialogue about subjects often seen as taboo. For this they should be commended, as should Netflix, for taking on this subject matter.

And yet, 13 Reasons producers seemed surprised by the outcries from public health community after the series aired. Their vision was to show the brutal gory truth of what a real suicide looks like, believing this would act as a deterrent to teens. They seemed unaware of the research that shows suicide portrayals statistically can lead to copycat suicides or contagion among teens, a group particularly likely to experience suicidal thoughts. Producers responded to criticisms by adding advisories and resource pages to their websites and to their films. They sponsored 13ReasonsWhy.info as a global resource center for people seeking help or information.  But this backtracking could have been avoided if the producers had thought more deeply about the influence their series could have on their young audiences.  Their creation amounts to more than telling a compelling story – they offer a glimpse into attitudes and actions that could be adapted – a “how-to” manual of sorts. To the Bone producers were more authentic in their presentation, but critics still felt the nature of the material could cause trigger behaviors.

These are dedicated creative professionals sharing meaningful stories… but in their roles as producers, writers, directors, casting and make-up professionals, the project teams failed to fully realize the POWER of their work to influence real behaviors in real life.

At the Lear Center’s Media Impact Project, we study the impact of news and entertainment on audiences. Our goal is to prove that media matters, and to improve the quality of media to serve the public good. The Lear Center’s Hollywood, Health and Society program offers free expert advice to entertainment industry professionals on a wealth of media issues from leading experts in health, public safety and security. We invite the creative community professionals telling stories with possible public health issues to contact us if they have any questions about the effects their work might have on viewers.

Filmmakers are the storytellers of our time…  their work can easily reach millions of viewers. And here they have a challenge – recognizing that their stories have impact. They wield, in many ways, powerful force for emulating positive or negative behavior. They create, in fact, more than entertainment, more than a movie.  For as Plato said, “Those who tell the stories rule society.”

Netflix added this resource page for crisis services after the broadcast of 13 Reasons Why spurred outcry from school counselors and suicide prevention organizations.

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