For Those at Risk of Suicide, the Internet Can Both Hurt and Heal
Life online poses an array of hazards, amplifying hostility and encouraging dangerous impulses. But when used wisely, it can do the opposite. How can vulnerable individuals navigate this divide?
By Jesse Bering Ph.D. published November 6, 2018 - last reviewed on April 19, 2019
Have you ever done something that you immediately regretted? Something along the lines of, just for example, mailing a melodramatic love letter to the object of your infatuation in which you confess your endless longing and burning gay desire for him, without knowing—or in fact having any reason whatsoever to believe or even suspect—that this person, this perfect young Adonis whose initials you've secretly been scribbling in your notebook every day for the past two years, is anything but straight?
Okay, fine, maybe it's just me.
Nevertheless, this is the predicament in which I found myself as an easily mortified, closeted high school junior who made a boldly romantic move in a time of lucid stupidity. What might make for a formulaic secondary plot in some crappy teen romcom was in fact a nightmarish situation for me in small-town Ohio in 1992. For four torturous, relentlessly worrisome days, I experienced a level of anxiety, hopeless despair, and shame that I'd never known before. I'd soon convinced myself that the other boy was undoubtedly straight and, having foolishly entrusted him with an amount of discretion impossible for our age, I braced myself for my heterosexual mask being ripped off in the most painful of ways. Every waking moment, my head was filled with visions of what was to come: the onslaught of homophobic slurs in the hallways, my overnight metamorphosis into a pariah, the excruciatingly awkward conversations with my family.
At my nadir, I found myself at the top of a hundred-foot reservoir near my house, where I stared down at the valley of the massive dam and visualized, over and over, my body falling fast, whistling in the wind, thudding into the concrete sides. What prompted these suicide-fantasy excursions was a craving for quiescence, a desperate muting of my furiously buzzing thoughts. I wanted out of my head. I was in an altered state of consciousness, one that I now know to be paradigmatic of the suicidal mind.
Imagine my relief, then, when the following Monday, I discovered my own unopened letter in the mailbox, with a gloriously bureaucratic "Return to Sender/Wrong Address" stamped in faded red ink.
I don't know if I would have survived my love letter episode if texting or email had existed then. I also recall an incident in which I wrote a long and steamy note (are you beginning to see a pattern to my problems?) to my "beard" when I was a bantamweight high school freshman. That note got passed around, Xeroxed, and, by the end of second period, was pin-tacked in multitudes to the bulletin boards in the cafeteria and hallways. But the point is, humiliation tactics were much shorter-lived back when I was a teenager.
I think I breathe a collective sigh of relief on behalf of an entire generation of former teen misfits who traveled through those unsteady pimply years before social media came along and upended absolutely everything.
Cyberbullying, which has been defined as "the use of email, cell phones, text messages, and internet sites to threaten, harass, embarrass, or socially exclude," affects an estimated 20 percent of middle and high school students. From a mental health perspective, experts believe that this form of victimizing can be even worse than its "real world" equivalent. Cyberbullying can occur day or night, intruding into the otherwise safe haven of the home and anywhere else where there's a cell phone or internet connection. Nasty messages, embarrassing pics, and public smears are instantly distributed to one's peers and often a wide network of complete strangers. One recent meta-analysis, which included nearly 285,000 participants ages 9 to 21, found that being the victim of cyberbullying was more likely to lead to suicidal thinking than getting stuck in the crosshairs of old-school traditional bullies. Cyberbullying has become so problematic that the Centers for Disease Control and Prevention has designated it "a serious public health threat."
The online world exploits our evolved social psychology in predictable ways. Emory University psychologist Philippe Rochat calls rejection "the mother of all fears," and for an animal whose emotions are so tightly bound to what others think of it, the internet can be an incendiary device for igniting our deepest anxieties.
One of the best examples of our extraordinary sensitivity to being "e-ostracized" comes from Purdue University social psychologist Kip Williams's cyberball experiments. In these studies, you're one of three players in what seems to be an innocent ball-toss game on the computer. The first few minutes go by nicely; the rules of social etiquette dictate that each of you tosses the ball to the next person. Suddenly, the other two characters, following a preprogrammed script, begin ignoring you; in an apparent snub, they're now throwing the ball only to each other. A few occurrences of this are enough to generate sadness and anger in participants.
Being ignored online is obviously a disagreeable experience in its own right. But for many cyberbullying victims, the experience is probably more akin to having the cyberball thrown right at your poor cyberface and breaking your damn cybernose. Over and over and over again. "The 'social network' is not the platform, but the community of people interacting between themselves through this platform," writes Matthieu Guitton, editor of the journal Computers in Human Behavior. "Some people may use this platform while forgetting—or sadly, not realizing—that behind each account is sitting one of us, another human being with his strengths and weaknesses."
The Wrong Kind Of Help
The internet has also given everyday people, including those who are actively suicidal, unprecedented access to material that, not so long ago, would have been off-limits to all but psychiatrists, police, and coroners. Although the most common online content about suicide stresses prevention, it's certainly easy enough to find—or stumble upon—less benevolent material. One content analysis of 373 websites that were found through the use of a set of suicide-related search terms revealed that 29 percent were anti-suicide (offering links to mental health resources and encouraging visitors to seek help), and 11 percent were pro-suicide (promoting suicide as a solution to problems and often including detailed information on various methods). Other sites the researchers examined were not focused on suicide or were characterized as "suicide-neutral."
For some, simple curiosity may be behind visits to websites with disturbing images or those featuring quasi-philosophical, rather than preventative, discussions about the subject. A 2013 study in the Journal of Medical Internet Research tells us that search terms that led people to pro-suicide sites included "committing suicide with a gas oven," "pictures of murder by strangulation," and "photo of a severe burn." Still, even if we grant that a fair proportion of these ill-advised sojourns are motivated by morbid interests, the worry is that there are many people genuinely on the edge who will find themselves poring over this lugubrious material as well. A recent cross-cultural study by a team of Finnish researchers found that the most likely visitors to pro-suicide websites include recent victims of online bullying.
Many of these sites, of course, prefer to trade under the heading "pro-choice" rather than pro-suicide. On one controversial Swedish website, which has been around since 2005, visitors are told: "The purpose of this page is to try to report all suicide methods existing in this world as objectively as possible. The idea is not to encourage anyone to end his life, but to spread information about the different methods." Despite this disclaimer, the content makes it clear that the site operators disagree with Camus's famous sentiment "... in the end, one needs more courage to live than to kill himself." The website's original dedication was to "everyone who has had the courage to flee from this hell by killing themselves." We're then offered a to-do list for mentally preparing ourselves for suicide.
At a certain point, the suicidal individual's capacity for inhibitory thought can become impaired; with a drone-like focus on concrete details, abstract thinking that would normally generate spiritual or other protective ideas about, say, finding hidden purpose in suffering are alarmingly absent. Such dangerously irresponsible advice gas-pedals this most precarious state of disinhibition.
When it first aired in March 2017, the controversial Netflix series 13 Reasons Why—based on the popular young adult novel of the same name by Jay Asher—caused a huge stir in the suicide prevention community. The gist of the story is that high school junior Hannah Baker has killed herself because the people in her life treated her poorly. While her locker turns into a colorful memorial decorated with Post-it Notes about how much she'll be missed, we learn that before her death, Hannah recorded a series of audiotapes in which, as the title of the series alludes, she explains why she did it. Given that the target audience for the series is 15- to 19-year-olds, an age range especially at risk for copycat suicides, a lot of adults were very concerned about this glamorized portrayal of a tragic heroine who "defeats" her tormenters by taking her own life.
The decision to show a graphic, three-minute scene of Hannah slitting her wrists in the bathtub seemed to shrug off all caution. The TV executives ultimately ignored research-backed warnings about the possible contagious effects of depicting suicide methods on adolescent viewers who might see such portrayals as step-by-step instructions.
In an opinion piece for Vanity Fair, Nic Sheff, one of the series' executive producers, presented the traditional counterargument for how society should be handling this sensitive issue with teens. "Facing these issues head-on—talking about them, being open about them—will always be our best defense against losing another life," wrote Sheff, a suicide-attempt survivor himself.
Clearly, many people do benefit from speaking openly about the plague of suicide. It's complicated, though. The data paint a complex picture in which raising public awareness of suicide, along with other well-meaning attempts to reduce the stigma attached to it, can make some already suicidal people more likely to take their own life. For instance, suicide is among the leading causes of death in teens, but by conveying the message that teen suicide is common—when in fact the base rate of the behavior is quite low—efforts to "de-stigmatize" it may inadvertently lead some vulnerable adolescents to believe it's less unacceptable.
A brief study published in 2017 may have confirmed, at least indirectly, critics' worst fears about 13 Reasons Why: A group of "infodemiologists" led by John Ayers at the University of California San Diego revealed that Google searches for suicide-related terms and phrases rose dramatically following the series premiere. Although some of that rise can be attributed to precisely the types of help-seeking behaviors the producers of the show wanted to encourage—phrases like "suicide hotline" (up 12 percent) and "suicide prevention" (up 23 percent)—the spike was also associated with far more worrisome Google searches. "How to commit suicide" shot up by 26 percent, "commit suicide" was up 18 percent, and "how to kill yourself " rose 9 percent. These data don't necessarily reflect an increase in actual suicides, but similar studies in the past have found a clear correlation between suicide rates and online searching.
Suicide contagion via the media is nothing new. After Goethe published his popular 1774 novel The Sorrows of Young Werther, in which the lovelorn protagonist—dressed meticulously in black riding boots, a yellow vest, and a blue coat—shoots himself in the head while at his writing desk, numerous young men dressed in similar attire, often with a copy of Goethe's book open before them or tucked in a breast pocket, were found dead in the identical manner. There were so many casualties from this so-called "Werther effect," in fact, that, for a time, the book was banned in several European cities.
Sociologist Steven Stack at Wayne State University, who has led the charge in advising the media on responsible reporting around the subject of suicide, published a sort of meta-review nearly two decades ago of all available data on the subject of suicide contagion. Although the findings weren't always clear-cut—with some studies indicating a significant copycat effect and others showing none at all—Stack was nevertheless able to discern a few reliable trends.
Perhaps the most revealing pattern was that finding a copycat effect depends largely on how researchers define the term. If we include as evidence rates of attempted suicides rather than just completed suicides, then we're far more likely to find that media exposure to suicide stories does, in fact, inspire copycats. News coverage of suicides may not always lead to an increase in actual suicide deaths, in other words, but it almost always leads to a notable spike in suicidal behaviors.
Stack also determined that a copycat effect is more likely to be found for stories that center on real, not fictional, suicides. That doesn't mean that fictional suicides won't lead to copycats, but that, overall, they're somewhat less likely to have this effect. Additionally, by taking the perspective of the misunderstood decedent whose suicide leads to public outpourings of remorse, recognition, and appreciation—as in the wake of the recent suicides of Kate Spade and Anthony Bourdain—copycats may erroneously anticipate a future self enjoying a similarly positive social response after their own untimely deaths.
An axiom of the electronic age, of course, is that the dead are often memorialized online. These displays of adoration can be dangerously seductive to young people who covet social media approval.
In a 2012 article for the journal Crisis, Lindsay Robertson, a New Zealand-based researcher in preventive and social medicine, analyzed the content of online memorials dedicated to young suicide victims. "These pages typically included photos or slideshows of the deceased young person, videos, poems, statements about suicide, and messages posted by friends and family members acknowledging the person's life," Robertson and her colleagues wrote. One of the victims in this memorialization study also had an elaborate funeral that was filled to capacity owing to the details of the event being circulated widely across the decedent's social media accounts. "Sources reported that young people were heard commenting on how impressive the funeral was," Robertson and colleagues wrote, "and how they hoped their own would be similar."
This isn't to say that we shouldn't mourn, or indeed celebrate, those lost to suicide—only that it's a dangerous mix when the digital age puts such a premium on clicks, views, likes, followers, and comments, and the only perceived guarantee of receiving such attention (or perhaps just halting an assault of negative judgment) is death.
The internet is a manifestation of human nature, and because of its unique capacity to bridge formidable social divides, it's important to emphasize that it can also summon an astonishing amount of good in us.
The positive influence of media on suicide prevention was dubbed the "Papageno effect" by Austrian suicidologist Thomas Niederkrotenthaler in a 2010 article in the British Journal of Psychiatry. The literary, and literal, opposite of the Werther effect, it is so named after a scene from Mozart's opera The Magic Flute, in which the lovesick character of Papageno is persuaded by the spirits of three young boys not to take his life when he becomes desperately suicidal.
It's difficult to measure how many lives have actually been saved by having relatively effortless access to concerned others, but major social media companies now have fairly simple mechanisms in place for users to anonymously report posts that threaten or indicate self-harm or suicide. The flagged posts are triaged by a team that quickly assesses the relative risk for each submitted case. Once the online alarm button is pushed, network responses might include reaching out to the original poster to help that person liaise with a trained crisis counselor or someone from the nearest suicide prevention organization, or—in the most urgent scenarios—sending first responders to the individual's home. (Some companies, including Facebook, are currently experimenting with artificial intelligence to automatically detect suicidal users, but so far these efforts have been hit-or-miss.)
Online interventions also hold promise for reducing the stigma surrounding suicide. Because many people fear being ostracized as a result of sharing their thoughts of self-harm, suicide-related stigma is a formidable barrier to efforts that encourage help-seeking behaviors. In a study published this year in Behaviour Research and Therapy, researchers from Florida State University administered the "Stigma of Suicide Scale," for which participants rated how much they agreed or disagreed that suicide is "an embarrassment," "stupid," "cowardly," "immoral," and so on. Next, they were randomly assigned to peruse one of three websites for 20 minutes. These included a website filled with facts, figures, resources, and descriptions of risks and warning signs (suicidepreventionlifeline.org); another featuring first-person testimonials, portraits, and stories of recovery from suicide-attempt survivors (livethroughthis.org); and a control website matched for health-related content but unrelated to suicide. People who viewed one of the suicide-prevention websites displayed an immediate reduction in their suicide stigma score. For participants who reported no personal experience with suicide prior to the study, this drop in negative judgments persisted a month later.
More generally, the relative anonymity and access to similar others afforded by the internet can lead to greater self-disclosure, which is a central part of suicide prevention initiatives. To receive assistance, the suicidal must share. A frustrating finding is that those most at risk of suicide are often the hardest to reach, because unlike nonsuicidal people dealing with personal crises, suicidal people often refuse help. In the offline world, there is a negative correlation between degree of suicidality and help-seeking behaviors. Yet a recent study by Australian psychologists Amy-Lee Seward and Keith Harris indicated that young suicidal adults may become more willing to reach out for help online—specifically, on social media—as their suicide risk increases. "If you were experiencing suicidal thoughts," participants were asked, how likely would they be to seek help from various sources? The list included one's partner, relatives, friends, doctor, online or offline mental health professionals, support sites, social networks, and anonymous online forums. Compared to those at lower risk of suicide, young adults at the highest risk expressed more reluctance to seek help face-to-face but an increased willingness to go to social networking sites for help.
Internet relationships are often, for better or worse, the most significant and sometimes the only meaningful social ties that a person has. For those who lead busy lives and have few opportunities to regularly share their problems with like-minded others dealing with similar daily stressors, online support systems can be lifesavers. Take veterinarians, who have one of the highest suicide rates of any profession. Recently, I spoke with Carrie Jurney, a veterinary neurologist based in San Francisco and one of the moderators of the private Facebook group NOMV (Not One More Vet), which claims 10 percent of all U.S. veterinarians in its membership. The formation of the group was inspired by the 2014 suicide of Sophia Yin, a popular vet and animal behaviorist who'd been in the public eye for years as a television host on Animal Planet as well as being a writer, speaker, consultant, and peer educator. "Because she was such a positive force," Jurney told me, "it was kind of a gut kick, you know? Like, if it can happen to Sophia, it can happen to any of us."
The fledgling community quickly grew through word of mouth, meeting what was, apparently, an enormous unspoken need for people in this field. As with most medical professions, stress is rampant and impossible to avoid, but there are also some special aggravations inherent in being a veterinarian. "One of our members put it really perfectly the other day," Jurney told me, "about the emotional roller coaster she has to go on every day at work, where for five minutes she's excited about seeing a new puppy and educating the owners about it, the next five minutes she has to give terminal news, the next five minutes she's counseling someone through a bad decision regarding a pet's treatment, and the next five minutes someone's yelling at her about a bill. When you consider that a good week for the average vet is 50 hours and a bad week can be closer to 90, it's a lot to take on, emotionally."
I asked Jurney what sort of conversations tended to take place on the NOMV Facebook page. "A lot of it is just people talking to people who understand," she said. "It's the equivalent of going out for a beer with your colleagues after work and letting off steam. It's just that all of our hours are so different, and we don't have time to do that in the real world. There's a lot of talk about self-care and a lot of check-ins with people who are having a bad day. We surround our members with people who care. For veterinarians who need help, but feel as though they cannot afford to walk away from their practice, we've had the community rally to cover their clinic while they go to inpatient care."
One thing that probably makes NOMV—and other groups like it—so effective is the emphasis it places on the real-world identities of its members. Names and faces are transparent to everyone in the private network. This way, people genuinely get to know one another as complex individuals, not just caricatures with drive-by comments. This structure cultivates true relationships that sometimes spill into the offline world, benefiting people's careers, families, and overall well-being.
When people know that they will be held personally accountable for their words and behavior, altruism flourishes. Funny how that works.
Jesse Bering, Ph.D. is the author of Suicidal, Perv, Why Is the Penis Shaped Like That?, and The Belief Instinct. He is the director of the Centre for Science Communication at the University of Otago in New Zealand.
Reprinted with permission from Suicidal. © 2018 by Jesse Bering. Published in the United States by the University of Chicago Press. All rights reserved.
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