It was another tragic week with news of two celebrities' suicides. The tragedy is compounded by knowing these were two of a multitude of daily suicides in the U.S. alone; the CDC tells us there were over 44,000 deaths by suicide in 2015. The urgency of this piece is not about the epidemic nature of these numbers but about the role of the media itself. The story begins in Germany in 1774 when a novel, The Sorrows of Young Werther, was first published.
As the title intimates, the book chronicles the misadventures of Werther, opening with the foreboding line, "How happy I am that I am gone." After a series of disappointments, including seeing his beloved Charlotte married to another, the protagonist, young Werther, ends his life in despair by suicide. The book was an instant best-seller, establishing Johann Wolfgang von Goethe as an author, kicking off his path to becoming one of the greatest writers of all time. What followed was a wave of suicides by young men, some dressed like Werther, some using similar pistols. The book was banned in many countries but eventually fell into the mainstream of European romanticism and gave us the Werther Effect.
The Werther effect is defined as "an increase in suicide rate linked to media coverage of suicide." The size of the effect is non-trivial and has been shown in epidemiological studies time and again in several countries including the U.S., the United Kingdom, Austria and Korea.
Media guidelines on reporting suicides have also been shown to be effective in decreasing suicide rates. Well-crafted messages following such guidelines have the potential to reverse the Werther Effect by actually decreasing the suicide rate in what's known as the Papageno Effect.
In Mozart's opera The Magic Flute, Papageno prepares to kill himself when he fears he has lost the object of his love. He's then saved by three boys coming along and giving him alternatives to dying. In the Internet Age, one fears Papageno has a small following while Werther is still retweeted widely.
The World Health Organization has a quick reference guide for responsible reporting on suicide with a list of Do's and Don'ts. Here are five of the six Don'ts that were repeatedly done this past week in the news:
• Don't place stories about suicide prominently and do not unduly repeat such stories;
• Don't use language that sensationalizes or normalizes suicide, or presents it as a constructive solution to problems;
• Don't explicitly describe the method used;
• Don't provide details about the site or location;
• Don't use sensational headlines.
These reports reach populations with a significant risk of suicidal behavior and are shared, commented on, perpetuated and misapprehended.
An analysis of long-term covariation between suicide trends and reporting was consistent with a long-term Werther effect contributing to the establishment of suicide as a mass phenomenon in the 19th century. Let's heed the lessons of failure and prevent the same from happening in our adolescent 21st century.
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Dr. Erick Messias, M.D., MPH, Ph.D., is the associate dean for faculty affairs of the College of Medicine at the University of Arkansas for Medical Sciences in Little Rock.
Editorial on 06/15/2018