Mar 15, 2021
Thomas Niederkrotenthaler is associate professor at the Suicide Research Unit at the Institute of Social Medicine, Center for Public Health, Medical University of Vienna. He is the co-chair of the International Association for Suicide Prevention's Media and Suicide Special Interest Group.
Reacting to suicidal revelations - is Piers Morgan right?
Research on suicide reporting suggests a surprising effect of Meghan's interview
by Dr Raj Persaud
Piers Morgan, a controversial TV host, has now left his national broadcasting position after expressing strong disbelief over Meghan’s confessions of suicidal thinking in her interview with Oprah Winfrey.
BBC News reports that Piers Morgan continues to stand by his criticism of the Duchess of Sussex. Ofcom, a regulator of broadcasting in the UK, is investigating his comments after receiving 41,000 complaints from the British public.
The duchess apparently formally complained to ITV about Morgan's remarks. It is reported that she raised concerns about how Piers Morgan's sentiments affect the issue of mental health, and what it might do to others contemplating suicide.
Is Meghan correct in her reported analysis? Or is Piers Morgan right to stand by his comments?
Or, in discussing suicide during an Oprah Winfrey interview, did she in fact make it more likely that others will self-harm?
Media reporting of suicidal behaviour has been found to contribute to an increase in suicidal thinking and actual suicides in the population. At this point Piers Morgan may argue the duchess is wrong to criticise him, and has only herself to blame, if there is a spike in suicides following the interview.
Recent research found that Google searches for “How to kill yourself” significantly increased after the release of ‘13 Reasons Why’, a popular Netflix American teen drama on the aftermath of high school student's suicide. The study calculated there were 900 000 to 1.5 million more searches than expected, for that time of year, in just over two weeks following the release of the series.
Another study, published in the Journal of the American Academy of Child & Adolescent Psychiatry in February 2020, estimated there were 195 additional suicide deaths among 10- to 17-year-old youths between April 1 and December 31, 2017, following the series’ release.
One of the first studies to investigate this effect, analysed 34 newspaper stories that reported on suicides, and found a 2.51% increase in suicide during the month of the publicity.
More worrying still, about the possible repercussions of the extensive reporting of Meghan’s suicidal thinking worldwide, is that, research by Professor Steven Stack, an expert on the sociology of suicide, based at Wayne State University, USA, found that studies measuring the presence of an entertainment celebrity in a suicide press report, are over 5 times more likely to find a copycat effect, while studies focusing on female suicide, were almost 5 times more likely to report a copycat effect, than other research investigating the impact of suicide reporting in the press.
Another example reported by Steven Stack is that in the year of the publication of a book which focused on self-harm via a particular method, suicide by that specific recommended method, increased 313% in New York City. In almost one third of cases a copy of the book was found at the scene of the suicide.
On average, following the media reporting of a suicide, approximately one third of persons involved in subsequent suicidal behavior appear to have seen the reporting of that suicide and may be copycat suicides.
The suicide of actress Marilyn Monroe was associated with a 12% increase in suicide.
One theory as to why reporting of a celebrity killing themselves or feeling suicidal, according to Professor Steven Stack, is that the vulnerable suicidal person may reason, ‘If a Marilyn Monroe with all her fame and fortune cannot endure life, why should I?’
Copycat suicides following media reporting of self-harm has been termed the ‘Werther Effect’, following a notorious historical incident after the publication in 1774 of a popular novel in which the hero kills himself. Entitled, The Sorrows of Young Werther the book by Goethe was rumoured to be responsible for a subsequent epidemic of suicide in young people. European authorities were so worried about its impact, that the book was banned in Copenhagen, Italy and Leipzig.
Goethe is reported to have commented on the phenomenon; “My friends … thought that they must transform poetry into reality, imitate a novel like this in real life and, in any case, shoot themselves; and what occurred at first among a few took place later among the general public …”
However, now new research suggests that, in fact, Meghan Markle in talking about suicide, may have indeed performed a positive service in terms of suicide prevention.
The study entitled, ‘Role of media reports in completed and prevented suicide: Werther v. Papageno effects’, refers to a ‘Papageno Effect’, which the authors claim may be the opposite of the ‘Werther Effect’, and happens when suicide rates go down following a particular kind of self-harm publicity.
The ‘Papageno Effect’, the authors explain, is based on Papageno's overcoming of a suicidal crisis in Mozart's opera ‘The Magic Flute’. If media reporting has a suicide-protective impact this should now be referred to as the ‘Papageno Effect’ the authors argue. In Mozart's opera, Papageno becomes suicidal upon fearing the loss of his beloved Papagena; however, he refrains from suicide because of three boys who draw his attention to alternative coping strategies.
Thomas Niederkrotenthaler and Gernot Sonneck from the Medical University of Vienna, Austria, led a team who analysed all 497 suicide-related print media reports from the 11 largest Austrian nationwide newspapers, including the term suicide, between 1 January and 30 June 2005.
Reporting of individuals thinking about suicide (not accompanied by attempted or completed suicide) was associated with a decrease in national suicide rates. This study suggests that media items on suicidal thinking, perhaps as described by Meghan in her recent interview, formed a distinctive class of articles, which have a low probability of being potentially harmful.
The study, published in the British Journal of Psychiatry found that in marked contrast, media stories attempting to dispel popular public myths about suicide, in other words articles that you would have thought would be helpful, and were intended to be helpful as regards suicide, were associated with increases in suicide rates.
Other articles associated with increases in suicide rates include stories where the main focus was on suicide research, items containing contact information for a public support service and also the reporting of expert opinions.
In other words, all the previous so-called expert opinion of how the media ought to report suicide was not actually linked to drops in suicide rates, but instead increases.
The authors conclude that the actual reporting of suicidal thinking may contribute to preventing suicide. Therefore, it follows that whatever Piers Morgan may think or believe about the Meghan interview, the latest scientific research suggests she may have performed a public service in drawing attention to suicidal thinking.
One theory as to why this might be the case include the suggestion that reporting someone thinking about suicide enhances identification with the reported individual, and thus highlights the reported outcome as ‘going on living’.
This research suggests a new public health strategy as regards suicide prevention. This may be most effective when articles are published on individuals who refrained from adopting suicidal plans, and instead adopted positive coping mechanisms, despite suffering adverse circumstances.
The authors refer to this kind of press story as ‘Mastery of Crisis’. One example they quote: ‘Before [Tom Jones] had his first hit, he thought about suicide… and wanted to jump in front of an Underground train in London… In 1965, before he made the charts with “It's not unusual”, he thought for a second: “If I just take a step to the right, then it'll all be over”.’
Whatever else you may think of her, or the interview, the key question becomes, did Meghan exhibit ‘Mastery Of Crisis’?
REFERENCES
Piers Morgan stands by Meghan criticism after Good Morning Britain exit https://www.bbc.co.uk/news/entertainment-arts-56343768
Internet Searches for Suicide Following the Release of 13 Reasons Why. Ayers JW, Althouse BM, Leas EC, Dredze M, Allem J. JAMA Intern Med. 2017;177(10):1527–1529. doi:10.1001/jamainternmed.2017.3333
Association between the release of Netflix's 13 Reasons Why and suicide rates in the United States: an interrupted times series analysis. Bridge, J, Greenhouse, JB, Ruch, D, Stevens, J, Ackerman, J, Sheftall, A, et al. J Am Acad Child Adolesc Psychiatry 2019; 28 Apr (doi: 10.1016/j.jaac.2019.04.020).
Suicide in the Media: A Quantitative Review of Studies Based on Nonfictional Stories. Steven Stack. Suicide and Life-Threatening Behavior 35(2) April 2005, 121-133
Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Thomas Niederkrotenthaler, Martin Voracek, Arno Herberth, Benedikt Till, Markus Strauss, Elmar Etzersdorfer, Brigitte Eisenwort and Gernot Sonneck. British Journal of Psychiatry, 197(3), 234-243. doi:10.1192/bjp.bp.109.074633