If you haven’t heard about the Netflix original show 13 Reasons Why (based on the book Thirteen Reasons Why  by Jay Asher), it might be a good time to acquaint yourself with the premise of the show. If you have a teenager, they have probably watched this show or are hearing all of their friends talking about it at school. 13 Reasons Why is a story about a 17-year-old teen named Hannah Baker who commits suicide and leaves behind 13 tapes for the 13 people that she says contributed to the decision to kill herself. The show has started a national conversation about teen suicide and how it has been portrayed in this show. 

The creators of the show and the author of the book have shared that they intentionally made choices in filming to demonstrate that suicide is real and that actions have consequences. They defend their choices to show graphic sexual assault scenes and a graphic suicide scene in a show geared towards teens and young adults.

The show has certainly sparked conversation about suicide, why it happens and how it impacts survivors of suicide. However, there are many things about the way the show presents suicide that concern me as a mental health professional. My primary concern is that teenagers who are binge watching this show on Netflix do not have the ability to process what is accurate and what is inaccurate about how suicide is portrayed in this series. 

Though you can not “catch” a mental illness, suicidal contagion is something that is well documented by research. Suicidal contagion is a very real phenomenon in which publicity surrounding a suicide is linked to a subsequent increase in suicide, especially among teenagers and young adults. Fictional dramatizations, such as the one in 13 Reasons Why, have been associated with a risk in suicide, as demonstrated by multiple researchers. It is important not to glamorize suicide or to make it seem like a simple solution for escape.

The way that media covers suicide can increase the rate of suicide if the suicide is not discussed in a responsible manner. This risk increases when the suicide method is described, or in the case of 13 Reasons Why, is shown in an extremely graphic scene that plays out as a how-to guide for suicide. Another concern is that imagining that you can kill yourself to get back at people who wronged you "feels like an adolescent fantasy," according to Dr. Victor Schwartz, medical director of the JED Foundation.

13 Reasons Why has started a conversation about teen suicide and introduced a way for parents, teachers and counselors to talk about suicide in a way that may feel more accessible to teens. Talking openly about thoughts of suicide and about emotional distress is okay and will not increase someone’s risk of suicide if they are already having suicidal thoughts. There are resources available for anyone who is having suicidal thoughts. However, 13 Reasons Why shows Hannah reaching out to a school counselor who is unable to identify that she is struggling or help her. This is not an accurate portrayal of mental health providers and discourages teens from reaching out if they need help. 

13 Reasons Why can be dangerous for teenagers to watch without any support or talking points with an adult. The show is not an accurate portrayal of what happens when a teenager commits suicide. It is a fantasy of an adolescent who is able to speak from the grave though audio recordings and find a way to blame others for her suicide. Though there are other students who are shown bullying Hannah or treating her badly, there is no exploration of the underlying mental health issues that Hannah may be experiencing. Of course, it is an important lesson that we should always treat others with care and kindness because we do not know what they are going through. However, there is nothing romantic, glamorous, or justified about committing suicide. 

13 Reasons Why is not reality. It is a scripted TV show based on imagined events. Though I believe that teenagers have the ability to separate reality from fiction, for a teenager who is experiencing suicidal thoughts and mental health issues, this separation may be more difficult. It is important to treat watching 13 Reasons Why with care for those who may be at risk for suicide. 

If you or someone you know is considering suicide, please call the National Suicide Prevention Lifeline. We can all help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. 1-800-273-8255

​Setting healthy boundaries with our schedule sounds like a wonderful concept. By saying no we open up space our on schedule, avoid being involved with things we don’t really want to do and generally feel more mentally healthy. Boundaries are important because they are the way that we communicate with others what is and is not okay in their interactions with us. Healthy boundaries help us have a sense of control over our lives and our schedules. Boundaries can often keep us from feeling helpless or overwhelmed. 

So how can we say no? For some of us, saying “no” might be something that comes easily and naturally. For others of us, saying “no” might feel completely counter to how we operate. Our first instinct might be to say “yes” and commit to something regardless of whether or not we have the time to do it. 

Here are a few steps for saying no: 

Stop and think when someone asks you to do something. If your first instinct is to always say “yes!” then you need to give yourself time to consider whether or not you can actually commit to something. It is perfectly acceptable to tell someone that you need to check your schedule or you need some time to think about something before you commit. 
Be kind and firm. Saying “no” isn’t a bad thing. You might have to untrain your brain from thinking that it is. Saying “no” is completely acceptable! If someone asks you to do something, asks you to come to an event or even asks you a question that you don’t feel comfortable answering - it is completely okay and healthy to tell that person no. 
Be clear. It can be tempting to be vague when saying no because it feels less harsh. We’ve all said “we will try to make it” when we have absolutely no intention of going to something. However, being clear from the beginning can help from disappointing others or being disingenuous. 

The secret to setting healthy boundaries is practice. Setting boundaries may feel strange and awkward at first. However, with practice we can find clarity and discernment around kind ways that we can set boundaries with others. 

When I start to feel overwhelmed by life the first thing I do is check in with myself on whether or not I am practicing healthy boundaries. Am I saying “yes” too often? Is my calendar completely filled with absolutely no space for anything else? 

Life can be filled with so many wonderful opportunities to say “yes!” to something. We can fill our calendar with good things: coffee with friends, volunteer work, helping a coworker, going to a birthday party. Saying “yes” is easy when saying “no” feels uncomfortable or unkind. Saying “yes!” is easy when we are saying yes to things that are helpful, are fun and are good. 

But are you at the point where you’ve said yes so many times that you feel like you’re drowning in obligation? Are important things - like your health, your relationships, your self-care - being ignored because you’ve filled your calendar with “yes!”? 

There are so many things that I love to do. If I had enough hours in the day I would do absolutely everything that I wish I had time for. But when I fill my calendar with everything I miss out on everything else. 

You can do anything but you can’t do everything. There has to be space on your calendar for margin in your life. Living from activity to activity makes us mindless, simply going from one thing to another. Learning to say “no” can actually help you be more mindful about the things that you chose to do. If you don’t have space for self-care in your calendar then you may be having a hard time setting healthy boundaries. 

Not sure how to set healthy boundaries? Check back for our next blog post where we talk about strategies for saying “no” in a way that is firm but kind. Thank you for reading!