November 11, 2003

Suicide is a leading cause of death, substantially more prevalent than homicide. About 30,000 people kill themselves in this country yearly and half a million more wind up in the emergency room following a suicide attempt.

Does media coverage of suicide reflect these realities? Generally not. Instead, coverage tends to focus on a rash of suicides at a university; a study that finds evidence of family tendencies toward suicide; or the prominent, successful doctors, actors, writers, or business people who kill themselves.

And in some cases, we create written or unwritten rules not to cover suicide out of fear of inspiring copycats. Copycat suicides are a real problem, but suicide experts generally agree that it’s not a question of whether media should cover suicide, but how we do so.

Gauging from the news, it would be easy to conclude that suicide is rare, rather than a widespread and ongoing public health problem. As journalists, we’re fond of criticizing ourselves for over-covering homicide. Why do we fail to address our under-coverage of suicide?

In 1999, former Surgeon General David Satcher issued a “Call to Action to Prevent Suicide.” It was part of his unprecedented effort to draw attention to mental illness and its impact on our country.

Have we looked at whether and how that Call to Action has been heeded across the country? Have we considered funding and the lack thereof for suicide prevention programs? Have we drawn the connections between depression and suicide? Have we looked at the fact that elderly men are more likely than any other demographic group to complete suicide? Have we considered the implications of the fact that an average of 25 suicide attempts are made for every suicide that is completed?

As journalists, we’re fond of criticizing ourselves for over-covering homicide. Why do we fail to address our under-coverage of suicide?

It seems to me suicide needs to be covered in the context of mental illness, stigma, and lack of parity in health insurance. Why?

Mental illness is almost always present in a case of suicide. To report on suicide without discussing the role of mental illness is like reporting on a tornado without mentioning the underlying weather conditions. Tornados don’t whip up out of nowhere, and neither does suicide.

As for stigma — many of us still view mental illness as a sign of personal weakness, rather than as a brain disorder, which the best current science indicates that it is.

And this may be part of the reason for the well-documented and widespread lack of parity between insurance coverage of “physical” and “mental” illness. Despite the fact that mental illness is treatable, many people face obstacles every step of the way: doctors who don’t accept their insurance, insurers who severely restrict mental health care, medication they may not be able to afford, etc.

With those issues in mind, here are some basic principles to consider, culled from a variety of media guides on covering suicide, especially “Preventing Suicide: A Resource for Media Professionals,” put out by the World Health Organization:

  • Suicide is never the result of a single incident. So when the media focus mainly on a bad review received by a renowned chef in Europe prior to his suicide, we overlook a serious depression he had for a long time before his death — and squander an opportunity to talk about depression and its potential role in suicide. Blaming the media, or anybody else, for a suicide is not likely to be of much use.
  • Details of the method or the location a suicide victim uses may lead to copycat suicides. So in coverage of a suicide at an urban university, a reporter’s specific information about the victim diving to her death out of an apartment window just sensationalizes the incident. A reporter should not risk providing another person considering suicide with the details of how it can be achieved.
  • It’s vital to use statistics and mental health information very carefully. When a newspaper reporter notes that in addition to suicide being a leading cause of death among youth, schizophrenia also often emerges at this time of life, she is offering accurate information, but misleading readers. Schizophrenia is a devastating illness, and people with schizophrenia sometimes commit suicide, but with no indication of schizophrenia in a particular case, why mention it? It’s probably more helpful to note that mental illness (particularly depression) is generally associated with suicide, and that mental illness is treatable.
  • Suicide coverage is an opportunity to provide the public with information and resources that could save lives. Journalists often fail to do this, despite the obvious potential to do good. People who commit suicide do not do so suddenly, even if it might appear so at first glance. There are warning signs, and I think any coverage of suicide should incorporate them.

With regard to resources, many states have suicide prevention programs (but in the roughly half of states that don’t, it might be instructive to consider why not). Many other resources also exist (see sidebar at right).

Al Tompkins has provided resources and ideas on coverage of suicide several times in his Morning Meeting column (some examples: 7/16/02, 7/30/02, 10/14/02, and 10/7/03).

It’s important to avoid romanticizing suicide or suggesting it’s been used to “solve” a problem. When a newspaper report about a murder-suicide quotes unidentified family members saying the couple may have engaged in an “act of mercy” based on their failing health, the question is: Could that be taken by other seriously ill or dying people as a rationale for them to commit suicide?

Journalists face any number of difficult decisions when covering suicide. As in the case just mentioned, family members may be able to shed some light on the motivations that drove their loved ones to kill themselves. However, such speculation may imply a simple explanation, which in turn may suggest a logical reason.

What’s wrong with this?

It erases the line that separates motivation from rationality, making suicide seem like an understandable, if not unavoidable, culmination of a person’s experience. Suicide is not a rational act. It is an act of desperation, carried out after a monumental struggle.

Suicide is not a rational act. It is an act of desperation, carried out after a monumental struggle.I realize it is not universally believed that suicide is wrong in all cases. Certainly, many people say that a person experiencing great pain in the end stages of terminal illness should be allowed to die sooner rather than later. And it could be argued that Do Not Resuscitate orders fall into the category of suicide. Dealing with these issues in some cases may be vital. But the vast number of suicides are not carried out by terminally ill people.

Earlier I mentioned not incorporating into reports specific information about how a person commits suicide. This is probably the one thing suicide experts warn against that journalists do in almost every case. It makes perfect sense — we are trained to seek out and include detail. But consider: Do we need detail of this kind, or does it just serve prurient interest in the guise of journalistic curiosity?

Rather than focus on the details of a completed suicide, it might be more instructive and more helpful to discuss the effects of a suicide attempt — physical ramifications, regrets, and how that person’s life has proceeded after his or her survival.

I don’t advocate that we tape media guides on suicide to our walls and mindlessly follow every stricture listed. There may be cases in which NOT following the guidelines is appropriate.

Let’s say a bridge in town has become a focal point for suicide. In that instance, it’s possible that not covering this development might prevent policy makers, law enforcement, or even “ordinary” citizens from putting an important prevention program into place.

Also — at the risk of assigning blame — I do think it’s our responsibility to hold health insurers, agencies, and ourselves (as citizens, taxpayers, voters, etc.) accountable in cases where clear indications of suicidal behavior were ignored or mishandled.

And most importantly, we need to recognize that suicide is not an episodic story, but a chronic public health problem with individual and societal implications.

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