Let's Give Paris Jackson Some Privacy and Revisit Safe Reporting on Suicide (and Attempts)!

I always cringe when the announcement of a celebrity suicide or suicide attempt comes through my news feed.  First and foremost, because it is incredibly sad to learn that anyone is suffering enough to consider suicide.  Second, because the news coverage that will follow is often invasive and downright dangerous to the rest of us.  The way the media covers suicide can influence behavior negatively by contributing to contagion or positively by encouraging help-seeking.  I have often written on this topic for Pop Health and even as an op-ed for the Philadelphia Inquirer.  However, the message is so important that it bears repeating.

According to multiple news outlets, Paris Jackson (daughter of the late Michael Jackson) was hospitalized this morning after a suicide attempt.  The story was apparently confirmed by her biological mother Debbie Rowe- Paris was hospitalized with cuts on her wrists.  Now I was already concerned that a 15 year old girl was having these personal, medical details released to the media.  Then I saw the coverage on TMZ and just got plain angry.  I won't link to it here because (1) the irresponsible coverage could be dangerous to readers and (2) I refuse to drive traffic to their site.

As a journalist (or public health communication professional) working on this story, your first stop should be Recommendations for Reporting on Suicide.  Although the guide focuses on suicide, the recommendations are highly relevant for attempt stories as well. The recommendations were developed by leading experts in suicide prevention and in collaboration with several international suicide prevention and public health organizations, schools of journalism, media organizations and key journalists as well as Internet safety experts. The recommendations are based on more than 50 international studies on suicide contagion.  Based on their recommendations, here are some of my concerns with the Paris Jackson articles:

• Sensational headlines:  E.g., "Paris Jackson Attempts Suicide, Rushed to Hospital" (US Weekly)
• Oversimplification:  E.g., "A source close to the family tells Entertainment Tonight exclusively that the reason Paris attempted suicide is because she wasn't allowed to go to a Marilyn Manson concert".
• Including photos of the method of death (or in this case attempt):  TMZ has published multiple pictures of Paris (some undated) that zoom in on her wrists to identify possible cutting scars.  This is bad for several reasons:
• 1- Without any confirmation, the writers are suggesting that Paris has a history of suicide attempts.
• 2- The writers are suggesting that anyone who cuts their body is attempting suicide when in fact, some self harm behavior is non-suicidal.  A good resource for definitions of various forms of self-directed violence comes from the Centers for Disease Control and Prevention (CDC).  There can be self harm behavior (like cutting) without the presence (whether implicit or explicit) of suicidal intent.  

A lot can be learned in public health by monitoring this media coverage, highlighting mistakes, and reinforcing safe messaging.  The Paris Jackson articles should:

• Inform without sensationalizing
• Provide valuable education to readers (including suicide warning signs, ways to help a friend/family member, and resources like the National Suicide Prevention Lifeline)
• Seek advice from suicide prevention experts before reporting on data or making assumptions about Paris' intentions or medical history
• Be hopeful! Emphasize that mental illness is treatable and many local and national resources exist

Resources:

1.  Associated Press (New!) Stylebook Entry on Mental Illness
2.  Recommendations for Reporting on Suicide

3.  The National Suicide Prevention Lifeline 1-800-273-TALK (8255)

What Do You Think?

• What was your reaction to the media coverage of Paris Jackson's suicide attempt?
• What other resources would you add to my list to support safe media reporting on suicide and attempts?

"Call Me Crazy": Lifetime's New Movie That Champions Hope and Resilience Around Mental Illness

*Warning: it was difficult to write this post without including a few small spoilers, but I hope you'll watch the whole film anyway.

On Saturday April 20th, Lifetime debuted "Call Me Crazy: A Five Film".  The film (which boasts a star-studded cast and director list) includes five short stories that examine the impact of mental illness from various perspectives.  Each story is named after the main character: "Lucy", "Grace", "Allison", "Eddie", and "Maggie".

In the first story, we are introduced to Lucy (played by Brittany Snow).  Lucy, a law student, has recently been admitted to a psychiatric institution after experiencing a schizophrenic episode.  She is struggling to see how she can live a "normal" life that includes relationships and a career.  Her clinician encourages her to finish law school because she has insight into something very few people understand (mental illness)- so who knows how many people she could help?

In "Grace", we meet a daughter who has been living with a bipolar mother for her entire life.  Grace is played beautifully by Sarah Hyland from "Modern Family"- I loved seeing her in a dramatic role.  We see the "highs" and "lows" of her mother's condition.  We also see the devastating impact that it has on Grace's life when it is not treated.  Grace often plays the role of caretaker- making sure her mother is safe.  We see her struggle to have her own life aside from her mother's illness.

"Allison" offers the viewers a twist.  She plays Lucy's younger sister.  So we step back from Lucy's view and we see how mental illness has affected her entire family.  Allison's childhood, her sense of safety, her relationship with her parents- were all changed as a result of her sister's illness.  She has bottled up a lot of anger and finds it difficult to support her sister through her recovery.

"Eddie" introduces the only male main character.  He is suffering from severe depression.  He has withdrawn from his wife and his friends.  He has stopped receiving help from his therapist.  We watch his wife intervene after discovering that he may be thinking about suicide.

Finally, "Maggie" introduces topics that (unfortunately) are all too common these days- post traumatic stress disorder (PTSD) and military sexual trauma among our returning veterans.  Maggie (played by Jennifer Hudson) was victimized during her time in the Army and its lasting impacts are threatening her ability to have a healthy relationship with her family.  Here we get another update on Lucy- she is now a lawyer and is representing Maggie in court.

While each story stands on its own, Lucy's story is woven throughout "Allison" and "Maggie" as well.  I really liked this strategy.  Not only because I became invested in her character during the first story...but also because seeing her evolve over time helped to demonstrate some key themes from this film- hope and resilience.

As Lucy says to Maggie: "I am living proof". [Of what?] "That there is hope".  In court, Lucy reminds Maggie's judge that having mental illness does not mean that you are a bad person or a bad mother.  She also reminds him about the importance of social support, "it is nearly impossible to get well alone".  Even though we see all of these characters at their lowest point- there is still hope that they can feel better, have strong relationships, and contribute positively to the world.

It seems fitting that Brittany Snow's character delivers these messages about hope and resilience, as she is a strong advocate for them in real life.  Together with the Jed Foundation and MTV, she founded Love is Louder.  Love is Louder is an inclusive movement that amplifies messages of love and support to combat negative messages resulting from bullying, loneliness, and stigma.  She has also publicly shared her own battles with anorexia, depression, and self harm.

As a health educator, I highly recommend this film as a resource for discussing mental illness, suicide, stigma, social support, and help-seeking.  Since each story is approximately 20 minutes, they can be broken down into segments or watched all together.  This film is a great example of Entertainment Education, which is an area of public health that acknowledges the strong impact that television and movies play in educating the public about health issues.

If you or someone you know is struggling with a mental illness, please reach out:
National Suicide Prevention Lifeline (1-800-273-8255)

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Seth MacFarlane: An Oscar Host who is Harmful to Comedy and the Public’s Health

This week’s post for Pop Health was co-written by Beth Grampetro, MPH, CHES. Beth has been working in college health promotion for 7 years and her interests include feminism online and in popular culture. You can follow her on twitter @bethg24. 

The role of society is important in public health.  Health is not just influenced by individual decisions and behaviors.  It is also influenced by our interactions with the world around us- our communities, our families, our workplaces, our schools, entertainment, celebrities, and the media.  These interactions can have a very strong influence (good or bad) on the public’s health.

With that in mind, we were horrified to witness host Seth MacFarlane’s monologue and ongoing commentary during Sunday night’s Oscars.  According to Nielsen ratings, approximately 40.3 million viewers tuned in to the Oscar telecast.  This broad audience watched MacFarlane, a widely known celebrity, make jokes about domestic violence, female actresses’ bodies, and various forms of discrimination.

In the opening number, MacFarlane sang a song entitled “We Saw Your Boobs”, about the scenes in various movies where actresses in the audience had appeared topless. While it has been reported that the actresses were in on the joke, it is nonetheless disturbing that this number passed muster- especially given that several of the scenes he referenced were from movies where the actresses he named portrayed rape victims.

Other jokes included a reference to Jennifer Aniston’s past as a stripper, a congratulatory statement about how great all the actresses who “gave themselves the flu” to lose weight looked in their dresses, and a comment about how Latino actors (in this case Javier Bardem, Salma Hayek, and Penelope Cruz) have difficult-to-understand accents “but we don’t care because they’re so attractive.”

MacFarlane also tried some jokes that had men as their targets but still managed to get mud on a few women in the process. He joked that Rex Reed was going to review Adele’s performance (a reference to Reed’s recent movie review in which he called Melissa McCarthy a “hippo”) and made a joke about 9-year-old nominee Quvenzhané Wallis dating George Clooney. Some defenders of MacFarlane’s performance argued that these jokes were meant to be about the men in question, but ignored the fact that they were made at the expense of women and girls.

The Oscars are billed as “Hollywood’s Biggest Night”, and it’s incredibly disappointing to see what is the biggest event for the entertainment industry turned into the worst office party in history, complete with a leering coworker who’s creating a hostile environment.  If MacFarlane succeeded at anything, it was reminding women that they’re expected to always be thin, be pretty, and be willing to shut up and take it, lest they spoil the whole evening.

There is evidence to show that (unfortunately) these types of jokes and messages that devalue women are believed and internalized within our communities.  For example, a 2009 study by the Boston Public Health Commission found that over half of teens surveyed blamed the singer Rihanna after she was beaten by her boyfriend Chris Brown.  In addition, research shows that a mere 3-5 minutes of listening to, or engaging in, fat talk can lead some women to feel bad about their appearance and experience heightened levels of body dissatisfaction.

Research also tells us that these internalized messages and social norms are correlated with serious public health outcomes.  For example, the CDC outlines the risk factors for sexual violence perpetration.  Under society level factors we find (among others):

• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women's inferiority and sexual submissiveness
• Weak laws and policies related to gender equity

So the issue is much bigger than if Seth MacFarlane was funny or made a good Oscar host.  The issue is about the quality of the role models we choose to represent our communities and the messages they send.  These messages can have a broad and long lasting influence on public health.  We hope the Academy will choose wisely next year.