Sushant Singh Rajput. Photo: Twitter/@itsSSR.
Trigger warning: Discussions of suicide.
Before June 14, 2020, I had no idea who Sushant Singh Rajput was. This does not reflect on him but on my age, my old-fashioned reading habits and ignorance of all matters Bollywood. But after the report of his tragic death that day, it has become impossible to escape the headlines in newspapers and the sensational coverage on TV day after day.
About 30 years ago, I had attended a conference on injury prevention, and learned there that journalists need to report suicides and murders very carefully and sensitively – or the articles thus written could cause emotional harm to victims’ relatives and friends, and could even result in copycat murders and suicides. Not surprisingly, on July 31, the press reported that a 30-year-old TV actor and a 13-year-old girl had also died by suicide, using the same method as Rajput.
The idea that the publicity of suicides can encourage more suicides is not new. In 1845, Amariah Brigham, the founder editor of the American Journal of Insanity, claimed:
“No fact,” says a late writer, “is better established in science, than that suicide is often committed from imitation. A single paragraph may suggest suicide to twenty persons. Some particulars of the act, or expressions, seize the imagination, and the disposition to repeat it, in a moment of morbid excitement, proves irresistible.” In the justness of these remarks we concur, and commend them to the consideration of the conductors of the periodical press.
In 1911, the American Academy of Medicine devoted a section of its annual conference to this matter and the participants labelled the press as “incendiary literature”, “vile and pernicious” and “an accomplice in crimes against the person” for publicising suicide cases and associated details. The British Medical Association moved in 1948 to prohibit press reports of inquests in cases of suicide, observing that the publicity might lead to imitative suicides.
Research on this issue continues to date. Initially, the focus was on the printed press, then movies and television, and now includes the social media as well. More than 150 studies have investigated the effect of media reports on incidence of suicide. Media reports on suicides resulting in copycat suicides have also been dubbed the Werther effect, based on a reported spike in suicides in young men in Germany and across Europe after the publication of Johann Wolfgang von Goethe’s The Sorrows of Young Werther in 1774.
In 2003, in a major study, Madelyn Gould of Columbia University and her colleagues summarised findings from studies around the world and stated that the phenomenon of copycat suicides has been documented in many other countries besides the US, including Austria, Germany, Australia and Japan. This added to the extensive work prior to 1990 in the US, which found considerable evidence that suicide stories in the mass media, including newspaper articles, are followed by a significant increase in the number of suicides. They concluded that “suicide contagion is the process by which one suicide facilitates the occurrence of a subsequent suicide. Contagion assumes either direct or indirect awareness of the prior suicide. Imitation, the process by which one suicide becomes a compelling model for successive suicides, is one underlying theory to explain the occurrence of contagion”.
Patricia Ortiz and Eindra Khin Khin of the George Washington University reported in 2018 that research largely supports the view that traditional and new media reporting on suicide can and does have a significant impact on suicide rates. More recently, a systematic review of all studies ever reported on the association between suicide reporting in the media and suicide was published in March 2020 by Thomas Niederkrotenthaler of the Medical University of Vienna, along with 12 other researchers from ten research institutions. After screening 1,496 publications, they studied the full texts of 143 studies and selected 31 for further analysis. Their conclusions include the following findings:
* Increase in total suicides in the period after the report of a death by suicide of a celebrity
* When the press reported the method used by the celebrity, researchers found evidence of a corresponding increase in the number of suicides by the same method
* Three mechanisms explain the increase in the number of suicides associated with reporting on suicide: (a) identification with the deceased person, which might occur more frequently when the suicides concern individuals in high0social standing, (b) increased media reporting of suicide leading to normalisation of suicide as an acceptable way to cope with difficulties, and (c) information on suicide methods, which might influence the choice of method by a vulnerable individual.
Several countries and organisations, including the WHO, the Samaritans, the American Foundation for Suicide Prevention and several countries, such as Australia, Canada, the US and the UK, have developed guidelines for media reporting on suicide. New Zealand stands alone as the country with criminal laws governing what can be said publicly about a suicide. Specifically, starting in 1988, it became a criminal offence to report details of suspected suicides without the coroner’s ruling that it was safe to publish the details. In 2006, this law was tightened further with the Coroners Act, which restricts reporting or publicly discussing specific aspects of individual deaths.
A 2017 WHO report summarised recommendations in the form of what should or should not be done (I have collected them and others below as a table). It is telling that almost no media outlet or official agencies in India have paid any attention to these guidelines for decades. Public health organisations, mental health professionals and media regulators need to give much more importance to the monitoring of newspapers, TV and social media in the reporting of suicides according to well-established norms.
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Dos and don’ts
Don’ts first
1. Do not use big or sensationalistic headlines, or prominent placement (e.g., “Katie Used X-Object”).
2. Do not include photos/videos of the location or method of death, grieving family, friends, memorials or funerals. Don’t explicitly describe the method used. Don’t provide details about the site/location.
3. Do not describe recent suicides as an “epidemic,” as being “skyrocketing” or other strong terms.
4. Do not describe a suicide as inexplicable or “without warning.” Avoid reporting that a suicide death was “caused” by a single event, such as a job loss or divorce, since research shows no one takes their life for one single reason.
5. Do not say that a suicide note was left behind and share its contents.
6. Do not quote police officers, first responders or doctors not expert on the subject about the causes of suicide. Apply caution when interviewing bereaved family or friends.
7. Do not refer to suicide as “successful,” “unsuccessful” or a “failed attempt.” Do not use the word “committed”.
Dos
1. Inform the audience without sensationalising the suicide and minimise prominence (e.g., “Katie Dead at 27”) and apply particular caution when reporting celebrity suicides. Don’t unduly repeat such stories.
2. Use school/work or family photo. Include hotline or local suicide help numbers. Do provide accurate information about where to seek help.
3. Carefully investigate the most recent NCRB or international dataset and use non-sensational words like “rise” or “higher.”
4. Most, but not all, people who die by suicide exhibit warning signs. Include the “warning signs” and “what to do” from scientific sources.
5. About don’t #5: saying “A note from the deceased was found and is being reviewed by the investigators” is preferable.
6. Report on suicide as a public health issue and quote from available guidelines without spreading myths.
7. Describe as “died by suicide” or “took his/her life”.
If you know someone – friend or family member – at risk of suicide, please reach out to them. The Suicide Prevention India Foundation maintains a list of telephone numbers (www.spif.in/seek-help/) they can call to speak in confidence. You could also refer or accompany them to the nearest hospital.
Dinesh Mohan is an honorary professor at IIT Delhi.