The effect of the media on suicide

1
The effect of the media on suicide

• Armin Schmidtke
• Paper presented at the
• Meeting on Suicide and Suicide Research
• On the occasion of the opening of the
• Beijing World Health Organization Coordination
  Centre
• 8th of March 2009
• Unit for Clinical Psychology, Department of
  Psychiatry and Psychotherapy, University of
  Würzburg, Germany
• NASP Karolinska, Stockholm
• WHO/EURO Network on Suicide Research and
  Prevention
• Prevention

2
Although the research results are not
unequi-vocal, the majority of research findings
demon-strates that suicidal behaviour can be
learnt by imitation. Therefore, today most
suicidologists also agree that media coverage of
suicidal behaviour can lead to imitation of this
behaviour. The divergent results of studies can
be explained by the theory of social learning by
Bandura and various differences of the studies.
3

• There exist already early clues for the
  influence of print media on attitudes towards and
  imitation of suicidal behaviour

Elisabeth Charlotte von der Pfalz wrote in 1718
that the French started to adopt English
manners (to commit suicide) and in 1722, that
suicidal behaviour started also to be fashionable
in Paris.
The sorrows of young Werther, by J. W. Goethe,
first published in 1774. Often quoted as first
case of suicide imitation caused by print media.
First reported prevention measures.
4

• Media also influence the attitudes towards
  suicidal behaviour.
• Positive presentation in the media correlates
  with a greater acceptance of suicidal behaviour
  (also assisted suicide) and higher suicide
  rates.
• (Schmidtke Fekete, 1996 Fekete, Schmidtke et
  al., 1998, 2001, Fekete et al., 1999,
  Niederkrotenthaler Sonneck, 2007))

5
In the development of suicidality there exists a
phase of suggestibility
Phases
Consideration
Ambivalence
Decision to commit suicide
Suggestible period for imitation of suicidal
behaviour
6

• Also in this suggestible period media can
  influence
• - the attitudes towards suicidal behaviour,
• - the contemplation of suicidal behaviour,
• - the choice of method and
• - the suicidal acting itself

7
The divergent results of empirical studies can be
explained by the theory of social learning by
Bandura and various differences of the studies.
8
Newer studies of suicide imitation

• In total 29 studies in Hong Kong, the United
  States, UnitedKingdom, Austria and
  Germany(Pirkis et al. 2005, Schmidtke, Schaller
  Wasserman, 2007)
• They differ in
• Methodology (design of the study)
• Kind of data
• - Focussing on population data
• - Focussing on clinical data
• Kind of suicidal behaviour (suicide or suicide
  attempt(s)
• Method of suicide or suicide attempt
• Similarity of model and recipient (observer)
• Sample(s)

9
Classification of Model Behaviourand Type of
Presentation
PRINT MEDIA
ELECTRONICMEDIA, INTERNET
SUICIDE-IDEAS
MUSIC
OTHER
SUICIDE-ATTEMPT
FILMS
TYPE OF PRESENTATION
SUICIDE
REAL
FICTIONAL
10
Paintings Photos Theatre Operas TV
Reports Films Video Clips Blogs
Kind of visual media depicting suicidal behaviour
Beautiful suicide, blog
The suicide of Lucretia, 1512
One picture is more worth than 1000 words
Google search in the Web (February
2009) 17.900.000 suicide images 2.340.000
Suicide photos 47.400 Suicide paintings
11
Media imitation effects depend on

• Understandable vs. incomprehensible
• (Schmidtke Häfner, 1988 Fekete Schmidtke,
  2004)
• Amount of publication(Phillips, 1974 Schmidtke
  Häfner, 1988 Etzersdorfer, 2000,Niedertrkroten
  thaler Sonneck, 2007)
• Number and type of recipients(Hassan, 1995
  Schmidtke Häfner, 1988,Etzersdorfer, 2000
  Marsden Attia, 2005Niederkrotenthaler
  Sonneck, 2007) (

12
Imitation effects depend on

• Similarities between model and observer
  (possible imitator) (Bollen Phillips, 1982
  Phillips, 1974 1977 Gould Shaffer, 1986
  Phillips Carstensens, 1986 Schmidtke Häfner,
  1988ab Stack, 1987, 1999)
• Age Youngsters (Gould Shaffer, 1986
  Schmidtke Häfner, 1988ab)
• Ethnic origin Same ethnicity
• (Stack, 1996)
• Sympathetic vs. unsympathetic (Schmidtke
  Häfner, 1988 Stack, 1999)

13
Imitation effects depend on

• Method The more bizarre the method the
  greater the probability of imitation.
• Examples Self-burning, parachuting, subway
  suicides, jumping from high places

14
Summary of recommendations for old media Avoid
sensationalizing or glamorizing suicide, or
giving it undue prominence Avoid providing
specific detail about the suicide Recognize the
importance of role models Take the opportunity to
educate the public Provide help/support to
vulnerable readers/viewers Consider the aftermath
of suicide Acknowledge that journalists are
vulnerable too (WHO Media recommendations, 2008
Media recommendations of various counties
15

• Proposed Solutions in Detail
• for the portrayal of suicidal behaviour
• WHO (1993, 2008)
• Toning down reports in the media
• - No sensational reporting
• - No frontpage reporting
• - No reporting of details
• - No photos

16

• Proposed Solutions
• Recommendations for media reporting or the
  portrayal of suicidal behaviour
• No advertising of methodsand places
• No reporting as understandable way of problem
  solving
• Reporting of offers for help

17
Evaluation studies Evaluation studies of the
effect of media campaigns to seek help are not
very convincing. Campaigns did not influence
attitudes or intentions to seek help (Gaigle et
al., 2006).
18
Example of evaluation studies Evaluation studies
of the implementation of media recommendations
are rare Switzerland The implementation of
media guidelines led to less sensational and
higher quality reporting (exception one yellow
press) . No effect on suicide rates was studies
(Michel et al., 2000) Austria Studies on subway
suicides (Sonneck et al., 1994) and on the
effectivity of media recommendations
(Niedekrotenthaler Sonneck, 2007)
19
Example of positive effects of sensible press
reports suicides and suicide attempts in the
Vienna subway system 1980 - 1993
Introduction of media recommendations
SOURCE DEISENHAMMER ET AL. (1997)
20
New Media

• Songs/Clips
• Visual Media
• - Videoclips
• - Blogs
• - Films
• SMS
• Videoconferences
• Internet
• Web Sites
• Chatrooms
• Counselling

21
Survey The portrayal of suicidal behaviour in
films is widespread. It increased over
time. Young people are disproportionately
overrepresented The act(s) shown becomes
lengthier The act(s) is/are more extensively
modelled The act(s) is/are more likely to involve
firearms (in USA) The act(s) is/are more
romanticised, glorified and condoned (Pirkis et
al., 2005 Schmidtke, Schaller Wasserman, 2007)
22
Survey How people perceive the depiction of
suicide in films Overexaggerated Sometimes
as a joke Rude language Not real life Not
the whole truth of the life of the ill
person (Hartig, 1999 Finzen, 2000 Kissling,
2003 Pirkis et al., 2005)
23
Survey 11 European Film Academies or Film
Schools 8 German Film Academies or Film
Schools Up to now no answer indicates that
suicide is a special topic in the curriculum
or indicates that there is material about this
theme available Answer from an English film
school Although we do not teach this topic in
our curriculum, films are made which touch upon
this topic. We are happy to make the films
available to you for your research. One example
of our films would be the animation film 'Apart'.
24
Exception Curriculum Resources for Australian
Universities (The Response Ability
Project) Multi media package which includes case
study material, hypothetical video scenarios and
examples of recent news reports on
suicide. (Pirkis et al., 2007)
25
Recommendations for films No glamorising No
romanticising Not approved and/ or otherwise
positively reinforced No depiction of positive
consequences of the suicidal act (Pirkis et al.,
2005 Schmidtke et al., 2007)
26
Videoconferences
There is one report about the use of
videoconferencing in suicide risk assessment in a
rural community in Canada. In a videoconference a
psychiatrist, a nurse and/or counsellors assessed
the suicidality. The service was evaluated by
patients and mental health providers as highly
satisfactory. (Jung, 2004)
27
SMS and e-mail
There are some programmes using e-mail
communication in suicide prevention (Wilson
Lester, 1998 Bale, 2001 Howlett Langdon,
2004) Large scale studies about the effect do
not exist. The feedback from help-seekers and
volunteers is positive (Howlett Langdon,
2004 Krysinska DeLeo, 2007)
28
Information about suicide in the Internet
Language Number of hits English/French
(suicide) 65.500.000 Chinese (??
zìsha) 46.800.000 (??? zìshazhe)
1.920.000 (?? zìmiè)
1.590.000Japanese (?? jisatsu) 18.700.000
(??Jigai ,histor. word) 373.000 Russian
(??????) 1.330.000 Spanish (suicidio)
4.630.000 German (Suizid)
752.000 (Selbstmord) 1.740.000 Polish
(Samobójstwo) 1.920.000
(Google search 28. 02. 2009)
29
Forms of information provided on the Internet
Non-interactive Professional Lay
system Web-sites of associations Web-sites
of individualsand organizations and self-help
groups Web-sites of psychotherapists
30
Forms of information provided on the Internet
Interactive Professional Lay
system Moderated news groups News groups
Mailing lists Mailing lists (normally by
experts in the (normally unmoderated field)
by people with similar problems) E-the
rapy/cybertherapy(organisations and
individual therapists)
31
Possibility of suicide pacts Cyber Suicides
32

 
View this article onlysgNewroupsalt.suicide.holidayDatum2003-03-31 230350 PST
VonToc (smg5388_at_yahoo.com)BetrifftExit Partner
Wanted
am lookng for someone who wants to exit in
approx. 10 to 15 years. There are 2 reasons why I
have that time limit set. 1. I have a dog now who
is the pleasure of my life and will not exit
while she is under my care. So she will have to
exit first then I can exit. 2. I don't want to
exit with just anyone. I want it to be with a
good friend. That will take time. So I will spend
that time until my best friend passes (my dog)
and attempt to find another soul who would want
to exit at I that time. I have the method all
planned (painless) but it takes 2 to really
party. I want it to be in a party setting with
good music and refreshments (pot or drinks) or
whatever you choose is up to you. my preference
will be pot as it makes me rather silly and I
think that is the way to exit (happy). I am not a
circus freak. I have been trying for almost 2
years now to find someone who is of extremely
high moral calibre (no cons,crooks,liars etc.)
You have to be honest and honorable. I can't
tolerate anything less. If you have these
qualities, please contact me and let's talk. I
have at least 10 years to get to know you and
vice-versa. I am a retired concert pianist and
auto mechanic and a fanatical Pink Floyd fan and
classic rock also (Hendrix,Doors,Cream,Eagles,
etc.) I enjoy oil painting and chess and ragtime
and above all, Animals. Because they are truly a
gift beyond measure. If more people had the
morals of a dog, what a world this could have
been. Thats it I guess. Lets meet online and get
to know each other. Any sarcastic comments about
my idea will be totally ignored by me. I only
want to know those of unquestionable honor and
integrity.
33
VonDiUK (drowning_in_uk_at_hotmail.com)BetrifftRea
dy to die? Drowning?
Is anyone here prepared to die to the point of
having a planned method, place and time? If you
are please e-mail me. I am. I would like to go
together with someone else though to share the
experience. I have researched extensively. If I
was going on my own then I would use CO tank with
gas mask in my own bed - but I want to experience
drowning - the sensations will be wonderful. Pain
if any will be irrelevant. Please note that
suicidal drowning is not painful since the pain
caused by holding breath and CO2 build up does
not occur - since you do NOT hold your breath! I
have included a previous e-mail content partly
describing the experience from another friend who
nearly drowned. DiUK
34
Problems of interactive imitation
Internet-requests for suicide pactsObservation
period 08. 01. 01 06. 01. 02 Source
Moderated suicide forum/archives
Suicide cluster
35
Problems of interactive imitation Internet-based
clusters for joint suicides in Japan (Cyber
suicides)Observation period 01. 01. 2001 30.
11. 2005 Source Japanese newspaper archives
Suicide clusters
2001
2003
2004
2002
2005
36
Comparison of different media
Kind of media Effect Telephone
Hotline Internet Groups IG gt by Youths more
accepted Telephone Hotline Chat Online Support
Group More suicide threats in the OSG Gilat
Shara 2007
37
Controlling the effects of the Internet is
difficult Reasons Design of the Internet Use of
the Internet Interactive possibilities Information
is unlimited
38

• Do only predisposed people seek information in
  the media?
• or
• Can emotions and suicidal behaviour also be
  induced through the media?

• Investigations show that on / through the
  Internet emotions can be induced
• (Göritz, 2002)

39
Suicide prevention on the Internet?
40
Arguments pro and con the use of the Internet in
suicide prevention
Pro Con Emotional support No need to resolve
problemsSense of community Stuck were they
areInclusiveness Secondary gainFeeling less
isolated Do not develop skills for real
relationships No training in therapeutic
technics Sparse mechanisms for dealing with
hostile contributors Diffusion of
dependency

(Finn, 1995 Stoney, 1998, Lebow, 1998
Zuckerman, 2003 Hsiung, 2007)
41
Advantages

• Low thresholds low level access possible
• Communication on the Internet is more
  disinhibited than in real life clients get
  earlier to the point
• Available to populations that currently have
  limited or no access to therapy, e.g.
• Handicapped people, deaf people
• People in rural or remote locations
• People ambivalent about treatment

(Dunaway, 2000)
42
Pros
The newsgroups on the internet can provide an
opportunity to suicidal persons to anonymously
express the despair, hopelessness and feelings of
being trapped, and to get a reaction under
circumstances when they feel they cannot confide
in people physically close to them or do not wish
to meet face to face with professional counselors
such as doctors and psychologists. Here
suicidal persons may find- without having to
reveal anything an acceptance and
understanding of their experience that they
cannot expect in real life. In real life they are
afraid of misunderstanding, stigmatization,
hospitalization, and monitoring. Lindner
Fiedler 2001
43
Recommendations for news (support) groups after
the suicide of a member
The recommendations are the same as for print
media Not idealizing or romantizing the deceased
member Not describing the method and location Not
presenting the suicide as inexplicable or as a
means to an end (Hsiung, 2007)
44
Recommendations for news (support) groups
Not allowing encouragement of self-harm Not
allowing posting of instructions for suicide Not
allowing false reports of suicidality or
suicides Providing support and education Suggestin
g online-line and real-life resources, including
qualified treatment Obtaining IP addresses for
the possible identification of people at risk In
case of apparent imminent risk, alerting local
emergency services (Hsioung, 2007).
45
Examples of professional interactive suicide
prevention on the Internet
Befrienders International since 1994 e-mail
contacts In e-mail ca 80 described themselves
as suicidal compared with 25 in phone
contacts (Farmer Borton, 1995) Several
hotlines in Germany (e.g. Cologne, Krefeld)most
e-mail writers are young, suicidal, hopeless,
with ambivalent feelings toward
psychotherapy. (Dorrmann, 1998)
46

Suicide-preventive organizations should increase
their presence in the Internet to provide valid
information and professional help. Lowering the
threshold for help-seeking but ambivalent people
by providing e-mail contact can possibly be
life-saving.
47
Thank you for your attention
EU/WHO Research Group Dr. C. Löhr DP K.
Benkelmann DP J. Wohner DP I. Sell