Robin Williams and the Hypocrisy of Suicide Prevention Organizations

The sudden emergence of suicide prevention organizations and their representatives in the media responding to the death of Robin Williams has been mind-blowingly outrageous to me – I track the suicide coverage – assisted and non-assisted – of old, ill and disabled people regularly. It’s part of my job. A near-constant in reading and watching that coverage has been the near-total absence of suicide prevention organizations and professionals in reacting to any suicide of old, ill or elderly people labelled as “right to die,” death with dignity,” “end of life,” “assisted suicide” or any other terminology that seeks to differentiate the suicides of some people from the larger group deemed as “preventable tragedies.”

In the aftermath of Robin Williams’ apparent suicide, suicide prevention experts and the press want to take special care about warning the public and make sure that the coverage of his death doesn’t spark a rise in suicidal behavior.  Here’s a sampling of the reactions, starting with a response to a tweet put out by the Academy of Motion Picture Arts & Sciences as reported in the Washington Post:

On Monday night, as fans around the world began to grieve Robin Williams’s death, the Academy of Motion Picture Arts and Sciences — best known, in many circles, as the people behind the Oscars — sent out what may be the iconic social media image of Williams’s death.

“@TheAcademy: Genie, you’re free. pic.twitter.com/BPsV44mTvD”

8:26 AM – 12 Aug 2014 Los Angeles, CA, United States

More than 270,000 people have shared the tweet, which means that, per the analytics site Topsy, as many as 69 million people have seen it.

The problem? It violates well-established public health standards for how we talk about suicide.

“If it doesn’t cross the line, it comes very, very close to it,” said Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention. “Suicide should never be presented as an option. That’s a formula for potential contagion.” (Emphasis added.)

Moutier is referring to a well-documented phenomenon, better-known as “copycat suicide,” in which media coverage or publicity around one death encourages other vulnerable people to commit suicide in the same way. Adolescents are most at risk of suicide contagion; in recent years, groups like AFSP have also become particularly attentive to the role the Internet plays in romanticizing notorious or high-profile deaths, something it has long asked both the news and entertainment industries to avoid.

“The potential for online reports, photos/videos and stories to go viral makes it vital that online coverage of suicide follow site or industry safety recommendations,” one media guide reads.

But in the hours since @TheAcademy’s tweet went viral, professionals like Moutier have become concerned that it doesn’t, in fact, follow established safety recommendations. The starry sky from Disney’s Aladdin, and the written implication that suicide is somehow a liberating option, presents suicide in too celebratory a light, Moutier said.

The International Business Times presented this quote from a representative of the American Association of Suicidology:

The American Association of Suicidology has advised journalists to sensitively cover the death because certain types of news coverage are believed to increase the likelihood of suicide in vulnerable individuals. The association noted that the risk of copycat suicides increases when the story specifically describes the suicide method, but covering the suicide carefully can change public misperceptions and prompt those who are vulnerable or at risk to seek help.

Those are just two examples, but they’re typical of the way in which top suicide prevention organizations have been aggressively going after the press and spreading caution about the harm caused by irresponsible journalism.

I, for one, am extremely unimpressed and underwhelmed by the suicide prevention brigade. Even in this latest episode of a publicized suicide, I see nothing in their messaging to indicate that any of the organizations or their reps care at all if old, ill and disabled people kill ourselves (unless, of course, we’re Robin Williams).

Let me offer up one more quote before I talk about the total lack of integrity these organizations have shown in regard to suicides of old, ill and disabled people – deaths I get to read about far too often.  This is from Michelle Cornette, executive director of the American Association of Suicidology, who appeared on Lawrence O’Donnell’s show “The Last Word” on MSNBC:

I think what`s really important to keep in mind with respect to
suicidal thinking and individuals who die by suicide is that they have
essentially reached a cognitive state where they`re not really thinking
about other people. In fact, there`s some interesting research that`s come
out in recent years indicating there`s a very strong association between 
perceptions of burden on others and risk for suicide, meaning the 
individuals come to believe that their death is worth more than their life 
to their loved ones. (Emphasis added.)

Starting with that last point – about the association of being a burden – there’s an elephant in the living room (one of many) in Oregon assisted suicide data. According to information given by prescribing doctors, 49% of people requesting assisted suicide give “being a burden” as a major reason for wanting to commit suicide.  Oregon, btw, has one of the highest overall suicide rates in the country, and the rates for all ages are climbing. The state government (and suicide prevention organizations) aren’t inclined to look at legalized assisted suicide and the promotion of suicide as rational, even brave by both pro-assisted organizations and the press and how they might be influencing the overall suicide rates. One would think that good science would dictate at least considering a contagion effect from the normalization of suicide under the assisted suicide statute.  It’s interesting – and disturbing – that outside of ex-director of the American Foundation for Suicide Prevention (AFSP) Herb Hendin, I’ve never heard or read any suicide prevention professional highlight that the feeling of “being a burden” is a significant risk factor for suicide in general.

All of these suicide prevention organizations have media guidelines on reporting responsibly when covering suicides.  Among those guidelines are:

*Suicide is complex. There are almost always multiple causes,
including psychiatric illnesses, that may not have been
recognized or treated. However, these illnesses are treatable.
• Refer to research findings that mental disorders and/or
substance abuse have been found in 90% of people who
have died by suicide.
• Avoid reporting that death by suicide was preceded by a
single event, such as a recent job loss, divorce or bad grades.
Reporting like this leaves the public with an overly simplistic
and misleading understanding of suicide.
• Consider quoting a suicide prevention expert on causes
and treatments. Avoid putting expert opinions in a
sensationalistic context.
• Use your story to inform readers about the causes of
suicide, its warning signs, trends in rates and recent
treatment advances.
• Add statement(s) about the many treatment options
available, stories of those who overcame a suicidal
crisis and resources for help.
• Include up-to-date local/national resources where
readers/viewers can find treatment, information and
advice that promotes help-seeking. (Source: https://www.afsp.org/content/download/1066/16814/file/recommendations.pdf)

 

Over the last eight years, the activities of the Final Exit Network (FEN) – whose “exit guides” are claimed to have facilitated hundreds of suicides in the U.S. – have received national coverage.  The greatest coverage has come from their role in the death of John Celmer of Georgia, clear of mouth cancer he’d been treated for, but deeply distressed over his post-surgery appearance. The death of Jana Van Voorhis – a woman without serious physical illness but a history of emotional issues – has also received a great deal of attention.  Favorable profiles of FEN and its members have appeared in Time magazine and in the Washington Post.  A  NY Times health columnist recommended FEN as a resource for nonterminally ill people who want to kill themselves.  (FEN openly advocates the “right” of anyone with any kind of illness, condition, etc. to receive assistance and support in committing suicide.)

Virtually every one of these articles broke every single element of “good practice” in terms of reporting about suicide.

• Percentage of articles detailing means of suicide: ~100%;
• Percentage of articles sharing contact info for suicide prevention: almost none;
• Percentage of articles quoting a suicide prevention representative: almost none;

A couple of articles got our hopes up that maybe suicide prevention groups were beginning to wake up and maybe give a crap about the ongoing promotion of suicide as “rational” for old, ill and disabled people.

In 2010, FEN put up a number of billboards across the country with the message “My Life My Death My Choice,” and their URL printed underneath. One of the first appeared in the San Francisco area.  The Bay Citizen, an independent newspaper, published an article with two suicide prevention professionals responding to the billboard:

 “This is irresponsible and downright dangerous; it is the equivalent of handing a gun to someone who is suicidal,” wrote Lanny Berman, president of the International Association of Suicide Prevention, in an email. “This message, communicated to thousands of vulnerable individuals, suffering from psychic and or physical pain that is treatable, invites a tragic and final solution to problems that most often can be solved with proper evaluation and treatment.”

There’s also a quote from a representative of  a local organization:

“Regardless of what someone might feel about assisted suicide, I feel the message behind this billboard is confusing and dangerous,” wrote David Paisley, deputy director of San Francisco Suicide Prevention, in an email.

“It assumes people will understand that it is a billboard about assisted suicide or they will go to the website,” he wrote. “In reality, most people who see the billboard from the street or car will not go to the website, but are left with a message that could be interpreted very tragically by someone in crisis and acting impulsively.”

At the time, I thought these comments were terrific breakthroughs.  To the extent that the reporter managed to get suicide prevention folks to come out of hiding for this story, it was a breakthrough.  But the more I read them, the more troubling the comments became.  Berman and Paisley seemed not so concerned with the general message so much as the possibility it would reach the wrong audience.

Within weeks, that concern would be validated in another story about the billboards – this one from New Jersey, where FEN also paid for a billboard. In July 2010, Judith Springer spelled it out:

Dr. Judith Springer.  Springer is a psychologist and board member of the Society for the Prevention of Teen Suicide.

The first red flag went up on Springer’s comments in her first press quotes that appeared in the Star-Ledger, giving her reaction to the FEN billboard:

Therapists called the billboard “irresponsible,” arguing it could serve as a “tipping point” for troubled teens or others at risk of suicide.“The idea of any of these upset, impressionable kids seeing a billboard like that absolutely horrifies me,” said Judith Springer, a Morristown psychologist and board member of the Society for the Prevention of Teen Suicide. “You can’t filter who sees a publicly displayed sign.”

The quote bothered me a little, since there seemed to be room here that – in her opinion – there is an appropriate audience for the sign and the organization.

Turns out my vague concerns were all too valid.  The good Dr. Springer ended up showing the depth of her concern when it comes to suicide for the elderly – or more accurately, her complete lack of concern.  In a July 16th article written by Fox News religion correspondent Lauren Green, Springer reiterated her previous comments and then expanded on them:

But Springer says she’s not opposed to Final Exit’s mission, just how they’re delivering the message.

“I visited the website and it’s populated by elderly folks who are at the end of a very long life and are in pain,” she said. “That’s a whole different issue to me.”