‘ All that Followed a Death. . . ’: An Alleged Celebrity Suicide,Media Discourse and Mental Health

Prologue

On 14th June 2020, a renowned Indian actor was found dead at this home, with post-mortem reports ascertaining the cause of death by alleged suicide. An investigation was immediately launched into the circumstances of death, and what followed was a rippling paparazzi of rumor-mongering, conspiracy theories and speculative witch-hunt that is at par with the ‘dark’ tone of a thriller flick (Ellis-Petersen, 2020). The legal and political connotations of the case are beyond this discussion and are expected to take their due course. What was indeed shocking to see was the public reaction, heavily influenced by the controversial and skewed portrayal of the media, that overshadowed the possible ‘mental health’ perspective related to the untimely death of a young man. There has not been a day, that digital or print media has not involved in rigorous discussion about the nuances of the suicidal act, vivid display of images, distorted psychological autopsy and finally retrospective speculations of how this could have been prevented. Many of my colleagues have been contacted frequently by the media personnel to comment on the ‘reason’ for this suicide, even before the investigation started. However, what the interviewers were more interested in was the critical discourse of the ‘celebrity glamour’ rather than the risk factors which could have contributed to the suicide. It was sad how every personal detail was dug up, norms of privacy were disregarded, and along with the ‘fantasized’ information, a plethora of misinformation and disinformation triggered the mass responses. The terms ‘depression’, ‘schizophrenia’, ‘stress’, ‘trauma’, and ‘mental health’ suddenly became more popular than ever in the superficial discussion, which was soon overtaken by the conspiracy buzz of ‘who did it’! Subsequently, the treating psychotherapist was allegedly obliged to ‘disclose’ confidential details about the treatment of the deceased, which further fueled debates. The existing Indian helplines operating for the pandemic started receiving distress calls related to suicidal ideations in the days following the incident. Though media has its own obligations to portray ‘high-impact’ news, such incidents potentially alter the already existing public attitude toward mental health and perpetuate stigma against deaths due to suicide, thus hampering the prevention of this social evil. With this background, Raj et al. (2020) in their recent article titled ‘Do online media adhere to the responsible suicide reporting guidelines? A cross sectional study from India’ attempted to explore the compliance of contemporary online media reports with Indian guidelines for responsible reporting of suicidal acts. After studying 295 articles published by the local and national media sources for 30 consecutive days from those mentioned above alleged ‘celebrity suicide’, the authors reported that greater than 80% of the media reports breached at least one recommendation criterion. While the maximum deviation was noticed in news headlines, ‘sensational’ wording used in the articles and vivid description of suicide methods, the other domains involved were reporting confidential suicide pacts, unnecessary linkage of apparently unrelated suicides in a single report, excessive importance to ‘perceptions’ over facts and linking suicides with religious practices. This article draws on these findings by Raj et al. (2020) and attempts to contextualize them in the Indian scenario.

The problem statement

The official figures mention suicide rate in India as 10.2 per 1,00,000 population in 2018, which is a 3.6% increase over the last 1 year (National Crime Records Bureau [NCRB], 2018). While ‘suicide portrayal’ in media has always been a controversial issue, Raj et al. (2020) direct our attention toward the guidelines released by the Press Council of India (PCI) in 2019 which is based on the World Health Organization (WHO) guidelines of 2017 (Vijayakumar, 2019). In all this debacle that followed the alleged actor-suicide, something essential was missing: the discourse of the social and environmental factors that can affect the mental health of an individual, making him consider taking off his own life! Roughly, 1.5% of global deaths occur due to suicide, and India contributes to around 17% of it, with the young population (15–40 years) being the most affected (Ropper, 2020). The statistics are, however, only partly reflective of reality. Compared to the rest of the world, psychosocial triggers in India play a significant role in suicides especially financial impoverishment, intimate partner violence, child and elder abuse, farmer suicides, and untreated psychiatric disorders (Anil & Nadkarni, 2014). The latter is due to the wide mental health gap, as reflected in the National Mental Health Survey 2015 to 16 conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru (Murthy, 2017). Suicides in low- and middle-income countries (LMIC) are grossly under-reported due to legal hassles of reporting, under-recognition, lack of awareness and absence of appropriate data audit. This has been partly reduced when the recently passed Indian Mental Healthcare Act (MHCA), 2017 decriminalized suicide. The socio-economic disparities are also one of the prominent reasons for the differences in this reporting. The National Crime Records Bureau (NCRB) reported a total of 2,96,438 farmers who committed suicide since 1995, and this is just the official number. India thrives on agriculture, with around 72% directly or indirectly depending on it for their livelihood. Farmer suicides make for 11.2% of the total suicides in India (Plewis, 2018). Various factors have been attributed for the same, high financial debts, issues with subsidies, crop failure, lack of systematized public health policies, large families, administrative apathy and easy access to pesticides, to name a few (Das, 2011). Added to these are student suicides, suicides due to domestic violence and caste or racial hierarchies. For obvious reasons, these suicides are not ‘sensational’ enough to make it to the headlines or generate a media frenzy like the recent incident discussed above, primarily due to the marked difference in the television rating points (TRP) that get generated as selling factors of specific news. Ironically, the premature deaths on both ends of this socio-economic spectrum are but tied through the strings of ‘public apathy, the romanticization of the deaths by media and short half-life of mental health relevance’. As rightly pointed out by Raj et al. (2020), non-celebrity suicides were often made ‘more appealing’ to the audience by using ‘suicide’ in the headlines.

On the other hand, the mention of various features related to the identity, occupation and background was more prominent in celebrity-suicides. While methods and location were more ‘important’ for suicides in the general population, contextualizing the ‘suicide’ by ‘proposed theories’ was common in high-profile suicidal deaths, which most often deviated from the facts. Hence, the prevention strategies that we keep discussing each year, especially on World Suicide Prevention Day (10th September), does little to serve and save the lives in the community, despite the best intentions.

Media and mental health: The missing link

It is impossible to imagine a life without media. This has got a renewed impetus due to the Coronavirus disease 2019 (COVID-19) pandemic, where the ‘need to know’ has been more than ever before. Lockdown and restriction of travel have increased the consumption and outreach of all forms of media. Mass media refers to all sources of publicly delivered information and entertainment, and since the evolution of humankind has been the cornerstone of information, communication, public discourse and education. Social media, on the other hand, is a ‘two way and one-to-one’ platform which has a much wider penetration, with the unlimited number of channels. Besides being the traditional repository for knowledge, both mass and social media can significantly impact human thinking, perception and behaviour (Wahl, 1992). The most recent example of this is the COVID-19 pandemic, which has often been referred to as a ‘digital infodemic’, due to the global snowballing of misinformation about the illness and its remedies (Kadam & Atre, 2020). This trend has been projected to outlast the outbreak itself possibly. Due to their universal effect, media can be considered to have a ‘“dual-edged’ directionality with mental health. As much as it can help mental health promotion, education and service development; it can also sabotage the awareness, perpetuate misinformation and consequent stigma related to mental health. Generalization bias, cultivation theory, social learning and attribution, negativity bias, rumour modelling, interpretative bias, motivated reasoning, fear-reasoning and boomerang effect are some of the explanatory psychological models that have been used in how media modifies human thinking and behaviour (Banerjee & Rao, 2020; Wang et al., 2019). Over the years, mental illness has many times been stereotyped and ‘fantasized’ in movies/books leading to faulty perceptions about its treatment and reinforcing the traditional need to ‘socially segregate’ the mentally ill. In today’s healthcare, that advocates a rights-based approach, such an effect is undoubtedly detrimental to the global landscape of mental wellbeing. Besides depiction of psychiatric disorders, mental health and mental health professionals, media reporting and portrayal of suicides can have marked influence on public understanding and hence community suicide-prevention strategies.

Sensitivity, empathy and non-judgmental approach are not just considered as non-specific factors in the doctor-patient relationship but are also critical media-reporting attributes. Some of the stereotypes generated by media depiction of suicides are that ‘suicides can occur only in people who are mentally disturbed’, ‘only depression leads to suicide’, ‘suicide is just an impulsive death’, ‘suicide cannot be predicted and prevented’, etc. This is further compounded by the romanticization of ‘suicidal deaths’ in movies, where the protagonist is shown glorified choosing to ‘end his/her life’ for the greater good. Sometimes, it is even shown as an act of ‘bravery and heroism’ (Pirkis and Blood, 2001). This conveys the wrong message to the millions of viewers, underestimating the series of events that can eventually lead to the stress of ‘ending one’s own life’. The failure to view suicide as a ‘process’ rather than as an event, is a significant barrier in its conceptualization and hence prevention. There is also a tendency to link suicides exclusively to ‘mental health’ or medicalize suicide. To quote Vijayakumar (2019), this often unnecessary and potentially harmful medicalization and pathological categorization of human distress lead to ‘disregard for the situational and dimensional nature of human experience in suicide’. On similar lines, Raj et al. (2020) show that nearly 40% of the media reports on suicide linked them to mental health issues and substance abuse, albeit superficially. Gould et al. (2003) has reviewed multiple studies showing the relationship between media suicide depictions and public behavior. As mentioned earlier, the WHO has recommended clear guidelines for responsible reporting of suicides (Table 1), which are often disregarded for commercial or personally vested interests (Bohanna, 2013). More than 80% of the media articles following the alleged celebrity-suicide deviated from both the WHO and PCI guidelines in the study by Raj et al. (2020).

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Table 1.

Responsible reporting of suicides by media.

Preferred ways of reporting	Practices to be avoided
Accuracy of information	Personal assumptions, biases, ‘tales’ of suicide
Authentic sources of help-seeking	Conspiracy theories
	Detailed and repetitive reporting
Facts & risks of suicide	Sensationalizing, fantasizing or normalizing suicides
Suicide-prevention methods	Reporting self-harm as ‘heroic’ or ‘constructive.’
Vulnerable groups at risks for suicide	Generation of fear, stress and panic
Expert opinions for qualified professionals / first-person accounts of coping	Extensive debate and discussion with multiple professionals about the same incident: which generates confusion
Sensitive and humane interviewing of the bereaved	Avoid using ‘catchy’ or sympathetic headlines/phrases
	Coercive questioning of the bereaved on-camera
Peer debriefing and support among the media personnel to deal with trauma	Avoid visual content (photographs, videos, social media links, etc.) whenever possible
Factual reporting of the suicide event (especially celebrity suicide)	Excessive emphasis on personal life, contextual information
	Judgemental comments
	Explicit details of methods used

Note. Modified from the World Health Organization (WHO, 2017). Preventing suicide: A resource for media professionals, update.

Media depiction of suicide: ‘The Dual Edge’

Like many other nations, India too has suicide prevention strategies incorporated in its National Mental Health Policy, though a national suicide prevention program is still lacking. However, legislations often stay confined to the paper, with pragmatic barriers in community implementation. Types of media reporting of suicides, especially ‘sensitive’ cases can facilitate or halt the suicide prevention strategies. Making a ‘one-to-one’ connection of a proximal event with the act of suicide, using outdated terms such as ‘completed suicide’, extensive detailing of the circumstances of death and unnecessary investigations into unrelated personal connections, might propagate the myth that suicide cannot be predicted or prevented. This also turns the focus away from the stress, trauma and mental health hazards that could have led to the suicidal act, to distal factors like the success or failures of a person. Like the recent incident of the celebrity suicide in India, careless and unempathetic media reporting also opens up the crevices for political and social mud-slugging. The lines of ‘investigative reporting’ and ‘sensitive reporting’ tend to get blurred, especially in high-profile cases. Factual information, discussion about guidelines and expert ‘voices’ are lacking especially while reporting high-profile suicides. In their analysis too, Raj et al. (2020) mention about very few reports that discussed suicidal research, suicide prevention strategies, debunked misinformation, highlighted statistical data and brought forward expert comments related to the deaths. The news instead tends to get overshadowed by public opinions and individual perceptions, the authenticity of which is naturally doubtful.

It is essential to understand that a single wrong message in the wrong hands of a gullible reader/viewer, can snowball the catastrophe. This is reflected in the well-known copy-cat suicides, called the Werther effect (Kim et al., 2013). On the other hand, media also has the potential to use this influence for the benefit. Responsible and sensitive reporting of suicides, especially in ‘high-profile’ cases, presenting the facts rather the assumptions, focusing on the risk factors and utilizing them in suicide prevention, as well as liaison with health professionals for building community awareness through audio-visuals, infographics, etc., can go a long way in building resilience. This might foster understanding of the suicide risk, ways of prevention, reduce stigma and facilitate help-seeking. The classical ‘gatekeeper training’ program where every individual is considered and trained as a possible ‘preventor’ of suicide, irrespective of the expertise, socio-economic status and profession, can also be enhanced by the media. This protective influence of the media is termed as the ‘Papageno effect’. The term gets its origin from the story of Papageno in Mozart’s Opera ‘The Magic Flute’, who feels suicidal after a personal loss but ultimately manages to live with redemption, hope and optimism, being reminded of the alternatives by the society (Niederkrotenhaler et al., 2010).

Misinterpretation of information can arise out of misrepresentations in media, which can decrease and distort understanding of a phenomenon (Stuart, 2006). As mentioned before, this creates stereotypes. Common examples of this in mental health are the depiction of a mentally ill individual as either a ‘homicidal maniac’ (in Psycho, 1960) or ‘the rebellious free spirit’ (in One Flew Over the Cuckoo’s Nest, 1975). The latter movie also depicted mental health professionals as oppressive and the use of electroconvulsive therapy, one of the evidence-proven and effective forms of psychiatric treatment, as punitive. Such beliefs remain ingrained in public discourse and beliefs, which are common in our daily practice, and act as potential barriers to help-seeking. On similar lines, the ‘suicidal person’ has been shown as a ‘victim’ to crime or exploitation, detached and non-contributing to society, and beyond any form of help (in Perfect Blue, 1997) (Pirkis et al., 2006). While these can be some of the isolated risk factors, generalizing a preventable cause of death like suicide to just materialistic deprivation, is eventually reductionistic and non-productive for public health. All portrayals of mental health in media are not negative, and responsible use of mass media has helped reduce stigma in the general population (Clement et al., 2013). The stigma generated by any form of media must affect the ‘stressed’ or those who are contemplating suicide beside the general population. The ‘Health, Stigma, Discrimination model’ posits that such ‘self-stigma’ in the ‘sufferers’ get amplified by their interpretation of social (media) content and is associated with decreased access to healthcare, misconceptions about mental health and treatment, under-detection, non-compliance and dropouts, and eventually poor prognosis (Stangl et al., 2019). The Werther effect, initiation and progression of substance use disorders and ‘body image’ disturbances are few such examples. Similarly, educational and motivational campaigns propagated by the media can boost the self-esteem of those affected, enable help-seeking and prevent an irrational act that might lead to death. While substantiating this viewpoint, Raj et al. (2020) also caution about adopting a ‘simplified and linear version of suicide’ that can under-estimate the complex biopsychosocial facets of suicidal behaviour, thus undermining its preventive potential and equating suicidal acts solely with ‘circumstantial stress’.

The long way ahead

The engagement of media with the mental healthcare providers need to be collaborative and bi-directional. Raj et al. (2020) while discussing their findings aptly suggests dissemination of media guidelines, increased liaison between media and public health professionals, inter-Ministerial collaboration, updating existing media-reporting guidelines, policies to dis-incentivize non-adherence by the media and integration of these measures into a national framework. This again resonates with the long-due need to formalize a National Suicide Prevention Program (Strategy) for our country, especially when the ‘suicide problem statement’ seems to be rising. Misquoting, misinterpretation and mis-contextualizing remarks of psychiatrists or psychologists lead to the strained relationship between the two. As a result, many physicians avoid active discussion with the media platforms related to suicide or related mental health crisis, that might benefit public health. Coordinated and active liaison is the need of the hour and needs to involve training of health professionals to interact with the media in an informative, factual, yet non-judgmental way. The scientific discussion needs to be encouraged in the media platforms, free from independent biases, assumptions, myths and stigma.

Most importantly, suicide needs to be viewed from a multi-dimensional and holistic angle to appreciate the complex interaction between the individual, environment and his/her macro and ecosystem; rather than ‘one isolated incident that was bound to happen’. Also, the approach might be more effective ‘top-down’ focusing on primordial preventive strategies targeting the risk factors, instead of being ‘bottom-up’ which exclusively includes crisis-interventions after the ‘breaking-point’ (Armstrong & Vijayakumar, 2018). This is particularly essential with the ongoing pandemic crisis. For long, suicide has been primarily seen as a ‘health sector issue’ with minimum importance to the socio-ecological (macro level) factors that can affect an individual negatively. For example, focussing on the depression and its treatment for a marginal farmer in debt, without actually accounting for the fact that the debt and agricultural policies may be the cause of the depression has led to shifting the blame from ill-designed policies and making it a narrative about individual vulnerability. On similar lines student suicides are often related to academic stress and adjustment alone overlooking the societal as well as familial expectations and stereotypes. These approaches are individual-based and hence play a limited role in community-targeted suicide prevention strategies.

Various nations have guidelines from the Press Council and the National Mental Health Associations on sensitive media reporting and discussion about suicides, which need active implementation. Media forms a powerful tool in suicide prevention but ensuring it remains a collective administrative responsibility. Singh (2020) aptly calls for specific guidelines in India and other nations, about the psychiatrist-media interaction. He stresses on the principles of factual and scientific information exchange, clear rules of the transaction including ‘recording of statements’ to prevent misuse, differentiating professional and personal comments, avoiding comments without assessment and finally contextualizing the information based on the available evidence. Every such interaction has the potential for improving the knowledge, attitude and practice of the masses helping to fight the ‘social evil of suicide’. Also, both public health and journalism research should focus on ‘adherence to suicide reporting guidelines, quality reporting and impact of social media’ (Raj et al., 2020). The recent media uproar about the celebrity suicide might cease, following a more ‘competitive’ headline. However, the bottom line remains: preventing suicide is not just about halting an untimely death but understanding and modifying the detrimental processes that have led an individual to come to the grave decision of ending his/her life. Without this premise, retrospective dissection of facts and figures will do little in preventing the loss of identities. Sensitive media reporting and discourse of suicides is a vital issue in public health and administrative policies. The currents situation in our country as evidenced by the timely findings of Raj et al. (2020), however, reveals that there is still a long way to go!