Psychiatry has a problem. A large number of children are given SSRIs and within a short period of time, they kill themselves. The deaths of these children are not the problem of course – psychiatry is used to explaining them away – the problem is that their parents just will not shut up about them. They talk to the media about how they were great kids, they make it clear they were from loving families, they dispute they had any mental disorder and they blame psychiatric drugs for their children’s deaths.
As if that’s not bad enough, their stories gain traction because they are more compelling and have a stronger evidence base than the stories of psychiatrists that these children were ‘deviants with mental illness’, victims of poor parenting and maternal mental illness or brain disordered children whose deaths were inevitable. As the prescribing of SSRIs increases, so does the number of bereaved families and the numbers of news stories in which they claim psychiatry and the pharmaceutical industry cause suicide.
Now, every problem has a solution and in this case the solution is rather neat. Position these mouthy parents as a suicide risk and make sure that it becomes accepted fact that allowing them to speak is dangerous and causes suicide. Throw around phrases like contagion, copycat and epidemic in discussions of how we should talk about suicide and watch governments, the media, institutions and religious leaders take up the job of gagging families bereaved by suicide. The reach this strategy achieves is remarkable – it can simultaneously stop the media reporting suicide stories, prevent the families using facebook to talk about their kids’ deaths, ensure families keep their children’s funerals low key and prevent them creating public memorials.
In New Zealand it is against the law for families or the media to tell the stories of people who have died from suicide. Despite a Bill of Rights which guarantees freedom of expression, families who tell their children’s stories in an effort to prevent other children’s deaths, can be fined $1,000 for breaching this prohibition. Media who publish stories about those who have died from suicide can be fined $5,000.
Around the world media guidelines which restrict the reporting of individual suicide cases have been promulgated as have prohibitions on public memorials and guidelines for funeral directors, schools and other institutions urging them to constrain parents in talking about their dead children. The following advice recently released by the Irish Minister of Health is typical
It is important that people speaking at the funeral do not glamorise the ‘state of peace’ the deceased may have found through death. Some communities may feel a need to express their grief by suggesting a memorial and memorial activities. It is often difficult for loved ones to understand why such memorials are not a good idea when people who die in other ways are often memorialised. Unfortunately, we have to remember that constant reminders, glorification, or glamorisation of a suicide death might have the effect of making it seem attractive to others.
The media guidelines are supposedly to reduce the risk of ‘suicide contagion’ or ‘copycat suicide’ which is particularly high where suicide is glamorized through media reporting. Nowhere in the copycat suicide literature or media guidelines is there an explanation of what it actually means to glamorize suicide or what a glamorous media report of suicide looks like. Presumably, using the dictionary definition, it’s a report that makes suicide seem more attractive or exciting than it actually is.
The proponents of the ‘reporting glamorizes suicide’ belief claim that vulnerable people may read reports of suicide or see footage of funerals and decide that they will kill themselves so that they will receive the attention and love expressed for the victims of suicide. For this reason the New Zealand media guidelines urge that journalists should not “just focus on the person’s positive characteristics.” Compliance with the guidelines means finding something negative to say about the child who died. It is hard to imagine that being included in guidelines on reporting the deaths of children from any other cause.
This kind of thinking may have led a teacher in Australia to believe it was appropriate to post on facebook, the day following the suicide death of a child at his school
You were a moody, disrespectful little brat in and away from school who was always given excuses by your parents and soft people in authority. Your [sic] gone, good no sympathy or empathy from me . . . 
The media guidelines implemented around the world, exhort the media to avoid using the word suicide in reporting suicide, explain suicide as arising from mental illness and consult reputable sources (read psychiatrists or other mental health professionals) for quotes.
This is consistent with the views of the Royal Australian & New Zealand College of Psychiatrists who urge
Reporting of suicide should aim to encourage discussion as to why people die by suicide and the link between suicide and a range of risk factors, including mental illness. Psychiatrists may be well placed as a source for media to explain some of these risk factors as well as ways these risk factors can be best managed.
In a coup for the pharmaceutical industry, in a number of countries, guidelines for reporting suicide focus on a prohibition on naming the product or brand of any substance used in a suicide death.
On the ground, the notion that suicide can be glamorized and that this leads to copycat suicides has seen the re-emergence of practices which are reminiscent of the past when suicide victims were denied burials on consecrated ground, had stakes driven through their hearts before burial and they and their families were vilified.
Take the recent words of a politician in New Zealand who, in response to messages that we must not glamorize suicide said
“If a child commits suicide, let us consider not celebrating their lives on our marae; perhaps bury them at the entrance of the cemetery so their deaths will be condemned by the people.”
“In doing these things, it demonstrates the depth of disgust the people have with this. Yes it is a hard stance, but what else can we do?”
The significance of burial in the entrance to the cemetery is that people will walk over the dead as a mark of disrespect. This politician is not alone, others have suggested burying suicide victims face down to signal shame or standing up so they do not rest in peace. I was told of a funeral at which those carrying the coffin, including the elderly grandmother of the child who died, were required to crawl on their knees to show shame.
While I challenged the view of this politician publicly and in a meeting with him and he subsequently apologized for his comments, an editorial in our largest newspaper supported him saying
The problem is that, as things stand, the self-inflicted deaths of young people are often followed by outpourings of public mourning that look uncomfortably like celebration. To confused and desperate youngsters looking on, the danger is that it all looks terribly romantic. Anything that we can do to de-romanticise suicide is to be encouraged.
In case people think this is purely an indigenous response to the messages from mental health professionals about glamorizing suicide, the evidence is that this is not the case. When a very exclusive New Zealand school had four pupils die suddenly in a short space of time, one who died of natural causes and another who died from alcohol poisoning had the traditional funeral in the school chapel while the two whose deaths were suicides had funerals away from the school grounds, as per government guidelines.
The notion that media reporting of suicide causes copycat suicides is one that is rarely challenged and endlessly stated as fact by journalists, mental health professionals, suicide prevention organisations and other commentators.
Repeatedly it is claimed that a large body of evidence has shown that reporting of suicides causes increases in suicide rates. So ubiquitous is this belief and so extreme are the actions that arise from it, it would be reasonable to assume that the body of evidence supporting it is strong and unequivocal.
That assumption does not hold up however when the literature on copycat suicide is actually reviewed. I would suggest that in fact the evidence for a causal relationship between media reporting of suicide and actual suicide is incredibly weak and is underpinned not by science but by ideology and the desire to silence the critics of psychiatry, protect the pharmaceutical industry and enhance the status of ‘suicidologists.’
Jane Perkis is one of the strongest proponents of restrictions of media reporting of suicide, and frequently cited in guidelines. In 2010, she and a co-author conducted a review of the evidence on the causal link between suicide reporting and suicide rates. They found strongest evidence for a link between newspaper reporting and suicide but rather than finding evidence of a causal link between such reporting and actual suicide the best they could conclude was that
The vast majority of these [studies] have provided at least some evidence to suggest that an association exists and that newspaper reports of suicide may exert a negative influence. Under these circumstances, it is reasonable to regard the association as causal.
Actually when you look at their findings, it is not at all reasonable or in any way scientific to regard the association as causal. Putting aside the publication bias which is likely to have limited their review (studies finding an association are much more likely to be published than those which find no association), the vast majority of the studies were ecological studies in which it was impossible to establish whether the newspaper report occurred before or after the suicide. As one of the few sociologists who has published extensively on media reporting and suicide states
Most of the evidence to date for a copycat suicide effect is very indirect and not fully satisfactory. The associations are drawn between the presence of a suicide story and a rise in the suicide rate. It typically is not known to what extend the people committing suicide are even aware of the suicide story
That’s right, there was no evidence in most studies that the person who died had seen a newspaper report of suicide, or even that the report was published before their death. In fact, the media story that is supposed to have caused their death may have been the report of their death. Ecological studies can identify correlation but not causation.
Pirkis claims that the difficulties of ecological studies are overcome in studies in which subjects drawn from the general public are surveyed on their responses to suicide reporting. In these studies, subjects are shown a hypothetical newspaper article describing a suicide and asked questions about their attitudes towards suicide and the likelihood of their killing themselves. While these studies certainly overcome the ‘ecological fallacy’ they do not point to a causal relationship between suicide reporting and suicide given that according to Pirkis
The majority of these studies found that participants were unlikely to report that they would be influenced to engage in suicidal behaviour by a newspaper report of suicide, regardless of the circumstances of the suicide.
The methodology employed by Pirkis for assessing causality is interesting. She and her co-author assessed the evidence against five factors – consistency, temporality, strength, specificity and coherence. In their assessment of the relationship between newspaper reporting and suicide, this is what they have to say about each factor:
The association would appear to be consistent, with the effect being reliably observed under almost all study methodologies, strong (with a dose‐response effect being evident such that the greater the newspaper coverage of a particular suicide, the more substantial the increase in subsequent suicides) and coherent (with the findings making sense in the light of what is already known about the influence of the media and suicide). Although the evidence from ecological studies is less reliable with regard to temporality (with only a limited number of studies permitting a determination of whether the media stimuli preceded an increase in suicide rates) and specificity (with few studies being able to demonstrate that a reasonable proportion of those who subsequently died by suicide were exposed to the media stimulus), some individual‐level studies suggest that these conditions may also be satisfied.
So the evidence is consistent because the same findings are made by a number of studies with the same methodological flaws. It is strong because in the months where there are a large number of suicides there are also a large number of media reports of suicide. It is coherent because it fits with the conclusions of the studies it reviews (!) and it fails on temporality and specificity.
The weak links found in this review would not appear to justify legislation that makes it an offence to report individual suicides and thus remove from families their rights to freedom of expression and constrain media freedom. This is particularly so when one considers that the vast majority of studies only look for harm associated with media reporting of suicide. A review of 24 studies conducted by Pirkis in 2005 found that of the 24 studies reviewed, only 3 looked for evidence of positive or protective effects.
Pirkis seems comfortable with making definitive statements based on studies where methodology is unable to support the conclusions she reaches. She is the author of a 2007 study that found “SSRI use in adults with affective disorders is not associated with suicide risk.” The study’s control group was people who had not taken SSRIs within the previous two weeks but who were not asked about SSRI use prior to that time which means they could well have been people in withdrawal from SSRIs. Fortunately for Pirkis she found no association between SSRI use and suicidality as she acknowledges that causality would not have been possible to asses as the study’s “cross-sectional nature precluded determining whether an individual’s SSRI use preceded or followed his or her suicidality.”
In 2003 she co-authored a study decrying the media’s reporting of the verdict of a judge that Zoloft was responsible for the actions of a man who killed his wife and then attempted suicide.
Supreme Court Judge, Justice O’Keefe said in his decision:
The killing was totally out of character for the prisoner, inconsistent with the loving, caring relationship which existed between him and his wife, and with their happy marriage of 50 years. I am satisfied that but for the Zoloft he had taken, he would not have strangled his wife.
Pirkis is highly critical of papers who reported the story claiming “Some newspapers were alarmist and raised fears about the safety of the anti‐depressant, whereas others stressed the exceptionality of the case.”
She states that some were “framed by an anti-drug-company agenda” complains that “No interviews with people who had benefited from taking Zoloft were included” and is critical of the fact that Professor David Healy (who she describes as ‘drug company critic, Dr Healy) was described as ‘a leading voice in the world debate about Zoloft.’ She notes that on a positive note however, her colleague and co-author Professor Hickie is quoted as saying that “the benefits of antidepressants are far greater than the risks, and that people who suffer from serious depression can be abnormally aggressive and it is important to distinguish between this behaviour and the effects of medication.” She neglects to mention that Prof Hickie is a paid speaker for, and has received research funding from, Pfizer, the makers of Zoloft.
Pirkis is a member of the research committee for Orygen Youth Health (formerly the Early Psychosis Prevention and Intervention Centre (EPPIC) ) along with Ian Hickie and Patrick McGorry who have received significant funds from a large number of pharmaceutical companies. She is employed by the University of Melbourne who receive funding from Johnson & Johnson, GSK, Pfizer and Sanofi. It is possible that these links influence the conclusions Pirkis reaches.
It is hard to imagine that if Pirkis assessed the causal link between SSRIs and suicide using her “consistency, temporality, strength, specificity and coherence” methodology she would not reach the conclusion that it is reasonable to regard the association as causal as she did with media reporting and suicide.
Aside from Pirkis, two of the most recognized recognized names in the ‘copycat suicide’ literature are Hawton and Gould. Last year, Hawton published a study on the influence of the internet and self harm in which he claims “there is strong evidence indicating that suicide contagion is a significant phenomenon.’ He cites two studies to support this statement. The first, a study he co-authored on suicide clusters doesn’t in fact provide strong evidence of suicide contagion. It states that
The majority of studies lack methodological rigor. Many different psychological mechanisms are described, including contagion, imitation, suggestion, learning, and assortative relating, but supporting empirical evidence is generally lacking”
The other study is one from 1990 which states
The magnitude of the clustering effect is relatively small, even among teenagers and young adults.”
As strong evidence that ‘suicide contagion is a significant phenomenon, these studies clearly fail.
The other prominent researcher in this field, Gould has been described as “among the suicide scholars who present suicide contagion not as a theory but as epidemiological doctrine.” Her instruction in a 2003 study that “The existence of suicide contagion should no longer be questioned”  supports the view that she has moved from science to ideology.
Fortunately, other researchers have not heeded the dictate of Gould and have challenged the notion of suicide contagion, looking for more credible explanations for suicide clusters. A study in 2007 for example supported the alternative theory of homophily – the notion that similar people cluster together. If suicide is triggered by social and environmental factors and people who live in close proximity to each other share similar characteristics and circumstances, it is not surprising the authors, having identified a large suicide cluster found that once socioeconomic deprivation was controlled for, the cluster became insignificant. They comment
Whether some form of contagious behaviour is involved is difficult to determine empirically; an alternative explanation is that vulnerable people cluster together well before the occurrence of any overt suicidal stimulus, and experience of severe negative events, such as the suicide of a peer, may increase the suicide risk for the whole group.
Media impact theory tells us that the media influences both what we think about and how we think about it. For those whose professional status and financial fortunes rest on psychiatry’s involvement in suicide prevention, controlling the extent to which the public thinks about suicide and how they conceptualise it is critical to maintaining their power. Encouraging the media to raise awareness of suicide and presenting it as a medical issue that requires biomedical treatment and that psychiatrists are experts in suicide prevention, is critical to maintaining authority. Allowing parents to present evidence that their children were not mentally ill, worsened as a result of treatment and killed themselves as a result of psychiatric drugs and / or social factors, does not.
The recent history of restricting suicide reporting in New Zealand makes it reasonable to call into question the motives of those pushing the copycat suicide barrow. In 2010, Pirkis found it was irresponsible reporting, not reporting per se, that triggered suicide. In the same year a government funded review in New Zealand of suicide reporting found that 100% of news items did not portray suicide in an inappropriate manner and 96.7% were not reported in such a way as to normalise suicide. The concerns the report highlighted were failure to promote mental health services and/or to ask ‘official sources’ for comment on suicide stories. Additional concerns included the fact that a significant proportion of stories focused on suicide as the outcome of mental health treatment and the views of the news industry that the suicide industry has been captured by a small number of people. Despite the fact that New Zealand does not have a problem with irresponsible reporting of suicide, the following year the government in collaboration with the media developed guidelines for tighter restrictions on reporting of suicide.
The impact of copycat suicide theory and restrictions on media reporting of suicide is the silencing of the voices of those who have expertise in the lived experience of suicide and who want to share their stories to warn others. It censors those who attempt to tell the story of iatrogenic suicide, of prescription drugs that give rise to compulsive suicidal thinking and acts, of the failure of psychiatric approaches to emotional distress. It privileges the voices of psychiatrists and those who follow psychiatric ideaologies over the voices of those who have suffered fatalities as a result of involvement in the mental health system.
For a multitude of reasons, we will not be silenced. First because our childrens deaths should not remove our rights as citizens to freedom of expression. Second because to criminalise us for trying to save the lives of others is an abuse of the power vested in the state and third because we know that with persistence we can reframe the story of suicide and give people the information they need to keep themselves and their loved ones safe from iatrogenic suicide.
In his thesis, David Chartrand from Kansas State University tells the story of how the suvivors of child loss can effect change through the media by looking at how the voices of Mothers Against Drunk Driving and political activist Ralph Nader reframed the story of the automobile industry. He says
By the end of the 1980s, passenger cars had lost their reputation as the ticket to entertainment and the good life. Consumer groups successfully re-described the automobile as a deadly, killing machine. Despite the auto industry’s efforts to reverse this framing, the consumer activists had carried the day. By winning the race for media attention and credibility, the consumerists were able to shape the media’s framing of the health and safety issues involved. Shouts of protest from automakers became helpless whimpers once the news media accepted drunk driving and dangerous cars as two pictures requiring a single frame, refusing to let the industry distance themselves from the carnage caused by drunk drivers media enabling consumer activists to referee the line between available information and existing information. 
According to Chartrand “Those forces patient enough to develop media trust and credibility over a long period of time are most likely to shape the media’s eventual framing of the issues involved.“
Framing families and the media as posing a suicide risk while denying that there is a risk of suicide from the use of psychiatric drugs is mischievous. To date, I am aware of zero suicides suspected to be causally associated with the media assisting me to tell my son’s story of iatrogenic suicide and tens of thousands of suicides suspected to be causally associated with SSRIs.
My child is dead and all I have left is his story and time. I intend to use both to prevent psychiatry and the pharmaceutical industry promulgating the myth that suicide arises from mental illness, that psychiatric treatment prevents suicide and that talking about suicide causes contagion.
 Mary O’Sullivan, Mike Rainsford & Nicole Sihera, Suicide Prevention in the Community Health Service Executive (2011)
 Noras, B., Jempson, M., & Bygrave, L. (2001). Covering Suicide Worldwide: Media Responsibilities.
 A marae is a meeting ground where significant events, including funeral rites, are held and celebrated by Maori, the indigenous people of New Zealand,.
 Sisask, M., & Värnik, A. (2012). Media Roles in Suicide Prevention: A Systematic Review. International Journal of Environmental Research and Public Health, 9(1), 123-138.
 Pirkis, J., Blood, R. W., Francis, C., & McCallum, K. (2005). A Review of the Literature Regarding Film and Television Drama Portrayals of Suicide. Program Evaluation Unit, The University of Melbourne.
 Pirkis, J., Burgess, P., Johnston, A. and Whiteford, H.; Use of Selective Serotonin Reuptake Inhibitors and Suicidal Ideation: Findings from the 2007 National Survey of Mental Health and Wellbeing. Letters MJA Volume 192, Number 1. 4 January 2010
 Daine K, Hawton K, Singaravelu V, Stewart A, Simkin S, Montgomery P. The power of the web: a systematic review of studies of the influence of the Internet on self-harm and suicide in young people. PLoS One. 2013; 8(10)
 Haw, C., Hawton, K., Niedzwiedz, C., & Platt, S. (2013). Suicide clusters: a review of risk factors and mechanisms. Suicide and Life-Threatening Behavior, 43(1), 97-108.
 Gould, M. S., Wallenstein, S., Kleinman, M. H., O’Carroll, P., & Mercy, J. (1990). Suicide clusters: an examination of age-specific effects. American Journal of Public Health, 80(2), 211-212.
 Chartrand, D. V. (2013). The media and mental health: media familiarity with nationwide standards for reducing mental illness and suicide (Doctoral dissertation, Kansas State University).
 Exeter, D. J., & Boyle, P. J. (2007). Does young adult suicide cluster geographically in Scotland?. Journal of epidemiology and community health, 61(8), 731-736.
 Price, V., Tewksbury, D., & Powers, E. (1997). Switching Trains of Thought The Impact of News Frames on Readers’ Cognitive Responses. Communication Research, 24(5), 481-506.
 Brian McKenna, Katey Thom, Gareth Edwards, Ray Nairn, Anthony O’Brien & Ingrid Leary. 2010. Reporting of Suicide in New Zealand Media – Content and case study analysis. Centre for Mental Health Research, The University of Auckland (2010), Auckland: Te Pou