After having teetered so close to the edge of death, I am surprised a lot of days that I am actually still alive, that I didn’t perish in the bathtub when I dropped the hairdryer into the water.
I finished watching the second season of 13 Reasons Why last night, and this show has stirred up a storm of thoughts and emotions for me, given my experience, so I thought I might contribute to the conversation that this show is igniting.
I first started having suicidal thoughts when I was a junior in high school. As I drove home from school, I often thought about swerving into oncoming traffic. One night, I was up late writing a paper for English class, and I was so tired that I didn’t think I’d be able to finish it in time. I opened the knife drawer and thought that perhaps cutting my wrists could shield me from the shame of not turning in an assignment on time. But cutting myself would result in another kind of shame, a shame much worse than tardiness. I shut the knife drawer, finished my paper, and told no one that my mind frequently wandered to this dark location.
What did I have to be upset about, anyway? I grew up in a safe, privileged environment. My parents were together, and they showed me that they loved me on a regular basis. I had at least one loyal friend. I had goals, and I worked hard. I did not yet know that clinical depression is a very different thing than being “really upset” or “really unhappy.” There are distinct differences between these mental states.
Furthermore, there are not always external “reasons” that can explain why a person would contemplate suicide. In many cases, the “reason” is almost purely chemical. In most cases, it is a combination of brain chemistry and environmental, interpersonal factors. But the concept of brain chemistry or even the words “clinical depression” or “major depression” are not mentioned once in the first season of 13 Reasons Why in explaining what happened to Hannah Baker. The second season barely approaches these factors, but only sort of in passing.
I did not know that what I had could be called depression until I was a senior in high school when I took an AP Psychology course. I read ahead in the textbook to the chapter on Psychological Disorders, and as I read the clinical definition of depression, I heard resounding echoes of my daily mental experience — the hopelessness, the frequent thoughts of death and dying, the dim view of my future despite my promising circumstances. I tried to tell my parents how I felt, but they didn’t understand how serious my problem was because I was too ashamed to tell them the worst of it. They offered to refer me to a counselor, but I refused, given how embarrassed I was and how shut-down I felt.
Throughout the rest of my senior year, my depression grew worse. I accidentally told the principal at my small school that some of my classmates had been drinking at a school event. Some people received suspensions, and when word got out that I was the one who “snitched” I was ridiculed in person and on social media. I felt ostracized from the one community I had known for most of my life. Therefore, I can relate to the social isolation that Hannah feels, which is particularly shown in Season 1 and which she names as a “reason” why she ultimately chooses death.
The truth that the series does not really touch on, however, is that sometimes depression comes before the social isolation and then social isolation only deepens it. My depression made it very hard for me to engage with my peers because so many of the thoughts going through my head were not socially acceptable to admit, so I felt isolated long before I was bullied, and the bullying only worsened it. I felt powerless to stand up for myself because I thought the worst about myself.
I was pleasantly surprised that Season 2 actually mentions that Hannah has a family history of mental illness, even though this mention is very brief and in the context of the school providing a reason why it was not responsible for Hannah’s death. However, I wished that the series would have delved deeper into that revelation — perhaps mentioned a family member who also suffered from depression and had died by suicide. Even in the second season, it still appears that the show’s writers and thus the characters are uncomfortable with having called Hannah’s condition “depression.” This is an important term to use because “depression” can mean the difference between surviving a sexual assault and not surviving a sexual assault. Hannah was raped and chose to end her life, while Jessica, who was also raped, asserts in the second season that she never even contemplated doing what Hannah did. Both of these girls had suffered many of the same physical and psychosocial injuries, but one was in so much pain that she did not want to live. This pain of not wanting to live is called clinical depression, and it is not caused by weakness but by a lack of “happy chemicals” in the brain, such as serotonin. A lack of appropriate serotonin production is a genetic factor that can be inherited and can predispose a person to being especially susceptible to stress, such as the trauma of sexual assault.
I know this because I finally learned the biochemical route of my depression when I was 25. In my mid-twenties, my depression grew so severe that I was in and out of various levels of psychiatric care for a year and a half. I saw over ten different mental health professionals, tried over 15 different medications, and was hospitalized at seven different facilities in five different states. During that time, I tried to electrocute myself in the bathtub in my parents’ house. Luckily, my mother had turned off the breakers and found me before I could complete what I was trying to do. At that time, I was 100% convinced that I would never get better and that my life was over. Like Hannah, I felt overwhelming psychological pain that I thought would only go away if I died.
Finally, I saw a psychiatrist who offered a new plan that no one had proposed before. We would try genetic testing. The nurses took a cheek swab for a sample of my cells and sent them off to a personalized medicine company, which then sent back a report to my doctor. He informed me that I had three faulty genetic mechanisms working against me. My brain does not produce adequate amounts of serotonin and does not recycle serotonin properly. My brain is also highly susceptible to the stress hormone, cortisol, so when I get stressed my low production of serotonin plummets. After years of wondering why I was so “weak” and “sensitive,” here was my scientific explanation. Given my genetic deficits, I was destined to have a major mental health crisis. It was not my fault, and I finally felt the blame lift from my shoulders.
Perhaps Hannah’s suicide would be better understood if the writers gave us more context about her family history and the genetic, biochemical factors at play. Perhaps Hannah’s parents, as well as all the friends she left behind, would understand what she did if they knew that she had a serious medical condition that no one recognized, so it went untreated. The whole system failed Hannah, just as it failed me for years, and is currently failing millions of people who are not adequately informed about what causes depression and how we can treat it.
Depression is caused by the interplay of genetics, brain chemistry, and the environment and can be treated effectively given treatment that is truly individualized, both in terms of medication management and talk therapy. The most effective medications for the individual can be determined through genetic testing. In addition, providers should show compassion for their patients and regard for them as unique individuals, not as walking problems or diagnoses. (You might be surprised how rare this approach actually is.)
The second season made a valiant effort to flesh out Hannah as a lovable yet flawed human being who deserved better than what she got in life, but I still feel like there is a huge part of the story missing, and this gap perpetuates a popular misconception that we have about people who choose to die by suicide. In one particular scene, Hannah’s parents are crying and trying to reassure each other that Hannah was happy while she was alive. Her suicide reveals that she was not happy or unhappy. She was depressed. It is different. When you are unhappy, you do not think seriously about ending your own life. When you are depressed, you do, because it is a whole different level of pain. It is the pain of not being able to see meaning in life and not being able to see the good in life or yourself or other people. Your brain renders you physically incapable of doing these things, so you begin to think the only way to stop these thoughts is to permanently turn off the thing that is creating them. Sleep may be a welcome respite, but death looks like the only way to permanently stop the tide of rushing negativity. These become the options: endure this perpetual, piercing pain or die. No one wants to end up with these choices, but too many people do.
Season 2 tiptoes a little closer to the issue of mental health diagnoses and rehabilitation with Skye’s story. She tries to explain to Clay that she has overwhelming feelings that make her cut herself. She is hospitalized and then sent to a psychiatric facility after a serious self-harm attempt. She tells Clay that she has been diagnosed with bipolar disorder, which explains her erratic behavior and feelings. She very briefly mentions that she has started taking medication. If this were real life, Skye would probably still have a lot of trouble in her future. If her doctors do not practice with genetic testing, it is unlikely they will prescribe her the right medications even though they have bestowed a diagnosis upon her. Practicing without genetic testing is like shooting bullets in the dark, hoping they will somehow reach the bull’s eye. Most people have to endure this trial and error method of psychiatry and grow frustrated that none of these “treatments” seem to work. Their doctors will tell them that they must have “treatment resistant depression,” which is what doctors informed me. After getting the genetic testing done, I learned that my depression was not “treatment resistant” but that none of the previous treatments had targeted my specific biochemical deficits. Once I was prescribed the right medication, my mental state began to improve in a matter of weeks.
I commend the whole 13 Reasons Why cast and crew for creating a piece of art that has launched conversation about the issues of suicide, bullying, and sexual assault, but I would really like to know why the causes of Hannah’s depression were not explored more deeply in Season 2 and why the series seems to shy away from the word depression itself. Depression is a treatable medical condition and should be framed as such. Sometimes “reasons” for suicidal thoughts are concocted by the mind in order to try and justify the hopelessness to which it is already prone. Therefore, suicidal thoughts should be recognized as symptoms and treated with individualized medicine and therapy long before any “reasons” for suicide are enumerated.