Augusta, Ga. (WJBF) — It started as a book and has now become a Netflix phenomenon – “13 Reasons Why”. Many young people are watching it because it is about them. Many see themselves in the characters portrayed, so that prompted The Means Report to dedicate a broadcast to the series – because it is not just any subject matter for children. The series deals with suicide in a very blunt, in-your-face way. And Dr. Dale Peeples, a child and adolescent psychiatrist with the Medical College of Georgia at Augusta University helps to navigate the waters.
Brad Means: “13 Reasons Why”” is our topic all Means Report long. Dr. Dale Peeples, a familiar face to viewers of The Means Report and to members of our community. He’s a child and adolescent psychiatrist at MCG at AU. Dr. Peeples, thanks for coming back.
Dr. Dale Peeples: Oh, it’s great to be here, thanks.
Brad Means: Well, you take us through some pretty tough issues, bullying mostly recently, and now suicide, sometimes the two go hand in hand, sadly. You’re using or have used the Netflix version of “13 Reasons Why” in your work, tell us about that.
Dr. Dale Peeples: That’s true, I haven’t used it now with patients, but the context we do use it in is with our trainees, our residents who are becoming psychiatrists. We use it to show, better illustrate aspects around suicide, the impact that it can have.
Brad Means: The themes that come up in that series and in the book, are they themes or topics that you’ve seen a lot in your practice, in your work with children?
Dr. Dale Peeples: Right, so, as viewers may be aware, in addition to the suicide, the show also touches on sexual assault, it touches on bullying. And those definitely are issues that some of my patients deal with.
Brad Means: Now, just to recap, the story is about the main character, Hannah. Hannah commits suicide and before she does, she makes several tapes that she distributes to the people who she thinks, good and bad, played a role in her life, in particular, played a role in her decision to end her life. And so, let’s move from getting your future colleagues to watch this as they prepare to go into the field of psychiatry, to how we should deal with these topics. And I guess the main question is, it sounds like a stupid question asking it, and now that I’m about to pose it, but is suicide ever the right response or an acceptable response to anything you’re dealing with in life?
Dr. Dale Peeples: It’s a problem that we can always work around. Thoughts about suicide are very common in teenagers. About a third of high school students in any given year may have very fleeting, very temporary thoughts about suicide, and imagine if all those kids acted on them. It would be an unimaginable loss. There’s always a solution, and it’s just sitting down and figuring out the workaround. There’s no reason to ever use suicide as the only option.
Brad Means: Alright, so how do we know when a child is serious? When you get past the typical adolescent angst and you start saying, wait a minute, this kid’s crossed the line, they may do something?
Dr. Dale Peeples: Depression is a huge risk factor for suicide, so the more and more symptoms of depression we’re seeing in a kid, the more we’re going to worry that they may actually act on those impulses. And when we talk about depression, we’re talking about obviously depressed mood, feeling bad and feeling down. But some kids will describe the sense of anger and irritability instead of sadness. So, any changes like that in the emotion that a family is seeing in their kid should be warning signs. Withdrawing from activities that a child used to enjoy, changes in sleeping patterns, changes in eating patterns, decline in academic performance, those are going to be warning signs to a family as well that something is wrong here.
Brad Means: Well, and at that point, do you just start the conversation with them and try to get them back to a happy place, to oversimplify it, or do we seek professional help? How do you know when to make that move?
Dr. Dale Peeples: That can be a little tricky to figure out, and the teenager in question can be a good source for families, if parents are talking to their child, and their child really feels like that this is getting out of control, this is something they can’t handle, then, yes, you definitely, you immediately wanna seek professional help. But, you know, sometimes there are issues that a family can work through on their own. You wanna think about the severity of the thoughts, so, I mentioned a number of kids will have thoughts about, life’s not worth living, wishing they were dead. When you start thinking about ways you might hurt yourself, we worry a lot more. When you start making a concrete plan, you’re giving away possessions, that’s extremely worrisome.
Brad Means: We saw the main character do that in the book and in the series, how many, you don’t have to give a number, but generally speaking, do a lot of kids who come in as your patients want help, or do they feel that their parents forced them to be in that chair across from you?
Dr. Dale Peeples: Yeah, it’s a good question, there are both cases, there are certain situations where a child’s really not acknowledging the problem but the parents see, see that it’s there, evidently. Most kids I see do want help, and are looking to change things, and usually after a child has gotten a chance to know you, you’re no longer the stranger that’s kind of asking these personal intimate questions about their life, generally speaking, they come on board with treatment, and they’re looking to fix the situation with you.
Brad Means: We talked about this with, I believe, smoking and violence, and I think sex, and the topic was when you see those things glamorized on the big screen, or in this case, the small screen, television, does it make you want to do that? Are you worried that “13 Reasons Why” may make suicide glamorous?
Dr. Dale Peeples: Yeah, that’s a huge, huge worry with this, and really my advice to families is if you feel like your child is at risk, they’ve had trouble with depression, they’ve had trouble with self harm, this is not good entertainment for them. You’re probably aware that suicide has a contagion effect, meaning that if we see a suicide in a community, you’re likely to see other suicides follow it, and this series in particular does add an extra layer of glamor to it, the main character, she’s able to continue to narrate the story after she’s died, she’s still having a direct impact on the lives of others, there’s sort of a cosmic justice carried out through her actions, and none of those really happen with true suicides, so, it gives kids this fantasy picture.
Brad Means: How powerful are other people’s words and actions when it comes to pushing someone to the point of suicidal thoughts? The reason I ask is because, at the risk of sounding insensitive, there were many times when I read the book that I thought, this girl is going through what every high schooler goes through. How dare she think this is worthy of ending her life? And so, again I say, can you be bullied or put down to the point of, I wanna end it?
Dr. Dale Peeples: So, every year or so there’s gonna be a big case in the news about suicide linked to bullying, and we’ve seen it in the past, but suicide never has just one cause, there’s never just one factor. Oftentimes there are underlying mental health issues, depression being the most common, but sometimes substance use issues as well, that kind of lay the groundwork for a suicide, and certainly life stressors can factor in, whether it’s issues at home or issues at school with friends, poor academic performance, all those can be a contributor, but usually you can’t just identify one cause.
Brad Means: What about the, the role of the guidance counselor, excuse me, in schools, do you think that they are qualified enough and doing enough to help these children? Sometimes those are the folks that see them way before you do.
Dr. Dale Peeples: Yeah, and that was another concern I had about the series. The guidance counselor really wasn’t very helpful.
Brad Means: Not helpful, not really good at his job, no.
Dr. Dale Peeples: Yeah, and the reality is, again, thoughts about suicide are extremely common in teenagers, and guidance counselors are prepared for this. They do know how to help an individual seek further assistance. Again, sometimes they might be able to work with the child or with the family on their own and manage a situation, but at the very least, they’ll put you in touch with crisis services.
Brad Means: Does it run in the family, the, the thoughts of suicide, if mom or dad or a grandparent or a relative committed suicide are you more likely to try?
Dr. Dale Peeples: Yes, family history is a risk factor with suicide. One, oftentimes there are the issues of depression that really led to the first suicide, and we know that that’s very heritable, so, parents with depression, it’s likely that a child could have depression as well, too. And then you also can have that contagion effect we discussed earlier, where this suicide has been modeled for the child, they’ve had a close family member commit suicide, they’ve seen how it was carried out, and then they follow a similar course.
Brad Means: When The Means Report continues, we’re gonna continue our conversation about teen suicide based on this phenomenon of “13 Reasons Why”, we wanna talk to Dr. Peeples about the treatment options that are available. If you have a young person in your life who has maybe some of the signs or symptoms that the doctor has already outlined, and you wanna take that first step, we’ll tell you what to expect if you walk into a psychiatrist’s office and what happens from there, and a little bit later in the broadcast, we will let you know how you can get some help, some resources that are available right now for you, just from the comfort of your own home, on your tablet or your computer or your smartphone, so you don’t have to wait until all the offices open on Monday, as The Means Report continues.
Brad Means: Welcome back to The Means Report everybody, as we tackle the tough subject of teen suicide with child and adolescent psychiatrist Dr. Dale Peeples of the Medical College of Georgia at Augusta University, and Dr. Peeples, let’s talk about once people have the courage to walk through your door, or a psychiatrist’s door with their child, what happens, take me through the initial steps of therapy.
Dr. Dale Peeples: Okay, so, yeah, so a first visit would tend to last about an hour, and a lot of times you’re just reviewing background history, so you’re getting all that basic stuff, medicines, allergies, surgeries, any medical problems. You focus on that, and then you talk about what’s been going on, what prompted the family to make the appointment. So, that usually would run about 45 minutes, and in the final 15 minutes or so, you take some time to discuss diagnosis, what you feel like might be going on here, prognosis, what a family could expect in terms of the course of the illness or treatment, and then treatment options, and hopefully you come to an agreement that satisfies everyone about a direction with treatment, whether it’s medications or therapy, and you proceed from there. Then you’d follow up in a week or two usually, and see how things are going.
Brad Means: How long do they have to stay with you until they’re better?
Dr. Dale Peeples: So, it kind of depends on what you select as far as a treatment goes. If you’re talking about medications, usually you’re gonna see improvement about a month or two out.
Brad Means: Are we talking about anti-depressants primarily?
Dr. Dale Peeples: Yes, sir, that’s correct.
Brad Means: Alright.
Dr. Dale Peeples: If you’re talking about talk therapy, like a cognitive behavioral therapy strategy, usually you’d start seeing treatment response in a similar ballpark, about six to eight weeks. With cognitive behavioral therapy, you might look at about 15 sessions total. With medication management, kind of depends on how stable the individual’s doing, if we’re very worried about someone’s safety we’re gonna see them a lot more frequently, but you might be checking in once every month, or perhaps once every three months if you’re just doing medication alone.
Brad Means: What would you say on behalf of all psychiatrists to the frustrated parent who may be watching, saying, listen, I love what this man’s saying, but you’ll never get through to my child?
Dr. Dale Peeples: Well, you never know until you try, and a lot of kids, at that first visit, they are a little hesitant, they are a little distrustful, you’ve got a stranger asking them intimate details of their life, a lot of kids, it’s not that pleasant, but when kids start seeing that these are people who care about me, these are people who are listening to my story, who care what I have to say, and when a kid starts seeing that things are improving, usually you see a big shift in attitude.
Brad Means: You know, when I think back to my high school days, I think about how important my peers were, and so I wanted to ask you if peers can be part of the treatment process, either directly by sitting in your office with the patient, or somehow indirectly, and how?
Dr. Dale Peeples: Well, kids can do a lot for one another, and particularly, encourage kids to be thoughtful about their interaction with everyone at school, and just creating a supportive, inclusive environment can go a long way in helping people out. Social support is extremely helpful, so, making sure that you have friends that you can talk to, that’s gonna help with depression. Engaging in activities, having distractions to take things off your mind helps, so kids can help each other out that way, just by being there, being active. In terms of coming in for therapy sessions, you see that less frequently with depression. From time to time, I’ve had a kid who’s asked if they could bring a friend in just because it increases their comfort level, but for the most part it’s not a typical therapy approach.
Brad Means: In our first segment you mentioned, I think you said, the contagion that can come with suicide, that is, that it sometimes spurs other people to commit suicide, copycats, if you will, and I wanted to go back to the glamorization of it very quickly. We see, sometimes, suicide, people who commit suicide, their lockers are decorated, shrines are created to them. Does that add to the glamorization process, and how should those left behind deal with it, just never discuss it again, pretend like that person wasn’t there, ’cause you don’t wanna put them on a pedestal like suicide’s a good thing.
Dr. Dale Peeples: Yeah, it’s a real balancing act between honoring the memory of a lost loved one, and the risk of glamorization of suicide. I think when you have that direct contact with an individual, when it was your family member, it was your friend, yeah, you need to be able to mourn, you need to be able to remember them. Having all the typical memorials, funerals and services, you still want to engage in all those normal cultural acts. It’s a little bit more of a concern, a worry, when the memorial takes on a larger cultural meaning, when it starts getting out in the community beyond the individual who was just affected, so when people in other schools are talking about it, if it were to pick up news coverage, that’s when we start to worry a little bit more about it getting glamorized.
Brad Means: Yeah, we have a policy, not only here at Channel 6, but in every station where I’ve ever worked, we don’t cover suicides, and unless the public is, someone jumps off of the 13th Street bridge with a bomb strapped to them and there’s 100 boaters below, we probably would, but, we don’t wanna glamorize it, we don’t want people thinking it’s something that could get you on T.V., and that leads me to one of just a couple of final questions, and that is do you think that young people’s brains are developed enough for them to understand the permanence of suicide, to get that it is final, they don’t get to be on Netflix like Hannah, do you think they grasp it?
Dr. Dale Peeples: You hit on a very, very, very significant point. One, children’s brains aren’t fully mature, that doesn’t happen until around the age of 25 or so, so even young adults, you’re still growing, you’re still developing, so kids are much more impulsive, they’re much more reactive than adults due to that. And then the second thing you touched on, the permanence of death, that’s a concept that really develops with age as well, and younger kids, kids who might be a little bit more immature than their peers, will really believe these fantasies that, maybe I can come back, maybe I’ll be reunited.
Brad Means: Right. And that’s scary. My last question, how does it make you feel when you turn lives around? I know you’ve taken a child from the brink of suicide, the brink of total darkness, and seen them go back to their families as a bright child again, your thoughts on how that must feel.
Dr. Dale Peeples: Oh, yeah. I love my job and I love the successes that come with it. I do some inpatient work, so I do work with kids who have just attempted suicide, and I’ve known kids over the years, and I’ve had decade, a decade relationship with people who could have been lost, and seeing them develop, seeing them grow, go off to college, enter relationships, it’s beautiful, you know?
Brad Means: It is, it is beautiful, and it’s because of you and your peers in the field, and I thank you for that so much.
Dr. Dale Peeples: Absolutely, thank you.
Brad Means: Anytime, Dr. Dale Peeples, a friend of The Means Report, and a friend to you young people. You know, it’s not over, you know, you can get help, and when we come back we wanna share some resources with you that will help you get the help that you need. We have websites, if your parents wanna do the boring website search, they can, kids, we have a way for you to text for assistance right now, and sit in the comfort of your room and just get on your phone and see what’s out there as a resource when The Means Report returns.
Brad Means: Welcome back to The Means Report everybody, “13 Reasons Why” and teen suicide our topic today, so where can you go for help other than calling Dr. Dale Peeples’s office? How about these resources?
First of all, the National Suicide Helpline, you see their telephone number on your screen, 1-800-273-TALK, 24/7 for them, and the Jed Foundation, you can go to their website, https://www.jedfoundation.org, or you can, and this was what Dr. Peeples was telling me during the break, I think it’s fascinating, you can text START to 741-741, okay, kids, listen to me, text START to 741-741, and that’ll get the conversation started on that front, so you don’t have to talk to anybody, you don’t have to deal with anything really, you can do what you always do and just text.
We just want you to get help, can you tell, that’s all we want.
We want you to help shape future editions of The Means Report as well, and it’s easy to do that. Our social media sites are always active, Facebook, Twitter, and Instagram, the address is one word, TheMeansReport. You can also email us, we love to get those emails on Sundays and Mondays after the show airs. Marlena’s address is MWilson@WJBF.com, mine is BMeans@WJBF.com, and you can watch all the previous episodes of The Means Report, including this one, on our website, https://www.WJBF.com, we love it when you do that, and we appreciate your input shaping our future broadcasts.
So thanks again to Dr. Peeples and the help that he provides to our young people who always need to realize help is always available, it’s never over. For Levi, Marlena, and the entire Means Report family, take care.