Imagine a game that asks young people to kill themselves, leaving a trail of bodies from Ust-Ilimsk to Mumbai to West Midnapore. Your first impulse is to dismiss it as another bizarre fad that "normal" homes like yours are immune to. But if you have a teenage child, or a young brother or sister, perhaps it gives you pause. Youth can be a confusing time. Who knows what demons might be tormenting that mind?
What do you do? Confront them? Snoop on them? Take away their devices so that they do not fall for the deadly lure of Blue Whale when no one is watching?
India is the world's most depressed country... Yet, in our homes and in public discourse, mental illness is a black hole.
Or do you do nothing, hoping that they won't know? What if anything you do ends up pushing them into the arms of a morbid obsession?
Oh well, it's all over the news anyway. They know.
This is my story. A young cousin I love to bits lives his life online. Though I am the journalist in the family, I cannot match the speed with which he catches on to the freakish curiosities that only the internet can spawn. How do I know if Blue Whale has him in its thrall? How do I protect him from its sickening tales, 23,80,000 of which are thrown up by a simple Google search?
Ultimately, my doubt paralyses me. I do nothing. The fear still keeps me up at night.
By itself a game cannot kill. But give it a lost mind and just enough motivation, and it can turn into a knife or a free fall from the terrace. In India, there seems to be no dearth of motivation for the morbidly minded: 371 Indians kill themselves daily on average; 18-29-year olds are particularly at risk. Many more attempt to but fail.
Horrifying as the numbers are, they are only a symptom. The malady runs deeper. India is the world's most depressed country. Estimates vary, but the World Health Organization (WHO) says 36% of us are likely to suffer from major depression at some point in our lives. At least 60 million of us—more people than in all of South Africa—reportedly live with some form of mental disorder. And while it is difficult to precisely correlate the mentally ill population with those who ultimately commit suicide, that there is a correlation is without doubt.
Yet, in our homes and in public discourse, mental illness is a black hole. Until recently, suicide was a crime, leading to rampant underreporting. Little wonder that an open, informed conversation on what drives a person to take their own life has remained a mirage.
Something has to fill this conversation vacuum—and it does. The news cycle's appetite for death-as-spectacle. Story after sensational story on suicides, of kids scarred by growing up or celebrities hounded by scandal.
[A]n open, informed conversation on what drives a person to take their own life has remained a mirage. Something has to fill this conversation vacuum—and it does. The news cycle's appetite for death-as-spectacle.
Like any other epidemic, suicides are newsworthy, yes. The danger is, they also make for easy clicks. To be sure, mental-health coverage is frequently feckless in the offline world too, as we will see. But the newfound logic of virality, where speed tramples sensitivity, is threatening to trigger a crisis that could rapidly spiral out of control.
Think that's a stretch? That people have been killing themselves since long before the media's current zeitgeist? Arjun Bhardwaj's family might tell you a different story. On April 3, 24-year-old Arjun jumped to his death from the 19th floor of a hotel in Mumbai. He live streamed the act on Facebook. A Hindustan Times report quotes psychologist Dr Pulkit Sharma: "Most people commit suicide because they're depressed and hopeless," he says. "They do it silently in a closed room. But those suffering from personality issues might have a lot of anger and resentment in them. They might also be attention-seekers in some way ... They die with the hope that their story will go into the newspapers; people will talk about them and watch their video (emphasis mine)."
Between the sinister spread of Blue Whale and the burgeoning trend of suicide streaming a pattern is emerging—the unprecedented pursuit and promise of "attention" in the new media age supplies added motivation to self-destruct. (Look a little askance, and you will find it sucking in the non-suicidal too. Within four years of the Oxford English Dictionary anointing selfie the Word of the Year, more Indians are killing themselves trying to take winsome selfies than people anywhere else in the world.) In these pop-culture-soaked times, the temptation to become the "story" lurks everywhere.
Between Blue Whale and the burgeoning trend of suicide streaming a pattern is emerging—the unprecedented pursuit and promise of "attention" in the new media age supplies added motivation to self-destruct.
Psychologists speak of the Werther Effect, or the phenomenon of copycat suicides influenced by popular culture. In 1774, Goethe published the novel The Sorrows of Young Werther, in which the protagonist, Werther, kills himself out of unrequited love. The novel is said to have triggered a wave of suicides in Europe. In 1991, American novelist and euthanasia activist Derek Humphry published Final Exit, laying out several methods of suicide. The book, a New York Times bestseller, stirred immediate controversy since critics feared it could nudge even those not terminally ill to commit suicide.
Of course, 1774 and 1991 were long before the nexus of social media and news media set out on its perpetual prowl. The potency of letters and images has increased immeasurably since. Not all of us want to kill ourselves, but the echo chambers of our newsfeeds are making ever-increasing numbers of us terribly unhappy, even clinically depressed.
Some, like the author Manu Joseph, believe something more insidious is under way. What if we live in a culture that glorifies the idea of being depressed? "Today there is something triumphant about having a problem," he writes. It could fetch you "one of the highest rewards of our modern times"—going viral.
Though I was vaguely aware of the pathology of our times, it didn't really hit home until March 2017. I was a proud journalist who believed in the media's salutary influence on society. I was addicted to Twitter. I was not a selfie-lover, but I thought it was an interesting (if irritating) sociological phenomenon. Things changed in March, when I was diagnosed with depression and anxiety.
The reporting is mostly reactive: When there's a suicide (or more so, when it's a sensational suicide), or when it's World Mental Health Day... or when a big study is released. Nelson Vinod Moses, journalist
As part of my therapy, I started arming myself with information on my illness and speaking up publicly about my experience (some of it did go somewhat viral). Then one day, a friend introduced me to Amrita Tripathi, the founder of The Health Collective. "Do you think there is a story to be told about the Indian media's portrayal of mental-health issues and suicide?" Amrita asked me. Over the next few weeks I found myself poring over academic studies, interviewing journalists, even ambushing my own doctor for perspective.
It wasn't hard to get a sense of the consensus. The media has messed this up, big time.
My first port of call was Nelson Vinod Moses, an independent journalist writing on mental health, a writing fellow at online-counselling platform YourDOST, and founder of the not-for-profit Suicide Awareness and Prevention Foundation India. I had discovered Nelson through his deeply researched article on the role of technology in mental-health management. Nelson says there isn't enough reporting on mental health in India. "The reporting is mostly reactive: When there's a suicide (or more so, when it's a sensational suicide such as in the case of Arjun Bhardwaj), or when it's World Mental Health Day, World Suicide Prevention Day, or World Health Day, or when a big study is released."
Nelson is scathing about the way the media handled Arjun's suicide. "The media does not know how to report on mental health," he tells me. "[They] aired a video of him which showed him describing how to research suicide, what to do before, and how to go about executing it. The video, which was first posted on Facebook, describes everything in great detail, and shows Arjun's vulnerability before he took the extreme step. The video went viral on social media and a few websites, before it was taken off Facebook, and the Mumbai Police urged the media not to air the video. Funnily enough, the father blamed the police for the video going viral. The next day, the drama played out again but in greater detail, as the newspapers splashed the news across the country."
[Many reports] fall afoul of the guidelines prescribed by the Indian Journal of Psychiatry—report neutrally, do not glorify victims as martyrs, help improve public awareness about issues related to mental health...
Nelson argues that the media botched up a lot of things in the process, undermining the fight against suicide. "Other than airing the video, they described the whole suicide in graphic detail. They reported the contents of the suicide note and also quoted the police stating that there were lots of sites that he visited that had to do with dying and 'celebrating death'. In addition, almost no one spoke to a suicide-prevention expert or psychiatrist or explored whether it was a mental-health issue. Almost no one posted numbers of suicide-crisis helplines."
Though I did not personally track this case, cursory research shows Nelson is broadly right. Each of these breaches is in grim violation of the WHO's guidelines on responsible reporting on suicide. They also fall afoul of the guidelines prescribed by the Indian Journal of Psychiatry—report neutrally, avoid reporting suicide as the only method of coping with personal crisis, do not glorify victims as martyrs or the method as an acceptable one, do not publish suicide notes, do not repeatedly play on the event or theme, and help improve public awareness about issues related to mental health and suicide and sources of assistance, among others. Anecdotally, I spotted similar neglect in multiple reports on the suicide of Mukesh Pandey, a 32-year-old IAS officer from Bihar, as well as several of the Blue Whale stories.
[NIMHANS] researchers... found an alarming incidence of non-compliance to guidelines... Only 16% reported mental disorders related to suicide, and less than 3% included information on suicide prevention and helplines.
There has been no nationwide research on the media's suicide-reporting practices, whether in print or online. But research on the print media in specific Indian states presents a dismal picture. A study published in the Asian Journal of Psychiatry scrutinised 10 newspapers circulated in Jaipur, Rajasthan, between October and December 2014. All 10 newspapers were screened daily for news related to suicide. Each news item was rated using a scale developed by psychiatrists and journalists, based on WHO guidelines. While most newspapers did not publish the photograph of the deceased or glorify the victims and were largely neutral in their reporting, the researchers concluded that there was "a strong inclination towards sensationalism. No effort was made to include any educative material in the reports."
In another study of 341 newspaper reports published in three Kannada and three English newspapers in 2013, researchers from the Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) found an alarming incidence of non-compliance to guidelines: 89% of the reports gave away the method of suicide, 95% mentioned gender, 90% reported the name, 80% reported age and suicide location, 75% reported life events related to suicide, and 70% reported occupation. Only 16% reported mental disorders related to suicide, and less than 3% included information on suicide prevention and helplines.
Nelson says compliance suffers since there is no regulatory body to monitor reportage. "Media houses don't adhere to these guidelines because they are not mandatory, and also because most editors and reporters are perhaps unaware that guidelines exist." The Mental Healthcare Act of 2017 does not include any rules for the media, other than asking them to refrain from using photographs without the subject's approval.
In fairness, India is not the only country where the media struggles while reporting on mental illness. The table below, from a study on the portrayal of suicide in the print media in Asia and Oceania, illustrates the magnitude of the problem. The state in digital media, with its often laxer editorial oversight, is anybody's guess.
TABLE: Reporting of suicide in the print media across Asia and Oceania
Not everyone believes that guidelines or regulations are a panacea. Gunjan Sharma, editor of Healthpost, won an international award for her undercover investigation on the shocking state of India's government-run mental-health hospitals for The Week. When I ask her if she believes mental-health reportage requires regulation, she strongly disagrees. "Mental health does not require any special framework or regulation devised by an external agency," she says. "Whenever people's lives are concerned, a reporter should take care to not sensationalise no matter what they write about, whether it's suicides or floods or railway accidents."
In fact, she argues, special attention to stories on mental illness might undermine the campaign that seeks to project it as any other disease, "like fever or dengue or chikungunya."
How does a reporter wade into raw human suffering and still retain a measure of distance? What does writing about such vulnerable subjects do to the holy grail of journalism: objectivity?
Except stories on dengue or chikungunya don't make for clickbait, neither do they claim victims because of the copycat effect.
When I first read Gunjan's investigation, a different question swirled in my mind. How does a reporter wade into raw human suffering and still retain a measure of distance? What does writing about such vulnerable subjects do to the holy grail of journalism: objectivity?
There are other, more practical, challenges. Nelson points out that there isn't enough information and data on mental health. Even when there's data, it is riddled with discrepancies. For instance, in 2012, the WHO reported that India had 285,075 suicides, while the National Crime Records Bureau (NCRB) reported 135, 445.
Mental health is also a vast topic, Nelson adds. Understanding all the various disorders is tough. It is tougher to pitch stories that go beyond the familiar narrative about the large numbers suffering, lack of funding, and inadequate infrastructure and personnel. Then there's the issue of access to patients as well as professionals who are bound by confidentiality.
Finally, there's the risk of activist-style reporting creating a trust deficit with a key constituency—doctors. When I ask Dr Alok Sarin, who has treated me at New Delhi's Sitaram Bhartia Institute of Science and Research and has been part of government policymaking, about the media's work in exposing institutional apathy, he seems less than convinced. "We have painted it [mental-health institutions] all black," he says. "What we don't realise is that by doing that, we have actually harmed those who need care."
This is where training and a sense of calling become critical. Gunjan, for instance, has been a health journalist for 14 years. "Health is my passion, I cannot think of doing anything else," she tells me. She says writing about health has completely changed her outlook on life. She has learnt not to blame any single stakeholder for the problems that plague the sector. She has also become a lot more "practical" in her approach to her subjects. "Still, there are times when it takes me days to recover from something I saw," she adds after a pause.
At some point in my own journey with mental illness, I started wondering if I could become a part of the solution. India has one psychiatrist per 200,000 people. It also has a massive shortfall of qualified therapists and counsellors. During my last visit to Dr Sarin, I asked him how I could help. Are there places that will train someone like me in, say, basic counselling services?
Training journalists to report responsibly on suicide and imposing of media blackouts on suicide reporting have both been found to be effective in population-level suicide prevention.
He referred me to a couple of organisations in Delhi (here and here) but then added something unexpected. "I hope you will continue the work you do right now, through your writing and advocacy. Between that and offering a [healing] service, who is to say what is more important?" I was reminded of something Gunjan had told me. "At the end of the day, if even one hospital shows a little bit of improvement because of my reporting, my job is done."
There is reason for hope. Amid all the turmoil that the media as an industry is engulfed in, not least owing to its uneasy transition to new business models and the strain of increasingly polarised audiences, it is easy to lose sight of a momentous fact. Bucking global trends, trust in the Indian media has actually increased, according to Edelman's 2017 Global Trust Barometer. "The past two-three years have seen the introduction of the Mental Healthcare Act, PM Modi talking about it in his Mann Ki Baat address, the coming out of celebrities like Deepika Padukone to talk about depression, the setting up of foundations like White Swan, Vandrevala, and The Live Love Laugh Foundation, and the surge of investments in startups like YourDOST and Seraniti," Nelson reminds me. Add to that the emergence of a new breed of media, and the opportunity to reach out to new audiences thanks to the deepening penetration of the Internet, and you could see why there has never been a better time to rewrite the narrative around mental illness.
History shows that real change can happen surprisingly quickly. Between 1984 and mid-1987, the subway system in Vienna saw a sharp increase in suicides. The beleaguered city introduced guidelines for responsible media reporting, and just as dramatically, there was a 75% decrease in the rate of subway suicides and a 20% decrease in the overall suicide rate in Vienna. Training journalists to report responsibly on suicide and imposing of media blackouts on suicide reporting have both been found to be effective in population-level suicide prevention.
Can we expect this kind of discipline from the Indian media, with its reputation for noise and bombast? Apparently we can. When researchers working on mental-health trends in Asian media asked "whether it would be possible to persuade the media in India to accept recommendations for reporting on suicide," they found that the answer was "yes."
Days after a young boy from Mumbai killed himself, allegedly to fulfil the fiftieth and final instruction of the Blue Whale Challenge, I bumped into the Yellow Dolphin Challenge. Conceptualised by YourDOST, it includes goofy tasks like writing "yellow dolphins are the best" with a marker on your hand and going to a park and patting someone else's dog. The first three to complete all 50 tasks will get a surprise "Happiness Box."
[YourDOST's Yellow Dolphin is] the kind of counter-narrative that ought to go to viral, with a little leg up from India's heaving mainstream media. But as of now, that's a bridge too far.
Suyash Kumar from YourDOST says the team was "very distressed" by the Mumbai incident and wanted to create something that would both replace the challenge and help people get more control over their lives and mental health. YourDOST is promoting the challenge to its email database and on its social media platforms. So far, 135 players have signed up.
I loved the idea at first sight and plan to share it with my cousin. This is the kind of counter-narrative and joie de vivre that ought to go to viral, with a little leg up from India's heaving mainstream media. But as of now, that's a bridge too far. Even as the media keeps churning out stories on the killer whale, YourDOST's yellow dolphin has found no takers.
This piece was first published on The Health Collective.