Patients who are at risk need to be assessed, monitored, and seen often. Their grief needs to be acknowledged, whether or not the object of grief was known to them.
Our group of eight got off to a good start. We cried and shared our feelings. The women talked about their suicidal urges. “Her life was so great compared to mine,” one woman said. Everyone agreed, as she added, “She was rich; she was beautiful; she was talented. Look at all the men who loved her!”
“This group is a catharsis,” I proudly pronounced to my fellow residents.
But this is what happened next. Three of the women in the group attempted suicide, one very seriously. Fortunately, all three survived. The head nurse, frightened by what had happened, contacted the head of our ward in Europe. He immediately cut his vacation short and returned to New York. The first thing he did was to end the group. Then, he gave me the worst dressing down of my life. I thought it was the end of my residency, but he allowed me to stay. What came to an end was my early confidence in myself as a therapist. Since then, there has always been a seed of doubt when I see a patient. I now ask myself, “By stirring the pot, am I perhaps doing more harm than good?”
It was not as if I hadn’t read up on suicide. I had read Émile Durkheim’s work in my first year. In the French sociologist’s 1887 study on anomie, he had in fact underplayed the effect of imitation as a critical factor in suicide.1 Durkheim believed it was useless, for instance, to prohibit newspapers from publishing suicide stories. But he was wrong. Human beings are very easily influenced. What my Marilyn Monroe group had done was to bring together eight vulnerable women who, with the complicity of their group leader, had laid fertile ground for intense behavioral contagion.2 I had unknowingly created a suicide cluster.3,4 Out of a mix of would-be Marilyn Monroes, raw emotions, media prodding, and myself as a greenhorn therapist, the belief had emerged that suicide was the answer to distress.
Today, this is called the Werther effect after the widespread emotional reaction to the 18th century novel The Sorrows of Young Werther by the famous German writer Goethe.5 The story is about an unhappy lover who ends his life with a pistol. At publication, the book precipitated a massive wave of imitative suicides throughout Germany and much of Europe. This response was not unlike what took place the month after Marilyn Monroe’s death when there was a 10% increase in suicides in the US.6[PDF]
1. Durkheim E. Suicide: A Study in Sociology. New York: Free Press; 1966.
2. Wheeler L. Toward a theory of behavioral contagion. Psychol Rev. 1966;73:179-192.
3. Haw C, Hawton K, Niedzwiedz C, Platt S. Suicide clusters: a review of risk factors and mechanisms. Suicide Life Threat Behav. 2013;43:97-108.
4. Niedzwiedz C, Haw C, Hawton K. Platt S. The definition and epidemiology of clusters of suicidal behavior: a systematic review. Suicide Life Threat Behav. 2014;44:569-581.
5. Phillips DP. The influence of suggestion on suicide: substantive and theoretical implications of the Werther effect. Am Sociol Rev. 1974;39:340–354.
6. Seeman MV. The Marilyn Monroe group and the Werther effect. Case Rep J. 2017;1:004.
7. Stack S. Celebrities and suicide: a taxonomy and analysis, 1948-1983. Am Sociol Rev. 1987;52:401-412.
8. Fahey RA, Matsubayashi T, Ueda M. Tracking the Werther effect on social media: emotional responses to prominent suicide deaths on twitter and subsequent increases in suicide. Soc Sci Med. 2018;219:19-29.
9. Ueda M, Mori K, Matsubayashi T, Sawada Y. Tweeting celebrity suicides: users’ reaction to prominent suicide deaths on Twitter and subsequent increases in actual suicides. Soc Sci Med. 2017;189:158-166.