When Threats Backfire: A Critique of the NYU Child Study Center’s 2007 “Ransom Note” Campaign – Debora Case

Introduction

The New York University Child Study Center is a nationwide resource for parents, educators, physicians, and

mental health professionals. Their focus is “to improve the treatment of child psychiatric disorders through

scientific practice, research, and education, and to eliminate the stigma of being or having a child with a

psychiatric disorder.” (1) In December 2007, the Center introduced a public health campaign in New York City

to raise awareness of mental illness in children. The campaign was produced pro bono by BBDO and included a

series of billboards and advertisements represented as ransom notes containing threats from the perspective of

depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, autism, Asperger’s

syndrome, and bulimia. Underneath the notes are short messages with the organization’s website and

telephone number listed for more information. These ads were posted across billboards, kiosks, magazines,

newspapers, and the Internet. (2-3)

Many professional organizations and advocacy groups, such as the Autism Self Advocacy Network, responded

negatively with immediate complaints. Dr. Harold Koplewicz, the center’s founder stated, “Everyone who

participated felt the ads were informative… I am disappointed. I thought the people we’d be arguing with are the

people who believe psychiatric illness doesn’t exist.” In response to their concerns, a petition was successfully

organized and the campaign was halted two weeks after its introduction. (4)

Although this campaign is no longer current, it provides an excellent opportunity to discuss fear, threats, and public health

intervention efficacy. Why did these advertisements invoke such a response? What could the designers have done

differently? We will discuss three main concerns associated with this campaign:

1) The intended message, recommended response, and target population are unclear, potentially encouraging denial and defensive avoidance of the threat.

2) The presented message enforces stereotypes and further stigmatizes those who suffer from these disorders and illnesses.

3) There is a lack of a suggested alternative behavior or response, a critical component to fear appeal based social science models and theories.

For the purpose of this critique, we will focus primarily on the notes written for autism and depression, as each of the six diagnoses are accompanied by many different theories on causes, effective treatments, and prevention or intervention strategies.

The two notes state:

We have your son. We will make sure he will no longer be able to care for himself or interact socially as long as he lives. This is only the beginning. ~ Autism

We have taken your son. We have imprisoned him in a maze of darkness with no hope of ever getting out. Do nothing and see what happens. ~ Depression (2)

Concern #1: What is the message?

In a public health intervention campaign your message, including desired response, is your core. Who are you trying to reach and what do you want them to hear? What information are you sharing and what do you want them to do with it? The following is an excerpt from the NYU Child Study Center’s press release regarding their intended message.

“Twelve million American children and adolescents face daily battles with

psychiatric disorders, yet childhood mental illness remains stigmatized, under-diagnosed and under-treated,” says Dr. Harold S. Koplewicz, founder and director of the NYU Child Study Center, which is dedicated to preventing, identifying and treating childhood psychiatric and learning disorders.

“Left untreated, these illnesses can hold children hostage. That’s why we’ve chosen to deliver our message in the form of a ransom note,’ says John Osborn, President and CEO of BBDO New York. “We hope the campaign will act as a wake-up call to families, educators and healthcare professionals, and spark dialogue so children can get the help they need. (2)

These quotes from Dr. Koplewicz and Mr. Osborn suggest the message is to promote discussion. Dr. Koplewicz is concerned with stigma and treatment, and the hope is that the discussions will result in children getting the help that they need. This is a serious public health concern and these are positive goals. However, this is not what the advertisements say.

The advertisements say, “Do-or-die!” It is a threat: If you do nothing, your child is doomed every time. Ransom notes are connected with terror, crime, ultimatums, and helplessness. Victims are presented with a strict time frame and demanded they give up something of great value or suffer grave consequences. This message doesn’t demand any alternative, positive or negative. At best, it offers a small message in the corner to call the center and alludes onto to do “something”. This places the burden onto the parent, taking any responsibility to reach out to them away from the center.

If this is the message being sent, who is it intended for? Mr. Osborn suggests they are trying to reach “families, educators and healthcare professionals.” (2) Since there is no mention of symptoms to look for in the autism note, it could be assumed that some previous knowledge is expected. By stating, “We have your son” and “We have taken your son”, the message is most likely intended for a parent. However, it is unclear what type of parent they are addressing.

One option is parents of children without a diagnosis. As stated above, Dr. Koplewicz is concerned with under-diagnosis and under-treatment of these illnesses, thus they may wish to encourage these parents to bring their children in for an evaluation. However, there is no mention of signs or symptoms to look for. This lack of information leaves too much room for a parent’s own assumptions. Only telling parents that autism or depression is chronic and will continue to get worse may discourage them from seeking help. These parents could easily avoid the threat entirely A common response to fear is defensive avoidance. This refers to denial or a minimization of the threat. ( 5) If having a child with such an illness is so horrific and traumatic, why would one seek out the diagnosis and all the suggested pain associated with it? “Of course my child is different from that child.”

The second potential target population is parents of children who have already been diagnosed. The center may wish to remind them that these illness or disorders are all consuming and chronic, or to suggest some of them aren’t doing enough to prevent things from getting worse. This may invoke anger, as their parenting choices are being questioned or attacked. They could interpret this as insulting or a threat to their freedom of choice in their child’s treatment. This may induce reactance. Reactance occurs when someone feels their perceived freedoms are reduced or taken away completely. The result is often an active choice to reclaim ones freedom, usually the opposite of what is being suggested. (6) In this case, if they feel they are being told to pay attention or take more action, they may choose not to listen and do nothing. In addition, denial that may be experienced with the first group of parents could also apply here. “Why does this have anything to do with me?”

Concern #2: Why is the message stigmatizing?

Mental illness is well known for its constant struggle with social stigma. As Dr. Koplewicz states, “childhood mental illness remains stigmatized.” The same is true for adults and adolescents. Neurological disorders and psychiatric illnesses are still seen as frightening, mysterious, and misunderstood. Advocates in mental health, such as the National Alliance on Mental Illness’s Stigma Busters, dedicate efforts to fighting inaccurate and hurtful representations of mental illness. They constantly observe and review movies, television, and the press for stigmatizing agents and then bring these to the attention of the public to correct misconceptions. (7) A common theme is that mental illness is terrifying, incurable, and threatening, that those with a diagnosis may as well no longer be members of society. These notes offer gross, negative generalizations regarding each diagnosis and connect mental illness to all of these frightening thoughts. Mental health is anything but black and white and none of these illnesses or symptoms associated with them should be presented as evil, especially to the general public.

The word “autism” can represent either autistic spectrum disorder (ADS) or the more severe form otherwise known as classical ADS. ADS is a wide range of complex neurodevelopmental disorders, including many forms of disability. (8) It is assumed that this ad is referring to classical ADS, but it is worth noting that as a spectrum disorder, many individuals will respond to treatments, or lack thereof, very differently. The autism note shoves them all into one category of someone who cannot “care for himself or interact socially.” This misrepresentation may cause anyone with previous knowledge of the spectrum to disregard the message as it loses credibility. The same goes for depression, as there are many different symptoms, degrees of severity, and causes of the illness. There are multiple diagnoses under the umbrella term in the DSM-IV. (9)

As ransom notes are associated with threats of abuse and murder, they will likely make one think of death. For autism, the note assumes that the life of someone who cannot care for himself or interact socially must be comparable to not living at all. For depression, the threat “Do nothing and see what happens.” could be interpreted as alluding to suicide. Not everyone who is living with these symptoms wants to die. These are both hurtful assumptions for anyone living with either diagnosis.

Concern #3: We feel threatened, what should we do?

The fact that there is no clear suggestion for alternative action is a key component to the ineffectiveness of this campaign. Fear appeal has been used through the history of public health intervention and a number of researchers have created social science theories to review how it works, such as the parallel process model. A more recent model, the extended parallel process model explains why there are instances when it doesn’t work. We will review this model to discuss why the lack of an effective alternative was detrimental to the campaign. (5)

There are three key variables used across the board of fear appeal theories: fear, perceived threat, and perceived efficacy. Fear refers to the high level of emotional arousal that is felt in response to perceiving an event, most often a dangerous or harmful one. The feeling of fear is followed by perceived threat. A threat is an external stimulus, while the perceived threat is how the individual interprets this stimulus. Perceived threat consists of perceived susceptibility – how at risk someone may feel – and perceived severity – how harmful he or she feels the threat is. The third variable, perceived efficacy has to do with an individual’s outlook on the response. Perceived efficacy consists of perceived self-efficacy - his or her belief on how well they would be able to perform the response or adapt to the new behavior – and perceived response efficacy - how well they believe the behavior or response will work to avoid the threat. (5 & 10)

The next step is outcome. In fear appeal theories there are two categories of outcomes commonly referred to: acceptance and rejection. Message acceptance is defined as an attitude, intention, or change in behavior. The other outcome is message rejection, as mentioned when discussing the first concern. Message rejection can include defensive avoidance, such as denial or minimizing the threat or reactance, when one feels their freedom is in jeopardy and they chose to reclaim the freedom. This is often executed by doing the opposite of what is demanded or strongly suggested of them. (6)

The parallel response model, also referred to as the parallel process model was developed by Howard Leventhal in the early 1970’s. Leventhal’s model suggests that there are two independent processes involved in fear appeals: danger control and fear control. Danger control processes are efforts an individual exerts to control the threat itself, while fear control processes are efforts to control an individual’s own fears about the threat. (11) This model is not well supported by specific evidence, due to the fact that it is difficult to test. However, it is the basis of the extended parallel process model (EPPM). (5)

EPPM is the theory best used to evaluate this particular campaign. It was introduced by Kim Witte and Mike Allen in 2000. This model differs from others because it explains both successes and failures of fear appeals. It suggests that the perceived threat contributes to the individual’s emotional response, but that the perceived efficacy is what contributes to the nature of their response. (5)

To review this model, we will refer to a subject named Joe and follow him through the model after he is exposed to one of the ransom notes. Joe is a father and has some previous knowledge of mental illness. According to the EPPM, there are two appraisals of the message. First, Joe will evaluate the threat from the message. (The child is held hostage.) The more he believes he may be susceptible to the threat, the more likely he is to move onto the second appraisal, evaluating the efficacy of the recommended response. If he doesn’t believe he is susceptible and sees the threat as insignificant, he is likely to ignore it. (5)
As a father, Joe chooses to evaluate the efficacy. He will likely become scared of the threat as ransom notes are terrifying to a parent. (Could this be my child?) This fear will motivate him to take some course of action to reduce the feeling of fear. This is where perceived efficacy comes into play. It is this stage that determines if an individual will follow with Leventhal’s suggested danger control or fear control. If Joe feels he can perform the recommended response, he will likely choose to control the danger. If Joe doubts his ability to follow through on the recommended response or doubts the effectiveness of the response, then he his more likely to control his fear through message rejection: denial, defensive avoidance, or reactance. (11)

As you can see, this theory suggests that efficacy of a fear appeal relies heavily on the suggested response. As there are no clear responses recommended, Joe could easily respond with fear control and message rejection. This is why the lack of a clear alternative action or behavior is the issue in this campaign.

Now What? How to prevent a backfire

There is no debating whether child mental illness awareness is a public health concern. Below are suggestions on how to address the concerns discussed above and examples of alternative campaign options.

Suggestion #1: Review social science models and theories to identify target populations and details of the issue.

There are unlimited options on ways to approach a public health intervention and campaign. Social and behavioral science models are very useful to help shift through human behavior and predict outcomes. They are used to investigate and understand why people may engage in certain behaviors and why they may or may not adopt an alternative. It has been common to use theories such as fear appeal, the health belief model, or the transtheoretical model to improve public health and design a number of different types of interventions. (12-13)

Fear appeal was the basis of this campaign, but as we reviewed above, this was not effective because there was no alternative mentioned, no option for the viewer to decide how to confront the threat and deal with the danger. What is missing from these campaign notes is hope. For a family that can feel trapped suggesting that they are is counterproductive. Reminding them that they can escape the feeling and improve their situation is your best alternative. If any of these messages were accompanied by a response from the child or parent to the illness stating that they are taking control and not letting the illness take over their lives, this would have been much more effective. The alternative action that this suggests is to take back the feeling of control that he or she feels they have lost. Freedom and control are basic human core values and it is helpful in public health campaigns to focus on them.

Suggestion #2: Be clear on the issue, target population, and desired effect, in both design and implementation.

Understanding the population, your goals, and your barriers is challenging, but well worth the effort when designing your intervention. Why are you doing this campaign? Who are you trying to reach and what do you want them to hear? What do you want them to do with it? How do you do it? As you start to research your target population EPPM or any additional social science theories can be used to assess the situation and help you decide how best to approach an intervention.

What if the biggest issue in this situation is lack of service utilization? If this is our concern, we will need to evaluate a number of factors. Why are services not being utilized? Is this because of a concern that people aren’t seeking help or that the help isn’t there? If the former is true, then your target would be parents of children who likely have an illness or disability and have chosen, for one reason or another, not to seek treatment. If this is the case, then it would help to evaluate why. Are there barriers preventing them from seeking treatment? Do they know where to look? A possible intervention strategy includes education for parents, possibly from the schools, on what signs and symptoms to look for, while always adding in a feasible next step should they notice anything. In addition, if there are any other barriers observed, it is best to include suggestions or options on how to work around these as well. (10)

What if they know where to look, but the lack of utilization is because of a lack of services available to the community? If this is the case, your assessment should involve a review of where effective services are and why there aren’t more of them. Is it simply that more personnel are needed to meet the demand? Are these government or private services? Are you concerned about the school system or private physicians? If this is the case and awareness to the general public is your goal, a suggestion would be to focus on the positives of treatments. Instead of showing how terrible the disease is and end the note with doom, suggest a positive outcome that can demonstrate the magnitude of recovery possible.

Suggestion #3: Be conscious of possible perceived messages, whether intended or unintended.

Unfortunately, we will never be able to predict exactly how someone will perceive a message we are sending. However, it is possible to creatively review possibilities by trying to think like the population we are serving. In what sort of light is this message placing the child? What about the parents or the illness? Are these messages accusing or blaming anyone of anything negative? Subliminal associations are always possible too, so it’s important to really examine our finished product with objective lenses. In this case, because the center is concerned with fighting stigma, it may have helped to review things that they find stigmatizing. Perhaps focus groups of parents, children, and healthcare providers would help to gage the response to the intervention in addition to just the design process.

In this case, it would be best to avoid a negative association with the illnesses and focus more on the positive aspects of recovery. For many illnesses, early intervention is important. An intervention could be designed to fight the stigma of seeking services by sharing information on how receiving a diagnosis will help, not hurt the child. Again, the perceived effectiveness of the suggested action is the ticket. (10)

Conclusion

In conclusion, this campaign failed because it did not properly take into account all behavioral aspects of fear appeal as referenced in the EPPM. A meta-analysis of fear appeal models from the past 50 years suggests that it should be used cautiously. They can, and in this case did, backfire if the audience doesn’t feel they have any option to avoid the threat. Strong fear appeals work best when accompanied by strong efficacy messages. “Fear appears to be a great motivator as long as individuals believe they are able to protect themselves.” (10)

REFERENCES

(1) The New York University Child Study Center. New York, NY. www.aboutourkids.org

(2) The New York University Child Study Center. New York, NY. Press release: Millions of Children Held Hostage by Psychiatric Disorders: Provocative New PSA Campaign Highlighting Autism, Asperger’s ADHD, OCD, Depression and Bulimia, Debuts in December in NYC, December 1, 2007.

(3) Kaufman, J. Campaign on Childhood Mental Illness Succeeds at Being Provocative. The New York Times Online, December 14, 2007. www.nytimes.com

(3) Kaufman, J. Ransom-Note Ads About Children’s Health Are Canceled. The New York Times Online, December 20, 2007. www.nytimes.com

(4) Nabi RL, Roskos-Ewoldsen D, Carpentier FD. Subjective knowledge and fear appeal effectiveness: implications for message design. Health Communication, 23: 191–201, 2008.

(5) Witte K. Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs; 59: 329-349, 1992.

(6) Brehm, JW. A Theory of Psychological Reactance. New York, NY: Academic Press, 1966.

(7) The National Alliance on Mental Illness. Fight Stigma. Arlington, VA. www.nami.org/stigma

(8) National Institute of Neurological Disorders and Stroke. Autism Fact Sheet. Bethesda, MD. www.ninds.nih.gov/disorders/autism/detail_autism.htm

(9) American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Arlington, VA: American Psychiatric Publishing, Inc., 2000.

(10) Witte K, Allen M. A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. Health Education Behavior; 27, 5: 591-615, 2000.

(11) Leventhal H. Fear Appeals and Persuasion: The differentiation of a motivational construct. American Journal of Public Health; 61: 1208-1224.

(12) Smedley BD, Syme SL (Eds.). Promoting Health: Intervention strategies from social and behavioral research. Washington, DC: National Academy Press. 2000

(13) Crosby RA. Kegler MC, DiClemente RJ. Understanding and applying theory in health promotion practice and research (Chapter 1). In: DiClemente RJ, Crosby RA, Kegler MC, eds. Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health. San Francisco, CA: John Wiley & Sons, Inc., 2002, pp. 1-15.

Suicide Risk and Prevention in South Korea – Glory Song

BEHIND THE PRISTINE VENEER

In the past ten years, South Korea has seen major economic and cultural advancements. Not only has its technological and automobile industries become giants in the global economy, even its cultural export, consisting of music, dramas, movies, fashion, and impeccable looking celebrities, have now garnered worldwide followings and have become household names across all of Asia. Historically a deeply traditional society founded on rigid hierarchy and a strong sense of unification, the influx of wealth and Western ideals have transformed the nation into a hub for consumerism and pursuit of higher living. The ritzy avenues of Seoul, with its fashion billboards, endless stores and countless plastic surgery centers attest to the shift in societal ideals to a glorification of what is glamorous, luxurious, and beautiful.

However, behind Korean National Tourism’s best effort to portray the nation as the junction where rich tradition meets modernity, lie deep-seated social problems of increased senses of alienation and pervasively unaddressed psychological anxieties that serve as direct consequences of a nation that has not confronted the mental illness and social vices brought about by their rapidly transforming society that is leaving so many of its people alone and behind.

A UNIQUE PHENOMENON

In 2006, South Korea surpassed Japan in having the highest suicide rate among the 30 Organization for Economic Cooperation and Development (OECD) nations that include the United States and large parts of Europe (1). In 2009, suicide made up 6.2 percent of the total number of deaths in Korea and ranks as the 4^th leading cause of death in the country, behind common pathological conditions of cancer, cerebrovascular diseases and cardiovascular ailments such as stroke (2). The National Statistical Office (NSO) reported 26.1 suicides per 100,000 people in Korea for 2005. The corresponding figure for the United States was 10.2 (3).

Perhaps a phenomenon that has been unique to South Korea is the overwhelming number of heavily publicized suicides by public figures, including those of former president Roh Moo-hyun, millionaire Samsung heiress Lee Yoon-hyung, and a string of entertainers such as singer U;Nee, supermodel Daul Kim, and most recently, Park Yong-ha, who had been a frontrunner in the “Korean Wave” cultural export movement (4). Due to widely available media outlets, a large subscription to entertainment by the public, and the homogeneity of the population, Korean public figures have an unusually close dynamic with the general public, and everything from their outfit to their personal life to their past history is constantly monitored and a potential subject of scrutiny by the people.

Since popular actress Lee Eun-joo’s suicide in 2005, a consistent trend of copycat suicides have followed in the two months after the announcement of a public figure suicide. Statistics report that the number of people who commit suicide within two months after the death of a celebrity was distinctly higher than those in other months in a given year. The numbers were 2,568 for actress Lee Eun-joo in February, 2005; 2,330 for U;Nee in January, 2007; and 2,876 for actor Ahn Jae-hwan in September, 2008 (5).

Such phenomenon in which people mimic the suicide method they observe has come to be known as “The Werther Effect” (6) and has contributed greatly to Korea’s sharply increasing suicide rate. Yet it is only within the last two years that the national government has really made a centralized effort to launch a campaign in response to this growing social tragedy.

TACKLING THE SURFACE

In late 2008, 10 government ministries and offices came together to develop a blueprint for a national anti-suicide campaign (7). The long-term goal focuses on strengthening the social and economic safety net for those in the low-income brackets and the aged, but in the meantime, the government has also established a series of short-term measures. These measures target what are considered the two main perpetrators for enabling suicide among the population: 1) the media responsible for disseminating news of celebrity deaths to the public and 2) the accessibility of suicidal means to the individual.

In an effort to limit the sensationalism surrounding celebrity death, the Ministry of Health and Welfare has requested that media companies 1) refrain from printing celebrity suicides as headlines and 2) refrain from describing the specific means or situation of the death and interviewing family members of the deceased (6). In efforts to close off access to various means of suicide to the common people, the Ministry of Land, Transport and Maritime Affairs have plans to set up more screen doors at subway stations to prevent people from committing suicide by jumping in front of trains and the Ministry of Food, Agriculture, Forestry and Fisheries have plans to regulate purchases of poison pesticides in an attempt to cut off access to the abuse of such supplies (8).

While it remains to be seen whether these preliminary strategies will make any impact in reducing the rate of suicide, there are certain flaws in these rationale that raises concern as to their efficacy. This paper will highlight three critiques of the Korean government’s anti-suicide intervention strategies and provide alternative suggestions that address each of the three shortcomings.

CRITIQUE 1: OVERSIMPLIFICATION OF THE SOCIAL COGNITIVE THEORY

Social cognitive theory posits that individuals learn by watching what others do and that behavior change is affected by environmental influences, personal factors, and attributes of the behavior itself (9). Furthermore, self-efficacy, or the belief a person has in his or her capability to perform the behavior, is central to the individual performing the behavior. However, within a societal set-up like South Korea, environmental influence and social pressure play a formidable role in the coercion of individual behavior.

While the social cognitive theory as it stands may be valid in a Western society where individualism and self-reliance are upheld, its component make-up become less balanced in traditional Asian societies that strongly value homogeneity and conformity to a set of social expectations. In South Korea, environmental influence is so extensive that it spills over to influence personal belief and even the ideation of self-efficacy.

The fundamental assumption underlying the effort to restrict public exposure to celebrity deaths is that individuals imitate what they see and thus conversely, if individuals are shielded from such exposure, they will be less likely to imitate. While it seems the Ministry of Health grasps, to a certain extent, how powerful the entertainment industry is in influencing public opinion, it does not understand just how deeply its citizens are drawn into the lives of these glorified entertainers.

Efforts to limit public exposure are impractical in two ways: 1) it is simply not feasible to control all channels of information that reach citizens on a daily basis and 2) the level of response to a celebrity suicide is not so much determined by the choiceness of words in its reporting or whether it makes it to the front page, but by how well-known and well-loved that individual was prior to his or her death.

Indeed, according to monitoring by the Korean Association for Suicide Prevention , among 343 articles in 10 major newspapers and 113 reports by four major broadcasters, 60.1 percent failed to follow the guidelines (6). Furthermore, even if all media outlets did refrain from overt reporting, the news of their death can still travel via blogs, forums, chatrooms, unofficial news sites, word of mouth, etc. Ultimately, it’s the shock and perceived gravity of the loss, and not the degree of its exposure, that triggers individuals to follow suit.

CRITIQUE 2: MISUNDERSTANDING OF “SELF-EFFICACY”

The rationale behind the government’s effort to censor the ways in which individuals can achieve suicide is understandable – after all, with fewer viable means of committing suicide, it would seem that less people would choose to do so. In this way, the government may believe they are undermining the perceived self-efficacy of individuals and deterring them from committing such an act. However, what they may not realize is that for an individual to witness the death of a well-known public figure may provide the strongest support that he or she can take action and ownership of their life and end it. While the government believes that the availability of resources is what limits or enables the perceived ability of someone to make a choice, the very reality of someone well-known actually committing suicide is infinitely more powerful of an instigator. Thus, expending resources to limit certain means out of an almost infinite number of possibilities may prove futile as a buttress against the impact of real death.

In another way, limiting access also may prove too late of an intervention in preventing suicide. In one study performed in Korea looking at clinical characteristics of depressed patients, researchers found that of 1183 participants they recruited, 21.4% had a history of suicide attempts (10). This means that individuals who are attempting suicide may have a long history of suicide ideation and even unsuccessfully acting on it. When one contrasts a few mere subway screens to the years of ideation and depression that may have taken root in an individual, it is easy to see why such prevention efforts may be limited in their efficacy.

CRITIQUE #3: NOT IDENTIFYING THE ROOT OF THE PROBLEM

Finally, one can argue that asking the media to refrain from reporting may actually aggrevate the problem by conveying the message that suicide is not a serious issue that needs to be addressed. At the root of the phenomenon is not simply that individuals simply mimic what they see celebrities do, but rather, that long withstanding pressures and anxieties pressing in from all sides has driven them to a point where seeing someone else acting out the thought that had been plaguing their own minds for so long only serves as the trigger that catapults them from contemplation to action.

Studies have found that since the 1997-1998 East Asian Financial Crisis that yielded 19.9 suicides per 100,000 people, numbers have consistently been high and on the rise (11). One study found that suicide rate was clearly related to the unemployment rate and also a result of the widening rich-poor gap and social polarization that also resulted from the financial crisis (12). Additionally, studies found that while the absolute increase in suicide rates are attributed to older individuals over 45, the proportional increase in rate was most prominent among younger people (13), an indication that the problem has expanded to society at large and individuals across all age groups have been increasingly feeling the burden to take their life as an escape from environmental pressures.

Ultimately, neither the Werther effect nor Social Cognitive Theory can fully explain the depth of this prevalent suicide phenomenon in South Korea nor provide an adequate solution out. What is necessary is a return to unity and a collective effort to raise the morale of everyone from peasants to millionaires, and to instill hope that alternative methods of dealing with life’s uncertainties and anxieties are better options than ending one’s life.

SOLUTIONS IN RESPONSE

MAKING THE MOST OF CELEBRITY INFLUENCE

While the consequence brought on by a celebrity death can be categorized under “unintended media effects ” that stem from Social Cognitive Theory (14), South Korea can take advantage of the massive popularity of celebrities and the uniquely intimate dynamic between public figures and the public to launch an anti-suicide television show or education series. The underlying assumption of Social Cognitive Theory is that individuals mimic behavior they see in others. As a result, mere 30 second advertisements or empty, cheery words may have little effect. However, should well-loved and respected public figures partake in a documentary or television show that brings together the reality of individual struggles and shows how these individuals deal with them or help others address them, this may substantially provide examples of solutions or encouragement that viewers are not alone in their problems and as a result, restore a sense of unity and promotes greater openness in confrontation and discussion of such problems.

Another way of bringing about positive and “intended media effects” is to take advantage of social media outlets and make a push for positive blogs and anti-suicide pieces. Studies have shown that a reliable preliminary indicator for suicide attempt is the posting of some “final words” on the individual’s blog or homepage. In a country like South Korea where such a large proportion of the population have ready access to the internet, online communication has over the years come to replace in-person interaction, especially among many of the younger generation. The internet provides an anonymous, removed setting on which one has the freedom to express anything on their mind – and many times have served as breeding ground for malicious remarks and bullying. Many times, celebrity’s personal pages are the most consistently followed. If there can be a campaign launched where celebrities agree to post encouraging messages or sharing of their struggles onto these sites, these entries can serve as a platform for greater dialogue among individuals young and old who read them.

INTERVENE EARLY AND APPROPRIATELY

As discussed earlier, one of the shortcomings of attempting to set-up subway screens and pesticide purchase monitoring is that the financial resource could instead be used for more early intervention that more directly target the root of suicide attempts. Instead of money spent that poses as physical barriers to a behavior, money should instead be allocated for the creation of a community in which individuals can mutually entrust and encourage, as supported by the Social Support Theory (14). The Theory posits how networking and interacting help individuals cope with stressful events.

Erecting screen doors on subways and denying individuals of poison will only more glaringly put them face to face with their suicide ideation and negatively represent government’s role in addressing the problem. Instead, if support groups can be created, either through local religious groups or grassroot groups that will take individuals from their isolation and plug them into a community that builds long-term relationships and support, this will minimize feelings of alienation and other ideations that pushes one to take extreme measures. It also provides a system of accountability and mutual monitoring for warning signs of potential harmful behavior.

GETTING TO THE ROOT OF THE PROBLEM

Finally, no single campaign with slogans or visuals can provide a long-term solution, because it doesn’t address the root cause of why individuals undergo depression and eventually spiral into suicide ideation instead of recovering from their condition. The first step to bringing suicide rates down is to truly understand what factors are involved that has made them rise. The societal stresses placed on men differ from that on women, and the anxieties that plague the youth lies in great contrast to those that demoralize the old. Only when these factors are identified and explored can they then be addressed with hope of being resolved.

For youths in South Korea today, life can be both suffocating and strenuous. On one hand, there is immense academic and parental pressure to perform in school and to excel, because the reality is there is a limited number of jobs and opportunities domestically. On the other hand, the allure of the glamour and ease that comes from the media’s portrayal of celebrity life draws hundreds of thousands youths each year to try out for talent agencies, each with hopes of being a part of the next international-hit boy band or girl group. For young girls, the issue of self-image is particularly hurtful, as societal pressure dictates very clearly a very narrow standard of beautiful, and a single fold in the eyelid could be the determinant of whether or not you are hired. Growing up in such a stifling and psychologically tumultuous environment, and many times devoid of open dialogue with parents, youths often find they have no true guidance or support. In a study that examined the main risk factors in relation to suicidal ideation among high school girls and boys, it found that for males, all behavioral variables (i.e. smoking, drinking) were predictive of suicidal ideation while for females, sexual orientation and bullying were predictive factors (15). Such results reflect the need for greater parental intervention and school education that covers such heavily stigmatized topics as divorce and sexual health.

The public figures who have died in recent years suffered from depression brought on by a variety of psychological burdens. Former president Roh hung himself following a number of high-profile corruption investigations. Actor Park Yong-ha had a terminally ill father and felt financially burdened despite his many sources of incomes. Singer U;Nee committed suicide reportedly as a result of work pressure and depression over her overly-sexualized public image. Actress Jang ja-yeon left a suicide note listing in detail all the sexual favors and forced services she was forced by her entertainment agency to perform in order to secure roles and advance her career (16). These few individuals’ rationale for taking their own lives highlights a vast array of deeply entrenched problems with Korea’s society as a whole – from corruption to sexual assault, work pressure to financial paranoia.

FINAL THOUGHTS

The suicide epidemic that has overtaken a South Korea that gleams so brightly from the outside illustrates the complexity and challenge of public health intervention. On the surface, the mortality figures may not seem so shocking – a high profile death here and there, with most of the suicides going unreported or publicized. However, a closer look at the few cases that do get more deeply investigated unveils a multitude of societal problems that is undermining the mental health of an entire nation. Difficulties, challenges, environmental pressures will always exist, especially within emerging nations like those of East Asia where old conservatism and new openness have created a life that is at once bustling with life and locomotion but at the same time, eating away at long withstanding lifestyles grounded in peace and simplicity. While people are sacrificing their time and their health for the pursuit of a larger house, greater purchasing power, and improved social standing, it is twined with irony that in the process of gaining what is disposable, they are disposing of what cannot be regained.

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