Have you Heard About the Papageno Effect?
Himanshu Agrawal, MBBS, DF-APA
A psychiatrist-psychotherapist shares how his own vulnerability came back to affect him...
It started as a run-of-the-mill psychiatric intake on a Wednesday afternoon. The Milwaukee clouds were weeping outside, as I settled in to listen to a new story. A medical resident was telling me about growing up battling anxiety and depression.
At one point, the resident stopped narrating their social history. I sensed a bit of hesitation and wondered if there was something on their mind that they wanted to share.
“Err…yes, actually there is…. You may not remember this, but last year you wrote an article for Transformational Times (Being Human in Medicine: Fabulous Failures), where you talked about how you did very poorly on your (USMLE) Step 1 exam, and it devastated you. And you maybe were thinking of ending it all, and some random person helped you carry on. Do you remember the essay I’m talking about?”
I bloody well did! Not only was it one of the most emotionally difficult “manuscripts” I had ever put on paper, having received little to no feedback after its publication, I had been left with a lingering sense of awkward embarrassment; that feeling you get when you realize you tried something out of your comfort zone, and it probably fell flat on its face. I had been consumed with doubt ever since — why did I write that piece?! It was inane and out of sync with my surroundings. It had not helped my imposter syndrome at all!
My inner monologue was interrupted by my patient.
“…well, to tell you the truth, I had done very poorly on a similar exam, and I had decided that I would kill myself that Saturday.”
My heart sank as they carried on.
“It’s so bizarre. I usually don’t read the Transformational Times, but for some reason, I ended up reading your article. And suddenly, I decided I wouldn’t kill myself. It was exactly what I needed to hear. As you can see, it took me a little bit longer to come and find actual help. This is such a coincidence that you ended up being the psychiatrist I was assigned!”
I was stunned. The clouds were now weeping inside my office, too, in both ends of the room. Speechless, I am not certain what I mumbled in response.
What I am certain about is that I will never doubt myself about writing something that feels so central to my authentic self.
In scientific literature, we talk about a phenomenon called the Papageno effect, named after a character who loses his love and plans to end his life in Mozart’s opera, The Magic Flute. The suicide is prevented at the last minute by three boys who remind him that there are alternatives to dying.
The reason this effect is named after Papageno is quite simple: For individuals in crisis, the way that the media reports on suicide could have either a positive or negative effect on the individual’s decision. What this complex phenomenon boils down to is this: If an individual struggling with suicidal thoughts and intents reads or hears about someone else who has gone through a similar struggle, but somehow continues living, this may have a positive effect on the individual who is struggling. The protective effect is even stronger if the individual can somehow relate to the person in the story (e.g., how my patient could relate to my story when I was a medical student).
The Transformational Times essay, "Being Human in Medicine: Fabulous Failures," just happens to be a concrete example of this phenomenon in action. Who knows whether a life could be directly or indirectly saved by another essay in the Transformational Times.
Please enjoy.
And please live!
[Please note — owing to the sensitive nature of this essay, the author heavily disguised the (former) patient described. Additionally, the author has the individual’s permission to share this story, which occurred several years ago.]
For further reading:
Hawley LL, Niederkrotenthaler T, Zaheer R, Schaffer A, Redelmeier DA, Levitt AJ, Sareen J, Pirkis J, Sinyor M. Is the narrative the message? The relationship between suicide-related narratives in media reports and subsequent suicides. Aust N Z J Psychiatry. 2023 May;57(5):758-766.
Character and Caring: A Pandemic Year in Medical Education. Kalet, Adina, et al., eds. Ten16 Press (2021)
Himanshu Agrawal, MBBS, DF-APA, is an associate professor in the Department of Psychiatry and Behavioral Medicine at Medical College of Wisconsin and sees patients for psychotherapy and medication management at the Tosa Health Center. He is a small group facilitator within the Kern REACH (Recognize, Empathize, Allow, Care, Hold) curriculum. He is co-editor-in-chief of the Transformational Times.