"It's gonna be you + me."
In the photo I'm looking at on Instagram, those are the words literally carved into what appears to be either someone's forearm or the underside of their thigh. The wound looks fresh, with drops of blood dripping down from different letters; it's surrounded by older wounds and cuts that have already started to heal.
"'Our song forever on my skin," the caption reads. "Thanks for all the pain. For all the tears I've cried and all the cuts I've made. I love you."
I found this photo by searching a secret hashtag, one of several that teens use every day to share controversial images on social networks like Instagram and Tumblr without getting caught. In a world where these companies actively police hashtags like #cutting and #proana to crack down on inappropriate content, young people are trying — and mostly succeeding — to fly under the radar by creating codewords like #sue and #secretsociety123 to discreetly form communities organized around self-harm, and they're showing up in strong numbers. An Instagram search for the #sue hashtag, a secret word for suicide, reveals nearly 800,000 tagged posts. The vast majority of these posts all contain evidence of cutting, quotes about depression, and messages related to self-harm.
"People who are posting on Facebook or in forums just kind of need to get that information out of themselves and put it somewhere," said Nicola Survanshi, director of programs and operations at the nonprofit organization ReachOut, which helps teens and young adults achieve mental health and wellness through technology. "That alone can be really helpful and cathartic."
While there are a fair share of positive messages within the stream of #sue and #secretsociety123 posts on Instagram and Tumblr, they're outnumbered by darker posts about self-harm. Some of them overlap with the traditional hashtags; for example, a photo with the hashtag #sue can also be tagged #deb, #ana, and #anorexia.
Of course, the #sue hashtag doesn't just display posts promoting self-harm. There are also posts on Instagram and Tumblr with positive messages and quotes about optimism, like "Don't give up now" and "Stay strong." It's clear that there's a contingent of young adults who try to flood the hashtag with positive and inspirational messages, hoping that others teens using the hashtag earnestly will take some positivity from it.
Over the course of a couple months, I reached out to almost 50 teens on all different kinds of social media — including Tumblr, Instagram, and Twitter — as well as via email. I asked if any of them would be interested in talking to me anonymously about how young people are using social media and the internet to discuss mental health, depression, and content around self-harm. I didn't receive a reply from any of them. It seems extremely clear that hashtags like #sue and #secretsociety123 are meant to be just that: secret societies unto themselves where outsiders are not welcome.
In April 2012, Instagram banned the pro-eating disorder hashtag #thinspo after it started getting noticed on a number of sites and garnered more attention. The site responded by updating its community guidelines with one specific policy, "Don't promote or glorify self-harm." It reads:
"While Instagram is a place where people can share their lives with others through photographs and videos, any account found encouraging or urging users to embrace anorexia, bulimia, or other eating disorders; or to cut, harm themselves, or commit suicide will result in a disabled account without warning. We believe that communication regarding these behaviors in order to create awareness, come together for support and to facilitate recovery is important, but that Instagram is not the place for active promotion or glorification of self-harm."
When I asked representatives at Instagram if they were aware of the hashtag, they sent me a link to the guidelines posted on the website. But Instagram clearly is aware that #sue exists because when you search for the hashtag on the site, a content advisory message pops up: "These images may contain graphic content. For information and support with suicide or self-harm please tap on learn more." You can then click one of three buttons: learn more, show posts, or cancel.
These new hashtags seem to indicate that teens today are using social media to find catharsis. Patrick Keohane, a ReachOut volunteer, said that younger people who grew up with technology are more likely to turn to social media when they need help with their personal problems because they think of it as a safer, more anonymous experience.
"Many people are uncomfortable approaching counselors, teachers, family members, and friends about their issues because they feel shame or embarrassment about what they're going through," he said.
All of this information isn't just theoretical. Last year, researchers at Ohio State University found that technology plays a significant role in how teens cope with mental health issues, and also how they use social media to seek help. Scottye Cash, one of the head researchers on this study, said that one component of her research revolves around the stigma people feel when trying to talk to someone else about suicide.
"Because they don't always know how common it is, teens sometimes feel like they're isolated in this. But we found in this one evaluation that if they had higher depression, they had a lower stigma around seeking help," said Cash, who is also an associate professor at OSU.
"If teens using these hashtags have gone to a mental health resource before, then there's less stigma. If they haven't, then they may not know who to contact so they throw out these feelers trying to see what kind of responses they'll get."
But Cash is ambivalent as to whether Instagram should ban hashtags like #sue and delete self-harm content as soon as it pops up. She thinks it could be both good and bad if sites like Tumblr and Instagram remove the content altogether, but Cash also said there are other ways for the social networks to guide teens in a positive direction.
"If something pops up when you search for certain hashtags that can help connect teens to get help in other ways instead of going to a repository of all of the negative things that have been said using that hashtag, that would be a good thing," she said.
This is, in fact, what does happen when you search for particular trigger words on Tumblr and Instagram. If you search for the #thinspo hashtag today, nothing shows up at all, but when you search #sue, #secretsociety123, or #suicide, part of the message that Instagram displays points to inspirational resources: "For information and support with suicide or self harm please tap on 'learn more.'" If you click on "learn more," you're brought to befrienders.org, described as a website "providing emotional support to prevent suicide worldwide."
Liba Rubenstein, director of social impact and public policy at Tumblr, said that while a lot of people outside of the tech industry do want policies in place that remove content based on hashtags, "removing the content doesn't remove the issue."
"Wanting to keep those conversations hidden and that sort of secret language is something we work with our colleagues across the industry on," Rubenstein said. "Something like #sue can mean so many other things…we have to balance between intervening when people really are talking about concerning issues and not scaring people if they really aren't."
According to Rubenstein, Tumblr has a similar system in place as Instagram: When you search a triggering hashtag or word, a notice pops up on your screen and intercepts users from going directly to the search results. It also recently implemented a flagging feature, so users can report individual posts that are dangerous and violate community guidelines.
"We have the power to take those posts down, but primarily we're focused on the types of intervention," she continued. "Really, our goal is to create dialogue around these behaviors and help people. We want Tumblr to be a place where we facilitate that."
Rubenstein also said that for every story that makes it into the news about people who actually hurt themselves and expressed it on social media beforehand, Tumblr has also seen a lot of positive feedback from users about how their site helped them in times of need.
"There are many, many more who contact us every day thanking us, like, 'Thank you for saving my life because I was connected with people who supported me,'" Rubenstein said.
Teens — and adults — have long turned to the internet to grapple with mental health. But there will always be new, evolving ways to talk about internal pain. While teens have proven to be resilient and resourceful among themselves when it comes to fighting against suicide, Cash thinks one of the most important things that can be done is to let them know they have unconditional support from the adults around them.
"We need to tell young adults that it's OK to have some questions or to struggle," Cash said. "The data is just so new. Teens are going faster than our research is."
It's nearly impossible to see past the pain behind the raw photos under the #sue hashtag, but when you look past the images and scroll down to the comments, it's easy to get a sense of why teens gravitate toward this medium for help and community. One user left a comment on the photo I mentioned earlier that reads: "I'm so sorry you have to feel this way. No one deserves this but it'll get better I promise. No matter how dark it seems right now. 4 months ago I was sure I was going to kill myself but I'm here and I think I'll be okay and I know you will too. Ilysm and I'm here if you ever need anything [sic]."
The initial poster thanked the user for their "kind words."
The commenter responded, "And if it means anything, I honestly think you're extremely gorgeous and your body is beautiful."
"Thank you... i cant see that tho [sic]," the poster wrote.
But the commenter didn't give up. "I really hope you will one day, you're fantastic."
If you or someone you know is going through a rough time, feeling depressed, or thinking about self-harm, you can call the national suicide prevention lifeline at 1-800-273-8255 or visit their website. You can also head over to ReachOut.com and check out some of its resources.