The study, while troubling, is not entirely surprising. In May, I examined how 13 Reasons Why managed to break virtually every rule that exists when it comes to portraying suicide, featuring a graphic, prolonged scene of the main character’s death in the final episode and glamorizing it as a force for positive change in her community. One of the biggest concerns among psychologists and educators was that the show might spark a contagion effect, where increased coverage of suicide in the media leads to a related increase in suicide attempts. Netflix doesn’t release data regarding its viewing figures, but the wide discussion of the show on social media (it became the most-tweeted about show of 2017) implies that a significant number of people watched it, particularly teenagers. The rush to produce a follow-up season (currently being filmed and scheduled for a 2018 release) indicates the show has been a big hit for the streaming service.

The question is whether this particular study, or any of the allegations that the show directly led to copycat suicides and suicide attempts, will be enough of an impetus for the show’s producers to respond. The study’s authors suggest that editing out the scene of Hannah Baker’s suicide from the show and adding information about suicide hotlines to episodes could immediately minimize some of 13 Reasons Why’s “deleterious effects.” Netflix’s response to the study, though, indicated no such moves would be forthcoming. “We always believed this show would increase discussion around this tough subject matter,” the company said in a statement. “This is an interesting quasi-experimental study that confirms this. We are looking forward to more research and taking everything we learn to heart as we prepare for Season 2.” Netflix declined interview requests from The Atlantic regarding the show.

What the study does show is that art and entertainment have real power, and that as patterns of media consumption change, directors and producers don’t have the luxury of imagining their work in a vacuum. When television shows can be consumed instantaneously by Netflix’s 100 million subscribers, they can also have an immediate impact on public health, particularly when they’re targeting teenage viewers. An editorial published at JAMA commenting on the study stated that teens are particularly vulnerable when it comes to binge viewing. “This immersion into the story and images may have a particularly strong effect on adolescents,” it argued, “whose brains are still developing the ability to inhibit certain emotions, desires, and actions.”

Netflix and the producers of 13 Reasons Why, who reportedly disregarded advice from mental-health experts not to release the first season, have repeatedly claimed that the show is raising awareness around the subject of suicide, banishing stigmas, and leading to more discussion of a sensitive topic. But as this study implies, focusing public attention on suicide without taking recommended efforts to minimize harm can be counterproductive, and even dangerous. Dr. Dan Reidenberg, the executive director of Suicide Awareness Voices of Education, told me in May that he disagreed with the argument that simply broaching the topic in popular culture is enough. “It has definitely started a conversation about suicide,” he said, “but it hasn’t been the right one.”

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