Spanning just 13 episodes, the Netflix drama 13 Reasons Why is so powerful—and so controversial—it’s sparked a national debate about suicide. In the show, a teenager explains why she killed herself, and its frank take on its subject matter has both won over teen viewers and freaked out adults and public health officials who worry that it glamorizes self-harm. Opponents claim it could spark a “contagion effect” that could make teens kill themselves in real life. But can fictional narratives really spark copycat suicides?

In the 1980s, suicidologist Steven Stack looked at the links between fictional television films and suicide. Despite a healthy debate about how teenagers responded to reports of real-life suicides, fiction had been largely neglected as a factor. Mixed data and a lack of effective controls on previous studies were reason for concern, too. So Stack decided to test a previous study’s hypothesis that fictional films increase teen suicide by comparing data from New York to the timing of fictional films with content related to suicide.

Stack looked at 4,074 cases of teenage suicide and four television films that dealt with characters killing themselves. All four films aired nationwide, in a much smaller media landscape than today’s on-demand environment.

The study controlled for everything from month of the year, day of the week, and public holidays, all of which are known to have an affect on suicide rates. Stack’s analysis, however, didn’t support the first study’s findings. Rather, it showed that the movies didn’t increase the incidence of suicide.

There was a possible confounding factor: The suicides in New York—where the first study claimed a “contagion” effect due to film existed—all occurred during a time when the state was “a center of news stories” about suicide. Some of those stories crossed over with the dates on which films were aired. Perhaps there was a crossover effect, Stack surmised—maybe fictional stories made it more likely for a person to opt for suicide when paired with other media coverage of the topic. But when he redid the analysis with controls for those shows, there remained no definite connection between films and suicide.

Since Stack’s study, more work has been done on how fiction and suicide converge. But no distinct link has been proven. TV news coverage and celebrity suicides are clearly linked to outbreaks—and even indirect exposure to suicide seems capable of causing harm. But it’s much less clear how a work of fiction might influence someone who’s experiencing a crisis.

Decades after Stack’s study, the words he wrote back in 1990 still ring true: “A more rigorous theory of the imitation process needs to be developed” before “these complex questions”—questions highlighted by shows like 13 Reasons Why–can be answered.

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Social Science Quarterly , Vol. 71, No. 2 (June 1990), pp. 391-399
University of Texas Press