Recently, a gunman shot a lobby valet at the Boston hospital where I work. I was treating patients in the emergency room when my computer screen flashed, “Active Shooter Alert.” I’ll never forget the feeling of my heart sinking as we closed the curtains and doors to our patients’ rooms and waited, unsure of what would happen next.

I remember feeling a similar sense of anxiety a few months ago in a movie theater when I was watching Joker, a psychologically complex retelling of the story of how Batman’s arch nemesis was birthed. I kept thinking of the shooting in an Aurora, Colo., theater in 2012 as I nervously eyed the theater exit.

And then Joaquin Phoenix won the Best Actor Oscar for playing the title in that same film. The honor was richly deserved—but it was also a window into how far Hollywood still has to go in portraying mental illness more accurately and compassionately. Phoenix’s character, Arthur Fleck, lives a life of debilitating depression, mania and psychosis. He has no social support system, is abandoned by his mental health counselor, has an abusive family history, and is given a gun by a colleague—which he later uses to commit his first murders. Joker engages more deeply than other violent movies with the narrative of how a person with mental health issues could become a killer.

As a doctor, I find the story of his social difficulties to be familiar. Many of my patients share the same sort of hardships. I have also treated victims who have died of gunshot wounds, and other patients who have felt their only options were to kill themselves or others. In a time when lone-shooter gun violence is increasing (there have been over 30 documented mass shootings—those that involve more than three people—in 2020 alone), movies like Joker beget questions of the appropriateness of selling entertainment around sensitive national themes. What role and responsibility, if any, does the media industry have toward major public health issues?

To be clear, a movie is not the reason America has a gun violence problem. Movies don’t kill people; people with guns kill people. With more guns and less regulation than any developed country on earth, the issue in America is undoubtedly the number of firearms, and especially those in the wrong people’s possession. But it’s still fair to ask whether violent movies can serve as the metaphorical trigger pull for more gun violence? Will our next mass shooter be inspired by a movie in which a character creates meaning and purpose in his life through a gun?

In fact, a recent study showed that violent crimes actually decreased during the day that violent blockbuster movies were released—largely, the authors speculated, because many of the people prone to commit crimes were at the theater. But there were no long-term follow-ups; we don’t know whether violent crimes increased months later in any notable pattern.

Similar studies have examined video games and their link to violence. A study by researchers at Harvard and Stanford found that video games were linked with an increase in aggressive behavior—but that the effects were small. Given what we know about gun violence, Daniel Webster, director of the Johns Hopkins Center for Gun Policy and Research, says, “While I don’t recommend watching a lot of violent movies or playing a lot of violent video games, and think it is not good for one’s mental health, violent media is not where I look when I consider how to reduce gun violence and homicides.”

The data are clearly limited on whether violent movies directly cause violence, but we know with certainty that movies do impact people. They are designed to do exactly that—sometimes for good, and sometimes, unintentionally, for bad. As an audience member, I could not help but feel sympathy for the Joker, especially as the society around him did so much to push him down. His violence, at least initially during a scene where he is protecting himself, is portrayed as almost justifiable.

Moreover, there were plot points that made us see the humanity in him. In a tense scene, he surprisingly spares one man’s life, saying, “You're the only one that's ever been nice to me.” Unfortunately, this narrative comes to the wrong conclusion: that violence may be the answer to depression or mental health disease—both of which are ongoing epidemics in the United States. And while this is meant to be the story of a villain, at times it becomes easy to forget that.

The media industry dealt with this situation not too long ago. Last year, Universal Pictures scrapped the release of its horror film The Hunt in the aftermath of the El Paso shootings in Texas. And Warner Bros. has responded to mounting pushback against the Joker movie, saying that it is “not the intention of the film, the filmmakers or the studio to hold this character up as a hero.”

But intention is only half the equation. And if works of art are going to involve issues of public health, then public health becomes, in part, the artists’ responsibility as well.

Gun control is a complex issue. The media industry won’t be able to solve it. However, neither will the health care industry; the justice system; law enforcement; the legislative branch; psychiatrists; bullet proof vests; more guns; or fewer guns. The answers require nuanced, interdisciplinary solutions. They demand that everyone—including moviemakers—participate in a concerted effort. Tighter gun legislation, including reducing the number of guns in circulation, will undoubtedly make gun violence less likely. But a lone shooter who is inspired by a violent plot with a character that reminds him of what he could be will not necessarily be stopped by these measures alone.

Families of the victims of the Aurora shootings have reached out to Warner Bros., asking for a corporate commitment to gun control measures through political lobbying, and they asked as well that the company end any support for candidates who are backed by the NRA. It would be prudent for the company to do so. Moreover, Warner could use profits to help fund further research into what creates mass shooters—and perhaps in the process reassure all of us that it is in fact not violent movies. The media industry holds immense power—far more than my stethoscope—and it should use that power to protect our health.