“Have you seen that Black Mirror episode where you choose the ending?” he asked. I was interviewing Frank*, a high school boy, as part of a psychological evaluation. I told him that yes, I had seen that episode of the Netflix science fiction series.
“That messed me up,” he said, looking down. “It just made things worse. I thought I would be okay, but as soon as the guy starts talking to you through the screen, I had to turn it off.”
Black Mirror: Bandersnatch is about Stefan, a programmer in the 1980s who is developing a “choose your own adventure” style video game. The novelty of this particular episode is that it allows you, the viewer, to make decisions throughout (becoming its own “choose your own adventure”). You can decide at the press of a button which cereal Stefan will eat, or what music he will listen to. Each decision has ramifications within the story, changing the ultimate outcome for Stefan.
Stefan appears to be a troubled young man. He is seeing a therapist. Once he begins working on the video game, he starts losing his grip on reality. He questions whether there is some conspiracy against him. At one point, you, the viewer, become a character within Stefan’s reality, as he wonders whether some outside force is controlling his actions. As soon as Frank brought up the show, I knew what he was going to say: He couldn’t watch it. It was too similar to his own experiences. Frank was worried that the same things that were happening to Stefan would happen to him. When Stefan talks to the camera, it unnerved Frank so much that he had to turn it off, lest he lose his own sense of reality and start actually believing that this TV character was communicating with him.
Frank was referred to our clinic by his therapist after he started hearing a woman’s voice in his head. The voice sounded very real, as if someone was whispering in his ear, even when no one else was around. Our clinic specializes in evaluations and treatment for young people who are experiencing psychosis symptoms. “Psychosis” is a scary, misinterpreted word that comes with a lot of baggage. What psychosis actually refers to is a set of mental health symptoms where a person has trouble knowing what’s real and what’s not. A person with psychosis may experience hallucinations (such as hearing voices or seeing things that are not there), delusions (unusual beliefs not based on fact or evidence, such as the belief that the CIA is spying on you), or disorganized behavior (such as unintelligible speech). People vary in how much they believe that these experiences are just in their head. Some people, like Frank, will hear a voice that sounds very real, but remain grounded in reality – they know it’s not coming from anywhere else outside of their mind. Others might believe the voices they hear are a demon talking to them, or a dead relative – they have lost the ability to distinguish reality from fantasy, and meet the clinical definition for having a “full” episode of psychosis. Schizophrenia is the main psychiatric diagnosis where a psychotic episode is the defining feature. However, these symptoms can occur when someone is feeling depressed, manic, or after a traumatic event, and experiencing symptoms of psychosis does not necessarily mean that someone will ever have a “full” psychotic episode (i.e., lose touch with reality).
It’s not unusual for a young person with experiences like Frank to name a piece of pop culture that reminds them of their own symptoms. The 1999 film The Matrix is often brought up by people with psychosis as something that is difficult to watch because it can make their psychosis symptoms worse. In the film, Keanu Reeves’ character Neo learns that everything he thought was real is not, and that he is the “Chosen One” to save humanity from a terrible, robot-driven dystopian nightmare. For a young person who has difficulty distinguishing fantasy and reality, this movie includes some terrifying messages: Nothing is real. You are being unwittingly controlled by robots. Don’t trust anyone. Outside of the context of science fiction, these experiences and beliefs are incredibly distressing for people who experience psychosis. Thus, even when films and TV shows do not intend to comment on mental health, they can still have an effect on people with those experiences.
Bandersnatch is different: It is centered around a character seeking mental health treatment. You, the viewer, even get to decide whether he takes his psychiatric medications or not. While not made explicit, Stefan is clearly experiencing psychosis. There are many, many potential endings to the show, with the majority of them tragic: Stefan kills himself, he kills his dad, he kills his friends, he goes to jail, and/or he has a daughter who will go on and lose her grip with reality as well. These endings all center around the same message: mental illness is a curse that will lead to madness and violence.
Time and again, psychosis and violence are inextricably linked in the public imagination. When people hear the word “psychosis,” they think about Alfred Hitchcock’s Psycho, or Hannibal Lecter, or about a homeless person screaming obscenities on the street. If they live in the US, they may think about the most recent mass shooting. In a study of US news coverage of mass shootings from 1997-2012, the phrase “dangerous people” with serious mental illness (i.e., people who experience psychosis) was more likely to be mentioned than “dangerous weapons” as the cause of gun violence.
However, the connection between psychosis and violence portrayed by the media is misleading at best and dangerous at worst. The negative portrayal of people with serious mental illness leads us to believe they are dangerous, unpredictable, and require increased social distance (including not wanting to live in the same community as them). It can also increase discrimination against people who experience psychosis, including in medical settings. This stigma further affects people with serious mental illness, possibly leading them to not seek appropriate treatment or deny their illness because of the negative qualities associated with it.
While Bandersnatch may have been an innovation in streaming storytelling, it relies on old, pervasive tropes of mental illness as a curse you cannot escape from. It depicts therapists as not to be trusted, psychiatric medications as useless, and violence as inevitable. While it may effectively depict the horror of someone losing his ability to know what’s real and what’s not, it does so in a way that reinforces the notion that people who experience psychosis are dangerous or doomed.
The fact is that people who experience psychosis on the whole are not violent. Rather, people with schizophrenia are over 10 times more likely to be a victim of violence than to perpetrate it. Two hundred and thirteen people with mental illness were shot and killed by police in the US in 2018, making up 21% of all police shooting fatalities that year. In reality, people with serious mental illness are more likely to harm themselves than to harm someone else, with estimates ranging from 5-13% of people with schizophrenia will die by suicide. Certain factors can increase the likelihood of someone being violent when they experience psychosis, such as alcohol/drug use, going off of one’s medications, and a history of violent behavior. However, many of these risk factors are also risk factors for violent behavior in the general population. With 76% of violent incidents in the US being perpetrated by men in 2017 alone, being male is a better predictor of violent behavior than having a serious mental illness. Additionally, there are many evidence-based treatments that are effective at helping people who experience psychosis, including for young people like Frank who have yet to lose insight into his symptoms.
Frank was initially wary about discussing his experiences with his therapist because he thought that only “crazy, dangerous” people hear voices. Like many people who experience psychosis, the only person Frank has ever tried to hurt is himself: He had already tried to kill himself twice. During the consultation, we told him that many young people have these types of experiences. We also told him that we would recommend to his current therapist some new strategies to help him manage these new symptoms. I said I was glad that he took care of himself and decided to stop watching a TV show that was causing him stress.
He looked relieved.
*Name and identifying characteristics changed to protect client privacy.