When Your Patients Are Binge Watching: Challenges Associated With Streaming Television in Child and Adolescent Psychiatry

Abstract

Brief Case Illustration: Sierra is a 16-year old girl who is in psychiatric treatment for major depressive disorder without psychotic features. Several months after starting treatment, Sierra’s mother brought her into the office for an urgent safety assessment. Sierra had been sent home from school after reporting new onset command auditory hallucinations to harm herself and perceptions that she was not in control of her body’s actions. Sierra described hearing an unknown male voice that instructed her to kill herself; while Sierra had not acted on this, she was scared that she could no longer keep herself safe. During the emergent psychiatric appointment, Sierra revealed that she first heard the voice shortly after watching the streaming television show Black Mirror on Netflix. Specifically, Sierra had watched the Black Mirror film Bandersnatch, which piloted a novel interactive format where the show’s viewers could direct the actions of the show’s teenage protagonist through use of a remote control, trackpad or computer mouse. Decisions made for the protagonist ranged from choosing his breakfast cereal to choosing to physically assault another character. Sierra’s mother was unaware that her daughter had watched Bandersnatch, and was unfamiliar with the episode’s interactive format. Sierra’s psychiatrist, however, had recently watched Bandersnatch and recognized both the show’s underlying theme of loss of free will and the viewer’s unique ability to “become” the show’s protagonist. Sierra’s psychiatrist explored possible connections between the new symptoms and the show, to which Sierra responded positively. Sierra reported often feeling affected by screen media, but never before for this long or with this symptomatology. Sierra reported significant symptom improvement at the end of the appointment. This acute improvement, coupled with the lack of other indicators of organic psychosis, led the psychiatrist to recommend continued treatment at the outpatient level of care with watchful waiting and increased surveillance. One week following their onset, Sierra’s symptoms resolved without additional intervention.