12 Slays of Xmas: "White Christmas" (from Black Mirror)

Viewing a Black Mirror episode through the lens of a psychiatrist

Posted Dec 13, 2018

Synopsis

Matt Trent runs an online group that watches each other have sex with unsuspecting women. Harry is the next man up. At an office Christmas party, Matt can speak to Harry and see what he sees. Jennifer overhears Harry talking to Matt “in his head” and invites him back to her apartment. Having misinterpreted Harry’s conversation with Matt as responding to internal stimuli, Jennifer forces Harry to drink poison through a funnel before ingesting it herself. Jennifer had planned her suicide and when she saw Harry “talking to his voices too,” she knew that “he understands” her. 

How it relates to the field of psychiatry

The above scenario identifies two psychotic features: a) auditory hallucinations and b) ideas of reference (IoR). An IoR is defined as a delusional misattribution (erroneously drawing the conclusion that Harry is experiencing auditory hallucinations) of a real stimulus (seeing Harry talk to himself). These two chronic psychotic features reach the threshold for diagnosis of Schizophrenia. As Schizophrenia is a diagnosis of exclusion, Jennifer would need to be assessed for the following illnesses before a final diagnosis of Schizophrenia could be made: Substance-Induced Psychotic Disorder, Psychotic Disorder due to Another Medical Condition, Schizoaffective Disorder, Autism Spectrum Disorder, and a primary mood disorder.   

The group tries to delete the evidence, but they are found out. Matt Trent is eventually placed on a sex offender’s list, leaving him “blocked” by everybody. This renders him a colorless silhouette that people hear as a distorted stream of noise. He is now a registered as sex offender afflicted with Voyeuristic Disorder, a condition defined by recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. Jennifer, a case study of Schizophrenia, also represents the 20 percent of adult women who have been targets of persons with voyeuristic intention.