Diagnosing the Black Swan (General Psycholgy)

            In the psychological thriller film, Black Swan, Natalie Portman portrays a ballet dancer. Portman’s character, Nina Sayers, is depicted as a shy and quiet. Sayers becomes the ballet company’s main star as she takes on the lead role as both the black swan and white swan. She began to develop multiple mental symptoms while trying coping with the stress of the role while becoming the black swan. The film shows the Sayers character’s gradual transformation into an unfamiliar person (the black swan) compared to who the audience was introduced to at the start of the movie (the white swan).

            The character can be diagnosed with schizophrenia due to her many symptoms. Some of Sayers’ symptoms include hallucinations, delusions, paranoia, and self-harm. According to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria includes how often the delusions occur within one month, hallucinations, manic or major depressive episodes, and symptoms not being attributed to other physiological effects of a substance or other medical conditions or mental disorder (such as body dysmorphic disorder or obsessive-compulsive disorder).

            After carefully studying Nina Sayers, it is shown that she has the grandiose, persecutory, somatic delusional disorder types. Nina is the persecutory type due to her paranoia that a fellow dancer (Lily) is out to get her and wants to take her spot as star. The DSM-5 says that the persecutory type is “[…] the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.”  Also, stated in the DSM-5 is the definition of a somatic type which is “[…] the central theme of the delusion involves bodily functions or sensations.” This is definitely seen when Nina has intercourse with Lily, however later on it is revealed that the two never went that far.

            The information presented are facts regarding schizophrenia. According to the Oxford Press Journals, African Americans were about 3-fold more likely than whites to be diagnosed with schizophrenia. The National Alliance on Mental Health states that there are “1.1% of adults in the U.S. live with schizophrenia.” The Centers for Disease Control and Prevention reports that the “age of the first episode is typically younger among men (about 21 years of age) than women (27 years). Of persons with schizophrenia, by age 30, 9 out of 10 men, but only 2 out of 10 women, will manifest the illness. Persons with schizophrenia pose a high risk for suicide. Approximately one-third will attempt suicide and, eventually, about 1 out of 10 will take their own lives.”

            The way Nina is depicted in the film is accurate in terms of someone who has schizophrenia. Throughout the movie, Nina constantly saw hallucinations and illusions. For example, in certain moments she would see herself. This doppelganger was a darker form of her which could be considered the black swan of herself. The black swan version even appeared as Nina instead of being her own body. The scene where Nina killed Lily turned out to be a hallucination and during the killing, the “normal” Nina was not present, but the black swan version was. There was a point in the film where Nina was practicing before the day of her big performance. She sees herself moving in the mirror even when she actually is not. She later finds her boss and Lily in intercourse, however, when the boss faces her, he is a black swan-like creature. When Nina returns home, she finds all the paintings in her mother’s bedroom talking and mocking her.

            There are also moments when the main character turns into a swan. She finds feathers growing from her skin and her eyes turn from white to red. Then, her legs snap backwards. ON the night of the performance, she realizes her toes are starting to join as if she was forming webbed feet. And when she finally wears the black swan costume, the black swan version of herself takes over. For the remainder of the dance, her eyes are red and her skin flares with feathers. Her arms began to be covered in feathers and turn into wings, then her whole upper body was covered as well. In actuality, none of this was happening. When she thought she killed Lily, it turns out that Nina stabbed herself.

            This negatively affected Nina’s life. Her paranoia about being replaced grew heavy to the point where she ran to the boss crying about not wanting Lily as her replacement. She felt as if Lily was out to get her. This made her relationship with Lily strained, also. Nina’s black swan version came out when she fought with her mother. Nina slowly grew defiant. Her mother even said, “You are not my Nina right now.” One of their last interaction was when Nina  injured her mother’s hand by slamming the door on it.

            Nina could have been treated through medication. The National Institute of Mental Health calls it “antipsychotic medications” or “atypical antipsychotics.” However these medications can lead to drowsiness, rapid heartbeat, and tardive dyskinesia (TD). Another treatment could be therapy. These therapies would include, “psychosocial or cognitive therapy, rehabilitation day programs, peer support groups, and nutritional supplements. In certain severe cases, some patients also respond to electroconvulsive therapy transcranial magnetic stimulation (TMS).” In the entire film, the character did not receive any kind of treatment.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association

Bresnahan, M. (2007, April 17). Race and risk of schizophrenia in a US birth cohort: Another example of health disparity? Retrieved November 30, 2016, from https://ije.oxfordjournals.org/content/36/4/751.full Published by Oxford University Press on behalf of the International Epidemiological Association

Burden of Mental Illness. (2013). Retrieved November 28, 2016, from https://www.cdc.gov/mentalhealth/basics/burden.htm

Mental Health By the Numbers. (n.d.). Retrieved November 30, 2016, from http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

National Institute of Mental Health. (n.d.). Schizophrenia. Retrieved November 29, 2016, from http://www.nimh.nih.gov/health/publications/schizophrenia-booklet-12-2015/index.shtml#pub8

Schizophrenia Help & News for Families, Sufferers. (n.d.). Schizophrenia Treatment. Retrieved November 29, 2016, from http://schizophrenia.com/sztreat.html