Psychiatric Analysis of Black Swan



 

The following post was composed as an assignment for my Psychopathology Module, where we were required to watch a movie portraying someone with a Psychiatric Disorder. We were then required to submit an analysis about the presentation of the disorder in the movie. I chose the movie Black Swan as it was intriguing on many levels, and the protagonist had many layers to her disorder, making it all the more interesting to analyse.

 

“I had the craziest dream last night. I was dancing the White Swan”. Nina Sayers is a fragile and repressed ballerina, who strives for the lead in Tchaikovsky's "Swan Lake," a role that will require her to play both the gentle white and the seductive black swans. Nina lives with her controlling mother and constantly strives for perfection. However, this is not enough for her demanding and sexually aggressive director who wants her to ‘lose herself’ in order to dance the seductive black swan to perfection. As the film progresses we see Nina’s descent into psychosis, as the stresses of being the lead ballerina and her mother’s emotional abuse become too much for her fragile state of mind. We see her embracing her role to the fullest and transforming from the virginal, pure white swan into a dark, ominous black swan.

Looking at Nina from a psychiatric point of view, she displayed many psychotic features associated with Schizophrenia. According to the DSM-IV-TR the diagnostic criteria for schizophrenia are as follows. The person must experience two (or more) of the following symptoms, each present for a significant portion of time for 1month and lasting more than 6 months: delusions; hallucinations; disorganized speech; grossly disorganized or catatonic behaviour; negative symptoms, i.e., affective flattening, alogia (poverty of speech), or avolition. They must also experience social or occupational dysfunction, and mood disorders and substance abuse must not be present.

The two symptoms Nina frequently presents with in the movie are delusions and hallucinations. We see this right from the start where she may have been experiencing the prodromal phase of Schizophrenia. This is the phase where one sees the first appearance and escalation of symptoms. She experiences about 22 hallucinations in total throughout the movie. Her first hallucination is in the train where Nina sees herself at a distance. She later realizes that it was not her but a new dancer at the company called Lily. There are also other instances where she sees her face on Lily or a passerby, or sees her reflection watching her. It seems as if the hallucination of herself is the darker and bolder side of her. We see an escalation in her hallucinations after she receives the role of the black swan. She starts to hallucinate of herself more often and also sees herself bleeding when she is not. She also starts developing a rash on her shoulder that her mother reveals as her bad habit of scratching when she stresses, but Nina does not seem to recall this and seems bewildered on noticing the marks.

The pressures from the director Thomas seem to fuel her downward spiral from there on. One of the psychological causes of Schizophrenia is stress. Stress precipitates the onset and relapse of Schizophrenia. Nina stress stems from pushing herself to become what Thomas wants her to be. On more than one occasion he reprimands her and pushes her to become passionate and lose herself. He also encourages her to explore her sexuality. He rightly guesses that she is a virgin and because of this she is too frigid and not passionate enough to represent the Black Swan. He even attempts to seduce her and encourages her to respond to him. This clearly added to Nina’s stresses. We see Nina grapple with her sexuality even in her delusional state of mind. She pleasures herself, is attracted to Thomas and has a detailed hallucination where she has sex with Lily.

Her hallucination of sleeping with Lily is her first major psychotic episode. It was most probably brought on by the drugs that she took while out partying with Lily. It is also the stage we start seeing the breakdown of her relationship with her mother. Erica has kept Nina from having friends, and we see this when Lily comes to visit and Erica drives her away without telling Nina. This pushes Nina to rebel and she then leaves with Lily for a night of clubbing and drinking, which ends in her vivid hallucination of them having sex. We know this was a hallucination because Lily has no recollection of the incident the next morning, and claims she left the club and spent the night with another man.

From here onward we start to see paranoid delusions of Lily forming in Nina’s mind. She begins to view Lily as a threat when Lily seems to have been nothing but friendly towards her. When the director makes Lily her alternate for the black swan, she is horrified and begs him to change his mind, claiming feverously that Lily is after her and wants to replace her! Thomas gently consoles her and tells her that no one is after her, but the seed of suspicion has been planted in her mind already.

As the days for the opening act draw closer we see Nina falling deeper into paranoia. The hallucinations also seem to drastically increase. The day before the opening act she sees the director Thomas and Lily having sex. This hallucination further fuels her paranoid beliefs about Lily being after her role. It is almost as though her mind causes her to see her worst fears. Her night continues to go horribly wrong. When visiting Beth, a retired dancer at the company who attempts suicide and is now unresponsive in the hospital, she hallucinates that Beth stabs herself in her face. The bleeding Beth is then seen again standing in her kitchen at home, her mother’s paintings are also talking to her, and the horrific visions continue. We also see the first signs of her transformation into a swan. The rash on Nina’s shoulder is getting worse, and picking at the wound reveals several black feathers imbedded inside. It becomes too much for Nina to take, and she locks her mother out of her room injuring her in the process. We see her legs morphing into a bird like state and she falls over, knocking herself out in the process.

The day of the opening act is a changing point for Nina. Her mother attempts to stop her from going claiming she is too ill, but she becomes violent and leaves, uncaring that she has hurt her mother in the process. Here we see a total different Nina emerging. The darker, daring side of her emerges that she so often saw in her reflection. She confronts the director very boldly about giving her part away to Lily, an attitude uncharacteristic of the shy and fragile Nina. We also see more of her transformation. Her toes appear to be stuck together and webbed just like a bird or swan. When the show begins she experiences her second major psychotic episode. After a disastrous opening performance she finds Lily waiting in her dressing room, dressed as the Black Swan and claiming she wants to take over Nina’s performance. Once again her hallucination seems to be fueling and conforming to her deepest delusional fears. Lily attacks her and attempts to throttle her but Nina fights back, breaking a mirror and stabbing Lily with one of the shards. Hiding the corpse of her rival, Nina returns to the stage for the second act and gives a brilliant performance. As she receives a standing ovation, Nina imagines that black feathers have sprouted from her body and so her transformation into the black swan is complete!

When she returns to her dressing room to prepare for the final act, she finds Lily waiting to congratulate her. As it turns out, Nina did not stab Lily. Noticing the broken mirror, Nina realizes that her psychotic brain caused her to stab herself. Looking at the escalation in hallucinations from the day before to the point of her second major psychotic episode, she seems to have entered the active phase of Schizophrenia. Her hallucinations and delusions have become distinct to the point that she unconsciously injures herself. Despite her injury she dances the final act with both passion and abandon. It is possible that her psychosis numbed out the pain of her physical injury and allowed her cope right till the end. The closing moments of the film show Nina proud of her performance, and seemingly on her death bed, triumphantly whispering, “I felt it. Perfect. I was perfect.”                               

Along with her hallucinations and delusions, Nina also experiences many co-morbid problems. Her last words prove to us how much she needed to achieve perfection. Perhaps it was the constant pressure from her mother to achieve that drove her to become like this, and the psychosis simply pushed it to the extreme. The drive to achieve perfection may have also have influenced her eating disorder. We see her only eating a sponspek for breakfast and at a later stage refusing to eat a cake that her mother bought. The eating disorder could also be a negative influence of the ballet industry where dancers are expected to be a specific weight and figure.

Another obvious problem is her self-mutilation. Although she seems unaware of herself doing so, she constantly scratches her back causing abrasions to form and her skin would often bleed. Watching her closely throughout the movie I noticed that she had a very restricted affect. In most situations you do not see a wide range of expressions on her face. An abnormality in affect is one of the negative symptoms of schizophrenia. She also has clear dysfunction in social interaction which is one of the DSM criteria. She has an unhealthy relationship with her mother, and when Lily is friendly towards her she does not know how to respond, and instead takes her as a threat. She also seems very emotionally immature for her age. She is a virgin, has never been to a club or gotten drunk or high. Her room is very childlike and she is overall very sheltered.

An analysis of Nina would be incomplete without looking at the influences of her relationship with her mother. Erica is an unaccomplished dancer who retired at 28 to birth and raise Nina. She now makes paintings of Nina, sleeps in a chair in Nina's room, runs Nina's schedule, calls Nina several times a day and, perhaps most controlling, undresses Nina to her panties. From her dysfunctional and inappropriate relationship with her mother, we see evidence of one of the causes of Schizophrenia; faulty learning. Nina has been conditioned into believing the world is an unfriendly and threatening place.  This is a result of her disturbed social interaction (due to her mother), observing her mother behaving in inappropriate ways and making great effort to meet her mother’s inappropriate expectations. According to research this results in faulty assumptions about reality (her delusions), difficulty with sense of self and self-worth, emotional immaturity (her lack of normal social experiences), and lack of effective coping skills (her self-mutilation in the form of scratching).

Although Nina’s frequent hallucinations lead me to believe that she is Schizophrenic, she could have a differential diagnosis of Dissociative Identity Disorder. There are several reasons as to why she may be diagnosed with DID. Firstly she clearly seems to have 2 or more distinct identities or personalities. Her innocent and fragile side that strives to be perfect, and her bolder, darker side that self mutilates, injures her mother, and in the end stabs herself. We see evidence of this gradually. She first starts to see a different side of herself in her reflection, and sometimes on Lily. This ‘reflection’ often casts her evil or cunning glances and it is this ‘reflection’ that is seen scratching her back. This ‘darker personality’ even tried to kill of the ‘good personality’. We see this when she sees her face on Lily after they sleep together and this hallucination or ‘personality’ tries to smother her with a pillow. It was almost like she was fighting back with her other identity and attempting to kill it, and without realizing she actually stabbed herself instead of Lily. Perhaps she see’s Lily as one of her ‘personalities’ or the personality she would like to become, as Lily is the total opposite from her. As the movie progresses we see her innocent side fading out, and the darker side taking over more and more until it totally takes over her at the end when she transforms into the Black Swan.

 Other evidence of dissociation is in her detachment. She experiences depersonalization where one has feelings of body parts changing shape or form. This is evident in her feet becoming webbed, her legs becoming deformed and towards end, feathers sprouting out of her in her complete transformation into the Black Swan. She also experiences derealisation where the outer world assumes an unreal appearance. Her hallucinations especially the ones where she sleeps with Lily and stabs Lily but instead has stabbed herself, can be classified as unreal appearances of the outer world.

In conclusion Nina had many layers to her personality. The movie was so brilliantly portrayed that it makes you question yourself. What was real and what was a hallucination? Was it a hallucination or just a dissociation of Nina’s own personality? The movie was in my opinion, a very accurate depiction of psychosis although the symptoms may not always add up. Nina’s diagnosis was not something we could put into a box. Nevertheless, it was a thoughtful and insightful look into the life of a psychotic person.