Black Swan

• Chris Clark, Cinema St. Louis

• Steve Franklin, MSW, LCSW

• Michael Uthoff, Dance St. Louis

SteveFranklinMSW@JUNO.com

• Natalie Portman as Nina Sayer• Vincent Cassel as Thomas Leroy• Mila Kunis as Lily• Barbara Hershey as Erica Sayers• Winona Ryder as Beth

Macintyre

• Directed by Darren Aronofsky

• Other Oscar nominations: – Cinematography– Editing– Best picture

Rated R

for • strong sexual content• disturbing violent images• language and • some drug use

• It’s just a movie…….

• What is real?

• Simply the price of great art…

• Or psychopathology?

“SANITY"

The ability to build a construct of "reality"

with other people, while still retaining the capacity for autonomous perception and

judgment;

balancing our need for private self-experience

against the equally-important need to share experience

with the important people in our lives.

... Alex Lerman  

http://www.dailykos.com/user/Alex%20Lerman

“SANITY"

The ability to build a construct of "reality" with other people, while still retaining the capacity for autonomous perception and judgment; balancing our need for private self-experience against the equally-important need to share experience with the important people in our lives. ... Alex Lerman

 http://www.dailykos.com/user/Alex%20Lerman

Speculation

about specific diagnoses

possibly depicted

in “The Black Swan”

Psychosis

• delusions• hallucinations• disorganized speech• grossly disorganized or catatonic behavior• negative symptoms (reduced emotional expression/speech/ motivation )

Psychosis

may be associated with

Schizophrenia

or many other causes

Eating Disorder?

Anorexia Nervosa 

• Body weight < 85% of normal range • Intense fear of gaining weight • Disturbance in the way in which one's

body weight or shape is experienced • Amenorrhea • “Restricting” or “Binge-Eating/Purging”

Miscellaneous Developmental

• Childhood History of Abuse?  • Ongoing unhealthy parental

relationship? • Incomplete ego development?

Personality Disorder

• cognition • affectivity • interpersonal functioning• impulse control• --in a range of personal/social situations • --significant distress or impairment in • --social/occupational/important areas

Borderline Personality Disorder

• unstable relationships, tending to idealize or devalue

• unstable sense of self• inconsistent, reactive moods• feelings of emptiness

BPD

• an intense fear of abandonment• suicidal or self-mutilating behavior• often intense and sudden anger• self damaging impulsivity• stress related paranoia or

dissociation

Obsessive-Compulsive Personality Disorder

 • Preoccupation with lists, details• Perfectionism interferes with task

completion• Work focus out of balance with

leisure/friendships• Overconscientious/inflexible

OCPD

• Unable to discard objects• Difficulty delegating • Miserly spending style• Rigid, stubborn

Obsessive Compulsive Disorder

• Obsessions:• Intrusive, distressing, recurrent

thoughts, impulses, images--(not simply real life worries)--that a person tries to stop--that are recognized as self

generated

OCD

• or Compulsions:• repetitive behaviors driven to perform• aimed at reducing stress or • unrealistically preventing dreaded event

• Self-recognized as unreasonable• Interfere with life, • are time consuming (>1 hour), or

distressing

Psychodynamic

• Repression of “dark impulses”

• Shadow

May disguise or deny

Black Swan

What is real?

 • Director leaves it unclear

• Clients and therapists may also be unclear

Simply the price of great art?

• What do we expect of performers/artists/athletes?

• Perfectionism?• Dissociation to avoid pain?• Necessity to have ballet body

type?

“SANITY"The ability to build a construct of "reality"

with other peoplewhile still retaining the capacity

for autonomous perception and judgment; balancing our need for private self-experience

against the equally-important need to share experience

with the important people in our lives. ...

Eating Disorder?

Anorexia Nervosa

• Body weight < 85% of normal range • Intense fear of gaining weight • Disturbance in the way in which one's

body weight or shape is experienced • Amenorrhea • “Restricting” or “Binge-Eating/Purging”

Personality Disorder

• inner experience and behavior that deviates markedly (2 or more areas):

• Cognition, affectivity, interpersonal functioning,impulse control

• --range of personal and social situations • --clinically significant

distress/impairment• --social/occupational/other functioning.

Obsessive Compulsive Personality Disorder

• Preoccupation with lists, details• Perfectionism interferes with task

completion• Work focus out of balance with

leisure/friendships• Overconscientious/inflexible • Unable to discard objects• Difficulty delegating • Miserly spending style• Rigid, stubborn

Borderline Personality Disorder

• unstable relationships, idealize or devalue• unstable sense of self• inconsistent, reactive moods• feelings of emptiness • an intense fear of abandonment• suicidal or self-mutilating behavior• often intense and sudden anger• self damaging impulsivity• stress related paranoia or dissociation

Obsessive Compulsive Disorder

• Obsessions: Intrusive, distressing, recurrent thoughts, impulses, images that a person tries to stop,that are recognized as self generated

• or Compulsions: repetitive behaviors driven to perform aimed at reducing stress or

unrealistically preventing dreaded eventSelf recognized as unreasonable; Interfere

with life… time consuming … distressing

Miscellaneous Developmental

• Childhood History of Abuse? • Ongoing unhealthy parental

relationship? • Incomplete ego development?

Psychodynamic

• Repression of “dark impulses”

• Shadow

Essence of the Swan Lake story

Dermatillomania

• CSP (Compulsive Skin Picking or Chronic Skin Picking).

• impulse control disorder

• body dysmorphic disorder

Psychosis

• delusions• hallucinations• disorganized speech• grossly disorganized or catatonic

behavior• negative symptoms (reduced

emotional expression/ speech/motivation)

Schizophrenia?

• Psychosis, plus• Social/occupational dysfunction• 6 months of disturbance, 1 month

of symptoms

Other?

• Electrolyte imbalanceFrom purging?

• Drug InducedEcstasy?