Nina Sayers’s Mental Disorders in the Black Swan Movie

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Table of Contents

Synopsis
Diagnostics
References

Synopsis

The film is the author’s interpretation of Swan Lake – the world-famous ballet staged in 1877. The Lincoln Center Ballet Company in New York is planning a new production of Swan Lake. Prima ballerina Beth McIntyre is forced to leave the stage because of her venerable age for a ballerina. French choreographer Thomas Leroy chooses Nina for the role of the swan performer. She is a dancer of a ballet troupe, diligent, and stubborn, but until the beginning of the story, she did not receive significant roles. Further, she is modest, quiet, vulnerable, and lives with her mother (Aronofsky, 2010).

Diagnostics

Symptoms

Soon after getting the role, Nina begins to suffer from strange, ominous hallucinations: the pictures of her mother come to life, the reflections in the mirror behave strangely, and she mystically develops rashes and injuries. Tomas cannot come to terms with Nina’s constraint and increasingly criticizes her in front of everyone. Lily, the new ballerina of the theater, who Nina considers a rival, interferes in their relationship. One evening, after rehearsals, Lily catches a crying Nina in the hall. Nina shares her feelings with her. The next morning, Tom has a skirmish with Nina, which makes it clear that Lily told him about her conversation with Nina last night. Nina and Lily are fighting. Deciding to make amends, Lily invites Nina to a nightclub, where she gives her ecstasy, which makes Nina’s visions intensify.

In the morning, Nina wakes up and realizes that she overslept the rehearsal. She runs to this rehearsal; in the hall, she hears the music from her role and sees Lily rehearsing the part of the black swan. Nina is increasingly worried about the fear that Lily may take away her role and Tom. Nina rehearses the whole evening before the premiere of the ballet. She is tormented by hallucinations. In the last act, Nina dances the role of a white swan. Then, when she enters her dressing room, she sees Lily in the form of a black swan, the girls argue, and Nina kills Lily. Then she transforms into a black swan, performs her part beautifully, and kisses Tom. After the dance, Lily enters her dressing room, and Nina realizes that the murder scene was again a hallucination, and in fact, she wounded herself in the stomach.

Another part of the plot is Nina’s overcoming of internal self-control; she strives to be perfect in everything, to do everything perfectly, but literally from the first frames, everyone tells her that she needs to let herself go, she needs less control, more freedom in dance, in life. Gradually, Nina begins to let go of herself: she allows the development of relations with Tom and goes with Lily to a nightclub. The main problem with this position is that although it enables Nina to discover something new in herself, no one bothered to explain to her the limits of self-control. Taking ecstasy, she lets out all her “demons,” finally losing touch with reality. Analyzing the subsequent events of the film, it is already difficult to separate fantasy from reality. The last step to madness is probably Tom’s words: “The only person who gets in your way is yourself. It’s time to get rid of her; let yourself go.” It is after these words that Nina “kills” Lily, in whom she sees her own image.

Disorders

It seems reasonable to assume that during the movie, Nina suffers from delusional disorder and schizophrenia. However, it should be emphasized that the mentioned disorders have a number of common features, and Nina goes from delusional disorder to schizophrenia. The crucial characteristic of delusional disorder is the occurrence of one or more delusions that are taking place for at least one month. Then, this diagnosis could not be given if Nina has ever had symptoms that align with the ones of Criterion A for schizophrenia (APA, 2013).

Finally, according to APA (2013), “Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd” (p. 92).

It is evident from the movie that Nina has a delusion that she is being followed and conspired against by Lily, who wishes to take her leading role; her actions are not bizarre or odd. Hence, Nina suffers from a delusional disorder of persecutory type (APA, 2013). The given diagnosis should be distinguished from obsessive-compulsive disorder – during the latter, Nina would have recognized that her false ideas are irrational and are products of her own mind (APA, 2013). Meanwhile, these ideas are firm, and Nina considers them true even though there is evidence that they are not.

Approximately by the middle of the film, Nina starts suffering from schizophrenia. The following essential criteria are met: delusions and hallucinations (Criterion A); the level of functioning in interpersonal relations and self-care is below than before this onset (Criterion B) (APA, 2013). Then, anxiety is inherent to Nina, which is an associated feature supporting diagnosis. However, this diagnosis should be differentiated from obsessive-compulsive disorder and body dysmorphic disorder. According to APA (2013), “these disorders are distinguished from schizophrenia by their prominent obsessions, compulsions, preoccupations with appearance or body odor, hoarding, or body-focused repetitive behaviors” (p. 104). Nina does not demonstrate the mentioned features; thus, schizophrenia seems to be an appropriate diagnosis here.

Etiology

Each storyline leads to an inevitable ending – Nina’s madness. The transition from the authorities of Mother-Beth to the ones of Thomas-Lily, loss of control, and internal contradictions. The main antagonism, which at first glance lies in the confrontation between Nina and Lily, probably also has internal roots, and Odile is, in fact, Nina’s inner essence. It is the fact that Odile and Odette are in one person that causes internal conflict because they both strive to possess the same.

Internal contradictions are also caused by the character of Thomas, who, in this case, took on the role of a prince. He demands that Nina reunite with her inner self, with her femininity. His role in this antagonism is that he is able to love only a black swan. It is after the transformation of Nina that he calls her “my princess,” as Beth used to call her. Based on the madness of Nina and Beth, we can say that it is he who is the main catalyst for the internal trauma and contradictions of both women, which makes them wonderful ballerinas, but internally flawed personalities.

Ethical/Legal Considerations

The primary ethical issue that might occur is related to Nina’s personality – in particular, her essential features such as timidity, innocence, and shyness. These characteristics will impact the dialogue with the patient when the episodes of hallucinations with sexual content are discussed. In this regard, the figure of Thomas should be mentioned – it seems that in some cases, he indeed caused the situation of sexual harassment. The extent to which Nina was affected by the latter from the psychological perspective will determine the necessity of taking some legal measures or even punishment to Thomas.

Cultural Considerations

I, as a physician, and Nina share the same cultural background, as well as no language barriers are likely to take place. However, I should take into account her social environment during our conversations – she is not involved in a considerable number of societal relations and is substantially influenced by the mother’s opinion and understanding of life. Our main stimulus will be to obtain the idea that Nina should not be over-focused on the work in theatre and has to diversify her living to an appropriate degree. This degree will be the central aspect to identify during the meetings.

Critical Review

The movie contains a specific number of Nina’s symptoms so that her disorders – the delusional one and schizophrenia – can be diagnosed. Moreover, a transition from one disease to another is smooth and can be identified without any substantial difficulties. However, in this vein, an exact extent of ambiguity might take place for a viewer without the necessary background. This ambiguity may occur due to a plethora of similar symptoms of delusional disorder and schizophrenia.

Reflection

Natalie Portman’s acting skills allow studying the visual and disguised features of the mentioned identified disorders significantly. Given the theoretical foundation provided by DSM-5, I learned how to determine delusional disorder and schizophrenia in a patient. What is more, I obtained the required knowledge for treating patients with these disorders, as well as for holding professional conversations with them. The reviewed film and Nina’s case greatly enriched my experience of dealing with complex and – at times – similar diseases.

References

APA. (2013). Diagnostic and statistical manual of mental disorders (5^th ed.). American Psychiatric Publishing.

Aronofsky, D. (2010). Black Swan [Film]. Cross Creek Pictures.

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