The Black Swan
Chris Clark, Cinema St. Louis
Steve
Franklin, MSW LCSW
Michael Uthoff, Dance St. Louis
(Will
upload my PowerPoint)
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Natalie
Portman asNina Sayer
2011 Best Actress Oscar
Vincent
Cassel as Thomas Leroy
2009 Golden Globe best European actor
Mila
Kunis Lily
Born in Ukraine
SAG and Golden Globe supporting actress
nominee for Black Swan
Barbara
Hershey Erica Sayers
Oscar Nominee 1997 for Portrait of a
Lady
Winona
Ryder Beth Macintyre
Oscar Nominee in 1994 (Little Women)
and 1995 (The Age of Innocence)
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Darren
Aronofsky
Oscar, best director nominee
(The Wrestler (AFI Film Award,
Independent Spirit Award-Best Feature, Pi)
Other oscar nominations:
cinematography, editing, best picture
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Rated
R for strong sexual content, disturbing violent images, language and some drug
use
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This
is just a movie. What is real?
And, it’s a story in which we don’t know all
of the background.
In
this way, it is like being a therapist.
We
only know the story as well as the client reports it, according to their own
perception.
If
you feel confused by some story developments, imagine how the individual
involved may also be confused.
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Simply
the price of great art, or psychopathology?
It
is interesting to observe in this movie how great art may require a lot of hard
work and sacrifice. But is that
sufficient to explain the events that unfold.
Can a person go too far, even in the name of art?
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"Sanity”–
the ability to build a construct of "reality" with other people,
while still retaining the capacity for autonomous perception and judgment;
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balancing
our need for private self-experience against the equally-important need to
share experience with the important people in our lives. http://www.dailykos.com/user/Alex%20Lerman
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Speculation about specific diagnoses possibly depicted in “Black Swan”
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Schizophrenia
negative
symptoms (reduced emotional expression, speech or motivation
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Psychosis may be associated with
Schizophrenia,
or many other causes
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A. Refusal to maintain
body weight at or above a minimally normal weight for age and height (e.g.,
weight loss leading to maintenance of body weight less than 85% of that
expected; or failure to make expected weight gain during period of growth,
leading to body weight less than 85% of that expected).
B. Intense fear of gaining
weight or becoming fat, even though underweight.
C. Disturbance in the way in which
one's body weight or shape is experienced, undue influence of body weight or
shape on self-evaluation, or denial of the seriousness of the current low
body weight.
D. In postmenarcheal females, amenorrhea,
i.e., the absence of at least three consecutive menstrual cycles. (A woman
is considered to have amenorrhea if her periods occur only following hormone,
e.g., estrogen, administration.)
Specify
type:
Restricting Type: during the current episode of
Anorexia Nervosa, the person has not regularly engaged in binge-eating or
purging behavior (i.e., self-induced vomiting or the misuse of laxatives,
diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia
Nervosa, the person has regularly engaged in binge-eating or purging behavior
(i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
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Childhood History of
Abuse?
Symptoms could include flashbacks, self injury, sexual role confusion
or sexual repression, sexualized behavior, emotional reactivity, boundary
issues
Ongoing unhealthy
parental relationship?
Or just close, or protective?
Incomplete ego
development?
Undeveloped sense of self, poor ego strength, codependency
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Personality
Disorder?
An
enduring pattern of inner experience and behavior
that
deviates markedly from the expectations of the individual’s culture .
This
pattern manifested in two or more of the following areas:
cognition
(i.e., ways of perceiving and interpreting self, other people, and events;
affectivity
(range, intensity, lability and appropriateness of emotional response);
interpersonal
functioning
impulse
control
B.The enduring pattern is inflexible
and pervasive across a broad range of personal and social situations
C.The
enduring pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D
The pattern is stable and long duration and its onset can be traced back at
least to in adolescence or early adulthood.
E
cannot be explained as a manifestation or consequence of other adult mental
disorder.)
F..not due to …substance….
General medical condition
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(Borderline)
Personality Disorder x5 of items listed
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stress
related paranoia or dissociation
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OCPD? 4x of listed items
Preoccupation with lists, details
Perfectionism interferes with task completion
Work focus out of balance with leisure/friendships
Overconscientious/inflexible
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Unable to discard objects (e.g. hoarder)
Difficulty delegating
Miserly spending style
Rigid, stubborn
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OCD
Obsessions:
Intrusive, distressing, recurrent thoughts, impulses, images
(not simply real life worries)
that a person tries to stop
that are recognized as self generated
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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 distress
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Psychodynamic
Repression
of “dark impulses”
Movement
out of consciousness of thoughts, memories, feelings that are too painful or
repulsive to face.
They
may be expressed through projection (seeing in other people)
Psychogenic
illnesses
Anxiety
Depression
Shadow
Jungian
concept of a hidden part of self,
not
necessarily negative but feared because it is unknown.
It
might be thought of as an undeveloped
part of self
that
contributes to chaos if it is left undeveloped and unrecognized.
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(Film
showing)
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What is real?
Director leaves it unclear
Clients
and therapists may also be unclear
Not
clear to me whether Nina died
Not
clear whether Lily was trying to undermine her.
As
a therapist, this is the reality of dealing with our clients.
We
know that there may be different perspectives from other people
that
help provide a clearer picture.
This
can be an advantage to family therapy.
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Simply the price of great art?
What do we expect of performers/artists/athletes?
Perfectionism?
The
character of Lily seems to me to be offered in evidence of the idea that perhaps
it is possible to succeed without imbalance.
She was new to the company, but a few minutes away from taking on the
Swan Queen role.
Dissociation to avoid pain of stretching the body
beyond normal limits.
(The
massage therapy scene was of an actual treatment Natalie Portman was receiving
during her work in the role.)
Necessity
to maintain ballet body type
Is anorexia a disorder or a
condition of employment?
What
price to pay for art?
(Does Nina ever dance with pleasure,
joy?
Is
there pathology or mental illness, or just some sort of artistic temperament
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“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
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Anorexia Nervosa
Body weight less than 85% of normal range
Intense fear of gaining weight
Disturbance in the way in which
one's body weight or shape is experienced,
amenorrhea, i.e., the absence of at least three consecutive menstrual
cycles
(Report
that Portman was uncomfortable with placement of to blood in the closing scene,
but seemed to be convinced it was legitimate because it related to
menarche. Is it possible that she was
experiencing a first, or irregular, menarche, that was repressed because of he
discomfort with an adult body?)
Restricting Type: Binge-Eating/Purging Type
.
One recent study found that high-level ballet training is associated
with
"late
onset of menarche, menstrual disorders, lower weight and height development,
and abnormal feeding disorders."
…
another
study found that it's not just the pressure to be thin per se that makes
ballerinas susceptible, it's the interaction between that pressure and their
personalities,
which
tend toward perfectionism and
neuroticism—
hallmarks of anorexia.
A. Refusal to maintain body weight
at or above a minimally normal weight for age and height (e.g., weight loss
leading to maintenance of body weight less than 85% of that expected; or
failure to make expected weight gain during period of growth, leading to body
weight less than 85% of that expected).
B. Intense fear of gaining weight
or becoming fat, even though underweight.
C. Disturbance in the way in which
one's body weight or shape is experienced, undue influence of body weight or
shape on self-evaluation, or denial of the seriousness of the current low body
weight.
D. In postmenarcheal females,
amenorrhea, i.e., the absence of at least three consecutive menstrual cycles.
(A woman is considered to have amenorrhea if her periods occur only following
hormone, e.g., estrogen, administration.)
Specify
type:
Restricting Type: during the
current episode of Anorexia Nervosa, the person has not regularly engaged in
binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of
laxatives, diuretics, or enemas)
Binge-Eating/Purging Type: during the current episode of Anorexia
Nervosa, the person has regularly engaged in binge-eating or purging behavior
(i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
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Personality
Disorder?
An
enduring pattern of inner experience and behavior
that
deviates markedly from the expectations of the individual’s culture .
This
pattern manifested in two or more of the following areas:
1.
cognition
(i.e., ways of perceiving and interpreting self, other people, and events;
2.
affectivity
(range, intensity, lability and appropriateness of emotional response);
3.
interpersonal
functioning
4.
impulse
control
B.The enduring pattern is inflexible
and pervasive across a broad range of personal and social situations
C.The
enduring pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D
The pattern is stable and long duration and its onset can be traced back at
least to in adolescence or early adulthood.
E
cannot be explained as a manifestation or consequence of other adult mental
disorder.)
F..not
due to …substance…. General medical condition
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Obsessive-Compulsive Personality Disorder 4 items
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???
“I
just want to be perfect”;
In the end, despite her death (??) she seems quite
satisfied, because she was perfect.
“Perfection is not just about control; surprise the
audience, transcendence.””
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Borderline
Personality Disorder 5 items
splitting
The
notion of splitting and duality pervades the entire film:
white
swan/black swan,
good
Lily/bad Lily,
and
pristinely perfect but frigid Nina who is threatened
by
the emergence of her dark, sexual and murderous shadow self.
identity
confusion; sexuality, seeing projections of self
self-abuse in
the form of consistently scratching and picking at skin, creating wounds and
drawing blood
angry
outbursts—mom Lily
stress related paranoia or dissociation -----
reactions to Lily
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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
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
In fact,
Portman, who studied psychology at Harvard, has said that she played
the character as OCD
PORTMAN: This was actually a case
where something I learned in school did translate into something practical in
life, which is very, very rare. It was absolutely a case of obsessive compulsive
behavior. The scratching and the anorexia and bulemia are forms of OCD. Ballet
really lends itself to that because there’s such a sense of ritual, with
wrapping the shoes every day and preparing new shoes for every performance.
It’s such a process.
compulsive skin picking is an actual
impulse control disorder known to the medical profession as Dermatillomania,
and may also be referred to as DMT or derm, Neurotic Excoriation, or CSP
(Compulsive Skin Picking or Chronic Skin Picking). Dermatillomania (also known as compulsive
skin picking or CSP) is an impulse control disorder characterized by the
repeated urge to pick at one's own skin,
often to the extent that damage is caused. Dermatillomania can be a compulsion
of body dysmorphic disorder (BDD).
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Mom undresses her (she allows it)
Mom, when celebratory cake (“It’s
our favorite.”) is “rejected”: “Then it’s garbage.
“Touching self: mom in room? Not enough space for individuation
..(the career) I gave up to have you…
“What happened to my sweet
girl? She’s gone.”
Were
there prodromes, early indications of psychosis/schizophrenia which the
dependency on Mom protected /obscured?
Throws stuffed animals in trash;
breaks music box
Insufficient ego strength?
Nina
has clearly disowned an important part of her emotional experience, undoubtedly
because her false and brittle mother couldn’t tolerate its expression.
In psychology speak we call this enmeshment:
a relationship characterized by unboundaried bonding, in which the parent uses
the child to meet her own needs versus supporting the child in developing into
her own, separate self.
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Stealing
from Beth
Re
Beth, after “accident” :..on purpose?
everything came from within,dark impulse, what makes her thrilling to
watch, dangerous, even perfect, but also so damn destructive
Walking
home, seems to encounter image of self walking towards her… but then it seems
to be someone else. Homoerotic, or
encountering image of self? Repression?
Attention drawn to Lily, on train,
entering room while she auditions
Nina
can survive as a "white swan", i.e. as a trembling and naïve child.
But when the passage to adulthood demands that she face her own envy,
rage, and sexuality – the fabric of her mind and personality disintegrates.
“You
could be brilliant, but you are a coward.”
Her
failure to integrate her sexuality into her ego – her conscious awareness of
herself – leads to Nina’s unconscious externalisation of her sexuality and the
formation of a complex and pivotal relationship with one of her peers, Lily
(Mila Kunis).
Lily
seems to represent integration: Lily
When confronted about “meddling”, Lily seems
un-defensive, sure of herself”
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Schizophrenia
(2 of..)
negative
symptoms (reduced emotional expression, speech or motivation) No?
B. Social/occupational dysfunction: For a significant portion
of the time since the onset of the disturbance, one or more major areas of
functioning such as work, interpersonal relations, or self-care are markedly
below the level achieved prior to the onset
6
months of disturbance, one month of symptoms
Continues
to work..
Lamberti also suggests that the repeated vomiting
and weight loss in the days leading up to her final performance may have caused
an electrolyte disturbance that could have contributed to the psychosis.
Psychosis may appear in
Schizophrenia, schizophreniform disorder, schizoaffective disorder,
depression
or bipolar, brief psychotic
disorder, delusional disorder,
schizotypal, OCD certain
personality disorders, including borderline,
secondary
psychosis in medical conditions such as delirium, alzheimers, stroke, brain
tumors, malaria, syphillus, thyroid problems, electrolyte disturbances, sleep
disorders, during use of drugs or withdrawal
Ecstasy releases
serotonin in the brain, a chemical that stimulates the brain's pleasure
centers. Those with excess levels of
serotonin sometimes feel agitated or restless.
Some people with
elevated levels of serotonin experience confusion or hallucinations.
High levels of serotonin can produce
hypomania,
Psychological stress is also known to contribute to and trigger psychotic
states. Both a history of traumatic incidents experienced throughout the
life-span, and the recent experience of a stressful event, is thought to
contribute to the development of psychosis. Short-lived psychosis triggered by
stress is known as brief reactive psychosis.
Sleep deprivation has been linked to psychosis, although there
is little evidence to suggest that it is a major risk factor in the majority of
people. Some people experience hypnagogic or
hypnopompic hallucinations, where unusual sensory experiences or thoughts
appear during waking or drifting off to sleep. These are normal sleep
phenomena, however, and are not considered signs of psychosis
“first-break” psychosis,
or “first episode psychosis.
“Roll”..
term for ecstasy “These effects usually begin about 20 to 40 minutes after
taking ecstasy, and peak at about 60 to 90 minutes. They subside in 3 to 6
hours.”
That is why users feel content and experience the other effects you
mention above. But it's also why after a night of rolling, people often feel
really terrible: their bodies are depleted of their normal supply of serotonin.
Over time, this effect may become permanent. This is of particular concern for
those who are already coping with a mental health issue. The drug also releases
dopamine, a chemical that helps to suppress pain, which might explain why
you describe feeling numb.
In
bath (is this hallucination, or a dream from sleep/deep rest?) hypnogogic
[If
hospitalized, would psychiatrist put her immediately on antipsychotics, or wait
to see how it develops. There are those
who believe that more people should be treatable without medication and in
supportive settings –an asylum—rather than develop drug dependencies]