Background
“Black Swan” is about Nina Sayers, an aspiring ballerina, who had to deal with the pressure of her career, discordant relationship with her mother, and sexual advances from her mentor. Nina wants nothing more than to play lead in the New York City ballet company’s upcoming “Swan Lake” production. Her chance came when Thomas Leroy, the director, dismissed Beth, the lead, and subsequently chose Nina to take her place. Throughout the film, Nina’s psychoses surface on account of her experiences with his sexually aggressive mentor, Thomas, who also puts the most pressure on Nina to perform better, her career, and her narcissistic mother who creates tension between them at home. Manifestations of psychoses in the film, specifically in Nina’s character will be discussed in detail below following the DSM IV Multiaxial Classification System.
Psychoses in Black Swan
The DSM-IV Multiaxial system classifies mental disorders through components and guidelines of five axes or dimensions. In Axis I, assessment focuses on the identification of a principal disorder in an individual that requires urgent clinical attention. In Axis II, assessment focuses on the identification of personality disorders in an individual, specifically those that affect or influence the individual’s response to the principal disorder. Axis III focuses on the identification of medical disorders that affect or are relevant to the individual’s mental disorder. In Axis IV, assessment focuses on identification of external psychosocial stressors that affect the individual’s state or condition. Axis V sets a classification of the individual’s level of functioning at the time of assessment. To identify the code that describes the individual’s level of functioning, practitioners utilize the Global Assessment of Functioning (GAF) Scale. The GAF Scale has ten codes from 1 to 100 and each code describes an individual’s level or type of functioning. The codes in the GAF scale will be discussed further in the assessment.
Axis I
Many psychoses emerge in the story but the most prominent one that describes Nina’s behavior and state of mind is Delusional Disorder. Towards the second half of the film, Nina experiences a series of delusional episodes which first manifests when she goes out with Lily, a dancer in the same ballet company who Thomas praises because of her characteristics that would make her a suitable black swan as opposed to Nina. Nina and Lily go to a restaurant and later on a club where Lily slips ecstasy in Nina’s drink. Later that night, Nina goes home where her mother Erica confronts her about going home late. Nina and Erica fight and she storms to her room. The next scene is of Nina and Lily’s sexual encounter in bed. In the morning, when Nina confronts Lily about what happened last night, Lily told Nina that she went home with another man. At this point, we learn that Nina perhaps dreamed what happened or the episode could be a substance-induced psychotic disorder. Nevertheless, later on we discover that even without taking drugs, Nina suffers a series of hallucinations. Nina’s hallucinations include her finding Thomas and Lily in a compromising position and watching Beth hurt herself with a nail file at the hospital. During the actual production of Black Swan, Nina delivers a satisfying performance until she experiences another hallucination, which led to her partner, The Prince, to drop her. Nina goes back to her dressing room where she has delusions of Lily telling her that she will play black swan. Consequently, Nina confronts Lily and out of anger, she shatters the mirror in the dressing room, takes a shard, stabs Lily with it, and hides her body in the dressing room. During the second act where Nina plays the Black Swan, she hallucinates as she transforms to a black swan as she grows bristles and black wings.
If we are to look beyond the manifestation of Delusional Disorder, we can observe other psychological disorders based on Nina’s distinct behavior. In one scene, Nina runs to the bathroom and heaves or vomits after a meal. Moreover, Nina controls what she east as she refused to eat food offered to her. These specific behaviors are characteristic of an individual suffering from Anorexia Nervosa. Nina also suffers from anxiety disorder, specifically Obsessive-Compulsive Behavior, based on her repetitive behavior such as methodical and excessive hand washing, and the duteous way that she prepares in the dressing room. Nina also exhibits self-harm with her frequent habit of scratching and cutting. Towards the end, after Nina’s hallucination in the dressing room, she unknowingly stabbed herself with a shard after she broke the glass. Nina continued the second part of her performance as the black swan. It was only when she fell that she and other people on stage realized that Nina was bleeding.
Axis II
Nina’s behavior falls under Cluster C, specifically Obsessive-Compulsive Personality Disorder, which inhibits individuals from being spontaneous and flexible because people that suffer from this disorder aim for perfection, order, and control. In the film, Nina exhibits these behaviors and it especially shows because her behavior contrasts with Lily’s who is more spontaneous, and thus, can assume the part of the black swan. As noted earlier, Nina exhibits obsessive-compulsive behavior because she aims for perfection in general, she is very uptight, and she does repetitive things that stem from her anxiety, such as her constant hand washing and thorough preparation in the dressing room before each performance. Since this is in Axis II, it means that Nina’s obsessive-compulsive behavior affects her response to the identified principal disorder, and consequently, Nina’s response to treatment in terms of her openness to it and acceptance of her flaws.
Axis III
Axis III focuses on an individual’s medical conditions that relate to his or her psychological disorder. In the case of Nina, the film does not show any indication that she could be suffering from a medical condition. Nevertheless, we may consider the physical strain of Nina’s constant training as a factor that may have exacerbated her anxiety and psychosis.
Axis IV
As previously noted, Nina’s mother Erica depicts narcissistic behavior as shown by her self-portraits at home and her hostile behavior towards Nina. Erica appears to be an overbearing mother who pressures her daughter to succeed as a ballerina because she was once a ballerina too. Nina and Erica’s interactions also hint at the latter’s vindictiveness, such that Erica blames Nina of why she had to end her career in ballet to take care of Nina as a child. Moreover, their interactions also hint at the probable emotional abuses that Nina might have suffered as a child, which influenced the way she sees herself. Hence, as an adult, Nina becomes anxious about her career and her relationship with Erica and these manifest in her behavior.
Aside from Nina’s relationship with Erica, other external psychosocial stressors include Thomas’ aggressive nature and impatience. Thomas is sexually aggressive and it is quite palpable that Nina does not feel the same way about him but since Thomas is her director, she cannot fully express her feelings. Nina also sees Lily as a threat to her career. She feels that she can be easily replaced by Lily so she feels threated by her. At the same time, however, Nina also admires Lily because she characterizes the black swan easily, as evidenced by her hallucinations after going out with Lily. As the performance draws near, the pressure that Nina feels about the upcoming event also manifests in the frequency of her hallucinations. We can also stress that the competitive nature of ballet is a stressor that affect Nina’s behavior. Nina was in a precarious situation and she realizes this when she witnesses Thomas and Beth’s confrontation, which led to the latter being booted from the company. Leads or principal ballerinas are replaceable and an individual such as her would then feel anxious being chosen as the lead as she can be easily replaced.
Axis V
Based on the GAF scale codes, we may categorize Nina’s behavior under 21 to 30. Under this code, the individual exhibits behavior that is “considerable influenced by delusions or hallucinations”. Since imagining a sexual encounter with Lily, Nina has several hallucinatory episodes, most of which affect her behavior or mood. Seeing Beth may have aggravated her anxiety on account of feeling that Thomas could easily replace her with Lily just as he replaced Beth with her. Furthermore, seeing Beth may have intensified Nina’s fear of failure, which consequently intensified the pressure and her anxiety. It is also important to note that Nina’s hallucinations take over and affect the way she responds to situations. In the dressing room, Nina thinks that Lily told her she will play black swan. Nina’s hallucination led her to smash the mirror and hurt herself in the process. In this scene, Nina’s behavior falls to 11 to 20 in the GAF scale, which describes one behavior as “some danger of hurting self or others”.
Recommendations and Treatment
Psychotherapy would help Nina deal with her delusions. These delusions are manifestations of issues that Nina is yet to identify, acknowledge, and deal with. Hence, this would require trust between Nina and a therapist for her to open about her issues and to acknowledge them. This is important so Nina can identify reality from her delusions, and consequently avoid self-harm. Nina also suffers from other disorders, including Anorexia Nervosa and Obsessive-Compulsive Disorder. Cognitive-behavioral Therapy (CBT) will help Nina deal with her anxiety disorder. Through CBT, Nina can identify her obsession and compulsions through repetitive exposure. To deal with her eating disorder, Nina would have to undergo counselling. Through counselling, Nina can learn about the health hazards of anorexia and undergo nutritional counseling to help her maintain a proper diet. Medication is not recommended for Nina due to her delusions. It would help Nina if she refrained from taking medicines as common drugs for this psychosis is not generally effective. Hence, for Nina’s treatment, she should consult a psychotherapist, a psychologist that specializes in CBT, and a nutritionist.
References
Aronofsky, D. (Director). 2010. Black Swan [Motion Picture]. United States: Fox Searchlight Pictures.
