Meghan Foley In the film, The Black Swan the main character, Nina has a mental disorder and it is identified as Dissociative Identity Disorder but she actually suffers with comorbidity–having two or more disorders at the same time–:Eating Disorders, Stress, Anxiety and Paranoid Schizophrenia. The film portrays Nina’s Psychological Disorders through: hallucinations of voices and images, delusions of herself with different characteristics, subconsciously and severely scratching her skin, known as pruritus, lacking emotion and expression, unreasonable thoughts only she believes are true and at times becomes violent. She also experiences symptoms of anxiety and stress, along with the eating disorders, anorexia and bulimia. (Kazdin, 2000)Nina is an ethereal ballerina, she in her early twenties and lives with her protective mother, Erica. Ballet is very demanding because it imposes a lot of stress on dancers to achieve the “look” by being slim and pretty, along with perfecting the “classical style” of ballet. (Wulff, 2008) Nina’s only focus in life is ballet and her goal is to be the “perfect” ballerina; because of this she stresses herself out and pushes her limits. (Chapman, 1984) She lacks facial expressions and it foreshadows the consequences of her detachment from reality. She overworks herself by dancing for hours after practice is over, hardly eats and is shown throwing up frequently to maintain the look. The mix of Nina’s bulimia and anorexia produce health risks like unbalanced emotions, irrationality and heart problems. Along with the health risks, her eating disorders affect her quality of life, reasoning, and are the source of her anxiety and stress. (National Collaborating Centre for Mental Health, 2004)Once Nina is cast as the Swan Queen her mental health progressively deteriorates. She shows symptoms of Paranoid Schizophrenia: lack of emotion, increased stress and anxiety levels, hallucinations and delusions, Pruritus. (Patel, .2010)  (Encyclopedia of Psychology, 2002) The role of the Swan Queen requires two sparring personalities, Nina only has one. She is a very delicate, innocent and composed dancer and has no problem performing the White Swan; her trouble is becoming the polar opposite and dancing as the sexual, relaxed Black Swan. Her PS is illustrated throughout her journey of finding and becoming the Black Swan. Nina has recurring delusions of blood and herself as her polar opposite twin with the characteristics in the Black Swan. She also has hallucinations of unusual voices and her name. The delusions and auditory hallucinations frighten and taunt her; they widen the gap between her sense of reality and state of detachment. From them, she is reminded of her struggle to drop her innocence and make her believe everyone (Erica, Lily and Beth) is out to get her. (Schiffman, Abrahamson, Cannon, 2001) A rare symptom of Schizophrenia Nina experiences is Pruritus; while sleeping she scratches a particular spot on her back and in her dreams imagines wings sprouting from that area. The scratching reveals her subconscious determination and anxiety of fully becoming the Swan, while the wings represent her accomplishment. (Strickland, Rostron, Haddad, 2002)This film is placed in the Dissociative Identity Disorder category, but in reality should be in the Schizophrenia category. Nina has Paranoid Schizophrenia because she experiences the main symptoms of it, accompanied with anxiety, stress and eating disorders which last for months. The root of Nina’s PS comes from her inability but determination to perfect both the White and Black personalities, her eating disorders and anxiety intensify it because of her fear of failure. She does not have DID because in summary of the definition given by the Glossary of Psychological Terms is having multiple, distinct personalities. (2002)Schizophrenia is a disorder that usually begins to affect people between the ages sixteen and thirty, more common to men. There are a number of things that correlate to how a person can get it: genes, environment, brain structure and chemistry. Some examples of things in the genes and environmental categories that would put you at a higher risk of being affected by schizophrenia would be: a family member you share genes with has/had schizophrenia, you had lots of viruses growing up, your mother had problems in the womb with you, you experience lots of stress or have depression. Now here are the risks in the the brain structure and chemistry categories that would put you at a higher risk of being affected by schizophrenia: dopamine and glutamate chemical reactions in your brain, pre- developed brain, or even if psychotic hormones were triggered during puberty. (The National Institute of Mental Health, 2015) There are a lot of factors that could put one at risk of having schizophrenia but only about point three percent of adults are affected by it. (2015)  It is possible that other factors could have been involved in the cause of Nina’s Schizophrenia but the only supported one is that she is under an immense amount of stress and had been for a very long time. My hypothesis is that her mother had problems with her during pregnancy and when Nina went through puberty her psychotic hormones were triggered because she didn’t have a dad around to raise her and most of the time was surrounded by women: her over protective mom and other catty ballerinas. I also think that Nina’s eating disorders played a big role in her hallucinations because she had no energy in her body to fuel her brain and it caused her to mentally break down. Nina is given no treatment for her disorders. She tries her best to keep them a secret but her mom knows of her eating disorders and Pruritus. Erica doesn’t do much to stop Nina’s eating disorders but she does try to stop her scratching. Erica notices Nina’s scratched back because she knew she had done it before. When her mom sees it she freaks out, she cuts Nina’s nails and at one point in the movie she put socks on her hands in the middle of the night to try to stop her from doing it. Nina’s mom is very concerned with Nina’s wellbeing and tries to protect her by suffocating her with attention. She wakes Nina up in the morning, cooks for her and at times watches her sleep as if she were a baby. Erica’s attempts to help her daughter result in Nina’s rebellion and and at times violence. Nina’s delusional and irrational thinking comes into par because she thinks her mother’s protection and attention is out of spite and that she is out to get her. Although it seems like Erica is very attentive and helps Nina, she isn’t because she is and has been aware of some of her severe symptoms for a long time and doesn’t contact doctors for help. Nina’s rare disorder needs a lot of treatment and care and she gets none. First, she needs to stay away from ballet because obviously it has fueled a lot of her disorders. Then she needs to be checked into a Psychiatric Institute and get evaluated and diagnosed with Paranoid Schizophrenia, Bulimia and Anorexia, and Anxiety; they will also educate Erica about her diseases. Nina needs to learn about her problems and face them. The most effective therapy for Nina is Psychotherapy and Biomedical Therapy focused on the Cognitive Theory. Psychotherapy with a trained therapist would work very well for Nina because she doesn’t really have anyone in her life she can fully confide in and needs someone to talk to about the underlying factors of her problems. (2015) Along with Psychotherapy, Biomedical Therapy would be useful. By correctly prescribing and medicating Nina, she would have a better grip on reality and that will allow her to rationalize thoughts, actions and her hallucinations. The therapist would use the most efficient approach of counseling by using Cognitive Theory and meet with Nina at least twice a week. This approach will allow the therapist to explain the ways Nina perceives things and why she experiences her symptoms. She will work with Nina to change her perceptions of: herself, the motifs of her actions, people, the environment she lives in and ballet. Nina will be able to understand why she has been having delusions and hallucinations and potentially will be able to remove the triggers and stop having them completely. (Brown, 2017) The Black Swan did a decent job of portraying the realities of individuals with Paranoid Schizophrenia, Eating Disorders and Anxiety. Their portrayal of anxiety, anorexia and bulimia was very accurate because Nina was extremely thin and never ate and claimed her stomach hurt when she was offered food, in fear she would gain weight and lose her “ideal” figure. A lot of ballerinas and dancers have eating disorders because of the pressure they feel to be “perfect” and suffer with anorexia or bulimia. So by making the film about ballet and showing the tragic consequences one could face, they raised a lot of awareness to the health risks of eating disorders. (2008)  The Eating Disorders and Anxiety was the perfectly portrayed because it factored into some of the indications of PS. The portrayal of Paranoid Schizophrenia was also very accurate. The main symptoms were included: auditory hallucinations, delusions, lack of emotion and irrational thoughts, they even included less common symptoms like Pruritus and violence. The execution of rendering the symptoms allowed the viewer to feel a lot of the mixed emotions Nina felt: curiosity and fear, determination but discouragement and accomplishment alongside failure. (2000) Society views Nina’s Paranoid Schizophrenia throughout her struggle in finding herself as the Black Swan as a very sad story and they feel a lot of sympathy towards disorders and makes them want to help. A problem in The Black Swan was that no psychologists or psychiatrists made any appearances and at the end of the movie, the audience is left hanging as to what would happen next with Nina. The portrayal of Psychological Disorders was good but by not following through with getting Nina help or at least showing her with a doctor, makes the film seem as if it wasn’t fully thought through and as if the goal wasn’t to raise awareness for disorders. Work CitedKazdin, A. E. (2000). Encyclopedia of psychology. Washington, D.C: American Psychological Association.The National Institute of Mental Health. (2015). Schizophrenia. Retrieved January 21, 2018, from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtmlJackson, T. (2013). Social Neuroscience, the Imitative Animal, and Aronofsky’s Black Swan. Style, 47(4), 445-465. Retrieved from http://www.jstor.org/stable/10.5325/style.47.4.445Schiffman, J., Abrahamson, A., Cannon, T., LaBrie, J., Parnas, J., Schulsinger, F., & Mednick, S. (2001). Early Rearing Factors in Schizophrenia. International Journal of Mental Health, 30(1), 3-16. Retrieved from http://www.jstor.org/stable/41344959Chapman, J. (1984). XXX and the Changing Ballet Aesthetic; 1828-32. Dance Research: The Journal of the Society for Dance Research, 2(1), 35-47. Retrieved from http://www.jstor.org/stable/1290778Brown, A. (2017). Mental Disorders Powerpoint. Retrieved January 21, 2018.Wulff, H. (2008). Ethereal expression: Paradoxes of ballet as a global physical culture. Ethnography, 9(4), 518-535. Retrieved from http://www.jstor.org/stable/24047913Glossary of Psychological Terms. (2002). Retrieved January 21, 2018, from http://www.apa.org/research/action/glossary.aspxRecognizing the signs of schizophrenia. (2002). Retrieved January 21, 2018, from http://www.apa.org/helpcenter/recognizing-schizophrenia.aspxPatel, T.. (2010, July). Therapy of Pruritus. Retrieved January 21, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885583/Strickland, P., Rostron, E., & Haddad, P. (2002). Assessing and Managing Compulsive Scratching in Schizophrenia with Chronic Renal Failure. The Canadian Journal of Psychiatry, 47(5), 484-485. doi:10.1177/070674370204700515National Collaborating Centre for Mental Health. (2004). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. Retrieved January 21, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK49318/The National Institute of Mental Health. (2015). Schizophrenia. Retrieved January 21, 2018, from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

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