Black Swan

1. Black Swan • Chris Clark, Cinema St. Louis • Steve Franklin, MSW, LCSW • Michael Uthoff, Dance St. Louis SteveFranklinMSW@JUNO.com

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

3. Directed by Darren Aronofsky • Other Oscar nominations: • Cinematography • Editing • Best picture

4. Rated R for • strong sexual content • disturbing violent images • language and • some drug use

5. It’s just a movie……. • What is real?

6. Simply the price of great art… • Or psychopathology?

7. “SANITY" The ability to build a construct of "reality" with other people, while still retaining the capacity for autonomous perception and judgment;

8. 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

9. “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

10. Speculation about specific diagnoses possibly depicted in “The Black Swan”

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

12. Psychosis may be associated with Schizophrenia or many other causes

13. Eating Disorder? Anorexia Nervosa 

14. 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”

15. Miscellaneous Developmental • Childhood History of Abuse? • Ongoing unhealthy parental relationship? • Incomplete ego development?

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

17. Borderline Personality Disorder • unstable relationships, tending to idealize or devalue • unstable sense of self • inconsistent, reactive moods • feelings of emptiness

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

19. Obsessive-Compulsive Personality Disorder • Preoccupation with lists, details • Perfectionism interferes with task completion • Work focus out of balance with leisure/friendships • Overconscientious/inflexible

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

21. 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

22. 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

23. Psychodynamic • Repression of “dark impulses” • Shadow May disguise or deny

24. Black Swan

25. What is real? • Director leaves it unclear • Clients and therapists may also be unclear

26. 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?

27. “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. ...

28. Eating Disorder? Anorexia Nervosa

29. 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”

30. 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.

31. 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

32. 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

33. Obsessive Compulsive Disorder • Obsessions: Intrusive, distressing, recurrent thoughts, impulses, imagesthat 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… time consuming … distressing

34. Miscellaneous Developmental • Childhood History of Abuse? • Ongoing unhealthy parental relationship? • Incomplete ego development?

35. Psychodynamic • Repression of “dark impulses” • Shadow Essence of the Swan Lake story

36. Dermatillomania • CSP (Compulsive Skin Picking or Chronic Skin Picking). • impulse control disorder • body dysmorphic disorder

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

38. Schizophrenia? • Psychosis, plus • Social/occupational dysfunction • 6 months of disturbance, 1 month of symptoms

39. Other? • Electrolyte imbalance From purging? • Drug Induced Ecstasy?