Black Swan

1
Black Swan

• Chris Clark, Cinema St. Louis
• Steve Franklin, MSW, LCSW
• Michael Uthoff, Dance St. Louis
• SteveFranklinMSW_at_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

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Rated R

• for
• strong sexual content
• disturbing violent images
• language and
• some drug use

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• Its just a movie.
• What is real?

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• Simply the price of great art
• Or psychopathology?

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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.
• ... Alex Lerman
•  
• http//www.dailykos.com/user/Alex20Lerman

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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
•  
• http//www.dailykos.com/user/Alex20Lerman

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Speculation

• about specific diagnoses
• possibly depicted
• in The Black Swan

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Psychosis

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

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Psychosis

• may be associated with
• Schizophrenia
• or many other causes

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Eating Disorder?

• Anorexia Nervosa 

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• Body weight lt 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

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OCPD

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

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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

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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 (gt1 hour), or distressing

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Psychodynamic

• Repression of dark impulses
• Shadow
• May disguise or deny

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• Black Swan

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What is real?

•  
• Director leaves it unclear
• Clients and therapists
• may also be unclear

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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 lt 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

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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, images 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 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

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Dermatillomania

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

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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

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Other?

• Electrolyte imbalance
• From purging?
• Drug Induced
• Ecstasy?