Black Swan- a cinematic portrayal of schizophrenia?

The highly acclaimed psychological thriller “Black Swan,” directed by Darren Aronofsky and starring Natalie Portman, Mila Kunis and Winona Ryder, is a fascinating story of a young ballerina’s emotional plight in the competitive world of professional ballet. Portman plays Nina, a principal ballerina for the NYC Ballet Company who has newly acquired the lead in Swan Lake, a classic story depicting the virgin/whore dichotomy that men face when choosing a lover. Nina is overshadowed by her controlling and emotionally abusive mother (played by Barbara Hershey) who is convinced she “gave up” her career for parenthood. The film brilliantly captures the brutal physical and emotional demands that ballerinas face in their short-lived career span.

Aronofsky clearly enriches the film with a storyline that points to Nina’s first psychotic break, likely triggered by a combination of her genetic heritability, childhood experience of abuse, age, and the heightened environmental stress placed upon her as principal ballerina.  I am often fascinated by clinically accurate depictions of mental illness. While Black Swan appears to be a loose cinematic portrayal of the onset of schizophrenia, it likely leaves untrained viewers confused about the diagnostic details of schizophrenia. This article serves to explain schizophrenia and it’s diagnostic criteria and known causes.

Contrary to popular belief, schizophrenia is not a split personality, (professionally referred to as Dissociative Identity Disorder.) Schizophrenia is actually a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a maze of confusing thoughts, images, and sounds. The behavior of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behavior, which occurs when people lose touch with reality, is called a psychotic episode.

Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticably higher in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age.

Schizophrenia varies in severity from person to person. While some people experience a single psychotic episode, others have many throughout their life. Some lead relatively normal lives between episodes and others suffer tremendously and remain unstable. Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions.

What are the different types of schizophrenia?

* Paranoid schizophrenia: People with this type are preoccupied with false beliefs (delusions) about being persecuted or being punished by someone. Their thinking, speech and emotions, however, remain fairly normal.
* Disorganized schizophrenia: People with this type often are confused and incoherent, with nonsensical speech. Their outward behavior may be emotionless/flat, inappropriate, silly or childlike. Often they have disorganized behavior that may disrupt their ability to perform normal daily activities like showering or preparing meals.
* Catatonic schizophrenia: The most notable symptoms of this type are physical. People with catatonic schizophrenia are generally immobile and unresponsive to the world around them. Their bodies are often very rigid and stiff, and unwilling to move. Occasionally, these people have peculiar movements like facial grimacing or strange postures. Or, they might mimic a word or phrase just spoken by another person. People with catatonic schizophrenia are at increased risk of malnutrition, exhaustion, or self-inflicted injury.

What Causes Schizophrenia?

The exact cause of schizophrenia is not yet known. It is known, however, that schizophrenia — like cancer and diabetes — is a real illness with a biological basis. It is not the result of bad parenting (i.e. the ‘schizophrenogenic mother‘ or personal weakness. Researchers have uncovered a number of factors that appear to play a role in the development of schizophrenia, including:

1. Genetics (heredity): Schizophrenia tends to run in families, which means the likelihood to develop schizophrenia may be passed on from parents to their children.
2. Brain chemistry: People with schizophrenia may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a brain chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells, and sights and can lead to hallucinations and delusions.
3. Brain abnormality: Newer research has found abnormal brain structure and function in people with schizophrenia. However, this type of abnormality doesn’t happen in all schizophrenics and can occur in people without the disease.
4. Environmental factors: Evidence suggests that certain environmental factors, such as a viral infection, poor social interactions, or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more often surfaces when the body is undergoing hormonal and physical changes, such as those that occur during the teen and young adult years.

How Is Schizophrenia Diagnosed?

If symptoms of schizophrenia are present, a physician will perform a complete medical history and physical exam. While there are no laboratory tests to specifically diagnose schizophrenia, a physican may use various tests, such as X-rays and blood tests, to rule out a physical illness as the cause of the symptoms.

If a physican finds no physical reason for the schizophrenia symptoms, he or she may refer the person to a psychiatrist or psychologist- mental health professionals who are specially trained to diagnose and treat mental illnesses, and use specially designed interview and assessment tools for their evaluation. The therapist bases his or her diagnosis on the person’s report of symptoms and his or her observation of the person’s attitude and behavior, and may include interviews with family members. A person is considered to have schizophrenia if he or she has characteristic symptoms that last for at least six months.

Can Schizophrenia Be Prevented?

There is no known way to prevent schizophrenia. However, early diagnosis and treatment can help avoid or reduce frequent relapses and hospitalizations, and help decrease the disruption to the person’s life, family, and friendships.



34 thoughts on “Black Swan- a cinematic portrayal of schizophrenia?

  1. Pingback: Black Swan (2010) | Blog

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  3. Keeping in mind that Black Swan is a dramatic film, very theatrical, I came away on a second viewing with a somewhat different interpretation of Nina’s psychology. (And I am not a clinical psychologist – just a cinephile, so I defer to you and am actually interested in your much more informed opinion.)

    Consider the extended shot of Nina after she leaves the stage for the first time after performing as the Black Swan. The audience actually starts chanting her name (which must surely be an auditory hallucination considering the mid-performance decorum of a typical ballet), and she becomes almost orgasmic. I think there is more to Nina than psychosis induced by environmental pressures and whatever other factors might exist outside the film. From the very first shot (Nina alone in a spotlight) to the very last lines she utters in the film on her death bed (“I felt it. Perfection. I AM perfect.”), and all points in between (there is not just a number of mirrors, but a number of shots of her checking herself out in various reflective surfaces), it seems to me that Nina is a pathological narcissist.

    Looking at the nine proposed amended criteria for diagnosing NPD (from my armchair), I see five from the film, although there might be more if you could get Nina on the couch. From what I understand, it is not uncommon for pathological narcissists to actually be socially withdrawn like Nina; and it is common for a pathological narcissist to have at least one parent who also had the disorder. (The way Nina’s mother acts toward Nina suggests that she too may be a pathological narcissist scarred by age and failures.) Also didn’t Freud associate secondary narcissism with psychosis and auto-eroticism? (I’m thinking of the bedroom scene with Lily – well, actually not Lily, but herself.)

    In this context, it seems to me that the doppelganger is only one manifestation of a narcissist’s self-objectification. (How do most mainstream movies/TV portray a narcissist? Usually by the person referring to himself in the third person – another form of self-objectification.) By the end of the film, Nina is not only seeing her own face on Lily, but on ALL of the dancers.

    Duality – not just reflection – is certainly a dominant visual motif throughout the film. Don’t pathological narcisissts also have a split – between the “True Self” and the “False Self”? And if the technically-proficient frigid False Self that Nina has worked so hard to build (the White Swan) fails to meet the demands for Narcissistic Supply (the adoration and appreciation of her mother, director, and the audience), is it possible that her psychotic break might arise from the need to create another looser, more seductive False Self (the Black Swan)?

    Anyway, I had this thought that schizophrenia might not be the end of the story – psychologically speaking – because I have this feeling that the writer/director was trying to pose a more general question about the elite artists/performers. (As you note, Black Swan tells us little to nothing about Nina’s individual history, and Nina is not the only character in the film given double imagery to seemingly represent a duality.) That is, what sort of mental state is required to do these sorts of extreme artistic endeavors (e.g., ballet), and would we really want to be inside their heads?

  4. Ori

    Hi Dr. Villarreal

    I enjoyed your article, and I have 2 questions- the first- I have read that Schizophrenia is also chararcterized by lack of desire to plan the future and lack of desire to build and invest in social relations, but in the movie Nina cares a lot about her role as a dancer and considerably want to have a friend. how can it be?
    the second question is in response to your answer to Mat- is it may be possible that Nina was not sexualy abused by her mother? there is a hint that Nina had a sister, maybe a twin, that died young. maybe the mother’s way of dealing with her daughter’s death is trying to make Nina a little girl forever? by showering her, keeping her room all pink and dolled up, not letting her out at evenings and so on?
    im sorry for any grammer mistakes- English is not my native language.
    Thanks for reading!

  5. Thanks for a great review and explaining Nina’s likely mental health issue. Having BPD (Borderline Personality Disorder) myself I was interested to watch Black Swan as the wikipedia entry for films portraying BPD suggested that Nina’s condition was BPD. From the start I could draw some parallels between BPd and Nina but also picked up on the psychosis and other things that made her condition stand apart from BPD. Reading your post I can now see how schizophrenia is a better fit!


  6. Hi Courtney, thanks for your response. Yes, for a person to receive a formal diagnosis of ‘Schizophrenia, Paranoid Type’ they need to exhibit a preoccupation with 1 or more delusions, or frequent auditory hallucinations. The specifier or phrase “with psychotic features” is used with a diagnosis of a Mood Disorder, such as Major Depression, Mania or Mixed Episode. The DSM-IV-TR has a handy pocket-sized version that’s a great reference resource for nurses or any health professional. Lastly, it’s important to note that the character portrayed by Portman in the film does not exhibit a thorough representation of someone with Schizophrenia, but rather, appears to be loosely based on this classification of mental illness. I’m happy you found my article useful!

  7. Courtney

    Thanks for this article! This is such an interesting movie that is enhanced with your explanation of schizophrenia. I am a nurse and have had little experience in mental health. Is it assumed that all people with paranoid schizophrenia have delusions and hallucinations or would this be considered with “psychotic features”? I was not sure if there is such a classification in the DSM-IV or if the diagnosis paranoid schizophrenia completely describes the mental illness portrayed by Portman. Thanks again for your article! You are really an excellent writer!

  8. Hi Adam, thanks for your thoughtful response! Your train of thought and deductive thinking style are right on track; you’re accurate in pointing out we can’t pinpoint any DSM-IV diagnosis due to lack of specificity regarding the presence, duration, and chronicity of Nina’s symptoms. You’ve also done a great job at pointing out likely contributors to the onset and progression of her mental illness. The producers of the film opt to leave us guessing, which I believe gives the film it’s mystique. Most professionals in the field of mental health recognize that while some of us are more resilient to extreme levels of stress and hardship, others are genetically predisposed to experiencing psychosis or various other types of mental illness, with or without heightened levels of stress. While it’s certainly true that increased stress may in part, contribute to the onset of psychotic symptoms or a ‘mental break’, many people will experience similar symptoms with far fewer environmental stressors than those experienced by Nina. Thank for the film suggestions- I’ve enjoyed all of those! You may want to watch Catch Me If You Can with Leonardo DiCaprio.

  9. Adam

    Hello there! I thought your review of the film was interesting. I typically enjoy psychological films because I find mental illnesses both very interesting and also both scary. So did you think, without assessment from the DSM-IV, that Nina’s character was OCD (she collected many objects from Beth), Paranoid Schizophrenia (multiple deluions and hallucinations combined with harming herself), or Multiple-Personality Disorder? I don’t think it was this but there is some evidence of this in her almost split-personality where we see the duality of the white swan/black swan and Nina/Lilly good/evil. Even in the beginning of the film I know something is going on mentally when we see Nina study with fascination another female from the back, on the train, that seems to be another copy of herself and the cinematography was brilliantly destabilizing at times when we would see flashes of Nina’s face on people that weren’t her…so are these “hallucinations” of seeing oneself typical of schizophrenia or more a mark of Multiple-personality disorder?

    I often find trying to figure out WHY the person has become mentally ill the most interesting aspect of such films and often very hard to pin down as alot of it is subjective and internal, would you agree? Can you come up for a few reasons for Nina such as Maternal bloodline genetics? Perfectionist personality? Extreme stress career? What about the whole dynamic between Nina and her director who keeps telling her that she needs to lose control and go to the “dark side” of human nature? Do you think the pressure of stressing and questioning of one’s established self-image and personality could lead to this sort of “mental break”? Interesting to hear your thoughts!

    If you were interested in the psychological aspects of this film others you may enjoy are: Shutter Island, Identity, The Number 23, and Memento.

    Thanks and Farewell!

  10. Jan

    Dr. Villarreal: I was glad to read your response to Irene including the possibility of a Dissociative Disorder diagnosis. As a therapist who specializes in treating complex trauma and dissociation, the character of Nina reminded me of several patients I have seen who are dissociative; moreso than schizophrenia. One reason (among many) that the differential diagnosis is so important in these cases is that the treatment is very different. DID (or DDNOS) cannot be treated with medication, only the symptomatology; intense psychotherapy is crucial (not that psychotherapy isn’t useful with schizophrenia, but a different type of therapy). Nina’s fragile identity and its seeming breakdown as she gets in touch with other parts of herself is very much like DID/DDNOS treatment as the patient discovers concealed, suppressed, and dissociated parts of herself.

  11. Hi Jane, thanks for your comment. So according to the Diagnostic Statistical Manual of Mental Disorders (what clinicians/researchers/health insurers/policy makers use to classify mental illnesses and other aspects of human personality/social situations) Schizophrenia is a diagnosis that contains various subtypes, depending on the types of symptoms a person is experiencing. So to answer your question, people with Schizophrenia of the Paranoid type is classified by the DSM-IV as a person who is experiencing a preoccupation with one or more delusions or frequent auditory hallucinations, and does NOT have PROMINENT disorganized speech, disorganized or catatonic behavior, or flat or inappropriate emotional affect. However, it’s important to keep in mind that the DSM is simply a classification system to organize symptoms of mental illness, and there are certainly people who display/experience a varied course of symptomatology in mental illness. Skilled clinicians take a thorough history and track symptoms over time in order to best capture a person’s episodes of mental illness to determine the best course of treatment. Films that aim to capture some aspects of mental illness may not display an accurate depiction of common symptoms, because the directors/producers choose to follow a more artistic approach for their fictitious characters.

    The film is billed a psychosexual thriller I assume because Nina displays both heterosexual and homosexual urges at various points within the film. I think you have a good take on the director’s aim in guiding the viewer to believe that Nina’s sexuality appears to have a strong influence upon her mental stability.

    Thanks for your thoughtful words, and sharing your curiosity with me!

  12. Jane

    Hi! After reading your article I had a few questions.

    1. Is it possible to experience more than one type of schizophrenia at the same time? Or is it unlikely? I’m just curious since Nina seemed to experience both paranoid and disorganized schizophrenia.

    2. The movie is billed as a pyschosexual thriller. What exactly makes it pyshosexual? Is it because of how Nina’s sexuality and her sexual relations with others greatly affects her mental stability?

    Just curious! Great article as well!

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  14. Hi Irene, thanks for your comment. Truthfully, without quantifying specific symptoms according to the DSM-IV, we can’t know what the proper diagnosis is; schizophrenia is one speculation. I think with more information, a differential diagnosis of dissociative disorder could also be warranted.

  15. Irene

    Hi. After reading a lot about schizophrenia and DID (as an exercise of identifying what is wrong with myself – I was diagnosed with DDONS for the moment), I think that Black Swan’s Nina is a clear example of primary structural dissociation, and not schizophrenia.

  16. Rikesha

    Hi Dr. Christina:
    Thank you for sharing your expertise. As a special education teacher, I, too, picked up on the schizophrenic overtones in the Black Swan; hence my stumble upon this site. I have taught several students with this disorder. People without a background in mental illness were totally lost in the plot (I’m referring to some people who viewed the movie with me). One thought that I had concerning the mother was that while she was overprotective, she knew of her daughter’s illness and was desperately trying to actually help her. I never thought about her being emotionally abusive. That’s a good take on it. Again, thank you for sharing your expertise.

  17. Hi, thanks for comment. I agree, the film captures the destructive nature of perfectionism, and for some with a genetic predisposition for mental illness, can serve as a trigger for psychosis.

  18. Hi, thanks for your comment. I agree, watching the mother’s character develop throughout the movie gave me the sense that her relationship with her daughter was dysfunctional/abusive, enmeshed, and entirely inappropriate for the healthy development of a child. I too, got the sense that the director was alluding to the mother’s mental instability in several scenes, but like the rest of the film, preferred to leave the audience to draw their one conclusions. The sexual undertones in the film are also meant to leave the audience guessing, which adds to the film’s mystique and eerie lack of closure.

  19. Mat

    I thought the movie was great – but doesn’t match “Requiem for a dream”. Kudos to Portman for the portrayal of the fragile yet determined balerina. I especially loved her reaction after winning the lead. Slightly overplayed maybe, but still not over the top.
    But something really bugged me about the mother – would you say it’s possible, that Nina was being sexually abused by her mother? There are several hints throughout the movie, especially the mother saying “Are you ready for me?” when Nina is going to bed and the famous lesbian love scene – after which we learn that Lily didn’t stay for the night yet somebody opened the barred door to Nina’s bedroom. From inside. I wonder if you got the same impression.

  20. Christine Banks

    Hi Dr. Villarreal, I saw Black Swan today & thought it was a wonderful movie. I could also relate to it. I have a son who was a very talented University trained actor & classical singer and a perfectionist who couldn’t cope with the stress when he got physically ill with a virus. His personality changed dramatically and he cut me off as well as his father, girlfriend, brother & sister, plus all his friends. He moved to QLD. & now leads a normal life which doestn’t include any of his former life or friends, he dabbles in some country music as a hobby. He is now in contact with my husband & I & we have been to QLD. several times to visit him & his wife. He has no contact with his sister & brother & their children. He hasn’t been to our home for 12 years. He has never admitted to anything being odd about his behaviour & obviously still believes we all did something terrible to him. Recently he went back to Uni to study Business & Accountancy & of course only wants to get high distinctions in every subject as part of his perfectionist personality. I feel this movie was an excellent portrayal of how the stress of artistic performance & perfectionism can take its toll on the human condition & trigger a mental illness.

  21. Hi Dr. Villarreal –

    I just saw Black Swan yesterday and will be linking to your post in my blog review of the film. Really enjoyed your post.

    From the filmmaker’s standpoint, I think the reason he isn’t advertising Black Swan as a film about mental illness is because he wants audiences come to that conclusion themselves, and to state that up front would be a huge spoiler.

    The entire film can also be read as an allegory for the artistic journey, and the transformation required to take on such a role. There are enough film cues to read the film both ways.

    However, as the wife of a bipolar husband, I read the mental illness cues loud and clear. If you think about how the mother’s character and the Mila Kunis character are presented, for example, they’re both given to us through the POV of the mentally ill main character. There are clues to suggest that both are friendly toward Natalie Portman, and she is perceiving them through a veil of paranoia.

  22. Wow Jamey, thank you so much for sharing. It’s great to hear about people who have learned to manage their mental illness effectively. It’s true, the film nor it’s advertisements hint at the portrayal of schizophrenia, and choose to shroud the central character’s experiences in mystery, perhaps to allow viewers to decide for themselves what is real and what is imagined. However, I do think it’s important for the general public to be informed about the diagnosis of Schizophrenia, and understand that the symptoms of schizophrenia can be well managed with medication and therapy. I wish you and your son the very best.

  23. Thanks for reading Suzanne. As a clinical psychologist I often pick up on story lines that are vaguely patterned around various mental illnesses. I am happy to share a more comprehensive picture for the public, as clarification between what is artistic creativity, and what is clinically accurate.

  24. Jamey

    My son, who was diagnosed with Schizophrenia 11 months ago at age 13 when he had an onsetting psychotic episode, and I just saw this film. I had no idea what the movie would be about and felt sad because my son so understood what she was going through. His response: I am so grateful for medication and taking care of myself. Thank you for this article. Education makes such a difference.

  25. Maury M McFadden

    what a great article… thank you for this. I truly appreciated your insight and simplistic explanations/definitions… I’m a fan!! I look forward to more… 🙂

  26. Pingback: 2010 in review « Drchristinavillarreal's Blog

  27. Suzanne

    Thank you for being among the few to notice that this movie, billed as a “thriller” seems to be a portrayal of a woman experiencing the onset of schizophrenia. It is a sad, sad film.

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