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Black Swan Review

Swan Lake, a ballet performed by the New York City Ballet, is central to Black Swan (Aronofsky & Medavoy, 2010). Nina Sayers is a petite, bashful dancer who wishes to be the lead in “Swan Lake,” which requires her to play the white and black swans. But, to fully immerse herself in character and please her demanding and sexually aggressive director, she must abandon her “sweet girl” persona and embrace her darker side. As a result, she experiences a wide spectrum of paranoid hallucinations and incorrect beliefs. In this paper, I’ll discuss Nina’s experiences with psychosis, from diagnosis through the end of her treatment, and the consequences it had on her.

Case Formulation

In the film Black Swan, Natalie Portman plays Nina Sayers, a ballerina for a New York City ballet company preparing to perform “Swan Lake.” Sayers doesn’t have any recognized physical difficulties, diseases, or disabilities at the moment, but there are hints that her health isn’t good. The patient is visibly underweight and has numerous foot injuries due to her career as a professional dancer. Sayers’ body is riddled with cuts and sores, many of which appear to have no apparent justification for being there. The individual could have caused these wounds. Following this, Sayers begins to exhibit a variety of symptoms that have been related to a variety of mental health issues. Sayers’ cuts and wounds appear to result from self-abuse, but she claims she has never hurt herself and has no idea how they got there. Sayers is constantly plagued by visual and aural hallucinations (Aronofsky & Medavoy, 2010). Many of her hallucinations have been proven untrue, such as seeing nonexistent feathers and peeling off sections of her skin that are still attached to her body. She is also getting bizarre thoughts at the moment. Even though she has no proof, she is certain that one of her other dancers is plotting to steal her spotlight in the next show. She also believes incorrectly that her dance partner is having an affair with the show’s director. Sayers is concerned that obtaining the lead role in a well-known dance production will deprive her of the opportunity to be “perfect” (Aronofsky & Medavoy, 2010).

Based on the facts available, the American Psychiatric Association believes Sayers has paranoid schizophrenia (Diagnostic and Statistical Manual of Mental Disorders). For a schizophrenia diagnosis, at least two indicators must be present: 1. False assumptions; 2. Scenes made up by you; 3. Verbal disarray; 4. Acting as though catatonic or entirely out of control; 5. Apathy, alogia, or a lack of motivation are negative symptoms. Sayers’ Black Swan meets the first and second requirements for delusions and hallucinations. Second, the condition must have been present for at least six months, with at least one month of active symptoms (or fewer if successfully managed) and significant difficulty with social or occupational functioning throughout that period. For most of her life, Sayers has had skin-peeling hallucinations and the delusion that she doesn’t have some of her wounds and sores. She’s been having more and more visual and aural hallucinations in the last month or so. She has also suffered a persecutory delusion that her role has been removed for the past month or two. It’s not clear if this is her first time thinking someone is after her. Second, one or more important areas of functioning, such as a job, relationships with other people, or taking care of oneself, are much poorer than before the disturbance started. Nina’s delusions and hallucinations have produced problems in her profession and personal life. She is always late to rehearsals, which is incredibly aggravating for the other people in the ensemble.

Lastly, there were no Major Depressive, Manic, or Mixed Episodes during the active-phase symptoms. This suggests that Schizoaffective Disorder and Mood Disorder with Psychotic Features can be ruled out. If mood episodes did develop during the active-phase symptoms, they didn’t continue as long as they did during the active and residual phases. Sayers does not exhibit any of the obvious signs linked with the mental diseases in Black Swan. Even though she has always spent a lot of time dancing, her conduct is too constant to be labelled an episode. This rules out any mental health difficulties. The disruption is not caused by the specific physiological effects of a drug or by a general medical condition. Sayers has no known medical issues, abnormalities, problems, or limitations that could cause her schizophrenia symptoms. The ordinary viewer would get a reasonably true picture of how paranoid schizophrenia develops, especially since Nina Sayers is the ideal age to start, but not necessarily of what it’s like to live with it every day after it starts. She had never done drugs before recently, but her symptoms were there long before she did. For example, she would see and hear paintings laughing at her and chat with and meet individuals who weren’t there. Some of the indicators of schizophrenia may have been played up too much in the movie, but not so much that it wouldn’t be fair to conclude that the character in the issue had schizophrenia. Nina’s concentration on visual hallucinations is rare for a patient presentation; however, hallucinations of noises are regularly discussed. The assumption that her aggressive conduct would get worse as her mental health got worse is a misconception promoted by the media and not substantiated by studies. Unlike many other movies and TV shows that mistakenly utilize cases of Dissociative Conditions as proof of schizophrenia, this one helps the public grasp what the disorder is truly about.

Nina Sayers’s symptoms may be an exception because most persons with schizophrenia have symptoms that come on more slowly than they do in her instance. Because of this, Black Swan is a wonderful example of how a person can descend into paranoid schizophrenia. Many specialists suggest that both hereditary and environmental factors contribute to the development of the illness. Stress at home is a common cause of psychosis, even if parenting style is rarely the direct cause. Everything about Nina’s existence drives her to the edge. Lamberti states that her director wanted to kiss her, that she was in a very intense competition, and that her relationships with her mother and understudy were tight. People don’t know if her mother has a mental disorder, but it could be that it runs in the family. All these concerns at once could be emotionally devastating for a young woman who is already a bit naive, sheltered, and socially hesitant. Nina’s problems are exacerbated worse by how much stress she is under. Lamberti also adds that a problem with the performer’s electrolytes could have caused the problem, as she had been vomiting up and losing weight in the days before her last act.


In the DSM-5, Nina did not seek aid in Black Swan. Her psychotic symptoms worsen with time, much like in real life. Nina could have a good future if she gets the attention she needs as soon as feasible. Kupfer (2022) states that most psychiatrists think the best way to treat schizophrenia is through medication, counselling, and self-help. Since anti-psychosis medications were made available, there has been a dramatic change in how schizophrenia is treated. They make it possible to treat and care for most patients outside of a hospital. It could take them a long time to get healthy, and they may feel alone as they do so. When the initial indicators of schizophrenia show up, the person must have the full support of their loved ones and local resources.

According to the movie, the most well-studied psychosocial treatments are social skills training, cognitive-behavioural therapy, cognitive remediation, and social cognition training (Aronofsky & Medavoy, 2010). Sayers should start taking a moderate dose of an antipsychotic like Vesprin immediately after a complete medical examination. Like other Axis I disorders, most people with schizophrenia react effectively to current treatments. Sayers and her mother can start family counselling once the medication is created and the dosage is stable. This will help them learn more about the disease, develop ways to deal with it, and teach Sayers’ mother to be more accepting of her daughter’s condition. Sayers could also benefit from learning how to get along with other people since she only gets emotional and social support from her mother right now. Sayers could improve her relationships with her coworkers and have less trouble with them if she joined the dance company and took social skills classes.

Accuracy and Stigma

Schizophrenia has real-world effects, as the movie Black Swan shows. Covington Behavioral Health says that untreated schizophrenia can lead to being alone, not getting medical or dental care, not taking care of family or pets, fighting with others, and having trouble getting along. Nina’s delusions and hallucinations have produced problems in her profession and personal life. She is always late to rehearsals, which is incredibly aggravating for the other people in the ensemble. Nina’s behaviour is also becoming more unstable and unpredictable because she is increasingly worried that Lily is trying to take her place and hurt her. Nina gets increasingly angry as she does things that hurt herself, like try drugs and alcohol and jump from one relationship to another. Nina accidentally stabs herself with a piece of the broken mirror when she thinks it is the knife she used to stab Lily during their fight over who would dance the last act of Swan Lake. This brings the film to a tragic end (Aronofsky & Medavoy, 2010).

Schizophrenia and other mental illnesses make it hard for people to distinguish between reality and fantasy. This makes it hard for them to keep a job and care for themselves and their loved ones. So, they have no choice but to count on their family and friends. Black Swan does a great job of showing how mental illness affects people and their relationships when it is not treated. Overall, the video is a powerful example of how psychosis can make people unable to function and how important it is to get treatment for mental illness to have the best quality of life possible.


Aronofsky, A. (Director). (2010). Black Swan [Film].

Kupfer, D. J. (2022). Anxiety and DSM-5. Dialogues in clinical neuroscience.


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