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Black Swan • Chris Clark, Cinema St. Louis • Steve Franklin, MSW, LCSW • Michael Uthoff, Dance St. Louis [email protected] • • • • • Natalie Portman as Nina Sayer Vincent Cassel as Thomas Leroy Mila Kunis as Lily Barbara Hershey as Erica Sayers Winona Ryder as Beth Macintyre • Directed by Darren Aronofsky • Other Oscar nominations: – Cinematography – Editing – Best picture Rated R for • strong sexual content • disturbing violent images • language and • some drug use • It’s just a movie……. • What is real? • Simply the price of great art… • Or psychopathology? “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 “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 Speculation about specific diagnoses possibly depicted in “The Black Swan” Psychosis • • • • delusions hallucinations disorganized speech grossly disorganized or catatonic behavior • negative symptoms (reduced emotional expression/speech/ motivation ) Psychosis may be associated with Schizophrenia or many other causes Eating Disorder? Anorexia Nervosa • 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” Miscellaneous Developmental • Childhood History of Abuse? • Ongoing unhealthy parental relationship? • Incomplete ego development? Personality Disorder • • • • • • • cognition affectivity interpersonal functioning impulse control --in a range of personal/social situations --significant distress or impairment in --social/occupational/important areas Borderline Personality Disorder • unstable relationships, tending idealize or devalue • unstable sense of self • inconsistent, reactive moods • feelings of emptiness to BPD • • • • • an intense fear of abandonment suicidal or self-mutilating behavior often intense and sudden anger self damaging impulsivity stress related paranoia or dissociation Obsessive-Compulsive Personality Disorder • Preoccupation with lists, details • Perfectionism interferes with task completion • Work focus out of balance with leisure/friendships • Overconscientious/inflexible OCPD • • • • Unable to discard objects Difficulty delegating Miserly spending style Rigid, stubborn 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 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 Psychodynamic • Repression of “dark impulses” • Shadow May disguise or deny Black Swan What is real? • Director leaves it unclear • Clients and therapists may also be unclear 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? “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. ... Eating Disorder? Anorexia Nervosa • 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” 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. Obsessive Compulsive Personality Disorder • Preoccupation with lists, details • Perfectionism interferes with completion • Work focus out of balance leisure/friendships • Overconscientious/inflexible • Unable to discard objects • Difficulty delegating • Miserly spending style • Rigid, stubborn task with 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 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 Miscellaneous Developmental • Childhood History of Abuse? • Ongoing unhealthy parental relationship? • Incomplete ego development? Psychodynamic • Repression of “dark impulses” • Shadow Essence of the Swan Lake story Dermatillomania • CSP (Compulsive Skin Picking or Chronic Skin Picking). • impulse control disorder • body dysmorphic disorder Psychosis • • • • delusions hallucinations disorganized speech grossly disorganized or catatonic behavior • negative symptoms (reduced emotional expression/ speech/motivation) Schizophrenia? • Psychosis, plus • Social/occupational dysfunction • 6 months of disturbance, 1 month of symptoms Other? • Electrolyte imbalance From purging? • Drug Induced Ecstasy?