Black Swan- a cinematic portrayal of schizophrenia? By Dr. Christina Villarreal

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. Through my lens as a clinical psychologist, 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. As a mental health professional, 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.

Sources: Webmd.com, psychcentral.com, imdb.com

For professiona referrals or questions, please contact this author at christina.villarreal@gmail.com or visit her website at www.drchristinavillarreal.com