Black Swan & mental disorders

Black Swan: Lily and Nina, girl’s night out

'BLACK SWAN': Psychiatrists Diagnose Ballerina's Descent

by SUSAN DONALDSON JAMES
ABC News Posted on December 20, 2010 at 12:03 PM

(ABC News) - Black Swan, a new psycho-drama anchored in the competitive world of ballet, is getting as much analysis on the psychiatrist's couch as it is Oscar buzz.

The Golden-Globe nominated film takes viewers deep into a ballerina's descent into madness in a frightening portrait of psychosis that doctors say resonates realism.

Nina Sayers, a fragile and repressed ballerina, played by Natalie Portman, strives for the lead in Tchaikovsky's "Swan Lake," a role that will require her to play both the gentle white and the seductive black swan.

But in the process, she will have to shed her "sweet girl" persona and embrace her darker side to fully embrace the role and to please her demanding and sexually aggressive director.

Her metamorphosis is so complete, that Nina eventually develops webbed feet, bird-like legs and sprouts feathers and wings to actually become the black swan.

"It was intense and disturbing and fascinating and mysterious," said Nadine Kaslow, vice-chair of the department of psychiatry at Emory University and psychologist to the Atlanta Ballet. "What was a hallucination and what was real? When people are psychotic, it's difficult as a therapist to know what's real and what's not."

Nina, who constantly strives for perfection, lives with her controlling mother Erica, played by Barbara Hershey, who gave up dance to have her daughter in a tiny New York City apartment, cluttered with her mother's narcissistic paintings.

When artistic director decides to replace the aging prima ballerina for the new season production of "Swan Lake," Nina is his first choice. But she has competition in new sexually open dancer Lily, played by Mila Kunis.

After securing the role, Sayers is asked to "lose herself" to play the black swan, and so she does.

In visual hallucinations, she sees a black-clad version of herself across the subway platform and again in the maze of hallways at Lincoln Center. Even the pink stuffed animals that adorn the bedroom she shares with her neurotic mother seem to come alive and mock her.

"As a movie fan, it held my attention," said Dr. Steve Lamberti, associate professor of psychiatry at University of Rochester Medical Center. "It was poetic in a way, showing this transformation gone wrong."

But speaking as a psychiatrist, Lamberti said the film did not accurately depict schizophrenia, as has been widely speculated, but "does present a reasonable portrait of psychosis."

"People tend to be scared of things they don't understand," he said. "If you have never treated or observed a person with psychosis, it's upsetting."

Psychosis is a loss of contact with reality that usually includes false beliefs or delusions, and seeing or hearing things that are not there.

Like a fever, psychosis is a symptom rather than a disease, and can be caused by a variety of triggers: exposure to mercury (the hats of the Mad Hatter were impregnated with the heavy metal), drugs like amphetamines, epilepsy, a brain tumor, dementia or psychiatric disorders like schizophrenia.

But unless psychosis is due to neurological causes, patients normally have auditory, rather than visual hallucinations.

"In terms of cinematography, it's much easier to portray the visual," he said. "Whispers are not nearly as dramatic as seeing something."

Several risk factors that may have made the fictional Nina susceptible to psychosis if she had a genetic vulnerability, said Lamberti.

"Natalie Portman's character was involved in a highly stressful competition, she had conflicted relationships with her mother and with her understudy, and she was the object of sexual advances by her director," he said. "Any one of these issues alone would be stressful but experiencing all of them at once could be emotionally devastating, particularly for a young woman who is somewhat naïve and sheltered."

Ecstasy, a powerful hallucinogen that Nina and Lily take in one scene, can also trigger a psychotic event.

Lamberti also suggests that the repeated vomiting and weight loss in the days leading up to her final performance may have caused an electrolyte disturbance that could have contributed to the psychosis.

The film took liberties with a host of anxiety disorders: anorexia, bulimia, cutting and obsessive compulsive disorder -- most of which would not all appear together, say psychiatrists.

Nina is meticulous about preparing her slippers, lining up the make-up in the dressing room and washing her hands at each turn. Viewers see hints of anorexia as she stares at a simple pink grapefruit for breakfast and turns away the fatty cake her mother buys to celebrate getting the coveted role.

Nina also makes frequent bulimic trips to the bathroom to throw-up. Her scratching and cutting is hardest to watch - blood oozes from her fingers as she rips off old scabs.

Director Darren Aronofsky has a "wild imagination, according to Jonathan Abramowitz, associate chair of psychology at the University of North Carolina at Chapel Hill, who specializes in obsessive compulsive and anxiety disorders.

"It would be fairly rare to have a psychosis and an eating disorder. People in psychosis are not in touch with reality. With eating disorders and OCD, they are too in touch with reality."

Psychosis Usually Involves Auditory Hallucinations

Psychosis, particularly in schizophrenia, involves negative symptoms, as patients start "slipping away from contact with reality," he said. "They don't care about social interactions and what they look like and speech starts to deteriorate. It's the polar opposite with anxiety disorders and OCD."

Those disorders abound in the dance profession, according to dance psychologist Nadine Kaslow, who continues to perform and teach.

"The world of ballet is intensely competitive," she said. "They over-exercise and eat very little. Anorexia and bulimia are extremely common. It's not as rampant as it was 20 years ago when we saw people get sick and die. But there is still a lot of controversy over how thin you should be."

Cutting is occasionally seen and substance abuse, particularly with drugs that help the dancer lose weight or keep up energy, is widespread.

"It's all about perfection and you can never be perfect," said Kaslow. "But the demand for it is off the charts."

The exploration of bisexuality was also intriguing in the ballet world, where men are often gay and where women's physiques are more childlike.

"The ballet world gives you such a message to look like a child," she said. "They are pretty flat-chested and they look like kids. The notion of being sexual or being a woman –- it's not uncommon to struggle with that.

But could Natalie Portman's character have carried off the demanding ballet performance in a psychotic state? Doctors say it would have been "unlikely."

"Psychosis usually interferes with a person's ability to function," said psychiatrist Lamberti. "However, artists and musicians have been known to perform despite the presence of psychosis. For a dancer who is trained to cope with pain and other distractions, it might be possible to perform in a psychotic state depending on the severity of the psychosis.".

"It may be possible for them to cope to an extent at a pretty high level, but it's not typical," he said. "Still, human resilience is remarkable."

For more information on OCD and anxiety disorders, go to the OCD Foundation or Anxiety Disorder Association of America.

Personal Comment: I was pleased to read that a number of psychiatrists agree with my own analyst, a knowledgeable follower of classical ballet, who thought the Black Swan fairly realistically, portrayed a ballerina’s mental deterioration. Since film is primarily a visual medium he thought her psychosis – hearing and/or seeing things that aren’t there – depicted through visuals of her delusions was handled very well. He also thinks that Nina seemed to have conflicting mental problems, but thinks it might be because she was developing a second personality and each of them had its own set of disorders. I am indebted to my reader, the mysterious ‘J’, for bringing this article to my attention.

Black Swan – Should young dancers see it?

Natalie Portman as Nina Sayers

The New York Times
January 7, 2011

To Some Dancers, ‘Black Swan’ Is a Cautionary Tale
By SARAH MASLIN NIR

“CARMELLA IMRIE spent six grueling hours last Wednesday mastering steps like the brisé and jeté battu for Keith Michael’s ballet “The Alice-in-Wonderland Follies.” But instead of going home to nurse her toes afterward, she and five other dancers with the New York Theater Ballet headed out to see “Black Swan.”

After sitting through the nearly two-hour-long thriller, Ms. Imrie, 27, left the AMC Loews theater in Kips Bay wanting to shake her arms, as if her skin were crawling. It wasn’t the gore of the bloodied tutus, but the psychological subtext. “It’s the destructive personality that makes it really creepy,” she said. “You don’t ever want to have that to become you.”

“Black Swan,” which stars Natalie Portman as a ballerina whose rise to the top comes at the price of her sanity, has become something of a must-see movie for young ballerinas, not just because it is the rare Hollywood film that uses ballet as its central universe. Some dancers say that the film holds up a mirror to a darker side of ballet.

The film’s director, Darren Aronofsky, might have set out to make a thriller, but for dancers, the chills come from the unsettling topics he laid bare: the blind pursuit of perfection, the anorexia and bulimia to achieve a fat-free swanlike figure, the sexual abuse of fragile ingénues.

Those tensions are embodied in Nina Sayers, a young ballerina played by Ms. Portman. The movie begins with Nina choking down an ascetic breakfast: one grapefruit. Later, she heaves her bony shoulders to retch in the ballet company’s bathroom, and refuses even a taste of a pink-frosted celebration cake her mother has bought her.

The scene may be played with melodramatic effect, but its underlying pathos is familiar to ballet dancers. Tara Hutton, 21, a senior at Butler University in Indianapolis who is studying dance, said the specter of eating disorders haunted many of her classmates. Ballet, she said, can be a “sick and twisted art form” that puts an unrealistic value on “achieving this beautiful thin body.”

At dance camps she attended growing up, drinking quarts of Crystal Light and cup after cup of coffee to tame hunger pangs was a common practice. Dancers who starve themselves also increase the likelihood of stress fractures and other injuries, she said. In one scene from the film, Nina’s toenails crack off in her toe shoes.

“You see a dancer who is injured, and you can’t help but think twice about the fact that it could” be from eating disorders, said Ms. Hutton, who is preparing to audition for ballet companies in the Midwest this spring. “You’re working every day to achieve something that is physically impossible.”

For Nina, the impossible reflects the demands of her smothering mother, a failed dancer herself who seeks vicarious fulfillment through her daughter.

Cheryl Kaeser hesitated to let her daughter Emma, 15, a ballet student in Manhattan, see the movie. “I was concerned that it may show a particularly ugly side of ballet,” she said. Only recently has she decided to take Emma to the film, after serious consideration.

The film also portrays ballet as a quixotic art form that demands nothing less than total submission to the craft. Nina pirouettes until her feet are bloodied, twirling before the barre so long into the night that the theater lights go out on her, and still she wants more. Hidden under her fashionable shrugs are angry red lines that she clawed into her skin, and her fingers are bandaged to hide the raw patches of skin she casually peels. The pressures dancers face rang true for Ellen Bar, a soloist with the New York City Ballet, who attended the film’s New York premiere with 30 dancers. “The psychological torture of being an artist” felt real, she said. “The way it shows an artist being her own worst enemy.”

Jennifer Homans, a dance critic whose new history of ballet, “Apollo’s Angels,” has drawn critical applause, said that dance tends to draw people who have a kind of discipline and dedication that can flip into obsession. “They are obsessed with trying to make their bodies into something beautiful and special and otherworldly,” Ms. Homans said. “There is an enormous psychological pressure cooker there at a very young age.”

Torture for Nina came also in the form of the sexual advances of her director, Thomas Leroy, played by Vincent Cassel. He slides a wanton hand down her leotard when teaching her a turn, and shoves his tongue into her mouth when she dares to slip into his office and ask for a better part.

The dynamic has a historical precedent: the charismatic choreographer George Balanchine had a well-known weakness for his own dancers, reported in newspapers and tabloids during his time, and in books including “All in the Dances: A Brief Life of George Balanchine,” by Terry Teachout.

“Is there a problem with a sort of dominant male figure and a woman under his power? Yes, that happens,” Ms. Homans said. But the problem, she added, might be exaggerated in cases of ballet companies filled with young female dancers and directed by men. “The outside world may glom on to this more in the dance world because it’s a physical art form, so the power relationships seem physical. They exist in all worlds, but they may seem to people more intense here.”

Not everyone agrees with the gloomy picture of ballet that Mr. Aronofsky paints. They argue that the eating disorders and sexual exploits are stereotypes, and that the issues dancers face are over-dramatized to the point where the film borders on farce.

Diana Byer, the artistic director of the New York Theater Ballet, said that movies that try to dramatize ballet usually miss the mark by turning actors into caricatures of tortured artists, obsessed and tormented by their craft. “Dancers are people, they have a job like everybody else,” she said during a break in rehearsal last week. “A person who doesn’t live life can’t bring anything to a ballet. You have to live life to create an art form.”

Still, she made a point of seeing the movie soon after it came out, along with nearly everyone in her 14-member company. They debated Ms. Portman’s ballet techniques during breaks in practice, critiqued some of the dance performances and gushed over a few of the costumes. The fact is, it’s not every day that Hollywood portrays their art.

Their biggest complaint about the film, she said, wasn’t the melodramatic portrayal, the inaccuracies or the ugly stereotypes. It was that there was not enough dancing in it.”

Personal comment: Black Swan is a must-see for every dancer I know! I think every ballet student who is serious about dance as a career should see the film. Except for the ending I thought the portrayal of the inner workings of a ballet company were fairly accurate. I don’t think the stresses that dancers have to deal with in a hyper-competitive environment were over emphasized. There really are dancers with eating disorders, intense competition for roles, injuries from over-training and some paranoia too, at least to some extent in most major companies. A good company cares about the health of its dancers and requires bone density scans and weigh-ins to check on their dancer’s health.

A dancer's body image

Does this dancer need to lose weight?

Body image: The Ideal female ballet body, according to George to Balanchine, is a girl with long legs and neck, a short trunk and small breasts and head and large feet. He loved watching what he called ‘juicy’ pointework by girls with large feet! Go figure! For women who don’t have ideal dancer’s bodies, and that’s almost all of us and even for the lucky ones with Balanchine bodies, the mirror is one of our harshest critics. In our reflections we often see only our flaws. If a girl is large enough to be a showgirl 5’8” or taller then she can let her weight go a bit and add an inch or two to breasts and hips as long as her bod is firm. But those of us dancing the classical idiom can’t get away with that. Even with a relatively high metabolism a classical dancer has to be careful of her diet because weight can be so difficult to manage. I think that’s because we spend so much time standing around while the choreographer sets a piece or waiting for our role to come up in rehearsal. Where we usually get the best workout is in class so most of us try to take as many classes as we can afford or that we have time for. The thing we absolutely must avoid is poor nutrition from fad or crash diets that can develop into eating disorders like anorexia and bulimia that can shorten careers and even lives. For dancers who are struggling with weight problems the best course is to get with a dietitian to develop a diet with meals and snacks of the right amounts of nutritious foods to build muscle and store energy.