MOVIE REVIEW – ADVANCED ABNORMAL PSYCHOLOGY | MARY GRACE ALOLINO

PSYCHOLOGICAL EVALUATION REPORT

A MOVIE REVIEW from the American Psychological Horror and Drama Film entitled

“BLACK SWAN 2010 Film”

Directed by:

DARREN ARRONOFSKY

Prepared by:

MARY GRACE B. ALOLINO

MA Guidance Counseling Student
Cebu Doctors’ University

Evaluation Report Dated:

April 25, 2021

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 Confidential Psychological Evaluation Report

Name: Nina Sayers Birthdate: X

Present New York City Age: 28years old

Address:

Sex: Female Nationality/Race: Caucasian

Work: Ballerina Workplace: New York City Ballet Company

Place of Birth: X Date of Evaluation: April 25, 2021

REASON FOR REFERRAL

EVALUATION PROCEDURES

A. Mental Status Observation

B. Case History

Mental Status Examination

Nina Sayers has a serious focus facial expression, clean, neatly dressed, excellent posture
incoordination, and average height with a normal body built for the ballet industry but the
seamstress noted that she lost weight. Nina has an abnormal hobby of scratching her back when
stressed. Her mood-congruent was like happy when given an important scene and sad when she
knows she is dying. She has a normal and stable affect. The observed feelings are sadness, anger,
worry, happiness, and distress. She has hallucinations and delusions or paranoia. Her speech has
ordinary speed, soft-spoken and clear. She responds only to the asked questions. Her cognitive
functioning, she lacks the insight of her illness, lacks judgment, inability to come to an
appropriate conclusion, impulsive behavior in some instances.

Case History

Nina Sayers is a ballerina in New York City Ballet Company. Her life is completely
consumed with her passion for dancing. She lives with her obsessive former ballerina mother,
named Erica who exerted suffocating control over her. The director Thomas Leroy decided to
replace the prima ballerina Beth MacIntyre for the opening production of their new season, Swan
Lake, then Nina was his first choice to take the role. But Nina has a competitor, who is a new
dancer named Lily who impressed Leroy as well. Swan Lake requires a dancer who can play
both the White Swan with innocence and grace and the Black Swan, who represents guile and
sensuality. Nina fits perfectly with the White Swan role but Lily is the personification of the
Black Swan. As the two young dancers expand their rivalry into a twisted friendship, Nina
begins to get more in touch with her dark side – a recklessness that threatened to destroy her.

In the movie, Nina dreamed about her being the cursed princess by an evil magician that
turned her into a White Swan. In her dream, Nina showed excellence in her dancing talent and
with a burst of emotions that was expected for the role. Then, Nina waked up happily and
realized it was just a dream. Nina told her mother about her dreams but her mother
unintentionally ignores her. Nina’s mother noticed some scratched on her back when she was
about to leave but Nina just said it’s nothing when she was being asked. Nina’s aimed for
perfection, she stole Beth’s things for the purpose to be showered with perfections came from her
things. Because Nina perceived Beth as a perfect beautiful dancer and she wanted to be like her.
Later, Nina in the principal studio impeccably dances the White Swan part but when she dances

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the Black Swan part she was told by Thomas that she failed to capture the sensuality of the Black
Swan. Nina was heartbroken after that then went home and practice the dance moves until she
cracked her big toenail. Nina’s mother advised her not to be hard on herself if she finds it hard to
perform the part. But, the determined Nina who aimed for perfection, went to Thomas the next
day and told him that she successfully finished the Black Swan dance last night and wanted the
role, being the Swan Queen. Nina was tested by Thomas and deceived her that Veronica already
got the role and Nina was devastated even though she didn’t show her sadness to Thomas but her
eyes are visible of sadness. He told Nina that she has to try to lose herself and stop controlling
and Nina replied that she just wanted to be Perfect. Thomas slammed the door as Nina was about
to exit and kissed Nina passionately. It turns out that Nina has been chosen as the New Swan
Queen. Nina was stunned and confused but she got overjoyed and nauseous, she ran to the
bathroom where she called her mother and told her that she won the part. Over the next several
days, the stress of the role and her inability to perform got into Nina. She begins seeing a darker
version of herself in random passers-by.

Thomas organized a party for the official announcement of Beth’s retirement and Nina’s
rise as the Swan Queen. Nina went to the bathroom to wash her hand which she imagined and
thought that she got blood and a wound on her finger but it turns out nothing after many attempts
of washing it off. Then after she witnessed Lily took off her panties and put it in her purse, then
sat on the vanity. Lily congratulated her but Nina felt uncomfortable and attempted to excuse
herself, Lily playfully asked her to stay, but Nina left. In the other scene, Nina got offended by
Beth’s questions asking her if she sucked Thomas's cock to get the role. Thomas brought Nina
out and takes her to his place. When they sat on the couch, he brusquely asked her if she’s a
virgin. Nina looks away and smiles uncomfortably. He asked if she likes making love and when
Nina didn’t answer, he gave her a homework assignment that she must touch herself and find her
sexuality so that she may better inhibit the role. Later, when Nina’s mother was helping her dress
for bed, she saw scratches on Nina’s back and asked what happened. Nina said they’re nothing
but a rash. Her mother becomes suspicious and angry that she grabs Nina’s hand and takes her
to the bathroom to cut her fingernails with scissors. Her mother thought that Nina has been
scratching her back which made a scratch mark. During her cutting of Nina’s nails, she
accidentally wounded Nina’s finger and apologizes profusely but continues to trim Nina’s nails.
Nina has a history of scratching her back when stressed so her mother realized that right now it
has become worst than usual because she has been seeing her back having scratched all the time.

The next morning Nina waked up and began touching herself as Thomas asked. She got
aroused and as she turned her head she saw her mother asleep in the chair next to her bed. At the
studio, Nina got the news that Beth got hit by a car and was seriously injured. Nina felt that it
was her fault why Beth intentionally throw herself into that accident so she visited Beth and saw
the horrible situation of Beth, she then quickly left. After that, she practiced again the dance but
still, she didn’t get the passion of the Black Swan into her performance. Thomas witnessed it and
disappointed, he stepped in to dance as Nina’s partner. As they dance together, he slowly moved
his hands under her thighs and began touching her. After a deep kiss, he lets go of her and
walked away, calling over his shoulder that he just seduced her and that it should be her doing
the seducing with her dancing. Nina calls after, pleading, but she does not turn back. Nina feeling
defeated in her attempts to be perfect, sat alone and cried inside the studio. Lily arrives and
witnessed Nina cried and lights a cigarette as she walked near to her. Lily chats casually,
implying that Thomas had a tendency of sleeping with the troupe and Nina tried to defend him.
Lily had realized that Nina has a crush on Thomas and jokes about it. Infuriated by such a
thought, Nina gets upset and left. Nina got angry and berates Lily as Lily told Thomas to take
easy on her, then an angry Thomas confronted Nina if she can’t do the role then he can find a
replacement which will be Lily. During the confrontation, Lily looks abashed and said she’s
trying to help but Nina told Lily that she didn’t need any help and Lily walked away irritated.

One night, Nina and her mother Erica worked on Nina’s toe shoes. Erica made small talk
with Nina and she asked her if she’s been scratching and Nina answered “No” without looking at
her mother. Erica told her to take off her shirt to check it but Nina refused to do it. Erica was
about to force Nina but someone knocked on the door and her mother check it. Just a few

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conversations with someone with her mother before closing it again. Nina asked her mother and
Erica said that it was no one. Nina checked it herself and open the door and saw Lily waiting for
the elevator. Nina then approached Lily in the hallway and asked why she knew her place. Lily
said that she asked Thomas’s secretary. Erica went out and said that Nina needs to get inside and
take a rest but Nina said to close the door, which Erica abide with protest and slams the door.
Lily then invited Nina to go out with her to a club but Nina refused. As again Nina’s mother tells
her once more to come inside and take a rest and told Lily to leave. Nina was persuaded to just
come with Lily and grab her stuff and left with Lily. Nina and Lily went to a local bar for drinks
and some food, but Nina is so uptight that Lily offers her a pill to relax, saying it would only last
a few hours. Nina refused and went to the bathroom and as Nina returned, she saw Lily put the
content of the pill into her drink as she flirts with two guys. Nina was reassured by Lily that the
pills will only last a few hours. The two have a crazy, drugged night of clubbing with two guys.
When Nina is lucid, she finds herself hooking up with a man in a bathroom. She quickly left to
find a cab and Lily runs to catch up with her. They went to Nina’s place and Lily comes onto
Nina and begins gently rubbing Nina’s crotch until Nina stops her just holds Lily’s hand.

When they get back to the apartment, Nina’s mother was waited for them and asked Nina
what she was doing out late. Nina was drunk and somewhat belligerent but replied that she was
with two guys and she fucked them both and Nina laughs. Nina’s mother felt horrified and
slapped her. Nina grabs Lily and went to her room and yelled at her mother to leave her alone.
She turned around and look at Lily, then walked towards her and kissed her passionately. They
moved to the bed where Lily and Nina undressed each other then Lily ripped Nina’s panties. Lily
begins to orally pleasure Nina and she briefly saw Lily morph into herself and then back to Lily
which scares her. Lily didn’t stop and the two continue to have sex. The next morning, Nina
woke up with a hangover and headache and find Lily not around, then she realized she’s late for
rehearsal. Nine hurriedly went down and saw her mother in the living room. She yelled and
asked her mother why she didn’t wake her up. Her mother Erica answered that her role is
destroying her and as Nina rushed out the door, she told Erica that she is moving out.

At the studio, Nina asked Lily about what happened between them last night and asked
why she left her house. Lily answered that she went home with Tom and that the last time she
saw Nina was at the club. Lily teased her but Nina wondered if what happened last night, did it
happened or not. Later after, Nina was fitted for the Swan costume then Thomas told Nina that
Lily will be her alternate just in case. Enraged and afraid, Nina begged Thomas to not make Lily
her alternate. Thomas soothed her and told Nina that she’s being paranoid and that the only
person trying to steal or sabotage Nina is herself. That night, Nina practiced dancing when the
Piano Player stopped playing and got up and left. He told Nina that he has a life too and he told
Nina not to practice too long. As she begins dancing, the lights shut off then she called someone
to turn on the lights. Then she saw a cloaked figure darting around in the shadows just like the
Sorcerer from her dream. Nina hears laughter and follows the noise to find Thomas was having
sex with Lily on his work table behind a curtain. She saw that Lily smiles at Thomas and laughs.
This made Nina shed tears and runs over back to the dressing room where she grabs the items
she took from Beth. In a fit of hysteria, Nina went to the hospital to visit Beth and intended to
return the items she took. Nina arrives and quietly puts the items on the table next to Beth. Beth
suddenly grabbed Nina’s hand and asked why she stole her things. Nina said that she just wanted
to be perfect like her. Beth looked at the item and said that she was just nothing and continuously
said that she was nothing and then noticed the nail file. Beth grabs it and stabbed herself in the
face repeatedly. Nina grabbed the nail file from Beth’s hand and ran fearfully from the room to
the elevator. As she got inside the elevator, she dropped the bloody nail file. Then Nina returned
home, dashing hysterically in the kitchen to wash her hands which are covered with blood. When
she turned off the kitchen lights, she heard someone whispered “sweet girl”, then she turned back
the lights on where she saw Beth standing in front of her covered with blood. She ran to the
bathroom and vomits. Then she went to her mother’s art studio where she heard voices inside. As
she peered, she saw her mother’s paintings moving and talking to her. She also finds herself
transforming into some bird-like features, her eyes started to turn red and joints jot inverted same
as a bird. Her hallucinations disorient her and she falls that made her hit the head of the bedpost
which made her unconscious. Nina got severely disoriented and her behavior got worsen

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especially her treatment of her mother. The role made her pressured and her perfectionist
attitude, her obsession to be the best and perfect, her insecurities made her developed
psychological disorders. She even stabbed herself without even knowing that she did it to herself.
She just thought that she stabbed Lily and she just wanted to be the Swan Queen then have a
perfect performance.

CLINICAL IMPRESSION

Nina manifested symptoms of a psychotic disorder known as Schizophreniform Disorder

in which her diagnosis is comorbid with a personality disorder known as Borderline Personality
Disorder at a severe level of rapid onset symptoms at her first episode of psychosis based on the
criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM – V). Based on
the duration of the symptoms in the movie, it only takes seven days upon counting the day and
nights in the movie, so the diagnosis for Brief Psychotic Disorder may be considered when the
duration of the symptoms is less than one month.

The following are the evidence:

Nina’s Schizophreniform Disorder Symptoms:

A person commonly is diagnosed with this kind of disorder when the presence of 2 (or
more) of the symptoms is present for a significant portion of time during 1 month (or less if
successfully treated). An episode of the disorder lasts at least 1 month but less than 6 months;
when the diagnosis must be made without waiting for recovery, it should be qualified as
“provisional”. So, Nina’s case is under the provisional level for further observations and
evaluation if the disturbance persists beyond 6 months, the diagnosis should be changed to
Schizophrenia. The following are presently existing to Nina’s case based on the movie reviewed:

 Hallucinations – Visual and Auditory Hallucinations. Perception of a nonexistent event

or object and sensory experiences that are not caused by stimulation of the relevant
sensory organs. It involves hearing, seeing, feeling, smelling, or even tasting things that
are Not Real. In Nina’s case, she has visual and auditory hallucinations which she
experienced seeing a horrible moving image and hearing voices and sounds that have no
physical source. For example in the scene:
 During the official announcement party for her rise as Swan Queen, she
perceived blood and wound in her middle finger that made her went to the
bathroom and wash it many times until then she realized that there wasn’t a
wound and blood.
 Another scene where she perceived that she saw her confident evil version of
herself in public places and then another scene where she saw her dark side
image during she took a bath in the bathtub intensely looking at her and smiling.
 Then another scene where she perceived that she got an intense sexual activity
with Lily after they both went to the club and take prohibited drugs.
 Then another scene where she perceived that her reflection in the mirror is doing
scratching at her back even though she’s not doing it and another mirror
incidence where she perceived that her reflection is looking at her back and
another scene in the mirror where her reflection is not following her actions
during her intense practice.
 Then another scene where she saw Thomas and Lily having sex in the studio and
then Thomas turned into a black witch.
 Then another scene where she saw the bloody face of Beth looking at her and
laughing then another image of Beth walking toward her with a bloody face.
 Then another scene where she saw her mother’s paintings moving, hear crying,
and do horrible sounds.

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  Then another scene where she perceived that she was slowly turned into a swan,
where there is a small feather that grows at her back and her legs formed into a
swan-like figure of her legs and feet.
 Then another scene where she perceived that she stabbed Lily in the stomach and
it turned out that she did stab herself and she was the one who got badly hurt
without even knowing that she did it to herself.
 Then another scene, during her performance she perceived that she transformed
into a real curse black swan than made the audience praise her performance
because she danced perfectly as if it is real.
 Delusions – Nina has Mixed Delusions which she has obvious Grandiose and
Persecutory delusions. Mixed delusions have two types of delusions or more that meet
the criteria. Persecutory delusions where it is an experience when a person believed that
someone or a group of people wanted to hurt her/him even without proof, it is a form of
Paranoia. Grandiose delusions where it is an unusual belief about one’s greatness.
 Grandiose delusions had happened to Nina when she perceived that she was
transformed into a black swan.
 Persecutory delusions when Nina believed that Lily had hostile intentions and
wanted to harm her to take her place as the leading role for the performances. She
was trying to persuade the director to choose someone else to be her alternate but
she was unsuccessful.
 The disturbance is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition.
 With good prognostic features: This specifier requires the presence of at least
two of the following features:
The onset of prominent psychotic symptoms within 4 weeks of the first
noticeable change in usual behavior or functioning;
Confusion or perplexity:
Good premorbid social and occupational functioning;
and absence of blunted or flat affect.

Nina’s Borderline Personality Disorder Symptoms:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects,
and marked impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated that at least five of the diagnostic criteria is present and Nina has the following:

 A pattern of unstable and intense interpersonal relationships characterized by alternating

between extremes of idealization and devaluation. For example in the movie scenario:
 Idealization – Nina let her mother took off her dressed and undressed her clothes
even though she’s already 28 years old. Her mother prepares food for her and
there’s a scene in the movie where she eats a piece of the cake her mother
prepared for their celebration of Nina’s new role as Swan Queen. Even though
Nina doesn’t want to eat it but when she sees her mother is frustrated saying she
doesn’t want to eat it, she then took a little bit to please her mother.
 Devaluation – Nina didn’t listen and disobey her mother. Example scene when
her mother protest not to let her go out with Lily, then another scene when her
mother asked her to check her back if she’s been scratching but Nina answered
“No” and refused, and then another scene when her mother wanted to get inside
her room but she didn’t let her in until such time that her mother force to come
inside but Nina slams the door on her hand, crushing her mother’s hand.
 Identity disturbance: markedly and persistently unstable self-image or sense of self. Nina
perceived that she has become the Black Swan and Not Nina the sweet girl anymore.
Nina also showed of becoming attractive to a woman (to Lily with her sex scene) and a
man (she seems to like it when Thomas kiss and touch her).
 Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-

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 mutilating behavior covered in Criterion 5.) Nina has shown some signs for example in
the movie scenario:
 Nina steals Beth's things.
 Scratching her back.
 Nina does smoking with Lily in the dance hall and also Nina does use prohibited
drugs with Lily in the club.
 Nina did not eat the right amount of food for example when she was given food
by her mother, it showed in the movie that it was only 1 piece of boiled egg and
grapefruit for breakfast.
 Recurrent self-mutilating behavior. The above mentioned are a good example of Nina’s
self-mutilating behavior except the stealing of Beth’s things.
 Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights). For example in the movie scenario:
 Nina intentionally slams the door that made her mother’s hand being crushed by
the door.
 Nina aggressively gripped her mother’s injured hand.
 Nina shouted at her mother and told her mother that her sweet girl has gone.
 Nina got angry when Lily went to her room claiming her role as Black Swan and
fights with Lily until Nina perceived that she stabbed Lily and killed her.
 Nina got angry with Lily when Thomas was informed by Lily that Nina got a hard
time pursuing the role of the Black Swan. Lily just emphasized that she was just
concerned about Nina but Nina just said that she doesn’t need her help.

TREATMENT PLAN FOR NINA

Due to the patient’s current conditions with psychotic thoughts and personality
dysfunctions with a possibility of hurting herself, it is recommended that Nina should be
assessed immediately by a Psychiatrist and a Psychologist during her hospitalization to closely
monitor her case. It should be better for her to slowly quit her job as a ballerina for her to focus
on her recovery. A supportive environment with minimal stimulation is most helpful.

Note: A full medical exam and history will be done by a doctor to rule out a physical cause and,
if none is found, then mental health treatment begins.

The general aims are as follows:

To protect and secure Nina from hurting herself or other people or her mother.
Nina showed that she’s capable of hurting herself and her mother and other people like
Lily based on the movie, she has no idea that she had stabbed herself instead of Lily.
Another scene when she slammed the door caused her mother’s hand to get crushed even
though Nina consciously knows that her mother’s hand was there. So her anger is
obviously out of control that can cause her to harm other people and herself. The goal is
to prevent her from hurting herself and the other people that surround her. Better to
hospitalized her until she is stabilized.
To minimize Nina’s Psychosocial impact. Nina’s role as the Swan Queen made her
pressured and her aim for perfection made it worst. The environment and the people that
surrounded her added negative effects in her case. So, the aim here is to help her realized
that every person is not perfect including her even though her stage may have limited
exploration or idea about her diagnosis and may be in denial. So, the focus here is to
eliminate and formulate a strong family support system. Since Nina’s immediate family
is only her Mother. It might be better if her colleague ballerinas will show support to her
and understand her situation especially the director Thomas.
To find a solution and solve Nina’s target symptoms with minimal adverse effects.
Nina showed several symptoms that pointed it to two major disorders, Schizophreniform
Disorder and Borderline Personality Disorder. In her case, it did not mention that her
hallucinations, delusions, and other symptoms take for more than six months which will

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 supposedly be developed as Schizophrenia but since it only occurs for less than a month,
so the diagnosis will be Schizophreniform Disorder. But it is still under provisional level
if it will take more than six months before she will recover or still be an ongoing disorder
for more than six months then the diagnosis will now be developed as Schizophrenia. The
aim here is to treat and manage her diagnosis before it will get worse since it is still her
first onset episode of psychosis. Then another disorder is Borderline Personality
Disorder which made it difficult for her to deal with. So, to fully help her she will
undergo several therapies and careful medications with licensed professionals in the field.

Therapies that Nina will undergo are as follows:

PSYCHOTHERAPY
 Cognitive–Behavioral Therapy. A type of counseling and most common therapy used to
treat Schizophrenia-related disorders. The goal for this therapy is to help Nina recognize
and learn about the illness and its treatment, we will set goals, guide her to manage her
everyday problems related to the condition. To help Nina handle her distress linked to the
symptoms. The CBT is recommended for Nina to take it 30 minutes to 60 minutes once a
week for 12 to 16 weeks until she will be stabilized.

 Cognitive Remediation Therapy – This therapy is a set of techniques designed to teach

thinking skills and can be thought of as a form of cognitive rehabilitation. It involves
training in a set of tasks designed to improve cognitive abilities and social functioning.

 Family and Social Vocational Therapy – It is helpful for Nina and her mother Erica to
effectively deal with Nina’s conditions. Her mother will be informed and will be mindful
of the things that can trigger Nina’s diagnosis so that they can prevent it from getting
worse.

 Psychoeducation – This is an intervention with systematic, structured, and didactic

knowledge transfer for an illness and its treatment, integrating emotional and
motivational aspects to enable patients to cope with the illness and to improve its
treatment adherence and efficacy.

Pharmacotherapy -

SUMMARY AND RECOMMENDATIONS

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