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Schizophrenia and Eating Disorders in Black Swan

Darren Aronovsky’s 2010 film Black Swan centers around a dedicated, obsessive ballerina named Nina Sayers. The film’s entire conceit, and the story arc of its lead, are based around psychosis and duality, just like the Swan Lake ballet that the characters carry out. While it’s never stated outright, Nina displays symptoms of schizophrenia and eating disorders like bulimia and anorexia. For what it’s worth, the movie never seems as concerned with any kind of message as much as it is with its premise, its imagery, and its build- which place its depictions of mental illness on brightly-lit center stage.

In the film, Nina (Natalie Portman) lives on the Upper East Side of New York City with her mother Erica (Barbara Hershey), herself a former ballerina. There is no mention of any further relatives, and the only concrete information we know about her mother’s career is that she never left the dance corps before quitting to raise Nina at age twenty-eight. Her relationship with her mother is always filtered through her complete dedication to dance- her mother undresses her when she gets home, refuses to give Nina privacy, and herself displays, on multiple occasions, harsh mood swings.

Her mother also reveals that Nina has a history of scratching herself, providing the viewer with the crucial context that what they’re about to see didn’t come out of nowhere. Nina is constantly seen picking at her skin and discovering scratches on her back, even though we never see her actually inflicting them until near the climax of the film.

The production of Tchaikovsky’s Swan Lake that the story follows is an unprecedented one- the roles of the innocent, incorruptible White Swan and the chaotic, sensual Black Swan are to be performed by the same dancer. Director Thomas Leroy (Vincent Cassel) makes it clear to Nina that he doesn’t see in her the darkness or abandon necessary to play the Black Swan- that is until they begin an arguably predatory relationship behind the scenes, and Nina is pitted against an edgy newcomer named only as Lily (Mila Kunis).

Nina is elated to find that she has gotten the part of both swans, but as the grueling rehearsals for the show drag on, she starts to lose her grip on reality. Her relationship with her mother grows more and more volatile, she does ecstasy with Lily, and she begins to hallucinate. Her visions usually involve seeing Lily as her own doppelganger, or injuries she inflicts upon herself. Everything comes to a head the night of the first show, as she seemingly murders Lily to embrace and become the Black Swan. Finally, just like the White Swan, she dies by her own hand at the end of the show.

The film’s escalation is very steady, and can be marked best by Nina’s hallucinations as they increase in length, frequency, and severity. They come in two different forms- visual (though these are usually accompanied by a non-diegetic audio cue) and auditory. A 2016 study by the University of Chicago at Illinois supports an assertion that Nina suffers from schizophrenia rather than a possible bipolar disorder like her mother:

In the present study, participants with schizophrenia reported significantly more auditory verbal hallucinations (AVHs) than did participants with bipolar disorder with psychosis. This is consistent with previous research indicating that the prevalence of hallucinations among hospitalized psychiatric participants was highest among participants with schizophrenia, relative to participants with bipolar disorder and participants with major depression.

The same article further compounds the theory by finding the same correlation the other way around, by observing the diagnoses of patients that had experienced a fully formed auditory hallucination in the past seven days:

Of these 76 participants with present-state psychosis, 53 (33 male) were diagnosed with schizophrenia, and 23 (11 male) were diagnosed with psychotic bipolar disorder.

Other symptoms of schizophrenia include delusions (such as Nina’s unfounded paranoia that Lily is out to sabotage her) and agitated movements. It could be argued that her scratching and picking habits, which could be seen as symptoms of anxiety, are actually a further manifestation of her schizophrenia, especially when they tie into a visual hallucination of blood and ripped skin.

The portrayal of Nina’s specific auditory hallucinations, which most notably include the rustling of feathers and a voice saying “sweet girl”, are in line with the cognitive model of auditory hallucinations summarized by a Spanish study from earlier this year:

The ‘cognitive’ model maintains that they are due to a failure to recognize internal, non-perceptual stimuli – for example, inner speech, mental imagery or intrusive memories – as being self-generated.

The phrase “sweet girl” carries a lot of baggage for Nina- it represents the person she was before Swan Lake as well as the current White Swan, who was dedicated to technical perfection and accepted her mother’s overbearing behavior. They are presented as self-generated and can occur at any time, more tied to the preceding circumstances than any actual auditory stimuli. Whether or not the cognitive model is more scientifically sound than the alternate neurological model, it seems to be the one that Black Swan bases its representation on.

Finally, Nina is shown frequently vomiting after eating and taking extremely small meals, i.e. half of a grapefruit for breakfast. When she lands the lead role in Swan Lake, her mother surprises her with a cake, and a brief but intense argument ensues about the size of Nina’s piece, and her compulsions are seemingly rewarded when a costume designer observes that she has lost weight. Anorexia (self-starvation) and bulimia (binging and purging) can certainly be classified as their own illnesses, but there does exist a connection between these eating disorders and schizophrenia. A study published in Psychiatry Research, titled Features of schizophrenia following premorbid eating disorders, came to these three conclusions in August 2019:

• Ten percent of schizophrenia cases in a large case series met criteria for premorbid eating disorders (ED).

• Cases with premorbid ED may constitute a distinct subtype of schizophrenia.

• Premorbid eating disorders should be considered as a feature for psychosis risk in prodromal schizophrenia.

Eating disorders have always been prevalent in the dance world, and it’s possible that Nina still would have suffered from them without the impetus of Swan Lake, her psychosis, or Lily, but Aronofsky presents them in much the same way- deeply intertwined with the progression of the story and with each other. It’s no coincidence that Lily, whom Nina temporarily sees as the evil Black Swan, is seen ordering an extra bloody hamburger at a club while Nina eats nothing. As her visions grow more involved and disturbing, so do her fasting and vomiting, supporting the theory that her psychosis and eating disorders are all part of one mental illness.

While Black Swan never seems to make any kind of overarching statement about mental illness or the way that anyone but Nina is treated, and its portrayals of these symptoms are poetic and dramatic, its representations seem consistent and accurate. Tied in with its unique story, dynamic visuals, and performances, it stands as a culturally significant depiction of eating disorders, schizophrenia, and their relationship.

 Works Cited

Jenkins, Lisanne M., et al. “Working Memory Predicts Presence of Auditory Verbal

Hallucinations in Schizophrenia and Bipolar Disorder with Psychosis.” Journal of Clinical and Experimental Neuropsychology, vol. 40, no. 1, Jan. 2018, pp. 84–94. EBSCOhost, doi:10.1080/13803395.2017.1321106.

Fuentes-Claramonte, Paola, et al. “The Interfering Effects of Frequent Auditory Verbal

Hallucinations on Shadowing Performance in Schizophrenia.” Schizophrenia Research, vol. 208, June 2019, pp. 488–489. EBSCOhost, doi:10.1016/j.schres.2019.01.019.

Malaspina, Dolores, et al. “Features of Schizophrenia Following Premorbid Eating

Disorders.” Psychiatry Research, vol. 278, Aug. 2019, pp. 275–280. EBSCOhost, doi:10.1016/j.psychres.2019.06.035.

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