The movie Black Swan remains one of the most iconic and highly acclaimed film of 2010. Based on a ballet play of the same name by Pyotr Tchaikovsky, it is a psychological thriller starring academy award-winning actress Natalie Portman who plays the role of Nina Sayers.

Portman’s character is a shy and repressed ballet dancer who is given wants to play the lead role in Tchaikovsky’s “Swan Lake”, a role that requires her to play both the black and white swan.

As the movie progresses, we see Nina Sayers shed her sweet and shy persona and embrace her dark side to immerse herself in the role of the black swan fully, but this comes with a cost.

Throughout the movie, we see the protagonist struggle with a wide range of mental illnesses such as bulimia, OCD, and schizophrenia as she slowly loses touch with reality.  Psychosis is used to describe the conditions that affect your thought process and cause you to lose touch with reality.

Psychosis is more than a break from reality; it is characterized by disruptions in the way your brain processes information and makes it difficult to ascertain is real and what is not. Psychosis is not a disease; it is a symptom of an illness and can be caused by a variety of triggers.

While the film, Black Swan, has been criticized for taking liberties in depicting bulimia, anorexia, and schizophrenia – most of which would not usually appear together, it was said to present a reasonable depiction of psychosis. People who have psychosis may often experience hallucinations, delusions, or both.

Types of Psychosis

  • Substance-induced psychosis or toxic psychosis commonly associated with drug abuse and withdrawal symptoms
  • Brief reactive psychosis occurs when a patient is going through an extremely stressful situation, such as the loss of a loved one.
  • Brief psychotic disorder
  • Menstrual psychosis
  • Manic-depressive psychosis that occurs in the manic phase of bipolar disorder.
  • Postpartum psychosis associated with childbirth
  • Psychotic break
  • Shared Psychosis

Signs and Symptoms of Psychosis

The two significant symptoms of psychosis are;


These are sensory perceptions or experiences that occur in the absence of external stimuli. Hallucinations differ from illusions.

Hallucinations typically involve seeing or hearing things that are not there; illusions, however, is the distortion of the perception of external stimuli. Hallucinations affect the senses and take on any form.

Experiences may consist of simple sensations such as sound, taste, and smell and become more complex such as interacting with people and animal who are not there and hearing voices. Auditory hallucinations are the most common characteristic of a psychotic episode.


These, on the other hand, are intense and unrelenting beliefs held by the person suffering from a psychotic episode. These beliefs are not in line with the surrounding context or culture and are contradicted by reality and what is commonly believed to be true.

They could be delusions of grandeur, paranoia, or somatic delusions. People who have delusions of paranoia may think they’re being followed or watched by government agents, demons or aliens (they usually aren’t), or that someone is sending secret messages to them.

Delusions of grandeur involve an exaggerated sense of self-importance, believing they have superpowers or unique abilities or believing they are responsible for negative events such as an earthquake. While somatic delusion is the belief that the body is abnormal and diseased even if the person is healthy.

Other symptoms of psychosis include;

  • Insomnia
  • Anxiety
  • Distorted perception
  • Obsessive thinking
  • A significant drop in grades or job performance
  • Withdrawal from friends and family
  • General lack of hygiene
  • Decreased motivation
  • Inability to feel pleasure
  • Reduced spontaneity

Causes of Psychosis

Cases of psychosis vary from one patient to another, and the cause sometimes is not always clear. However, certain situations can trigger a psychotic episode, and illnesses can cause psychosis.

Triggers include drugs, emotional trauma, and environmental conditions. Young adults and teenagers are more at risk of experiencing a psychotic episode due to hormonal changes in their brain during puberty.

The following factors contribute to psychosis:


Whether psychological, emotional, or physical, trauma has been linked increased risk of experiencing a psychotic episode.

Trauma such as the loss of a loved one, war, a blow to the head, or sexual assault may trigger a psychotic episode. Most importantly, studies have shown that childhood trauma may increase the risk of teenage and adult psychosis.

Medical conditions

A large number of medical conditions may trigger psychosis. Examples include degenerative disease that affects the brain, such as Parkinson ’s disease, Alzheimer disease, and dementia.

Infections such as malaria, HIV/AIDS, and syphilis can also cause psychosis. Sleep disorders like narcolepsy, endocrine diseases such as hypothyroidism and hyperthyroidism, metabolic disorders like hyperglycemia are all medical conditions that can cause psychosis.

Mental illness

Psychosis is often a symptom of an existing mental disorder. The Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) lists the following as psychotic disorders:

Psychotic symptoms may also be observed in post-traumatic stress disorder (PTSD), dissociative disorder, and sometimes in obsessive-compulsive disorder.

Psychoactive substance

Substances that alter one’s mental state like alcohol, cocaine, psychedelic drugs, and marijuana have long since been shown to aggravate psychosis in its users in varying degrees.

Hallucinogenic drugs like LSD may cause the user to see or hear things that are not there. Substances like alcohol and heroin can cause the user to experience psychosis during intoxication and withdrawal.

Diagnosis of Psychosis

The diagnosis of psychosis would be performed by a psychiatrist after all possible causes have been excluded. The initial test for psychosis would be performed by a general practitioner would include a comprehensive medical history and family background.

The tests would be done to exclude possible causes like medical conditions, substance use, toxins, and medications.

Brain scans may be performed to check for other conditions like tumors so they can be ruled out. Electroencephalography (EEG) records the brain’s electrical activity and helps to rule head injury, delirium, epilepsy, or stroke. When mental illness is determined to be the cause, treatment can begin.

Treatment of Psychosis

Treatment of psychosis depends on particular diagnoses (schizophrenia, substance use, or medical condition) and may involve a combination of therapy and medication. Medication usually involves the use of antipsychotic drugs and tranquilizers.

Rapid tranquilization is necessary in cases where the psychotic person becomes a danger to themselves and others. Antipsychotic medication help reduce the symptoms of psychosis, such as hallucinations and delusions. Medication is tailored specifically to the root cause of the psychosis.

Counseling and cognitive behavioral therapy are other means of treating psychosis. It involves regular meetings with mental health therapists and counselors with the aim of changing thinking and certain behaviors.

Living with a Psychotic Illness

There is a strong stigma associated with people living with psychotic illness. This negative perception may be due to depictions of mental illness in mainstream media and films. Characters with mental illness in films are usually of a violent disposition. This stereotype makes people react fearfully when they encounter someone with a mental illness.

Stigma, of any kind, hurts. Therefore it is crucial that you, as a loved one of someone living with a psychotic ailment, educate yourself about mental illness and protect yourself and loved one from the negative perceptions of psychosis.