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Director Calin Peter Netzer, a member of Romania's renowned new wave in film-making, told the story of a wealthy and controlling mother who fights to get her son acquitted after he kills a poor teenager with his car.
"I want to thank the jury for this amazing prize, this wonderful prize," Netzer, 37, told the panel led by Chinese director Wong Kar Wai, adding later at a press conference that he was "shellshocked" by the honour.
The Berlinale, the first major European film festival of the year and typically its most politically minded, handed two prizes to the Bosnian docu-drama "An Episode in the Life of an Iron Picker".
Nazif Mujic, the real-life protagonist of the picture about a Roma couple denied life-saving medical treatment, was the surprise winner of the Silver Bear best actor prize.
The ultra-low-budget film also took the runner-up jury prize.
Its director Danis Tanovic, who won an Oscar for his 2001 wartime black comedy "No Man's Land", said his anger after reading news reports about the couple led him to seek them out.
"I'm so happy for Nazif and his family because the whole point of this film was to try and change their lives and I hope it changes their lives," he told reporters.
Berlin daily Der Tagesspiegel hailed "worthy" winners in what it described as a disappointing competition.
The Golden Bear for Netzer "reflects not only the relatively strong showing of eastern European directors this year but also the political nature of the festival", which got its start during the Cold War, it said.
"17,000 euros and amateur actors are enough to beat the arthouse productions with budgets in the millions at a major film festival when a moving story is told well and beautifully," the website of Der Spiegel news weekly said, referring to the meagre budget of the Bosnian film.
"That is the message this Berlinale jury is sending to all the film-makers from eastern Europe, a region often ignored by Cannes and Venice, whose citizens are struggling with the social upheaval of post-communism."
--- A thinker and a poet --
David Gordon Green picked up the Silver Bear best director award for his quirky US buddy picture "Prince Avalanche", a remake of the 2011 Icelandic film "Either Way".
The movie, the only comedy among the 19 contenders at the festival, stars Paul Rudd and Emile Hirsch as highway maintenance workers in Texas at crossroads in their lives.
Best actress went to Chile's Paulina Garcia for "Gloria", a feel-good movie about a middle-aged divorcee who refuses to give up on a shot at happiness.
Best screenplay went to "Closed Curtain" by Iranian dissident director Jafar Panahi and his longtime collaborator Kambuzia Partovi, a film made in secret in defiance of a ban by Tehran authorities.
"It is impossible to stop a thinker and a poet. Their thoughts bear fruit everywhere," Partovi said, accepting the award because Panahi was not granted permission to travel.
"Child's Pose" figured in a particularly strong year for films exposing new fissures and rampant corruption in the former communist bloc.
Lead actress Luminita Gheorghiu, best known for the 2005 dark comedy "The Death of Mr Lazarescu", dazzled movie-goers as a manipulative mother who sees the fatal accident as a chance to reconnect with her estranged son.
In spite of triumphs like the 2007 Cannes Palme d'Or for Cristian Mungiu's chilling drama "4 Months, 3 Weeks and 2 Days", "Child's Pose" producer Ada Solomon said Romanian cinema needed the boost the Golden Bear would offer.
"I think that Romanian politicians should pay much more attention to the ambassador that our cinema is around the world," she said, slamming subsidy cuts.
"I want to thank those people who didn't help us and didn't support us and that made us more determined."