Joker medical condition

Did Pseudobulbar Affect Cause the Joker’s Laughing Condition?

Joaquin Phoenix’s jarring and raw rendition of the title character in the 2019 film, Joker, is most known for the character’s uncontrollable and creepy laughing condition. Laughing when made to feel uncomfortable, crying tears of sadness when seemingly happy, and breaking into a classical ballet-esque dance after a traumatic and fatal altercation. Is this Hollywood or is there some truth to such an affliction? As it turns out, there exists a condition known in medicine as pseudobulbar affect. But did the movie get it right?

Unlike previous Batman-related films, this picture focused less on the struggle between “good and evil,” with the trite and familiar trope of the heroic character coming to save the day from the supervillain. Instead, the film delved deep into the struggle that is within us all, the very human concept of profound strife. Joker tells the story of a man down on his luck battling his lot in life, his environment, and his obstacles, but also something more – mental illness. The movie highlights the failure of our public systems to help those with psychological illness. Yet, there is more to the brilliant portrayal of the title character, Mr. Fleck – a malady manifested by outbursts of inappropriate emotion. 

Neurology Question Bank Sample Question

Before we dive into the details of pseudobulbar affect, test your knowledge by answering the following practice question from the BoardVitals Neurology Board Exam Question Bank. The answer and explanation can be found at the end of this article:

A 45-year-old female with relapsing-remitting multiple sclerosis presents for a routine neurological follow-up. She discloses that over the last several months she has been increasingly bothered by extreme emotional lability, sometimes laughing at inappropriate times when she does not even feel happy or joyful. She is very bothered by these symptoms and worries about the way they may affect her occupational and social life. She asks if there are any approved medications for treating these emotional symptoms. What do you prescribe for this patient?

A. Corticosteroids

B. Benzodiazepines

C. Dextromethorphan and quinidine

D. Dalfampridine

What is Pseudobulbar Affect?

The condition known as pseudobulbar affect (PBA) is characterized by brief uncontrollable outbursts of crying or laughter that are incongruent with the patient’s feelings of sadness or joy. 

Also known as emotional lability disorder or involuntary emotional expression disorder, PBA is caused by the disruption of neural pathways between the centers of emotional control in the frontal lobe and reflex centers in the brain stem, resulting in involuntary episodes of anger, laughter, or tears. The episodes are stereotypical and although they may be completely inappropriate responses to an emotional trigger, they may simply be an exaggeration of an appropriate response. In cases where the emotional response is not inconsistent with the individual’s mood, the degree of the emotional response is disproportionate.

PBA occurs as a result of structural changes in the brain in patients with dementia, stroke, Parkinson’s disease, traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Wilson’s disease, and tumor. PBA has also been related to lesions of the cerebellum. Studies suggest that in addition to modulation of motor function, pathways from the cortex to the pons to the cerebellum also modulate cognitive and affective function.

PBA is often mistaken for psychiatric conditions, including depression and bipolar disorder. Although pseudobulbar affect is a neurological disorder, up to 35% of patients with PBA have comorbid depression. The outbursts result in patient discomfort and embarrassment that often leads to restriction of activity and social interactions. PBA is distinguished from depression by brief episodes and the absence of sleep disturbance, loss of appetite, or other neurovegetative features of depression.

Who is at Risk for Pseudobulbar Affect and is it Hereditary?

The prevalence of PBA in the general population is unknown, but among patients with specific neurological conditions, including ALS, MS, Alzheimer’s disease, stroke, Parkinson’s disease, and traumatic brain injury, prevalence is estimated at 9. 4% to 37.5%, depending upon criteria used for diagnosis. The prevalence among nursing home residents is estimated at 9%. PBA has not been linked to heritable genetic mutations. 

What is the Pathogenesis of Pseudobulbar Affect? 

Although the pathogenesis of PBA is not clear, it is hypothesized that the cerebellum acts as a modulator for the motor element of emotions, receiving and modulating direct input from the motor cortex, frontal cortex, and temporal cortex. The motor input is normally inhibited by cortical somatosensory input and disruption of these pathways results in disinhibition and inappropriate emotional expression. The primary neurotransmitters involved in PBA are serotonin and glutamate.

Can PBA be Treated?

The first-line treatment is selective serotonin reuptake inhibitors. Tricyclic antidepressants can also be effective due to serotonergic and noradrenergic effects. Recent studies show dextromethorphan-quinidine is safe and effective for the treatment of the disorder.  

So did Joaquin Phoenix’s rendition of the Joker get the condition right?

In my opinion, as evidenced by the numerous scenes of his character laughing uproariously when in situations of discomfort or fear, it would appear that Mr. Fleck (aka the Joker) did indeed suffer from PBA. That said, however, Hollywood definitely embellished his presentation. For example, his hyperbolic ballet dance after a trauma would not seem to be explained solely or at all by PBA. Additionally, while it would appear Mr. Fleck may also be suffering from another occult psychiatric condition, he did not exhibit any obvious signs of ALS, MS, Alzheimer’s disease, stroke, or Parkinson’s disease – diseases which we know have been seen to be associated with PBA.

Neurology Board Exam Question Answer & Explanation

Here’s the answer and explanation to the BoardVitals Neurology board review practice question above:

Correct Answer:

C. Dextromethorphan and quinidine

This woman is suffering from pseudobulbar affect (PBA), which is characterized by involuntary displays of crying and or laughing often without accompanying inner feelings of sadness or joy. The emotional displays are out of proportion to or incongruent with a person’s internal emotional state, are often uncontrollable, and can be very distressing for patients and their caregivers. PBA is less commonly known as involuntary emotional expression disorder. The prevalence of PBA in multiple sclerosis (MS) is estimated between 7-10%, although it also occurs in other neurological conditions. A combination capsule of dextromethorphan and quinidine (known by the trade name Nuedexta) was shown to be effective in several randomized controlled trials of PBA (including on specific to MS cited below) and was granted FDA approval for PBA in 2010. The recommended starting dose for dextromethorphan/quinidine is a single 20 mg/10 mg capsule daily for 7 days, after which patients usually increase to the maintenance dose of a 20 mg/10 mg capsule every 12 hours.

Incorrect Answers:

A. Corticosteroids are used for treating relapses in multiple sclerosis. It is quite unlikely that this patient’s subacute (several months) somewhat progressive symptoms signify a new relapse or indicate new disease activity. Furthermore, steroids can exacerbate emotional lability. Therefore, steroids would not be the treatment of choice for this woman’s PBA.

B. Benzodiazepines are used primarily for treating anxiety disorders, which this patient does not have. Although they could be used off-label for treating PBA, they are not approved for this indication, have considerable side effects, and also carry substantial abuse potential.

D. Dalfampridine (known by the trade name of Ampyra) is a potassium channel blocker that is FDA-approved to improve walking speed in persons with MS. It would not be expected to improve PBA symptoms.

Want more free practice questions to help you study for your board certification exam? Sign up for a free trial of any BoardVitals question bank today!

Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: prevalence and management.
Therapeutics and clinical risk management, 9, 483–489.
Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and Neurobehavioral Correlates of Pathological Laughing and Crying in Multiple Sclerosis. Arch Neurol. 1997;54(9):1116–1121.
Fitzgerald K, et al. Prevalence and Characteristics of the Pseudobulbar Affect in a Large Population of People with Multiple Sclerosis (p1.425). Neurology Apr 2018;90(15):P1.425.
Foley, K., Konetzka, R. T., Bunin, A., & Yonan, C. (2016). Prevalence of pseudobulbar affect symptoms and clinical correlates in nursing home residents.
International journal of geriatric psychiatry, 31(7), 694–701.
Panitch HS, et al. (2006), Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 59:780-787.

Is the Joker's Laughing Condition Real?

  • Todd Phillips's Joker stars Joaquin Phoenix as the iconic DC villain.
  • The Golden Globes-nominated film places focus on the Joker's under-treated mental illness.
  • But is the Joker's laughing condition a disorder that affects people in real life?

The movies of the official DC extended universe—Aquaman, Justice League, and Suicide Squad, to name a few—chose to reintroduce their best-known comic book characters via slick, CGI-budget-busting blockbusters. But Joker, Todd Phillips's 2019 film starring Joaquin Phoenix, ran in the opposite direction, earning fan praise and award nominations for its gritty portrayal of how a loner named Arthur Fleck became the man who'd one day face off against Batman.

Though mental illness and Gotham City's lack of adequate resources can't be fully blamed for Fleck's eventual descent into violence, Phillips does make a point of showing how isolating Fleck's struggles become without support. In a scene that finds his social worker informing him that the funding for his treatment program has been cut off, she doesn't mince words: "They don't give a s--- about people like you, Arthur. " Fleck is forced to be his own advocate, and carries a card that fails to reassure the strangers who scowl at his behavior. "Forgive my laughter," it reads. "I have a condition."

While Joker doesn't name Fleck's condition, nor any of the mental illnesses he's been medicated for, there is a real disorder that can cause fits of uncontrollable laughter. And tears.

The real laughing disorder is called the Pseudobulbar Affect.

According to the Mayo Clinic, "Pseudobulbar affect (PBA) is a condition that's characterized by episodes of sudden uncontrollable and inappropriate laughing or crying." Echoing the language on the Joker's laminated card, PBA can indeed occur in people with brain injuries, stroke, or certain neurological conditions such as ALS or multiple sclerosis. Though more research is needed regarding the causes of PBA, it "involves a disconnect between the frontal lobe (which controls emotions) and the cerebellum and brainstem (where reflexes are mediated)," per the American Stroke Association. Those who experience PBA don't necessarily feel emotions like sadness or amusement more intensely; it's more about their brains' inability to regulate when and how those emotions are expressed.

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When someone's experiencing pseudobulbar affect, uncontrollable laughter can bubble up during an inappropriate or outright sad moment. Or an innocuous conversation can trigger a crying jag that, to outside observers, seems to come out of nowhere. Given that these involuntary outbursts can last from seconds to several minutes at a time, PBA can feel profoundly alienating for the person living with it. "Severe symptoms of pseudobulbar affect (PBA) can cause embarrassment, social isolation, anxiety and depression," the Mayo Clinic writes.

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Joaquin Phoenix doesn't think the Joker suffers from the pseudobulbar affect.

The actor told Movieline that he developed his own theories about his character's "affliction" while shooting the film.

"I question if that’s really what he has,” he said of the pseudobulbar affect. “It’s one of those examples of something I didn’t want to answer." Though Phoenix initially played Arthur Fleck as having PBA, he decided something else may be at play. "I thought of the movie as a commentary on humor in our PC culture. Somebody who was out of touch with the world, laughing at school at something horrible that has happened," he continued. "How to explain that to the principal? I never decided which one it was, but I liked the idea that it was perhaps his real nature emerging that other people were trying to suppress."

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However, Movieline points out that director and co-writer Todd Phillips did take pseudobulbar affect as inspiration for Arthur Fleck's behavior—going so far as to show Phoenix a video of someone with PBA the first time they met about the film.

Fortunately, the "laughing disorder" is treatable.

People experiencing PBA are often misdiagnosed with depression, says the American Stroke Association, because...well, because of all the crying, mainly. According to the organization, the condition has been treated with antidepressants but that "may be only moderately successful." Instead, the ASA offers a list of coping techniques that range from deep breathing and change of posture during an episode to remaining "open about the problem so people aren’t surprised or confused when you have an episode." Which, of course, is what the Joker was attempting to do with the card he presented on the bus.

As with any sharp shift in mood or mood regulation, the most important thing to do is talk to a professional as soon as possible.

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Samantha Vincenty

Senior Staff Writer

Samantha Vincenty is the former senior staff writer at Oprah Daily.  

This content is imported from OpenWeb. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

Joker. Psychological Review - Movies & Series on DTF


I'm not going to disassemble the acting game, staging the frame. Let's leave that to other film reviewers. Here - solely an attempt to get into the head of the most famous movie villain of the DC Universe, embodied by Joaquin Phoenix in 2019.

PS. I do not pretend to be the ultimate truth. As they say, I am a couch psychologist, I see it that way.

!!! Spoilers!!! I have them!!!

First Look

How does Arthur Fleck appear before us in the first half of the film?

We see a deeply unhappy, insecure character forcibly stretching his lips into a happy smile. He is infantile, shy, unable to stand up for himself. His movements are comically ridiculous. He smokes one cigarette after another. In moments of severe stress, an involuntary tremor of the limbs is manifested. And laughter. Oh that laugh. I will return to this topic a little later.

From a conversation with a social worker, we learn that he has already been a client of a psychiatric clinic more than once. He complains of feeling unwell, “negative thoughts.” He appears before us in a state of severe, clinical depression, his suicidal tendencies are obvious even to a non-specialist. does not receive an adequate response.

When we are faced with depression, frustration? Generally speaking, this is a state when our expectations do not coincide with the real picture of the world. What expectations of Arthur Fleck turned out to be unfulfilled? Let's figure it out.


The first minutes of the film eloquently describe Arthur's whole life - being a kind and good-natured person, he sincerely tries to amuse and bring joy to people, and in return receives only anger and cruelty.

Artur works as a funny clown animator in a small entertainment agency. It is curious that the clown, in one of its meanings, is not only an artist of the clownery genre, but also a “laughing mark” - an object of bullying and humiliation. Such is the future prince of the underworld.

At work, colleagues do not have much respect for him - they are afraid of him, they consider him strange. The boss is absolutely intolerant of him. When one of his colleagues gives Arthur a gun (a real "Chekhov's gun"), a logical question arises about the sincerity of his intentions - did he sincerely try to help Arthur or wanted to bring a colleague objectionable to the team to a prison term, giving a deadly weapon with real, live ammunition to a person with pronounced deviations?

The only person who warmly relates to Arthur Fleck is his undersized colleague, who is also noticeably different from the others, and is also bullied because of his features. But they are not close and almost do not communicate with each other.

It is curious that children are actually the only characters in the film who do not show aggression towards the eternally laughing eccentric, they do not hang labels and openly perceive the world, thereby liberating Arthur, allowing him to express himself and show emotions without fear, show them speeches.

During and after work, he encounters aggression and rejection from people who are completely unfamiliar - bystanders, fellow travelers in the subway, marginalized teenagers. After work - goes home, to the society of an unhealthy elderly mother.

So, day after day, being in an aggressive environment for himself, he lives his life. Society rejects him, because people try to avoid strange people, so different from them. “The worst thing about mental illness is that people expect you to act like you don't have it,” he writes in his diary.

But Artur does not give up - he regularly visits the social worker, takes medication, keeps the aforementioned diary. He tries to fight his devils, does not want to be different from others, passionately craves love and recognition. In the absence of real ones, ephemeral ones will do.

That is why he instantly becomes emotionally attached to his neighbor, who smiled politely but sincerely at him in the elevator. After all, she is the only one who "noticed" him, showed a grain of warmth, without condemnation and mockery.

As we can see, although negative, but still reaction, Arthur regularly receives from society. What is Arthur talking about, subsequently shouting more than once that no one notices him?


The roots of problems always come from childhood. The hero's childhood is revealed to both us and Arthur at the same time through Arkham's medical notes on his mother.

From the memoirs we learn the tragic story of little Arthur Fleck.

He grows up in the company of a mentally ill mother and (at least for a while) her sadistic roommate. He is regularly subjected to severe beatings and humiliation on the part of the latter and complete indifference, tacit consent to what is happening on the part of the mother.

He grows up, becoming a victim who is unable to fight back his offenders. He cannot escape from personal hell, he is not even able to express sincere feelings about what is happening, therefore, he drags learned helplessness with him in the future through the years. An interesting fact is that in the future, Arthur displaces painful memories of childhood from his psyche, not returning to them, but again raising them from the recesses of memory only when reading Penny's anamnesis.

Decades later, Penny's indifference to her son continues. They still do not have a trusting and warm relationship, even if Arthur tries to build them. She prefers to ignore Arthur's obvious problems, her only focus being her own letters to her former employer. When Arthur shares his joy that he had a date, but she ignores it, when he talks about his ultimate dream of being a comedian, she gently stomps on her, planting a seed of doubt in him. “Where did you get what you can do?” she asks in an innocent voice.

She refuses to accept reality. “He never cried, he was always a cheerful and joyful boy,” she says of her downtrodden, beaten, bullied child by her stepfather, when asked why Arthur was found beaten and chained to a radiator. “My joy,” she calls her always gloomy son. And don't let the sight of "God's dandelion" deceive you - Penny Fleck continues to be a latent sadist.

We perceive the first half of the film as the Joker's mother through the prism of Arthur's perception of her - she is a sick elderly woman whom he must take care of, whom he must not upset. He practically spoon-feeds her, bathes her in the bathroom, carries her in his arms, and therefore we have the complete impression that Penny is paralyzed from the waist down. But in the dance scene, we see that this is not at all the case - she is able to move on her own, and she is not that old either (assuming that Arthur is a little over 30 years old at the time of the story, then she should not be more than 65- ti). Why does a man who is able to look after himself allow his son to completely serve himself and his needs?

Whether the adopted child is Arthur or the natural son of Penny Fleck and Thomas Wayne, there is no direct answer in the film, there are arguments in favor of both versions. And therefore, whether Arthur's disease is of an organic nature - and is the result of a brain injury, genetically transmitted from a mentally ill mother, or became a deplorable result of childhood psychotrauma (or maybe it's a combination of all factors) - is also an open question.

Fantasies and main dream

One way or another, being unable to break through the iron curtain of his mother's alienation, thereby losing the support of his own person, not having a clear example of his father's figure, an example to follow, Arthur is forced to dive into the world of his fantasies, embodying an ideal picture in them world, making up for their unfulfilled desires in reality.

It is almost physically painful to watch the future Joker's fantasy of performing on his favorite TV show - the unsatisfied need of Arthur's inner child for love and recognition from the father figure in the face of the presenter is so clearly conveyed.

His other fantasy in the form of a neighbor personifies his need for support, at the same time reflecting hidden thoughts about the correctness of his own actions, becoming a living embodiment of self-justification. Curious is the fact that the object of desire, the main source of care becomes a dark-skinned girl so unlike her blond mother (not racism, but a statement of fact!).

Even his chosen profession as a comedian is not a desire to make people laugh. Laughter inherently represents a deep positive emotion, the emotion of approval. When we laugh at the jokes of others, we simultaneously show them our sympathy, form affection. Through laughter and jokes, Arthur tries to generate positive emotions that he does not have.

Not having an example of a person who loves him and shows him sympathy, Artur tries to figure out how to get it, to develop an algorithm, following which people can like him. He sincerely tries to understand what is considered funny and what is not, writing down jokes and comments on them with the reaction of society in a personal diary of experiences (which is significant). He visits stand-ups of novice talents, watching the reaction of others and trying to imitate them, not to differ from them as much as possible, because his own sense of humor is not at all the same as that of the others.

Despite Arthur's difficult childhood, his repressed anger and aggression at the injustice surrounding him, there is no place for violence and revenge in his fantasies - only endless, unconditional love and acceptance, which he had not had all his life.

The man who laughs

Arthur's essentially positive emotion appears as deeply negative, painful, suffocating and painful.

He grew up in an atmosphere of absolute dislike, rejection, and meanwhile indifference on the part of the closest and dearest person, and not knowing how to achieve these feelings, he did what his mother expected of him. "You must always smile," the future crime prince of Gotham clarifies as a child, in the hope that in this way he can win her sympathy. He learns to hide real emotions by suppressing himself, hiding his real self behind a smiling mask.

Inappropriate laughter manifests itself at moments of deepest stress, at moments of excessive anxiety, at the moment of experiencing the strongest feelings. This is a disguised manifestation of Arthur's true emotions and feelings - his anger, shame, emotions, even sadness, which he actively suppresses.

Remember the scene after the beating of Arthur by teenagers at the beginning of the film. He is scolded by the boss, to which he demonstrates behavior that is atypical for unfair accusations - instead of the natural emotion of anger, he smiles (rather cringely). And only when no one sees him, he gives out a real emotion.

Concealment of true impulses, excessive control of "It", life under the mask leads to the loss of a sense of one's own "I". “I'm not sure that I exist,” says Arthur, since he is real, his true feelings and impulses are not expressed outside.

People who doubt their own existence, as a rule, try to get out of this state in all possible ways, it is so painful. The simplest let - to show aggression, external or internal. Finally show emotion. The "parent's" internal prohibition against directing aggression towards others pushes him to direct it towards himself - hence Arthur's depressive and suicidal impulses.

It is noteworthy that after the release of the inner beast outside, with the complete cessation of attempts to control oneself, pathological laughter, which torments Arthur the whole picture, no longer appears.

First kill or transformation

Arthur Fleck accumulates a huge unexpressed aggression against the injustice surrounding him, but he is not able to throw it out, constantly restraining himself. But it is infinitely impossible to fill the vessel, the last drop will spill all the contents out, without a trace - the "spring effect" will work, and the person will either finally break down or give a response proportional to the force of pressure.

The attack on him on the subway is the last straw for Arthur. As you know, there is no more dangerous beast than a beast crammed into a corner. Especially if he has a weapon. And, finally, he finds the strength to fight back, for the first time taking out his accumulated anger on living people. This murder is the logical outcome of the rebellion of a driven person.

Of course, we can refer to the necessary self-defense, but is it? It is difficult to argue with the murder of the first two employees of the Wayne company, but Arthur is already deliberately and purposefully sent to kill the third, releasing many more bullets into a person trying to escape than was necessary for protection.

The reaction of a person after a murder is usually very eloquent, through which we understand the true attitude of the killer to what happened. The first reaction of Arthur Fleck is to run away, to hide from what happened, the fear of being caught in the act. He does not feel regret, sadness either immediately after the act, or after. He suffers neither from guilt, nor from Dostoyevsky's fear of persecution.

It is symbolic that he commits his first crime under a mask, which helps him to abstract from what is happening, close his real self and safely try on the image of “another Arthur”.

The scene in the toilet is very expressive, his movements in the dance are light and slow, devoid of any tension. For the first time, he finds the desired calmness, demonstrates absolute peace, receives a long-awaited liberation from the framework that binds him. The murder was a real relaxation for Arthur, after which he received genuine satisfaction and deep self-confidence (and possibly real excitement) - it is after the first murder that he decisively goes to the girl next door, which he did not dare to do before. It is the first murder that becomes the starting point for the irreversible transformation of Arthur Fleck into the Joker.

Life begins to play with new colors, his relationship with a girl develops, he begins to smile sincerely. Only after the murder, he decides to try himself in his favorite role.

A daring crime in the metro inevitably attracts public attention, but its causes are misinterpreted by society, finding a lively response in the hearts of the masses. It and the subsequent inaccurate statement of the candidate for mayor of Gotham Thomas Wayne become an occasion for rallies and street riots, giving vent to the accumulated aggression and discontent of the inhabitants (does it remind you of anything?). Arthur, still convinced that no one notices him, sees a stormy response to his action, and, albeit anonymously for the time being, attracts the desired attention of people.


It is worth saying a few words about politics here. Of course, the picture touches on political topics more than once, but the film is not about it at all.

Gotham has always been a dark and unpromising place, with a huge number of economic and social problems: from the strongest social stratification to the highest level of crime (along with useless police work). Accordingly, without the accumulated human dissatisfaction with all this, it is problematic to imagine real popular unrest. Any uprising needs worthwhile reasons, and reasons (like the murder of three workers of the “upper” class), as you know, will be found.

Arthur himself has always been far from politics, which he directly mentions several times during the picture. When you live in a personal tragedy day after day, it becomes not up to political claims. Let's remember the scene with throwing the clown mask - a symbol of popular unrest - into the trash after it was no longer needed for disguise. He joins the protesters only because he is attracted by the outburst of emotions that the crowd demonstrates, and which, accordingly, can be manifested independently. In the crowd, the sense of responsibility for oneself and for one's actions decreases, a feeling of unlimited one's own strength appears. Let's add here the heady feeling of power from the fact that you, without expecting it, have become a powerful incentive for what is happening. In the end, the crowd, and especially the angry crowd, creates chaos and confusion, which Arthur's soul craves, so tired of living right.

Politics here appears only as a toolkit, thanks to which the formation of the Joker as such took place, because what is a leader without minions? The Joker, so desperately in need of love and recognition, simply finds a fertile audience, his faceless "like-minded people." He does not care who will applaud him, as long as there are such. And therefore, unwittingly, he becomes a symbol of the fight against injustice (as, in turn, Batman).

Subsequent Kills, Rebirth

Once you have solved your problems by killing another, it is no longer possible to stop on your own. Perception is definitively deformed, and it no longer finds another way out except for subsequent murders.

Especially if your fantasy ideal world starts to crack. And the reasons for that begin to pour on Arthur like from a cornucopia.

Thanks to his mother, he learns the truth (?) about his origin and acquires a new fantasy about a rich and influential father. In an effort to verify the truth of this fantasy, he travels from Wayne Mansion to Arkham Asylum. And each goal on this path hits Arthur's already unhealthy psyche with a butt.

His mother ends up in the hospital, Artur is on the heels of an investigation into an accident in the subway, due to staff cuts, the social service can no longer deal with him (and this means depriving him of his medicines). His main fantasy that the performance in the stand-up club was successful is shattered by harsh realities (interestingly, the fact that the performance turns out to be a failure is forced out of his memory, as well as traumatic memories from childhood). He is ridiculed by the idol in which he saw his father, disappointed in his own dream, in himself. And at the same time, angry.

He passionately seeks a meeting with his father, in the blind, childish hope for the desired love and “warm hugs”, but receives only neglect and rejection from Arthur by the latter. He discovers his mother's betrayal. His already shaky fantasy world is in danger of being finally destroyed. Thoughts of suicide become obsessive (think of rehearsing your own death on your favorite TV show).

What finally destroyed Arthur's mental health? It's hard to say for sure. This is a whole set of reasons that go back to deep childhood. This is a set of reasons already in adulthood, i.e. there were plenty of triggers. In any case, Arthur's "alter ego" gradually replaced him, giving birth to an insane psychopath, whom we know as the "Joker", who deliberately abandoned his original pure idea of ​​\u200b\u200bcreation in favor of destruction.

He destroys everything that had a certain value for him, everything that he loved, but from which he did not receive love in return. He destroys everything that retained a drop of humanity in him, cuts off all the bridges of affection at the root. He destroys everything that kept his air castle afloat. The series of murders that followed Arthur's final breakdown is not accidental. These are symbolic murders of one's fantasies - a fantasy about a loving mother, about a woman who loves him in the form of a neighbor (this is not directly shown in the film, but I dare to assume that this is exactly what happened), about a receiving father-patron in the face of an idol. The last murder, above all, is the murder of a dream, the rejection of the idea of ​​\u200b\u200bwho he had wanted to become all his life, an act of latent auto-aggression. All this is the rejection of rose-colored glasses, the acceptance of the world around you as it is, unloving, aggressive. This is the acceptance of oneself, one's destructive side, without concessions and attempts to please. Curiously, it's when Arthur stops trying to please, lets go of this obsession, that he really manages to win the sympathy of society.

The ladder as a symbol of the release of the inner beast and acceptance of oneself

Many have noted the staircase, which is repeatedly repeated as the story progresses. At the beginning of the picture, Arthur Fleck steps heavily up it, practically bending down to the ground, laden with an invisible burden. This is the burden of his psychological problems, described in detail earlier.

At the end, the Joker is already quickly and easily running down it, dancing at the same time. He no longer restrains himself, giving himself permission to express emotions and desires. This is the rejection of the control of "It", the release of it outside, the rejection of the idea of ​​a "good boy", the release of the devils that torment him to freedom. Perhaps because we ourselves dream of such lightness, this scene, which has already become memetic, has such a bewitching effect on us.

(Tough question for lovers of biblical references - if this is Jacob's ladder, then why does he climb to heaven with such a heavy burden?)

Declaration of intent

On the TV show before the final murder, Arthur/Joker speaks for the first time openly about his feelings, says that he is tired of enduring what is happening to him. “I have nothing more to lose, nothing scares me,” he says on the show, because he ruined everything in the bud with his own hands. And the most dangerous criminal, as you know, is just such, the one who cannot be bribed or intimidated. He has noticeably changed outwardly (and this is not at all about makeup) and demonstrates confidence, and even signs of narcissism, but the inner child is still rushing out.

He publicly takes responsibility for his notorious murder. Does he have an unbearable sense of guilt? Not at all. “They were disgusting,” he spits out contemptuously and sincerely does not understand why people mourn and pity such vile people as the dead employees of Wayne's company were, and not people like him. With this statement, he actually says that what happened in the subway is not an accident, but the beginning. “There are three less bastards in Gotham, a million left.” With a demonstrative, impulsive murder of Murray, he finally declares a crusade to people who are not able to show empathy, love and compassion.

The tragedy of the Phoenix Joker is that, despite the obvious psychiatric disorders, he had all the prerequisites in order to remain a normal (with certain reservations), accepted person in society. People who showed concern, kindness to him, would significantly alleviate his condition, because Arthur had no initial craving for destruction. For all its bleakness and cruelty, this is a film about love. About love and understanding, which should be given more often than we are used to.

“What happens if you combine a mentally ill individual with a society that ignores him and treats him like garbage? You will get what you deserve.”

"Joker": what is the mental illness caused by the laughter of the hero Joaquin Phoenix?

  • Laura Plitt
  • BBC Mundo

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Image copyright Warner Bros

Image caption

The Joker's laugh sounds forced and unnatural, but he can't do anything about it.

Frightened look, broken voice, nerves on edge - Arthur Fleck is trying to pull himself together before a performance at the Gotham comedy club.

Joker - namely, this is the name Arthur chose for himself0012 ) - coherent speech is not easy: every attempt to speak is interrupted by an attack of sharp, strained laughter, which he is unable to stop.

It is this attack that overcomes the character in one of the key scenes of the recently released movie "Joker".

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Late at night, returning from work in a clown costume, Fleck becomes an unwitting witness to how three decently dressed men in the subway molest a woman. And at the sight of this, he bursts into Homeric laughter.

Image copyright Warner Bros

Photo caption

In another scene, Arthur is overcome with uncontrollable laughter on the bus


The men think Fleck is laughing at them and start beating him severely. In response, he pulls a revolver from his pocket and kills all three.

By this point in the film, the audience already knows that Arthur is suffering from some kind of mental illness. To cope with his symptoms, he takes seven different medications at once, keeps a diary and sees a therapist regularly.

Is there really a disease that causes uncontrolled fits of nervous laughter?

It turns out, yes. Joaquin Phoenix's character may have a rare form of epilepsy known as laughter epilepsy.

"It's a fairly rare variety - it accounts for only about 0.2% of all seizures," explains neurologist Francisco Javier López, who researches epilepsy, to the BBC.

Image copyright, Getty Images

Image caption,

Many critics call Joaquin Phoenix's performance flawless

"Laughing like that is totally out of place. The patient is not really amused or funny, he or she just can't control the seizure," adds Lopez.

Laughing epilepsy most often develops under the influence of a small, benign tumor known to physicians as a hypothalamic hamartoma. It disrupts the normal functioning of the hypothalamus, a part of the brain responsible for a number of critical functions, from regulating body temperature to emotional reactions.

Additional stress

However, sometimes the cause of such laughter can be a tumor in another part of the brain - for example, in the frontal or temporal lobe.

Most often, patients suffering from such a tumor also periodically experience seizures.

"In any case, an attack of uncontrollable laughter causes additional stress, because in a normal attack the patient loses consciousness and does not understand what is happening around, - explains Lopez. - But if you are conscious and aware that your laughter completely inappropriate, it could cause serious suffering to yourself."

Image copyright, Getty Images

Image caption,

Some brain tumors can cause uncontrollable laughing fits

Antiepileptic drugs are usually prescribed to reduce the likelihood of such seizures, and sometimes even surgical intervention is offered.

Seizures can occur daily if left untreated, but with proper medical care, their frequency can be reduced to one or two per month, and sometimes completely eliminated.

According to Lopez, adults experience this problem more often than children or teenagers.

In addition, such seizures may signal the early development of senile dementia.


Despite the fact that this is a rather rare disease, the Spanish neurologist says that in his practice he met patients with this pathology at least three times.

Image copyright Warner Bros

Image caption

Laugh epilepsy has nothing to do with violence, experts say

One of them is a court lawyer. Before each meeting, he had to tell those present about his illness and warn that he might have a seizure, as this often happens in a stressful situation.

However, the tendency to violence - an integral and defining feature of the protagonist of the "Joker" - has nothing to do with this disease, the expert says.

Emotional incontinence

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On the other hand, laughter epilepsy is not the only condition that can cause involuntary and uncontrollable fits of laughter.

Learn more