Joker mental disorder

Analysing Joker: an attempt to establish diagnosis for a film icon


. 2021 Dec;45(6):329-332.

doi: 10.1192/bjb.2020.146.

Valentin Yurievich Skryabin  1



  • 1 Moscow Research and Practical Centre for Narcology, Russia.
  • PMID: 33407973
  • PMCID: PMC8727382
  • DOI: 10.1192/bjb.2020.146

Free PMC article


Valentin Yurievich Skryabin. BJPsych Bull. 2021 Dec.

Free PMC article

. 2021 Dec;45(6):329-332.

doi: 10.1192/bjb.2020.146.


Valentin Yurievich Skryabin  1


  • 1 Moscow Research and Practical Centre for Narcology, Russia.
  • PMID: 33407973
  • PMCID: PMC8727382
  • DOI: 10.1192/bjb. 2020.146


Todd Phillips's film Joker, a 2019 psychological thriller, has stirred up strong reactions to the portrayal of the lead character's mental disorder, which is never specified. I used DSM-5 criteria to study whether Joker/Arthur Fleck showed signs of a real mental disorder. The psychopathology Arthur exhibits is unclear, preventing diagnosis of psychotic disorder or schizophrenia; the unusual combination of symptoms suggests a complex mix of features of certain personality traits, namely psychopathy and narcissism (he meets DSM-5 criteria for narcissistic personality disorder). He also shows the symptoms of pseudobulbar affect due to traumatic brain injury. This apparent co-occurrence of both mental disorder and a neurological condition may be confusing for audiences trying to understand mental illness.

Keywords: DSM-5; Mental health; personality disorders; psychopathology; stigma and discrimination.

Conflict of interest statement

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    1. Peaslee RM, Weiner RG. The Joker: A Serious Study of the Clown Prince of Crime. University Press of Mississippi, 2015.
    1. Placido D. How does Joaquin Phoenix's ‘Joker’ differ from previous versions? Forbes 2020; 28 Aug.
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Publication types

As a psychiatrist, I was blown away by the latest Joker


  • Culture
  • Movies
  • Mental health

This was published 3 years ago


By Kamran Ahmed

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Like many others, I recently went to watch Joker aware of the controversy surrounding the film: is it an irresponsible portrayal of mental illness likely to incite copycat violence, or a cinematic masterpiece and powerful political statement?

Being a psychiatrist, I abhor negative depictions of the mentally ill but as an ardent Batman fan I was hopeful. As it happens, I was blown away. Joaquin Phoenix’s towering performance and Todd Phillips’ masterful direction undoubtedly helped, but mostly it was the way it approached mental illness.

Joaquin Phoenix plays the eponymous character in Todd Phillips' Joker.

The film poses an important question vocalised in no uncertain terms by the Joker at its climax. "What do you get when you cross a mentally ill loner with a society that abandons him and treats him like trash? ... You get what you f---in’ deserve," he proclaims as he murders the talk show host before him.

Although this response and the violence in the scene are vicious, it is a stark metaphor for the disastrous consequences that can arise if we do not give mental illness the importance it deserves.

The Joker (or Arthur) appears to have a complex mix of diagnoses, including pseudobulbar affect – a rare condition consisting of uncontrollable laugher or crying, and possibly a psychotic illness, evidenced by his apparent hallucinations about the subject of his affections (played by Zazie Beetz). In addition, he displays features of certain personality traits that are not technically considered to be mental illnesses – psychopathy (he feels no empathy for the victims of his violence) and narcissism (which makes him crave attention and adulation by any means necessary).

Phillips has clearly done his research and illustrates the path to the development of these conditions elegantly. We are told Arthur suffered early life trauma – horrific abuse as a child at the hands of his mother’s partner including head injury, which is a risk factor for serious mental illness including pseudobulbar affect. He also has a family history – his mother has delusional disorder and narcissistic personality disorder, and he experienced abandonment as a child and the absence of a father figure, which can predispose to certain psychiatric conditions.

To those with mental illness, some aspects of the film will be immediately relatable. The loneliness, isolation, and "constant negative thoughts" Arthur describes are problems my patients face every day. An entry in his notebook, "the worst part of having a mental illness is that people expect you to behave as if you don’t", is poignant and those with a mental health issue of any description will relate. I have social anxiety – a relatively less serious mental health condition – but I can’t turn up to a dinner party and open with "I’m freaking out right now" just as someone hearing voices can’t disclose this experience to those around them.

But the major difference between the Joker and other less favourable on-screen accounts of mental illness is the attempt to explain how Arthur got to this point. This is not your typical stigmatising tale of a crazed villain who should be exterminated by the hero. Even The Dark Knight was occasionally guilty of this, with Batman’s pejorative description of the Joker as a "schizophrenic clown". Nor is it a film ridiculing the mentally ill like the detestable Me, Myself & Irene. We are not laughing at Arthur nor distancing ourselves from him; instead we are forced to empathise with the protagonist.


Any suggestion of a strong link between mental illness with violence is, of course, inaccurate and although the Joker does commit unspeakable atrocities, these appear to be driven by his personality traits and not his mental illness. In reality, some mental illnesses can at times make people do tragic, awful things because they are scared, paranoid or desperate. But what are we going to do about it? Fund services that can help and treat them with sympathy and respect, or deprive them of assistance, discriminate against them and leave them and others to suffer the consequences?


In the current political climate all over the world, public health services are shamefully underfunded and public sector health workers feel devalued. The scene where the jaded social worker interviewing Arthur tells him "they don’t give a shit about people like you … and they don’t give a shit about people like me either" will resonate with the mentally ill who feel abandoned and the healthcare professionals struggling to help them.

Although concerns have been raised that this film will incite violence (perhaps intensified by the 2012 mass shooting in Colorado during a screening of The Dark Knight), the same could be said of any film featuring a violent anti-hero. Targeting Joker specifically seems unjust. Joker searingly addresses some of today’s most pressing issues – mental illness and the disenfranchisement of the underprivileged, which should be our focus. It invites the public to try to understand mental illness and empathise with those suffering from them. It also challenges governments around the world to fund mental health services adequately and reduce inequality The question is will they take it seriously, or write it off as a bad joke?

Dr Kamran Ahmed is a psychiatrist.


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What mental disorders tormented the heroes of Suicide Squad and other comics

Harley Quinn - hysterical personality disorder

Charming and dangerous Harley Quinn, who fell in love with the Joker and turned from a psychiatrist into a patient, suffers from a hysterical personality disorder10 . It is based on "the need to be in the center of attention and excessive emotionality", while the emotions are theatrical and feigned. Such people may use appearance to attract attention, exhibit sexually provocative behavior, and be influenced by authority figures. nine0008

Shot from the film "Suicide Squad" © Kinopoisk

Joker - schizophrenia

In the case of a sinister clown with green hair and an insane smile, we can talk about one of the variants of the course of schizophrenia - schizotypal disorder , Viktor Nurdaev told WMJ. ru . With him, "patients are characterized by eccentric and asocial behavior, a tendency to isolation from society." However, the specialist notes that the Joker is able to plan and implement complex schemes, which is difficult for patients with schizophrenia. nine0008

Shot from the film "Suicide Squad" © Kinopoisk

Daredevil - depression

One of the saddest heroes of comics suffers from depression. In this disorder, the patient loses interest in life, he "reduces the ability to enjoy the surrounding positive events." The condition may be accompanied by suicidal thoughts, apathy, guilt and worthlessness.

Shot from the film "Daredevil" © Kinopoisk

Hulk - emotionally unstable personality disorder

This character can burst into flames like a match and put his opponent in his place both in word and deed. The Hulk diagnosis is "characterized by a tendency to act impulsively, outbursts of often negative, difficult to control emotions. " He can be conflicted, aggressive and unpredictable.

Still from the film "Hulk" © Kinopoisk

Deadpool - psychosis

A controversial character with the ability to regenerate, suicidal tendencies and a specific sense of humor - cynical and vulgar - suffers psychosis . For the most part, it is characteristic of schizophrenia, and among the manifestations are hallucinations, delusions and loss of contact with reality.

Still from the movie "Deadpool" © Kinopoisk

Jessica Jones - post-traumatic stress disorder ( PTSD )

The purple man subjugated Jessica with the ability to control his mind, forcing him to help in his atrocities. When the girl was freed from his power, she had to fight PTSD, which occurs after a shocking stressful event. The condition is characterized by tormenting intrusive memories and nightmares and a desire to avoid events that could trigger re-experiencing the trauma.

Shot from the series "Jessica Jones" © Kinopoisk

Lex Luthor - antisocial personality disorder

Superman's sworn enemy is insidious and cunning, lacks empathy and suffers from antisocial personality disorder. Such people are unfamiliar with guilt and remorse, they ignore the law and the rights of others, and lie for pleasure or profit. nine0008

Shot from the movie "Superman Returns" © Kinopoisk

Two-faced - obsessive-compulsive disorder

Batman's enemy, using a tossed coin to solve his villainous questions. The obsessive-compulsive disorder from which he suffers is characterized by obsessive thoughts and the performance of certain rituals to release tension or avoid unpleasant emotions.

Frame from the film "The Dark Knight" © Kinopoisk

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"Joker": what mental illness causes the laughter of the hero Joaquin Phoenix?

  • Laura Plitt
  • BBC Mundo

Sign up for our 'Context' newsletter to help you understand what's going on. Warner Bros0122 .

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

Joker - namely, this is the name Arthur chose for himself ( in English Joker means "jester" or "joker" - editorial note ) - coherent speech is not easy: every attempt to speak is interrupted by an attack of sharp, strained laughter that he can't stop.

It is this attack that overcomes the character in one of the key scenes of the recently released movie "Joker". nine0008

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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

Image caption

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


The men decide that 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? nine0008

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,

Joaquin Phoenix's acting is flawless by many critics

"Laughing like that doesn't fit the situation at all. It's not really fun or funny for the patient, it's just that he or she can't control the seizure." , Lopez adds. nine0008

Laughter epilepsy is most commonly caused by 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. nine0008

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 fits of laughter

To reduce the likelihood of such fits, the patient is usually prescribed anti-epileptic drugs, and sometimes even surgery is suggested.

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 face this problem more often than children or teenagers. nine0008

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

Experts say laughter epilepsy has nothing to do with violence

One of them works as 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. nine0008

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 disease that can cause involuntary and uncontrollable fits of laughter.

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