Well-Being Mental Health

What does Joaquin Phoenix’s Oscar-winning ‘Joker’ role tell us about mental illness in America?

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Story at a glance

  • In “Joker,” Joaquin Phoenix plays a character with Pseudobulbar affect, a neurological impairment resulting from a brain injury.
  • Experts say that in reality, the mentally ill are far less likely to commit violence than the general population.
  • Some critics worry that the film’s dark themes could inspire mass shooters.

Todd Phillips’s “Joker” has become the most nominated “comic book movie” and highest grossing R-rated film of all time. Star Joaquin Phoenix, who won for Best Actor, has been kicking up controversy since the movie’s release, from helping the Golden Globes go meatless to being arrested at a Jane Fonda climate change protest. (The film also won best original music score.)

But “Joker” was generating controversy before anyone had even seen it. 

One concern was that the portrayal of a mentally ill person turning to violence would perpetuate false ideas about mental health issues, undermining recent gains in public understanding. That concern is captured in the Guardian article, “Why Joker’s depiction of mental illness is dangerously misinformed.”

In the move, Joaquin Phoenix plays Arthur Fleck, who has Pseudobulbar affect, which isn’t a mental illness, but a neurological impairment resulting from a brain injury. It causes people laugh or cry in exaggerated or inappropriate ways, so it can look like a mood disorder. With Arthur, it manifests itself in a cackle he cannot control. He also has delusions, believing he has a partner that he doesn’t have (well … who hasn’t done that?). Kamran Ahmed, a psychiatrist writing in the Brisbane Times, who has high praise for the movie, says Arthur also displays psychopathy and narcissism, which are considered traits, not mental illnesses. 

In addition to all that, he’s barely surviving in a dark, violent version of New York City circa 1981, yet he still somehow believes he’s destined to entertain the masses as a stand-up comic. 

We know that he’s been incarcerated, but the institution diverges from the Arkham Asylum of the Batman canon in a major way, says Troy Rondinone, author of “Nightmare Factories: The Asylum in the American Imagination.” In “Joker,” the institution becomes Arkham State Hospital.

“This is the failed state hospital of [‘Halloween’s’] Michael Myers,” Rondinone says, in an era of awful conditions and no one getting well. Real-life patients at such facilities in the early and mid-20th century were subject to hellish conditions that often included squalor, overcrowding, starvation, electroshock therapy and lobotomies. Deinstitutionalization, the shutting down of large state institutions, was intended to place patients in smaller, more community-based care, but many were left with no support at all. 

This is the world Arthur inhabits, and although he begins the movie with a home, a job, a social worker and medication, he’s treated with suspicion by many people due to the stigma of mental illness. Although the mentally ill are better regarded than they were in past centuries, there are still lingering fears and suspicions. Then, when budget cuts deprive Arthur of his social worker and his medications, his deterioration into violence begins — and he is reborn as the violent, anarchic title character.

Stereotypes of violence

Rondinone found the movie “engrossing,” packed with complexity and nuance, but at the same time he worries that it perpetuates the stereotype of violence in mentally ill people. 

He says he was reminded of President Trump calling for the revival of mental institutions after back-to-back mass shootings.This is also a mental illness problem,” Trump said of the shootings. “These are people that are very, very seriously mentally ill.”

According to the American Psychiatric Association, people with severe mental illness are responsible for less than 1 percent of all gun homicides in the U.S. annually. The U.S. government mental health website says the mentally ill are 10 times more likely to be the victims of violent crime than the general population.

William H. Reid, professor of psychiatry at the University of Texas at Austin and author of A Dark Night in Aurora: Inside James Holmes and the Colorado Mass Shootings,” says that, on average, “psychiatric patients are less violent than the general population in almost every kind of violence,” unless you add substance abuse to the mix.

“I’m much more worried about the meth head next door than I am about the paranoid schizophrenic,” he says. 

Going off medication is the most common reason people with severe mental illness relapse, says Reid, who hasn’t seen “Joker” but is aware of the controversies. Some psychiatric disorders, like paranoia, are more likely to make a person violent if they’re off their meds, but mostly if a mentally ill person commits a crime, “it’s usually something like peeing on someone’s storefront,” minor, nonviolent offenses.

“As a professor I work very closely with the Disability Resource Center,” Rondinone says, “and the treatment and the ability of students to discuss their psychological issues has vastly improved since when I was a kid, when everything was stuffed under the carpet. I think we talk about these things in our society a lot more and that we’re aware of problems and stigmas,” which makes mental health issues easier to address.

Reid thinks that public understanding of mental illness has improved but says “we still have a long way to go, with both stereotypes about severity and violence,” as well as the idea that psychiatry can fix everything if patients would see them earlier and stay in treatment and on meds. “Most serious psychiatric illnesses can be treated and very often ameliorated, but not ‘cured.’ Better access to mental health care would “help millions of people, but it probably wouldn’t stop many mass killings,” though better funding of care, and widened access to it, could prevent a lot of suicides.

Links to shootings?

America averages a mass shooting every two weeks, so it’s not surprising that potential violence in the mainstream has been another fear about “Joker.” Prior to the movie’s release, a group of family members of Aurora shooting victims paired with the nonprofit Guns Down America, and wrote to Warner Bros. They didn’t ask for the film to be pulled; they asked Warner Bros to commit to safety by ending “political contributions to candidates who take money from the NRA and vote against gun reform.”

On Sept. 24, Warner Bros. made a statement saying that the company has a long history of donating to gun violence victims, such as those in the Aurora, Colorado shooting that took place during a midnight showing of the Batman movie “The Dark Knight Rises.” The studio noted that it had recently joined with other companies advocating for legislation to address the problem. Warner Bros. added that it never intended for the Joker in this film to be a hero. (See the complete statement here.)

Reid was one of two court-appointed psychiatrists who evaluated the Aurora shooter before trial. It’s important to remember, he says, that the Aurora shooter did not identify with the Joker character “or anything related to Batman.” The shooter said that someone at the jail “might have called him the Joker,” and “the media picked up a baseless rumor about the coincidence of his red (dyed) hair and the movie title.” He opened fired at a midnight premiere of the Batman movie because the theater would be full and “few children would be attending” at that late hour.

“It was the place where he could kill the most people,” Reid says.

Rondinone sees the movie’s “problematic aspects” as able to “shine a light on bigger problematic aspects of our society.”

To him, the film may comment on the narrative of “the wounded white man.” Someone at the bottom of society, maligned, mistreated and ignored, has “a fantasy of payback,” Rondinone says (which is often the mass shooter narrative).

Rondinone and Reid agree that “Joker” could inspire a copycat, but they say that censorship isn’t the answer.

John Hinkley Jr, who shot President Ronald Reagan in 1981, was inspired by “Taxi Driver,” Rondinone says. “But I’m not blaming Martin Scorsese for the assassination attempt.” 

Movies don’t unspool in a vacuum — they do influence their audience. But “if you point your finger at a movie director and you ignore the appalling gun violence statistics, incarceration failures and mental health failures, the structural things,” says Rondinone, you’re missing the bigger picture.

“If it’s a legitimately nice piece of work, in writing and art and acting, or even if it’s not, who am I to keep that off the screen?” Reid says, though he does say that, if he were running a psychiatric hospital, he wouldn’t want vulnerable patients watching “Joker” — not because it could inspire violence but because it could be an upsetting experience. The same goes for young adults whom he wouldn’t even want reading his book. It’s not about them becoming violent but about how they live their lives.

“How many people don’t like to swim in the ocean because of ‘Jaws’?” he says. “By the way, I’m one of them.”

What art does, Rondinone says, is to hold up “a fun house mirror to what’s going on in society and it lets you interpret it.”

And fun house mirror seems to be the most appropriate metaphor for this popular and controversial movie

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