The Joker is a villain that both fascinates and terrifies us. His origin has remained relatively mysterious, sparking questions about how a “psycho killer” is created. Using real methods and theory, clinical expert Dr. Andrea Letamendi examines several portrayals of the Clown Prince of Crime, including Jack Nicholson in 1989’s Batman, Heath Ledger in The Dark Knight, and Mark Hamill in Batman: The Animated Series. Given the raised concerns causing tension to surround the new film, Joker (2019), considerations are given to the science behind behavioral threat assessment, case study, and occurrences of real events in an effort to responsibly inform the discourse. The author wishes to note to readers that this collection of psychological profiles includes some references and descriptions of both real and fictional portrayals of mass violence, intimate partner abuse, and suicide. Just like the Joker, these conceptualizations are fictional and are not meant to diagnose any real person. This series is not intended as a substitute for the medical or mental health advice of psychiatrists or other clinical professionals.
SPOILER WARNING: Full spoilers for Joker follow.
The Misunderstood Loner
Arthur Fleck, played by Joaquin Phoenix in the solo origin story film Joker (2019) is an impoverished, scraggy middle-aged man who works as a party clown in the crime-riddled city of Gotham. Arthur is significantly underweight, his face sunken and pallid; and although he isn’t repulsive, his untidy, bizarre appearance is off-putting to others. Behaviorally, too, Arthur is odd. He is withdrawn and anti-social, but does not seem to be inherently callous or devious. In fact, Arthur is somewhat innocent and initially well-meaning toward others, especially children. Arthur lives with his mother, Penny, who he cares about deeply, but maintains no other strong, meaningful connections. His communication skills are generally poor; he may hold his gaze too long at someone, use abnormal body posturing or facial expressions, or miss important interpersonal cues, which cause others to be upset or discomforted around him. In his line of work as a cheap party clown, Arthur’s oddities are amplified. In many ways, Arthur is a product of interactionalsocialization; his peculiarities influence others to ostracize, bully, or avoid him, which in turn, lead him to isolate, grow weirder, and inevitably miss opportunities to improve his social skills.
Importantly, Phoenix’s Joker does not try to be disturbing or strange; he does not seek the thrill of upsetting or endangering others.
This Joker is not inherently provocative. In fact, when we’re introduced to him, Arthur has little insight in how he comes across to others. He’s generally aware that he is odd, but does not quite grasp the degree to which others find him unsettling. Quite the contrary, Arthur dreams of winning the adoration of others by becoming a successful stand-up comedian. He believes his purpose in life is to instill happiness in others—his overactive fantasies depict his mother as his number one support: “you were put on this earth to spread joy and laughter,” he imagines her saying to him adoringly. Arthur fantasizes of being in the spotlight, basking in the glow of show lights, approval, and applause. At times, he even closes his eyes and slowly dances to the sound of imaginary music; picturing himself as the center of attention, a popular figure like the famous talk-show host, Murray Franklin: visible, idolized, and respected. As he pantomimes the scene, Arthur envisions himself as charming, masculine, and dominant. Despite these uplifting dreams, Arthur’s actual life as a loner is monotonous, repetitive, unrewarding, and—much like the landscape of the Gotham City—hopelessly bleak.
In his portrayal, Phoenix delivers a unique biological basis for the Joker’s maniacal laughter. Arthur lives with a neurological condition that is described in the film as spontaneous, socially inappropriate laughter. The episodes are typically precipitated by an intense feeling of nervousness, anxiety, or shame. Laughter, the external expression of joy, is therefore in misalignment with his internal state of emotions. A single episode may last longer than a minute, and increases in intensity and loudness. The fits become so uncomfortably uncontrollable for Arthur that it causes him to cry, stutter, and react with guttural chokes.
The condition called Involuntary Emotional Expression Disorder (IEED), also known as pseudobulbar affect, is indeed a real neurological disease characterized by emotional lability, and pathological laughing. This expressive disorder is characterized by uncontrollable, sudden and intense episodes of laughter (or for some patients, crying) that are exaggerated and incongruent with the underlying mood. These episodes can be long-lasting, and are often embarrassing and socially debilitating for individuals who struggle to convey their real, experienced emotion.
The psychological outcome often includes outbursts of frustration, anger, and the development of depression.
IEED’s cause is unclear; but it is associated with traumatic brain injury, typically to the prefrontal cortex (the brain region just behind the forehead). Consistent with this theory, it is revealed in the film that Arthur was physically abused as a child, and experienced a significant violent assault that caused head trauma. It is theorized that IEED is a reflection of damage to the neuronal pathways that cause emotional expression, and it is highly likely that Arthur’s childhood injuries lead to the condition he has as an adult. Moreover, the behavior observed in patients with IEED (grinning, laughing, cackling, etc.) is not interpreted as actual laughing by medical professionals but considered a deficit in the patient’s ability to control their facial muscles. The inclusion of pathological laughter and distorted facial gestures –a neuropsychological manifestation of the Joker’s trauma—is more realistic if not an improvement of the existing Joker narrative. Disturbing laughter is not a result of the Joker’s disfigurement, self-injury, or a tactic to unsettle others; his laughter is his disease, a part of his psychiatric makeup that ultimately leads others to stigmatize him.
“I haven’t been happy all my life”
Unlike other portrayals, Phoenix’s Joker struggles to achieve a sense of intrinsic happiness and seems unable to activate pleasurable feelings within himself. Nicholson’s Joker, for instance, delights in his ostentatious, grand acts of performative terrorism; Hamill’s sustains euphoric mania by increasingly pushing the boundaries of risk-taking; Ledger’s Joker seems to be skilled in generating intellectual satisfaction. These Jokers certainly presented with their own idiosyncratic problems, but were able to find ways to achieve feelings of pleasure. Arthur Fleck attempts to find joy through his stand-up comedy, but cannot overcome the barriers of his disease. He is instead met with doubts, derision and even dismissive reactions from his own mother, who casually tells him, “You have to actually be funny to be a comedian.” Phoenix’s Joker directly deals with mental illness. He gives us, in his story, clear evidence that he has biomarkers of a brain disorder. Unlike other portrayals of the Joker, it is not simply implied that he has a characterological flaw. Phoenix’s Joker attends therapy, takes psychotropic medication, and follows behavioral prescriptions given by his providers. Though his exact psychiatric diagnosis is not named, Arthur makes direct reference to his meds (he is taking up to four different kinds), hispsychotherapy (he sees a social worker for weekly counseling), and his history of severe mental illness (he has been committed to Arkham State Hospital at least once). His treatments are provided at no-cost by Gotham City’s Department of Health as a state-funded service.
During one therapy session, Arthur asks his therapist, “Is it just me or is it getting crazier out there?” referring to the growing, segmented class of Gotham who are impoverished, disenfranchised and angry. “People are upset,” she responds to him, calmly. “These are tough times.” She isn’t unhelpful, but seems to focus on a set of structured steps or required, systematic checklists, rather than attune to Arthur’s direct (and changing) mental health needs. In the same session, Arthur pulls out his journal, which he says he’s using as a “joke diary” to keep his stand-up notes. The journal includes some scribblings of jokes, but also contains disturbing passages, intense drawings, and torn-out pages of pornographic magazines. His therapist does not seem to notice a glaring red flag: pictures of naked women with the clipping torn at the neck, or hard scribbling covering their faces. These are likely recordings of Arthur’s subversive fantasies. Depersonalizing women by “removing” their faces allows Arthur to objectify them and even experiment with feelings of aggression or sadism toward them. It remains unclear whether these are congruent with his desires or ego-dystonic(intrusive, upsetting thoughts that are not aligned with his sense of self). In the journal, is another red flag: Arthur writes, “I hope my death will make more cents than my life.” Taken together, messages of suicide, vague threats, and pornography are risk factors for targeted violence. They are known as “pre-offense” behaviors, due to the direct correlation between these types of passages and consequent acts of violence. This is a missed opportunity in that his therapist may have been crucial in connecting with Arthur during a period of risk, understanding his feelings of resentment and loneliness, and directing him to more effective resources.
“Does it help to have someone to talk to?” his therapists asks; and Arthur replies, “I felt better when I was locked up in the hospital.”
The film cuts to a shot of him banging his head against the wall of his cell. Here, it is likely that he had access to stronger or more intensive treatments, and may have experienced reprieve from his emotional pain. To his therapist, he adds, “I just don’t want to feel so bad anymore.” Arthur acknowledges his depression and his inability to escape from the weight of his disease. Clinical depression is a serious medical condition, rooted in neurobiological causes, that is associated with symptoms such as chronic feelings of melancholy, loss of pleasure, lack of energy, difficulty in concentrating, and suicidal thoughts. Consistent feelings of irritability, physical pain, and anger are also manifestations of depression. For individuals with treatment-resistant depression—in other words, few to no symptoms are relieved by the medication—standard treatments aren’t enough. In fact, up to 30% of people show no or partial response to standard depression medications. Just like Arthur, people who do not seem to respond well to first-line treatments often have severe despair, chronic hopelessness, frequent environmental or family conflict, maternal depression (have a mother with clinical depression), and a history of child abuse. Again, Arthur’s therapist is a key part of his potential remission. Medication is more effective when coupled with talk therapy, especially when the therapist addresses the underlying concerns that may be contributing to the patient’s depression. Psychotherapy is effective because it helps us discover ways to cope with life’s challenges, process past our emotional trauma, learn to manage our relationships in healthier ways, improve how we can reduce the effects of stress, and minimize addictive behaviors.
Throughout the film, Arthur is dating Sophie Dumond, a young single mother who lives in his building. We ultimately learn that Sophie is real, but their relationship is completely fabricated in Arthur’s mind. His fantasy-building is so intense that he was able to create a credible romantic narrative between him and Sophie, a story that supported his personal dream of being lovable, funny, and charming. Unlike a hallucination where Sophie would actually be projected, as if real, by Arthur’s mind–or a delusion in which she would be believed to be his actual girlfriend—Arthur’s manifestation of Sophie as his girlfriend is likely a product of his overactive imagination coupled with his desperate need to be seen. To matter. Arthur’s fantasy is one that he writes; he controls how Sophie reacts to him when he performs his stand-up comedy, when he takes her on a loving date, when he barges through her apartment door and forcefully kisses her on the lips. In his fantasy, she is passive and quiet, but she is notably supportive and consoling toward him. Sophie’s compassion fills the void, but soon, this dream is no longer sufficiently soothing to Arthur.
Arthur also momentarily becomes fixated on another source of emotional support, stemming from the idea that Thomas Wayne is his biological father. Penny had routinely written letters for Wayne, and to Arthur’s knowledge, the Wayne family only represented Penny’s employer before she became ill and was put on leave. Curious, Arthur impulsively opens a letter that Penny had written to Wayne, and reads her pleas for Wayne to take care of his “son.” Arthur is livid in learning the news, feeling resentment toward the Wayne family for not caring for him or his mother.
One thing to note is that before he engages in any violence, Arthur is particularly interested in getting better. This Joker pursues ways to integrate into society through normative, healthy channels. He is treatment compliant. He utilizes his therapy session for self-examination, he does his “homework,” and he takes his medication regularly. When he believes his medication is not working, he asks for higher doses. Arthur also makes concerted efforts to attend his job regularly, despite the challenges involved. His journal reads, “The worst part about having a mental illness is that people expect you to behave as if you don’t.” This belief means that Arthur is both willing to acknowledge that he needs help and that he is tired of asking for help. His descent into antisocial behavior and violence is, in part, influenced by the contextual forces around him. The system fails him.
What Happens When Protectors are Removed
Mental health “protectors” are the social, environmental, and personal factors that help us manage big changes in our lives, push through stress or emotional pain, and even safeguard us from developing mental illness. Arthur’s mother, for instance, is a protective factor for him because she is the source of a loving bond and a purpose in life. Arthur buys her groceries, provides her meals, and bathes her every night—and he genuinely cares for her. They enjoy watching the Murray Franklin show together, as a bonding family ritual. Arthur, of course, holds a fantasy of appearing on the Murray Show. In this fantasy, Murray Franklin welcomes him onto the stage and tells him, in front of the cameras, “I’d give it up in a heartbeat to have a kid like you.” In a way, his parasocial, unharmful relationship with Murray Franklin is a protective factor. Arthur seeks fatherly love, a sense of belonging and acceptance, and he feels somewhat fulfilled from this fictional relationship he’s created with Murray. Murray and Penny are his family.
But things take a turn for Arthur, and we begin to see significant changes in his behavior that align with the removal of his protective factors. First, his supervisor punishes him for being physically assaulted on the job; he directs Arthur to return the sign that his assailants used to essentially beat him. Arthur protests, but is met with complete disregard. Unable to express his anger and growing resentment, Arthur smiles awkwardly at his unempathetic boss, and later finds himself aggressively kicking bags of trash in the alley. Seems harmless at first, but this outward display of rage is Arthur’s “tryout,” for future violence. Novel aggression, or the experimentation of new forms of violence, may appear as an early warning sign of future, more severe and lethal forms of behavior for individuals who may be a safety threat to society. Feeling sorry for him, Arthur’s co-worker hands him a pistol one day at his workplace. “I’m not supposed to have a gun,” Arthur says cautiously (and, again, in compliance with his treatment plan). He is hesitant to take it, but agrees to keep the gun as self-protection.
While he’s performing at the children’s hospital, Arthur is sloppy. The newly acquired gun drops out of his clown pants and hits the ground in plain sight and is immediately fired. Following his termination is a chain of negative events creating significant loss and disruption in Arthur’s life.
Meanwhile, Arthur becomes fixated on his new weapon. He interprets the concept of a gun as an extension of his emerging identity.
To him, the gun is an emblem of importance; like a badge, a microphone, a spotlight. In search of power and control, he begins to fantasize with the loaded gun in hand. His bizarre, slow dancing is unsettling to watch, but for Arthur, the weapon represents a physical manifestation of his deeply cherished dream, a symbol of his desire to command the attention and praise of others. He is mesmerized by his new toy and the idea that it can bring him the devotion he craves. Over the course of time, the concept of harnessing a meaningful role in the dreary city begins to take shape: “I hope my death will make more cents than my life.” Arthur grows more comfortable with the weapon. In one instance, while fantasizing that he’s being interviewed on the Murray Franklin show, Arthur places the empty barrel of the gun under his chin, pulls the trigger, and throws his head back. Imagining an audience witness his suicide is exhilarating and uniquely satisfying – finally, momentary relief from his pain and suffering. Although he’s not yet sure where to direct it, Arthur begins to connect public violence with feelings of fulfillment and satisfaction.
Shortly after being fired, Arthur witnesses three Wayne Enterprises businessmen begin to harass a woman on the subway. Feeling uncomfortable and vicariously shameful, Arthur’s neurological condition is triggered, and he starts laughing uncontrollably. The men turn their attention toward him and begin to ridicule him. Once they begin to beat him, Arthur instinctively, pulls out his gun and shoots one of them to death. The other two men, however, he shoots at close range. During his third killing, Arthur is not impulsive or acting in a defensive manner. He is deliberate. Calm. Confident. He identifies as a killer.
Later, Arthur is grappling with the upsetting news that he was adopted by Penny, neglected, and beaten as a child. He discovers that Penny was admitted to Arkham State Hospital for serious mental health problems as well as child endangerment, and that Thomas Wayne is not his father. Overwhelmed with disappointment, Arthur drags all the food out of his refrigerator, climbs into it, and shuts the door behind him. Somewhat like the earlier pantomime of suicide by gunshot, Arthur’s wish to suffocate himself is a new sign of self-destruction. He is challenging his threshold of corporal pain. Notably, Arthur is already at high risk of dying from suicide, due to his pre-existing lack of social connections as well as his sense of “perceived burdensomeness.” This term refers to a deep, genuine experience of feeling unwanted and undervalued by society. Learning that he was adopted triggered significant beliefs that he had no real belonging in this world, no known origin aside from abandonment and abuse. According to the interpersonal theory of suicide, completed suicides are strongly associated with two things: 1) a strong desire to die, and 2) the capabilityof killing oneself. The desire to die is usually associated with thwarted belongingness. Many of us have had this feeling at least once in our lives. The second step, however, refers to a threshold that few of us cross. This threshold protects us from acting seriously on thoughts of self-harm. That is, we all typically have a strong sense of self-preservation, the resilient instinct to keep ourselves alive. Acquired capability means that a person has crossedthat protective threshold—they’ve overcome the normal inhibitions against harming oneself. Like with Arthur, this usually occurs when due to habituation of corporal pain and suffering. Arthur is susceptible, at this point, to risk factors, and then goes on to experience numerous additional environmental risk factors for suicide: disruption or loss of social relationships (his mother), financial distress (loss of a job), and intense humiliation (child abandonment and abuse).
“All I have are negative thoughts,” Arthur admits to his therapist. In a crucial session, he begins to leak his homicidal ideation.
In an effort to explain that he is beginning to feel different and that perhaps he’s found a sense of purpose that he’s uncertain of, one that scares him, Arthur adds, “even I didn’t know if I really existed.” This may have been his confession, or perhaps a fleeting last request for help. His therapist, however, is distracted. She tells him that all funding for Public Health Services are cut and that she will no longer be able to meet with him. This is their last therapy session. Seeing his disappointment, Arthur’s therapist discloses her beliefs about the government, “they don’t give a s**t about people like you, Arthur…” she says, sternly. Then she adds, solemnly, “they don’t really give a s**t about people like me.” Similar to Arthur, mental health providers are dismissed, rejected, and abandoned in a city like Gotham. The effect of this dynamic is dismal: If the people who are responsible for caring for others are not cared about, how can there be any hope of meaningful healing or recovery for anyone?
In rapid succession, Arthur’s many protective nets are pulled from underneath him. He loses his job, his therapist, his access to medication, and his relationship with his mother, who represented the single most supportive source of social support for Arthur. At the time he receives the phone call from the Murray Franklin show to appear as a guest, he has already killed four people, including his mother.
Emerging findings in the targeted violence literature support the belief that so-called “warning behaviors” will often include a fixation toward a public figure (e.g., personal cause, violent fantasies, grandiose delusions), and that though the relationship may not be real, such signs should be treated seriously. For Arthur, the intensity of his efforts to further the Murray Franklin quest increases following his first few murders. As said before, he’s “practiced” enough to build internal confidence that he can pull it off with his identified target.
Arthur’s appearance on the Murray Franklin show is filled with uncomfortable tension. As he sits on the very couch he used to fantasize about, Arthur’s guard is actually down. He speaks his mind freely and openly. Arthur tells Murray, quite smugly, “It’s been a rough few weeks since I killed those three guys.” When it becomes clear that Arthur is not joking, his smiles take on a completely different meaning, and the tension intensifies and fills the studio in the form of hundreds of held breaths. Murray, though, attempts to harness his own calmness and engages in the conversation, which continues to air to Gotham’s viewers, city-wide. Arthur then goes on to essentially deliver his verbal manifesto, starting with, “Everyone is awful these days…” Murray, now more irritated, tells Arthur that there is indeed chaos in the city, and that one reason the people of Gotham are being terrorized is because of Arthur’s murders, his attack on the rich and privileged. At the peak of his speech, Arthur asks Murray directly, in a raised and threatening voice, “What do you get when you cross a mentally ill loner with a society that abandons him and treats him like trash?” Murray, now fearful, commands his team to call the cops, but Arthur continues, now fully escalating: “I’ll tell you what you get – you get what you fucking deserve!” He then pulls out his gun shoots Murray in the forehead, killing him instantly.
Untangling Violence and Mental Health
Incidents of senseless, unforgivable acts of atrocities by lone gunmen have become a part of our cultural andpsychological landscape. The film Joker raises reasonable concerns about how entertainment media influences our current climate as it relates to unpredictable violence, simply because we have too few ways to predict such incidents and we cannot afford to be anything but hyper-vigilant. When exploring the traits of violent behavior, even if fictional, it’s imperative to clarify the overlap between violent crime and mental health. The following facts may help us appreciate the complexities:
1) There isn’t a single psychiatric diagnosis that maps onto “homicidal killer.” An interest in targeted violence alone doesn’t trace to any particular mental health problem. Despite its common usage, the term psychopathis not a clinical diagnosis, but refers to an extreme characterological condition with features of manipulation, selfishness, extreme callousness, violation of social norms and the need for stimulation. It is mostly associated with criminal behavior; not mental illness.
2) Mental health disorders are brain-related conditions that are quite common. One out of every four of us are affected by mental or neurological disorders at some point in our lives. Among violent killers, less than half have an actual known history of a mental disorder. Despite the largely held public notion that mental disorders account for gun violence, that factor only play one part in a more complex picture.
3) People with mental health problems are more likely to be the victims of violent crime than the perpetrators. As such, it is recommended that persons with mental health disorders are detected early and given access to effective interventions and reliable resources.
4) Having a psychiatric diagnosis is neither necessary nor sufficient as a risk factor for committing an act of mass violence. Similar to Arthur Fleck’s path to destruction, the triggering event for most targeted violence is the acquisition of a lethal weapon, coupled by a significant social, occupational, or personal loss.
Phoenix’s Joker may currently be received as the most frightening manifestation of a modern comic-book villain. He is horrific because he represents today’s fears: What could be more threatening to us right now than a single, white male loner with an untreated mental illness and a loaded gun?
Moreover, Joker was devoid of any fantastical, supernatural comic-book themes that might otherwise pull us out of our discomfort or help us detach from the horror of Phoenix’s realistic Joker. There is little resembling fiction to hold us in safety—no toxic waste dumps, tumbling Batmobiles, or absurd trolley games to separate us from the realness of the story. No, the most chilling line in the film is perhaps the most simple and direct accusation, and it is told in therapy: “You don’t ever hear me.” With this assertion, Arthur is asking his counselor to be vulnerable with him by giving him the space to safely share his feelings of hopelessness, despair, self-hatred and nihilism.
We take a comfortable distance in asking of killers, “what is wrong with them?” when we should be exploring the question “what happened to them?”
Like professor and researcher Brené Brown has said, to be empathetic—to truly offer up a sense of understanding for another person when they’re in pain—we must access something deep within ourselves that is similarly painful. It is easy for us to dismiss Phoenix’s Joker as a maniacal psycho who acts in unpredictable, senseless ways. But the truth is that we can trace nearly every step of his descent into destruction. This is how origin stories go: The Joker is shaped by his traumas, haunted by the void of compassion, and discarded by a failing system. Undoubtedly, employing our empathy for him feels irresponsible and dangerous, and it makes us sense our own fragility, shortcomings and weaknesses. Relating to the Joker is now more subversive than ever. And the truth is, it is unlikely that each of us,at the individual level, can harness enough human compassion to keep everyone around us protected from harm—but we are equally guilty by actively ignoring each other’s pleas to be heard. The hardest aspect to acknowledge in Joker is the viewer’s participation in Arthur’s failed search for connection. Ultimately, Joker is hard to shake off because intrinsic to the storytelling is the direct warning that we may each be contributing to our culture’s mass destruction.