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.The film poses an important question vocalised in no uncertain terms by the Joker at its climax.
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 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 .
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.
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.