“Joker”: Views of Several Forensic Psychiatrists

There are two characters in the film [Joker] who undergo treatment for mental illness, and each inflicts serious harm to others. Meanwhile, in real life, the mentally ill are more likely to be victims of violence than perpetrators of it. Gabrielle Bruney, Esquire

As presented in a previous post, “Gun Violence and Mental Illness: The True Relationship,” psychiatrist Gordon Livingston concluded that “(t)he only real predictor of future violence in anyone turns out to be a past history of violent behavior.” Most people with mental illness are not violent.

But Joaquin Phoenix‘s Joker, or Arthur Fleck, is depicted as a man mentally ill—not specifically diagnosed—who does become quite violent. Moreover, according to Callie Ahlgrim, Insider, “he names his mental illness as a specific motivation for violence at the end of his climactic monologue, which sounds like the movie’s thesis statement.”

In lieu of having to watch the violence of Joker myself, below are excerpted quotes from several psychiatric professionals who’ve weighed in with explanations about Arthur as well as some of the film’s misleading messages:

I. Forensic psychiatrist Ziv Ezra Cohen, New York Daily News:

Research shows that people who commit mass shootings in the vast majority of cases do not have a clear mental illness that would explain their behavior. In addition, just 1% of gun violence is attributable to mental illness.

He does not show symptoms of delusions or a thought disorder that one would see in an illness like schizophrenia. He does not show the impulsiveness that one sees in many personality disorders and in bipolar disorder. He is cold, calculating, ruthless. A term we use in psychiatry to describe such people is psychopath.

However, even if we label him a psychopath, we still are not explaining why this particular psychopath behaves in this particular way, as opposed to, say, becoming a white-collar criminal. In addition, many persons who do much good for society have “psychopathic traits,” such as some surgeons, bomb sappers and intelligence officers. Why do they become “good psychopaths” as opposed to “evil ones”?

II. Forensic psychiatrists Vasilis K. Pozios. Philip Saragoza, and Praveen Kambam, in Hollywood Reporter:

...(T)he sympathy engendered through Arthur’s struggles with mental illness becomes conflated with a more problematic understanding of the violence he exacts against those who have wronged him. Fleck’s turn to violence is meant to elicit disdain for the character as his underlying psychopathic traits become more prominent; however, Joker achieves rock-star status because of his violence…Paradoxically, Phoenix’s Joker seems more organized in thought and appearance the more distant from treatment and the more violent he becomes.

Arthur Fleck’s character arc echoes an unfortunately familiar scenario: a lonely, traumatized individual with emotional problems (insecurity, anger, shame, hopelessness) and limited intrinsic or external resources experiences a series of losses, disappointments and insults. All of this leads to his cultivation of a grievance culminating in exacting retribution towards those he holds responsible for his plight — a process known in the practice and science of targeted violence prevention as the “pathway to violence.”

Although people with untreated mental illness have some increased risk of violence against others relative to the general population, this typically occurs in very specific situations such as when an individual experiences persecutory delusions and acts in perceived self-defense. This risk is still low compared to that attributable to other more common violence risk factors like substance use and being a member of the male sex.

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