Psychiatry & Psychotherapy Podcast - Joker: An In Depth Character Analysis

Episode Date: November 23, 2019

Joaquin Phoenix stars in "Joker" which has divided critics and movie goers alike. Surprisingly, it has divided mental health professionals as well. Some say Phoenix's performance shines a light on the misunderstandings of mental illness while others believe it promotes a falsehood that mental illness is responsible for violence. In this episode, David Puder, M.D. and Hans von Walter, M.D. discuss Joker's cinematic and mental health themes. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is emailed to you in seconds. All right, today I'm joined with Hans von Walter, Dr. Hans von Walter. I'm Dr. Peter, and today we are going to go through an analysis of the recent film Joker. And I would like to say that as a psychiatrist and a psychotherapist,

something that really gripped me with this movie was the depiction of human suffering, of Arthur, the main character's suffering, and I had a mixture of nausea, disgust, sorrow, and pleasure. I think I left the movie with a slight headache in the best way possible, right? Yeah. And maybe I think our discussion, in our discussion, I really want to go through the mental health aspects of this movie,

the depiction of mental health. we'll go through the different diagnostic criteria. We'll also talk about mass shooters, talk about the narratives, talk about why it's so controversial by people either love it or hate it. Yeah. So just starting out,

what were some of your general sort of, this is how I felt watching it and how I felt leaving? Well, first of all, I just want to thank you for inviting me to the podcast, Dr. Puter. It is truly just an honor to be nominated. I also want to commit to you. you on properly calling this movie by its correct title, which is Joker, not The Joker. I have seen that mistake in many places, and it's annoyed me to no end as a true

cinephile. But for me, personally, as a psychiatrist, going through this film, I was, I think I was just gripped in my seat by what I felt was a almost like horrifyingly, like, distortedly accurate kind of depiction of what I imagine a good amount of like my patients have to go through. And it was, you know, because so often the experience that we are privy to is the one where we see either in the office, in the clinic, or on the inpatient unit. And so to see this kind of visualization of what happens when beyond those doors, it was a little chilling. I think chilling was the word that I came away from it.

Yeah, everything from the music, the music itself, like, I'm pretty sure if I just played that soundtrack for like a full day, like I would feel like in a very sort of disturbed, perturbed mood. Like it was dissonant. And then I watched like a 30 minute sort of like tutorial on the lighting. Yeah. And how they use lighting to depict kind of the loneliness or the disgust or the sort of the dreariness of it all. There was like a harsh kind of fluorescence throughout the film. You know, a lot of kind of, you know, halogen office type lighting. hardly

any, like actual, like, just natural sunlight. Yeah. You know, like when they're out, when he's outside, it's almost like it's covered, you know, Gotham is depicted as a very, you know, kind of city in,

in, in disarray. So with that, you know, comes like this kind of air of, like, pollution, you know, when he's visiting the Wayne Manor, it's like cloudy overhead. Like, there's, there's,

no, there's almost no depiction of just any sort of like just natural sunlight, except I want to say in the big pivotal scene when he is going down the stairs. I think that that's when, I think that's when things take a little bit of a different turn for him. And that scene has now become very iconic. Very iconic. Yeah. Yeah. Yeah. And I think for those of you who haven't seen this, there are going to be some big spoiler. Like basically all the spoilers. And I would also say, like... Batman's parents die. This is...

Don't say that. No, I'm joking. I would also say that we're going to be giving our opinions, but we're also going to be talking about science and talking about what's known about psychiatry and what isn't known and hopefully teaching as well about mental health in this. So... Let's dive into it. Yeah, one other thought that I had about just the overall ambience was there is no skylines.

Yeah. So, and I watched the director talk about the making of it, and he specifically took out any skylines. So he added in, like, industrial stuff in the background to take away any skylines. It's deep. To make you feel like you were kind of caged in. Yeah, very claustrophobic. I think there's another good word that kind of describes the, the environment of the film.

Yeah, one of my friends said, if a movie makes you feel something good or bad, if it makes you feel something, either good or bad, it's done its job. It's not about whether you like it or not. It's about if it worked to make you suspend disbelief that the person or those people

were actually going through that thing. Right? And I think, Joaquin, Phoenix, you're saying that right? I know you. That is correcto. Watkin Phoenix's Joker did that.

He was incredible. I think he'll get an Emmy. Is that the right word? Oscar. He'll get an Oscar. Emmys are for television. Oh, yeah. Oscars are for the movies.

Yeah, so do you want to get an Oscar and Emmy? Is that your life goal? Why not both? Okay. One thing you may not know about Hans is he won Jeopardy. Is it? That is correct. I was on college Jeopardy.

back in my college days. And actually we're coming up on 10 years ago that that happened. So good times. Yeah. You know, this is the top profitable comic book movie of all time at this point. And when I was reading, and we'll talk about this later, is that some people are not watching this just one time, not just two times.

Some people are literally going to the theaters like 10 times. And I'll read some of the quotes that I found from real people. That's crazy. I think that the most interesting part of this film to me is the empathy they were able to generate in the audience. Yeah. Okay. So perhaps the start of the empathy was when they showed a character who we want justice for, right?

Some sort of growth, some sort of transformation. He also demonstrates empathy. Although odd, you know, his kindness to his mother, you know, getting her mail. giving her a bath, which was... Yeah. Yeah. It was odd. Yeah.

But it's a flip side of like a desire for empathy that starts to become a little bit, almost pathologic, I think. Well, it's almost like he was childlike in it. Yeah. Like he was... And he came across as childlike to me. Yeah. Yeah.

He seemed to show kindness to the children that. he interacted with, right? Like he authentically wanted to make them smile. He wanted to make them laugh. And we feel empathy for his coworker, right? Yeah. The little clown that was getting laughed at. Yeah.

No, he, I think what was evident just in all his scenes, like with his coworkers, was definitely like he was finding peace in that camaraderie. And so I think later on when that when that kind of breaks down that has a rather like, you know, they specifically set set up those scenes of him, you know, interacting like with his coworkers and whatnot. So that a couple of scenes later on would be a lot more impactful for kind of the twist or turn of events that he has to go through like basically almost like, you know, betraying an empathy that kind of he was like searching for in the first. place. Right. Even this like empathy that they sort of start to to build in you towards him and his character, I think it continues even as he starts to do some of the killings. So, you know, after, for example, after the first killing, it seems like self-defense. And we'll get to that a second. But the second thing

is that he demonstrated a deep desire for empathy and connection. And something as the audience member, felt a desire to give him. Yeah. So he's looking for empathy, right? So he says the worst part of having mental illness is people expect you to behave as if you don't. Yeah, that's a quote that I've seen getting shared in a lot of different places. And I think that that, like, if this film had a thesis, that one would be the closest that we would have to exhibiting.

And I see this, I see this in all domains. Like even on the interview trail, sometimes there's stigma against the applicants who have mental illness as they go into psychiatry to treat mental illness. I see it in churches, you know, like how we treat people who have mental illness in the church leaders or not leaders. Yeah. Even in my, I mean, like, even in my own, you know, in my own experience of like, you know, I come from a Latino background. And so mental health can be a little bit more, um, stigma. in that culture. And so I think even in, I think I remember telling, like my mom about mental health, she, it was more so that she was, like,

happy about the aspect of like, oh, you're going to be like a pastor. And not so much the like, oh, you're going to be like giving medications. They're shocking people. Yeah. I think that there's a much lower percentage in the Hispanic community.

I was recently looking at like the metadata across the U.S. and it's like, I think it's about a third of what the, you know, white people, Caucasian people seek out like three times more than Hispanic people. That's crazy. Yeah. So, you know, there were these parts of him that needed empathy, right? At the same time, there were parts of his, like, moral decision making, which at the end of the day were his choice. Yeah.

You know, and so it's like this fine line and this movie between this is his mental health issue. And these are his, like, choices that he's making. Yeah, and I've seen that a lot in particular when it comes to just, you know, a lot of times, you know, when we are faced with an action that someone has done, we as human beings have a tendency to want to immediately try to rationalize it. Like, we try to look for a rational explanation. and sometimes the, I think, I think the false easiest, the false easiest thing to go to is like, well, they have a mental illness. And it's, it's a distinct, you know, it's, and it, I think it makes it like easier to, like, come up with that, with that, with that, um, explanation rather than face the, like you said, the, the, the, probably, like, moral conundrum of, like, this person did have a choice. you know, whether it's like someone who like wrongs you or, you know, or what ends up happening to Arthur later on in the,

later on in the movie. Yeah. And I would say that only 5% of violent acts are committed by people with mental illness. So if you have mental illness, it's actually more likely you're going to be a victim of violence than a perpetrator of violence. And that is a huge, like even when I talk to people who are well educated, but they don't have any training in mental health.

They tend to think that people with mental illness are more frightening, more scary, more violent, and I think it's really good to set the record straight. There's a difference between mental illness and violence. Yeah, no, I think that that's one of our biggest responsibilities as psychiatrists is to be able to firmly set that record straight as far as the fact that a lot of our patients suffer. Like, they suffer greatly.

So to see oftentimes what I think is like a depiction in some forms of media where oftentimes, like a person with mental illness is the perpetrator of a crime, that makes it very difficult to be able to, like, have a good conversation about this. Right. Yeah. Yeah. So, okay, here's a moment where I felt some empathy towards him. Mm-hmm.

his boss asks him why he lost the sign and he said didn't you hear i got mugged and here's an authority figure who he wanted to under he wanted to be understood by right and believe the worst about him right and it's this this moment where you like you're just like you don't see him yeah you don't see him um i wanted to jump in the the scene and defend him yep yep there was a scene of the where he he was with a social worker and he said, no one hears me, you never even listen.

Do you even listen? His therapist responded, you know, you're on six medications. They have to be doing something. Yeah. And my, a couple of the other co-residents that I went to go watch this with,

we did have a vigorous conversation about what those six medications possibly were. So we have, We have a, we have a, we have a few theories. But, uh, yeah, no, it's, like, to, to see that everywhere that he was churning, he was getting no, like, moral support. And that was his, you know, that was his perception. And actually, you know, like, this all being his perception, I think, like, plays a

bigger role later on when we talk about what could it possibly be in a hallucination, a delusion, you know, we talk a lot about in mental health. health, you know, with certain, let's say, personality disorders that a lot of times it's like a distortion, you know, personality disorders or psychotic disorders or, you know, that it's a distortion of perception and sometimes a distortion of reality. And so that's one thing that, you know, especially like, you know, in like DBT type training and therapy, you know, we try to educate people on how something they might be perceiving may be coming from like a different perspective. So seeing that consistent, you know, feels like no one is hearing me, feels like no one is

supporting me, understand me. I think that that is an interesting aspect to, you know, what we later see, when we later see happens soon. Right. So sometimes in someone who's, has more personality structure, they could have been empathized and heard and understood for 20 sessions. But the one session where they don't feel heard and understood, they'll say something like you never hear me, you never understand me. you just don't get me. And it's really speaking to as well, like the developmental trauma that's there where they didn't feel heard, they didn't feel seen, they didn't feel understood.

So it's hard to differentiate in a movie this short, what was what? Like, did she really connect with them other times? Or every time was she just repetitive and redundant and unhelpful? He also told the man he thought he was his father, Wayne, that he just wanted a little warmth. So there's a scene in the bathroom and he confronts Wayne like you're my father and it's like he was yearning

for that sort of embrace and instead he gets a punch to his nose or from the talk show host instead of like being told like you're awesome like I would love to have a son like you he gets ridiculed for his medical condition you know

so he desires this hug and he gets the opposite, right? And in this fantasy with his neighbor in the hospital scene, he gets a back rub. So once again, like all of his like desires and yearnings are for connection. Right.

Right. I love that you point out, especially about the back rep because there's such a subtle directing choice to like tell the actor, just give him a little back rub you know like that because didn't have to be in there but it added that extra little element of like you know that's that's that's that's a visual cue for the audience of this is a connection that's being made or that you think is being made um that he's that he's

desiring that he's longing for yeah so then we move into like the murders right so the first two murders seem to be in self-defense right he's getting beat up by three guys and he pulls out his gun and he shoots two of them. And then, um, you know, it even pulls you in where you're kind of like, these guys are like, these guys are like people you do not like. Yeah. Right. They're being sexually provocative to a young girl on the bus. They're being totally inappropriate. You just want to like, you want you, you want to stand up. You want justice. Yeah. You're right. And they're murdering Sondheim, you know, like the, the song that they're singing is send in the clowns and they're just off key it's just horrible the worst crime in humanity

I'm not and and so we feel this reaction of like a little bit of like justice yeah you know and so this is kind of like I'm trying to pull in like how they tried to try to pull you into this movie so far with empathy that you continue to align with him right yeah you you root a little bit for him to to defend himself however which way however which way possible, even though it ends in, you know, in these guys being dead.

What I think is interesting kind of about where the movie goes from here is, you know, this is ostensibly a city that's very corrupt, very crime-laden. So the, you know, the idea that like a couple of like self-defense kind of murders on a subway would make like such a big impression, like across the press of the city and that kind of thing. Um, that was one of the, like, for me, elements of the story where I, it made me wonder, like, is this another element of, you know, almost like an idea of reference, like for the, for the Joker, for Arthur to think that like, he's making a bigger impression or he's making a, like, his actions are larger than maybe like what they might actually seen. Like, for, for all we know, like, you know, we, you know, the movie establishes pretty, um, pretty firmly. later on that Arthur is an unreliable narrator. So for all we know, this could have been just like a little blurb in like one of the, like, you know, one of the, you know, page six of the Gotham times or whatever, rather than big front page, like, right.

A couple of douchebags get murdered on the, get murdered on the train. Yeah. I would, I think for, for the sake of our analysis, I think it's interesting to look at, like, we don't know. Yeah. We don't know. And that's what makes. makes this so much fun, like, analytically, right?

Is like, we don't quite know. So he kills the third guy, which is interesting. He chases the third guy to kill him. Right. And then he ends up in a bathroom, and it's dreary and it's dark, you know, and he kind of does he do a dance there or he moves his body. Oh, is that? Yeah, that's the scene where he's like contorting himself and he's got like the gun.

Yeah. Yeah, yeah, yeah. Yeah. And then after the heartbreaking discovery that he was abused as a child, right? So he finds out, you know, movies don't have the same HIPAA protections that we do. So he goes to the psych hospital and he grabs this chart from his mother and he finds out that his mother's been lying to him and that she really suffers from delusions and that he was horribly abused. and it's interesting. I heard this before I went to the movie

and I was expecting to see a lot of visuals of the abuse and I was expecting to be like jarred by those visuals. And I think a lot of people who are in the lay public like they don't come up against like imagining those visuals on almost a weekly or daily basis like we do like in our field. Yeah. But it still was very very difficult. It's always difficult.

Yeah. I mean this is one of the classic kind of, horror movie moves, you know, you think back to like the, the scariest thing is the, is the unseen. So you think back to like, Jaws, you know, like the, you know, the whole movie, you know, Jaws is like terrifying like this town, but, you know, all you see is a little fin, but then your, your mind just, like, fills in, like, with the imagination of, like, what could possibly be lurking into the water. Same thing with this, like, they didn't have to show the abuse, but just the, the way that it

affected him, like, your, your mind just starts, like, you. filling in all these like horrible like what if scenarios of what could possibly happen to him and in many and in many ways that it's almost that's almost like more horrifying to one as a viewer than just maybe actually like seeing a depiction of it not that not that I was like hoping to see a depiction of it but right right no I just thought that wasn't interesting yeah yeah I agree that that's a very that was a very deliberate choice to not show anything from like his past not even like an implication or anything like that yeah and I heard um some parents were taking

and they're like really young kids like eight nine year olds i'm like please do not do that that's just ridiculous that's like i was exposed to some of this content at that age and i wish i was never exposed to it um that's disappointing so someone um and then he goes on to kill his mother yeah right and his mother had had a stroke and so um interestingly when i was like reading through tons of articles and read it and stuff like that someone said well, I actually think like it was altruistic, altruistic for him to do that. Like he was doing it out of a good place. Yeah.

But it just showed how some of the people who have watched this, you know, kind of like are once again, like empathizing or joining the hero. Right. And it's also that like rationalization aspect that I mentioned earlier. Like they're trying to look for like, you know, a reason, like, why, like beyond just like, this person just did an act. Right. You know.

Right. Yeah. this person made a choice to like commit this um this this this this action and then um he um he kills uh randall his former clown co-worker who um lied to him about so or lied to his boss about him potentially um potentially got him fired and also kind of bullied him it kind of seemed like it seemed like it was kind of like he made fun of him a lot but um he didn't kill the small clown because the small clown it seemed had shown him compassion what do you think that was i think that was one scene that that for me just just as a movie goer bordered a little bit on um

uh that was a little bit i felt exploit exploitative to me like i felt viscerally uncomfortable tell me more about that um i think for me it was you know i i think one element that it was trying to dial into was like first of all the the horror that um he's like trying to you know that he's kind of um torturing this poor you know this poor little person um and then when when he's trying to jump up and like unlock the door and that was the part for me where i was just like i don't feel like this was necessary like to bring home the point that this scene was already showing that Arthur was undergoing a transformation, like a transformation, like of kind of like ego and of mind.

So that was one part where I was just like, this is, this, this wasn't necessary to bring home the point that this scene was already conveying. Okay. Yeah. Yeah. You felt, you felt bad for that. Yeah. Yeah.

For the smaller cloud. Mm-hmm. Yeah. Glad he survived. I'm actually like, I would have been really upset. I would have been killed. Yeah. I'd been really upset.

And then Murray Franklin was finally killed after he was attempting to humiliate him on television. You know, it's interesting, you know, when this film was greenlit, it was basically greenlit under the, under the conceit of like a, what if a comic book movie, was made like a Martin Scorsese movie. And so the closest, and like that's how the studio, like, funded the film was, was being like, okay,

we're going for like kind of a different aesthetic, like the other kind of DC universe movies. You're going to have to break that down. Who that other guy is and what movies he's made? Martin Scorsese. Okay. So he's done taxi driver. Okay.

He's done Gangs of New York. He's done a Raging Bull. He's done, did Wolf of Wall Street, the Aviator. So he's famous for very kind of lengthy character-driven narratives that you're basically witnessing an on-screen transformation. And so the closest analogue to this movie is Taxi Driver, which also stars Robert De Niro in the Arthur Fleckish kind of role

as he kind of like descends into this, you know, in that movie, he's more blatantly kind of like a psychopathic madman or a sociopathic madman, which we'll talk about it a little bit. So his choice like to be cast in this particular role, I felt was kind of an homage to that. So overall, like as the movie progresses, we kind of blur our idea of traditional right and wrong. Yeah.

You know, and we enter into his mind. and his reasons for his murderous rage. And that's interesting. It's interesting to have that experience. It's kind of like, it kind of reminds me of the picture of Doreen Gray. Oh, wow. Do you remember that book? Classic English literature, English, right?

Okay. Oscar Wild. Basically, in the picture of Doreen Gray, this guy starts to do progressively more and more evil things. And as he does it, the painting changes and gets more evil, but his face stays childlike. Right. And when it came out, there was this huge upheaval about it. Yeah.

Like, people did not like that this book existed, period, right? But people have said, like, look, no, this book accurately is portraying the progression of something. Yeah. Of evil in particular for the picture of Dorian Gray. And because of its accuracy, it's stood the test of time as a good literary work. And I think this is going to be a cult classic. I think so too.

It's definitely made its impact pretty solidly in this point. Okay. So let's go into, first of all, his medical condition. Okay. So Joker had a laughing disease. Pretty prominent, yeah. It's pseudo-bober affect. And these are uncontrollable episodes of crying and laughing.

Sometimes they come spontaneously with patients, but for him it came with emotional content. In the US alone, 1.5 to 2 million people have this. So some people who have it, they just don't go out as much. It's pretty debilitating. I've seen a couple of patients with it and it's the word that gets to use a lot is emotional incontinence, just like an uncontrollable, like, or sometimes rapidly random, just bursts of emotion. And so in some cases that might manifest as laughter, for some people that might be tears.

Um, you know, but it's, it's, it's, it's pretty debilitating, difficult. Yeah. And so for him, like, there was this like deep sadness and agony underneath, but it also matched his loneliness to some degree. And his feelings of like disconnection from reality. So for example, like, or no, disconnection from connection with real people. Right. So he's on the bus.

He humors the child. The mother turns around and kind of gives him like, stay away. Uh-huh. And then he breaks out in this like laughter. Uh-huh. And it's like he's also got this like agony of like, like, no, I was like connecting with this kid. I was making him happy. So I've seen multiple clients from this.

You know, I run a program at Loma Linda for people with medical and psychiatric issues called MEND. And we've had people who come into the program. And it's really good to be in a group over time, over longitudinal, because people start to, they see it. and they have compassion for you. And usually it's from a traumatic brain injury. Yep. And so the patients that I've had have had huge amounts of stigma from this.

And it's been like a daily sort of burden that they carry that people just don't get it. Yeah. There is actually another movie that's out right now called Parasite. It's a Korean film that's kind of gaining quite a following. And there's another depiction of pseudo-bulber affect, like someone undergoes a traumatic brain injury and ends up having kind of uncontrollable fits of laughter.

I won't say anything more because it would spoil the movie, but you should check it out. It's interesting that pseudo-bulber affect is having its moment in the media spotlight. The second medical condition that we know he had was a traumatic brain injury. So he had a card that he informs people about his pseudo-bulber affect and on the card it said he had a history of a traumatic brain injury. And I would say the other symptoms that he has that kind of connect with the traumatic brain injury are his like childlike intelligence.

So I really think like the Joker is not the Joker we see in subsequent Batman films. Right. Like you can't all of a sudden become a mastermind. Hugely like Machiavellian. Yeah, yeah. And like very sort of like tensile. steps ahead of everyone else, right? He's a little bit disorganized.

He has a simple language to describe things. He, you know, his sketchbook is very chaotic. Even on meds. And he, and I've also seen with traumatic brain injuries, unfortunately, I mean, this is like really traumatic, but people can be more depressed chronically, more irritable. PTSD is a huge problem. Yeah, PTSD and traumatic. brain injury are really linked, especially in the military, you know, concussions, multiple

concussion syndrome and football players. And it's, if he had enough damage from the TBI to cause a pseudo-bulber affect, he's probably got damage in other areas of the brain. Yeah. Because that's got, that's a, that's a very deep-seated, that's a very deep-seated injury if someone does have pseudo-volver affect because the, those structures are, kind of like kind of deeply embedded um in the brain so there's a lot of other things on the way to to that area that um are also very important in one's a kind of um neurological functioning yeah so um so now let's move to the psychiatric issues and we'll go through um different diagnosis diagnosis diagnosis diagnosis that he could have diagnoses um I had one person who email

me it's not diagnoses that's the other reason why you brought me onto this show what's the word again so once again it's good to remember that mental health issues do not cause violence more than the general population

right and I'll put the citation on the blog to kind of support that good so how did Joker's childhood trauma influences behavior. So thinking sort of pre-diagnostic criteria, right? So we know that childhood trauma and continued trauma was something he experienced throughout his life. And the psychological impact of that,

especially on a child is, you know, it's immeasurable, honestly. Um, you know, during that, during that time in a child's life, there's so much, um, pruning and imprinting that's going on in the brain, um, you know, like within, you know, I think something like between the age of love like five and ten, the brain grows a certain number of like, you know, a certain number of size in comparison to what it was before. Um, and so for something as traumatic as the abuse that he suffered to happen repeatedly to him when he was. was that young, that's the kind of thing that ends up, that ends up just sticking with, um, sticking with a lot of, a lot of people who, uh, end up having to go through that. Yeah. And unfortunately, you know, I've known people who have had mothers who are like schizophrenic or psychotic or untreated. And, um, the amount of like therapy and treatment or that they need, it's, it's like years of treatment. But they do come out of it, you know. And so

when I watch this, I'm also thinking like, gosh, I wish, she had like a good day treatment program. Yep. Like that would make so much of a difference. Right. Right. Oh, okay. So, you know, and in the midst of that trauma,

he continues to have this odd relationship with his mother. Mm-hmm. Right. So one example is he's giving her bath. He's co-authoring her narratives. By that, I mean he's checking her letters. He believes her delusions. And I've seen that in some people who have grown up in traumatic families.

they almost sort of side with the aggressor, the aggressor being the person that abuses them or allows them to be abused. And so they side with the aggressor and they continue to sort of support the aggressor. You know, he was neglected. He was physically abused. He, instead of being angry,

it was most adaptive to him early on Right. To join with her, to nurture her, to be her caretaker. In some ways, that helps alleviate the constant traumatic blow of being in such an abusive relationship. I mean, I mean, we see that classically in so many people who are with abusive domestic partners, men and women who it's just a lot of times just easier to go along. with it, um, rather than take, you know, take whatever standard is when he, and, and in a situation like this, like, where he's already starting with a pretty kind of, um, shall we say, uh, poor deck of cards. Um, he's not going to have, uh, like the, the ego wherewithal to be able to make a conscious

decision like that to break away from his aggressor, especially if he's, he himself is someone who, you know, he needs, presumably at one point, she was helping take care of him as he aged into adulthood and whatnot. Although he is the one that's serving her and her needs, at least in the parts that we've seen, it's some form of longitudinal connection that he has outside of that. Like, who does he have? Yeah. You know? So as a therapist, I wouldn't be immediate to want to cut out that relationship, right? Yes. Because that is, that might, I would want to, I would want to, I would want to, help him have some boundaries and help him move into more adulthood and hopefully maintain the relationship. So boundaries would keep him in relationship with his mother. But, you know, unfortunately,

we never got to see that sort of thing happen. So it's interesting also because I also think sometimes when people carry that anger and they turn it on themselves, like he's chronically depressed. Right. Right. So he's, he's angry about the injustices and the things that have been done to him, but he turns it on himself. He blames himself. And there's a point in the film where he kind of turns that anger outwards, and it's a murderous rage. Yeah, and I'm glad that you pointed that out, because so much of, I think, the discussion about this movie's kind of mental health element has focused on, you know, the psychosis and the delusions. But that element of depression that is, like, consistently chronic and present throughout the entire film.

I think that that plays as much, if not a bigger role feeding into this than, you know, some of the more colorful, you know, symptoms or aspects of the film. I think people who are incredibly lonely resonate with this film because of his depiction of depression. Yep. You know, he says things like, all I have are negative thoughts. Right. all they have are negative thoughts.

The worst part of having a mental illness, the worst part of having a mental illness is people expect you to behave as if you don't. You know, he has this chronic depression. It's always there. He's never happy. Yeah. You even see it in his, like when he,

like I would arguably say that when I see him the most happy in the film, even before like kind of the, the the climax at the end is when he is performing for the kids and even then there's still a just kind of a a background kind of a baseline level of despair um and i think the word they use um here dystymia um i think is a as a perfect description of that because you know it's it's basically just like that kind of baseline level of just like a functional depression in a sense yeah um and that's that's where he had been living for looks like probably the most of the most of the most of the majority of his adult life until the events of the film. Yeah. And I will add that people who are

depressed, if they can make other people happy, if they can make other people laugh, they feel that. Yeah. They feel that. Our brains light up in the way of other people's brains through mirror neurons and stuff. And so when we make other people grateful, we feel grateful. When we make other people feel happy, we feel happy. And so he's in this, so it's an example of his empathy as well. I think people without any affective empathy without the ability to feel other people's feelings. Like, they don't care. They treat other people like insects. You know, they treat other people like they're like, like, they're nothings.

Yeah, so he had the depression. He had the poor interest, poor sleep, irrational guilt, low energy, poor concentration, sometimes, you know, like kind of like it's a disorganized thought process. Poor decreased appetite. Oh, yeah. Like, he was emaciated. He had to lose a, you know, this poor actor wanted to be a little bit heavier on the heavier side.

But the director said, no, you must lose weight. So he lost 50 pounds. Well, and the funny thing is, I think there were several points in the movie where you can tell that, you know, Hawking Phoenix is a fairly fit guy. And I think you can tell at a few points that this is someone who used to be fit, who lost a rapid amount of, lost a lot of weight in a rapid amount of time. So I just thought that that was interesting. Yeah.

Yeah. Did he have high functioning Asperger's, you know, or high functioning autism. It's called autism spectrum disorder now. It used to be called Asperger's. Do you think he had autism? I think that that's an interesting conjecture. Maybe define autism.

Okay. So autism is considered a, oh boy, I feel like I'm being pimped. Just a couple of the symptoms that you might see in someone with autism. So someone with autism displays a kind of a chronic level of difficulty with interacting with others in a social situation. Particularly those kinds of things include picking up on social cues, this kind of idea of like being able to like read a room. And it's not just like that it's in certain situations. It's just it's persistent. It's, you know, it's persistent at home.

It's persistent. You know, like when they, when you go out, there's a certain sense of structure that those with autism really like. You know, there's this idea of what this term is called stereotype behaviors, being able to like repeat a thing in order to, like, you know, there's a sense of calm that comes from being able to, you know, like, let's say line up, line up certain, you know, belongings in order or keeping, like things, you know, different from, I would. would say like an OCD type, type pathology, but still kind of in that same range. So all these things come together in someone who is more, I would say, inwardly focused. And it's a, you know, it's a neurodevelopmental disorder that can be very difficult to live with. Yeah. So, you know, could you say he had a narrow set of interests being a clown? Right. But here's why I think he probably wasn't autistic.

I think he actually... Convinced me. Okay, so in autism, they lack cognitive empathy, but they have affective empathy. So affective empathy, the ability to feel other people's emotion. Like, even my patients with autism not come in. They can feel when their parents are unhappy with them. They can feel when we're happy with them.

And as opposed to cognitive empathy, which is being able to pick up on what others are things, or that's essentially picking up on the social queue. Picking up on the social queue. Like if someone is trying to like silently like tell you something like with their eyes, you know, like, hey, stop talking or something. Like that's not the kind of thing that they're going to be able to like pick up. Yeah.

Yeah. Which I mean, he did lack some social sort of, he lacked the ability to read some social situations. But at the same time, I think he had a deep desire for social connection. I agree. And, you know, sometimes you'll see the autistic kid playing in the corner with, like, some objects. And, you know, sort of uninterested in the human engagement. That being said, I've seen autistic kids who really do enjoy, like, coming to my sessions,

where they enjoy seeing me, they enjoy coming in. they um and or like when they play sometimes they do enjoy engagement but it's like a different kind of like they want to like play with an object and maybe you're playing with the object with them or something um now further people with Asperger's autism are not more violent than a general population so at the end of the day I don't think he was autistic yeah and I and I think there's you know we have enough evidence that there were so many other kind of um psychosovoise social factors at play in contributing to the person he was or ultimately became that attributing it to a kind of inherent neurodevelopmental disorder such as autism is I think

kind of discounts all of that other evidence. Yeah. I bring that up because in some of the mass shootings, they'll say like they'll throw around that word like, oh, he was autistic or oh, he was Asper he's. And I think it's good to, sometimes also people get misdiagnosed as autism. I'm not saying this is a case for him. If they're antisocial or psychopathic. So, okay, what were the Joker's psychotic delusions is the next question.

So the Joker had this desire to be important and to be connected to people, right? And so, for example, he has a fantasy of being on the show. And I would say this was a fantasy. I don't think at this point we were watching this as if he was really believing this was happening. I agree. That was definitely depicted as a wishful, kind of like place that he went to, like, for to bring himself a little bit of, try to bring himself a little bit of joy. And because he was able to recognize that he wasn't actually there. Um, which is, and it's, and the reason I agree with you is because it's in stark, it's, it's in stark difference to, or contrast to some of the later delusions that we do see are basically confirmed to be delusions, such as, um, the, the, the entire relationship with the, with the neighbor.

With the neighbor. Right. So in this show, he desires a fatherly hug. He's being told, I wish I had a son like you. And this was just such a glimpse. Fantasies can sometimes be a huge glimpse into the inner world of someone. And I would say I have a lot of patients actually who have lived heavily in fantasies. Like I had one patient who was spending like three to four hours a day in fantasies every day. And they were able to recognize that it was a fantasy and not that they were actually living out. some delusion. Yeah. And they knew that it probably wasn't the best thing, but they just enjoyed it. It's comforting. It was comforting. And it's a narrative that to some degree they have control over.

It's adaptive. Yes. Yeah. It's adaptive. And so I think as a therapist, I approach that with curiosity, without shaming it, of course, and without, and with trying to help them tell me the story. Right. And we'll look together at it and look at it. And look at it. how it has been adaptive. And I'm not in the impression that they need to get rid of it right away. No. You know? I agree.

It's something that can, it's a potential like kind of unpolished tool or, you know, diamond that you could potentially like sculpt and mold into something that could be very useful for the patient eventually on down the road, like this idea of, you know, the idea of like a coping skill of being able to think of something happy or think of think of being be in your happy place i don't know i don't know if i tell people to be in their happy place for the record sure sure for the record no happy Gilmore going on here right no happy Gilmore but um but you know to see it as like people people are on a journey and um the the fantasies are telling you what you desire they're giving you a glimpse of what you find meaningful and so once we have that as as

as professionals, then we can start to help them take small steps towards those things. And so sometimes it's very hard to get accurate representations of what someone truly desires. And so I love fantasies and dreams for being able to do that. And then there was this woman, right, who there were a couple moments where I was like, I can't believe that just happened. Yep. Like he opens the door and he like kisses her. And I'm like, okay, I did not see that coming at all.

Like, I didn't think he had the courage to do that or the social skills. Like, this is like throwing like a pretty big. Yeah. Like, it's a wrench in like the character that you've come to know by that point. Yeah. Yeah. And, you know, like, obviously the scene in which we meet that character in the elevator it's a relatively, you know, innocuous, you know, um, interaction, you know, she,

and they're like, you know, what a long day it's been. And then she does like kind of a, uh, you know, just shoot me kind of, um, you know, like gesture. And he really, you know, he really takes to that, like, and really just runs with it in, in such a, I think such a, I don't want to say adaptive, but like, you know, it's... It's empathy. He feels what she's feeling, and he feels that she's feeling exactly what he's feeling. Like, life is grim. Life is burdensome.

And here we are to pass her by. Or two people who are passing by who can share that moment, right? And then, you know, she's at the comedy club. And she's kind of smiling at him. she's supporting him um concerned about him at the at the hospital so we see this sort of nice moment of light yeah um and then it starts to kind of show us that maybe what he's seen is not reality right um yeah it's it's interesting because the specific shot that i'm thinking of.

When he's in, when he ends up in her apartment and you, you see her be like, are you the guy from down this, down the hallway, Arthur, right? You know, that's the big reveal that this, this relationship wasn't really like meant to be. It was a very specific, I remember a very specific shot composition where he's in the foreground and she's in the background and she's very blurry. like it's it's kind of like a like a diopter kind of shot and so I I think that that parallels like this fuzzy kind of fantasy that he was viewing of her that he has now transformed to like this whole thing

when in reality he doesn't know her and that's what that shot was like trying to like demonstrate yeah yeah it definitely it it really like broke my heart right I know I just wanted him to like just get a nice back rub. It's just a little back rub while your mom just had a stroke, you know? Just like, that's like, can I get you some coffee? I know. I'm good, thank you. So, yeah, one of my thoughts is like, just for the people who may be listening to this,

who don't have history of treating schizophrenia or some sort of psychotic illness, is that usually you can stop the intensity of the auditory hallucinations within a couple days. Yeah. Like day one on an Azei psychotic, right? The auditory hallucinations are already like getting like, like dimmed down. Yeah. The delusions may take months to go away completely. And so it's like if someone who was psychotic was faced with a woman who was like, wait,

why are you doing? Can you get out? Like he would only create further delusions. Right. to like make himself maybe feel better. And I believe it is at that point that there is a correlation, I believe, around that point that's when his medication circling taken away. I think that's around that time.

Yeah. So it's the question of like how much did that play a role. Right, right. Yeah, something that was maybe being kept at bay up until that point, at least from a biological standpoint or a pharmacological standpoint, was now slowly, like the dam was cracking. Yeah. You know, one thing that I try to teach the residents,

when we look at someone who's in the midst of psychosis, is how do we empathize, not with the psychosis of the delusion, but with the meaning underneath or the desire underneath. So to empathize for him, it would be like, of course you're entitled to desire connection with someone else, with someone, you know? That makes sense.

And of, you know, of course you're entitled to desire fatherly admiration, connection. And it's, and that that's a good desire. Yeah. You know, so it's not like co-authoring the delusion. Right. Co-authoring the delusion would be like, yeah, that girl really likes you. I could see that relationship really working out. You're agreeing with this delusion that he's having, that he's having a relationship with his roommate.

Yeah. No, and I think that that's, I think that even in my mind, level of training, that's still very difficult because, you know, the inclination when someone is kind of like active psychosis is, I don't know if I can penetrate this right now. I don't know if I can just penetrate what is very clearly a psychological, psychiatric barrier that otherwise I would be prescribed me a medication for. But there's still that therapeutic alliance that can be sent with someone who is in psychosis to be able to meet them at a place, almost like a neutral ground between like where they are in psychosis and where you are as a, as a practitioner.

There's like somewhere there's like a neutral parlay. Yeah. Parlay area. Yeah. So I'll get better of finding it. So now that we've talked about the delusion, the question is, did he have schizophrenia or schizoaffective disorder? And usually in schizophrenia,

the most common auditory hallucination for men is something insulting or druggatory, like you're stupid or you're an idiot or a common one that in the data is like you're gay or you're like, so some of these sort of things that would be experienced as derogatory or bad beliefs is the most common symptom of schizophrenia. And it seemed like to him, most of his fantasies were very positive.

Right. And I think I've honestly seen that to be more of a manifestation of very kind of psychotic depression where I'm thinking of especially a couple of adolescent patients where they retrieve into this more, a retreat into this more. more positive kind of auditory hallucination that they find comforting, that they find to be something that is, that is good to them. Because oftentimes they're maybe escaping a trauma or trying to escape some sort of reality of the outside world. And so then this positive auditory hallucination ends up being very comforting for them. Yeah. Like how you put that. So something that I've seen is in someone, for example, who's homeless and they're living behind a dumpster, they may believe that they're Jesus or the Queen of England or some famous person as a way of sort of feeling powerful.

Right. Feeling that they are sort of important. And it almost protects them from the reality of like, no, you're like, You're struggling. You're homeless. So sometimes there is that sort of grandiose delusion that sort of keeps them and at their mind psychologically sound. Right. And I think it's important to remember that for a lot of people, if that's a daily kind of like state of mind that they're living in and it's just the way that what they use is survive, it's not inherently in and of itself something that like needs to just be immediately. locked up you know it's it's it's um it's uh it's it's something that they have incorporated into their everyday life and into their their ability to be able to survive um so yeah let let that guy think he's the king of england yeah he's the ruler of his dumpster domain right it's not helpful to counteract a delusion right directly um if you've ever done that you realize that's very strongly um the only thing that will come up is a stronger delusion yep

Okay, so the next thing is, you know, and I'm not sure we really answered this question, by the way, and I'm okay with that. I'm okay with that, too. And I don't think the movie necessarily wants us to answer that question. But I think that in our role, especially a psychiatrist, I think this is a really helpful conversation to have because I have listened to one podcast in particular that has talked about this movie. and for the most part, it's the view of mental illness that I think that a lot of people think that this movie is perpetuating needs a little bit more nuance

to be able to discuss and honestly it's a reflection of how oftentimes like even we have trouble with the diagnosis, you know? Right. Someone like this would show up to the psychiatric hospital, we'd get this history. And then, you know, the next five days would tell us a lot of information, actually.

You know, how do they respond to medications? How are they sleeping on the psychiatric hospital unit? You know, are they sleeping only a couple hours a night? They're sleeping through the night really easily. You know, all these things change the way and that would make sense of things. Okay, the next thing is, did he have bipolar disorder? And so, you know, usually with bipolar, there's like this ramping up over, over days, weeks, right? And then you have decreased need for sleep.

You have increased speech, you know, you're talking more. You are grandiose. So you feel like you're on a special mission, a special purpose. You have flight of ideas. You're more impulsive. But really the decreased sleep and the grandiosity are, are really the things. And I like to say it always ends in a psychiatric hospitalization, jail or death.

Yep. Because usually when you get amped up that high, it's just not coming down in a normal way. Yeah. And what I like to, especially what I like to teach my medical students is what I look for when I'm, if I'm looking to diagnose bipolar disorder is I'm not, I'm not looking for, I'm not looking for just the word mood swings. Like if you come to me saying that someone's bipolar, like in the only criteria you have is mood swings,

then I'm going to have you go back and get more history. What I distinguish is bipolar disorder, especially like, you know, since the diagnosis involves either mania or hypomania, is distinct, sustained episodes of this elevated mood that you're talking about where you're not sleeping, you're, you know, you're, in fact, you like feel energized like from not sleeping like you're you're up all night like you're making plans you're um you know you're you're going on like almost like almost like a high like like you know like you got like an energizer bunny in you and so oftentimes when I you know if a patient

comes to me saying I have bipolar disorder I think I'm bipolar and disorder and so I paint this picture for them of like oh okay so you've had episodes where you've just been up all night like you know working on like you know all these like great plans and then you've gone out and spend like hundreds of thousands of dollars and you know blah blah blah and they look at me like no actually that's not me um so i i i have um been one especially like with my medical students to be like get the diagnosis right because it is it is a very is a very important diagnosis to like diagnosis to make sure that you have correct yeah you know in his character we did see some in insomnia yeah he um at one point in in sort of

sort of a really interesting way. He pulls out things from his fridge and he gets into his fridge and shuts the door. Wow, I completely forgot about that. That was bizarre. Yeah. That was just, that was just weird. Yeah. It was like, okay, what is going on?

What is he, like, what's the thought process that leads to that? The Joker did not have bipolar. So in summary, we don't think he was bipolar. I don't think so. Okay. So next we move on to forensic diagnostic stuff, you know, non-psychiatric, like this is not the stuff that normally psychiatrists treat. Right.

So you think we treat it. Well, what do you mean? Sometimes people think we treat it. Yes. Incorrectly. Incorrectly. If someone's like got these sort of forensic diagnosis, because they can be seen as, you know, existing,

they think therefore psychiatrists are responsible for them. Right, right. Any social personality disorder is in the, is in the DSM. Right. But unfortunately, yes, it falls into this category of forensic diagnoses that are very difficult to treat or control over the course of someone's lifetime. The only time that I ever see someone with this diagnosis is when they want something

from me, like Xanax or opiates. And once they realize that I'm not going to give that to them, then they move on pretty quickly. So, okay, was the Joker a psychopath? So let me define psychopathy. A lack of affiliative attachments. So they don't like bond to people normally. And they lack empathy and they lack fear.

Okay, they have a calculated predatory aggression, which means that they have strategic planning that leads to violence. Afterwards, they're remorseless. And they demonstrate callousness. They demonstrate a callous disregard for the rights and welfare of others. Now my question for you is, you know, so, and I know, as I'm sure you'll define sociopathy in a little bit, but the fact that psychopathy is named as such, is there an element of psychosis that's evident there that, like, maybe a psychiatrist could treat? No. No.

No. So psychopathy, and this definition is from like the, there's something called the psychopathy checklist. And this is thought to be around 2% of the male population, 1% of the female population. That's a lot higher than I would. It was an article by Cummings. It's one in every 50 people that's crazy. And it's thought to be some environmental factors are there, but it's largely genetic. And so there's a really good article, I'll link in the blog, going through the genetics and the brain changes and all of that stuff.

And, you know, depending on, like, their environmental stuff and their choices, they either kind of go one or two ways. One is, like, the classic, like, sociopath, violent, criminal, right, antisocial personality disorder, where they become, like, a hitman or a drug lord or a pimp or something where it's like they're doing nefarious things and hurting other people. And they're really just trying to benefit themselves. Right. The other is the pro-social. So interestingly, in psychopathy, because it's more of a brain state, where they lack fear, they lack the attachments, they lack the, you know, the empathy, they can do jobs where you don't need that stuff as much.

Actually, you would benefit from not having those things. Like if you are a bomb diffuser, not having fear would be a really good thing. Right. Certain military jobs, certain test pilots, you know, not having those. types of responses is a good thing. So my thought on this for him is that he actually showed empathy, which makes me think he was not a psychopath. He did show no remorse after killing, and he actually made the comment, like, I thought

I would care more. That was a little bit... Flirted with it. Yeah. Yeah. That was a little bit more traditional psychopath statement. Right. But I, like, I think my counterpoint to that would be of, you know, I think back to some of my, like, schizophrenic or schizoaffective patients that have difficulty with, you know, with empathy in the first place. And so when something happens to them that they're not used to, like, you know, schizophrenic accidentally, I think the, I think those first two, you know, or in self-defense, like killing someone,

that would be kind of, that's an odd happening to them. Like, and so that's, it's such a difficult thing to, like, process as a thing that is happening to you. I'm probably not explaining this correctly, but. Here's what a forensic, a forensic psychiatrist said once. He said, if, if someone who's pleading, like, not guilty for a reason of insanity, right. tried to hide his tracks,

that person would be more likely a psychopath. If the person is found standing over the person that they just killed and saying, I've killed the devil, and that person would be more likely to be like the schizophrenic or the psychotic. And I think the final shot of him standing. The psychotic schizophrenic, I just want to clarify. Right, yes. So the final shot of him standing on a on a on a on a on a taxi cab while chaos is raining around him.

I don't I think it's I think it's that it's it's that second psychotic element of you know like this is a thing that's happening because I was I was a victim or not necessarily when not as I do not think that in that moment his thought processes. is finally I have made the world burn. Like finally, this is the final step of my master plan. I do not think that that is what is going through his head at that point in that final shot. He's not Machiavellian. He's like childlike in a lot of the stuff that he's doing. So the other thing is usually psychopaths have a long history,

a predatory aggression. So for example, for Ted Bundy, like at camp as a kid, he was creating deer traps where he was like, trying to catch potentially people in these things. So there's a long history of predatory aggression in psychopaths. So I don't think he was a psychopath. The second thing was he a sociopath.

And the sociopath is more of the baked antisocial. It's the person who went through a ton of crap throughout their, you know, they have some basic structures of empathy like normal people, but they just go they go towards criminal activities. And the thing with him is like he had such a late life conversion to killing people. Right. So I don't think he kind of fit the sociopath either.

Right. And, you know, I think one of the things that you mentioned was, you know, this idea that for so many sociopaths and on a higher level psychopaths, this there's this persistent element of like almost like lack of um lack of adren you know adrenaline uh like adrenergic tone um you know like one like one of the classic triads we look for in uh in a child if whether they're going to um potentially express sociopathic traits later on in life is um you know the classic triad is like you know do they are they fire starters um do they harm animals? Are they wetting the bed at night?

And the third one is interesting because the mechanism that controls, you know, bed wetting is the alpha-1 receptors, the, you know, the noradrogenergic, the nor epinephric system. So the idea that, like, there's a correlation between, like, just like a general low level of, you know, essentially fight or flight stress, you know, like, you know, you take someone's, you know, you take someone like this, you know, their pulse, like, you know, while they're diffusing a bomb and it's probably like in the 60s, in the 70s. Yeah.

Yeah. That's in a lot of the early studies on how they identified psychopaths. They actually look for people with low reactivity to stress in their autonomic nervous system. So the next thing is, was Joker responsible for his actions? And, you know, at this point, I believe his, you know, he lacked the brain damage, developmental trauma, mental illness that would deny him the human capacity for choice, for moral choice. And most of his life, he operated in the law, right?

And then he had this kind of conversion to the darker thoughts of his mind. Yeah, and it was, you know, if you think about things as a result of, you know, as psychiatrists, we think of things like a biopsychosocial model. And so what this movie is depicting, I think, is like kind of like a Swiss cheese situation where all three of those elements came to, you know, like from a biological perspective, he was unable to get his meds. From psychological perspective, he's like learning more about his like past childhood trauma. From a social perspective, he's not getting the social support.

So all these things line up in like kind of a perfect storm for this conversion that we witness through over the course of the movie. Yeah. Yeah. So I think that every human has the capacity to do malevolent acts. You know, everyone has the capacity to violate the rights in humanity of other people. And it's something that some people wrestle with that face-to-face. They wrestle with their shadow, as Young called it, where they come face-to-face with their capacity. to do great evil.

And other people literally are just, they shove it into their unconscious and never come face to face with it. And it may come out more impulsively and they may be almost surprised, right? You know, I think for a long time, we were, you know, a part of a tribe of maybe 50 people, and you would see those same 50 people every day.

And so, you know, know, it's, this movie depicts a man who could go through a world where he would never see the same people over and over again. So he has no tribe. He's like taken out of his tribe and he's put, he's an isolated person, which would certainly mean death back in the time when people lived in tribes. So I think his, I think his violence had more to do with his narrative, his, the belief about his life. and how other people have violated him. It wasn't in a traditional mass murder sense. Like each person he killed, there was a specific reason. Whereas, like, a lot of the mass murders that are going on in the U.S.,

it's like irrational killing of many, many people. Right. It's indiscriminate. And, like, the contrast that I would, like, draw to is, like, the, you know, for example, the Joker that we see in the Christopher Nolan movies, played by Heath Ledger, classic psychopath. And so in my kind of head canon,

what I envision is that, you know, eventually Arthur Fleck, you know, Joaquin Phoenix Joker, was eventually taken in, locked up in Arkham Asylum for, you know, kind of inciting this like kind of mass violence.

And then this younger guy who, you know, the implication is that, you know, Heath Ledger's Joker had to go through, went through like some like military trauma. And so the idea is that, you know, you think of this young guy who like sees this like figure come through who like inside of this like whole movement. And so then when he ends up getting out of Arkham, like that's what he ends up, that's what

he ends up wanting to like carry through as a legacy. And then he does end up doing more indiscriminate kind of mass murder type. actions and stunts that are very showy and very Machiavellian and deliberate. So that's kind of my head canon as to like as to how one reconciles those two versions of the character. Yeah. And I think he's not this film, but the, the Dark Knight, is that what you're talking about? Yes. He's much more the classic psychopath and the Dark Tad, the narcissist, psychopathy and the Machiavellian.

Mm-hmm. I think a lot of... And we don't even talk about Jared Leto's Joker, so... Yeah. The, you know, so every person he killed was sort of in this narrative of like, I don't feel attention. Right. I don't feel heard or understood. And when he, after he killed the three men in the subway, he says, people finally see me.

You know, I'm not sure if I'm not sure if I, if I'm, I existed. Yeah. But people are starting to notice. You know, and it's, you never listen to me. So he's telling his social work of these things. And it's this, it's this picture of here's a guy who, um, who is deeply desiring to feel important, to feel connected to other people.

And he's feeling some sort of empathy from the masses. So I think there's a, a theme of attention and just the primary, like, there's a primary, I would say human drive of attention. You know, the infant desires attention from the mother. Attention and validation, you know, like he was seeking the validation of just existing. And so, you know, going back to like the idea that I kind of mentioned earlier about how we have a tendency to want to try to rationalize irrational actions, you know, The movie sets up a narrative where to some degree, you know, you can lull yourself into rationalizing like, you know, his murders versus, again, just to contrast, something like the Joker, there's no rationalization there.

It's pure chaos. It's pure madness. Right. Yeah. So he gets this sort of attention and then it becomes like a positive feedback towards more violence, you know? And so the next thing is that this movie is really resonating with the larger cultural narratives going on and experiences in our time. So, for example, mass shootings. You know, this is really unique to our time, our attention. We have a huge amount of attention on mass shootings, although mass shootings cause a very, very small amount of deaths.

Like the amount of deaths caused by something like fentanyl, is so massively higher or suicides. Right. So massively higher, but we've created a huge amount of attention. Right. Because they're scary. Right. And part of that that contributes to that is just the senseless idea of how random it is.

You know, I think for many it's easy to justify or, again, rationalize, you know, something like the fentanyl epidemic as. even though this is very simplistic, like, well, it's still that person's choice to do this to themselves. Or something like obesity or smoking. Like these are things that, yes, like, cause lots more deaths kind of annually in the U.S. than what mass shootings cause. But what I think what's become so culturally significant about the nature of a mass shooting is taking away that essence of choice. like from the people who end up being victims of it. And I think that's why it ends up being really scary and like really just kind of, you know,

something that like gets like gets talked about like on a on a more larger scale because, you know, I don't want to like be chosen to be shot, you know, just like going about my business in a mall or anything. Yep. And I think, I think imagine you're watching this and you feel hidden. You feel a ghost in our society. You feel without access to connection or empathy. You feel there's this deep underlying rage at maybe malevolent traumas that have been done to you by other human beings. Malevolent as in like someone like did this act against you to wrong you in some way.

And so, you know, this movie is resonating with people like that at a very deep level. and some people, you know, are feeling this incredible rate of loneliness. Like statistically, loneliness has gone up quite a bit just in the last 10 years for high school seniors. The amount of people connected, you know, in actual meaningful events where they like are with other people has decreased while social media has increased. And social media actually only 4% of the time are you actually like DMing some other human being. So most of social media is like entertainment and scrolling and like looking at other people. And these people that you're looking at are often, they're not real people. They're like, this is the best shot.

We put candy in our kids' mouths. We got them to smile. And this is the one shot of the year that we're going to share. And the 50 other photos that we had to take to get to this point. Right. Yeah. And some, you know, are heavily. photoshopped.

Like a famous people, like a lot of the famous people, heavily photoshopped their photos. And to a place where, like, we now idealize something that doesn't even exist. And we all end up just kind of intrinsically feeding into each other's insecurities. You know, I, you know, I'm sure those, even, even a famous celebrity who is, you know, they have Instagram feeds, they have Facebook feeds and they scroll through and, you know, what's it like for, you know, even someone like, you know, someone like Lainar DiCaprio to see that Brad Pitt is still looks amazing at his age. You know, like, you know, that's got to have some even just intrinsic, you know, effect on their own personal psyches and personal narratives that they craft for themselves.

Yeah. And envy, right? Envy is, you know, is envy, resentment, loneliness are at, I would say, an all-time high, despite the gifts that technology has given us. And think about like how, so one of the things that I observe is that our needs, like some of the basic drives that we have as humans are met by things that are more and more distant from the actual things that they were made for.

For example, sexual needs are met by porn, hunting needs are met by violent video games and shows, connection needs are met by social media, whereas only like 4% is actually like connection. And then you have things, that are on the decline, like, you know, religious activities. In the last 10 years, there's been like a 10% drop. And like a lot of people are just nothings.

And that was in a recent Gallup poll. And so you have this like shift towards activities that might have given connection in a systematic way. And you have a movement away from that into like more like just isolated sort of activities. So you're talking about a drop. in just like participation in like just something like a social gathering like that would in particular of like that would send from a religious um you know like going to church on a weekly basis there was there's this one paper in particular we reviewed in the um in my social media episode and it talked it it was it was like it showed the negative correlation of um like out of purporting interactions like social media.

And then it showed the positive health benefits of in-person interactions like sports and like religious activities. And so one of the things that we're seeing is we're seeing a shift away from some of those more bonding activities where you would do it with a group. And so I'm seeing a trend. And then I'm seeing this movie come up

where it's like you have an incredibly lonely, isolated person who doesn't have community. And I think about like all the ways that people people used to get community and connection. And so you have people who are literally watching this 10 to 14 times. Yeah. And they're resonating with that loneliness. There was one guy who said online, he said, at the end of the movie,

I really thought he was a hero. And he is, just not in the conventional way. He is the hero of the misunderstood, the forgotten, the oppressed, by society. He's like the hero of the villains that were born just because of society being itself, an artificial sector that benefits the normal ones and condemns the different ones. As a person who's been suffering of severe depression for many years, I really understood this. Yeah. Yeah, and it's interesting to me because, you know, as I referenced earlier, a podcast that I was listening to that I felt misunderstood kind of the mental illness aspect of the of the of what the

film is demonstrating but at the same time I recognize that like you know the vast majority of people who are going to be watching this are going to be people who come from the same background as far as like you know the the podcasters that I was listening to as far as training in mental health like they're like you know we are going to be seeing a lot of like nuance that like, you know, plays into kind of like the psychiatric element of it. But for the vast majority of people, there's, it is a question of like, what is the kind of message that's being, that they're going to proceed and that they're going to, and that is going to be perpetuated for themselves.

So I think that that's an important aspect to like keep in mind, especially as I'm, especially as we're reflecting to see. Right. Yeah. Yeah. Here's another quote. I'm so glad I didn't kill myself before seeing this movie. I would have missed out big time.

Nothing else in life has compared. Wow. That is a statement. Here's another quote. About to go for my ninth time. Ninth time. Obviously, I think it's groundbreaking, a masterpiece, and I'm so happy to be alive.

It means a lot to me, more than I could say. It's like having part of me repressed on the big... Represented on the big screen. and I never expected that ever. Read this last one for us. That is a statement, yeah. Hell yeah, I love these comments. I feel the exact same way.

I'm going for a 14th time next week. I feel so privileged we get to be alive and see this masterpiece in theaters. Yeah. Wow. So I think if this film resonated with you and you're listening to this, obviously if you're listening to this,

you might have been resonating with this film and searching out more content to learn more about it. Especially if you've stuck with us for this long. You know, realize that this is actually how many of my patients feel. Yeah. When they first come in to see me as a psychiatrist and as a therapist, I've had a number of people who have been incredibly disconnected, lonely, isolated. One patient in particular, he was literally living by himself for years.

And, but, I want you to know that it didn't stop there. Yeah. Right. So through therapy, we look at how to change like the narrative, you know, the narratives. We work through some of the traumas as well in the past. And, you know, if there is psychiatric illness, then we try to get on the medications that will, like, help bring them out of the suffering that they're in.

And so, you know, could the Joker have been met at certain points, you know? I think he could have been. I think he could have. been met. I think he could have been connected with. I think maybe when the Joker said something like, I am only understood, known, talked about, idealized love. It loved if I kill people. Right. And I think that it's important to realize that at the end of the day, this is a piece of art. And like so many pieces of art that came before it,

there's nothing inherent about the piece of art itself. that is making you or compelling you to do something or that is producing a product in society. Ultimately, it becomes about how you end up interpreting and perceiving it and have what you do with that perception that you take in for yourself. So, absolutely. And kind of coming back to like the history of mass shooting in America, I've been reading the Violence Project.

They have some really good data. They've studied all mass shooters. since 1966 and they found four commonalities. Number one, a history of childhood abuse, either neglect, sexual abuse, physical abuse, viewing domestic violence, severely bullied, which leads to depression, anxiety, suicidality. Number two, there's an identifiable crisis point

in the weeks or months leading up to the shooting. For example, change in job status, relationship projections, relationship loss, with often some sort of communication regarding suicidal or homicidal thoughts. So they're communicating this with outsiders. You know, they're putting out like things like, I need help. And then number three, in most studied past shooters, they're looking for some sort of validation of their motivation.

So they're hoping to also be famous, to be met with fascination, to, and there's this sort of social contagion that occurs. So there's groupings of the shootings that actually occur one after another. And this is really important for how we report actual mass shootings, right? Do we actually say their name? Do we tell their story? Do we show their journals? Do we show that to everyone over and over and over again?

And then four, they all have a way to do the plan. They have a place and a firearm. And interestingly, they found that 80% of weapons come from family members. So, you know, how easy is it to buy a safe? Right. You know, if you're a dad or you're a mom, you're listening to this, you have guns. Buy a safe, lock up those guns, you know? Yeah, and the evidence is strong that even just the, you know, sheer presence of a firearm in the home elevates the risk of suicide and homicide.

And so, like, where a lot of these mass shooters ended up intersecting kind of with, you know, at this crisis point in their lives, once they were able to have the intent to murder and to commit this heinous crime, then just kind of became a matter of putting the puzzle pieces in police. Yeah. It was crazy. So as someone who's watching this as a therapist and psychiatrist, like I wish that there were intervention points for this person, right? I wish that this guy was captured not like when he's like 30 or in 40. I don't know how old he was when he's living with his mom and he doesn't have a job, but like somewhere somewhere in high school, somewhere in junior high,

somewhere even earlier than that, you know, like grade school even. And someone, could this person have been met with people who cared about him and who could give him empathy and compassion, who could, you know, helped him understand and process through some of the difficult things in his life? And then also help him understand his anger. Yeah. You know, because he had an anger about being isolated and alone. He had an anger. And anger is there to overcome obstacles. You know, and I don't think the murder allowed him to actually overcome the obstacles.

It didn't allow him to actually gain meaningful connection. And especially like, you know, thinking about how, you know, even just like the statement, like you're on six medications, how are they not helping? I see so often that it's, especially like in someone like this, a patient like this, It's very enticing and attempting to chase down the big flashy symptoms like the delusions, the hallucinations and whatnot, and miss something as fundamental as the chronic depression. And what could be feeding that? And what is another element that could be being addressed?

And I could see in a society like Gotham where I imagine, you know, psychiatrist office are overbooked. You know, these clinics probably don't get funding. They got to, like, be in and out, like, you know, in, like, you know, a 10, 15-minute visit. Like, I can imagine a, like, him growing up in a, in a situation where he, where the care just wasn't there

and the environment just wasn't there to be able to provide, like, what he probably fundamentally needed at the basis of all this, in addition to his medications, in addition to social support. Yeah. He fundamentally needed connection. And this is where I think for the, if you're in the general public and you're listening to this,

we have things called partial programs, like day treatment programs, and you go there five days a week, seven, eight hours a day, and you're in group psychotherapy, you're learning different coping skills, and you're connected to a therapist in a really deep and meaningful way. And I've seen patients like,

The Joker. Yeah. You know, go through the psychiatric hospital, get on some meds, get into partial. And sometimes, you know, it takes longer than just a couple months, right? Sometimes it's like back and forth for six or eight months. For like, if someone's been through severe childhood trauma, it may take a couple years. You know, maybe after the partial individual psychotherapy for weeks and weeks and weeks, you know. But it's like there's progress.

And, you know, I've had patients who have been homeless and now they're starting to move towards their goals. It's easier to just blow the building up or burn the building down, right? It's harder to make small steps towards actually achieving meaningful progress. Like working through trauma is like tough. Right. It's tough because to work through trauma, you're going to have to remember the trauma. And I feel so, especially blessed at the institution, that we work at that we are actually able to, even within the model or the structure of partial hospitization programs, have a specific group where people who might have been from a similar

functional status as the Joker, Arthur Fleck, are able to work together in being able to kind of work on those skills of being able to function as a member of society, being able to have empathy and connect with others. Um, you know, I, I, I hear a lot about, uh, other partial hospitalization programs where kind of everyone's in kind of the same group together. Um, but, and so I think that there's a real, like, added element of like, you know, just the sheer act of being able to like, see that you are not alone. Um, that can be so, so powerful. Um, even for, even for someone as, you know, as sick as, you know, even as Arthur. Yeah. Yeah. And I, I, I want to reemphasize that. We're not saying this to take away his moral choice for murder, right? But what we're saying is that there's, there's like kindling in the fire that we can, we can actually, we actually have skillful ways of helping people. And we have a heart to help people. And like people in mental health, I think, really do want to help people, not progress to a place of being suicidal or not

progressed to a place of being homicidal. And, uh, So this is a guy, you know, who slipped through the cracks, who all of those sort of things aligned where he was given the gun and given the resources and, you know, had that sort of sequence of events that led him to create these acts of violence. And I think underneath that is a larger cultural story. that's going on in, I would say, hundreds of thousands, if not millions of men and women, where they're just incredibly lonely and disconnected, and they feel as if all of their attempts of connection have been thwarted. Yeah, no, it's, I think, I think in the right ways, in certain lights, I think that the metaphors of this film can serve as a little bit of a mirror to not necessarily the narrative, I think, of, you know, society has failed you and you're all alone in this, but rather, like, this is an epidemic of loneliness, like what you're saying, and so many others are in the same boat as you.

desiring for that connection, desiring for that empathy. Yeah. Yeah. So Hans, thanks for coming on. Thank you so much for having me. I think we'll leave it for there. Yeah.

If you're still listening, thank you. I would like to humbly submit this episode for a consideration for an Academy Award. Or for a Grammy, if you're just listening to the audio version. Or for an Emmy, if this ends up being on TV. you need to know how much that would mean to Hans. Oh, you have no idea. I've already practiced my acceptance speech. And if you're listening to this and you're like,

you know, I would really like Hans on my podcast, or I think he would be a great star in this movie I'm making. I'm sure you'd be open to that. Yeah, no. We're really hoping to launch your career here. Yeah, thank you. Just let your people call my people. That would be great.

We'll do that. Thank you so much. Thank you.