Why 'Joker' Shouldn't Have Relied on Mental Illness (Guest Column)

Hollywood often ties mental health struggles with violence, but such instances are vanishingly rare, write forensic psychiatrists  Vasilis K. Pozios, Philip Saragoza and Praveen Kambam.
'Joker'   |   Warner Bros. Pictures
Hollywood often ties mental health struggles with violence, but such instances are vanishingly rare, write forensic psychiatrists Vasilis K. Pozios, Philip Saragoza and Praveen Kambam.

[This story contains spoilers for Warner Bros.' Joker.]

Amidst the swirling cultural and political maelstrom spurred by a slew of mass shootings, speculation about their causes and a renewed national debate about how to prevent them, Todd Phillips’ critically acclaimed Joker stormed cinemas last week, opening to a record-breaking October box office. The film, featuring a self-described "mentally ill loner" who goes on a killing spree, has generated controversy since capturing the Golden Lion at the Venice Film Festival last month, with some critics voicing concerns the film may inspire copycat violence. On World Mental Health Day (Oct. 10), what can we learn from Joker’s portrayal of mental illness and its relationship to violence?

Joker protagonist Arthur Fleck (Joaquin Phoenix) is a complex character depicted as having a serious mental illness. In addition to experiencing symptoms of depression, Fleck exhibits signs of psychosis characterized by erotomanic delusions, ideas of reference, disorganized thoughts and possible hallucinations. We also learn of Arthur’s history of childhood abuse, including head trauma that may have caused neurological injury underlying his pathological laughter. Our sympathy for Fleck builds as he suffers a series of setbacks including losing coverage for his counseling and psychiatric medications. 

However, the 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. His new persona flashes Mick Jagger and David Bowie-esque swagger, scored by a rollicking stadium-anthem soundtrack as he dances his way down the same Sisyphean staircase he had previously trudged up as a broken, powerless man. Paradoxically, Phoenix’s Joker seems more organized in thought and appearance the more distant from treatment and the more violent he becomes. 

Joker is far from the first film to associate mental illness with violence, or, for that matter, to be accused of having the potential to inspire violence. After John Hinckley, Jr.’s 1981 attempted assassination of President Ronald Reagan, America learned of Hinckley’s bizarre motive: He hoped to win the attention and affection of actress Jodi Foster, who starred in the 1976 Martin Scorsese film Taxi Driver. Through repeated viewings of the movie, Hinckley cultivated his fixation on Foster and developed an identification with the film’s main character, Travis Bickle (played, incidentally, by Joker’s Robert De Niro), who plots to assassinate a presidential candidate.  

Like De Niro’s depiction of Travis Bickle, Phoenix in Joker delivers a disturbingly accurate portrayal of a man who exhibits many of the same psychological factors and warning behaviors that manifest time and again in mass shooters. 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.”

What sets Joker apart from films like Taxi Driver, however, is its iconic protagonist whose indelible mark on popular culture is undeniable. The Joker is one of the most celebrated villains of all time, spanning the gamut of comics, television, film and video games. In fact, the Joker’s widespread notoriety and the movie’s blockbuster success — paired with Phoenix’s largely sympathetic and self-righteous portrayal of a downtrodden loner turned symbol for the masses — may increase the likelihood that susceptible individuals will identify with the film’s depiction of the character.  

While concerns the pic could inspire at-risk individuals to commit acts of copycat violence may have some validity, what is unquestionable is how Joker reinforces negative and inaccurate stereotypes about mental illness and the nexus between mental illness and violence.

In one of the most harrowing scenes in the film, Joker launches into a diatribe while making a guest appearance on a live late-night talk show. Growing intensely agitated, he tells the host, Murray Franklin (De Niro), his grim “joke”: “What do you get when you cross a mentally ill loner with a society that abandons him and treats him like trash? I’ll tell you what you get: You get what you fucking deserve!” The punchline? A decidedly unfunny execution of the host on live TV. 

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. Indeed, despite the impression Joker may give, violence related to mental illness is vanishingly rare. In fact, a person is about 15 times more likely to be struck by lightning in a given year than to be killed by a stranger with chronic psychosis, and mass shootings by people with serious mental illness represent less than 1 percent of gun-related homicides. Mental illness, however, is incredibly common: Half of Americans will experience a diagnosable mental health condition sometime in their lives, with one in five experiencing a mental health condition in the past year.

Despite these facts, beliefs that people with mental illnesses are inherently violent persist. This is because we tend to reject the truth and accept these negative stereotypes, which are notoriously difficult to dispel. They are constantly reinforced by inaccurate and stigmatizing media representations of people with mental illnesses, and can, in turn, be weaponized for political expediency. While discussing the need for new legislation to help prevent mass shootings in the wake of El Paso, Texas, and Dayton, Ohio, President Donald Trump said that coming up with solutions is “not up to mentally ill monsters, it is up to us.”

Joker could have told a story just as powerful — and realistic — without relying on tired tropes playing on divisive stereotypes.  Although it’s tempting for some to scapegoat mental illness as a way to try to make sense of seemingly senseless violence, instead, it is up to us to resist this impulse.

Otherwise, the joke’s on us — and it isn’t funny anymore.


Vasilis K. Pozios, M.D., Philip Saragoza, M.D., and Praveen Kambam, M.D., are forensic psychiatrists.

  • Vasilis K. Pozios
  • Philip Saragoza
  • Praveen Kambam