In Todd Phillips’ 2019 film Joker, controversial main character Arthur Fleck aka Joker serves up commentary on mental illness. Joaquin Phoenix’s portrayal of Fleck has garnered rave reviews, even if the film has come under much scrutiny. Audiences seem to either love the film and or hate it before the previews start. Yet Joker’s portrayal of Batman’s arch nemesis is about more than villainy. In some sense, it’s the story of an illness as Joker struggles with an uncontrollable laughing disorder.
In the film we first learn of Joker’s laughing problem on a crowded bus. There, he attempts to make a child laugh, only to be scorned by the child’s mother. Despite the tension of the situation, Arthur randomly breaks into a creepy laugh, his face contorted in a choke, before he suddenly stops. A similar laughing outburst leads to a beating at the hand of three men who don’t understand his struggle. What causes these laughing outbursts in Arthur? He carries a card which claims its a condition. And it’s real.
Joker’s uncontrollable laughing is based on a real disorder called Pseudobulbar Affect or PBA. PBA isn’t limited to laughing, crying is also a main symptom of PBA with both the laughter and crying becoming involuntary, uncontrollable and frequent in nature. Sufferers often go through these outbursts regularly, creating uncomfortable situations of inappropriate laughing or crying. Some with PBA report symptoms that come on so fast it’s like having a seizure.
Unable to control their laughing outbursts in much the same way the Joker can’t in the movie, those afflicted with PBA often find it easier to stay locked away, out of sight. Life in the workplace can be just as trying given the nature of this laughing affliction. The social pressure of this affliction often leads to anxiety or depression, creating a situation where the crying version of PBA is diagnosed as depression or bipolar disorder.
Researchers believe PBA may be the result of damage to the prefrontal cortex of the brain. This is the area of the brain which helps control emotions. Changes in brain chemicals linked to mania or depression, as well as damage to other parts of your brain, are also thought to play a role in this disorder. Stroke, ALS (amyotrophic lateral sclerosis), MS (multiple sclerosis) or a traumatic brain injury are some of the known causes of PBA.
Scott Lotan is someone who suffers from PBA’s pathological laughing in real life. He saw Phillip’s Joker movie and spoke out to LADBible about his own struggles with pathological laughing and how they relate to Joaquin Phoenix’s portrayal of Joker in the film. Scott says Joker’s portrayal is spot on and calls Phoenix’s depiction “amazing”.
Lotan reports his Pseudobulbar Affect has placed him in many uncomfortable situations. His PBA is a result, or symptom, of his multiple sclerosis. It causes him to have episodes of laughter which can last as long as ten minutes. As a result he often has difficulty getting served in restaurants and has even been asked to leave for making customers and waitstaff uncomfortable. In other situations he’s been out for a drink with friends and ended up with people challenging him to a fight, when they believe he’s laughing at them.
Lotan says Phoenix’s portrayal of Joker’s laughing got it correct, right down to choking during his episodes. Scott recalls a real life incident of his own which could easily have been a scene from the movie. While on his way home from an engagement party with his girlfriend and mother, they were hit by a drunk driver. His girlfriend died on the scene, his mother three days later. He says, “I remember being at the scene laughing and being questioned by police.”
How does someone like Scott Lotan deal with a laughing disorder? An attempt to be aware of one’s surroundings seems to be the common answer for those affected but wishes to continue a normal life. Others seem to find their answer in a solitary life. The inability to control their laughing can be very stressful. Being able to explain to family, friends, co-workers what exactly is happening is their best way to relieve tension. Medication has also been prescribed for some diagnosed with PBA. Antidepressants are typically prescribed in lower doses as well Nuedexta, the only medication the FDA has approved which is designed specifically for PBA.
Misunderstanding PBA can be easy. The movie’s on screen portrayal of Joker’s laughing disorder may help those suffering with it in real life to find more understanding, patience, and empathy in those around them.