Perhaps the most important, yet understated event in Joker is that Arthur Fleck lost his medications and social worker. Due to budget cuts, publicly-funded social workers simply abandoned their cases, leaving Arthur with no easy way to refill his medication and no professional to talk to. These events, especially going off of one’s medications, can send people into psychosis, especially after a traumatic event like losing one’s job, being subject to violent crime, or having severe conflicts with loved ones. Arthur endures all three events within a short span of time, which was likely too much for him neurologically.
The movie doesn’t draw much attention to Arthur not having his medications. In fact, early in the movie, he says the medications aren’t working, and his social worker replies that he’s on seven medications, so they must be doing something. And I think it’s clear that they were helping to a significant degree. After going off of his medications, there seems to be a dramatic decline in Fleck’s mental health, from an entirely delusional relationship to dramatic mood swings, and thrill-seeking behavior. This is one reason it is hard to characterize Arthur as a villain. Even though he commits evil acts, it is doubtful things would have gotten so out of control if he’d been medicated and had someone monitoring his treatment (however overworked and depressed his previous help was). This is one way in which Gotham’s rich failed the poor. By not adequately funding basic mental health services, Arthur was deprived of one of his main tools for maintaining contact with reality.
I do not want to reinforce the dangerous stereotype that the mentally ill are violent. It’s not true. But all else equal, many of the severely mentally ill are more likely to commit suicide and engage in uncontrolled, risky, destructive, and even violent behavior without access to certain medications, especially antipsychotics. Joker helps to illustrate this even though we don’t know which medications Fleck was taking.
The movie does a fairly good job depicting the quality of mental health services for the poor in many parts of the country, at least in the early 1980s. I have a close family member who is a therapist, and she has worked with court-involved youth all over the country in prisons, juvenile detention facilities, extremely impoverished homes, and psychiatric hospitals. She’s seen how mental health services for the poor often work, and fail to work. I have also, for various family-related reasons, become acquainted with mental health facilities for low-income and lower-income people. The depiction of the mental health worker as overwhelmed by case loads, underfunded, and emotionally exhausted fits our experience. And the gray, depressing, yet often shocking and deeply uncomfortable experience in visiting some mental health facilities also rang true, even for some facilities today.
The main thing that’s objectionable in the movie’s portrayal of mental health services is their failing to depict at least some mental health workers as loving, passionate, and kind. All too often, popular culture assumes that people in the mental health field, especially those who work with the poor, are overwhelmed by their experience, and have the joy drained out of them. But that’s not true, not even usually.
So, Joker struck me as a broadly accurate portrayal of the dangerous game we play when mental health services for the poor (public or private) are inadequately funded and staffed.
There is much to comment on in the movie, which I can only describe as jolting, but it’s important to recognize that one of the prime precipitating factors of his descent into darkness was a failed mental healthcare system in Gotham City.
Many have commented on the importance the movie places on accessible mental health services. So my take is by no means original. But the movie illustrates the way in which mental illness has a life of its own, and how crucial it is to have the right help at the right time.