Joker distorts link between mental illness and violence

The critically acclaimed film Joker is playing to packed cinemas, but its portrayal of mental illness is worrying

The world of cinema has long used mental illness as a focus for a riveting story. Who can forget the stellar performances of Jack Nicholson in The Shining and, of course, One Flew Over the Cuckoo’s Nest?

In one he descends into some vague but violent disorder and terrorises his family, and in the other he plays a ‘sane’ interloper in a 1960s state asylum, dominated by the brutal Nurse Ratched.

Influence of popular culture on public opinion

The depiction of electroconvulsive therapy in One Flew Over the Cuckoo’s Nest is believed to have dissuaded many from receiving a treatment that, the evidence suggests, can be beneficial. Ultimately, Nicholson’s free-spirited character is subjected to a behaviour-controlling lobotomy.

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One Flew Over the Cuckoo’s Nest has always divided opinion. To the general public it’s a great film with a moving ending.

‘When artists inaccurately associate mental illness with violence it may give a licence to others to do the same’

As a mental health nurse, I have always considered it unhelpful in its depiction of psychiatry being used to modify, control and eliminate undesirable behaviours.

Of course, some would argue that this situation remains today. The film, an acknowledged classic, is art and art is open to interpretation.

So what are we as mental health professionals to make of the new film Joker, in which another outstanding actor, Joaquin Phoenix, plays a character with a collection of symptoms that are good plot devices but hardly realistic.

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 Unrepresentative image of mental illness

Joker is attracting huge audiences and critical plaudits, with Phoenix a likely contender for an Oscar. Can we really expect the general public to appreciate why its ‘diagnostic vagueness’ – as two doctors writing in the Guardian put it – is cause for concern?

Our concerns are hardly likely to be heard, and it could be argued that they betray a lack of professional self-awareness or a failure to understand the necessary freedom permitted to filmmakers. After all, Joker is entertainment, right?

People with poor mental health are more likely to be victims of violence

Well, there are some issues that push through delicate arguments about diagnostic vagueness, most obviously the film’s violence and how it is linked, almost casually, to mental illness.

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This historical association between violence and mental illness has ‘pepped up’ many a drama. It makes for exciting viewing and can be captivating. Yet if there’s one message we need to get across, as healthcare professionals, it’s this: mental illness does not necessarily have a causal relationship with violence.

People with poor mental health are more likely than the general population to be the victims of violence. When artists inaccurately associate mental illness with violence it may give a licence to others to do the same. It may even legitimise the verbal and physical violence that is used against people with mental illness. That is no joke.

Ian Hulatt is consultant editor of Mental Health Practice