Deconstructing Joker : The Pseudobulbar Affect


Source Credit: A still from the movie Joker (2019)


Joker is probably one of the most famous fictional characters in pop culture. DC Comics first introduced the character to the world and described him as "A homicidal artist, an agent of chaos, and the Clown Prince of Crime." A quick Google search showed me that the internet is torn between the infamous "Heath Ledger Joker" and the now most recent Joaquin Phoenix version. While his identity as Batman's archenemy remains a constant throughout most of his story versions, he is often described as a psychopathic killer with an abusive and dark past. This narrative is modified by many. However, the one thing that makes him unique – true to his 'Joker' mannerisms, is his humor. The Joker smile is inspired by the actor Conrad Veidt in – The Man who laughs.


"Why so serious? Let's put a smile on that face!"


- Joker in "The Dark Night"


The Todd Philips and Joaquin Phoenix version of the Joker had an exciting spin to his humor. Arthur Fleck put up a daily show, assuring himself he was happy. He was smiling on the outside while crying on the inside. He was "such a good boy after all," often stated his mother. A Joker by profession, he tried to make his audience laugh, except he would laugh uncontrollably. He has been diagnosed with the – Pseudo Bulbar Affect.


Source Credit: GIPHY

The Pseudobulbar Affect

Pseudo Bulbar Affect (PBA) is a neuropsychiatric condition characterized by uncontrollable episodes of crying or laughing. It has often been described with various names in literature – emotional dysregulation, emotional lability, pathological laughter, etc. This condition is actually due to lowering the threshold for laughter and crying. It is, in fact, a manifestation of disinhibition. Various studies show that the cerebellum is involved in this condition. This has been confirmed when cerebellar lesions were found to present with PBA. It has been proved that there is an excess of glutamate and serotonin in neural pathways connecting the cortex, subcortex, pons, and cerebellum. PBA is associated with neurological conditions like Amyotrophic lateral sclerosis, Parkinson's disease, Traumatic brain injury, and multiple system atrophy.



Laughing or Crying?


PBA is a clinically diagnosed condition. The crying episodes are often confused with depression and can be differentiated based on duration. An important feature to note is that PBA is uncontrolled crying or laughing disproportionate to the actual emotion the person feels. Since it is related to transitions in mood, it can occur without warning and is embarrassing for the person and the people around him. PBA is associated with a poor quality of life, and one of the main aspects of treatment is to reduce the frequency of these unannounced episodes.


Source Credit: GIPHY


Living with PBA


Treatment today is based on managing the excess serotonin, dopamine, and glutamate and hence is treated with Tricyclic antidepressants, SSRIs, and other antidepressants. A recent study showed that a combination of Dextromethorphan and Quinidine (DM/Q) has proved beneficial in PBA due to ALS and Multiple Sclerosis. The total burden of Pseudo bulbar effect may never be known, for it is often underdiagnosed and mistreated. However, these people, as discussed above, have a poor quality of life, and as clinicians, we can now be more aware than ever of the features and management of PBA.


In conclusion, the Joker is the perfect villain; you may never know his next move. Gotham City may have created its own superstar, and I can't wait to watch Joker in his next formidable incarnation.




Source Credit: Tenor





References:

  1. King RR, Reiss JP. The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration. Degener Neurol Neuromuscul Dis. 2013 May 27;3:23-31. Doi: 10.2147/DNND.S34160. PMID: 30890891; PMCID: PMC6065587.
  2. Ahmed, Aiesha & Simmons, Zachary. (2013). Pseudobulbar affect: Prevalence and management. Therapeutics and clinical risk management. 9. 483-489. 10.2147/TCRM.S53906.
  3. Pseudobulbar effect - Wikipedia. (2014, November 4). Pseudobulbar Affect - Wikipedia. https://en.wikipedia.org/wiki/Pseudobulbar_affectRosen H. Dextromethorphan/quinidine sulfate for pseudobulbar affect. Drugs Today (Barc). 2008 Sep;44(9):661-8. doi 10.1358/dot.2008.44.9.1258664. PMID: 19137121; PMCID: PMC2872986.
  4. JOKER Smile Though Your Heart Is Breaking & Hate In A Traumatized Boy - Characters On The Couch. (2020, March 28). Characters on the Couch. https://charactersonthecouch.com/joker-smile-though-your-heart-is-breaking/
  5. The Joker | DC. (n.d.). DC. https://www.dc.com/characters/the-joker
  6. Dandeneau, J. (2019, October 4). The Many Origin Stories of The Joker. Den of Geek. https://www.denofgeek.com/comics/joker-origin-story/
  7. Joker (character) - Wikipedia. (2014, August 9). Joker (Character) - Wikipedia. https://en.wikipedia.org/wiki/Joker_(character)


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