The Joker & Mental Health

Becoming Joker: Opening the Conversation on Mental Health

Mental health has become a buzzword in pop culture as of late. #SelfCare and #Therapy are hashtags that have made their way into mainstream, albeit, social media commentary.

While it is noble that #MentalHealth is being normalized, where are the conversations about mental illness, distressing experiences, and the decline in ability to function on a day to day basis?

Anxiety and depression are the more generalized mental health disorders the masses seem to discuss on Instagram and Twitter. However, there are a number of disruptive and distressing experiences individuals can have. From adverse childhood experiences (ACEs) such as abuse, neglect, and household dysfunction to severe mental illnesses (SMIs) such as schizophrenia and bipolar disorder. Mental health is a part of a spectrum of wellness, as opposed to something that is seemingly “wrong” with an individual.

The conversation about mental health goes deeper than “treat yourself” bubble baths and shopping sprees in the name of self-care. Truly understanding the circumstances that may aggravate mental health symptoms can bring a sense of understanding to those who may be struggling. But the idea of family background and environment versus genetics and biology can spark conversation about whether or not those struggling with mental health issues can recover or if they are “plagued” with these challenges forever. 

Introducing, Joker

Joker (2019) earned more Academy Award nominations than any other movie this year. It speaks to humanize a comic book character by the movie’s namesake. We learn of the main character’s (Arthur) past and look on as he endures interactions that shape his view of the world. Arthur struggles with the effects of head trauma, ACEs, and a system that seemingly has failed him.

Arthur faces many obstacles in his quest to merely become a fully functioning member of society. 

As Arthur speaks with a counselor in several scenes, we watch him become more assertive (and ultimately, aggressive) with regards to his mental health care. Taking part in a government-funded counseling program that becomes defunct, Arthur decides to take matters into his own hands in order to control how he ultimately lives his life. Through violence and a blatant disregard for possible consequences, Arthur receives acknowledgment for his actions. This makes him continue a pattern of undesirable behaviors. 

Arthur, with no accessible way out of his struggles, seems to embrace them, and ultimately, become them; personifying the way he feels and the adversities he faces. This leads him to become Joker.

Is it acceptance of what is?

A signal of defeat?

Or a reclaiming (and renaming) of an otherwise stigmatizing aspect of his life?

What is Mental Health?

Mental health is an aspect of our total wellness. It focuses on the brain and our interpretations of the world around us. One end of the mental health spectrum is what many consider to be mental illness. Mental illness can impact an individual’s functioning in some, many, or all areas of life. This includes things like losing touch with reality, not getting out of bed, and no longer being sociable.

By definition, to be diagnosed with a mental health disorder, the symptoms of any given disorder must meet certain criteria AND impair important areas of functioning. 

For example, to be diagnosed with Major Depressive Disorder (MDD), an individual must meet 5 or more of 9 specific diagnostic criteria and the depression they experience must markedly interfere with social, occupational, and/or other areas of functioning. In a nutshell, if depression is severe enough to hinder your performance interpersonally, at work/school, personally (hygiene, feeding, etc), essentially interfering with everyday life, you may be diagnosed with MDD. 

Is Mental Illness Shaped by Nature or Nurture?

Many people believe mental health is affected solely by the environment one is in. The fact of the matter is, mental health can be affected by both nature AND nurture, just nature, or just nurture. Some people have a genetic predisposition to be depressed. However, if the environment is not chaotic nor depressing to the individual, they will be less likely to develop depression. On the other hand, if the environment creates the perfect storm of chaos and adversity, the individual may develop a depressive disorder. 

Nature and Mental Health

Joker (2019) only hints at the idea that something is “off” about Arthur. We see him laugh uncontrollably at inopportune times. We learn his mother had her own mental health struggles which may have passed to Arthur. We look on as Arthur embodies discomfort in a manner that is uncomfortable to watch. 

In this mental health-specific debate, nature refers to the biological composition of the brain and body. Sticking with our example of depression, we will discuss the Nature component and how it can affect an individual.


Dopamine and serotonin play significant roles in depression. A lack of these neurotransmitters or their difficulty binding to appropriate receptors in the brain and body can cause symptoms of depression. In anxiety, low serotonin binding seems to be the culprit. Lack of dopamine is responsible for low motivation, (seen in clients with depression symptoms) whereas serotonin deals with emotional processing and the ability to regulate our feelings.2

Also, people diagnosed with depression seem to have physical differences in the appearance and function of the brain. The CA1 and subiculum regions of the hippocampus have decreased volume in persons with depression. This area holds some responsibility for reward-motivated behavior, along with regulating emotional behavior. Also, the amygdala, an area linked to emotion regulation, shows some reduction in glial cells – cells that aid neuronal function.4 

Some individuals with a first-degree blood relative with depression are more likely to develop depression. This genetic predisposition may be exacerbated through the nurture component of this debate.3  

Mental Health and Nurture

Keeping with our case study, we watch as Arthur (Joker, 2019) has a rough life; he is the target for violence, experienced abuse and neglect as a child, and goes on to be praised for negative behaviors. 

Nurture in the discussion about mental health refers to the environment an individual may be in. 

Nurtured Mental Health Risk Factors :

  • Adverse Childhood Experiences (ACEs) 
  • Traumatic events
  • Ongoing, chronic stress
  • Drug/alcohol abuse
  • Certain Medications 3 

ACEs, or Adverse Childhood Experiences, are situations a child may be exposed to that may shape how they view themselves or the world. ACEs include abuse, neglect, and household dysfunction, such as domestic violence. Other experiences can also be an adverse experience for children: bullying, not having basic needs met, being in foster care, among a number of other experiences. 

Adults can go through adverse experiences, as well. Being laid off, losing a loved one, living in poverty, harassment, witnessing violence, and lack of resources can shape their view of the world and self. Thus, making these circumstances traumatic. These situations can trigger a depressive response, causing a cycle of depressive symptoms, and possibly, a depressive disorder. 

Ways to Help Joker

As Joker (2019) progresses, we interact with Arthur in such a way that he seems to become the hero of the film. We root for his new found independence and sense of identity, despite the horrors of it all. Arthur represents a number of individuals – people who are unheard, ignored, and left to fend for themselves. In reality, these individuals need help with coping and altering their negative view of the world and of themselves. 


Counseling and Therapy are treatment methods that have proven to be effective in assisting individuals struggling with their mental health. Coping skills, changing behavioral patterns, and addressing negative thinking are just some goals of counseling. Building rapport with clients is a skill counselors and therapists should further develop.

A supportive and transformative relationship with a counselor is a main determiner of successful mental health treatment.

Prior to social services losing funding, Arthur was attending counseling sessions with a therapist who did not seem to develop a genuine relationship with him. The discussion between the counselor and Arthur made it plain that Arthur was not getting what he needed from their sessions. He was not making progress, but simply doing what he thought was right. He was motivated, but the system failed him as he believed he had no other options.

Medication Management

Medication for mental health (psychotropic medications) is usually managed by a psychiatrist or psychiatric nurse practitioner. These are well-trained professionals who understand the ins and outs of psychotropic medications. In most cases where medication is prescribed, counseling is also highly recommended (and in many cases, required) as an augment to aid in the success of the client. 

medication management

Arthur was on the brink of losing access to his medications. This was his primary concern as he learned the agency he was going to was defunded. By maintaining his medication regimen along with effective counseling sessions, Arthur may have seen significant progress in his symptoms and experiences.

Neurofeedback and EMDR

Neurofeedback is an extensively studied protocol that focuses on the function of the brain and the client’s physiology. A non-invasive, non-pharmacological treatment, neurofeedback has been effective in helping clients cope with distress in more effective ways. By visualizing the client’s brainwaves on a screen and coupling it with positive or negative feedback, clients can change their response to stressful situations. 

EMDR Therapy, Eye Movement Desensitization and Reprocessing, is an effective psychotherapy technique that reduces the stress response resulting from traumatic experiences. By reducing the overstimulation that occurs when recalling distressing memories, clients can return to a lowered, less anxious or hypervigilant baseline.

Arthur could have benefited from Neurofeedback and EMDR. His history of head trauma, ACEs, anxiety, depression, and poor executive functioning could all be addressed by Neurofeedback and EMDR. It could have given Arthur the tools needed to cope with the adversity he faced in his day to day life from childhood into adulthood. 

Neurofeedback with NeuroZone

At NeuroZone, we treat a wide variety of clients. From anxiety and depression to neurodevelopmental disorders and head trauma, our clients are able to realize their coping goals without medication. By creating customized treatment plans for each client, we are able to address their individualized concerns with empathy in an effective manner. 

If you or your child are struggling with mental health concerns, neurofeedback may be the solution you are looking for. Contact NeuroZone in Los Angeles today to learn how Neurofeedback can help change your view of the world into a more positive outlook. 

Continuing the Mental Health Conversation

The mental health conversation is one that is ongoing. From the individual level to the wider societal and global communities, people and policies are changing in an attempt to be more inclusive of those with mental health challenges and concerns. Joker (2019) can be a catalyst to continue the conversation. 

Additional Resources

  1. Baratta, R., Berman, B., Cloth, J., Cooper, B., Garner, J., Gilbert, A. L., Hamada, W., Nagpal, A., Tillinger Koskoff, E., Uslan, M. E., Webb, D, (Producers) & Phillips, T. (Director). (2019). Joker [Motion Picture]. United States: Warner Brothers
  2. Vandergriendt. C. (2018). What’s the Difference Between Dopamine and Serotonin? Retrieved from 
  3. Mayo Clinic. (2020). Depression (major depressive disorder). Retrieved from 
  4. Drevets, W. C. (2002). Structural Brain Abnormalities In Depression. [Abstract]. U.S. National Institute of Mental Health. Retrieved from 
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