Joker (2019) and Mental Health

Joker has always been my favorite villain. Throughout the comic lore and the two Joker movies I saw growing up (1989 with Jack Nicholson and 2008 with Heath Ledger) the character was wild and unpredictable, a force of sheer anarchy, in d&d terms a Chaotic Evil. He sat on a billion dollar cash throne, just to torch it for fun. He had no ideology. He “just wanted to watch the world burn.”

Todd Phillips reinvents the character. His incarnation of Joker (played well by Joaquin Phoenix) is the victim of unspeakable child neglect and abuse at the hands of a psychotic mother. Phillips portrays him not as a supernatural force of chaos but the very regular and predictable outcome of a society that left him behind.

Until the 1960’s, mental health patients were placed in insane asylums (“institutionalized”) which were a cross between hospitals and prisons. But eventually, new psychiatric drugs hit the market which could help most of those institutionalized be functional members of society. This, combined with a human-rights-based pushback against asylum imprisonment, created a movement called Deinstitutionalization. Rather than house mental health patients in prison-hospitals, the government would fund “community-based mental healthcare” so that a local distributed network of doctors at small clinics could meet regularly with patients. For most, mental illness was no longer a totalizing thing. It was one illness among others, so why not be free in society, as long as the needed support system is there?

JFK signed the CMHA (“Community Mental Health Act”) in 1963. The asylums were slowly drained of patients and new distributed networks became available so that former patients could integrate into society well. However, unlike the jumbo asylums that could not be easily defunded, the community-based systems had their budgets cut annually. They were never fully funded anyway, and over time shrunk at the hands of austerity. At the same time, the cost of private medicine continued to rise. Mental healthcare was less and less available over time.

Notice that Phillips sets Joker in the 1980’s. This is intentional. During the Reagan administration the budget cuts to mental healthcare accelerated. Reagan repealed the Mental Health Systems Act of 1980 (passed during the Carter administration), allowing state-level austerity to continue to dismantle the system. What happens in the movie? Joker goes to his local mental health office weekly, checks in with his therapist, and goes on with his normal life. Until the city government cuts the facility. Joker asks his therapist, “how am I going to get my medicine?” “I’m sorry,” she replies.

Then, absent his medicine, Joker slowly but absolutely loses his mind. Many people are killed. His bizarre fantasies become grandiose and violent. The film picks up its pace at this point, and the rest is pure showbiz.

Phillips didn’t make a movie about the Joker. He used the Joker to make a movie about us, and about those we have left behind.

After deinstitutionalization and the decimation of community-based mental healthcare, many people with mental illness have become homeless, and even more have become victims of mass-incarceration (so, prison-hospitals without the hospitals). For example, it is estimated that 1/3 of Cook County jail inmates have mental illness. This is why, rather than hire another warden, a few years ago they hired a psychologist as executive director of the prison. This is the insane asylum, but worse: less funding, less treatment, less patient rights, less trained staff, and on an unprecedented scale.

Joker may seem to pose the question “How could someone become so far gone?” Instead, it poses the reverse: “How could we do this to them?”