Pseudobulbar Affect Gone Mad
Uncontrollable crying. Uncontrollable laugher. Either can present unexpectedly secondary to a neurologic insult or brain injury. There is no apparent motivating stimulus that promotes the pathological emotional incontinence. It can be an excess laughter to something that is funny to begin with or to something totally inappropriate.
The main actor Joaquin Phoenix plays the Joker, who is seen laughing inappropriately to random words heard, behaviors observed or funny situations but in excess to the norm. The outbursts are sudden and unpredictable, lasting up to several minutes and occurring up to several times a day. Patients usually have insight and can recognize that their behavior is out of character and inappropriate.
Pseudobulbar affect can be caused by:
. . . and the list goes on. The social impact due to pseudobulbar affect is grave. It can lead to terminated relationships, awkward situations and even dangerous scenarios. In the movie, Joker inappropriately laughs when the three affluent young men make fun of the single girl riding the metro at night.
This obvious and obnoxious outburst led Joker into a physical altercation with the men and to their eventual demise. The actions that Joker demonstrates in the movie should not be taken point-blank; many of the violent and deadly actions committed by Joker are not symptoms representative of pseudobulbar affect.
In Joker’s case, his delusional psychosis was manifested through the implications of his pseudobulbar affect. As can be observed in the film, Joker was delusional the entire time: he was never dating the cute black woman down the hallway which he envisioned at his mother’s hospital bedside, or walking into her apartment and kissing her.
The delusional psychosis was Joker’s internal conflict. His pseudobulbar affect was his outer conflict. Because of the social ramifications of this outward appearance and behavior, Joker experienced a psychotic break with reality. He ends up killing the three affluent young men in the metro, his ex co-worker, Murray Franklin and his own mother.
His pseudobulbar affect became a vessel for his delusional psychosis to break free. As you can tell, Joker found freedom through his psychotic break: he was more free to act like himself by dancing down the steep city staircase, perfect his grand entrance at home for The Murray Show, return to his previous job with conviction and even take the life of his own mother during her hospital stay.
This is not to imply that psychotic breaks are good; they are the epitome of what every human should want to avoid in life. But in the case of Joker, he was never able to discover freedom before his psychotic break, because he was never comfortable with himself and the outcomes of his life.
So his psychotic break, unfortunately, provided him with a taste of freedom which he never previously experienced before. But this state of freedom got him into trouble with the law and flipped his life more upside down than already previously flipped. Freedom does not always bring peace and happiness.
What is your opinion of the mental illness known as pseudobulbar affect and Joker’s emotional and mental suffering?
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