• Todd Phillips's Joker stars Joaquin Phoenix as the iconic DC villain.
  • The Golden Globes-nominated film places focus on the Joker's under-treated mental illness.
  • But is the Joker's laughing condition a disorder that affects people in real life?

The movies of the official DC extended universe—Aquaman, Justice League, and Suicide Squad, to name a few—chose to reintroduce their best-known comic book characters via slick, CGI-budget-busting blockbusters. But Joker, Todd Phillips's 2019 film starring Joaquin Phoenix, ran in the opposite direction, earning fan praise and award nominations for its gritty portrayal of how a loner named Arthur Fleck became the man who'd one day face off against Batman.

Though mental illness and Gotham City's lack of adequate resources can't be fully blamed for Fleck's eventual descent into violence, Phillips does make a point of showing how isolating Fleck's struggles become without support. In a scene that finds his social worker informing him that the funding for his treatment program has been cut off, she doesn't mince words: "They don't give a s--- about people like you, Arthur." Fleck is forced to be his own advocate, and carries a card that fails to reassure the strangers who scowl at his behavior. "Forgive my laughter," it reads. "I have a condition."

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While Joker doesn't name Fleck's condition, nor any of the mental illnesses he's been medicated for, there is a real disorder that can cause fits of uncontrollable laughter. And tears.

The real laughing disorder is called the Pseudobulbar Affect.

According to the Mayo Clinic, "Pseudobulbar affect (PBA) is a condition that's characterized by episodes of sudden uncontrollable and inappropriate laughing or crying." Echoing the language on the Joker's laminated card, PBA can indeed occur in people with brain injuries, stroke, or certain neurological conditions such as ALS or multiple sclerosis. Though more research is needed regarding the causes of PBA, it "involves a disconnect between the frontal lobe (which controls emotions) and the cerebellum and brainstem (where reflexes are mediated)," per the American Stroke Association. Those who experience PBA don't necessarily feel emotions like sadness or amusement more intensely; it's more about their brains' inability to regulate when and how those emotions are expressed.

When someone's experiencing pseudobulbar affect, uncontrollable laughter can bubble up during an inappropriate or outright sad moment. Or an innocuous conversation can trigger a crying jag that, to outside observers, seems to come out of nowhere. Given that these involuntary outbursts can last from seconds to several minutes at a time, PBA can feel profoundly alienating for the person living with it. "Severe symptoms of pseudobulbar affect (PBA) can cause embarrassment, social isolation, anxiety and depression," the Mayo Clinic writes.

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Joker / Bus Laughing Scene (I Have A Condition)

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Joaquin Phoenix doesn't think the Joker suffers from the pseudobulbar affect.

The actor told Movieline that he developed his own theories about his character's "affliction" while shooting the film.

"I question if that's really what he has," he said of the pseudobulbar affect. "It's one of those examples of something I didn't want to answer." Though Phoenix initially played Arthur Fleck as having PBA, he decided something else may be at play. "I thought of the movie as a commentary on humor in our PC culture. Somebody who was out of touch with the world, laughing at school at something horrible that has happened," he continued. "How to explain that to the principal? I never decided which one it was, but I liked the idea that it was perhaps his real nature emerging that other people were trying to suppress."

However, Movieline points out that director and co-writer Todd Phillips did take pseudobulbar affect as inspiration for Arthur Fleck's behavior—going so far as to show Phoenix a video of someone with PBA the first time they met about the film.

Fortunately, the "laughing disorder" is treatable.

People experiencing PBA are often misdiagnosed with depression, says the American Stroke Association, because...well, because of all the crying, mainly. According to the organization, the condition has been treated with antidepressants but that "may be only moderately successful." Instead, the ASA offers a list of coping techniques that range from deep breathing and change of posture during an episode to remaining "open about the problem so people aren't surprised or confused when you have an episode." Which, of course, is what the Joker was attempting to do with the card he presented on the bus.

As with any sharp shift in mood or mood regulation, the most important thing to do is talk to a professional as soon as possible.

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