A clown in early-1980s Gotham

Todd Phillips’s Joker was released in the United States in 2019, with Joaquin Phoenix as Arthur Fleck. The city is Gotham in the early 1980s, marked by inequality, poverty, and crime. Arthur works odd hours as a clown and dreams of being a comedian. He lives in a tight apartment with his sick mother, Penny Fleck, and he has a laugh that bursts out at the wrong moment, a laugh he cannot hold.

He is in counseling and on medicine. Then a city budget cut stops the mental-health sessions and the drug support, and his condition slips quickly. He wants to be seen and met with some feeling, and he is ignored and mocked instead. In clown makeup he is beaten by thugs; on the subway he is beaten by men from Wall Street, and he shoots three of them. The killings are taken up by people angry at inequality as a symbol against the system, and protests spread through the city.

He looks into his mother’s claim of a past with Thomas Wayne, and the truth he finds is worse than the story she told. He was adopted. As a child he was badly abused and neglected by his mother and her lover, and Penny herself was lost in delusion. The shock turns his anger up to a peak, and he kills her. He completes the identity of Joker and appears on the live show of Murray Franklin, a host he had admired. On the air he names himself as the subway killer, says the city left the weak and mocked them, and kills Murray, becoming a spark for a large riot. In the chaos he is hailed as a kind of hero, yet the film ends with him confined in a psychiatric hospital, the madness still going on.

A life that will not sit in one diagnosis

Arthur is not given a single diagnosis. The problems are described as complex, with features of a depressive disorder and of psychosis spread broadly through what we see. The despair and helplessness can be read beside learned helplessness — the belief that nothing one does will matter — and the turn is from suicidal thought toward aggression aimed at other people.

He takes fantasy for reality: that he is Thomas Wayne’s hidden son, or that he has a relationship with a woman next door. An inflated idea of himself, a hunger for fame and wealth, and the laugh that comes at the wrong moment are set beside the inappropriate affect of a psychotic disorder, or beside the grandiose delusions of a bipolar state. In a manic state, energy runs abnormally high, speech is plentiful, sleep shrinks, and impulsive acts increase; in a depressive episode there is listlessness, sadness, guilt, and suicidal thought. Cognitive theory is used to say that Arthur is caught in a negative triad — about the world, about himself, and about the future — and that this is what draws the path toward a tragedy.

His violence is not read as pathology alone. It is also suppressed aggression, pushed outward after a long stretch of being ignored and mocked. A 2024 review of medicine for schizophrenia is listed among the sources; it is not used here as a label for Arthur. The Korean word for schizophrenia is said to come from the idea of tuning a string, a mind whose tuning has slipped. That etymology is noted as a way of thinking about a disordered inner life, not as a verdict on this character.

When the support stops, and what nursing is asked to hold

Medicine such as an antidepressant is said to take one to three weeks to show an effect, and in a chronic or recurring illness long-term treatment is essential. When the service is cut, adherence is undermined and the risk of relapse rises sharply. Arthur’s tragedy lies less in the illness itself than in this fact: at the moment the support was needed, it was taken away. The question put to nursing is practical. If care stops in the continuation and maintenance phase because a budget has been cut, what kind of integrated support can be built in the community so that a person does not fall back?

From early on, a nurse is asked to help the person notice, through cognitive behavioural work, automatic thoughts such as “I am a failure,” and to test and rebuild distortions such as taking a refusal as a personal verdict. Social-skills training and group therapy are named as ways to ease isolation. Over-identification, and canned comfort of the “cheer up” kind, are to be avoided. A plain, accepting line — “You seem to be having a very hard time right now” — is preferred, so that pain can be spoken inside a therapeutic relationship rather than acted out as violence.

A deeper trouble than the budget cut, some of the discussion says, is a structure that turns the patient into an other. Continuity of care is treated as the core reason relapse happens when it does. In a group discussion, some voices keep to medical continuity and monitoring, others with links to social welfare and resources, others with public understanding and the easing of stigma. They differ in emphasis, and they agree on this: poverty, stigma, and gaps in care all weigh on relapse, and a nurse is not only a person who delivers treatment. The work extends to livelihood, housing, and employment, in concert with social workers, counselors, and officials — as a connector, an advocate, and a teacher in the community. Relapse is not treated as a lack of personal will. It is what happens when the social system around a person falls away. If Arthur had been genuinely held and understood even once, might another life than Joker have opened? The same Korean report, at fuller length, is on CampusDown.

Sources

1. Kim Gyeong-hui and others, Psychiatric-Mental Health Nursing, 7th ed., Seoul: Hyunmoonsa, 2023, pp. 157–226.
2. Todd Phillips, dir., Joker, Warner Bros. Pictures, 2019.
3. Kim Seo-yeong and Kim Eui-tae, “Current advances in pharmacotherapy for schizophrenia,” Journal of the Korean Medical Association 67, no. 2 (2024): 96–102.
4. Kim Jin-mi and Shin Hyo-jin, “A study on the social-network characteristics, social support, functional recovery, and life satisfaction of people with mental illness,” Journal of Convergence for Culture Technology 9, no. 6 (2023): 85–96.

Last updated: 14 November 2026