The worst part of having a mental illness is that people expect you to behave as if you don’t.

I went to see The Joker last night. It was an extraordinary film to watch, a profound depiction of Arthur Fleck’s severe mental illness played by Joaquin Phoneix, and a disturbing illustration of society’s rejection of what we don’t understand.

With unabashed expertise, Phoneix adeptly exposes the gradual erosion of Arthur Fleck’s psyche.

A young boy with a family history of significant mental illness; the biological predisposition present at birth.

(the genes load the gun)

A prolonged childhood history that included severe sexual, physical, and emotional abuse, neglect, abandonment and brain injury. You watch him try to be a “good boy”, to smile, to make others happy. You see his absolute innocence early on. You watch him get beaten when he could have been accepted. You watch how society laughs at him when he needed to be understood. You watch how people walk past him, shun him, and ultimately blame him for things that are well beyond his control. You watch the therapist who just stares at him, who is not equipped to understand what is unraveling before her. You observe how government cutbacks wreak havoc; a societal message about priorities where mental illness is far, far down the list). Despite Fleck’s repeated attempts to belong, to work, and to seek treatment, he is continually met with a litany of rejection, abuse, and exclusion from anything that is healing or human.

(the environment pulls the trigger)

You watch all the opportunities to help this man slip by. The chances to have validated him, to have taught him, to love him, to provide proper treatment, to increase his support system, to treat him with kindness. So many lost opportunities.

We know that invalidation (abuse, neglect, being ignored) increases emotional dysregulation and worsens mental health. As the character responds predictably to the unforgiving environment, the more ill he becomes, and the more people judge and reject him. You watch as the chances of him getting the help he needs dissolves over time.  I’d like to tell you that this is an historical film about what USED TO happen to people with severe mental illness, but I can’t do that because I see it happen today all too often.

Some reviewers of the film have focused on, or made public statements about, the idea that the movie supports the myth that mental illness results in violence. I do not agree that the movie endorses this concept and if we focus on the violence in the movie, we’ve missed the whole point, and we become part of the very problem that the movie courageously addresses. The film was a social commentary on the  detrimental impacts that occur when biological vulnerability repeatedly collides with a severely abusive and invaliding environment. Can the result be violence toward others? Yes – but not very often. The result is more often violence or harm to the self (e.g., self-injury, suicide, substance abuse, eating disorders, depression)

(genes load the gun, the environment pulls the trigger)

Arthur Fleck reminded me of so many people I have known over the years both personally and professionally. The portrayal was so accurate that my heart hurt through the whole film. From the moment the character of Fleck appeared on the screen, I recognized him. I knew the appearance, the way he walked, the way the body moved, the look in his eyes, the Pseudobulbar affect (aka uncontrollable laughter or crying that is neurobiological in nature). I knew the character so well, the features so very familiar, all embedded in my bones and in my psyche.

In the 1960s they said my aunt woke up at the age of 16 unable to stop screaming, the onset of schizophrenia, a lifetime of experimental medicine, locked wards, control by sedation, ECT, talk of lobotomies. Her whole life, a dream or a nightmare….I fear it has been the latter.An uncle developed schizophrenia a few years later.  I remember visiting him on a mental health unit as a child in the 70s. I remember the bleak atmosphere, the absence of compassion, the smell of urine and bleach in the visiting room area, the eerie silence, the lack of hope for him, for them, for all of us. Walking into that hospital was like entering a vacuum, void of anything that felt natural or humane or healing. I didn’t understand then what I was witnessing. Maybe that is part of why I became a psychologist: to search for answers that didn’t exist.

How many patients have said to me that no one hears them, that no one seems to know what to do, that no one listens to them? In one scene, Fleck directly and with exhaustion says to his therapist. “You don’t listen, do you? You just ask the same questions every week. ‘How’s your job?’ ‘Are you having any negative thoughts?’ All I have are negative thoughts.” The therapist, unsure how to respond, simply moves on. Another missed opportunity. What he needed was to be heard, to have consistent, evidence-based care, to be told that he mattered, to be treated as an equal. Because any one of us is just a small shift away from being Arthur Fleck, a shift in DNA, a trauma, enough invalidation to activate our own genetic predispositions.

Sadly, I have worked in several institutions where the treatment is archaic, denigrating, and not overly different from the depiction of the care Arthur Fleck received in the film. I have witnessed patients being re-traumatized, blamed for their behaviours, invalidated, infantilized, and treated as non-humans. I have reported these behaviours only to watch nothing change. I see the look of despair on the faces of  patients and it reminds me of the look on my aunt and uncle’s faces more than 40 years ago. I have left hospitals and programs for this very reason.

Please know that I am aware and have great respect for the hundreds of men and women working incredibly hard to create healthier spaces and better treatments for those suffering…we just need more. Please also know that the problem isn’t unique to our hospital systems. Our society is still incredibly adverse to mental illness. Sitting in the theater, I could hear a group of older guys laughing and making fun of mental illness at very poignant scenes in the movie. As I walked passed them after the show I  could hear them talk and laugh about how “crazy” Fleck’s mother was. My god, I thought, you’ve missed the whole point of the film.I see it all the time. Those who speak publicly about being mental health advocates but then privately ignore, judge, and mistreat those who struggle. I see you. Everything in me reacts to these experiences and yet, I sometimes feel complete powerlessness to change such a dominant and oppressive world.

Professionally, I risk my career and my colleagues every time I speak openly about my experiences. I know I will lose people in my honesty and self-disclosure but I don’t care anymore. If I don’t speak out, I am part of the problem too. All I have to offer is my voice, my experience.

I don’t know what I can or should post on social media anymore. I don’t even know if I should post at all. Lately, I think I am too sensitive for this work. Maybe I shouldn’t do this? Maybe I need to change something? I don’t know what it all means –  I just know that this movie has created a shift in my head and in my heart that I am fully paying attention to.  I know that I do what I do because I want people to know that I SEE them, that I HEAR them, that I will FIGHT with them for what we all deserve.

Thank you to Joaquin Phoneix for the courage to play a character that we all need to see.