Did You See ‘Joker’? Here‘s the Real-Life Medical Condition Behind His Uncontrollable Laugh

The Joker, the infamous comic book villain and nemesis to Batman, has had many origin stories throughout the 80 years since his debut. These alternating narratives of how the Joker came to be have become part of the characters’ mythos, an extension of the anarchy he loves to inflict on Batman and residents of Gotham City.

In Joker, the latest film from Todd Phillips that opened October 4 and stars Joaquin Phoenix as the titular character, the villain’s origins are once again explored with a darker twist that strays far from past iterations of his backstory.

Phoenix plays Arthur Fleck, a man struggling with a variety of mental illnesses that keeps him from finding acceptance in a city that is slowly slipping into chaos itself.

One of these illnesses causes Fleck to uncontrollably laugh at inappropriate times, leading him to carry an informational card that explains the condition to people who may be near him during an episode.

While the movie never names what specific illnesses Fleck has been diagnosed with, these fits of controllable laughter are based on an actual disorder called the pseudobulbar affect, or PBA.

The condition causes bursts of inappropriate and uncontrollable laughing or crying, and usually manifests in people who have ALS, MS, neurological conditions or traumatic brain injuries, according to Mayo Clinic.

Joaquin Phoenix

These episodes can go on for minutes at a time, the organization says, and can cause embarrassment, social isolation, distress and depression.

“I thought of him having these reactions that one would consider inappropriate,” Phoenix told Indie Wire. “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. How to explain that to the principal?”

In Joker, Fleck’s outbursts were triggered when he became angry, embarrassed, shocked or nervous in public situations.

Eventually, it’s an incident during a PBA episode on a train that sparks Fleck’s transformation into Joker and his descent into villainy.

According to Indie Wire, the idea of Fleck having PBA came from Phillips. Phoenix, though, isn’t entirely convinced that Fleck has the disorder.

“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,” Phoenix explained to the outlet.

“I recognized from my previous work with You Were Never Really Here the signs of PTSD, and I saw that in certain moments he was in [fight] or flight,” he added. “I recognized these signs that allowed me to think about him differently.”

According to Mayo Clinic, treatment for PBA typically involves antidepressants and selective serotonin reuptake inhibitors which can help reduce episodes, but there is no cure.

Though Fleck/Joker commits despicable crimes, showing what the character is experiencing mentally could allow a path toward having sympathy for him.

“It’s hard not to have sympathy for somebody who experienced that level of childhood trauma: An overstimulated medulla looks for and perceives danger everywhere,” Phoenix told Indie Wire. “For someone in that state, does it mean his actions make sense or are justified? Obviously not.”

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