Movie Science: The Joker’s very real laughing condition

Tom Llewellyn April 3, 2020
Movie Science: The Joker’s very real laughing condition
Warner Bros.

Joker was one of the most popular films of 2019 and provided some of the most iconic moments in recent movie history, from the now-infamous scene of Arthur Fleck dancing down a flight of Gotham steps to his emotional final speech on the Maury Show. Since the film premiered, Joaquin Phoenix has received widespread praise for his portrayal of the ‘Clown Prince of Crime’ and one of the most memorable aspects of Phoenix’s performance was his haunting version of the Joker’s laugh; arguably the supervillain’s most notorious feature.

Throughout the movie, Arthur carries around a set of cards that he hands out to people when he abruptly breaks into fits of laughter which say: ‘Forgive my Laughter. I have a Condition.’ To most moviegoers, this may just appear as a convenient choice made by the writers to explain these sudden outbursts, yet the condition that Arthur suffers from is a very real ailment which affects up to 7.1 million people in the United States alone.

The Pseudobulbar Affect, also known as PBA or Emotional Incontinence, is classified as a type of ‘emotional disturbance’. Sufferers experience severe episodes of uncontrollable laughter, crying or other displays of emotion and certain patients can even suffer from ‘mood-incongruent’ episodes of PBA (when their mood conflicts with the situation). This can result in individuals excessively crying at something only moderately sad or laughing uncontrollably when they get angry or frustrated.

Warner Bros.

Now think back to Joker and the scenes when Arthur bursts into laughter: when he is frustrated at his therapist ignoring what he is saying; when he can’t help the woman on the train from being harassed; and when he is angry at Bruce Wayne in the theatre for insulting his mother. At multiple occasions during the film, Arthur’s behaviour can be explained by the real-world symptoms of mood-incongruent episodes of PBA.

The Australian and New Zealand Journal of Psychiatry report that the onset of PBA can be sudden and unpredictable, described by some patients as coming on like a seizure – similar to the laughing fit that Arthur experienced on stage during his stand-up routine. They also describe outbursts as having a typical duration between a few seconds and several minutes, explaining why each laugh felt as unique to the scene as it was uncomfortable to watch.

In terms of the neurology of PBA, the jury is still out. Early research has suggested that it is caused by lesions in the corticobulbar tract, a series of neurones in the brain that control the areas associated with emotions. Other researchers have claimed that the condition is related to structural abnormalities in the prefrontal cortex of the patient’s brain.

One thing that is agreed upon, is that Pseudobulbar Affect is a condition that occurs only secondary to that of either brain disease or injury, i.e. a patient will suffer from a disease such as Alzheimer’s, Parkinson’s or Multiple Sclerosis and then develop symptoms associated with PBA. Similarly, the risk of developing the condition is significantly higher in people who have experienced a traumatic brain injury or a stroke. In fact, a recent study from the Brain Injury Association of America revealed that 80% of survey respondents reported symptoms associated with the disorder.

Know Your Meme

In Joker, we learn at the Gotham Psychiatric Hospital that Arthur had suffered severe head trauma as a child after abuse from his dysfunctional family. In this scene, we also find out that his extreme laughing condition only started to develop after this injury occurred – again consistent with the real-world medical diagnosis of PBA.

Whilst there is no known cure for the Pseudobulbar Affect, there are multiple treatment options available. Therapy and antidepressants are usually the first things prescribed to patients alongside more specific medications. One option is dextromethorphan hydrobromide, a drug that targets the signals in the brain that trigger the cough-reflex which is commonly used as a cough suppressant. Another is quinidine sulfate, medication that affects the way the heart beats and which is generally used as treatment for heart rhythm disorders, although it is also used as malaria treatment.

In the opening scene with his therapist, it is revealed that Arthur is on seven different types of medication, therefore it is reasonable to think that one of these drugs were part of those seven he was prescribed. Furthermore, after Gotham cuts the funding for social services, he stops taking his medication. This would mean that if he was on either of these drugs that treat PBA, it is understandable why his condition progressed the way that it did from that point onwards.

PBA is a very real condition affecting millions of people around the world and it turns out that Phoenix drew on the experiences of sufferers to develop his own version of the iconic Joker laugh. In an interview with Italian magazine Vernerdi, he revealed that he had “watched videos of people suffering from pathological laughter” – which may have been PBA.

This wasn’t an easy part of Phoenix’s performance who disclosed to Entertainment Tonight that he was so dedicated to getting the laugh to its haunting final product that “I think it became more difficult actually. Sometimes one take would work, and another wouldn’t. I think it was something that was alive, in a way.”

Arthur Fleck’s laugh is as haunting as it is memorable, but what adds to Phoenix’s version of the Jokers laugh is that it is actually very accurate of someone in the real-world who suffers from PBA.

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Tom Llewellyn is the Head of World Content, Anime, and Comics at HITC Entertainment and also helps oversee all things deemed ‘nerd culture’ at Forever Geek. After gaining a BSc degree in Animal Behaviour, Tom continued his education with a Master’s degree in Science Communication (MSc) and post-graduate research; with his own independent project being published in the Journal of Zoological and Botanical Gardens in 2021. Since joining GRV Media in early 2020, Tom has amassed over 48 million views on his content and has conducted interviews with various actors and filmmakers from the wonderful world of anime.