This Film Is Far from a Joke

This article, in a slightly edited form, first appeared on Pain News Network on February 8, 2020.

Good films entertain. Great films inspire. Sometimes, they even galvanize people to create a social movement against injustice.

I recently saw one of those rare movies that fall into the category of movies that can inspire: Joker.

The film moved me, and I think it has the capacity to raise the consciousness of other viewers, too. This is why I was surprised to read extremely negative critical reviews about Joker.

The Guardian dismissed the movie as being “shallow,” while the The New Yorker described the film as “numbing emptiness.” The New York Times labeled it as an “empty, foggy exercise in second-hand style and second-rate philosophizing….”

These reviewers all missed the point.

To me, Joker contains substance and in-depth messages about the shortcomings of our health care system and the part that society’s cruelty plays in the development of a psychopath. The gravity of the film caught me off guard.

I was expecting to see just another comic book/adventure movie, but this was far more than that. The film clearly shows a pattern of childhood trauma, repeated shame, income disparity, lack of health care, discrimination, corruption, and rebellion. In other words, Joker reflects real life through excellent (and Oscar-nominated) acting and production.

It demonstrates what happens if you take two people and put them in two different environments. You shower one person with money, love, and all the advantages, while you deprive the other of all those things.

The movie shows that the result is the creation of one hero and one anti-hero.

Batman’s nemesis, the Joker, didn’t start off as a bad person. He once was a child named Arthur Fleck.

Arthur’s story begins with the physical abuse he suffers as a child at the hands of a harsh, rigid father and an enabling mother with serious mental health problems. She alleges that she had an affair with the wealthy businessman and politician Thomas Wayne (father of Bruce Wayne, who eventually becomes Batman).

Arthur believes his mother had the affair and, therefore, he is owed respect and support from Thomas Wayne. However, a callous and cruel man causes Fleck to doubt his parentage. Fleck learns from this man that he may not be Wayne’s child and, also, his mother may have adopted him and kept the truth from him. This deceit causes him unbearable shame.

In a startling contrast of good vs. evil, Bruce is blessed with a happy childhood, while Arthur suffers layer upon layer of abuse. His rage builds throughout the movie with recurring episodes of humiliation.

Arthur develops a neurologic disorder called Pseudobulbar Affect (PBA), a condition of involuntary, uncontrollable laughter and crying. The condition sets Arthur up to be repeatedly isolated and ridiculed.

Meanwhile, Fleck comes to see the inequity of his upbringing. Because the man he still believes may be his father withholds economic and emotional support from him, Fleck experiences escalating anger and mistrust of powerful politicians and the wealthy.

Fleck holds it together until his health care benefits are cut off, and he can no longer see his therapist or receive medication. Then he snaps and becomes society’s worst nightmare: the Joker.


Batman fans know the rest of the plot. So does anyone who follows the news.

What the Joker experiences, and the consequences of those misfortunes, happen all too frequently in real life.

Society’s failure to provide treatment for people with mental illness, and the cruelty with which we shun them, create the seeds of school shootings, terrorism, mass murders, and other horrible crimes.

People aren’t necessarily born with a greater capacity for hatred than others, nor are they necessarily destined to become criminals. They may be born with mental illness, but it is often environmental factors — including society’s lack of empathy, and its failure to treat them humanely and compassionately — that put them over the edge.

My hope is that audiences will see that a “joker” is made, not born. Some of the same ingredients that create a psychopath may also sow the seeds for drug abuse and many other societal pathologies.

Joker is not shallow or empty. It is a reflection of what society experiences when people receive too little empathy, too little love, and too little support.


Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, The Painful Truth,” and co-producer of the documentary,It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.




  1. Jacqueline on February 9, 2020 at 1:43 pm

    I have not seen the film myself, but agree with your view. However, some people can have the same negative childhood experience and go on to lead a stable, happy and productive life? What is it that sets the two apart?

    I believe the medical community in general has become deplorable and shameful. My faith in it is such that if I was faced with a life threatening illness, I would be hesitant to seek treatment. A young family member of mine with a long history of mental health issues wanted help, sought it, and never received any support or treatment from the medical community. More than once he took himself to the ER feeling suicidal and was told they had no beds??? That is the truth!

    The “system” has become a three ring circus! It’s an exhausting maze of failure, inefficiencies, red tape, delays, barriers to care, paperwork ect., all designed around profit instead of patient centered care. The human element doesn’t exist. We are just a number on a chart, all placed in the same box.

    Why anyone would want to become a Dr. in these times is beyond me…….

    • Brad on February 11, 2020 at 9:25 pm

      You state this so much more efficiently that my comment below, When initially faced with a severe injury and symptoms I couldn’t self-manage, I thought, “okay worlds best healthcare, show me your stuff”. Nothing for two months, then started all you’ve indicated, running w/another’s medical records while treating me, I found by, gasp, opening the secret file while the doctor stepped out. I came home from a 7 day utterly pointless hospital stay, on the way out I requested my records, there was all the nonsense and omittance relative to my stay but included were another patients records, revealing everything about that person, including a very sensitive write up of her condition. I considered calling her, decided it would be humiliating and burned her misplaced medical records.

      How the it was decided the CDC would take over prescription pain med dosing guidelines despite it not being consistent with it’s mission is stupefying to anyone w/ability to process thoughts, cause and effect.

      Or that heavy hitters from the senate leaned hard on DEA director in 2016 to limit legal production of these beneficial meds despite DEA knowledge that there were pill presses from china by way of southern border and relevant ingredients to mass produce opioids, including fentanyl w/o quality control. That these exist and continue to exist w/knowledge of DEA is criminal, incompetent and likely functioning w/foreign entities.

      The whole matter of Opioids is an echo chamber seemingly continuously analyzing something akin to raw data and then through same statistical analysis present their data in the most damning way possible,

      Whether for or against legalized Cannabis, whether beneficial or not, I did a lot of R&D on cannabinoids but we our method was unsuccessful at producing results Medical Cannabis will develop tolerance in patients require stronger or more concentrated doses to maintain relief of symptoms. I know from experience, mind you this is a sample of 5 individuals who smoked pot in high school. I did for 6 months and stopped, wasn’t for me, The rest moved onto cocaine, all four became distributors, at least 3 moved onto acid, 4 did at least one stint in prison, 2 were in and out and are now lifers in prison. One of the max security prisoners was the most naturally gifted athlete I’ve ever seen. You may know how selective the service academies are, almost impossible to be accepted. West Point was recruited this brilliant, incredibly gifted athlete as a high school junior, He’s been in prison close to 30 yrs.

      I know the aforementioned wasn’t your point but rather one I support completely, physicians need to pull their egos out of their ____ remember who and what they are. Listened to patient history themselves instead of having it on file. Did a thorough exam, then order relevant diagnostics to confirm a diagnosis. Instead, they use diagnostics to give them their diagnosis, then they look up what to do, like a cookbook, If medication is required, they consider what is dose to protect them not relieve patient pain or any other symptom. Then are the kickbacks from pharma for prescribing, then should a provider treat a Medicare, there is annually tremendous sums of money snuck in as a rider to an otherwise irrelevant bill to compensate providers who treated Medicare patients during that fiscal year, Given AMA bribery, I’m betting compensation rate is anywhere from 2:1 – 5:1 of Medicare patients actually treated.

      Unfortunately, this ___ storm won’t stop until the people pay attention, not just the lest politically defensible. I pray for the individual you mentioned, that s/he is still with us. I pray for you, Please tell your family member how truly valuable they are beyond my comprehension I know that they are so relevant, so valuable, Your comment brings tears to my eye’s it breaks my heart, This is not how we should be treating each other. Until we all realize how incredibly valuable we are as individuals and together. It will be tough going. I don’t know if you’re open to a stranger praying for the individual you mentioned but I probably will regardless,

      Many, many blessings to you and yours. I’m new at this, hopefully my comments will get more succinct.

  2. Gina on February 9, 2020 at 10:07 pm

    I think part of the problem is that too many people just want mindless entertainment, so they aren’t looking, or able, to see a message in a movie. I do agree with Jacqueline in that, in many cases, people can escape a harsh childhood and grow up to do great things, but for the most part, most children raised without love don’t grow up to be mentally-healthy adults.

  3. Jenny on February 10, 2020 at 2:41 am

    Bravo for your insight. I agree. Look up ACES (Adverse Childhood ExperienceS) and how this movie qualifies.

  4. Nancy on February 11, 2020 at 12:26 pm

    I haven’t seen the movie yet, but will now that I’ve read your insight and review. joaquin phoenix is a wonderful actor, and I’m glad to see him in something as big as Gladiator was for him. Now that he’s won the Oscar, I hope his career will take off again.

  5. Brad on February 11, 2020 at 8:01 pm

    “The film clearly shows a pattern of childhood trauma, repeated shame, income disparity, lack of health care, discrimination, corruption, and rebellion”

    Perhaps, childhood trauma is something connected to chronic pain, I can only speak for myself. As a youth, literally, from youngest memories to age 18 and until I left for good, I suffered horrify mental, emotional and physical abuse at the hands of my parents. This would typically concern some infraction on my part, their part was to react with utter rage. Examples: father in an utter rage, wiping w/o any caution for several minutes. For the next two weeks in gym class when changing or showering other kids were asking how I sustained all these bruises mostly on my back but also all over, I lied and made up some outrageous story about biennially sustaining this injuries.

    For reference, the genuine phrase, “I’m sorry” was never uttered by my parents.

    Mind you, I’m listing examples not isolated events…

    On another occasion, my father choked me until unconscious. I awoke to my mom shaking me awake and for an instant thought she was there to protect me, She got me conscious so my father could continue going at me until he again choked me out, The next time I awoke was alone on the floor of my parents room where this had all taken place,

    As a sophomore in high school, having committed some infraction my father beat me with a metal pipe. In particular, leaving a nasty bruise on my neck. Every student stopped to ask what happened, (no teacher), again an elaborate lie that seemed to suffice further questioning.

    I was sexually abused by the parish priest (pastor) repeatedly. No overt closure.

    At age 17, I had finally grown strong and not surprisingly I’d become very astute at street fighting. My parents went at me for the last time, afterwards all would be passive aggressive against me, My mother started, my father followed her lead, threw me against a wall, I punched him once, (my father was large and powerful}. Hitting him hard in the neck, I hadn’t realized how strong at fight savvy I’d become. He dropped to the floor and started crying. This event was insane to me, despite past ones, this one in particular. He got up, called the police, told them his son was out of control and “abusing” mother and father” both.

    I had a younger sister that witnessed everything, she and I just sat on thee couch holding each other, crying, waiting for me to be hauled away. Police got there, took my parents version of events, Gave me ~ 1 minute to give my version and promptly explained what a horrible son I was and how grateful I should be that parents weren’t pressing charges and left.

    The injury which has wrecked my body began with an utterly horrific knee and hip injury as a freshman in college, It had nothing to do with childhood abuses of any sort.

    It began with hip/hip flexor/thigh/thigh deformity and adductor sudden onset of weakness. Between age 18 and 36… I had no less than 10 surgeries for torn cartilage in either knee. When I was 19, I had a spiritual awakening, that’s all I should say, but it had a transformative affect on me bar none. I began to take great joy, just joy, not a superior sense of self, but I felt compelled to help anyone, anyone, in whatever ability I had. I have no idea if any remembers me, some were quick simple acts, some financial, some took quite a bit of commitment. This was my true joy in life.

    At work, either before or after undergrad, I was also known, recognized for dedication to job, hard work, a quick study, even ability to assist those with far advanced education than me or experience, Of course, I valued tremendously being… valued. But I was operating on a spiritual level by then.

    All throughout my body declined but anybody paying attention to a medical history would have known all started with the hip injury at age 14. It sustained an ~ force of over 1500 lbs per inch squired probably higher. Most of the time, I figured out a new stretch, exercise, yoga pose or PT to keep moving forward joyfully, Doesn’t mean I was always happy, two different things.

    At age 35, combined diet and exercise routine, I never felt or looked healthier.

    One night, performing a groin stretch I felt something pop high in right groin (problem hip) and all hell broke loose relative to pain and physiological dysfunction, For the 1st time and since as compensating injurie rack up, I was introduced to the most dysfunctional, incompetent expensive entity I’ve ever had the misfortune of being part of, Can’t keep my records, straight, they enter inaccurate or dishonest data, but centralized e-records will fix all, My medical records would be more useful for fireplace kindling.

    I’m currently 52 yrs old, have all manner of broken, affected areas that all cause tremendous pain. Pain is a symptom suggesting something is causing it. The conundrum whereby healthcare will neither seek and treat causal event/s or effectively treat pain symptom is a national, governmental failure of epic proportions. I’ve heard explanation this is due the system not the people…. what makes the system? I have a wife and child whom I love beyond description and am incapable of being anything at all to them,

    My parents, the priest… I chose to forgive them, it wasn’t easy, it took awhile to follow through but we should all have grace to ask forgiveness, thereby recognize we committed a wrong, mistake and grace to grant forgiveness whether asked for or not, This helps keep things in proportion, I can’t speak for priest but believe my parents did the best they could with tools brought to the table, This isn’t some flaky avoidance issue, I see their beauty and ugliness and choose to forgive them and to love them for who they are,

    Disparity of income, I don’t like how this sounds because it implies a right of outcome regardless of who we are or what we’ve done so that all may be equally wealthy. Having said that, Lance Armstrong very likely got top flight medical access because he was wealthy, lived in a wealthy neighborhood and one of his best friends and next door neighbor was a physician, For most of us whether exceptional medical plans or not are an appt, It is unlikely the provider has reviewed any medical history or other documents provided, they may remember you when they see you. But they grab your error filled file seconds before entering the room for 5-10 minutes.

    On the one hand, I don’t believe in being envious of what another be it their possessions, income whatever. More so than income, I believe power a person holds in society is the real impetuous to action in our sadly, broken, yet to proud to admit so healthcare system. They like all, simply indicate if they had more money, still better access to politicians all would be made well,,,

    My family is middle class, we sacrifice and we have no debts. Yet with a medical professional there is no give and take, providing a service and I’m the customer. It’s their way or else, I quite literally had a doctor tell me a medication, taken for 15 yrs and helpful, that I needed to stop taking it.

    “Could you imagine what would happen to the practice if I died of an overdose”.

    As I blather on, I think the critical issues are time spent with patient, doctors can take a pay cut as can the practice and all the other entities tied into one’s apt. Provider should come to apt, prepared, knowledgeable of whom s/he, an understanding general anatomy or homeostasis and the viability of the human body. I struggle a bit w/income disparity, for example, we have decent insurance coverage, I had severe pain under right rib, near sternum, terribly painful and digestion was shut down. I went to see the md for digestive issues, she noted, I was severely malnourished and dehydrated. Her recommendation was I go to an ER. I asked if she’d call ahead to prep them, she did.

    In ER they agreed with her assessment and kept giving my hydrocodone via IV, despite ER docs notes indicating I appeared in no obvious discomfort. I was admitted to the hospital, intro to hospital doc was a sneer that as soon as I was stabilized, I’d be released, the second day, I had access to a recent lumbar MRI where an astute radiologist commented that my common bile duct was much enlarged from a year ago, Impressed and confident this was a likely source of all problems, I attempted to show these comments to hospital doc on day 2. He utterly refused until I asked him to read the single phrase about common bile duct issue. Suddenly, he was peacocking with a diagnoses, Long story short, I at some level diagnosed myself, which has become commonplace b/c whomever I’m seeing for what take no time, It’s almost cook book medicine, we do this diagnostic test, whatever conclusion it comes to, we promptly open to pg, 4 and read how to treat, diagnostic has already diagnosed. NO! Whatever test likely revealed the most obvious thing or if nothin obvious then nothing, After 5 days in hospital, 1 test today, read me results on 2nd day, 3rd day another test. The whole time a running debate with fresh nurses whom have never seen me before insisting any symptoms I had for anything were due the “O” word. I left in disgust and had the bile duct opened a couple months later, 6 months later gall bladder removed. This was ultimately discerned when I had to insist the digestive doc order a gall bladder functionality test. It wasn’t. It was removed a week or so later but I refused to stay in hospital as surgeon desired.

    Income disparity helps one gain standing, power in a given community so… yes, it is an unfortunate outcome, It does not mean equality of outcome is the answer it means doctors do their job, uphold their oaths, come prepared. Give at least the commitment to patient as practice. Were this fantasy to occur, causes of pain would more readily be found thus preventing a lifetime of insanity, pain, always increasing isolation and occasionally(?) just throwing in the towel and ending it all.

    Last word, when I did work, I did pharma R&D. the emphasis in pharmaceutical medicine was, in hopes of improving concept to marketplace, stop working on cures rather medications that treat symptoms that the unlucky individual will be required to take until death. During this election, All these healthcare entities are spending absurd amounts of money to bribe existing or hopeful politicians to only make healthcare more lucrative for itself and worse for those in need,

    Best wishes, please nobody give up, I struggle with this, but we have no idea how much worth we have whether another single person recognizes or not. YOU ARE SPECIAL, SPECIAL, SPECIAL. My heart breaks, and I pray for those caught in this snare.

Leave a Comment