The Joker was accompanied to Arkham Hospital by Gotham City Police Commissioner James Gordon, and Detectives Harvey Bullock and Renee Montoya. Details surrounding his apprehension were vague, though it must be noted that Det. Montoya casually made reference to the “bat-shaped” hand-cuffs located on his body at the time of arrest.
Mr. Joker is a tall, thin gentleman of indeterminable age. His forensic history is extensive, having committed more than 2,000 murders (Dixon and Nolan, 1996); several of these comprise many notable members of Gotham City’s elite.
One of the mostly flagrantly inaccurate diagnoses which Mr. Joker has received in the past is schizophrenia (Schwartz and Sprang 1952; Lyall, 2007; Rocksteady Studios, 2009).
Schizophrenia and other mental illnesses are often stigmatized in the media and a large percentage of service users report that they encounter offensive and negative depictions in the media on a regular basis (Wahl, 1999).
Offensive myths and stereotypes are often perpetuated which have been noted by several authors as the primary cause of stigma (Harrison and Gill, 2010; Wedding, Boyd and Niemiec, 2010), resulting in greater social distance and reductions in help seeking behavior (Wahl, 1999; Kim and Lemish, 2008).
The following Mental Status Examination discounts such previous unfounded diagnoses allowing for a more realistic and objective assessment of an individual whom the assessor does not believe to have a formal mental illness.
Mental Status Examination
Assessment Interview of The Joker.
Jack Napier, Joseph Kerr, Johnny Jape, W.C. Whiteface, Clavier Ankh, Mr. Genesius, Red Hood, Dr. J. Reko, Oberon Sexton, Jack White, Melvin White, Eric Border.
Present at Time of Interview
Dr. Izzat Tajjudin, psychiatric registrar, Arkham Hospital. John Goodwin, staff nurse, Arkham Hospital.
I indicated the purpose of my examination. In my view ,Mr. Joker had capacity to consent to interview, and he participated willingly in the interview process.
He was able to shake hands at the beginning of the interview (following removal of a suspicious joy buzzer) and maintained good eye contact. He did not appear distracted or significantly agitated in his behavior. There was no evidence of extra pyramidal side effects.
Regarding his physical appearance, he presented with tall stature and thin build. His facial tone has a slightly bleached color to it. He sported wavy green hair and bright red lips. I could not ascertain if this clown-like façade involved make-up or not. He sported several tattoos on his body, most notably, the word “damaged” was written across his forehead.
He had good rapport and appears to be charming, albeit in a superficial manner. He exhibited grandiose ideas of self-worth and can be manipulative in his behavior. His interview was not consistent with his previous chart.
He was emotionally shallow, never showing any remorse for his previous criminal behavior and unable to display any empathy.
There was no evidence of any affective instability on interview.
His speech was normal in rate and volume. There was no pause in speech and he was coherent and relevant throughout, and he answered appropriately to the questions put towards him. He did not show evidence of any formal thought disorder in the context of form and speech.
His mood was both objectively and subjectively euthymic. He demonstrates reasonable self-care. He did not report any biological symptoms of depression and reported good appetite.
Mr. Joker had no anxiety symptoms. He did not present with any significant obsessive compulsive phenomenon.
Medical systems review was non-contributory.
He did not report use of illicit drugs. There were no features of alcohol dependence syndrome present on interview today.
He never denied any knowledge of episodes of aggression. He was unable to sufficiently justify these previous episodes, stating “it’s all a monstrous, demented gag” and “do I really look like a guy with a plan?” (Moore and Boland, 1988; Nolan, 2008). He identified poor impulse control as his main cause of re-offending.
Thoughts of Self-harm
He had cut himself in the past but he hasn’t done so recently. He had cut his lips and tongue in the past. Currently he has no ideation and intent to harm himself, though he has stated intent to harm others; most notably, ‘The Batman’.
He has never had a long-term partnership. He describes his past relationships as highly volatile. He has had several short-term relationships (i.e. months). Of note, his relationship with Dr. Harleen Quinzell was very abusive, with Dr. Quinzell showing a pattern of dependent type personality.
Risk of Arson
Mr. Joker denied any current interest in starting fires. He did confess to burning his family home down when he was young (Straczyknski et al., 2010). He did not indicate whether there were people present while he acted on this impulse. This will require further exploration.
With regard to his current thought, he denies any hallucinations, paranoia or any other Schneider First Rank Symptoms. Objectively. he does not appear to be psychotic.
Diagnosis and Conclusion
Mr. Joker appears to be appropriate throughout the interview. He displayed appropriate orientation to time, place and person. He showed evidence of relatively intact memories for recent and remote events. He had good insight. At a clinical level, he appears to be functioning at a higher than average level as compared to the general population.
Antisocial/Dissocial Personality Disorder is not an appropriate diagnosis, as Mr. Joker’s actions are clearly beyond the realm of petty thievery. Similarly, a diagnosis of sociopathy does not seem a fitting one, considering that sociopaths or capable of loyalty, and demonstrate a sense of morality and conscience (Hare and Babiek, 2006; Pemment, 2013).
Mr. Joker exhibits superficial charm, grandiose self-worth, lies and manipulates pathologically, shows no remorse for his actions, fails to display any evidence of empathy, has a constant need for stimulation, is impulsive and irresponsible, and has had a series of several short relationships.
His most recent account of his childhood indicates evidence of early behavioral problems/juvenile delinquency. Mr. Joker meets most of the criteria on Hare’s revised psychopathy checklist.
I do not believe that Mr. Joker current requires treatment in Arkham Hospital and I recommend a transfer to Blackgate Penitentiary immediately.
Dixon, C. and Nolan, G. (1996). The Joker: Devil’s Advocate. New York: DC Comics.
Hare, R. and Babiek, P. (2006). Snakes in Suits. New York: Harper Collins.
Harrison, J. and Gill, A. (2010). The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: A way forward. Journal of Psychiatric and Mental Health Nursing, 17, 242–250.
Klin, A. and Lemish, D. (2008). Mental disorders stigma in the media: Review of studies
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Lyall, S. (2007). “In Stetson or Wig, He’s Hard to Pin Down”. The New York Times, 4 Nov, 2007, p.24.
Moore, A. and Boland, B. (1988). The Killing Joke. New York: DC Comics.
Nolan, C. (2008). The Dark Knight. [film]. USA: Fox.
Pemment, J. (2013). Psychopathy versus sociopathy: Why the distinction has become crucial.
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Rocksteady Studios (2009). Batman: Arkham Asylum. London: Rocksteady Studios.
Schwartz, A. and Sprang, D. (1952). “The crazy crime clown.” Batman. 1(74). New York: DC Comics.
Straczyknski, J. M., Hardin, C. and Justiniano (2010). Small Problems. The Brave and The
Bold, 3(31). New York: DC Comics.
Wahl,O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467–478.
Wedding, D., Boyd, M. A. and Niemiec, R. M. (2010). Movies and Mental Illness: Using Films to Understand Psychopathology. 3rd ed. Ashland: Hogrefe and Huber.
Izzat Tajjudin [MB, BCh, BAO] graduated from University College Cork in
Medicine (2003). He is on the Royal College of Psychiatrists’ training
John Goodwin [MA, PG Dip (PIMHC), BA (Hons), BSc (Hons), ALCM,
RPN] is a Ph.D candidate at the Catherine McAuley School of Nursing and
Midwifery, University College Cork, Republic of Ireland, and a staff nurse
in the Mercy Hospital, Cork. His research is focused on beliefs about mental
health care and media depictions of mental ill-health.