- Joker has smashed box office records and fans are applauding Joaquin Phoenix for his portrayal of the Batman villain.
- In the movie, Phoenix plays Arthur Fleck, a man with several mental illnesses, one of which causes him to laugh uncontrollably at inappropriate times.
- The condition isn't specifically named on screen, but it's likely based on a real disorder called pseudobulbar affect.
Joker is currently breaking box office records, and fans are riveted by Joaquin Phoenix's portrayal of the notorious Batman villain. In the movie, Phoenix plays Arthur Fleck, a man with several mental illnesses.
One of them causes Fleck to laugh uncontrollably laugh at inappropriate times (a side effect of a past brain injury), which is so disruptive that he carries an informational card that explains his condition to people who might be near him when he has an episode.
The condition isn't specifically named in the movie, but it's likely based on a real disorder called pseudobulbar affect. "When I first read [the script], a lot of his behavior and actions I felt were despicable," Phoenix said of the character in a recent interview. But, he added, "I saw that in certain moments he was in flight or flight. I recognized these signs that allowed me to think about him differently."
Here'e everything you should know about pseudobulbar affect, how it impacts a person, and what treatment looks like.
What is pseudobulbar affect?
Pseudobulbar affect (PBA) is a condition that causes episodes of sudden, uncontrollable and inappropriate episodes of crying or laughing, according to the National Institutes of Health (NIH). "It is most commonly seen in the setting of other disorders that can cause brain injuries or degeneration," says Amit Sachdev, MD, associate medical director for the department of neurology and ophthalmology at Michigan State University.
Episodes can last anywhere from "a few seconds to a few minutes," says neurologist Santosh Kesari, MD, PhD, chair of the Department of Translational Neurosciences and Neurotherapeutics at the John Wayne Cancer Institute at Providence Saint John's Health Center.
The condition usually happens in people with certain neurological conditions or injuries that affect the way the brain controls emotion, and it's more common in stroke survivors, as well as people with conditions like dementia, multiple sclerosis, Lou Gehrig's disease (ALS), and traumatic brain injury, the NIH says.
The condition can be "highly disruptive to everyday life," the NIH says, and can cause issues like distress, embarrassment, social isolation, and, in some cases, an inability to work. People with the condition also have agreater risk of developing depression.
PBA isn't overly common, but it's not incredibly rare, either: It's thought to affect more than 1 million people in the U.S., according to NIH data.
How is PBA treated?
Typically, doctors will recommend using antidepressant medications or a combination pill of dextromethorphan and quinidine. Counseling the patient on how to handle the episodes when they occur is also part of treatment, Dr. Kesari says.
FACT: PBA is thought to affect more than 1 million people in the U.S.
Treatment won't necessarily get rid of the symptoms, but it can work to reduce how often the outbursts happen, and how severe they are. "This disease is caused by an underlying problem," Dr. Kesari says. "The medications and behavior modification will help reduce the incidence and severity, but they don't completely take it away."
Understanding on behalf of caregivers is also key to successful treatment. "Reassurance and understanding goes a long way," Dr. Sachdev says.
That was one takeaway even Phoenix had. "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. For someone in that state, does it mean his actions make sense or are justified? Obviously not," he said. "There's a point where he crosses the line where I am no longer able to stick by his side. But it allowed me to approach him with less judgment and more compassion than what I had when I first read the script."
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The Joker's Uncontrollable Laugh Is Actually Based on a Real-Life Medical Condition, Source:https://www.prevention.com/health/health-conditions/a29414444/joker-laugh-pseudobulbar-affect-condition/