Pseudobulbar Affect is a thing. A real thing. A fascinating fictional example of it is found in Joaquin Phoenix’s blissfully uncomfortable portrayal of Batman’s arch-nemesis, Joker, in the October 2019 movie by the same name. Director Todd Phillips briefly captured the attention of a society that has become increasingly aware of the far-reaching consequences of mental illness with his out-of-the box and controversial R-rated depiction of the Clown Prince of Crime. As a recovering heroin addict who has struggled with mental health challenges all of his life, I appreciated the film’s ability to show how a well-meaning, moral individual can become overwhelmed by their illness, and descend to a place they had never imagined themselves capable of going.
Arthur Fleck, the character who eventually becomes the nefarious Joker, struggles with Pseudobulbar Affect, called PBA for short. PBA subjects one to involuntary episodes of laughing and/or crying. These uncontrollable outbursts are symptomatic of a neurological disorder or brain injury. A damaged nervous system is the culprit behind PBA. On the other hand, substance use disorder is a psychological matter as opposed to a neurological difficulty. The typical telltales of a psychological disorder are disturbed behavior and emotional state. Substance use disorder makes its presence known in the compulsive actions of the afflicted. The uncontrollable use of drugs is the obvious banner of addiction.
The commonality shared by PBA and substance use disorder is the devastating lack of control that a given individual has over their symptoms. Arthur Fleck lives life as an accepting outcast, plagued by embarrassing incidents of ill-timed crying and inappropriate laughter. By comparison, addicts are incapable of controlling their substance abuse and the consequences are damning. Their devious creativity becomes their defining characteristic, and they establish an unsavory reputation for their misdeeds. No matter how hard poor Arthur tries, he just cannot stop himself from having emotional outbursts. He eventually endures so much trauma that he snaps. Likewise, no matter how hard I tried to stop using heroin, I simply could not. It wasn’t until I was all but broken by emotional pain that I discovered the will to change.
This is not to say that I understand the plight of those who live with PBA. I don’t. PBA is a vastly more complicated problem than any I that I have had to contend with. But I do understand what it is like to be judged for that which I cannot control. I know what it’s like to be utterly destroyed by a constant inner-battle that I am hopeless to win. I sacrificed my career, important relationships, and my own integrity in order to get high. I didn’t want to. In fact, it hurt terribly to lose so much. I did not stop using because I could not stop using; not until I got help. For those of you who have someone in your life who has driven you to the brink of your own insanity as a result of their senseless struggle with addiction, know that they do not stop using because they cannot stop using. But also know that there is hope for them. People change.
In the end, Arthur Fleck reached a point of no return, and a super-villain was born of his ashes. Thankfully, not every story of transformation need be so harrowing. To anyone who is struggling with substance use disorder, help is available, and I hope this much is clear: You don’t have to be Joker. You can be Batman.
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