Neurology Unit, Department of Neurology, Le Havre Hospital, 29 avenue Pierre Mendes, 76290, Le Havre Cedex, France.
Department of Anesthesiology, Universitary Hospital Charles Nicolles, 37 Boulevard Gambetta, 76000, Rouen, France.
Acta Neurol Belg. 2020 Dec;120(6):1379-1382. doi: 10.1007/s13760-020-01332-3. Epub 2020 Mar 18.
In the psychological thriller film Joker, released in 2019 and starring Joaquin Phoenix in the first role, another possible origin story for this iconic character is reported. Above all, it brings us medical elements for the understanding of the development of this complex character. Contrary to other interpretations, we discover a lonely, timid and uncharismatic man (Arthur Fleck). He seems to be suffering from psychobehavioral disorders and seems depressed. There is a strangeness in his behavior along with social withdrawal. He suffers from fits of laughter that occur at socially inappropriate times. He also suffers from psychotic symptoms with visual delusions. We learn through the film that he was a beaten child, psychologically and physically abused with severe traumatic brain injury (TBI). The uncontrollable outbursts of laughter, behavioral and psychotic disorders followed these elements. As a neurologist, I was intrigued by these symptoms. I have explored the neuropsychiatric symptoms complicating TBI from which he seems to suffer and which have been reported in the literature. We can assume that the Joker is suffering from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe. The movie Joker has medical significance and covers social aspects of medicine and health care. First, it allows us to discuss whether psychotic disorder due to TBI should be considered a neurobiological syndrome. More broadly, albeit fictitious, it asks us about the management of patients with neuropsychiatric illness, which is a public health problem. It also reminds us that semiological descriptions of patients with neuropsychiatric disorders have served as inspiration for many authors.
在 2019 年上映的心理惊悚片《小丑》中，杰昆·菲尼克斯（Joaquin Phoenix）首次饰演了这个标志性角色，影片讲述了这个角色的另一个可能的起源故事。这部电影为我们带来了医学元素，有助于我们理解这个复杂角色的发展。与其他解释不同的是，我们发现了一个孤独、胆怯、没有魅力的男人（亚瑟·弗莱克）。他似乎患有心理行为障碍，情绪低落。他的行为举止有些奇怪，伴有社交退缩。他会在不合时宜的时候突然大笑，还出现了幻觉等精神病症状。通过电影我们了解到，他是一个被虐待的孩子，遭受了严重的创伤性脑损伤（TBI），经历了身体和心理上的虐待。无法控制的大笑、行为和精神障碍都是由此引发的。作为一名神经科医生，我对这些症状很感兴趣。我研究了他似乎患有并在文献中报道过的、与 TBI 相关的神经精神症状。我们可以假设，小丑患有与儿童 TBI 相关的神经精神后遗症，涉及额颞叶区域，特别是左额叶的外侧。电影《小丑》具有医学意义，涵盖了医学和医疗保健的社会方面。首先，它让我们讨论了 TBI 引起的精神病是否应被视为一种神经生物学综合征。更广泛地说，尽管是虚构的，但它让我们思考如何管理患有神经精神疾病的患者，这是一个公共卫生问题。它还提醒我们，神经精神障碍患者的症状描述一直是许多作家的灵感来源。
