“Joker” has grossed more than $334 million in the United States and more than $1 billion worldwide.

That makes it the most successful R-rated film – ever.

Directed by Todd Phillips, the film also has been a critical hit, garnering four Golden Globe nominations and winning two awards – for original score and for the performance of its lead actor, Joaquin Phoenix.

“Joker” figured even more prominently among this year’s Oscar hopefuls, with 11 nominations, including Best Picture and Best Actor. It was released on DVD and Blu-ray in early January.

But the movie’s distorted depiction of mental illness is both deeply troubling and potentially harmful.

The title character of the movie, which is (sort of) a bleak and gritty origin story of the iconic DC Comics villain – and Batman’s archenemy – may be only a fantasy inspired by a “funny book.”

But his condition is not.

Pseudobulbar affect disorder (also called emotional incontinence) is a real-life, treatable condition that affects more than 1 million Americans.

Those who suffer from the disorder tend to experience uncontrollable and excessive expressions of emotion.

They may cry when they don’t feel sad. And they may laugh when they are not amused.

These episodes often occur randomly and suddenly; they may repeat several times a day. They may last for only a few seconds or for as long as several minutes.

The last thing these people need is to have their illness exploited and used in a comic book/horror film.

Even worse, the Joker expresses his anger through murderous revenge – as if the source of his anger validates his violence and might be justified because he is mentally ill, which it is not.

Some of the murders are indiscriminate, and others are directed toward people who injured him.

The movie plays on the concept that the world (or at least the fictional Gotham City, a rat- and crime-infested stand-in for early 1980s New York City) is corrupt, with leaders and a privileged class who are bad people.

So, the Joker, aka Arthur Fleck, responds by becoming a murderer.

But he does make exceptions. In one scene, he shows mercy and pardons a former co-worker (Leigh Gill), a little person, whom we assume, Joker believes has had to suffer his own share of discrimination and hard times.

This seems to imply that underneath the clownish make-up and menacing laugh is a good person.

But suffering personal traumas and other misfortunes does not justify killing your mother – among others. Nor do the character’s delusions, which are often difficult to distinguish from reality.

For instance, Arthur conceives a psychotic fantasy that the woman (portrayed by Zazie Beetz) who lives down the hall from him is his girlfriend.

Yet, for the most part, he knows exactly what he is doing and why. His motives and reasoning are obvious and understandable.

As for the character’s mental illness, in this movie the Joker clearly plays the role of a psychiatric patient.

He is being treated with psychotherapy, receives medications and ultimately is psychiatrically hospitalized.

But the film suggests he does evil things because he is mentally ill.

The truth is the mentally ill account for less than 4% of all committed homicides. They’re much more likely to be the victim than the person who causes harm.

Yes, the movie does make a useful point about the consequences of cuts in social services funding. Arthur’s meds and sessions with a social worker are discontinued.

“They don’t give a [expletive] about people like you, Arthur,” she tells him during their final meeting. “And they really don’t give a [expletive] about people like me, either.”

But as a mental health professional, I’m bothered by the more powerful images of mental illness as a root for violence.

The movie stigmatizes, and to some extent, demonizes mental illness. Arthur is clearly desperate and evil and resorts to criminal behavior, but not as a result of his mental illness.

One of “Joker’s” most effective devices is its blurring of the lines between reality and delusion – that is, between the world Arthur actually experiences and the world he imagines he experiences.

The audience leaves the theater still not entirely certain of what did and did not actually happen in the film.

The problem is that audiences may have a similar problem distinguishing fact from fiction in the movie’s depiction of mental illness.

The moviemakers may not be obligated to contribute to the goodness of the world or have an uplifting moral ending, but who is the hero? A disturbed, vicious murderer?

This film uses the platform and the plight of the mentally ill to attempt to explain or justify a pathological killer.

“Joker” also implies a strong connection between mental illness and murderous revenge. This is simply not true.

MPAA rating: R for strong bloody violence, disturbing behavior, language and brief sexual images.

Director: Todd Phillips.

Writers: Todd Phillips and Scott Silver (Based on characters by Bob Kane, Bill Finger and Jerry Robinson).

Cast: Joaquin Phoenix (Arthur Fleck / Joker), Robert De Niro (Murray Franklin), Zazie Beetz (Sophie Dumond), Francis Conroy (Penny Fleck), Brett Cullen (Thomas Wayne).

The movie’s website is here.

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