What is so magnetic in chaos, destruction and violence? Why are sensationalist titles of crime chronicles the one that sells the best? Are we all vampires? A vampires on a couch, sucking the blood from the breaking news every evening. Staring like zombies, praying to the god of the magic box to bless us with another mouthful of killing, dying and suffering.

Jungian concept

C.G. Jung

THE SHADOW

THE JOKER portrayed by Heath Ledger

I certainly won't speculate on the effect this role had on the departed actor, as I'm not familiar with his psychic state prior the movie, nor would I discuss about health of any person publicly. I can just admire his interpretation and thank him for everything he has done to enrich human souls watching this great artist at work.

I've made a rough sketch of Jokers psychic status, according to what we saw in the movie. It would't be enough for establishing the final diagnosis, but according to my past experiences, I'm pretty much sure in what direction this continuum of symptoms would eventually lead.

DIFFERENTIAL DIAGNOSIS

While assessing the symptoms and clinical features psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) by the American Psychiatric Association.

BAP (bipolar affective disorder), schizophrenia and schizoaffective disorder

Some people may be misdiagnosed as having schizophrenia. Others may be misdiagnosed as having bipolar disorder. And those diagnosed as having schizoaffective disorder may actually have schizophrenia with prominent mood symptoms. Or they may have a mood disorder with symptoms similar to those of schizophrenia. It's really a continuum of clinical features that can present differently depending on the moment and the patient's current state. Psychiatrist's experience is of major importance in diagnostic such a severe disorders. You need to develop the right treatment strategy and maintain appropriate attitude towards such patients. It certainly isn't easy to handle a guy like this, let alone to persuade him to get to treatment. But in case like this, you have the legal rights (and obligation) to make sure that patient is hospitalized, whether he consents or not.

DIAGNOSIS

F25 Shizoaffective disorder

This relatively rare disorder is defined as "the presence of psychotic symptoms in the absence of mood changes for at least two weeks in a patient who has a mood disorder." The diagnosis is used when an individual does not fit diagnostic standards for either schizophrenia or "affective" (mood) disorders such as depression and bipolar disorder (manic depression).

TREATMENT

Combination of antipsychotic agents alongside mood stabilizers. In this case, according to it's severity, I'd go with a combination of clozapine and lithium. It's possible one more antipsychotic agent would be needed in the acute phases (haloperidol or promazine).

Is there any other character you'd like me to dissect?

Psychologically of course! ;)

PS. Don't be afraid of loosing control. Over-controlling can be more wicked.

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