10 Bat-Questions With...Vasilas Pozios, MD
Posted by: Bill "Jett" Ramey (Follow: @BATMANONFILM)
March 2, 2014

BOF’s celebration of the 75th anniversary of Batman with another installment of “10 Bat-Questions with….” Below, you’ll find my Q&A with my friend Vasilis Pozios, MD.

BIO: Vasilis K. Pozios, M.D., is not only a lifelong Batman fan, but also a board-certified physician specializing in forensic psychiatry. He is a co-founder of Broadcast Thought, a media consultancy and creative collective whose goals include shifting the paradigm of how the media and entertainment industries portray mental health issues. Broadcast Thought have partnered with Brett Culp to produce Legends of the Knight, a new documentary film about the inspirational power of Batman.

Find out more at BroadcastThought.com, follow on Twitter @BTDOCS, and learn more about LEGENDS OF THE KNIGHT at WEAREBATMAN.COM.

1) What is your first memory of Batman?

VASILIS POZIOS: It’s hard to pinpoint, but I think my first memory of Batman, like so many other Batman fans, is probably watching re-runs of the ‘60s live-action television series. The intensely visual elements of the show – the colors, the costumes, the choreographed action…the onomatopoeia! – appealed to me as a child. So, I suppose BATMAN ’66 (as it seems to be known nowadays) introduced me to Batman, but many other early experiences contributed to my love of Batman.

I watched repackaged re-runs of The Batman/Superman Hour cartoon (before cartoons were known as “animated series”) that sometimes aired during “The Bozo Show” on WGN, as well as The New Adventures of Batman cartoon of the late seventies. My great aunt gave me a Whitman Adventures of Batman coloring book, and I played with my older brother’s Mego 8” “action figures” (they were really dolls, and those boots were always getting lost!) and Pocket Super Heroes action figures.

Shortly afterwards, I started to repeatedly borrow Batman: From the 30’s to the 70’s from the Mount Clemens Public Library. And then I bought my first comic book! It was Detective Comics #540, featuring one Dr. Jonathan Crane, AKA, The Scarecrow. Looking back, I find this kind of ironic, given my profession.

2) What's your favorite Batman film -- live-action or animated?

VP: I’m tempted to say Batman '89, Batman Begins, or The Dark Knight. But when I really think about it, I have to say The Dark Knight Returns animated film. It isn’t perfect (I’m still not sure whether Dr. Wolper is a psychologist or a psychiatrist), but when I first read TDKR as a 10-year-old kid, I fantasized about seeing a film adaptation. It’s the ultimate Batman story. Hopefully the comic book-film genre continues to grow, if only to someday see a faithful, live-action film adaptation of TDKR. Michael Uslan, are you reading this?!

3) Doctor, anyalize Harvey Dent.

VP: If I were a forensic psychiatrist at Arkham Asylum evaluating Harvey “Two-Face” Dent, Obsessive-Compulsive Disorder (OCD) would top my list of his possible diagnoses. In most Two-Face stories, he has an obsession with duality and is forced to adhere to the results of a coin-flipping compulsion, even when it doesn’t benefit him. In Arkham Asylum: A Serious House on Serious Earth, writer Grant Morrison depicts Two-Face engaged in a form of exposure therapy, a real-world treatment for OCD. Two-Face might also benefit from a selective serotonin-reuptake inhibitor (SSRI), which is commonly used at high doses to treat OCD symptoms.

While OCD seems like a good fit, this diagnosis alone doesn’t fully explain Two-Face’s behaviors. Regardless of the depiction, Harvey Dent suffers physical trauma that not only scars his face, but his psyche as well. In The Dark Knight, Harvey experienced the trauma of having half his face burned, plus the additional trauma of learning about his fiancée Rachel Dawes’ death. So, the obvious question is – if he survived and his symptoms lasted more than a month – would he have been diagnosed with Posttraumatic Stress Disorder (PTSD)?

Certainly, Harvey Dent experienced the type of trauma that could lead to PTSD symptoms, but did he actually experience them? For example, did he have what are known as hyperarousal symptoms? Oh, get your minds out of the gutter. Examples of hyperarousal symptoms are irritable behaviors, angry outbursts, and reckless or self-destructive behaviors. While Harvey had brash behaviors prior to his disfigurement, seen when he played “Russian roulette” with one of Joker’s henchmen, as Two-Face, his recklessness and self-destructive behavior spiraled out of control. Whether misplaced or not, Harvey’s anger led him to seek revenge at all costs, with people’s lives – including his own – determined in a flippant (no pun intended) manner. After his trauma, Harvey was prone to angry outbursts and irritability – just ask Commissioner Gordon to “Say it!” Okay, Harv, geez!

But while Harvey had one intrusive distressing memory of the trauma when he saw the coin that he gave to Rachel in The Dark Knight, he didn’t appear to experience recurrent trauma-related intrusion symptoms such as nightmares or flashbacks. What’s more, he didn’t avoid reminders of the trauma like his coin – instead, it became his trademark. Rather than avoiding confrontation with Batman, Commissioner Gordon, or The Joker, Two-Face lured Gordon and Batman to the actual building where Rachel died. And when offered the chance to minimize the physical reminders of the trauma, he refused skin grafts and pain medications. The lack of recurrent intrusions and avoidance pretty much puts the diagnosis of PTSD to bed.

Just because Harvey from The Dark Knight wouldn’t meet full criteria for PTSD doesn’t mean he couldn’t have any trauma-related symptoms. Harvey Dent presumably refused medical treatment because of survivor guilt and/or negative alterations in his thoughts and mood related to PTSD. Following the death of Rachel, Harvey shuns his optimism and hopefulness, embracing a nihilistic worldview – Gotham’s White Knight became as scarred as his coin. But similar symptoms can be a result of a mood disorder like Major Depressive Disorder. In the real world, Harvey’s refusal of care would likely have prompted a psychiatric evaluation of such symptoms and whether he had the capacity to refuse medical care.

Furthermore, Two-Face’s “duality” alone doesn’t justify a diagnosis of Bipolar Disorder, even though it’s sometimes misapplied to him – he simply doesn’t experience episodes of mania, necessary for the diagnosis. Schizophrenia can also be excluded as a possible diagnosis. Contrary to popular belief, the term “schizophrenia” (Greek for “split mind”) does not imply a “split personality” or “multiple personalities.” Rather, someone with Schizophrenia may experience the psychotic symptoms of hallucinations, delusions, and disorganized thoughts and behaviors. However, Two-Face doesn’t display any of these symptoms. And although Harvey Dent’s personality changes following his transformation to Two-Face, he doesn’t display the presence of several distinct personalities, or “alters.” So, that would also preclude Dissociative Identity Disorder – formerly known as Multiple Personality Disorder.

Speaking of personality, Two-Face displays narcissistic personality traits, especially as District Attorney Harvey Dent. After all, a certain level of narcissism is required to be an effective politician. And like some politicians, Two-Face seemingly doesn’t want to take responsibility for his actions. So, he lets his coin make his decisions for him.

Another interpretation of Two-Face’s binary ethical system is that it is an extension of his rigid, “black-and-white” thinking. If so, he might benefit from Dialectical Behavioral Therapy which would be aimed at teaching him to be less judgmental and more flexible by embracing not only heads and tails, but all aspects of the coin. What if it doesn’t work? Well, at least his “black-and-white” thought process matches his fashion sense.

Finally, as seen in The Dark Knight, Harvey Dent demonstrated an element of sadism in the power/control he exerted over hostages when deciding their fates with the flip of a coin. We see this in certain psychological torture techniques and in the actions of some serial killers.

4) Is The Joker truly "crazy"...or simply "crazy like a fox?"

VP: It depends on what you mean by “crazy.” Obviously, “crazy” isn’t a clinical term used to describe mental illness, but it has been used to describe the Joker. Other terms – often used interchangeably – have also been associated with the Joker, like “mad,” “insane,” “psychotic,” and “psycho.” But do any of these terms accurately describe the Joker?

Some people call the Joker “psychotic” because of his seemingly irrational behavior. Let’s face it, to most people, burning a pyramid of cash isn’t rational. But the Joker isn’t most people – his anarchistic worldview guides his actions. If the Joker were truly psychotic, the rationality within his irrationality would follow a delusion (a fixed, false belief). The Joker doesn’t seem to have delusional thinking, at least not in the clinical sense. So then is his apparent irrationality a result of psychotic disorganization?

At first blush, there appears to be a superficial air of disorganization to the Joker’s mayhem, but if you look deeper, you’ll see that his crimes are, in general, exceptionally well-organized and intricately orchestrated. Take, for example, recent depictions of the Joker in the film The Dark Knight and Scott Snyder’s Batman storyarc, "Death of the Family,” both of which feature painstakingly planned and flawlessly executed crimes.

This isn’t to say that someone who is psychotic can’t have the ability to plan and execute a crime. For example, someone with paranoid delusions but with relatively less disorganized thoughts and behaviors is capable of planning an act of violence, usually in perceived self-defense. But for all his bizarre “boners,” you’d still be hard pressed (pun intended) to find any depiction in the character’s nearly 75-year history – save maybe Steve Englehart and Marshall Rogers’ “Laughing Fish” storyarc – where the Joker displays clinical symptoms of psychosis, such as hallucinations, delusions, and disordered thought.

You might still reflexively say, “The Joker had his own face cut off! That’s just insane!” But over-the-top violence – even to one’s self – isn’t necessarily a hallmark of psychosis (or insanity, for that matter, but we’ll get to that later). For example, some prisoners who engage in extreme self-injury (like cutting open their abdomens and pulling out their intestines) do so for shock value or manipulation rather than because they hear voices commanding them to do it. Some people participate in extreme body modification for shock, intimidation, or because of a distorted sense of their appearance. Still others harm themselves in a masochistic way; at the end of Detective Comics #1 (Vol. 2), the Joker seems to derive sexual pleasure from his face being surgically removed by Dollmaker.

But while the Joker isn’t psychotic, does he meet criteria for another psychiatric diagnosis? The Joker’s trademark laughing fits, elevated mood, gaudy attire, and excessive make-up could be manic manifestations of Bipolar Disorder. And in The Dark Knight Returns, the Joker appears catatonic, presumably because of depression – possibly bipolar depression – coinciding with Batman’s disappearance. What’s more, impulsivity, grandiosity, and increased risk-taking behavior – qualities often displayed by the Joker – can be associated with Bipolar Disorder. However, these behaviors seem more like permanent characteristics of the Joker’s personality rather than symptoms that occur only during discrete episodes of Bipolar Disorder.

Personality traits like volatile mood, impulsivity, recklessness, grandiosity, and a flair for the dramatic can sometimes be seen in Cluster B Personality Disorders. Although the Joker may have a few borderline and histrionic personality traits, the diagnosis of these disorders would better fit Harley Quinn. And while you could make a strong argument that the Joker meets criteria for Narcissistic Personality Disorder, a more appropriate diagnosis would be Antisocial Personality Disorder (ASPD).

Antisocial Personality Disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others. Certainly, engaging in repetitive illegal acts, conning others, impulsivity, aggression, reckless disregard for the safety of others, and lack of remorse would describe the Joker. And although we don’t know much about his youth (evidence of Conduct Disorder with onset before age 15 is a requirement) – the Joker’s behavior seems consistent with ASPD. However, ASPD doesn’t tell the whole story.

Instead, psychopathy fits Mr. J to a “T.” Psychopaths lack empathy, manipulate people, and treat them as mere pawns in their games – like in The Dark Knight when the Joker exploits a man by implanting a bomb in his abdomen, promising to “make the voices go away.” Although the Joker’s crimes are intricately planned, he lacks realistic long-term goals other than creating chaos. He is selfish, grandiose, impulsive and brazen, and prone to aggression and violence. The Joker also shows deceitfulness in his ever-changing explanations of the origin of his scars. But do these psychopathic traits mean the Joker is insane?

Since the Joker is a permanent fixture of Arkham Asylum – a forensic psychiatric hospital in DC Comics canon – by definition, he must be legally insane, right? Well, in most jurisdictions, acts that result from ASPD or psychopathy wouldn’t qualify for the insanity defense. But let’s assume, for argument’s sake, that the Joker had a diagnosis that could qualify for the insanity defense (usually a psychotic illness). To be found Not Guilty by Reason of Insanity in court, he would have to show that, because of the mental disorder, he didn’t understand at the time of his alleged crime that what he was doing was wrong. There’s no evidence that this is the case; the Joker knows Batman and Gotham’s Finest will try to apprehend him because he is breaking the law, and he does his best to evade capture. Unless, of course, the Joker wants to be captured.

Bottom line: The Joker doesn’t belong at Arkham at all – he’s Blackgate Prison material.

That is, if you can catch him. You see, the Joker is more than just your average serial killer. He’s also a mass murderer and a spree killer all rolled into one. As a “cross-over” killer, the Joker would be very difficult for a behavioral analyst to profile and apprehend. This sort of behavior isn’t typically seen in the real world and would make a real-life Joker exceedingly dangerous.

The Joker’s unpredictable, ultra-violent behavior is what makes him so frightening. It’s hard to imagine that a human being could be capable of such aberrant violence. Maybe that's why the Joker is reflexively presumed to have a clinical mental illness, reflecting real-life misconceptions about the relationship between violence and mental illness. Perhaps it’s too unsettling to accept that instead of his actions being beyond his control, the Joker simply chooses to be an “engine of chaos.”

5) From a "mental health" POV, what's the difference between Tim Burton and Chris Nolan's take on Bruce Wayne?

VP: The immediate difference is Nolan’s realistic approach to the story and cinematography, capturing the complex psychological motivations of both Batman and his villains. This result is, at times, jarring and in-your-face. The best example of this is the interrogation scene between Batman and the Joker in The Dark Knight. The scene is brightly lit, with no shadow to conceal the characters’ abnormal motivations. There’s no masking how damaged they both are – their respective neuroses are on display for all to see.

Personally, I like the Nolan films because some actual forensic psychiatric issues (specifically, Dr. Crane’s Competency to Stand Trial “evaluation” of Carmine Falcone) were depicted in Batman Begins, and as a forensic psychiatrist, that’s very exciting. I’m not too happy about Dr. Crane being a colleague, however. But I’ll watch out for him at the next meeting of the American Academy of Psychiatry and the Law!

In my opinion, Tim Burton attempted to paint a darkly absurd picture of the characters’ motivations through expressionism. His films were more atmospheric and utilized score in a more effective way. Also, Burton tended to focus on origin stories as an instrument to explain motivation, whereas Nolan seemed to use the personalities of the characters to demonstrate their motivations without necessarily spelling-out their origins. This is best exemplified in their different portrayals of The Joker.

6) Does Batman -- or Bruce Wayne rather -- have to have a Robin?

VP: Aside from companionship, from a practical standpoint, it doesn’t make sense for a vigilante who thrives on secrecy and surprise to have an accomplice (if you accept that a man dressed as a giant bat makes sense) – that’s one more witness who could testify against you at trial. And let’s not even get into what Child Protective Services would say in their investigation of Bruce Wayne.

That being said, I like Robin. He (she!) provides a different, hopeful perspective on Bruce’s one-man war on crime. But wars are not without casualties, which is bad news if you’re wearing green pixie boots. Just ask Jason Todd. And Stephanie Brown. And Damien Wayne. And Dick Grayson?

From a publishing standpoint, I think it’s important to note that if Batman were created in 2014 instead of 1939, there would likely be no Robin introduction in 2015. Comic books in the late 1930s and early 1940s were marketed to a younger audience, and Robin and other sidekicks were created for children to identify with. I, for one, am glad that Batman is a creation of the Golden Age, because I think Batman would be worse off without a Robin.

7) If Alfred is Bruce's father figure, what does Jim Gordon represent to him?

VP: The relationship between Batman and Jim Gordon is essentially a professional partnership. Like all good partnerships, they have a common goal: rooting out crime from Gotham and improving the lives of its citizens. They both realize this quest comes with its challenges and dangers, but their complimentary skill sets make this goal possible. Gordon plays things “by the book” and works within the law while Batman is able to work outside of it as a vigilante. Work comes first, often at the expense of their interpersonal relationships with family and friends. But while their personal boundaries aren’t always maintained and their communication skills could be improved (hey Bats, it wouldn't kill you to say goodbye to good ol’ Gordo just once), they have a strong mutual respect for one another, and in some depictions, are even close friends, finding some solace in their partnership.

8) How did you feel about the ending of THE DARK KNIGHT RISES? Did Nolan giving Bruce Wayne a happy ending jibe with your own Batman sensibilities?

VP: I actually gravitate toward a different interpretation of the ending of The Dark Knight Rises than most people, including Sir Michael Caine. I’m more satisfied by an ending in which Bruce didn’t escape the nuclear blast radius (despite a repaired autopilot system) and met his end saving the citizens of Gotham. In my mind, Alfred’s seeing Bruce and Selina in the cafe is a wish-fulfilling fantasy. It’s cruel, but Bruce shouldn’t have a happy ending. Even the pre-crisis Earth-2 Batman’s happy ending didn’t last long. One of my favorite Batman stories is Neil Gaiman’s “Whatever Happened to the Caped Crusader,” and that story tragically highlights that Bruce is Batman, and therefore, can never give up the Mantle of the Bat.

9) Who was the best live-action movie Bruce Wayne/Batman?

VP: Christian Bale*, because his is the closest live-action representation of my Batman. Although his growling Bat-voice is sometimes cringe-inducing, Bale’s approach to the character was novel and became the definitive version of the character for many people. And his Bruce Wayne (both his public and private persona) is spot-on. I thought Bale was spectacular in American Psycho, so when I first heard he had been cast as Bruce Wayne/Batman (probably on BOF!) I remember thinking to myself, “He'd make a perfect Bruce Wayne.” After all, Batman is a bit psychopathic.

*This is a qualified answer because we haven’t seen Ben Affleck as Batman yet. I think the Batfleck naysayers may be proven wrong. It’s clear he’s taking this role seriously and is determined not to repeat past perceived failures (read: Daredevil). He seems like a smart guy, and I think he’s going to surprise a lot of people.

10) What one piece of “Batman art” – be it a comic book cover or a movie poster, etc. – would you like blown up, framed and hung in your office…perhaps it’s already there?

VP: This might be my favorite question, because I’m a collector of original comic art. The most prized piece in my collection is an unpublished work, something I agreed never to publicly reveal. I wish I could, because it’s a controversial (and in some ways, historic) piece, but my lips remain sealed.

That being said, I think I’d like to have a cover or splash page from The Dark Knight Returns. But, alas, I don’t have hundreds of thousands of dollars of disposable income to spend on Batman memorabilia. And if I did, I’d probably buy one of these replica Batman ’66 Batmobiles from Hammacher Schlemmer!

Thanks again to my friend "Dr. P" for being a part of BOF's celebration of 75 years of Batman! If you have any suggestions for B75 guests or B75 questions, send them to me via JETT@BATMAN-ON-FILM.COM.

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