I worked in a psych ward and didn’t see the Joker anywhere. Granted, I was only there for a little over a month but I didn’t see him, Two Face, Carnage, or even Moon Knight. Harley Quinn was a maybe but I had to stretch and contort my imagination past the limits of rationality. So rather than meeting a living, breathing rogue’s gallery of comic book characters, I had the solemn privilege of working with many brave patients who were tragically affected by various psychiatric illnesses. This experience taught me how simplistic, often inaccurate the portrayals of these illnesses are within the panels and speech bubbles of our favorite stories. Yet we as comic book fans rally behind the Harley Quinn’s and Moon Knight’s because we feel that they attach gravitas to our stories and shed light on these unsung maladies. But how accurate are these depictions?
Watch how quickly I can ruin the leading diagnosis of some of your favorite characters. Moon Knight doesn’t have dissociative identity disorder because he doesn’t exhibit the hallmark lapses in memory when his alternate personalities take over and DID is several times more common in females than in males. The Joker? He’s more likely to have anti-social personality disorder than schizophrenia as he doesn’t exhibit auditory hallucinations, a blunted affect, or disorganized thinking. To the contrary, he’s often depicted at being a criminal mastermind capable of outwitting the “World’s Greatest Detective.” This leaves pop-culture darling, Harley Quinn, without a psychosis to share with her beloved “Mistah J” and therefore cannot have induced delusional disorder. She does, however, have a raging dependent personality disorder with a dash of histrionic disorder.
Full disclosure, I’m only speaking with the authority of a Google search. I have minimal to non-existent exposure to the field of psychiatry and my comments are wholly unsubstantiated by any sort of qualification. But if a wanna-be writer and his browser can poke holes in what is supposed to be well researched and edited character histories, something is askew. If we as a collective comic’s community are going to use real psychiatric diseases to imbue meaning and nuance to our characters, what responsibility do writers have to accurately represent them? What responsibility do we have to actual patients with psychiatric illnesses to ensure that their conditions are represented in their totality? Most importantly, are we disrespecting the plight of these patients by using their real pain to give our fictional characters depth? Spoiler, I’m going to use the next 801 words to talk about how comics are doing a shit job with all of this.
Battling a psychiatric disease is a deeply personal, tailored hell. Every patient has their own unique, nuanced, and precarious perspectives on their illness and disease course. Therefore while this inherent subjectivity makes it difficult to critique the portrayal of diseases within our panels, there are “party line” characteristics and natural history for each disease. The latter is often where comics fall short. They may sometimes get the basic symptomology correct but are generally unable to neither capture to long term ramifications of a given malady nor accurately depict the burden it places on the character.

Let’s revisit Harley Quinn and her dependent/histrionic personality disorder. Though she’s been written by many different writers by now, each seems to have a grasp on what exactly her neurosis entails. Every writer is sure to include her desperate need to be included in some kind of interpersonal relationship, how dramatic and unstable her mood can be, her overly sexual demeanor, and the way she changes her personality to coincide with whomever she’s paired with. The details are accurate in this instance but among all the stories Harley has been in, no one has stopped to examine what effect this personality disorder has had on her. No one has followed her on those sad, off-panel moments when she realizes she’s alone again. No one has shown how defeated and dejected she probably feels when the relationship goes awry. And most importantly, no one has described how her disorder has set her on the path to self-destruction. Harley’s mental illness isn’t a story of struggle, it’s a plot device glorify her quirky female dependence.
Continued belowFar too many writers have used this “Harley Method” of writing characters with mental illnesses. They’re content with simply depicting certain characteristics and symptoms of the disease in order to inform the audience of a given character’s motivations and pathos with the sole purpose of progressing the story. Rarely are the implications and ramifications of the disease presented to the audience in their entirety as the diseases themselves aren’t designed to build the character. They’re regulated to being simple plot points for the manufacture tension within the story.

Nate Powell’s seminal work, “Swallow Me Whole,” bucks this trend. Through the eyes of his main character Ruth, Powell provides an incredibly enthralling, educational, and illuminating portrayal of schizophrenia. Ruth begins the story by experiencing auditory hallucinations and, over the course of several years, her condition progresses to include visual hallucinations, bizarre and paranoid delusions, and other classic stigmata such as social withdrawal and disorganized thinking. But what truly separates Powell’s tale from others that involve schizophrenia, or any other psychiatric illness for that matter, is how he shows Ruth’s life crumbling around her. With haunting imagery, dialogue, and panel structure, Powell likens Ruth’s psychosis to a creeping shadow that taints every facet of her social well-being as her life slowly plunges into chaos.
Can you see the difference between Ruth and Harley? We, as the audience, can leave Ruth’s story with a basic awareness of the symptoms of schizophrenia and how it can tragically ravage the lives of patients in whom it develops. Harley’s stories, however, never give us anything more than “man, Harley gets sad when Joker isn’t around.” Powell dedicates his text to illustrating schizophrenia, centering it on Ruth’s ailment and descent into the throngs of psychosis. It’s an accurate, solemn, and well researched story that aims to encapsulate a standard patient experience with the affliction. Harley’s depiction of her disease is a glorification and oversimplification that flippantly uses the disorder as a character quirk and leaves the reader woefully misinformed about a real disease. Powell displays a thorough understanding of schizophrenia that is enough to do the disease and its victims justice, Harley’s more recent writers probably read a Wikipedia page and said “oh, this could work.”
Comics are littered with too many Harleys and it’s disrespectful. I fully support the presentation of psychiatric illnesses and behavioral disorders in media and fiction. It helps to educate people on the plight of patients who all too often suffer in silence while also encouraging these patients to seek help and promise them that better tomorrows are possible. But these depictions can have a profound effect on the perception of these diseases places which places a great deal of responsibility on their respective stories. Each story must therefore be crafted with meticulous study and understanding of the illness to capture the full essence and ferocity of the malady. And finally, the disease should always drive the narrative. Schizophrenia, DID, and dependent personality disorder aren’t plot gimmicks, they’re painfully real sicknesses that tragically dominate the lives of their victims. Their pain and their plight deserve better representation than Harley Quinn.