Hey there, my title is a little misleading so you're gonna have to read on.
From what I've read online about various personality disorders, I've understood that few mental health doctors were really aware of them before the 1980s. Director Todd Phillips said Joker takes place in 1981.
In the film, the clerk at Arkham State Hospital looks through the medical file of Arthur's mom and mentions she was diagnosed with Narcissistic Personality Disorder. He also said these files were thirty years old at the time.
The clerk could had rounded up to thirty from 25. With 1956 being the youngest her file could possibly be written, what is the likelihood of a woman like her being diagnosed with that? Say these doctors added to her file a few things after 1956, then what's the likelihood of NPD being diagnosed later?
Maybe back the only people getting diagnosed were extreme cases, and Arthur's mom would had been an extreme case. Then there's the question, did her character match up with what NPD looks like? I will greatly appreciate your insight into this question as well. As long as this thread is on the topic, why not?
I've seen a few articles online about therapists not knowing to look for these so I was just thinking about how Joker could had made lay-people aware of the concept of personality disorders for the first time. But then I had to ask, if doctors today have trouble diagnosing it then how'd the doctors in 1980s Gotham diagnose someone with it?
The concept of narcissistic personality is about as old as professional psychiatry. Freud refers to this idea frequently, but he did not call it a personality disorder. That concept was not in widespread use at the time. Instead, psychiatrists tended to divide conditions into neuroses and psychoses, and narcissism could be the cause of either. Psychoanalytic treatment guides for narcissistic neuroses and psychoses were being published by other psychoanalysts by the early 1930s (L.P. Clark, etc.). A modern psychiatrist or psychologist would probably recognize narcissistic neurosis to be vaguely similar to the condition that we refer to today as narcissistic personality disorder (NPD). However, psychoanalysis generally regarded personality issues as the foundations of more severe pathologies. The concept of a personality disorder would be seen as redundant to a psychoanalyst at that time, as all disorders were believed to be rooted in personality dysfunction.
The work of Kurt Schneider, first published in 1923, was probably the most influential foundation for the modern concept of personality disorders. He developed a taxonomy of psychopathic personalities that are seen as extensions of normal personality into the abnormal realm, rather than as an extension of severe pathology into the normal realm. Many of Schneider's personality disorders are reminiscent of the modern taxonomy, but none match in name, and NPD is not on that list. The first edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) was published in 1952, and it is widely acknowledged that Schneider was the main influence on the concept of personality disorders introduced there. The DSM was responsible for unifying various diagnostic systems into a single approach and introduced the concept of personality disorders into widespread use. However, NPD was not one of the 12 personality disorders included in the first edition of the DSM.
Heinz Kohut might be the first person to have published a treatise using the term NPD, in 1966. This was followed by a highly influential manual for treating NPD in 1971. Although he did not appear to use the term NPD until 1966, Kohut's ideas were fairly well known by the early 1950s. It was just that he had not fully integrated the psychoanalytic concept of narcissistic personality with the more recent concept of a personality disorder. The DSM-III, published in 1980, would have been when the term NPD was finally added to the most widely accepted psychiatric diagnostic system in the world.
I am not familiar enough with the film Joker to comment on how accurate the diagnosis of that character would be -- someone else would have to comment about that -- but I can discuss how accurate a diagnosis of earlier times would match current ones. In 1950, it is quite possible that someone would be diagnosed with a narcissistic neurosis, but the descriptor "narcissistic" would be rooted in psychodynamic causes rather than symptomatic presentation, so the match with a modern diagnosis might not be very good. A person with a modern diagnosis of NPD would likely receive a diagnosis of neurosis at that time, but there is a very good chance that a psychiatrist would decide that the underlying cause was due to some other process than an obvious similarity with the presentation. In 1966 it might be possible to obtain an accurate modern diagnosis of NPD from someone other than Kohut, and by the 1970s many psychiatrists familiar with Kohut's work would be using NPD as a diagnosis. Starting in 1980 we could expect most psychiatrists to agree on that term.