the joker, lying on couch in psychiatrist's office, speaking about his issues, concerned expression, (psychiatrist with expression of shock) in background taking notes, photo-realistic, sharp details, perfectly drawn eyes, (best quality:1.2), high-res, uhd, masterpiece, highly-detailed skin, (low contrast:1.6), ultra-realistic, (best render:1.4), sharp detailed facial features, (candid moment:1.4), (vivid color:1.4), framed medical certificates on wall,