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For the last day of this semester's Stan Lee Heroes class, I took students to see Iron Man 3. Little had we realized the increased relevance this film would have for our psychology course. Afterward, we discussed it for quite a while over dinner (with fortune cookies).
Does Iron Man 3's Tony Stark suffer from posttraumatic stress disorder?
At the climax of the narcissistic seeming character's previous appearance (fighting extraterrestrial invaders in 2012's The Avengers), Iron Man intercepts a nuclear missile aimed at Manhattan and guides it through a wormhole into another part of his universe. Having accepted that he will die alone in a nuclear explosion as the wormhole closes and his robotic suit expends the last of its power, he experiences what he truly believes to be his final moment of life before he falls back through the wormhole to be rescued by the Hulk. He has passed from the realm of his certain death and back into the land of the living.
When Iron Man 3 (a.k.a. Iron Man Three once in the end credits) takes us to today's Tony Stark, we find a man haunted by his experiences in New York, a hero who can barely sleep. He suffers anxiety attacks with shortness of breath whenever reminded of the New York invasion, an incident he refuses to discuss even when asked simple questions about it. Despite all this, he insists that he does not have PTSD, but would he really know? The only doctor with whom he eventually shares all these things has to point out to Tony, "You know, I'm not that kind of doctor!"
To qualify as suffering posttraumatic stress disorder (PTSD) using DSM criteria, Tony Stark must show specific trauma-related symptoms that cause distress and interfere with his ability to function.
PTSD Criterion A. Exposure to traumatic event. Yes, Tony Stark has undergone a trauma unlike any previous crisis or conflict: the certainty of his own imminent death. Although he faced death boldly, the experience exerted lasting emotional impact.
PTSD Criterion B. Persistent re-experiencing. Yes, distressing recollections of the events repeatedly intrude upon his thoughts and disturb his dreams.
PTSD Criterion C. Persistent avoidance. Tony tries to avoid thoughts and conversations regarding the trauma, avoids certain places and situations that remind him of the New York events, evinces a marked reduction in participation in activities previously appealing to him (which does benefit him in one way in that he appears to have lost interest in heavy drinking), feels detached from others, and has difficulty showing some feelings that came freely to him before the trauma. A person must show at least three of seven key symptoms to meet this criterion; Tony exhibits five.
PTSD Criterion D. Persistent symptoms of increased arousal. His severe insomnia and recurrent anxiety attacks (as he calls them) clearly fit.
PTSD Criterion E. Duration of disturbance for over a month. Yes, in fact, the problems have lasted for months.
PTSD Criterion F. Clinically significant impairment or distress. This may be the most debatable piece of the equation. Even though I've taught psychopathology courses almost 100 times in 20 years, functional impairment is not easy to pin down. Some therapists could conceivably take a different view, focusing perhaps on areas in which Tony becomes more productive during his sleepless days and nights. Regardless of whether we see eye to eye in deciding his changes in functioning count as impairment, though, these symptoms do distress him greatly, so he meets this criterion nonetheless.
In Iron Man 3, Anthony Stark appears to meet the full criteria for posttraumatic stress disorder. He either does not know enough about PTSD or he is in denial, refusing to recognize his own problem, which is a common occurrence among some of those who suffer similarly in real life.
Also worth considering: Are his self-assessed anxiety attacks, in fact, panic attacks? A panic attack is an intense and distinct period of strong fear or discomfort, abruptly showing at least four symptoms that peak within ten minutes. These symptoms might prove more difficult to judge because we cannot interview this fictional character about their variety and intensity, and because the script did not call for the actor to articulate every aspect of how he played each attack. They certainly look like panic attacks.
Panic Disorder Criterion A (1). Recurrent panic attacks. Whatever the attacks are, yes, he keeps having them.
Panic Disorder Criterion A (2). At least one related symptom. Tony shows all three symptoms in this list. He stays concerned about the possibility of having more attacks, he worries about their implications, and he significantly changes his behavior related to the attacks.
Panic Disorder Criterion B. Agoraphobia - yes or no. No, he is not afraid to go outdoors. This criterion simply distinguishes whether a person might have panic disorder with agoraphobia or panic disorder without agoraphobia.
Panic Disorder Criterion C. Psychological in origin. His attacks do not result from substance abuse (in fact, as noted earlier, we no longer see him abuse alcohol in the present). They do not appear to result from any general medical condition, although a physician might need to examine whether his unusual heart functioning could be creating some of his panic-like symptoms.
Panic Disorder Criterion D. Not due to other mental disorders. The DSM explicitly names PTSD as one of the disorders worth ruling out here.
Because PTSD better accounts for Tony Stark's overall pattern of behavior and suffering, it remains the more likely diagnosis for the distress he frequently feels during the months after he'd faced his own mortality on the other side of a space-spanning wormhole. The character who showed such great posttraumatic growth after a horrific experience at the start of Iron Man 1 is demonstrating a very different pattern when we meet him again at the start of Iron Man 3. Whereas coping with the attack and abduction by terrorists in his origin story required Tony Stark to muster his determination to survive, protecting New York from a nuclear weapon in The Avengers meant accepting his own demise in a way he had never done before.
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References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, D.C.: American Psychiatric Association.
