Once in a while a movie comes along that does a really good job of depicting mental illness. Rarely does one see an entire film series that follows a character through the ups and downs of a mental illness in all of its complexity the way the films of the Marvel Cinematic Universe show us how Tony Stark, Iron Man, develops and lives with Posttraumatic Stress Disorder. The events depicted in the film Iron Man and its sequels subject the character Tony Stark to situations where the development of PTSD is not only possible, but likely, and his actions throughout the film series demonstrate that a PTSD diagnosis is probably clinically indicated. My scope of inquiry will consist of the three Iron Man movies, The Avengers, and The Avengers: Age of Ultron. Captain America: Civil War will not be included in my assessment for the simple reason that it has not yet become available for individual purchase, making it difficult to refer back to.
Vital in assessing any patient is establishing a baseline for them. What was Tony’s condition before he experienced any trauma? We can only tell so much from the films, but aside from a poor relationship with his father (indeed, Tony even states that his father never told him he loved him) and the fact that he is repeatedly shown to be an egotistical womanizer, and while unfortunate (in the case of his relationship with his father) and odious (in the case of his womanizing) there is nothing particularly pathological in Tony Stark’s behavior that we are shown prior to his kidnapping by the Ten Rings terrorist organization.
So, does Tony Stark have PTSD? If so, at what point does he develop it? Fortunately, there is a fairly simple way to answer that. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders offers clear diagnostic criteria for PTSD. Does Tony meet those criteria? Let us take them one by one. Criteria A states that a patient must have “exposure to actual or threatened death, serious injury, or sexual violence,” and I doubt that anyone could question that Tony was directly exposed to multiple immediate threats of death or serious injury over the course of the films. From being taken hostage in Iron Man to flying a nuclear weapon into the Chitauri in The Avengers Tony has been exposed to legitimate threats of death multiple times.
Flying that nuclear weapon brings us to PTSD Criteria B, “Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
- Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)”
In Iron Man 3, Tony tells Pepper Pots that after The Battle of New York he cannot stop thinking about what happened, and we see at least one nightmare where he relives it. It is not made explicit, but there is the implication that he has those nightmares when he sleeps, so he tries to avoid sleeping as much as possible. Additionally, when the Chitauri attack on New York is mentioned Tony experiences significant and debilitating anxiety attacks. These incidents easily fit the intrusion symptom criteria required for the diagnosis.
Diagnosis Category C is about avoidance, with diagnostic criteria as follows:
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
On multiple occasions, talking to multiple people, in Iron Man 3 does Tony insist he does not want to talk about what happened in New York. In one scene, he literally runs away from a child’s drawing of him flying into the wormhole above New York.
The next two categories are a little bit more difficult to get a handle on, because they have a very wide range of symptoms associated with them and both require multiple symptoms to meet the criteria:
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g. “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”)
- Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others
- Persistent negative emotional state (e.g.fear, horror, anger, guilt, or shame)
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions (e.g. inability to experience happiness, satisfaction, or loving feelings)
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the folllowing:
- Irritable behavior and angry outbursts (with little or no provocations) typically expressed as verbal or physical aggression toward people or objects
- reckless or self-destructive behavior
- Hyper vigilance
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance (e.g. difficulty falling or staying asleep or restless sleep)
As far as Category D goes, Tony does not appear to have experienced significant amnesia, neither has he lost the ability to experience positive emotions, nor does he appear to experience feelings of detachment or estrangement from others. His romantic relationship with Pepper Potts started after his capture by Ten Rings and his friendship with Col. Rhodes is unchanged. The most obvious symptom to me is D5, “Markedly diminished interest or participation in significant activities.” Prior to his capture in Afghanistan, Tony was an active participant in the workings of Stark Industries, winning business awards, demonstrating products in the field, etc. After his escape from Ten Rings he announces he wants Stark Industries out of weapons manufacture, their primary business, but after making the announcement effectively cedes control of the business to Obadiah Stane and goes and hides in his workshop for weeks, refusing to even attend board meetings. Of course, to meet the criteria for Category D you have to have at least two symptoms, and I think the next most obvious candidate for inclusion is D2, “Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.” In Iron Man 3 Tony tells Pepper that the only thing keeping him from “cracking up,” is her and that the “threat is imminent, and I have to protect the one thing in the world I care about,” which is her. These expectations have led him to create Iron Man suit after Iron Man suit in his attempt to protect himself (and Pepper) from the threats he has experienced.
Category E is fairly cut and dry for Tony. In the scene from Iron Man 3 that I just referenced, Tony tells Pepper that he cannot sleep, and that once she goes to bed he goes to his workshop and tinkers on his suits. This clearly meets E6, “sleep disturbance.” Additionally, the nightmares he has when he does sleep would also meet this criteria. Examples of Tony’s behavior that meet the criteria for E2, “reckless or self-destructive behavior,” are fairly vast. One could argue that it started with the test flight of the Mk. 2 suit in Iron Man. The reasonable and responsible thing to do once the suit was finished would be to run small scale tests to establish the suits capabilities and limits, instead Tony jumps in and heads for the stratosphere. Which nearly kills him. However, in my opinion, the most reckless thing that Tony does in any of the movies is secretly experimenting with Loki’s scepter in Avengers: Age of Ultron. Regardless of how intelligent Tony Stark is supposed to be messing with an alien technology that you barely understand, a technology that has the power to open portals to distant points in space and control minds like it did in The Avengers is just not something you do on your own, or even with just one of your other brilliant friends. It is the height of hubris and recklessness.
Diagnostic Criteria F, G, and H are less symptom driven. Criteria F requires that the symptoms described in the preceding categories have lasted for at least a month. It is hard to say just how much time passes within and between these films, but I am going to make an assumption that they are supposed to happen at roughly the same time that they are released. The original Iron Man was released in 2008, and Avengers: Age of Ultron in 2015. So, given my assumption, the amount of time that elapses from Tony’s capture by Ten Rings, which is the first event in his life that meets Diagnostic Criteria A, to my most recent example symptom, the experimenting with Loki’s scepter in Avengers: Age of Ultron is approximately seven years, more than satisfying Criteria F.
I will skip over Criteria G for a moment, because there is a lot to say about it and briefly cover Criteria H. “The disturbance is not attributable to the physiological effects of a substance (e.g.medication or alcohol) or another medical condition.” Tony is a drinker, it is true, but it does not appear that the frequency or amount of alcohol he consumes changes from before his capture to after it. Further the only significant medical condition that we are made aware of is the shrapnel that he uses the arc reactor powered electromagnet in his chest to keep under control, which would not impact his behavior in any event.
Criteria G is the one category where all of this analysis can break down. It states that the patient must have “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” To be honest, I cannot say that Tony Stark meets this criteria. He certainly experiences clinically significant distress, but what sort of impact on his life does it have? Iron Man presents Tony as having three primary relationships, with Obadiah Stane, James Rhodes, and Pepper Potts. His friendship with Rhodes does not particularly change. There is certainly conflict between them, but at no point does it appear that their friendship is in jeopardy. Tony’s relationship with Pepper Potts goes from being a professional semi-friendship to a genuine friendship to a romantic relationship by the time Iron Man 3 comes around. It appears that by the time the events of Captain America: Civil War roll around their relationship has hit some sort of rough patch, but it is unclear what the source of the conflict is, and that film is outside of the scope of my inquiry anyway. Tony’s relationship with Stane is obviously fractured, but that had nothing to do with Tony and everything to do with Obadiah (inexplicably) attempting to have him killed.
One could argue that Tony giving up his role with Stark Industries could qualify as his symptoms impairing his occupational functioning, but it would take some convincing before I would argue that. After Obadiah's betrayal, Tony puts Pepper in charge of the company and turns his attention to being Iron Man and part of The Avengers. Being a super hero is now Tony’s job, and he does it quite well.
Ultimately, based on the evidence presented in these films, I cannot argue that Tony Stark fits PTSD Diagnostic Criteria G. However, there is no positive tests for psychiatric illnesses. All that a clinician can go on are observed behaviors and the patient reporting their thoughts and feelings over time, and even in that the DSM V is not a holy text. In psychiatry, every patient presents differently. The DSM V is a guide to assist in categorizing where on a spectrum of possibilities a particular patient falls and give the clinician a starting place for treatment. Tony Stark is suffering from something, as his symptoms make abundantly clear. Any halfway decent clinician would treat Tony, in spite of him not really Criteria G.
Tony is never seen seeking out help for his condition. The closest he gets is when he unburdens himself to Bruce Banner in the frame device for Iron Man 3. As Banner tells him, he’s not that kind of doctor, and is not really the person Tony needs to be talking to about his problems, but if Simple and Complex Post-Traumatic Stress Disorder: Strategies for Comprehensive Treatment in Clinical Practice is correct, this is one of the best things that Tony could do because “the preferred treatment for war trauma consists of helping the veteran tell his or her story of the significant events before, during, and after the traumatic war experiences.” Tony Stark is not a soldier. He is, actually, in a worse situation than a soldier. He has experienced combat, but has not had any of the psychological training that a soldier would have received before he ever went into that combat. An article published in the July 2013 issue of Clinical Psychology and Psychotherapy states that the “association between combat exposure and PTSD was diminished in those that reported higher levels of pre-deployment training,” which makes it all the more important for Tony to talk about his experiences. Banner falling asleep while listening to the story does not exactly make it the most supportive setting you could imagine, and it is unfortunate that a serious situation is played for cheap laughs, but as Banner said, he is not that kind of doctor.
Only Marvel executives know what the future holds for Tony Stark, and given the fact that Robert Downey Jr. is only, to my knowledge, contracted for one more movie, Avengers: Infinity War we may not get a whole lot more character development for Tony. I hope we do, I hope we get some resolution for him because a man that has saved the world a few times deserves a little healing for himself.
References:
Iron Man. Directed by Jon Favreau. United States: Marvel Studios, 2008. Film
Iron Man 2. Directed by Jon Favreau. United States: Marvel Studios, 2010. Film.
Iron Man 3. Directed by Shane Black. United States: Marvel Studios, 2013. Film.
The Avengers. Directed by Joss Whedon, United States: Marvel Studios, 2012. Film
The Avengers: Age of Ultron. Directed by Joss Whedon, United States: Marvel Studios, 2015
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Association, 2013.
Simple and complex post-traumatic stress disorder: strategies for comprehensive treatment in clinical practice. Mary Williams - John Sommer - Haworth Maltreatment and Trauma Press. 2002
Price, Matthew, Daniel F. Gross, Martha Strachan, Kenneth J. Ruggiero, and Ron Acierno. "Combat Experiences, Pre-Deployment Training, and Outcome of Exposure Therapy for Post-Traumatic Stress Disorder in Operation Enduring Freedom/Operation Iraqi Freedom Veterans." Clinical Psychology and Psychotherapy, July 2013, 277-85.
