'Iron Man 3': Does Tony Stark Have PTSD? (Guest Column)

Iron Man 3 VFX H
Digital Domain
Clinical psychologist Andrea Letamendi considers the mental health implications of the trauma and the triumph experienced by Robert Downey Jr.'s superhero.

I’ll cut right to the chase. This is not a review of a single film. It’s not even a review of all three Iron Man films. This is a psychological case conceptualization of a singular character in the Marvel Cinematic Universe: Tony Stark. If you have seen Iron Man 3 you may have already started to think about Tony Stark’s mental functioning. If you have not yet seen the film, you should know that this article contains spoilers. Throughout this film, Tony experiences recurrent panic attacks: sudden, intense, debilitating episodes of anxiety that cause him significant distress. Tony has been suffering from these anxiety attacks since the alien invasion in New York City (depicted in The Avengers, when Iron Man essentially launches himself into space on a nuclear bomb Slim-Pickens style to destroy the alien ship and thereby save Earth). Iron Man 3 marks the first time in the entire “Marvel Cinematic Universe” when we see a hero suffer undeniable instances of a significant mental disturbance.

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Since the movie’s release, some have already started to ponder about the psychology of Tony Stark, asking whether or not he has Post-traumatic Stress Disorder (PTSD), a real mental disorder mentioned in the movie by his 10-year-old companion, Harley. If you simply want to know whether Tony Stark has this mental illness, this article may leave you unsettled. I don’t work with absolutes. I won’t give you a black-and-white, yes-or-no answer. One reason is that, among the patients I’ve seen who have returned from Iraq and Afghanistan with physical and psychological injuries (my nonfictional comparison to fictional superheroes), a rare few have clear-cut diagnoses. As it turns out, exposure to multiple life-threatening environments, especially war zones, leads to complex psychological presentations not well represented or captured by one disorder. As explained by The National Center for PTSD, the current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma.

Second, in my field, while it is important to assign and “rule out” diagnoses, it is also important to determine why the symptoms are present in the first place and establish the course of illness. In the practice of clinical science, we explore the possible risk factors as well as protective factors that might make some individuals more vulnerable– or more resilient– when it comes to psychological functioning after a crisis. Why didn’t Tony begin to break down psychologically after his torture and captivity in Afghanistan? Why did Tony continue to pursue threatening and dangerous environments (e.g., joining S.H.I.E.L.D.) after nearly losing his life in his first experiences as Iron Man? How is he able to take on new threats such as facing the Mandarin while suffering from seemingly debilitating anxiety episodes? If he were my patient, I would explore all these case specific events. If he were my patient, I’d want to know what makes each situation different. I’d want to know what provoked his first episode of anxiety and helplessness.

I’d want to know what the hell happened in that wormhole.

I don’t necessarily mean what we experienced in the wormhole or how we interpreted the event. What did it mean to Tony? What made it different from other traumas Tony has already experienced up to that point in his life?

To summarize “what happened in New York:” Black Widow is ready to shut the portal down using the Tesseract in order to keep the alien ships from entering Earth’s atmosphere through the space wormhole. Tony decides to carry a nuke through the portal in order to destroy the entirety of the alien battalion. As he is shooting up to the sky, Captain America informs him, “You know that’s a one way trip,” implying that the task will be fatal. Tony already seems to know this. Through JARVIS, he phones his beloved Pepper Potts using the suit’s technology, ostensibly to say goodbye. But when he leaves Earth’s dimension, we realize Tony never gets through to her. While in space, his suit loses power, and he descends back toward the rift, watching the nuclear explosion obliterate the entire alien mothership. There is a notable moment where we’re held in suspension–like the rest of the Avengers, we see glimpses of the wormhole mouth, the sky, but no Iron Man. The Avengers decide to close the portal. In the last possible second, Iron Man is seen hurtling through the narrow hole, back down to earth, unconscious. The Hulk then catches him and breaks his fall onto the pavement. Tony remains unconscious until Hulk’s roar seemingly brings him back to life, awoken to superheroes surrounding him. “What just happened?” he asks. Good question.

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One of the most essential features of PTSD is how a person reacts or interprets a traumatic event. That is, a clinician doesn’t single handedly determine what is “traumatic”—the patient does. And people respond differently to different things. What was it about the alien invasion in NYC that caused Tony to respond with intense fear, horror, and helplessness? What was the traumatic part of that experience? Observing a catastrophic threat from another universe at close range? Trans dimensional shock? A near-death experience in the form of prolonged loss of consciousness? Saying goodbye to a loved one? Losing control? Hulk’s armpit stink? (What? It could be pretty bad.)

Multiple Traumatic Events: The Re-Deployments of Tony Stark 

We know the alien invasion wasn’t the first time Tony was faced with a traumatic event. What constitutes a trauma in clinical terms? The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines a “traumatic event” as one that involves actual or threatened death or serious injury (e.g., war, disaster, terrorism, vehicle accidents and violence) or threat to the physical integrity of oneself or others (e.g., Happy, Pepper, and Rhodey). I recommend you check out the full clinical criteria for trauma and PTSD here. As I’ve stressed before, the experience of a traumatic event itself is necessary but not sufficient for the proper diagnosis of PTSD. In fact, up to 60% or more of us will experience a traumatic stressor at some point in our lives, and according to U.S. epidemiological studies, only about 7% of us will ever develop the disorder of PTSD in our lifetime. That means the majority of people who are exposed to traumatic stressors do not develop PTSD.

When it comes to Tony Stark, the risk of PTSD is actually higher. Soldiers returning from recent military combat zones have nearly double risk. Why? Well, certain factors can increase the risk of developing this problem, including repeated exposure to threatening events. This may mean that the development of posttraumatic stress symptoms may occur only after a certain threshold of experiences are met. Tony certainly seems to have a high threshold.

From his father’s unexpected death to his three month imprisonment in Afghanistan, Tony has experienced numerous traumatic events in his lifetime. In the first Iron Man film, for instance, before developing the Mk 1 armor, Tony is visiting Afghanistan to represent his weapons development company. Tony’s humvee caravan is attacked by terrorists and he witnesses U.S. soldiers murdered by I.E.D.s and gunfire—ironically, from the very weapons Stark Industries has manufactured. Later, after months of captivity in a cave, Tony sees Yinsen, his new friend and only companion during his captivity, die from gunshot wounds while trying to buy time for Tony’s escape. Finally, during the climax of the film, the massive arc reactor explodes, knocking Tony unconscious and killing the villainous Obadiah Stane. In a single movie, Tony is exposed to nearly 5 clinically defined traumatic events. Iron Man 2 includes several more traumas one could catalog, including a near fatal car accident on the Grand Prix racetrack. Not to mention Whiplash. Just…Whiplash.

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Post-Traumatic Growth: Positive Responses to Trauma

Despite exposure to multiple traumas, we see few signs of post-traumatic stress responses throughout the previous Iron Man movies and The Avengers. Interestingly, after Tony returns from Afghanistan in Iron Man, Obadiah tries to remove him from the Board of Directors at Stark Industries by filing an injunction against him on the grounds of “mental illness” (citing PTSD); however, there is neither proof of this diagnosis nor review of any proper standardized evaluation or assessment for this diagnosis. Honestly, if Obadiah had asked me to provide such a clinical report at this very moment in Tony’s life, I would have sent him the hell out of my office. Obadiah was operating on the agenda to disarm Tony and strip him of any decision making power at Stark Industries, but citing mental incapacity couldn’t have had a more flimsy rationale for removing Tony from the Board. With determination to build a second, better suit and a new vision about how he wants to contribute to society, Tony is remarkably focused and psychologically sound at this point in his life. Similarly, in Iron Man 2, Tony realizes he is suffering from a chronic, life-threatening stressor in the form of a medical crisis. The arc reactor in Tony’s body—specifically its palladium core—is emitting a toxin so lethal, it is slowly killing him. By the end of IM2, Tony is described by S.H.I.E.L.D. documentation as being “narcissistic, self-destructive, and compulsive.” There are no signs or mentions of PTSD or anxiety attacks.

Psychologically speaking, one of the most poignant moments in The Avengers is when Bruce Banner and Tony Stark connect over many of their similar attributes while meeting in the S.H.I.E.L.D. helicarrier. Tony and Bruce see themselves in one another: misunderstood, highly intellectual, and both conflicted by their superhero potential. But Banner’s struggle is markedly dark. His superhero self comes with dangers he cannot reconcile with its heroism. Banner confesses that when he transforms into the Hulk, he is more vulnerable despite his size and strength: “I’m exposed, like a nerve…it’s a nightmare…”

Tony explains that even though he wears a suit of armor, “it’s not just a suit…I’m not just armor.” He explains that his superhero self is dangerous because it is built around the shrapnel lodged in his chest, an injury from the explosion that nearly killed him in Afghanistan. The suit symbolizes a constant threat.

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Unlike Banner—who has yet to accept both the responsibilities and the risks associated with being Hulk—Stark has come to a point where he has accepted the fact that the countless dangers, threats, and sacrifices he will have to make as long as he is dedicated to his superhero self will ultimately define him. The heroic lifestyle comes with a price. The very suit that protects him is a reminder that he is broken. Fear of Fear: Unexplained Panic Attacks Exposure to a traumatic event can often explain the presence of nonspecific sudden symptoms, such as heart palpitations, shortness of breath, tremors, nausea, insomnia, or unexplained physical pain. In Iron Man 3, Tony exhibits many of these symptoms. His panic attacks are characterized by hyperventilation, heart palpitations, and something called derealization—the feeling like you are outside of your body or that your surroundings are unreal. Actually, even with the absence of any trauma, many of us will experience at least one panic attack like this in our lifetime. Because of our protective biological makeup, once we experience a panic attack, we’re inclined to avoid experiencing them again. That is, we’d likely avoid the thoughts, sights, or memories that might trigger the attacks because the feeling of an attack is so unpleasant. However, avoidance of anxiety actually builds more anxiety. Avoidance—escaping the situation or “running from” the trauma reminder—helps to diminish the anxiety temporarily; the resulting relief reinforces the avoidance behavior, and thus confirms the belief that the anxious feelings are dangerous or a real threat.

When we first see one of Tony’s anxiety attacks, he is triggered when two children in a restaurant ask for an autograph on a drawing they had made of Iron Man. They happen to mention New York and “the wormhole.” Tony freezes. In a matter of seconds, he doesn’t know where he is or what is happening. He cannot form words or see properly. He experiences sudden dizziness, shortness of breath, and a feeling of being trapped. Imminent danger. He looks down to realize he had written “Help Me” on the drawing of Iron Man. Panicked, he runs desperately out of the restaurant and into his iron suit in order to escape the situation—perhaps to try to regain control. JARVIS performs a diagnostic and informs Tony that he had experienced an “anxiety attack” and displays a pictorial of his body with a mapping of anatomical and biological symptomatology.

Later in the film, another panic attack occurs while Tony is scouting a crime scene with Harley. Tony warns the youth that he “doesn’t want to talk about New York,” yet is reminded of the event when Harley makes an association between a large hole in the ground “and the wormhole.” Tony begins to notice his own shortness of breath, which immediately spirals him into a full panic attack: hyperventilation, hot flushes, confusion, and fear of what is to come. He recovers by running away from the problem—essentially, escaping the situation and avoiding further conversation about his anxiety.

PTSD: Does Tony Stark Meet the Criteria? As I mentioned, a more complex formulation should supplement a diagnosis, but it’s worth exploring whether the clinical features shown in Iron Man 3 are similar to the criteria of PTSD. A person with PTSD shows symptoms that fall in the following three categories: recollections (such as nightmares, flashbacks, and intrusive thoughts), avoidance (making efforts to avoid thoughts, feelings, or conversations associated with the trauma), and hyper-arousal (difficulty sleeping or being agitated). In the beginning of the film, Tony mentions that he has been awake for 72 hours while working on his Iron Man suits (hyper-arousal). As previously described, he escapes situations where he might be reminded of the trauma (avoidance). Undoubtedly, Tony is haunted in his dreams (recollection), which could arguably be one of the reasons he stays awake for days at a time (more avoidance). In a particularly unsettling scene, Tony is dreaming about the alien attack. While still asleep, he conjures his Mk 42 Iron Man suit to protect himself, but the suit assaults Pepper, who screams in horror. This isn’t an unlikely scenario. One of my patients used to sleep with a bayonet next to his bed, a protective habit he picked up while in the military. He confessed to me that he had woken up several times hunched over his wife with the bayonet pressed against her face. Incidentally, he didn’t meet full criteria for PTSD.

One of the most important characteristics of PTSD is significant “functional impairment.” That is, does the disturbance cause marked distress or impairment neither social, occupational, or other important areas of functioning? Clearly, the insomnia, panic attacks, and intrusive thoughts of the trauma are affecting Tony’s social relationships, namely: Pepper and Rhodey. But does the anxiety impact his ability to function as Iron Man?

Psychological Resilience: The Steeling Effect Resilience is a person’s ability to cope with negative events and manage the impact that those events have. Resilience is not about living an existence that lacks threats, attacks, or stress. Psychologists use the term “Steeling Effect,” which is characterized by having features of hardiness and resourcefulness in the face of adversity. It’s our ability to bounce back. At the end of Iron Man 3, the metal shrapnel in Tony’s chest is surgically removed. He exclaims that the next night is “the best sleep I’ve had in years,” hinting that he has overcome the symbol of imminent threat, and therefore releases himself from his own psychological captivity.

Surely, some might say we’ll never know if Tony Stark has PTSD or any mental illness for that matter because he is a fictional superhero and everything that happens to him is fantastical. On the contrary, the original Iron Man movie was created based on the writing of comic legend Warren Ellis, who wrote about very realistic themes spanning terrorism, combat, medical trauma and interpersonal conflict. Stark encounters some of the most realistic threats and dangers in comics to date.

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Developing an accurate diagnosis with a real patient is essential for a number of reasons—it helps us to plan appropriate treatments, monitor progress, and look for risk factors. With fictional patients, labels can normalize the experience of disorders and destigmatize mental illness. But the brilliance of the third Iron Man installment rests in the complexity of Tony’s psychology. Iron Man doesn’t work in absolutes either. The movie seems to intentionally depict mental illness with a sophisticated level of ambiguity and dimension, emphasizing the realistic point that the course of mental illness has no clear-cut causes, cures, beginnings, or ends.

Tony’s struggle with anxiety is poignant because it allows us to realize that he is, in fact, still human. To this end, it doesn’t matter to me if his panic attacks are indicative of clinical PTSD, complex PTSD, subclinical anxiety disorder or another psychiatric category we can use as a label. The point is this: A brilliant, powerful, and tough guy can be vulnerable, scared, and confused. Tony Stark is a superhero with the psychological makeup of a human. He is “just a man in a can,” after all.

Andrea Letamendi, PhD., is a clinical psychologist, scientist and convention speaker. This post first appeared on her blog, Under The Mask.