Recent issues of the top-selling title Batgirl have shown examples from Barbara's trauma recovery, including sessions with a therapist named after the real-life psychologist who has been advising comic book writer Gail Simone. Dr. Andrea Letamendi, a postdoctoral fellow at UCLA, has treated combat veterans and other individuals experiencing the process of trauma recovery. An expert on both psychology and comics, she has taken part in convention panels covering the psychology of superheroes at various fan conventions like San Diego Comic-Con, WonderCon, and New York Comic Con.
For Psychology Today, Andrea and I discussed Batgirl's recovery and touched on why a therapist would live and work in a place as dangerous as Gotham City.
Langley: What qualifies you to treat Barbara Gordon?
Letamendi: If you are asking about my clinical training and my background (which may be different than the fictional character treating Barbara), I have a Ph.D. from an APA Accredited training program, the SDSU/UCSD Joint Doctoral Program in Clinical Psychology, conducted clinical research in the Anxiety and Traumatic Stress Disorders Program at UCSD Psychiatry, completed internship at the West Los Angeles VA Healthcare Center, and am currently a Clinical Trials Supervisor/Postdoctoral Fellow at UCLA.
Langley: How do you diagnose a person like Barbara Gordon? Even if she is a fictional character, she has plenty in common with real crime victims and real people who have gained disabilities, but not everyone who experiences a great trauma will suffer PTSD or major depression over it.
Letamendi: Barbara is not unlike the patients I've seen who have faced adversity, loss, and trauma. We know from both practice and empirical studies that a small proportion of individuals who encounter trauma will actually develop the full diagnosis of PTSD. However, Barbara has demonstrated a presentation that may require psychological treatment. She suffers from trauma-related flashbacks triggered by trauma reminders, distressing nightmares, and cognitive distortions that indicate personalized guilt and hopelessness, which are common post-traumatic stress responses. It is therefore important for her to re-process her trauma, develop coping skills, and learn personal safety skills (to the best of her ability in Gotham City) in a therapeutic setting. I have seen many combatants who have returned from Iraq with similar clinical presentations—not all meet the necessary criteria for Major Depressive Disorder or Posttraumatic Stress Disorder—who certainly feel out of place in the world following very violent and victimizing experiences. In Batgirl #16, the first issue where we see Barbara Gordon interact with a therapist, a lot is still unknown regarding the severity of her symptoms and level of impairment. Does she believe her life will be shortened because of what happened to her? Does she predict more victimization and violation? Does she see the world as unsafe, unforgiving, and immoral? Someone may not meet all criteria for PTSD but deserves to learn or re-learn a more adaptive way to live, even in a place like Gotham City. If Barbara can do it, then many are inspired to reach their recovery goals too.
Barbara Gordon, still working on her trauma recovery, guardedly shares with Dr. Andrea Letamendi in Batgirl #20 (on sale now).
Batgirl #20 (2013). DC Comics.
Langley: I'd imagine that a masked crime fighter who suffers such trauma would face some of the same issues as real life crime fighters, firefighters, combat veterans, and others who devote their lives to making the world safer for others. Is recovery different for them? Are they more prone to criticize themselves for failing to prevent their own traumas?
Letamendi: It is important to emphasize that psychological treatment following violent and interpersonal traumas can be successful and lead to positive outcomes, and studies have shown that even individuals who face real-life crime, combat, and victimization on a more chronic basis can lead healthy, adaptive lives. We have found that some sufferers of this type of trauma (as opposed to traumas like natural disasters, accidents, etc.) develop additional, co-occurring clinical problems that may require additional attention. For example, anger, suicidality, self-destructive and impulsive behaviors, and drug/alcohol abuse are just some of the associated features that follow interpersonal, combat, or criminal victimization. Additionally, cognitive distortions surrounding self-blame, guilt, shame, and responsibility can impact treatment response if not addressed, and may be more prevalent with this population. Similarly, Barbara experienced what many people in the armed forces and law enforcement and have encountered: psychological and physiological injury, a double jeopardy in terms of risk. In my work treating servicemembers in an OIF/OEF Post-Deployment Clinic at the VA hospital, I have found that many patients with histories of combat-related trauma felt an overwhelming responsibility to protect others and have developed deeply-rooted beliefs that it is "my job to suffer" and "if I mess up, I deserve the pain." Outside psychiatric settings, however, servicemembers who have faced adversity on deployment and on the battlefield have demonstrated incredible resilience and psychological strength, in which case, core beliefs about their military duties can be seen as a protective factor and may even prevent them from developing psychopathology.
Langley: The Joker, the villain who shot and paralyzed Barbara long ago, recently captured her, nearly killed her mother, and made Barbara and all of the Robins worry that he might have maimed them in a creative new way. Barbara did not defeat the Joker. You've worked with combat veterans, real people who undergo extreme trauma and then sometimes experience even more. When a person who has been recovering get re-traumatized, what's that likely to do to her?
Letamendi: In a way, I'd say that Barbara does defeat the Joker. Not the Joker who brutally victimized her by shooting her at close range, that same Joker that kidnapped her mother and tortured her, the Joker who in issue #16 threatens to dismember Batgirl with a chainsaw. I believe Barbara defeated the Joker of her psyche: the horrific memory of a tragic and violating event that changed what she felt and thought about the world. Back in Batgirl #1, several years after the initial trauma, Barbara faces another villain, aptly named The Mirror. She finds herself in a position where her life is threatened again, with a gun pointed at her spine. To her, this is a re-enactment of her first trauma (see The Killing Joke). She finds herself completely frozen and caught in a flashback: unable to do anything but replay her initial trauma with the Joker, unable to defend herself against the Mirror. Later, in issue #16 where she is actually confronting the Joker, Batgirl is equally terrified and reminded of her initial trauma. However, she moves past her fear: "I've been afraid of this nightmare forever...I am done being afraid." She finds the emotional strength to combat Joker and his clown henchmen. She does not end up killing him, but she overcomes her "stuck" point, which is a sign of recovery for people who have suffered from traumatic stress. Re-traumatization is very common—especially for individuals who have roles where they serve and protect: police officers, soldiers, superheroes. For some people in this role, additional stressors and life-threatening events following a trauma actually allows them opportunities to practice psychological endurance and to become more empowered. Others, however, experience re-victimization and are not yet equipped to recognize a "stuck" point to re-establish control or recover from those situations.
Langley: Barbara might eventually trust her therapist enough to share her dual identity. If you lived in Gotham and your client turned out to be one of the city's costumed vigilantes, how might that change your therapeutic approach with her.
Letamendi: I believe that the therapeutic relationship between Barbara and Dr. Letamendi is actually quite relatable when it comes to clinicians and the patients under their care. The client may always have a "side" of themselves that they're reluctant or scared to reveal to their therapist. If Dr. Letamendi of Gotham City does indeed learn of Barbara's superhero self, I'd like to think that it would not change the nature of their relationship. The therapeutic approach may change, in that the doc might be interested in exploring why Barbara would want to put herself in physical danger again and increase her risk for re-victimization. In what ways would the superhero lifestyle impact her recovery? In what ways could it help her realize her psychological resiliency and strength? Perhaps the doc learns that resuming the Batgirl role, for Barbara, is symbolic of her psychological recovery and represents her ability to face the fears, both imagined and real, that have kept her guarded for so long.
Langley: Who’s healthier, Batgirl or Batman?
Letamendi: Defer! This is potentially a long discussion. They are more similar than people think, and both Scott Snyder and Gail Simone were paralleling their psychological strength in the recent "Death of the Family" DC run. I think they are both currently written as characters that are multi-dimensional enough to inspire a discussion of whether they are "healthy" or not!
Langley: Why would the fictional Dr. Drea live in Gotham? That place is dangerous.
Letamendi: Sometimes we choose to practice in environments that are outside our "comfort zone," whether geographically, clinically, or culturally speaking. Perhaps this fictional Dr. chose a challenging place to practice because it offers something we as the readers don't know about yet—access to some of the greatest villains (and psychopathologies) on earth? Collaboration with expert level researchers at Wayne Biotech? Invitations to a famous billionaire's parties? Plus, I hear Tim Drake knows where I can learn some awesome Ninjutsu.
Langley: Do comic books have therapeutic value?
Letamendi: Absolutely. A person may not have had the exact same experiences that these fictional heroes encounter--most of us don't know what it's like to have x-ray vision, telekinesis, or super-speed! But there can be something deeply meaningful about seeing our favorite characters encounter adversity and learn how to overcome their hardships and manage their distress. Psychological resiliency is universal and does not have to be seen as an unattainable superpower. I work with youths who talk about their heroes—Luke Skywalker, Batman, and Optimus Prime—and we use these fictional narratives as a therapeutic tool to learn coping skills. Thus, comic books, graphic novels, and science-fiction/fantasy can offer valuable aspects of modeling and learning for youths and adults in therapeutic settings.
Follow us on Twitter (Andrea Letamendi @ArkhamAsylumDoc, Travis Langley @Superherologist). Read Andrea's blog about heroes and villains at UnderTheMaskOnline.com.
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