A Clinical Perspective on Panic and PTSD in Iron Man 3

Throughout Iron Man 3, Tony Stark experiences panic attacks. This fictional character, the superhero better known as Iron Man, calls them "anxiety attacks," but he is no clinician. Even though we cannot go interview the character or get inside his head to assess the intensity and number of panic symptoms according to strict DSM criteria, the episodes' sudden, intense, debilitating, and significantly distressing nature nevertheless make them appear to be panic attacks. I've previously discussed the degree to which Tony Stark meets DSM criteria for posttraumatic stress disorder (PTSD) while pointing out that the degree of impairment could be debatable because one professional might focus on areas in which Stark is functioning poorly whereas another might focus on things that he does accomplish during this period of his fictional life.

Nobody follows a cookbook when developing a mental disorder. Human suffering can be great without neatly fitting DSM criteria. Controversies over the DSM-5 have shone a bright, hot spotlight on empirical weaknesses in all editions of the DSM. Many people forget that mental disturbance is not an all-or-nothing issue and that mental disorder labels listed in the DSM are terms people made up to summarize sets of symptoms.

This movie clearly delves into these issues without neatly providing us a textbook, by-the-numbers example. The character of Tony Stark is presently suffering as he struggles to cope with unique experiences. Although no one in our world has ever carried a nuclear weapon through a wormhole, plenty of people have faced what seemed to be certain death and plenty of people have undergone bizarre experiences that no one around them afterward can fully understand, so they often feel alone in their experiences.

Panic attacks and possible PTSD in Iron Man 3 have stirred up a great deal of discussion (e.g., "Twitter Takes on Iron Man 3: Why Can't Tony Stark Sleep?"), and that's a good thing. Fiction can help people contemplate real-world mental health issues. Most professionals who would pick apart the depiction in the film won't know enough about the character's comic book background or other film appearances, which limits the scope of what they might consider.

Dr. Andrea Letamendi, on the other hand, is a clinician who has worked with combat veterans suffering PTSD and one who knows comic book superheroes. She is, in fact, a comic book character. When writing the current Batgirl series in which Barbara Gordon returns to crime-fighting after spending three years in a wheelchair, author Gail Simone consulted with the real Dr. Letamendi in order to depict trauma recovery and the therapeutic process more accurately. Andrea Letamendi proved so helpful that Simone created a character, Gordon's therapist, modeled and named after her. Letamendi has also visited Iron Man's universe as an interviewee for the Marvel Augmented Reality app (e.g., Marvel AR for Morbius: The Living Vampire #3).

At her Under the Mask blog, Dr. Letamendi touches on the complexities of posttraumatic growth and posttraumatic stress as mentioned or depicted over the course of four films (Iron Man, Iron Man 2, The Avengers, Iron Man 3) in her latest post, "Iron Man: A Terrible Privilege." As she notes there, "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." Drawing on her clinical experience, her knowledge of all the films, and her additional knowledge about the stories behind the stories, she contemplates the complexities of Iron Man's posttraumatic stress.

"Tony’s struggle with anxiety is poignant because it allows us to realize that he is, in fact, still human," writes Letamendi. "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."

For Dr. Letamendi's specific analysis, read her "Under the Mask" post: "Iron Man: A Terrible Privilege."

Related posts:

* "Does Iron Man 3's Hero Suffer Posttraumatic Stress Disorder?"

* "Twitter Takes on Iron Man 3: Why Can't Tony Stark Sleep?"

* "The Avengers Teach Psychology: Class Assemble!"