Clinical Assessment: Iron Man a.k.a. Tony Stark
Psychologists from all over the world come into contact with a vast amount of individuals from all walks of life who are seeking help for a variety of conditions. The question of “how do they know what is wrong” is a valid one and easily answered. Psychologists utilize numerous methods to diagnose and treat patients, one of which is a Clinical Assessment. As mentioned already, a clinical assessment is a tool used to reveal the underlying causes, to understand the “why,” and to evaluate a patient's overall thoughts, feelings, and behaviors. This clinical assessment will be conducted on an extraordinary and revered patient, the infamous Iron Man, a.k.a. Tony Stark.
I. Identifying Information
The patient identifies himself as Iron Man. Iron Man’s true identity is Anthony Edward ‘Tony’ Stark. The patient is a heterosexual, single, Caucasian male in his mid-forties. While the patient possesses many homes throughout both the east and west coasts within the United States, he primarily resides in New York City, New York (Wikia, n.d.). The patient’s occupational status is quite impressive, and includes: Mechanical Engineer, Superhero, Inventor, and Industrialist, founder of the Maria Stark Foundation, Former United States Secretary of Defense Director of S.H.I.E.L.D, CEO of Stark Enterprises, Stark Industries, Stark Solutions, Circuits Maximus & Stark International, Computer Technician, and Philanthropist (Wikia, n.d.). The patient is incredibly driven.
Concerning physical appearance, without armor the patient is 6’1”; however, with armor the patient is 6’6”. The patient’s weight when devoid of armor is 225lbs, and with armor 425lbs. The patient has blue eyes and black hair. The patient also has an R. T. node embedded within his chest cavity and the node works to support his body functions (Wikia, n.d.). Overall, the patient appears to be in excellent physical health.
II. Chief Complaint/Presenting Problem
The patient does not have any chief complaints; in fact, he frequently refuses to admit that he has an issue at all (indicative of possible Narcissistic Personality Disorder). Nevertheless, the patient experiences incidences where he suffers from shortness of breath and subsequent anxiety attacks. This typically occurs whenever the patient is reminded of the event that took place in New York, upon which he intercepted a nuclear missile and entered another realm of the universe to dispense with it. As he entered the wormhole, he believed he would meet his imminent death (Langley, 2013). Though the patient survived, the affair has left the patient disturbed and unsettled. Despite the palpable symptoms afflicting him, the patient is adamant that he is fine and does NOT have Post-traumatic Stress Disorder (PTSD).
III. Symptoms
As maintained previously, the patient has a rough time acknowledging his afflictions; thus an extensive analysis and disclosure of symptoms have proven difficult to achieve. However, based on observation and outside sources the patient is aggrieved by nightmares and a profound lack of sleep. He also suffers from shortness of breath, heart palpitations, shaking, crying, feeling as though he is dying, and flashbacks. These symptoms present themselves at the mere mention of New York. These are all signs of PTSD, but also anxiety, which suggests comorbidity.
IV. Personal History
Iron Man, a.k.a. Anthony Edward ‘Tony’ Stark, was born to a Howard Anthony Stark and Maria Collins Carbonell Stark, the owners of the prestigious firm, Stark Industries (Botello, 2013), located within the United States. The patient was born and grew up in Long Island, New York (Botello, 2013). As a child, the patient was riveted and captivated with building and controlling machines. The patient joined the undergraduate electrical engineering program at the Massachusetts Institute of Technology (MIT) at the very ripe age of 15, graduating with two Masters Degrees by age 19 (Botello, 2013). Although the patient began working for Stark Industries, he exhibited a greater affinity for engaging in an irresponsible philanderer lifestyle, rather than putting his engineering talents to better use. Upon turning 21, the patient inherited Stark Enterprises after his parents were tragically killed in a car accident that was clandestinely arranged by a rival corporation, Republic Oil (later ROXXON) (Botello, 2013). With relation to relationships, the patient does not appear to have well-established interpersonal or romantic relationships. Though the patients parents are deceased, the patient appears to have always harnessed an estranged relationship with his father, whom the patient described as “He was cold, he was calculating, he never told me he loved me, he never even told me he liked me, so it’s a little tough to digest when you said the whole future was riding on me and he’s passing it down. I don’t get that. You’re talking about a guy whose happiest day was when he shipped me off to boarding school” (Iron Man 2, 2010). The patient’s romantic relationships are many, too many to document, which highly suggests the patient is quite the “Casanova” and likely struggles with commitment. Currently, however, the patient is having relations with a Ms. Virginia “Pepper” Pots. Interestingly, though, the patient has been able to form close friendships and working relationships with a wide-ranging assortment of fellow heroes (Adherents, 2014). There is still an underlying apprehension to let people get too close.
V. Family History
Currently, the patient’s family history is a tad choppy and somewhat vague. Nevertheless, with the little information accessible, the following information has been pieced together: The age of the patient’s parents at the time of birth is estimated to be between the late 40s and early 50s. The patient was sent away to boarding school at a very early age; thus it is to be assumed his primary caregivers were his boarding school instructors. The patient did not have a close relationship with his parents. The patient possesses ill feelings toward his father in particular, and this is because the patient felt he could never measure up in a way that would impress his father. There was dreadfully little father-son bonding growing up. The patient has no reported or documented siblings and comes from a wealthy Northeastern American background. Further, the patient exhibits rather secular belief systems.
VI. Therapy History
The patient has had no previous involvements with therapy and a therapist. The patient has reportedly reached out to a friend/co-worker, Dr. Bruce Banner (a.k.a. the Hulk), who immediately informed him that he was not that “kind” of Doctor. The patient has had no previous professional diagnosis, though hints of PTSD have been inferred by companions. While no professional interventions, pharmacological or otherwise, have been administered or implemented, the patient has seemingly engineered his own solution—building an enhanced suit of armor and battling repeated villains. From a trained standpoint, this suggests that the patient is finding distractions for inner instability and refusing to acknowledge core issues. With no previous professional treatment, treatment success is not applicable currently.
VII. Medical Conditions
As previously mentioned, the patient has an R. T. node embedded within his chest cavity. The reason for this implantation was due to an injury the patient sustained during a guerrilla ambush, where a missile (designed by the patient himself) blew up too close to the patient and resulted in the patient having bits of shrapnel enter his chest cavity. While a Prisoner of War (POW), the patient engineered an arc reactor, which used palladium for power, to prevent the fragments of shrapnel from making its way into his heart and killing him. However, the very thing designed to keep the patient alive was simultaneously killing him by poisoning his blood. To prevent his death, the patient had to engineer a new R. T. node powered by a different, non-poisonous element.
It is entirely plausible that this traumatic event was the beginning of the patients suspected PTSD. Furthermore, with the patient's narcissistic tendencies, the patient has built a legacy around keeping himself alive; thus it wouldn’t be too far-fetched to postulate that these near-death encounters have triggered some psychological blowback.
VIII. Substance Use
The patient has a history of alcohol use. As a wealthy aristocrat, alcohol has played a significant role in the patient’s social life. When the patient’s company was in jeopardy of being taken over at the same time the patient was experiencing overwhelming personal issues, the patient began to abuse alcohol in an attempt to self-medicate. The patient has abused alcohol on and off throughout many years, and the compulsion to drink has remained a continuous and perpetual temptation (Wikia, n.d.). However, the patient is currently on a path of sobriety while he is taking on his role as Iron Man and helping fight crime with his fellow Avengers.
IX. Collateral
The patient is a man of science. He is not a theorist, but a practical and logical thinker. When presented with a problem, the patient endeavors to solve and fix it. The patient is a pragmatist and tends to approach things from a matter-of-fact sort of way and often seems devoid of emotion. Due to the patient exhibiting severe control issues and an inability to truly relate to others on more than just a basic level, the patient has very few close relationships/friendships. The patient often comes across just as self-possessed as his armor and harnesses significant trust issues, which has been the primary cause of the alienation of friends and allies. Others, such as his Avenger allies, find the patient to be “volatile, self-obsessed and [not able to] play well with others” (The Avengers, 2012). His assistant and love interest, Virginia “Pepper” Potts is quite often in agreement with such sentiments. Although the patient appears quite buoyant much of the time, his quick wit and sarcasm are used as a deflection from most things “serious.” Those closest to the patient are generally in concurrence that his behavior is frequently rash and dangerous, and the more headstrong he acts, the worse things tend to become. Pepper Pots has threatened to quit working for the patient on numerous occasions due to his reckless behavior and extracurricular activities. She works exceptionally hard to reason with the patient to find alternative peaceful ways to resolve the issues impacting his life; however, she is often rewarded with sarcasm, detachment, and arrogance. Collateral sources are primarily the team of Avengers, Pepper Potts, and good friend James Rhodes. Each of these characters has their own unique makeup and way of handling stressful events/situations. They all harness powerful personalities, and when they are all working together, tempers and dispositions tend to clash rather forcefully. This has the vast potential to exacerbate the patient’s behavior/problems because he has a profound need to be in control. The distinct differences between his allies fuel his narcissistic tendencies and inevitably lead to more conflict than necessary. The patient’s inner turmoil and subsequent maladaptive behaviors (e.g., drinking, partying, etc.) are a reason for Pepper’s feelings of resentment and overwhelm. This atypical behavior also caused James Rhodes to begin to mistrust the patient, and he eventually partnered with enemy Justin Hammer (Clyman, 2010). Instead of corralling all available social support, the patient tends to resort to avoidance.
There are no police reports available on the patient; however, the patient does work with law enforcement and other government agencies to keep peace within communities all across the globe. Furthermore, while there are no personality and/or intelligence testing reports available on the patient, much of what is known about the patient is based on media reports, observation, or direct interaction. His personality and character are quite involved in the sense that he seems to suffer from textbook narcissism. The patient has seemingly built a wall between himself and his feelings as well as himself and those around him. This could undoubtedly derive from the sort of relationship he had with his father growing up, which was full of rejection. Nevertheless, if the patient is to get better and manage his condition, it starts with treatment aimed at freeing any mental hang-ups. Ultimately, the patient needs to work on balancing his rational brain with his emotional mind.
X. Results of Evaluation
Throughout the history of psychology, experts have relied on myriad theories to evaluate patients’ mental processes, their behavior, and their personality. The Psychoanalytic Theory is quite possibly the most popular theory and was introduced by Sigmund Freud. This theory suggests that an individual breeds neuroses due to unresolved conflicts (bottled-up id impulses materializing and overpowering the ego and superego) and because of issues that happened within patients’ childhood (Getzfeld & Schwartz, 2013). Another theory of personality was developed by Albert Bandura, and it is known as Social Learning Theory. This theory suggests that people learn by what they see others (models) do (Getzfeld & Schwartz, 2013). Albert Ellis is responsible for introducing Rational Emotive Behavior Theory. This theory maintains that disorders derive from “faulty” thinking (Getzfeld & Schwartz, 2013). Cognitive Perspective, pioneered by Aaron Beck, assumes that people acquire depression in childhood and adolescence due to the propensity to view the world negatively (Getzfeld & Schwartz, 2013). Additionally, Martin Seligman established the Theory of Learned Helplessness, which is where people foster disorders due to viewing themselves as helpless and unable to control their environment, and instead of trying to alter the situation they “grin and bear it” (Getzfeld & Schwartz, 2013, Ch. 1.2). And finally, there is Humanism Theory. Instituted by Carl Rogers, humanism theory suggests that dysfunction begins in infancy. When children receive “unconditional positive regard” from their parents early on in life, they tend to grow up to be more constructive and productive members of society in spite of their shortcomings (Getzfeld & Schwartz, 2013). A few of these theories seem to provide insight into the patient’s narcissistic predisposition, substance abuse, and the patient’s deep-seated need to be in control. They may also present elements of causation concerning the patient’s prevailing anxiety.
From all the information gathered thus far, it is easy to conclude that the patient is relatively complex. The patient is wealthy, highly intelligent, sarcastic and witty, and a bit narcissistic. This can be seen in the way the patient talks and treats others, often causing alienation, and though this is not done out of spite, the patient openly places himself above others. Moreover, the patient harnesses self-destructive tendencies, which come in the form of substance abuse (alcohol). The patient often exhibits his narcissism by placing others in harm’s way, only thinking of the consequences after the fact. The patient has a deep-seated need for recognition and admiration, and this is revealed through the patient’s orchestration of gaudy parties at his penthouse and incessant need to be in the eye of the media. Overall, the patient has a very arrogant “I don’t play well with others” attitude and exhibits a very guarded demeanor. I believe this derives from childhood but has been exacerbated by the betrayal of past friends. Considering all of this from a psychoanalytic perspective, it is possible to contribute much of this behavior to repressed feelings that began early on within the patient’s childhood. The patient did not harness a close relationship with his father. The inability to form strong emotional attachments early on may be a reason for his fragmented personality. As stated by Clyman (2010, para. 4):
He never received the unconditional warmth and validation from his father that he (and anyone else for that matter) needed to love himself. He suffered from a faulty attachment that engendered two maladaptive personality features – a fragile, loathing sense of self and a sense of others littered with equally profound pessimism and mistrust.
These skewed opinions of self and others were so harrowing; the patient developed a defense mechanism; his narcissism. This successfully mitigated and softened the rejection the patient endured as a child, imposed on himself and anticipated from others. However, the patient’s cushioning was challenged further in New York when he was forced to face his own mortality. This in and of itself could be the primary culprit in the patients suspected PTSD, due to the fact that when anyone who views themselves as superhuman is forced to see themselves otherwise, they are bound to suffer a state of perpetual distress.
XI. Diagnostic Impression With Differential Justification
While it is in my professional opinion that the patient has textbook narcissistic personality disorder, the more prevailing diagnosis in need of treatment is Post-traumatic Stress Disorder (PTSD). Getzfeld and Schwartz (2013, Ch. 2) defined PTSD as “An anxiety disorder that typically occurs after being exposed to a traumatic event such as war or violence; symptoms include anxiety, the avoidance of stimuli associated with the trauma, flashbacks in which the traumatic event is relived mentally, and a “numbing” of emotional responses.” To be diagnosed with PTSD utilizing DSM-5 criteria, the patient must illustrate specific trauma-related symptoms that trigger stress and significantly interfere with the patient’s ability to function.
PTSD Criterion A. Exposure to a traumatic event. The patient meets the following criterion as he has endured trauma where he was held as a prisoner of war, was tortured, threatened with death, witnessed a friend being killed, and he was faced with the certainty of his impending death when he entered the wormhole in New York (American Psychiatric Association, 2013).
PTSD Criterion B. Persistent re-experiencing. The patient meets the following criterion as he suffers from nightmares where he re-experiences going through the wormhole and then falling to his death (American Psychiatric Association, 2013).
PTSD Criterion C. Persistent Avoidance. The patient meets the following criterion as he persistently avoids thoughts, conversations, places, people, objects, activities, and/or situations where he might be reminded of New York and the wormhole. He actively tries to change the subject whenever anyone mentions the New York battle, and if they persist in talking about it, the patient flees (American Psychiatric Association, 2013).
PTSD Criterion D. Negative alterations in cognition and mood. The patient meets the following criterion as he harnesses a pessimistic worldview after his experience. This causes the patient to build an army of armor, often keeping him up for 72 hours straight. The patient also exhibits a profound diminishment in pre-traumatic activities like partying, drinking, being active in the proceedings of his company, etc. (American Psychiatric Association, 2013).
PTSD Criterion E. Alterations in arousal and reactivity. The patient meets the following criterion as he suffers from severe insomnia and recurring anxiety attacks. Moreover, the patient exhibits hypervigilance of threats towards himself, but primarily those aimed towards Pepper Pots. Hypervigilance is often accompanied by elevated levels of anxiety, which could help explain the anxiety attacks even further (American Psychiatric Association, 2013).
PTSD Criterion F. Duration. The patient meets the following criterion as the requirement outlined in the DSM-5 is that the persistence of symptoms in Criteria B, C, D, and E lasts for more than one month. The patient has been experiencing persistent symptoms in the aforementioned criteria for well over a month (American Psychiatric Association, 2013).
Criterion G. Functional significance. The patient meets the following criterion as he has rarely ventured into public without his suit of armor since the wormhole incident. The patient dons the suit whenever he is to go out in public out of fear of being caught unsuspectingly. The patient has ceased engineering devices for his company and focuses much of his time and energy on engineering devices for his protection (American Psychiatric Association, 2013).
Criterion H. Exclusion. The patient meets the following criterion as it requires that the patient’s dysfunction is not caused by medication, substance use, or other illness. The patient does not take any medication, has stopped his consumption of alcohol, and has no other reported and/or documented illnesses (American Psychiatric Association, 2013). Based on all the following, the patient meets all required criteria for a firm diagnosis of Post-traumatic Stress Disorder.
While the patient meets the required criteria for PTSD, another disorder worth considering is Panic Disorder. The patient calls his attacks “anxiety attacks,” but are they in fact panic attacks? Langley (2013, para. 11), maintained “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.” Symptoms include: “accelerated heart rate or pounding heartbeats, chest pain, sweating, trembling, shortness of breath, a choking sensation, nausea, dizziness or light-headedness ,numbness, chills or heat, a feeling of being detached from one’s self, fear of losing control and fear of dying” (Sheaffer, 2015, para. 2). The patient experiences all of this. However, the patient does not fear going outdoors; thus he does not meet the criterion for panic disorder with agoraphobia, and the DSM names PTSD as one of the disorders significant in ruling out. Therefore, because PTSD seems to better account for the patient's general pattern of behavior and dysfunction, it remains the more probable diagnosis.
XII. Recommendations
Before treatment recommendations can be considered, it is worth noting that there are specific ethical implications when it comes to treating this patient. The patient is Iron Man and therefore is expected to take on a high level of danger and threat at all times. This makes the treatment of his fear and hypervigilance rather tricky because eradicating his need to examine/seek risks could jeopardize him and his life. There is also the fact that the patient who has PTSD could seriously hinder his ability save those in harm’s way, yet client rights to confidentiality would prevent me from notifying others of my patient’s condition. With that being said, I recommend that the patient undergo and a combination of psychotherapy and exposure therapy. Psychotherapy will be employed to help the patient learn about his condition, his moods, his thoughts and behaviors, and his feelings. Exposure therapy will be utilized in an attempt to help the patient overcome his fear and anxiety. As maintained by Farmer and Chapman (2016, p. 271):
One key and defining feature of contemporary exposure therapy is the client’s engagement with fear-or emotion-eliciting stimuli in a repeated or prolonged fashion. These stimuli might include animate (e.g., spiders, snakes) or inanimate (e.g., toilets, door handles, knives) objects; events, places, or situations (e.g., criticism, public speaking, malls, movie theaters); or internal experiences (e.g., emotions, thoughts, bodily sensations, memories). Over repeated exposures, the probability, frequency, or intensity of the client’s emotional response to the stimuli often decline.
I feel these specific therapies would allow the patient to gain the upper hand and allow him to eventually understand and control his overall reaction whenever the battle in New York and/or the wormhole incident is mentioned. Once this reaction is under the patient’s control, the patient should see a decrease in all other subsequent symptoms as well.
To conclude, based on the compiled information within this clinical assessment, it is my professional opinion that the patient has Post-traumatic Stress Disorder. The anxiety, shortness of breath, lack of sleep, and the re-experiencing of traumatic events, and the overall social impairment are all tell-tale symptoms of this disorder. While the patient refuses to acknowledge that he is suffering from a diagnosable condition, I recommend both psychotherapy and exposure therapy to help the patient come to terms with what is afflicting him internally. It is my hopes that this treatment will help the patient understand what is happening to him psychologically and physically so that he can achieve the upper hand and get his symptoms and maladaptive behavior under control. Once he can successively do this, he can go back to being the loved and revered Iron Man.
References
Adherents (2014). The Religious Affiliation of Comic Book Character Tony Stark/Iron man. Retrieved from http://www.adherents.com/lit/comics/IronMan.html
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.
Botello, J. (2013). Biography for Iron Man. Retrieved from http://www.imdb.com/character/ch0020749/bio
Clyman, J. (2010). Iron Man on the Couch. Retrieved from https://www.psychologytoday.com/blog/reel-therapy/201005/iron-man-the-couch
Farmer, R. F., & Chapman, A. L. (2016). Exposure-based interventions. In, Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action (2nd ed.) (pp. 269-299). Washington, DC, US: American Psychological Association. doi:10.1037/14691-009
Favreau, Jon. (Director). (2010). Iron Man 2 (motion picture). United States. Paramount.
Feige, A. & Whedon, J. (2012). The Avengers. [Motion Picture]. United States: Marvel Studios.
Getzfeld, A., & Schwartz, S. (2013). Abnormal psychology: DSM-5 update . San Diego, CA: Bridgepoint Education.
Langley, T. (2013). Does Iron Man 3’s Hero Suffer from Posttraumatic Stress Disorder? Retrieved from https://www.psychologytoday.com/blog/beyond-heroes-and-villains/201305/does-iron-man-3s-hero-suffer-posttraumatic-stress-disorder
Sheaffer, H. (2015). Panic Disorder DSM-5 300.01 (F41.0). Retrieved from: http://www.theravive.com/therapedia/Panic-Disorder-DSM–5-300.01-%28F41.0%29
Wikia (n.d.) Iron Man: Anthony “Tony” Stark. Retrieved from http://marvel.wikia.com/wiki/Iron_Man_%28Anthony_%22Tony%22_Stark%29
Comments