Captain America: A Case Study in Veteran Mental Health

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Character Overview: 

Analyzing superhero Captain America, who wakes up 70 years past his time after crash-landing on a war mission, Steve Rogers’ mental health struggles to rediscover his place in society can arguably relate in numerous ways to military veterans across the country today, and their potential experiences returning from service.

Steve Rogers is the Marvel Cinematic Universe’s heroic protagonist from Brooklyn during World War II. In Captain America: The First Avenger (2011), Steve attempts to enlist in the U.S. military multiple times, consistently rejected because of his health problems and frail physique. These attempts catch the attention of an American organization, the Strategic Scientific Reserve (SSR), who work to bring down the Nazi science division named HYDRA. Because of Steve’s morality and inner strength, he is selected for a top-secret Super Soldier program developed by Dr. Abraham Erskine and Howard Stark (The First Avenger, 2011). After gaining superhuman strength through the transformation, Steve becomes a war mascot, an American icon, and a key member in the fight against HYDRA. Known nationally as Captain America, Steve frees captured Allied POW’s and actively fights HYDRA in a variety of attacks (The First Avenger, 2011). Steve ultimately crashes into the Arctic during his final mission with the SSR in 1945, becoming frozen in ice and preserved for 70 years. He subsequently awakens as not only a surviving war veteran, but also as a soldier very much out of his time. This case study will analyze Steve’s recovery process throughout The Avengers (2012) and The Winter Soldier (2014), and speculate on the importance of recognizing similar struggles in military veterans today. 

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Psychological Underpinnings: 

Though physically improbable to survive for 70 years frozen in ice, Steve’s experience rediscovering his life in a changed society can nonetheless be viewed as a metaphor of the dramatic challenges a military veteran faces when returning from deployment. Not only does Steve struggle to reacquaint himself with society’s new cultural norms and events over the past 70 years, having made a list of “things to catch up on” including items such as Thai food and Star Wars (The Winter Soldier, 2014), but he also feels disconnected to people around him due to lack of shared experiences, having been born in 1918.

“Believe it or not, it’s kind of hard to find someone with shared life experience.”
-Steve Rogers to Natasha Romanoff, Captain America: The Winter Soldier (2014) 

In addition, the recurring theme throughout The Avengers (2012), The Winter Soldier (2014) and The Age of Ultron (2015) is Steve’s inability to feel at peace without being at war, because he is used to the military lifestyle and constantly being ready for battle.

“Captain America… God’s righteous man. Pretending you could live without a war.”
-Ultron to Steve Rogers, The Avengers: Age of Ultron (2015) 

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Assessment: 

Based on the presented cinematic material in the Captain America and Avengers movies, specifically the exploration of Steve’s return to society post-war, it appears that Steve is struggling with an identity crisis rooted in readjustment issues after returning from military service. Rather than meeting criteria for a diagnosis, Steve’s tendencies and behaviors represent varying mental health struggles stemming from a lack of identity and de-actualized sense of self: these struggles include symptoms of depression, but do not necessarily meet the criteria for a full clinical diagnosis.

*Though it can be argued that Steve may have clinical depression, see the Counterargument section below for why I do not agree with diagnosing Cap with a depressive disorder. In addition, this inability to conclude a hard diagnosis is important in the field of mental health, because too easily can clinicians fall into the trap of looking for what they want to see, and unintentionally shaping a patient under the impression of a clear-cut diagnosis. (For more on this, see the Discussion section). 

Let’s see how Captain America’s behaviors and tendencies reflect mental health struggles in self-identity that veterans experience, symptoms including those of depression, but not meeting a full diagnosis:

  • De-actualized sense of self 
    • Self-actualization, defined as “the full realization or fulfillment of one’s talents and potentialities, especially considered as a drive or need present in everyone” (National Alliance on Mental Illness), seems to be the primary root of Steve’s readjustment issues. Because Steve feels maximally engaged as a soldier, serving his purpose to the highest potential through combating HYDRA and protecting his country (Captain America: The First Avenger, 2011), losing this sense of purpose, and essentially de-actualizing himself, is even harder to adjust to when Steve reawakens 70 years later.

“For as long as I can remember, I just wanted to do what was right. I guess I’m not quite sure what that is anymore. And I thought I could throw myself back in: follow orders, serve. It’s just not the same.”
-Steve Rogers, Captain America: The Winter Soldier, 2014

  • Insomnia or hypersomnia (symptoms under both depression and anxiety) 
    • In The Avengers, Steve is shown boxing late at night, to which Nick Fury walks in and says, “Can’t sleep, Cap?” (The Avengers, 2012). Steve responds stating that he has difficulty sleeping. This, he later attributes, is largely based on feeling like he isn’t doing enough, because he is accustomed to being alert at all times and gravitating towards war and battle.
  • Anhedonia, loss of interest in previously favored activities (symptom under depression)
    • In The Winter Soldier, Black Widow asks Steve what he is doing on Saturday night, to which he responds, “Well, all the guys from my barbershop quartet are dead, so…no, not really” (Captain America: The Window Soldier, 2014). It is also revealed throughout various scenes in the film that Steve doesn’t do much in his free time aside from Avengers missions, often shown in scenes sitting alone looking over photo albums or wandering the city alone. The Winter Soldier also takes place two years after Steve wakes up, suggesting that he has still not fully reestablished his social life after multiple years.

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Counterargument: Why No Diagnosis?

It has been argued that Captain America has depression, but I disagree. According to the DSM-V, persistent depressive disorder is “a chronic depression that is present for most days over a period of two years…milder than major depressive disorder” (5th ed.; DSM–5; American Psychiatric Association, 2013). To meet criteria for a diagnosis, the individual must show five or more of various cognitive symptoms, including “insomnia or hypersomnia”, “low self-esteem or feelings of worthlessness”, “diminished ability to think and make decisions”, “low energy or fatigue”, “psychomotor agitation”, “constant depressed mood”, and “anhedonia, or lack of interest in previously favored activities” (American Academy of Psychiatry and Law). These symptoms must be continuously present over two years, not induced by drugs or medical effects, not follow an immediate bereavement period, and not concurrently with any psychotic behavior suggesting schizophrenia, delusional disorder or any other psychosis.

Though Steve meets a few of these criteria, he does not qualify for at least five, and also does not meet the primary characteristic of depression which is a “consistent depressed mood”. In fact, he may even be quite the opposite, always running headfirst into battle opportunities, rarely showing signs of lethargy or lack of energy (Captain America: The Winter Soldier, 2014). Steve’s actions don’t suggest low self-esteem, but rather almost counters that with his invigorated sense of justice and desire to protect others. Additionally, Steve’s instances of any psychomotor agitation (defined as “emotional distress, restlessness, unintentional motions” by the Anxiety and Depression Association of America) can be explained by his super serum, which qualifies as a medical effect and thereby does not count as a symptom of depression.

Because there are so many classifications of depressive disorders, it can be challenging to differentiate similar symptoms. Steve’s behavior in the Marvel films is ambiguous, as I was unsure if he would classify under a clinical persistent depressive disorder case, or even perhaps the more temporary diagnosis, which clinicians know as situational depression (5th ed.; DSM–5; American Psychiatric Association, 2013). Situational depression “occurs when you haven’t yet adapted to the changes brought about by these situations and incorporated them into your overall life experiences” (Elemental Behavioral Health), which could have applied to Steve, since it can be argued that he merely hadn’t adjusted to a society 70 years past his time. It could even be argued that Steve is undergoing depression due to bereavement, because he loses almost everyone he knew before the plane crash, including his childhood best friend Bucky Barnes, whom Steve witnesses fall to his apparent death during The First Avenger (2011). All of these varying criteria show the challenges of diagnosis, and also suggest how inconclusive a hard label can be.

Suggested Diagnosis:

Returning back to the earlier analysis, Steve’s behaviors do not suggest that he has clinical depression, though he very clearly exhibits certain symptoms commonly observed in individuals diagnosed with depression. If he were a patient, treating for clinical depression would not focus on the root of Steve’s mental health issues, which are chiefly an identity crisis and diminished sense of self.

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Discussion:

Captain America’s case is important, because it shows that mental health struggles can go by completely unnoticed when they do not severely impair daily functioning. Throughout the Marvel films, viewers may not think immediately of how Steve probably struggles with symptoms of depression, because he still holds up as an unrelentingly tenacious superhero, willing to do whatever it takes to protect those in need. It isn’t instinctual to recognize the toll that such consistent acts of selflessness can have on an individual, and how much suffering can be masked by a fierce front of toughness. In addition, this case study explores how there is always more to an individual than they may externally present. Captain America’s internal struggles (feeling lost without war, his trouble sleeping, his anhedonia) are all examples of why mental health awareness is important to maximizing an individual’s overall well-being.

On that note, especially in observance of Memorial Day, I would like to acknowledge military veterans all across the country. Not unlike Cap thrown into a world 70 years in his future, war veterans everywhere may come back from service feeling lost, or out of place. They also may struggle to adjust back to a normal lifestyle, and it can be especially difficult forgetting experiences from being at war or the habits that develop from military routines. Though this case study on Steve Rogers focuses on one superhero’s challenges as a war veteran, Marvel touches on a larger topic of self-rediscovery after knowing nothing but a world of war. Many veterans not only have to readjust for themselves, but for their families and children as well, which can be additionally challenging because of the stress that a military family experiences (National Alliance on Mental Illness). Steve Rogers’ case is thus about veteran mental health difficulties that might be shared nationwide.

Military veterans may also face a variety of other large adjustments, common ones being constant relocation, reestablishing relationships, rediscovering their identities post-service, or starting towards a new career or profession (U.S. Department of Veteran Affairs). It is important to recognize that military families as a whole can be affected, not only the veteran. As a behavioral therapist, I have worked at an after-school center for children in military families, and provided emotional support to elementary-level children struggling with constantly moving homes, growing up with the constant absence of one or both parents, and even the loss of loved ones. Though I in no way claim to be an expert on the lifestyle of a military family, and I do not speak for everyone, it is clear that many children, spouses and family members struggle with challenges that accompany serving in the military, and mental health services are a growing need in this population. For more information, the U.S. Department of Veteran Affairs has an excellent page on mental health in veteran families, and the Anxiety and Depression Association of America provides a helpful list of resources for family members and loved ones supporting a returning veteran.

Finally, I’d like to extend a special thank you to my colleagues at the after-school center for providing feedback towards writing this case study. I would also like to thank my friends with direct experience in military life for providing their opinions and reviewing this case study before it was published.

As a disclaimer, this case study is my own opinion based on presented cinematic material. I recognize that there could be numerous other interpretations, and I am open to discussion or additions to this post. Have questions or want to add on to assessment? You can reach me via the Contact page.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5) Washington: American Psychiatric Association, 2013.

Anxiety and Depression Association of America. (n.d.). Tips for Soldiers and Veterans. Retrieved May, 2018, from https://adaa.org/living-with-anxiety/military-military-families/tips-soldiers-and-veterans

Brassert, S., PhD. (2017, August 30). Persistent Depressive Disorder (Dysthymia) Symptoms. Retrieved May, 2018, from https://psychcentral.com/disorders/dysthymic-disorder-symptoms/

Elements Behavioral Health. (2017, July 11). What is Situational Depression? Retrieved May, 2018, from https://www.elementsbehavioralhealth.com/mood-disorders/situational-depression/

Green, J. D., Annunziata, A., Kleiman, S. E., Bovin, M. J., Harwell, A. M., Fox, A. M., Marx, B. P. (2017, August). Examining the Diagnostic Utility of the DSM-V PTSD Symptoms Among Male and Female Returning Veterans. Retrieved May, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28763159

Make the Connection. (n.d.). Depression in Military Veterans. Retrieved May 23, 2018, from https://maketheconnection.net/conditions/depression

Marvel Cinematic Universe. (n.d.). Captain America. Retrieved May 23, 2018, from http://marvelcinematicuniverse.wikia.com/wiki/Captain_America

Marvel Studios presents; produced by Kevin Feige; screenplay by Christopher Markus & Stephen McFeely; directed by Anthony and Joe Russo. (2014). Captain America. The Winter Soldier. [Manhattan Beach, California]: Marvel Studios. 

Feige, K., McFeely, S., Markus, C., Johnston, J., Evans, C., Atwell, H., Weaving, H., … Marvel Studios. (2011). Captain America, the First Avenger. Hollywood, Calif: Paramount Home Entertainment.

Feige, K. (Producer), & Whedon, J. (Director). (2012). The Avengers [Motion Picture]. United States, Marvel Studios. 

National Alliance on Mental Illness. (n.d.). Veterans and Active Duty. Retrieved May, 2018, from https://www.nami.org/Find-Support/Veterans-and-Active-Duty

National Center for Post-Traumatic Stress Disorder. (2007, January 01). Depresion, Trauma and PTSD in Veterans. Retrieved May, 2018, from https://www.ptsd.va.gov/public/problems/depression-and-trauma.asp

Parker, G. F. (2014, June 01). DSM-V and Psychotic and Mood Disorders. Retrieved May, 2018, from http://jaapl.org/content/42/2/182

Russo, A., Russo, J., Markus, C., McFeely, S., Feige, K., D’Esposito, L., Fine, A., … Buena Vista Home Entertainment (Firm),. (2014). Captain America: The Winter Soldier.

U.S. Department of Veteran Affairs. (2013, August 15). Veteran Affairs Health Care: Mental Health. Retrieved May 23, 2018, from https://www.mentalhealth.va.gov/

Veterans Affairs Canada. (2017, November 28). Depressive Disorders. Retrieved May, 2018, from http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/entitlement-eligibility-guidelines/depression-dis

Veterans Crisis Line. (n.d.). Identifying Signs of Crisis. Retrieved May, 2018, from https://www.veteranscrisisline.net/SignsOfCrisis/Identifying.aspx

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Disclaimer: This character, their photos, and storyline references are all copyright by Marvel Studios. All information and content presented in this assessment are solely analyzed for general information and reference purposes. 

© Post material by Juliann Li and The Character Clinic, 2018.
All rights reserved.