Widely recognized for being one of the most prominent superheroes in the Marvel Cinematic Universe, Tony Stark, otherwise known as Iron Man, is the creator of a collection of high-power, engineered suits that provides him with superpowers to protect society. Although Tony Stark is the leading member of the Avengers team, as well as the CEO of Stark Industries, this fictional character suffers from various mental health difficulties, chief struggles being post-traumatic stress disorder (PTSD) and severe anxiety. As such, specifically evident in the film Iron Man 3, Tony’s presenting problem comprises of recurring panic attacks, insomnia, hypervigilance, and flashbacks, all which have persisted for a year since The Avengers (Feige & Black, 2013). The following material is an adaptation of a clinical assessment assignment in my graduate program. Given that these symptoms suggest debilitating mental distress, this case study will explore detailed biological, psychological, social and cultural factors to analyze this character’s presenting problem, and ensuing goal assessments and treatment suggestions will also be discussed. As this is a conceptualization, this case study will refer to Tony as a prospective client for therapeutic intervention, under the context of a hypothetical clinical assessment.
Given that Tony’s symptoms of PTSD and anxiety manifested a year after The Avengers, the specific event that triggered their onset was the Battle of New York (Feige & Whedon, 2012). During this incident, Tony managed to redirect a nuclear missile headed towards the city, at the cost of almost losing his own life. Along with this near-death experience, this world-threatening event entailed hundreds of casualties and significant damage to the city, which all meet the DSM-5 description for a traumatic event (5th ed.; DSM–V; American Psychiatric Association, 2013). Prior to this incident, other occurrences throughout this client’s life can also be considered experiences of trauma. For example, five years earlier, Tony spent three months imprisoned in Afghanistan, where a nearby explosion caused shrapnel to become lodged into his chest, leading to his ensuing development of Iron Man suits around the shrapnel. Tony also witnessed many soldiers and friends being killed by the weapons that he himself designed, which are all traumatic experiences of loss and grief that leave lasting impacts on a surviving individual. Tony’s presenting context therefore consists of persisting panic attacks, disturbed sleep, recurring nightmares involving distorted flashbacks of traumatic events, and constant hypertension. This client has no previous history of receiving psychotherapy treatment or taking any medication.
Historical: As described in Daniel Siegel’s article Interpersonal Neurobiology as a Lens into the Development of Wellbeing and Resilience, developmental and historical elements serve major roles in the shaping of an individual’s developmental trauma and wellbeing (Siegel, 2015). From a familial standpoint, Tony’s parents were both upper-class and Caucasian, with his father, Howard Stark, being the founder of Stark Industries, and a subsequent multi-billionaire. Tony’s father was flirtatious, casual, intelligent, and arrogant, and did not maintain a healthy relationship with Tony throughout his son’s childhood. Howard Stark was an emotionally neglectful father, rarely showing pride or affection though Tony greatly sought his approval (TV Tropes, 2017). As such, from a developmental standpoint, Tony was raised to be tough, with a pressure to succeed and take over the family company from a very young age.
Having inherited his father’s intellect, Tony graduated from the Massachusetts Institute of Technology at the top of his class at age 17. He also learned social skills from his father, developing characteristics such as being lighthearted, superficial and comical in lieu of expressing sincere vulnerability. Additionally, both of Tony’s parents were murdered when Tony was 21, leading to him taking over Stark Industries as one of society’s youngest CEO’s. The death of his parents is Tony’s earliest experience of trauma, and this incident is arguably another large component towards this client’s current presenting problems.
From another biological standpoint, Tony’s father was a persisting alcoholic, and drinking is a prevalent coping strategy that Tony himself also uses to blunt experiences of negative emotions and traumatic flashbacks. This character’s unhealthy struggles with alcoholism can thus be attributed to his genetic makeup, since many substance abuse predispositions are often intergenerational (Pears, Capaldi & Owen, 2007). It can also be observed that Tony and his father share many similar outward characteristics and tendencies.
Behavioral Features: Not unlike his father, Tony’s character comprises of comical, lighthearted, seemingly narcissistic, and very arrogant personality traits. Given his status as a wealthy company CEO, Tony is usually shown dressed in expensive suits or designer clothing. He does not openly express his emotions, and instead makes deflective, standoffish comments, or throws out an offensive joke, when he is put in a vulnerable position of feeling “one-down” compared to others. Tony is very intelligent and industrially talented the way his father was, and thus channels a lot of his maladaptive energy and negative emotions into his work. Presumably stemming from his childhood experiences, Tony is very driven towards success, and tends to take on all responsibility for daunting tasks and dangerous situations. His default coping strategies are therefore channeling emotions into work, such as through compulsively creating new Iron Man suits when experiencing insomnia at night.
Cognitive Features: As pioneered by Steven Stosny, core hurts are the triggering cognitive tendencies that are most relevant and hurtful to an individual (Stosny, 2004). Tony’s core hurts are the two thoughts of feeling powerless and feeling accused. Based on his recent traumatic event in New York, Tony felt powerless to save the hundreds of civilian casualties that ensued during the battle. He also frequently felt helpless to prevent the deaths of his colleagues throughout various incidents in the earlier Iron Man movies, and this client thus carries a lot of guilt and shame associated with his sense of incapability to save others. In Captain America: Civil War, the United Nations issues the Sokovia Accords upon the Avengers due to how many lives were lost during their various battles, and this exemplifies Tony’s second core hurt of feeling accused of malintent despite wanting nothing but to save others (Feige, Russo & Russo, 2016). Additionally, one of Tony’s most prominent nightmares are of the entire Avengers team being killed, with only himself surviving (Feige & Whedon, 2015). This dream demonstrates this client’s core hurt of feeling incompetent and a sense of blame, and also embodies Tony’s chief fear of failure that drives his obsessive devotion to his work.
Because a cognitive schema describes a recurring pattern of thought (Linker, 2016), four common negative schemas are questioning whether one is deserving, important, lovable, or good enough. Tony’s negative schemas build on his core hurts, and his dominant thoughts are questioning whether he is strong enough, and intelligent enough, to merit competency. As Dr. Brené Brown states in her book Rising Strong, every individual creates certain “stories” about their situations based on recurring thoughts and personal characteristics (Brown, 2015). These “stories” are often rooted in the individual’s core hurts and negative schemas. Tony Stark’s stories commonly narrate that he is powerless to save someone else, and that if any harm happens to the other person, it will be his fault. These schemas therefore impact his relationships with others. Tony automatically internalizes a sense of blame, and carries a prevalent burden of guilt for the many lives that he feels he was incompetent to save. As such, this client’s core hurts and default stories complement each other, and evidently impact Tony’s overall mental wellbeing and definition of self-worth.
Emotional: Literature in the social work and psychology fields support emotional regulation as an integral aspect of overall mental wellbeing, because of its impact on a client’s physical and psychological states (Greenberg, 2014). Based on Tony’s cognitive schemas, negative stories, and triggering core hurts, this client’s panic attacks and severe anxiety have been largely perpetuated by poor emotional regulation. Tony frequently experiences the emotions of fear, pain, and sadness, and in response to these negative visceral experiences, his default reaction is to suppress and deflect the feelings rather than being present and consciously experiencing them. Tony frequently feels these emotions too strongly, and too often, suggesting that his inability to healthily address these experiences contribute greatly to his current presenting problem.
As Bessel van der Kolk writes in his book The Body Keeps the Score, “Traumatized people chronically feel unsafe inside their bodies: the past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves” (van der Kolk, 2014). Portraying this description, Tony Stark’s evasive behavioral tendencies can be viewed as defense mechanisms protecting him from his traumatic experiences. This also details the importance of using a trauma-informed lens when working with clients, because of the enduring effects of trauma and their harmful impact on an individual’s identity.
Social Context: Although Tony does not have many close friends, he has an extensive range of professional associates and colleagues. His closest professional acquaintances are the Avengers, including Steve Rogers and James Rhodes, whom are arguably his closest personal relationships. Tony’s lack of intimate friendships can be attributed to his core hurts of feeling powerless and accused, because his fear of failure to save his loved ones is arguably preventing him from openly fostering and sustaining healthy attachments.
Romantically, Tony has been dating his former assistant, Pepper Potts, but similar issues have come up throughout this relationship. He frequently chooses work over spending time with her, also commonly devoting long nights and full weekends to working, given that this is his default coping strategy for his anxiety and PTSD symptoms. Rather than being emotionally vulnerable, Tony turns away from others socially, and recedes to working alone and being compulsively productive when his trauma resurfaces. This relational tendency is especially prominent in his relationship with Pepper. Because he deeply fears losing loved ones, Tony is therefore hesitant to pursue closeness. From a developmental standpoint, these relational habits can be attributed to his poor relationship with his father, where he was rarely affirmed or emotionally supported. The death of his parents is another traumatic incident of losing loved ones, which arguably has contributed towards Tony’s challenges with intimacy, since the experience was a painful loss that he does not want to relive.
As originally described by James Prochaska, stages of change describe a client’s current attitude regarding initiating change and addressing prominent issues towards a presenting problem (Prochaska, 1997). Relating to this case, Tony would be in the contemplation stage, which entails “when a patient is aware that a problem exists and is seriously thinking about overcoming it, but has not yet made a commitment to take action” (Norcross, Krobs & Prochaska, 2011). This client actively recognizes that his panic attacks are interfering with his relationships and work, which rationalize why he would place in the contemplation stage of change. However, despite being aware of the need for change, Tony maintains deeply rooted habits of overwork and emotional suppression, which originated early in his childhood. These tendencies therefore are heavily established, and will be difficult to adjust in a brief period of time.
Client Goals: Based on Tony’s presenting problems, this fictional client would likely be seeking treatment mainly for symptom alleviation, because he would want to continue devoting time to his work without the interference of panic attacks and traumatic flashbacks. Tony would request medication and the most efficient intervention possible to reduce his anxiety symptoms, and directly address his PTSD, such as working to improve his insomnia, hypervigilance, nightmares and hypertension.
Therapist Goals: After assessing Tony’s bio-psycho-social elements, as a clinician, I would not only hope to address Tony’s symptoms of anxiety and PTSD, but I would also recommend focusing on developing emotional regulation strategies, healthy coping skills, and existential exploration regarding meaningful living, given this client’s tendencies to overwork while channeling negative emotions into productivity. Self-care would be an important element that Tony may benefit from increasing, and a trauma-informed lens would greatly support working with this client, due to his extensive experiences of trauma and loss, as well as his abusive childhood preceding the loss of both parents in his young adulthood. Given Tony’s lack of close personal friendships and difficulty committing in his romantic relationship, I would also recommend a relational focus throughout treatment, which would address his social support systems and interpersonal needs.
Additionally, because dialectical behavior therapy (DBT) is a strength-based treatment that addresses maladaptive tendencies and negative thoughts (Chapman, 2006), I would suggest this as a modality for treatment because of Tony’s struggles with self-worth and emotional deflection. As Chu and Tsui (2008) describe in “The Nature of Practice Wisdom in Social Work Revisited”, strength-based assessment is integral to efficacious treatment, because understanding a client from a holistic, positive perspective allows for more individualized treatment, and would consider all aspects of a client’s life, ranging from his developmental history to his systemic and environmental influence. Additionally, as supported in Graybeal’s article “Strength-Based Social Work Assessment: Transforming the Dominant Paradigm”, focusing on a client’s strengths is also important because of an emphasis on the individual’s goals and skills (Graybeal, 2001). This approach would not only would increase intrinsic motivation towards improvement in therapy, but would also work to instill self-esteem and a positive sense of self within a client presenting with various negative schemas about themselves.
As Martin Drapeau and colleagues describe in “When the Goals of Therapists and Patients Clash”, goal congruence is when both the therapist and the patient want similar outcomes from treatment, and it is very common that the goals of the therapists and the goals of the patient will not align during initial assessment (Drapeau et al., 2004). Given the discourse about my recommendations as a clinician and Tony’s hypothetical goals for therapy, goal incongruence is a factor that would be considered and discussed before moving forward with treatment. Additionally, because of the ethical integrity of the social work field, it is important to employ a person-in-context holistic view throughout treatment while also employing evidence-based practices. As Zayas writes in “Evidence Based Practice in Social Work”, it is ethical for clinicians to incorporate the unique human experiences of every client and account for individual differences while still adhering to an empirically supported intervention that research has shown to be effective (Zayas, 2010). Literature also suggest that a strong therapeutic relationship is significantly beneficial to effective interventions (Greenberg, 2014), indicating that rapport-building and empathic support is critical to working with clients towards positive change. Therefore, through the ethical basis of an evidence-based treatment, and with a nonjudgmentally empathic, strength-based approach in sessions, supporting Tony in this hypothetical case study would not only meet the ethical expectations of clinical social work practice, but would also focus on establishing the most genuine human connection between therapist and client.
In conclusion, as overviewed through this clinical case study of Tony Stark, it is evident that numerous factors throughout one’s life can contribute towards the manifestations of negative cognitive schemas, maladaptive coping strategies, and severe mental illness. Given that biological, psychological and social factors all clearly play distinct roles towards Tony’s presenting problems, it is important for clinicians to employ holistic perspectives when assessing and treating clients in the field of psychotherapy. Assessing clients through a trauma-informed lens will also provide additional insight towards the origins of characteristics and tendencies. This is another useful tool for clinicians to have experience and competency with.
Finally, though this case study analyzes a fictional character, Tony Stark’s experiences of anxiety, panic attacks, and PTSD are relatable to that of many real individuals who suffer from similar symptoms. This leading superhero in the Marvel Cinematic Universe is thus a representative example of humanity’s adversities, and how individuals adapt to their environments on developmental, cognitive and social levels. Tony’s identity as Iron Man also embodies an example of a superhuman with human experiences, showing to fans and viewers nationwide that anyone can struggle with emotional and psychological challenges, and that mental health is a critical component of overall wellbeing and healthy living for everyone.
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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.
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