Panic Attacks, Combat Fatigue, and PTS – The Differences between All Three, and Why That Matters to Authors

When Iron Man 3 was released, I picked it up in order to see the next installment in the Marvel Cinematic series. But I did so with little hope that it would be better than Iron Man 2. I had to watch that film retroactively after seeing The Avengers, but it could have easily been skipped without ruining the flow of the main thread in the films.

Like IM2, IM3 was very disappointing to me as an author, in part because of the panic attacks we see Tony Stark experience during the adventure. Post Traumatic Stress is what the media called it, but that is not what Stark was experiencing at all. Since I love the military and wish to write about it, I have spent a fair bit of time learning about and ruminating on what most people call PTS. For this reason, it is a big part of the Space Marine/dystopia novel I am doing final edits for.

PTS – or Shell Shock, as it was once called – has been present in this world since the dawn of human existence. It is an important device in military themed stories. Whether they are set in the Pegasus Galaxy or the Milky Way doesn’t matter; going to war and coming home alters the way those who have fought encounter, perceive and respond to people and events. This is something many writers, no matter what genre they specialize in, wish to capture in their fiction at one point or another. But as we saw with IM3, not everyone does it right or even well.

For this reason, I am going to break Shell Shock/PTS down into three categories and explain them, so that you have some idea of the different levels your characters can/might experience coming home from war. I will be using four Marvel heroes from the films to illustrate my points. The three “levels” of Shell Shock/PTS which we will go over here are: 1) Panic Attacks, (2) Combat Fatigue, and (3) – well, for simplicity’s sake, we’ll just call this level PTS.

Too many current writers, from film artists to authors like Suzanne Collins, are taking the “time bomb” PTS stance toward Shell Shock. A few others are taking the IM3 route. One is the extreme and the other is the relatively mild end of the spectrum. You cannot call the Panic Attacks Tony Stark experiences in IM3 a proper representation of Shell Shock/PTS because they are used the wrong way entirely.

Furthermore, no combat veteran is a ticking time bomb waiting to go off. Those improvised devices waiting to explode are warped human beings that have chosen their paths and who are seldom veterans. The popular press/media paints with as broad a pop-psychology pastel brush as possible in this matter so as to demean, depress, and indict all those who have served in the nation’s armed forces. Combat Fatigue, meanwhile, is almost entirely ignored, by both authors and the media and their pet psycho-babblers.

Here are my own ideas, as an author, about the levels of Shell Shock/PTS your characters in the military can/might experience, readers:

Panic Attacks – Throughout Iron Man 3, Tony Stark suffers repeated “panic attacks” where he flashes back to the Battle of New York, specifically his flight into the portal Loki opened above his Tower. People just have to say the word “wormhole” to him and Stark will dive into his suit because it is the only place where he feels “safe” now.

For Stark and Iron Man 3, I thought this trope was unnecessary, not to mention entirely overplayed and misrepresented. If the writers had actually intended to use these Panic Attacks as part of the story, they should have placed them not in scenes of calm, but in scenes of battle. Showing Stark panicking and climbing into his armor to feel safe in a non-combat situation is useless to the plot and his character.

Panic attacks can happen any time, anywhere, it is true. But for this device to serve the story in IM3, it should have played a part not only in making Stark’s personal life difficult, but his career as Iron Man problematic, too. Yet the only predicaments we see him dealing with in the movie as a result of his Panic Attacks are his domestic troubles, which are mild to the point of banality when compared to most others’.

The better way to have handled this plot point would have been to show Stark freezing continuously in combat or a high stress situation, costing him a tactical advantage or putting others in greater danger. Having him dive into his armor because someone said “wormhole” to him in a restaurant or a staff meeting accomplishes nothing for his character or the story.

We see this best when we look closely at him and the use of the Panic Attacks in the film. Watching Stark’s flashbacks during the movie, I realized what his main problem was; during the Battle of New York, Stark saw how little control he has over the world and how little he actually knows about the universe.

This is a valid crisis for him to have at this stage in the series. The Battle of New York was not a full-blown war; it was rather a large battle to head off an invasion force. However, it was a step up from the conflicts Stark had participated in previously. Prior to The Avengers, he had only fought one main opponent at a time. Even in IM2, when Iron Man and War Machine destroy the android suits, there was only one villain with which they had to contend. Destroying empty, soulless armors is not the same as fighting hordes of menacing aliens from heaven only knows where.

The Avengers was Stark’s first major confrontation. Here he was dealing with an army of invading aliens and had to step up his game on the fly. And that scared Stark because it made him realize he had not prepared himself to fight more than one person at a time. This fear is what he should have been fighting to overcome in Iron Man 3.

Instead, the creators behind the film insisted he was dealing with military-style Shell Shock/PTS that was wrecking his personal life. Certainly, this first major battle for Stark was traumatic and stressful; but it did not provoke in him full-fledged Combat Fatigue or Shell Shock, the more accurate terms for the psychological problems experienced by soldiers returning home from war. As Stark himself says in The Avengers, he is not a soldier. Therefore, equating his misplaced Panic Attacks with the Shell Shock/PTS experienced by returning front line soldiers is a silly move on the part of the film’s creators.

It also shows that those who wrote IM3 wasted a perfect opportunity to make Stark grow up in this film. If Don Cheadle’s character, who has been to war, had been allowed to tell him to man up, the film might not have been so very bad. Instead we were stuck watching Stark be patted on the head and told not to worry about anything while he was acting like a whiny teenager.

That was not what Stark needed to hear in this film. IM3 should have shown Stark recognizing his flaws and overcoming them to become a stronger man – a real “Iron Man” – in mind and soul as well as body.

But the writers did not take him there; they left him in the swamp of narcissism and conceit where we first found him, when they should have pushed him out of it. Rather than force Stark to grow up, they instead allowed him to continue being a bratty adolescent who is ignoring or running away from his faults and fears. In terms of its effects on the series, Stark’s lack of maturity in Iron Man 3 leads directly into the problems the Avengers face in Age of Ultron and Civil War.

This is why I find the Panic Attack subplot in Iron Man 3 annoying. Apart from the fact that it shows poor craftsmanship, it did nothing to help Stark mature and it slowed the story down, making the film flow poorly. Instead of showing Stark becoming “Iron Man” in spirit, mind, and heart, the people behind IM3 left him in the exact same position where we found him in the previous films. It was a great disservice to their audience, the character, and the story. It should not be repeated.

Therefore, when you want to have your character suffering from Panic Attacks, keep in mind the aim of your story. If you are writing a mainstream/literary drama where the confrontations are not physical, then your protagonist probably will not need to overcome his Panic Attacks in spectacular fashion. If your hero is still going into battle, though, you cannot confine his Panic Attacks to mundane events. These are not likely to be triggers for such things in the character you are creating.

Combat, however, is a very probable arena where these things will occur to your hero. Placing the Panic Attacks here will also help your story, because your protagonist won’t simply be dealing with an external threat. He will be fighting his own fears and demons, raising the stakes and generating more interest in your character and story. As long as you use it well and thoughtfully, Panic Attacks may serve the purpose of your story and help your character grow in ways that will do good service to your audience and materiel.

Combat Fatigue – Combat Fatigue might best be defined as culture shock, readers and future writers. We will discuss that in more detail below, but I think it is important to state that two of the best examples of this form of Shell Shock/PTS in modern films occur in The Winter Soldier, where Captain America and the Falcon first meet.

In cases like theirs, Combat Fatigue manifests itself in restlessness rather than in violence. Neither of these heroes loses much sleep over their actions in the wars they fought, and they have learned to accept the deaths of their friends in combat as well. The grief is still knife-edged for both of them, but they do not let it rule them and dictate how they live or react to others. By this I mean that they do not drink, do drugs, carouse, or start fights; they behave in a mature, responsible manner, living quietly beside people who have not been and likely never will be in combat at some point in their lives.

This leads us into the definition for Combat Fatigue which I mentioned above. At the beginning of the film, after losing an impromptu race to Steve Rogers, Sam Wilson correctly identifies the reason for the First Avenger’s early morning run when he says, “It’s your bed, right?” He goes on to point out that in war, front line soldiers become accustomed to Spartan conditions and constant discomfort. So when they return home to soft beds and troubles such as the washing machine breaking down, they find the former uncomfortable and the latter no big deal.

The reason for this “disparity” is because the culture of survival in a war, where the soldier must adapt to the fact that his life is constantly at risk, means he forms habits of going without or taking spare accommodations gladly. So if, for instance, his personal washing machine breaks down, it is regarded as a minor difficulty by the soldier. This is because he is accustomed to washing his clothes in someone else’s appliance anyway. He can do that again now, calmly and without qualms, until he gets a new machine for his apartment/house. The soft bed, on the other hand, is not easily accepted by him. This is because, after so much time sleeping on the ground or in a hard Army cot, a “normal” bed is now uncomfortable for him; it is an adjustment that merely takes time to solve.

Likewise, a soldier returning from the front will react with perfect calm to a car accident because he is used to remaining cool under pressure. War is not a place to lose your equanimity; panic, and odds are good that you will die much faster than if you keep calm. This also means, however, that that same soldier who reacts to an accident with perfect composure will feel ill at ease in a crowd while he is out shopping.

The reason for this “disparity” these days is because, when the soldier was at the front, enemy insurgents liked to hide among normal civilians in order to generate more carnage and catch the soldiers unawares. Having this knowledge ingrained into his psyche by experience, the soldier’s mind goes into a state of hyper-awareness instinctively when he enters a crowd. Even when rationality catches up with instinct, it will likely be unable to shut it out.

In the Marvel films, Steve Rogers is suffering from double culture shock because of his long sleep in the ice. Therefore, the audience tends to think more about the culture shock he is enduring after going to sleep in the ‘40s and waking up in the 2010’s rather than the other culture shock, i.e. Combat Fatigue, all returning soldiers feel.

This is why it is important for writers to see that Sam Wilson is directing his attention to treating Steve’s Combat Fatigue in Winter Soldier rather than the secondary culture shock. He is doing this because the secondary culture shock will be easier to deal with when the primary source of discomfort is alleviated.

Later on, we watch along with Steve as Sam helps other veterans who are dealing with culture shock. None of these people are named or are of particular relevance to the story. And yet, at the same time, none of them are wild-eyed maniacs barely holding on to sanity. They are simply suffering from a form of culture shock and trying to learn how to adapt to a familiar environment which their combat-altered survival instincts rightly regard as full of potential threats. Because they like to distress and frighten, the media and most of Hollywood prefers to treat Shell Shock/PTS in a more sensational manner than this.

That is why, to me, the depiction of Steve and Sam’s Combat Fatigue in Winter Soldier ought to be emulated more often by writers than the media’s preferred approach. Their Combat Fatigue is real and genuine, unlike the exaggerated, over-the-top depictions we were treated to by entertainment outlets after the Vietnam War and which some are trying to revive for the Iraq and Afghanistan Wars’ returnees. The writers’ handling of these two heroes’ Combat Fatigue in The Winter Soldier does credit to real military veterans, and that makes their accomplishment worth remembering, readers and future writers.

PTS – In the Marvel movies, the character who comes closest to the media’s and academics’ idea of Post Traumatic Stress is Bucky Barnes. Turned into a ruthless killing machine by HYDRA, throughout Captain America: Civil War the former Winter Soldier is clearly tormented by the memories of the crimes he committed while leashed to that organization.

If you want to create a character like this, future writers, then the first thing you have to understand is that most soldiers do not have nearly as much to feel guilty about as Bucky does. The primary source of Bucky’s guilt is that he was an unwilling agent of the enemy he had sworn to destroy. His is not the guilt of a soldier who did an evil deed because his government told him to do so, or because a Viet Cong operative held a child in front of his body when Bucky was firing at him.

No, the primary reason for Bucky’s PTS is that he committed murder on behalf of the enemy. It does not matter that he did not want to kill innocent people like Maria Stark or old friends like Howard Stark. It does not matter that he was not in control of himself at the time he murdered them and others like them. In the grand scheme of things, of course, these are mitigating circumstances. Even our modern courts would have to admit to the fact that since Bucky did not rationally choose to do what he did, this prevents him from being sent to death row or to prison for more than a token term of incarceration.

But on the personal scale, in Bucky’s mind, none of these extenuating conditions matter. What matters to him is that he murdered innocent people on behalf of an enemy that he believes he should have been able to resist, evade, and escape from. He is and will always be haunted by the faces of those he killed not only because he committed murder on behalf of HYDRA, but because he feels he failed to stop himself from being the one to execute those people.

The fact that he could not successfully fight back in a meaningful way that would have saved lives is small comfort to him. Bucky is an honest man who wanted to fight the good fight and who believes that, for seventy odd years, he failed in his duty to his country and his fellow man. That is why he is consumed by guilt when he comes to himself in The Winter Soldier and why he says he does not believe he is worth the effort Steve is putting forth to save him in Civil War.

Another important fact to remember about Bucky’s PTS is that, for the most part, he handles his guilt in a relatively mature manner. He does not go out at night to carouse and drink, nor does he abuse drugs in order to make himself forget his past. He does not provoke fights in the street with innocent bystanders or even thugs to “deal with” his guilt. Prior to Civil War, Bucky lives quietly and simply, accepting his guilt and bearing the nightmares that will never go away.

What a future writer can learn from this is that a character like Bucky, who handles his guilt in such a manner, feels he has failed once. He does not intend to fail a second time and in a worse way.

This is the most extreme form of Shell Shock/PTS a character can endure. It is the most difficult form for the sufferer and his friends to deal with because a good man can manage his guilt, but he cannot forget it or erase it. Certain occasions or incidents will always bring it to the fore, meaning he will always have to put it away again.

Many of us are so familiar with PTS because it is the media’s and the psychiatrists’ “favorite flavor” of Shell Shock, since it can have the most appalling results. Some men cannot or will not deal with guilt in a rational manner, and so they hurt themselves or others because of that. Bucky is an effective example of the opposite, showing that an opposite can and often does exist. This is something you should keep in mind when creating protagonists dealing with Shell Shock/PTS, future writers; they don’t all have to be crazy killers or crippled souls. In fact, I would say most who suffer from PTS are like Bucky.

In closing, when you decide to create a character dealing with Shell Shock/PTS, consider the different levels this condition has. Not all men (or women) are the same; some go to war and never have a nightmare about it between the time they come home and the day they die. Others struggle to put the war behind them, and still others cannot let it go at all. If every military character in your novel(s) that returns home from combat is a paranoid recluse or a raving lunatic, you are limiting yourself as an author to one character type.

Authors should not want to be limited in any way. Even I, an author who prefers to work in the science fiction and fantasy genres, have left the door open to writing outside the niches I favor. Preferences are all well and good; everyone, author or not, has them. But to work one has to be flexible, and this includes being adaptable in character design and choice. Aside from the benefits to you as an author, you will appeal to a wider audience if you vary your character types.

Recall this, too: there are real people out there in these positions who may read your stories. You want them to enjoy your work as much as everyone else, and that means respecting their point of view. Those who do not do this may make a lot of money in the short term, but among more than a few audiences, their names are mud.

Do not end up on that list, future writers. It is a lonely playground in which to swing.

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