Pilots' mental health not nearly the safety issue of fatigue

Air Safety Week, Oct 16, 2000

Periodic psychological screening of pilots is an unnecessary response to a "Chicken Little" apprehension that mentally unstable pilots constitute a threat to air safety. That's the position expressed by the Air Line Pilots Association (ALPA). The organization went to general quarters after Canadian psychiatrist Dr. Daniel Cappon's article, "Is Your Pilot Safe to Fly?" appeared in the Aug. 2 edition of Toronto's Globe & Mail newspaper. In a letter to the paper, ALPA President Duane Woerth said, "In our dealings with Dr. Cappon, we were put off by his attitude that not only were mental health problems endemic (which they are not), but he seemed insistent that his answers and methods were the only ones worthy of consideration."

"Very few accidents worldwide have been attributed to mental health issues of the crew and none, to my knowledge, in Canada," Woerth continued. "But Cappon would impose mandatory mental health testing every six months on all airline pilots in Canada to chase this chimera."

Woerth suggested, "If he is looking for a human factors accident prevention cause to champion, we would welcome any support in demonstrating the role that pilot fatigue plays in accidents," Woerth declared. "It is dead certain that fatigue has killed far more passengers than will ever die as a result of pilot mental health problems."

However, if the actions of mentally unstable pilots were a factor in the 1997 crash of a SilkAir 737 and of the 1999 crash of an EgyptAir 767, the toll in those two accidents was 321 dead. These are two of six accidents in which pilot pathology may have been involved (see ASW, Nov. 22, 1999). The literature on pilot mental health goes back at least to the early 1980s, and two articles appeared on the subject in the Summer 2000 edition of the Federal Air Surgeon's Medical Bulletin, a publication of the FAA's Civil Aeromedical Institute (CAMI) in Oklahoma City.

Even 321 dead, however, pales in comparison to nearly 100,000 patients dying needlessly in American hospitals every year, ALPA's Woerth pointed out. "Despite these alarming numbers of unnecessary hospital deaths, I am not aware of any biannual psychiatric evaluations being required, or even demanded, for doctors," Woerth wrote. "If Dr. Cappon insists on finding a windmill to tilt at to save lives, perhaps he would best follow the wise counsel, 'Physician, heal thyself.' " >> ALPA, tel. 703/481-4440 <<

A Brief Literature Review of Pilots' Mental Health

According to British aircrew license insurance files, psychiatric disorders rank second only to cardiovascular disease as a reason for permanent grounding.

Source: "Psychiatric Disorders As They Relate to Aviation: Introduction to the 2d Scientific Session of the Association of Aviation Medical Examiners," by V.B. Maxwell and H.C. Davies, in Aviation, Space, and Environmental Medicine, July 1983

442 British commercial airline pilots participated in the most recent study on stress in aviators...the researchers...judged 28% of them mentally handicapped, a percentage greater than that expected in a male industrial population. After the researchers developed a cut-off point by dividing pilots considered 'normal,' but at the upper end of the average distribution, from those that were clinically 'ill,' just over 12% of pilots showed mental health scores above that point. And 2.2% had scores higher than those expected in psychiatric outpatients. Of course, those participating in the survey had all passed their mandatory airline check ups in recent months with flying colors.

Source: "Broken Wings: A Flight Attendant's Journey," by Nattanya Andersen (see http://www.brokenwings.com). Andersen was citing from C.L. Cooper & S.J. Sloan, "Pilots Under Stress," Routledge & Kagan Paul: London and New York, 1986

Depression: A Recoverable Stall

First, the Bad News: The bad news is that depression is now so common that it is called 'the common cold of psychiatry.' Between 10-20 million people in our privileged and affluent country suffer from it to the degree that they need treatment. Suffer is surely the proper word. One man in ten and one in four women will be affected (afflicted) by it at some time during their lifetime...

Think of the brain as a skull-enclosed, three-pound, electromechanical analog computer. This leads us to some of...

The Good News

Depression is not only the most common mental disorder but also the most treatable, with an 80%-90% success rate...The most common medications used today to treat depression...are the Selective Serotonin Reuptake Inhibitors (SSRIs). Serotonin is a chemical the brain needs for maintaining a good mood - SSRIs keep the level from being depleted. Prozac, Zoloft, and Paxil are among the most prescribed...The FAA is willing to return virtually all clinically depressed pilots back to flying after successful treatment....

(Among the ways to strengthen one's defenses against depression, the author offered the following advice) Open up more. Men just don't want to admit of anything that takes away from the macho image. Depression is thought of as a wimp disorder. Men may just tough it out until the Smith & Wesson cure seems the only solution. Harvard Medical School psychologist Dr. William Pollack said, "Men are limited pretty much to a menu of three strong feelings: rage, triumph, and lust. Anything else and you risk being seen as a sissy." Men (pilots?) have a tendency to self-destruct. The Macho Marlboro Man would do better to open his feelings up...and admit that things are not going so well for him...