Hi gang,=20
thanks for your interest in some deep explanation of "boomerangs" and "rouge
pilots" (interesting lapsus Tony, :), not freudism neither sexism here ;).=
=20
Since there are so many interested in Belgrade paper, it's easier for me
mail the docuemnts to the forum. But first let me comment on Doug and Graham
posts: =20
Doug said: "The personality angle weakens the argument that roguism is
treatable, and strengthens the 'get rid of them' school of thought. However,
career-threatening testing/profiling will not be popular."=20
I maintainted and wrote this position 12 years ago in my first book
"Systemic Aeronatical Psiquiatry" (NASA Technical Memorandum 77816), but
also coincide with Graham (and Dan Mourino) "I think that the rogue
individuals fall in this category (system failure) so the true problem must
lie in recruitment and / or training."=20
That is the problem solving issue with rogue pilots: recruitment and/or
training.=20
In both cases you must have a theoretical framework to orient yourself to
make decisions.
Safety is not jeopardized by the 95% of pilots who buy CRM, but by the rogue
5% (and others), CRM reluctant or rafractary.
But why are they reluctant or refractary?, is it enough with acrostics and
self check lists?, how many seminars and loft sessions are needed to change
their dangerous behavior? CRM is the best context to self examine and
insight, but have these individuals enought insight capacity? Has peer
presure demonstrate efficiency to deal with them?
When you are in front of a characteropathic individual, you are dealing with
a person unable to make any insight. They believe that they are the "best
pilots they ever saw" (remember The Right Stuff and the Chuck Yeager
Syndrome?, also Maverik's Top Gun Syndrome)...
Hard data: In the periode 1970-1990 we had 24 accidents with pasangers more
than 6,000 pounds ACFTs, 18 of them with a conspicuous rogue pilot in
charge. The other 6 also human factors, but spanning from corporate presure
to insufficient training. =20
The 18 fall in the category or "aeronautical characteropathies" I explain in
the paper attached.
Hope this trigger more discussion in this very interesting and
multidisciplinary forum.=20
Greetings from Buenos Aires
Hugo
Hugo Oscar Leimann Patt, MD, PhD
Argentine Aviation Authority and Air Force CRM Developer
Tronador 1515
(1430) Buenos Aires
Argentina
Tel/Fax (541)552-4266
hleimann_at_houseware.com.ar
http://www.houseware.com.ar/users/hf_crm
PS: Have also a psychological categorization of stewardesses, inspired also
in mythological Wagner Walkirias, Greeg Amazones and so on, but I'm affraid
some one will charge me as "sexist" :)
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Incidence of The Right and Wrong Stuff in Civil Aviation Accidents.=20
HUGO OSCAR. LEIMANN PATT, M.D., PH.D.
ABSTRACT:
Aircrewmembers (ACMS) enter a mortally hostil environment when they take off=
from Earth in their flying machines. Their physiological adaptation has=
been augmented and supported through ergonomics, avionics, and engineering,=
but no such technological aid helps them adapt their minds to that atypical=
condition. They must rely upon their own psychic resources, i.e.=
"aeronautical motivation" in the three levels of consciousness, and=
defense mechanisms to counteract their "aeronautical anxiety." Various=
relationships of motivation and defense give rise either to the flying=
adaptation syndrome or the various forms of the secondary flying=
maladaptative syndrome when ACMs must face the dangers of flight. These=
alterations of the ACMs' psychic balance may cause temporory or permanent=
medical disqualification due to the impairment of safety which they=
provoke. This paper propases an analysis of the interplay between=
motivation, psychic defenses, and aviation stress to expluin the=
manifestations of flight adaptation and maladaptative seen in some=
aircrewmembers.
THE HUMAN BEING is neither genetically programmed nor psychophysiologically=
conditioned for flying. Technological development has produced devices=
which correct these human deficits, and make it possible for aircrewmembers=
(ACMS) to reach the sky, the mythical home of gods and heroes, the image=
and wish of the ancients that we all still keep in our unconscious. This=
quantum environmental jump cannot be made without paying a=
psychophysiological price.
FLYING ADAPTATION SYNDROME-"THE RIGHT STUFF"
Taking off from Earth in their flying machines. Submitting themselves to a=
mortally hostile environment including hypoxia, dysbarisms (including=
sudden and explosive decompressions), and spatial disorientation because of=
linear and angular accelerations strange to the human semicircular canals=
and otolithic organs; involves a physiological adaptation process which=
humans would have never been able to carry out without the aid of=
technology, avionics, and ergonomics. But as regards the human mind, no=
technologic aid allows humans to adapt themselves to atypical conditions. =
Psychological adaptation must come from within the ACMS; that is to say,=
they must create it from their own "stuff."
As we know, every body heavier than the air will inexorably fall towards the=
center of the Earth, unless it fulfills the terms of a formula which can be=
simplified to Lift =3D [Speed x Wing Performance]/Weight.
By analogy, if ACMs want to "lift" themselves, and remain adjusted to flying=
duties during all their active lives, meeting highly risky aviation=
situations such as landing with marginal weather conditions, failures in=
the machine's systems, hijacking, etc., they will also have to fulfill the=
terms of an equation which could be stated as Flying Adaptation Syndrome=
(FAS) =3D [M x DI/A, where M represents the "aeronautical motivation" which=
would have its own characteristics and within which no inadequate,=
undesirable or spurious elements should be present; D represents the=
"defense mechanisms" which will have to be wielded by the ACM's ego to=
offset the third term of the equation, A, the "aeronautical anxiety."
Aeronautical Motivation
Motivation is a mental force capable of directing drives and inducing=
specific behaviors. Motivated behaviors are selective, active, and=
persistent-they increase in intensity according to deprivation and they=
tend to keel> internal balance and harmony with the environment.
At the conscious level, involving aspects known and accepted by the ACM=
without hesitation as his/her own, motivation comes from the "pleasure,"=
the "joy of flying" with its deep unconscious roots (9), the feeling of=
being free, the search for new sensations (some say, "Flying is like a=
drug"), and the social usefulness of flight. Flying aiso represents a kind=
of challenge to one's control of oneself; the expert psychophysiological=
performance of an activit which does not allow many mistakes.
At the preconscious level, motivation involves aspects not overtly=
professed but which can be recognized if the subject makes a real=
introspective effort. Examples include the prestige linked to the=
profession, the identification with heroic characters of aviation, the=
supposed sexual success and secondary benefits of this profession, a need=
to express aggressiveness extrapunitively, but inhibited by social=
standards and the superego. The ACM may wish to be free of some social=
conventions: aviation offers a freer atmosphere where supposedly everything=
is possible, including the possibility of "escaping." Richard Bach says:=
"Would you like to know a synonym for flying?: run away, escape" (2).
At the unconscious level, we can find the true motivational forces which=
explain atypical behaviors, and aviation activity is atypical for human=
beings. Jones and Perrien say that the prognosis of an ACM's=
psycho-pathological maladjustment depends on the characteristics of=
motivation, particularly the subconscious components (8).
Delineating this unknown "unconscious" can only be carried out through an=
interpretive approach, taking into account not only the infantile=
development of aeronautical motivation, but also every deep aspect of the=
ACM's psychology and possible psychopathologic manifestations. Here we can=
see the unconscious complex mechanisms ruled not by the "principle of=
reality" (Aristotelian logic), but by the "principle of pleasure," which=
resembles those magical relationships found in fairly tales and ancient=
myths (mankind's fairy tales), which also help us to understand the ACM's=
inner motivations. From ancient mythology, we can derive excellent=
information about the human spirit. Oedipus is not the only archetype;=
lcarus, Daedalus, Bellerophon, and Phaeton, as well as the Walkyries and=
Amazons, give us analytical clues about the unconscious motivation of ACMs=
(1 1, 12).
When the balance of the adapted ACM becomes unstable, "specific aeronautical=
psychopathology" shows
the inner conflicting forces within the ACM's mind, which explain "normal"=
behaviors as well as the
"abnormal" ones, the aviation behavioral maladjustments. Neurotic=
"aeronautical motivational" components are also widely describes in the=
literature. (3,5,6,8,15), from "counterphobic" components to latent=
suicidal dynamics.
Defense Mechanisms
Healthy aeronautical motivation is as important to carrying out a successful=
flying activity as adequate defense mechanisrns are to counteract=
aeronautical anxiety.
Defense mechanisms are defined as operative resources, or coping skills,=
used by the ego to maintain its bio-psychological integrity and=
psychosocial integration. These operations are not always conscious;=
actually, the most effective mechanisms are unconscious. These resources=
are generally used to avoid endogenous anxiety but the ego also uses them=
throughout the senso-perceptive process (16). The following mechanisms=
are:=20
Denial refers to the refusal to see a real potentially dangerous fact which=
comes from the outer world; in aviation, the danger of death has to be=
denied.
Repression or suppression derive from denial and consist of a more=
(repression) or less (suppression) unconscious obliteration of inner drives=
and aspects of outer reality, which could be very painful or blameful. =
Everything repressed keeps its psychic force and eventually, when defenses=
are down, it may appear in the conscious mind, producing the subsequent=
worry. What the ACMs repress are all those improper elements of their=
subconscious aeronautical motivation, which are so infantile as to be=
unacceptable for their moralistic superegos.
Psychophysiological habituation is an essential characteristic of fliers who=
have to learn consciously and willingly (later on unintentionally) to block=
some of the proprioceptive inputs that stimulate their vestibular nuclei,=
as well as other visual and vestibular senso-perceptive inputs. They must=
do this to avoid incongruency within a perceptual field with other=
non-habitual linear and angular accelerations. When this mechanism fails,=
the secondary flying maladaptative syndrome takes the form of motion=
sickness.
Rationalization is also a typical defense of ACMs. it refers to the=
preference for believing those statistics which say it is safer to travel=
by plane than by car, even though they tend to feel exactly the opposite=
during each instrument landing.
Identification is with the instructor, who lets the would-be-pilot enter=
that magical world of aviation, teaches him the necessary manual techniques=
to control an airplane, and is the student's model as a future pilot. The=
student thus acquires characteristic traits, operative manners, and=
attitudes similar to those of the flight instructor. Those are the reasons=
why, if we want to keep these characteristics within the frame of what we=
call "right stuff," the selection and instruction of instructors should be=
as important as the selection and instruction of pilots.
There are four defense mechanisms, among others, whose consequences are=
usually tragic when they are accentuated within ACMs' personalities. The=
first leads to substandard operational behaviors, and the other three to=
severe psychopathologic downfalls. In our formula they will be written=
"D."
Reaction formation refers to an activity or habit opposite to a wish or=
feeling which has been repressed because it is perceived as undesirable.=
Although this mechanism, as well as sublimation, is essential for a healthy=
superego, it is not the same in the aviation environment. Reaction=
formation is seen in some civilian "hot pilots" who tend to show reckless=
operational behavior in order to compensate for their unconscious fears or=
social resentment; thus, they become "accident-prone" pilots.
Evasion is one of the most usual mechanisms among cabin crews who use=
flying to avoid responsibilities as well as everyday boredom. In time,=
evasion becomes inadequate or useless, and the subject may suffer a severe=
breakdown (I have been aware of eight suicides).
Displacement and isolation redirect the feelings originally aimed at a=
certain object or person toward another, who is perceived as less=
threatening. Selection criteria should be based not only on the lack of=
mental disease but, preventively, on the detection of the best=
psychological conditions (motivation and defenses), in order to bear the=
subsequent aeronautical anxiety which is sure to come in an active flying=
career.
Aeronautical Anxiety
As we already know, flying is dangerous. The danger is both real and=
symbolic, generating fears and anxiety (9). Fear is an emotional=
manifestation, generally related to neurovegetative manifestations as a=
consequence of a real and outer danger. Fear is healthy and performs a=
kind of adaptive function telling the subject where a physical or psychic=
danger is (of course, seeing a situation as dangerous is mainly=
subjective).
On the contrary, anxiety has a mysterious, subconscious origin; thus, it may=
alter the personality because the ego does not know who and where its=
opponent is. Anxiety is provoked by the unconscious stimulation of early=
normal fears inherent in the subject's childhood. Aeronautical anxiety is=
the algebraic sum of fear, anxiety, and environmental stress.
SECONDARY FLYING MALADAPTATIVE SYNDROME: 'THE WRONG STUFF'
Modern manuals and books about aviation medicine usually use the DSM-III-R=
(8) classification of mental disorders. But in the aviation milieu there=
are mild psychopathologies which make one fit for flying, and there are=
"normal" personalities not suitable for flying. Besides, medical-legal=
difficulties arise because a specific aeronautical psychopathological=
classification is lacking. These maladjustment syndromes are particular to=
aviation because they are generally attributable to the service, or because=
they represent potentially morbid conditions which may jeopardize flying=
safety. These syndromes may be disqualifying for flying, but they are not=
listed in the DSM-III-R.
>From a systemic point of view (10,11), humans in general, and ACMs in=
particular, are bio-psycho-social entities. The following syndromes are=
presents in the three areas mentioned above even though their main=
manifestation is in just one of them.
In the following equations, remember that M =3D aeronautical motivation, D =
=3D defense mechanisms, and A =3D aeronautical anxiety; quotation marks =3D=
neurotic rather than healthy drives (i.e., "M", "D"). Up and down arrows=
denote, respectively, increases and decreases in these factors.
Fear of Flying - M x D
A ^ (meaning ^up and ! down)
This is the most frequent syndrome. Usually it is not incapacitating for=
flying activities, unless it becomes unusually severe.
In this syndrome, there is increased anxiety or uneasiness plus a sensation=
of insecurity under some flying undetected preexisting disorders, or recent=
life changes with libidinal readaptation. Strongin (18) published an=
excellent review of the uses and misuses of the expression and the=
administrative problems caused when bureaucrats don't consider it an=
aviation maladaptative syndrome, or a symptom without underlying illness=
(8).
Cabin crews are usually more affected by this syndrome than flight crews. =
This happens partly because their selection does not always fulfill=
strictly medical aeronautical criteria, and thus their motivation and the=
quality of their defense mechanisms are not generally the best; their=
instruction about emergencies (e.g., sudden decompression, hijacking) also=
is not enough; and, finally, because they must frequently remain passive=
during aviation emergencies. When a subject confesses a fear of flying to=
his examiner, he or she is asking to be grounded for a short period of=
time. I think that, whenever this happens, we have to accept his or her=
decision. lf not, the subject may acquire a more severe and irreversible=
pathology.
Flight Phobia -- M x "D" !
A !
When the frightened ACM keeps on flying for a while, his/her defense system=
may suffer some kind of damage needing to use latent second-line defense=
mechanisms, and thus fear may change into phobia, particularly when those=
not very adequate defense mechanisms-reaction formation, displacement, and=
isolation-are included. Flight phobia occurs when flying or environmental=
stresses debilitate denial and rationalization and when the unsuitable=
defense mechanisms are strongly present. There is no flying phobia if=
these elements are not present. That's why Davis (4) said of fear of=
flying: "Early recognition and active therapy in preventing phobias would=
eliminate the tremendous waste of time . . . because the nature of the=
condition was not recognized. "
Sometimes, the phobia is partial and flight per se is not the phobic element=
but only some types of aircraft or flights.
Chronic Flight Fatigue M! x D
A
Chronic flight fatigue is linked to aeronautical motivation by an inversely=
proportional relation. Motivation deterioration may be dramatically shown=
in the so called "get-home-itis," which is an important complication of=
acute operational fatigue that, for example, may induce the pilot to land=
with marginal weather or under minimums. "Get-home-itis," however, may=
have other causal factors.
The causes for motivation loss range from the weakness of its own=
components, especially the subconscious ones, to real problems with the=
company, which I call "labor microtraumata": low wages, lack of=
professional esteem, pilot's social and professional demotion, etc. All of=
these factors gradually undermine the aeronautical motivation, and thus the=
subject becomes
Aeronautical Climacteric =3D M !! x D
A
When motivation is damaged to a great extent, the ACM does not want to fly=
any more and seeks a medical or administrative way to be grounded. The=
causes are similar to those mentioned above. Motivation loss is a medical=
condition as incapacitating for flying duties as progressive deafness,=
notwithstanding that it is difficult for general practitioners to assess.
Traumatic Aeroneurosis =3D M x D
A^^^
When an ACM suddenly faces a great increase of stress which cannot be=
"metabolized," a suddenly traumatic aeroneurosis breaks out. Generally,=
this is an accident, a serious incident, a hijacking, or some other major=
trauma. Symptoms are not always immediate; generally, there is a latency=
period (rumination) of up to 1 year, and sometimes there has to be another=
event, even an insignificant one, to precipitate the latent neurosis.
The concept "psychic trauma" is completely relative, and depends on the=
ACM's susceptibility. lts symptomatology is also variable and polymorphous.=
A very important defense element is the active role of the subject during=
the event. That is why captains are usually less affected by such events=
as the rest of the crew. In hijackings, the opposite may occur (14).
Aeronautical Characteropathies =3D "M" x "D"
A
Character disturbances (personality disorders) may go unnoticed during the=
selection examination and periodic exams, but they may become manifest when=
flying. "Macho pilots" (paranoid characteropathy) are masters at freezing=
other flight deck members into silence by their prepotent, overbearing=
personalities, although most of them are excellent "stick and rudder"=
pilots.
To improve cockpit resource management and non-technical skills may become=
both a cultural (17), and a psychotherapeutic problem (12). I agree with=
Helmreich about the impossibility of teaching "old dogs new tricks," and we=
may have to wait for time to eliminate the untrainable (7). "Bellerophon"=
(aggressive-paranoid) and "Phaeton" (counter-phobic) characteropathies must=
be eliminated during the selection process (12).
Substandard Operational Behavior =3D "M" x "D"!
A^
In confirmed, efficient, and trained pilots, SOB may be provoked by the=
following psychological breakdowns: paroxismal emotional manifestations;=
decompensated diffuse anxiety, fear, or panic; thymic disturbances; the=
emergence of personal, psycho-affective, or working problems; temporary=
disturbances in awareness, memory, or judgement leading to wrong decisions,=
SOBs may also be caused by saturation due to overwork; personality=
problems, psychopathic personalities, ego hypertrophy, excesive=
self-confidence; emerging unconscious processes; self-punitive drives;=
death anguish; and, in extremis, suicidal and pseudo-suicidal behaviors.
Alkov et al. (1), describe "pilot error" as inadequate stress coping. My=
description is analogous, incorporating inner psychic dynamics into the=
analysis, thus allowing experts in the civilian milieu, where there are no=
flight surgeons in close relation with pilots and cabin crews, to act=
earlier and preventively.
Neurotic motivation and defense mechanisms should be detected early by means=
of informational feed-back between instructors and flight surgeons or=
psychophysiological boards, in the frame of a systemic preventiva=
philosophy applied to the aviation environment (10, 1 l). Later on, it is=
very diff=EDcult and painful to ground a pilot because he/she was wrongly=
accepted into the aviation system.
Compulsive ACM =3D " M" ^ x "D"
A ^
Among those who confess that flying is a drug, and especially among those=
who feel it but say nothing, there are those who just cannot stop flying. =
Flying becomes a symptom; it is a means through which such ACMs keep their=
personalities more or less adjusted. Obviously, this balance is very=
unstable and depends on the satisfaction of the main defense mechanism,=
evasion. This may also depend on the existence of conscious or unconscious=
spurious motivation components, driving these people to fly even when they=
are ill, thus jeopardizing safety and their own health.
Hyperdefensive Syndromes =3D M x D ^^^
A ^
These syndromes are characterized by an increased efficiency of defenses,=
such as denial and suppression, so that the anxiety doesn't reach the=
conscious, but is resolved at subcortical levels through somatization. =
Thus, severa] psychosomatic disturbances appear, especially gastroduodenal,=
muscular, cardiovascular and, particularly, motion sickness disturbances. =
Psycho-pathologically, motion sickness disturbances are organoneurotic=
symptoms, and are more likely to appear in obsessive and alexithymic=
personalities in stressful environments (13).
Substance Abuse =3D M x D !!
A^
In Yeager's (20) and Wolfe's (19) books, one can easily see how lax=
regulations were in regard to this matter. This has been reflected in the=
nice but dangerous aphorism "8 hours between bottle and throttle," which is=
insufficient, among other things, because it ignores hangover effects.
Gamma-Glutamyl-Transpeptidase (GGTP) dosage should be included in=
psychophysioiogical examinations in order to confirm possible cases of=
alcohol abuse. From a preventiva point of view, peer pressure must replace=
the so-called "conspiracy of silence." Alcoholics'self complacency should=
inspire our compassionate understanding during therapy but our firmness=
during the psychopchysiological examinations.
Such self-complacency is clearly shown in laboratory investigations and=
surveys, when pilots state that they have no subjective sensation of=
deteriorated performance after alcohol ingestion, and also extends to other=
drugs like marijuana (21,22).
I agree with Jones and Perrien: "Nothing excuses alcohol abuse. lt is=
maladaptive behavior that may quickly become an addicting disease" (8). =
Psychodynamically, it is a disbalance due to the increase of anxiety plus=
the deterioration of a weak defense system.
CONCLUSION
The adapted ACM enjoys flying. Any change in that enjoyment, and the=
subsequent consequences, is the product of a secondary flying disadaptation=
syndrome imputable to flying service.
This may occur either because aeronautical psychic micro- or macro-traumata=
eroded motivation or defensa and increased anxiety, or because the subject=
enterad the aeronautical system by mistake under selection criteria not=
based on aeronautical medicine and psychology scientific standards.
We must improve these standards, expanding the interpretative paradigm of=
our aeromedical discipline:
"The criterion of authority is science's main foe," Virchow.
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