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Post Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a complex and debilitating condition that can affect every aspect of a person's life.
This article provides some guidance concerning the psychological effects traumatic events can cause. Fortunately, for most professional pilots and Air Traffic Control officers, such events are uncommon but when they do occur it is important appropriate action is taken to ensure flight safety is not compromised and for the benefit of the individual(s) involved.
Traumatic events (called critical incidents) are those which involve an individual being exposed to an extraordinary situation (usually life-threatening, or believed to be life-threatening) which, depending on the circumstances, is perceived with a varying degree of fear, horror and or helplessness. Examples in aviation include:
- aircraft accident;
- involvement in disasters/major incidents;
- colleague seriously injured/dead;
- use of firearms;
- children injured or dead;
- situations of extreme strain, eg of long duration, high intensity and/or involving extreme sensory input;
- turbulence which threatens continued flight.
It is recommended that any individual exposed to a critical incident should be withdrawn from duty immediately. This will ensure that the following can take place:
- rest from immediate operational pressures;
- availability for a medical examination, which should be carried out at the first available opportunity, and which may indicate the need for a psychological assessment;
This should reduce the likelihood of the individual developing PTSD.
Many individuals will recognise the value of ‘talking through’ a traumatic episode, either with friends or colleagues. However, those who have been significantly affected by their experience may need professional assessment and/or treatment to ensure that they can return to operational duties as soon as possible. This is likely to involve more extensive debriefing (Critical Incident Stress Debriefing), giving an opportunity for the individual involved to discuss with a professional any emotions and memories of the critical incident with which he/she may be finding difficulty. The sooner this happens after the incident the less likely it is that the individual will develop PTSD.
Symptoms of a Deeper Problem
The immediate psychological reaction to a critical event comprises 3 symptom clusters:
- Re-experiencing of the traumatic experience: Nightmares, flashbacks and intrusive unwanted memories - this can be very unpleasant and distressing;
- Hyper-arousal and emotional numbing: intense symptoms of anxiety - physical (shortness of breath and a racing heart) and emotional (feeling on edge, looking for signs of danger or feeling panicky). Many people feel emotionally numb and have trouble communicating with others;
- Avoidance: The person avoids anything linked to the original trauma and which causes upset or irritation. Avoidance can become the main coping mechanism and lead to isolation and depression. Some will try to avoid the irritability by drinking and taking drugs - PTSD often presents with alcohol misuse and depression disorders.
In the majority, the symptoms settle down. However, in some people they can 'stick' and become chronic. If this is the case, PTSD may be said to be present.
What Causes PTSD?
One explanation of PTSD describes it as a memory filing error. At the time someone is being exposed to an intensely fearful situation, their mind 'suspends' normal operations and it copes as well as it can in order to survive. Usually the individual is aware of coping in an automated manner. Many will say later that their 'training took over' and they survived.
The mind does not lay a memory for the frightening event or events in a normal way because it has delayed this until the danger passes. The rule is that once the danger has passed, the mind will try to file away the memory. This means it tries to file the facts of what happened, the emotions associated with the trauma and the sensations (eg: touch, taste, sound, vision, movement, and smell).
The problem is that when the mind presents the memory for filing it can be very distressing. The mind repeatedly and automatically presents the memory in the form of nightmares, flashbacks and intrusive unwanted memories. The more the individual avoids things, including confronting what happened, the less likely is it that any memory processing will occur, and the more likely it is that further attempts at filing a memory will occur automatically. This leads to further re-experiencing. These re-experiencing symptoms then lead on to further hyper-arousal and emotional numbing, and this in turn leads on to more avoidance and so on. This is how the symptoms clusters perpetuate themselves in a vicious cycle which can go on for years.
For treatment to be successful, information processing must be completed. This is why therapies aimed at helping the individual to process and work through the traumatic material are extremely beneficial.