Some of you may know that I am a licensed psychotherapist. Since March of this year most counselors have been able to see clients virtually to address mounting mental health issues from the pandemic. I could probably work 24/7 right about now. I truly have never experienced anything like this in my 29 years of practice.
Last week I read a recent study Mental Health Disorders Related to COVID-19–Related Deaths by Naomi M. Simon, MD, MSc1; Glenn N. Saxe, MD2; Charles R. Marmar, MD3 published in the Journal of the American Medical Association [JAMA]. It noted that since the onset of COVID -19 the percentage of Americans who have a diagnosable mental health condition has doubled. Pre-COVID about 20% of the population in the United States was affected by a thought, mood, anxiety or substance abuse disorder. The survey taken in June 2020 now indicates that number has jumped to 40.9%. A stunning part of the excerpt below is that 10.7% of respondents who revealed serious suicidal thoughts in the last month.
A June 2020 survey from the Centers for Disease Control and Prevention of 5412 US adults found that 40.9% of respondents reported “at least one adverse mental or behavioral health condition,” including depression, anxiety, posttraumatic stress, and substance abuse, with rates that were 3 to 4 times the rates 1 year earlier.2 Remarkably, 10.7% of respondents reported seriously considering suicide in the last 30 days.2 The sudden interpersonal loss associated with COVID-19, along with severe social disruption, can easily overwhelm the ways individuals and families cope with bereavement.
As our flying started opening back up [with precautions] this summer I thought back to a piece I wrote for AOPA many years ago on recovery from trauma. I have included the article below. My hope is that as you get back in the airplane you will seriously consider a mental health checklist in addition to the checklist for the airplane you will be piloting.
Bouncing Back A psychotherapist’s guide for pilots
It was a beautiful day in the Columbia River Gorge. Hood River Airport is located in a picturesque valley, surrounded by mountains. A pilot was in his backyard garden enjoying the sunshine. He heard an airplane engine start to sputter, then quit, and listened to the sound of a loud impact in the neighboring vineyard. He jumped the fence and raced to the crash scene. There he found an aircraft nose down between the rows of red grapes. A quick glance in the cockpit revealed his deepest fear: the loss of a life.
As a psychotherapist who specializes in recovery from trauma or traumatic loss, I saw this pilot in my office four days later. “I am having a hard time. I keep hearing the engine quit, then the sound of the crash. I keep seeing the wreckage in my mind, over and over again. I run to him, but I know it is too late. He was still warm. I held him in my arms until the paramedics came.” When I asked him how often the movie is playing in his head, he said it was about 20 times per day. He had disturbed sleep, lost his appetite, and felt very hopeless about the intense flashbacks.
Over the course of our work together, I was able to help him understand how the brain reacts to trauma, and how professional care could speed recovery. In the end my client understood that while he was seeing the movie in his head hundreds of times, the pilot who perished only experienced it once.
Exposure to trauma
We all experience trauma in our lives, and as pilots, with medical certificates at risk, how we deal with it can be especially important. After exposure to a traumatic event, most people go through four distinct stages. The first is shock—a sense of disbelief or cognitive fogginess. During this stage a survivor may experience flashbacks, or mental movies of the event. Let’s also surmise that the person watched the news, listened to audio, saw photos, and viewed video of the event—thus re-exposing himself to the initial trauma. The re-exposure to the brain is essentially the same as the initial exposure. Should the person not get appropriate care, especially in the weeks or months after the event, an anxiety disorder such as post-traumatic stress disorder could develop.
Next comes a return to a “feeling” state and also a time to tell the story. When I worked at the Vietnam Vet Center, my supervisor—a combat vet and a psychotherapist—said, “Every trauma survivor has a story to tell and retell, and it is in the retelling that the healing is found.”
The third stage is when a person’s energy typically rebounds and a sense of focus develops. This energy could take the form of volunteerism, donating time and money, contact with rescuers, or helping other survivors.
Finally, reintegration must take place. A person must accept life on life’s terms now. Meaning is incorporated in life, in absence of what they lost. This is a time where we hear, “I have a new lease on life,” or “Life is precious.”
How does this apply to our ability to pilot an aircraft? One study says that intellectual power is decreased 50 to 90 percent when you are in the midst of the first stage. It is important not to make big decisions at that time. When we perform a preflight on our aircraft before launch, we are careful to consider all the aircraft systems. The effects of exposure to trauma cannot be underestimated. In our go/no-go decision, we should carefully reflect on our emotional health and how that will affect the flight. After all, we want to be able to fly the airplane instead of it flying us.
Here are some simple ways to put you and your emotional health on the pre-flight checklist, as well as some ideas on when to get support if needed.
Mood: Think back over the past week. Rate your mood on a scale of one to five, with one being the lowest, and five being a happy mood. What is your average? Has anyone told you that you look tired, depressed, or nervous? Sometimes our spouse or families are our greatest mirrors—we might not see our mood, but to them it is written all over our faces.
Sleep: Have you been sleeping well? The average person in a lab setting will sleep a six- to seven-hour stretch and take a one- to two-hour nap in the afternoon. Think back and check whether you have had any difficulties falling or staying asleep. Deep, restorative sleep typically happens well into an uninterrupted sleep cycle. Think about performing a go-around on every approach—when sleeping we simply cannot get down to Delta if the cycle is continually disrupted.
Energy: Has your get up and go, got up and went? Do you find yourself drinking coffee or energy drinks just to get through the day? Some pilots find they have too much energy and are unable to relax into a healthy focus. Between the tortoise and the hare, somewhere in the middle is the most efficient.
Anxiety and Worry: Someone once told me that worry is interest on a debt we don’t yet owe. An interesting study on worry shows that it can be healthy in small doses. Worry is a high-brain function—one that can help us sort through possibilities and strategies. Too much worry shuts down the function and we can find ourselves in a state: fight, flight, or freeze. Thirty minutes of worry once per week is effective. How many minutes this week have you racked up?
Concentration and Focus: Particularly important for the pilot in command is the ability to concentrate and stay focused. If you are noticing that your mind is wandering or you are distracted by worry, it might be best to keep yourself and the aircraft on the ground.
Sex drive: This might seem a strange item to have on your personal checklist, but a person’s sex drive can be indicative of emotional health. A lack of desire can suggest a mood problem.
Appetite: Does your favorite food taste good to you? Are you eating for comfort or to excess? Healthy food is fuel for the brain and the body. Make sure that you do not fly without fuel onboard.
Bumper sticker: If you had to summarize your attitude about life to fit on a bumper sticker, what would yours say? Is your bumper sticker upbeat and optimistic, or doubtful and negative?
When to get some “dual”
As a practicing psychotherapist and trauma survivor myself, I have come to believe in getting some couch time when you need support. The addition of the pandemic, isolation, uncertainty and lack of currency necessitates a closer look at your check list. If we do not take care of our mental health, it might end up taking care of us. Think of a licensed counselor as an advisor, or life coach. It truly is a gift to be able to talk with someone you trust about things that you might keep from others. Sometimes my clients think that they can tell me something that I have not heard before. That is simply not the case. We all have many of the same core insecurities, wounds, and doubts. The difference is in how you deal with them.
Recently I was flying a large turbine aircraft with a more powerful engine than I was accustomed to. When I was about 50 miles out, I began a descent, thinking about each thing that I was going to do next. As I began the approach I thought, “I am going to fly this airplane and make it do what I want it to do.” Imagine if I were instead plagued by doubt, anxiety, or insecurity, or maybe I did not sleep well the night before. Who would be PIC—the airplane, or me? Make sure that when you are in the left seat you are flying the airplane. The only way to do that is to consider yourself on your personal checklist.
If you want or need help, reach out. Most insurance companies are offering free or low-cost counseling visits virtually. Let’s make our return to the skies as safe, joyful and fun as possible.
2.Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057.