Why is mental health stigmatized in aviation?
The stigma surrounding mental health issues among pilots seems to be a current topic in aviation, yet being open and honest is seen as a weakness, rather than a strength. Pilots especially are perceived as made of “the right stuff”. It sort of comes with the job, that you are capable of performing anytime, anywhere.
A few years back I attended my annual CRM recurrent training. At one point we were informed about the high numbers of cabin crew being sick due to stress. I asked: “How big a problem is stress among the pilots?” The instructor looked at me with surprise and replied: “We do not have any reports from the cockpit, you are the one who is supposed to take care of the cabin crew”. Nobody commented further on that subject.
Though I do believe that we have made some progress, the stigma still exists.
What are we aiming for, when we talk about mental health?
In 2011, I went on leave from the pilot job and came back 3 years later. I remember being astonished when talking to my colleagues. Though their passion or flying was still intact, they were exhausted to a point I had not seen before.
One told me how he was on the edge of crying due to exhaustion when the alarm went off at 4:30 am, on the fourth day in a row. Knowing that 6 sectors in winter conditions in Norway was facing him.
Another one told me, how he spontaneously fell asleep the moment he sat on the couch to be with his family. Having no time with his children, he packed the suitcase and went off to work again.
Flying short-haul myself, I remember those days feeling like running all the time. Trying to meet the unrealistic planning, only to be met by Operations with the argument “you can still extend with Commanders discretion” when we were reaching the limit of duty.
So why not just report feeling unfit or fatigued?
I think the explanation is partly the stress caused by the nagging thoughts in the back of your head, circling around job security. Everybody today has an increased awareness of how fragile job security can be. A lot of us have experienced our airline going bankrupt, and some have even experienced several bankruptcies.
This awareness has a side effect on the job. You go the extra mile, in order to keep your job alive. You do not want to create a hassle; you just want to keep your job. Meanwhile, you might experience the nagging thoughts growing in your mind and combined with feeling exhausted, you are experiencing a dangerous cocktail - fatigue and stress. You are no longer in a state of well-being you are in “Fight - Flight” mode.
The stress response is a fantastic mechanism that guarantees our survival, and in small doses, it will help you increase your performance and being alert for the threat lying ahead.
However a lot of the stress today is not fighting or fleeing the animal on the savanna. It is fighting or trying to flee the perceived threats in your mind, created by you. The problem is, that the stress response was “designed” for you to meet a physical threat, deal with it, and then restitute. By fighting the animal or in the restitution afterward the stress hormones Adrenalin and Cortisol would get back to a normal level.
Today, the nagging thoughts in our minds, create the same stress response and release of hormones, not just once but multiple times a day. However, we are not physically fighting anything and honestly, how good are we at restituting? This leaves our body and mind pumped up with Cortisol, and that literally messes with our brain. The amygdala in the Limbic system associated with fear is working overtime; at the same time the hippocampus associated with memory can be damaged by the high level of Cortisol.
You might start to feel some of the symptoms associated with stress: The trouble of falling asleep, the increased heart rate, starting to forget the little things, being irritable, losing interest in what is going on around you and maybe even giving in to the urge of having that extra glass of wine or chocolate bar.
What can we do to reduce the stress?
First of all, I would like to emphasize that becoming stressed is not a weakness, but rather you being a human trying too hard. In my opinion, it is a massive strength in a job that is so dependent upon our physical and mental health, to be able to acknowledge and act on the symptoms of stress. And be assured, you are not the only one feeling like this.
Here are a few tips on how to reduce stress:
Use your social relations: One of the major elements in reducing or preventing too much stress, is using your social relations, and being able to actually talk about what stresses you.
Exercise: We have heard it before, but remember that the high level of Cortisol in your body had the purpose of pumping your muscles to fight or flee. Burn off those hormones with exercise.
Restitution: Give your mind a break. Try meditation, or set some time aside to do something that you enjoy and that requires nothing of you.
Make a plan: You either need to accept something or change something, in order to keep yourself out of too much stress.
With that said, dealing with mental issues, cannot be concentrated on an individual level, it needs to be addressed on an organizational level. If we are ever to reduce the stigma around mental health issues, we need to create a company culture where it is allowed to voice concerns, without the fear of consequences in our job.
So why is mental health still stigmatized in aviation?
Since nobody has talked openly about these issues in the airlines, too many pilots are afraid of losing their medical – not being aware of the fact that it is treatable. It can be difficult to express mental issues because it is individual and invisible to others. It’s always easier saying “I broke my arm, and will be away for the next couple of weeks”.
I find one of the reasons to why pilots find it hard to speak up, is trust issues with the management. Being a pilot is a dynamic job, with different colleagues every time, different places for check in and you might not have seen your leader/chief pilot in months. This can create a distance and a culture among aircrew where it is “them versus us” making it hard to establish a trust of which you would feel comfortable talking about mental health issues.
We have seen it with the problem of pilot fatigue. Again it’s individual, and not black and white. A survey made in Europe in 2012 told us that only 20-30% of pilots write a report, when being fatigued. The argument I meet when out teaching is often in the lines of “why bother, nobody does anything about it”.
Unfortunately, that seems to be reinforced by a benchmarking among 30 airlines made by European Cockpit Association (ECA) in the beginning of 2017, exactly one year after the implementation of the new FTL rules and Fatigue Risk Management. A system introduced to prevent pilot fatigue from endangering flight safety.
Philip Von Schöppenthau, ECA Secretary General concluded: “Fatigue Risk Management remains either misunderstood, poorly handled, inadequately overseen or simply used as a smokescreen to cover ongoing malpractice.”
One might suggest in the light of this that one step in creating a culture, where mental health is taken seriously, is to not just talk about fatigue risk management, as in “it’s in the manual”, but actually engaging in implementing and prioritizing it in the company. One might even suggest that the authorities could be better at checking whether this was actually the case in the airlines.
Maybe if the pilots felt listened to, and taken seriously when they raise their concern, they could again come closer to a state of well-being.
Gitte Furdal Damm is an experienced flight captain with a demonstrated history of working in the airlines/aviation industry. She is also the owner and CRM Instructor at About Human Factors, providing courses within aviation, such as Initial CRM, Recurrent CRM, Conversion Courses, Commander Upgrade, Teaching and Learning and individual coaching to pilots.
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