Fly Well: The man in the mirror

Surrealist René Magritte’s famous portrait of Edward James, Not to be Reproduced, depicts a man viewed from behind observing his reflection—seeing not his face, but the back of his head. It is perhaps an allegory for how we fail to see ourselves as others might. Fever causes delusions, alcohol and drugs retard speed of thought, and caffeine or sugar induce excitability. Similarly, stress or trauma can impair rational thought and behavior—and we might not realize it.

Media reports inform us of brave warriors returning from Iraq and Afghanistan afflicted with post-traumatic stress disorder, caused by injury or exposure to the horrors of war. As a surgeon I recall vivid emergency room or roadside images of broken, lacerated bodies and such pictures color how I see the world and react to certain stimuli. I might not fall to a crouching position, weapon drawn, when hearing loud noises as returning soldiers have been known to do, but glib or dismissive comments about driving or other urban risks can provoke a strong reaction. These examples illustrate how we are conditioned by our environment and experiences.

Weather briefings, aircraft state of repair, and preflight personal screenings such as “I’M SAFE” (illness, medication, stress, alcohol, fatigue, eating) are familiar, but do you adhere diligently to such checks? Are you seeing your true self? Evaluate emotion, sleep, energy, anxiety levels, focus, sex drive (a good indicator of mood), appetite—and if you were a bumper sticker, what would it say? If it reads “Life sucks,” leave the bird in her hangar (see “Bouncing Back,” April 2012 AOPA Pilot).

Having recently attended a seminar for parents of teen drivers, I learned that allowing one’s offspring to drive when euphoric about exam results or other achievements is as dangerous as after a romantic breakup. Emotions at either end of the spectrum impede one’s ability to control a car. Or aircraft.

Physical or mental trauma recovery follows a predictable course; initially one experiences denial or disbelief: “this is not happening to me.” Not a good idea to be hurtling through space controlling the avgas throttle when detached from reality. Clarity ensues, followed by anger that this is happening to you. After a period of bargaining comes depression and, finally, acceptance, with a gradual return to normality. Once that is achieved one can think about flying again.

Prior to every flight, self-evaluate to include a good look in the mirror. When facing major life events, good or bad, do something other than flying; an upcoming child’s marriage or marital problems, a recent promotion or challenges at work? Consider staying on the ground. The Holmes and Rahe Stress scale is a useful, illuminating tool. This was published in conjunction with an Air Safety Institute video featuring Russ Jeter, whose son died in an accident. His bravery recounting this devastating tale just might save your life or that of someone you love.

Witnessing an event can cause stress or PTSD, adversely affecting one’s ability to fly well. One pilot tragically saw friends killed in an airplane crash and suffered until he sought counseling, which ultimately proved helpful. Men tend to be averse to such aid, but just as seeing the runway appear as you break out of the crud, seeing a way to a better emotional landscape can be enormously satisfying.

A colleague told me of meeting two airline pilots deadheading to pick up a flight and noticed that one was quietly weeping; his wife had died one week earlier. Can someone dealing with such loss be on top of their game? Feeling ashamed about a sad emotional state and failing to seek help is understandable. Societal pressure and self-image drives us to be leaders; the phrase “Pilot in command” says it all.

Since April 5, 2010, pilots with established depression can obtain a medical certificate if taking certain medications ( “Fly Well: No Laughing Matter,” June 2010 AOPA Pilot). Who do we want in the cockpit—a depressed pilot or one who has faced his demons, sought help, and received treatment? Choosing to self-ground for a period of time when dealing with stress represents good judgment. If counseling is sought for personal life issues, reporting to the FAA is probably not necessary. If medication, substance abuse, or a psychiatric condition is involved, including PTSD, reporting is mandatory. After all, an airman dealing with this needs help to see his reflection as others do and that takes guidance, time, and effort. Just like learning to fly.

I am grateful for insights provided by Dr. Jack Hastings, Dr. Warren Silberman, and Gary Crump.

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through the AOPA Pilot Protection Services plan. Email the author at [email protected].