Flight Surgeons – Making a Stressful Occupation Look Cool

By Lt. Cmdr. Shawnna Chee, PsyD, ABPP, aerospace clinical neuropsychologist, Naval Aerospace Medical Institute

picHow can something that looks so cool possibly be so stressful?

As an aerospace clinical neuropsychologist at Naval Aerospace Medical Institute (NAMI) in Pensacola, Florida, nearly all pilots and air crew I see deny any kind of stress related to their jobs; or if they do mention it, they are adamant they are not suffering any problems because of it.

You see, my role at NAMI is to evaluate the mental health and cognitive functioning of all applicants and designated personnel on flight status prior being returned to duty, particularly if they have been “labeled” with a mental health diagnosis.

Everyone tells me they are fit-to-fly, good-to-go, and thumbs-up, so why wouldn’t I believe them?

In conducing informal research for this blog, I asked several pilot buddies of mine, on various airframes, what they thought was the greatest stressor for a fighter pilot. One helicopter pilot said “making sure their hair is in place and their aviator sunglasses are hanging exactly mid-chest from the zipper of their flight suit.” Another multi-engine fixed-wing airframe pilot said “managing all the girlfriends they collect while on an overseas deployment.” A fighter pilot, still in training, jokingly admitted that his biggest stressor was “trying not to pee on myself while using the piddle-pack in the cockpit.”

All kidding aside, the job of a military pilot is not as easy as you’d think, regardless of airframe. After all, this is not a commercial airline.

All military pilots endure similar occupational stressors given the nature of their mission, but fighter pilots in particular have even more challenges to face. First of all, they are doing the job of two previously separate aircraft and missions; air-to-air (fighter against fighter) and air-to-ground (surface attack). Next, they are alone in the cockpit of a multimillion dollar aircraft flying at over the speed of sound strapped to an ejection seat that is their only lifeline to catapult them away from the supersonic jet carrying several thousand pounds of explosives where if something should go terribly wrong, they have to be able to independently assess the problem, come up with a solution, input the correct controls, and communicate over the radio, with literally only seconds to spare before imminent catastrophe.

Being alone, they are performing the tasks of an entire crew within the technologically advanced ‘glass-cockpit’ with top-secret computer systems, multiple combinations of button and switch commands, redundant navigation systems, digital display indicators, and two control sticks that keep both hands busy. This requires intense multitasking that has been known to cause mental overload or what they affectionately refer to as “helmet fire.”

And, combat missions can involve extended hours in a cramped space taking them to critical fuel minimums prior to landing on an aircraft carrier that is essentially a moving platform that appears to be the size of a postage stamp when approaching for landing.

Oh yeah. Let’s not forget the nature of their mission often requires the use of deadly force upon a hopefully correctly identified enemy target with the very real possibility of collateral damage. This takes a special type of person.

Let me back up a moment and clarify that not anyone can become a fighter pilot, no matter how strong the desire. There is an actual ‘type’ of personality, or mindset, to make it through the enormous burdens of extended flight training and mission demands. Personality characteristics that are known to be successful for these specific demands have been identified through cognitive and objective personality tests.

A good start is a high average to superior range of intellectual ability, mental flexibility, and problem-solving skills with fast and accurate mental processing abilities, combined with an emotional temperament to take things in stride, evaluate options and make smart decisions under a time pressure. Other essential personality characteristics are a low tendency to have their feathers ruffled under stress, being a team player and a leader, obsessively following procedures and feeling very confident in their capabilities.

But, what happens when a person with all of these unique characteristics is faced with the stressors of the fast-paced, life-threatening nature of their job on a continual basis? Well, they can react like any normal human would to chronic stress – through physical, behavioral and/or psychological manifestations.

Common indications that stress begins to affect a person negatively could include frequent somatic (or body) complaints (fatigue, muscle soreness, stomach ailments, headaches), or uncharacteristic changes in their behavior (drinking more alcohol than intended, being late for meetings, having a negative attitude, withdrawing from others), and even emotional ones (lacking interest in previously enjoyed activities, irritability or angry outbursts, forgetfulness, episodes of sadness or crying).

What a flight surgeon may also see in a fighter pilot whose innate ability to remain cool under pressure is beginning to decline could include making careless mistakes like landing on the wrong runway or missing checklist items or routine things like forgetting to file a flight plan, reading the flight schedule wrong or a pattern of poor decisions beyond just one bad day. The expression of frustration, unnecessary risk taking, reckless driving, or getting into arguments with their coworkers/spouse may also be a sign. But knowing that these are uncharacteristic for each individual is why the role of a flight surgeon is not only essential but meant to be incredibly intrusive as well.

The flight surgeon needs to have intimate knowledge of and a close relationship with each of the squadron personnel in order to detect these changes or to be that trusted informant to whom any aircrew member can come to with issues of their own or concerns about a colleague.

My advice to flight surgeons? First, let the pilot know that what is happening is normal! Then, having already built a close working relationship with the resources available in their area, consult the local psychiatrist/psychologist, or have the chaplain or fleet service support center on speed dial to discuss the changes observed in the fighter pilot or their ground crew.

And, spread the word. There are many effective and typically short-term solutions available to get pilots back to their normal self without extended periods of grounding or being out of the cockpit for too long.

Just don’t let it go unchecked! After all, who else can make such a stressful occupation look so cool?