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The Importance of Mental Health in Aviation

September 26, 2023 12:18 | Anonymous

By Ron Lundquist 

Content Warning: Mention of Death, PTSD, Trauma

It’s a subject that is still misunderstood, or at least poorly understood. Soldiers returning from World War I often called it “shell shock.” As time passed, it came to be known as PTSD or Post Traumatic Stress Disorder. But PTSD, as we have come to learn, doesn’t just affect the military. PTSD is a disorder that develops in people who have experienced a shocking, scary, or dangerous event, sometimes known as a critical incident. While it is quite natural to feel afraid during a traumatic situation, that fear can continue for days, weeks, or even years afterwards.

I found inspiration for this article in two ways: one after visiting with a coworker, who is an airline pilot, and the other a family member, who also works in aviation.

First, my coworker. He had been in a serious accident with his personal plane and his friend, who was a passenger, was seriously injured. My coworker blamed himself for quite some time. After all, he was supposed to be a “professional” - he failed (in his words) and his friend was hurt. His friend eventually recovered and never blamed him, but the feeling of guilt did not subside for my coworker. The traumatic memories and feelings associated with that event continue to haunt him, but fortunately he has somewhat reached a point where he can accept that nothing can be changed, despite it still being hard to talk about.

A family member of mine also had an experience about 30 years ago that certainly could have caused PTSD symptoms. He had been on a “Go Team” - representing airline maintenance for a regional airline crash. As he explains it, he felt that he did not fully develop PTSD as a disorder but continued to experience symptoms akin to this. Sights, sounds, and even smells would trigger memories of working in the aftermath of that tragedy. Eventually, he was able to sit down and write his recollection of the event. This was done as a way to express how he felt during the event and helped him cope through it. Oftentimes in a safe environment, re-processing the event can be helpful, as exposure therapy has become more popular for intense PTSD. Even writing it down as he did, can potentially give a person suffering with symptoms a similar effect.

Have you had an accident? In an aircraft or something else? Did someone get hurt or did it scare you? Did you bend an airplane? Did you witness or have something happen that haunts you (aviation or non-aviation)?  There can be a variety of events that can cause PTSD. Let’s review a couple definitions.

Critical Incident:

The definition can be different to different people but the reactions to critical incidents are quite often similar if not identical. In the aviation world, critical incidents are accidents or incidents that evoke very strong feelings in those involved. It can be the pilots, mechanics, accident investigators or their families connected with an accident who are at high risk for a stress reaction after a critical incident.  

Stress Reaction:

Stress reactions are physiological and psychological changes that happen in people that have been exposed to a stressful event. A stress reaction that progresses often turns into PTSD. People who have had a traumatic event often make the mistake of dealing with the aftermath on their own. 

 I’ll use a few examples from my personal life to help explain how PTSD can occur or be triggered. Years ago, I found a friend of mine dead. This obviously classifies as a critical incident that caused a stress reaction, and I was physically sick in my body. A few months later, there was a flood that surrounded my family’s house. For weeks I stayed at my home, not sleeping more than a few hours at a time, worried about the rising flood waters and what they would do. My symptoms were lack of sleep, loss of appetite, stomach pains, muscle aches, feelings of detachment and a general sense of hopelessness. I had taken a 30% pay cut at work and my dad had been diagnosed with ALS (Lou Gehrig’s disease) a year prior. My cup was more than overflowing. Adding in my friend’s death to the mix, and this was a perfect storm for PTSD.

I eventually went to a doctor, who was also a family friend. He knew what was going on in my life and conducted various medical tests. I still remember when he came in and said physically there was nothing wrong with me. He thought I had PTSD. I thought he must be joking, but he insisted that PTSD didn’t just affect those in the military. He urged me to see a counselor, to process it, but I never did. In retrospect, I should have but I thought, “I’m a guy, I’m tough, and I’m a pilot.” Pilots compartmentalize things, handle emergencies. This is what we do. Unfortunately, the stigma surrounding pilot mental health is so prominent.

Being diagnosed with a mental illness or disorder like PTSD does not mean you are weak - and not being diagnosed does not mean you are strong. Things just are. Things just happen. In fact, you don’t even have to go through an event to experience these symptoms. Maybe your friend or a family member had been through something, and it ended up triggering something in you. Most experts agree that PTSD is not preventable, but what you do in dealing with it is the key. In my story, I continued to go to work and fly, and that helped me. It returned my life to something normal; I was in control again and it let me escape for hours at a time.

The U.S National Library of Medicine says that PTSD does change several areas of the brain. The hippocampus (that controls emotion, memory, and autonomic nervous system), the amygdala (which processes fearful and threatening stimuli) and the prefrontal cortex (that regulates our thoughts, actions, and emotions) may all be affected by experiencing trauma. We don’t have much of a choice on whether these brain areas are affected. This happens in some people and doesn’t in others.

After an accident or even an incident, we should be on the lookout for PTSD or at least be aware of related symptoms. If a fatality occurred (and you lived), one might experience survivor’s guilt. This can really trigger some PTSD symptoms that should be dealt with. The longer you put it off, it can manifest into a trauma itself. Often, we can’t see PTSD symptoms starting to develop in ourselves, but we may see it develop in others. Possible signs and timing of impending PTSD: This can be a very long list, but here are some that are common and hopefully easy to spot. 

Death of a spouse, child, sibling, or anyone close. 

An accident that you may (or may not) have caused, where serious injury or death occurred. 

Witnessing a death, loss of pregnancy, natural disaster, or being a victim of a violent attack, such an assault or abuse. 

Symptoms can include flashbacks, night sweats, insomnia, and panic attacks. 

If you find yourself (or someone else) increasingly isolating from family and friends, this also can be a red flag. 

Stress Management:

It is possible to mitigate the effects of stress and your reactions to it. Remember, these are normal, you are normal and having normal reactions to a situation that is not. About 3.5% or roughly 8 million of the U.S. adult population live with PTSD. Of people diagnosed, 37% show serious symptoms. 


Exercise is important to our overall health but especially within the first one to two days after a stressful or triggering event. Be sure to rest more than you normally do, as well as up your water intake. Reduce your caffeine and alcohol intake. Both hinder normal sleep and processing the accident/incident or trauma. Visit with friends and talk to people you trust. This can be the best healing action you can take. If you live by yourself, have someone stay with you for a few days. Try to keep the structure of your normal day. Follow your normal routine with eating, sleeping, and exercising. You may feel physically sore after an event. Psychological stress can bring this on. Do not make big life changes or decisions after a traumatic event. Make little ones to establish a feeling of control over your life. Seeing a counselor or therapist may also be helpful in processing emotions, as there are specified therapies for PTSD that will help reduce symptoms and allow you to get back to living.

I’ve obviously only scratched the surface of this subject. There are so many things that cause PTSD and so many things we can do to deal with it. I’ve witnessed first-hand people struggling and experienced it myself. If I could pass along any advice at all, I’d say be aware after a big event (whatever you define that as) and just as important, watch your friends and family after they’ve been through something traumatic. There’s a lot of information that can help us help each other. Try and educate yourself on the warning signs. The person you may end up helping is yourself.

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