A discussion of the implications of ignoring stress By Captain Dave Fielding fellow pilot was telling me recently why hed been off sick for a while. After a normal day at work hed come home to find his wife unconscious on the floor. Hed put her in the recovery position and called 999. After some diagnosis over the phone, it quickly became apparent that shed taken an overdose. The pilot checked that the door was unlocked so the paramedics could get in and set about finding out what his wife had taken, all the while making sure she was still breathing. When they arrived, he had all the information ready so that she could be taken to hospital and treated efficiently. She was stabilised, kept in overnight for observation, and the pilot went home. Then it hit him. Once the adrenaline had tailed off and everything was calming down, the full implications of what had just happened literally froze him on the stairs for hours as his mind tried to make sense of why his wife had attempted to take her own life, and what this meant for their future together. The next morning, he called the company to tell them he needed time off to sort everything out, which they facilitated. Thankfully by the time we talked his wife was on effective medication that had brought her back to stability; he was flying again and they were addressing the issues with her and their lives together that were causing problems. The reason for telling this story is that it illustrates very starkly the two different approaches to dealing with lifes stresses, and how pilots generally are very good at one, but not always so good at the other. Dealing with stress as a pilot When dealing with a Non-Normal failure on an Airbus, once the Immediate Actions have been completed and all ECAMs (Electronic Centralised Aircraft Monitor) cleared away, the last part of the Normal Procedures is to consider the FCOM (Flight Crew Operating Manual). This is to direct the pilots towards the wider implications of the failure: thinking ahead to anticipate problems so they can be dealt with much more easily if they do happen downstream. If we now transfer the cockpit Non-Normal to a life Non-Normal, you can see how the same skills can apply. Pilots are very good at running a checklist of actions that are required in a developing situation such as the one described above. In the majority of cases, particularly when it comes to a single failure (so to speak), they do consider the FCOM and deal with the longer-term emotional implications. My colleague did just that when he got home. The thing is, he had no choice because of the enormity of what had happened and the obvious impact it had on him. What happens if the stress is not so brutal and immediate, but more insidious and over a longer timeframe? Ive noticed over 20+ years of dealing with these sorts of cases that when multiple issues layer up gradually in a pilots life they often dont deal with the implications of all these stresses happening at the same time. An example might be a couple struggling with IVF, while moving house and a command course coming up. You just know whats going to happen, particularly when the pilot says: When I get through this course, it will all be OK. As if life as a new captain released into the wild for the first time is a stress-free existence. Failed command courses, and other performance issues, are often manifestations of unaddressed stress. Others Ive seen, as a disciplinary representative, include concerning behaviours in the cockpit, or inappropriate behaviour downroute because of alcohol or the perceived effects of alcohol (excessive fatigue through not sleeping properly can manifest itself as appearing drunk, as can sleepwalking. Both are stress-related). These all get reported to the company, which has to take formal action, and that is when it all comes out about the multiple layers of stress the pilot is suffering but hasnt dealt with properly. And facing dismissal or a serious sanction adds massively to the overall stress levels, which only makes matters worse. It is worth stating at this point that we are talking about a very small minority of pilots here. Data from mature Peer Support Programmes (PSPs) indicate that 95% of the pilot population cope with lifes stresses without needing any help from outside their inner circle of family and friends. It will be interesting, however, to run a survey in 20 years time to find out what percentage have sought assistance from a PSP at some stage in their careers. The point of looking at these extreme minority cases is that they can provide warning flags for the rest of us to be aware of the impact that stress in our lives and particularly multiple stresses can have on us mentally and physically, often without us knowing. Pilots view the inability to solve problems on our own as failure and, of course, pilots famously dont do failure Why dont pilots seek help? Why didnt these pilots under investigation seek help for their issues earlier and without the potential jeopardy of a formal process? My theory, based on nothing more scientific than dealing with these individuals over most of my career, is that pilots dont seek help for one of two reasons. Firstly: pilots are recruited and trained to be independent problem solvers, and we view the inability to solve problems on our own as failure. And, of course, pilots famously dont do failure. There can be a tendency to deal with each issue as a series of actions (confirm diagnosis of mums Alzheimers; find suitable care home; arrange finance; take dad to see mum at the care home, which is 30 miles away, on the first day after each block of work; make sure dad is OK on his own and keeping on top of his property; and so on) and think that this is all that is required. Layer another stress or two on top of this, which need their own sets of actions, and its easy to see how considering the FCOM and the long-term impact of everything on the pilot just gets forgotten. They are my problems, not the companys is a common explanation. Until they arent. Secondly: pilots often dont seek help because of fear fear of losing their medical, which is the inevitable (they think) consequence of taking time off to get professional help, and the fear of actually dealing with the emotional fallout of significant trauma. Implications Recent research1 in the US showed that 56% of the pilots interviewed reported a history of healthcare avoidance because they feared losing their medical. About the best you can say about that shocking statistic is that its better than it was 10 years ago. Since the Germanwings tragedy, awareness overall of the importance of pilot mental health has increased significantly and the availability of peer-support programmes, driven by EASA and now UK legislation, has improved the numbers of pilots seeking help for mental health issues. But there is still a long way to go. The psychological implications of a partner attempting suicide, or a child self-harming, are so profound and almost certainly uncharted territory for the pilot that one can understand a reluctance to go there. Combine this with the belief that revealing a mental health issue will result in your medical being pulled permanently (it very, very rarely does) and it perhaps isnt surprising that the pilot will find other methods of coping. There is fierce debate about whether alcoholism causes mental health issues or is the result of mental health issues, but it is interesting to note that the recent AMCs published by the UK Government for the support programme legislation2 highlight the importance of operators tying together education on PeerSupport Programmes with psychoactive substance abuse awareness. It is probably not contentious to say that any problems with alcohol are unlikely to improve if mental health issues (co-morbidities) remain unaddressed. Summary If you were unlucky and had a couple of accidents in succession in your car, and shortly after getting them fixed the car developed a worrying noise, would you ignore it and continue to drive at high speed on the motorways hoping that it would fix itself? Trauma affects us all, and the more severe the trauma, or when multiple layers of trauma are combined, the greater the impact. I know us pilots think we are superhuman and can cope with anything, but were not and we cant. If you are having a tough time in life, particularly on more than one front, then please consider the FCOM. Use your team to give you an external perspective: you may be in the eye of the storm where all is calm but chaos is reigning all around with your nearest and dearest. Help is available so that you can better deal with the psychological ramifications of what is happening to you, and a lot of the time you will be able to fly while receiving that help. You might be able to cope with it all on your own, but you are eroding your safety margins and the price of misjudging that can be very high indeed. References: 1 Hoffman et al: Journal of Occupational and Environmental Medicine, 2022 2 AMC1 CAT.GEN.MPA.170(b):(d):(3)