Sunday, February 1, 2009
PTSD, Aviators and Command
Combat aviators tend to be fiercely independent, self-reliant, type-A personalities; the personality type also most likely to ignore or pigeon-hole physical or psychological symptoms that may reflect a deeper medical condition. Denial is a powerful mental weapon and aircrews are among the best at wielding it. This month I want to offer some suggestions for military commanders and civil aviation leaders whose crews have returned from combat duty.
When your pilots return from duty overseas, their post deployment health assessments offer them the opportunity to document exposure to various pathogens, compounds and/or psychologically disturbing situations that could trigger post deployment physical or mental illness. These forms are written in ways that often vector the aviator toward a decision to not disclose their exposures as it may affect their career with a short-term flight grounding or security clearance downgrade. Furthermore, if a combat pilot suspected that he might be experiencing mental illness symptoms it is likely that he would strongly suppress the notion and/or the symptoms as it would usually result in immediate grounding. I know that many crewmembers are diligent and safety minded and would seek treatment. My assertion stands that many also would choose to ignore or conceal those symptoms and not seek treatment because Type-A personalities are particularly good at compartmentalization, allowing them to focus on demanding flight tasks. My advice is for this group.
I have first-hand experience with crews returning from combat after flying some pretty harrowing missions. One group fits the conceal/ignore (C/I) path and the other fits the seek treatment route. One crewmember in the C/I camp displayed immediately noticeable behavioral changes. He had experienced a traumatic event, was noticeably agitated and had chronic insomnia. His symptoms also included a "flexible application" of rules and boundaries. His behavior resulted in family and legal troubles despite referral for post truamatic stress syndrome (PTSD) counseling. The other group sought treatment, accepted their short-term grounding fate, and later received significant accolades and awards for their combat performance. The bottom line for them was no long-term stigma or career problems. Providing the vision to see past the short-term career interruption imposed by treatment is the challenge for leaders; to keep their best aviators in top shape and ready for the next challenge.
After researching the disorder, I came to discover that PTSD often triggers violent or criminal activity that may or may not be related to previously existing behavioral aberrations. If a person had a propensity to break rules prior to the event, subsequent PTSD may contribute to chronic rule breaking rationalization. A leader should: 1) recognize a behavioral change has occurred after the traumatic experience; 2) acknowledge and document the change, not ignore it or wait for it to subside; 3) find the key symptoms on the Veterans Administration Web site: http://www.ncptsd.va.gov/ncmain/index.jsp; 4) talk to the individual and encourage/direct treatment as allowed; and 5) ground or remove the individual from flight status, if required for his and others safety until properly treated. Legitimate PTSD diagnosis must encompass the following: 1) the individual must have experienced a traumatic event; 2) they must re-experience the symptoms; 3) they suffer from anxiety/arousal that causes life disruptions (insomnia, edginess, defensiveness); 4) they tend to succumb to avoidance/numbing coping mechanisms. Members eager and willing to talk about their significant events are usually not the victims of PTSD. The ones seemingly detached, emotionless, evasive, disproportionately defensive, and careless frequently are victims.
Helicopter crews are often the closest to traumatic combat events whether it’s combat rescue, medical evacuation, assault operations or resupply. They’re either delivering weapons "up close and personal" or pulling out folks that have been on the receiving end of hostile fire. Regardless of the mission, it’s important to be sensitive to the fact that even your best, toughest airmen may be affected and that you are responsible for their welfare, mentorship and counseling, and safe flight operations in your organization.
The challenge for leadership is to take the time to learn about the disorder as it’s your responsibility to take action if the member does not. Informed action is the key. Go to the V.A. web site and its PTSD links. Study the syndrome. Talk to PTSD counselors to gain their advice for how to help your crews. Informed observations are the key to proper counseling and direction. How you can observe behavior if the member is concealing his symptoms? It isn’t difficult to recognize overt symptoms that PTSD sufferers fail to conceal. Ensure that your counseling includes informed discussions of recent, more lenient policy changes regarding security clearance issues for mental illness treatment (http://www.army.mil/docs/OSD_Guidance_on_Revised_Q21.pdf). Ensure your crewmember knows that treatment may come with or without flying status grounding, and is designed to get them back into the game, not keep them out. Make sure that their perspective is on the treatment’s long-term benefit for them and the organization. Learn more about the disorder and share that knowledge with your crews to help them watch and protect their wingmen. The longer we’re in the global war on terror, the more these disorders will surface and helicopter crews will have a disproportionate share of those victims. Be informed, vigilant, engaged and helpful.