The healthy motivation to fly: no psychiatric diagnosis

Aircrew mission effectiveness may uniquely be influenced by subtle psychological factors not ordinarily brought to the attention of psychiatrists. Pilots tend to be bright, articulate, and anxious to resume their aviation duties when grounded. However, these patients are usually well defended, and rarely psychologically attuned or introspective. Greater insight into what constitutes the normal, healthy motivation to fly will help those who make judgments regarding the return of grounded aviators to flying duty. A review of associated birth order, personality theory, industrial and business psychology, aerospace, and psychoanalytic literature is presented. Highlighted are the difficulties inherent in examining the motivation of a healthy, well-defended population. Our conclusion: an examiner's countertransferential feelings are the best available tool for measurement of healthy motivation.

The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War

The authors examined the effectiveness of the prevailing treatment doctrine stressing the principles of proximity, immediacy, and expectancy for combat stress reaction among Israeli soldiers in the Lebanon War. Two treatment outcomes were measured: return to military unit and presence of posttraumatic stress disorder. All three treatment principles were associated with a higher rate of return to the military unit. The beneficial effect of frontline treatment was also evidenced by lower rates of posttraumatic stress disorder. The authors suggest that these principles can also be effective in treating other forms of posttraumatic stress disorder.

The USAF pilot selection and classification research program

A multi-year research program to improve the selection of pilot trainees and the classification of student pilots for either fighter or heavy aircraft training is described. A battery of experimental tests measuring psychomotor skills, personality traits, and cognitive abilities is being given via computer prior to training. The subjects' performance in training and operational flying is then tracked and analyzed. The preliminary results and future directions of this ongoing program are discussed.

The military performance of soldiers in sustained operations

Two 9-d tactical defensive exercises were carried out. The first assessed and compared the performance of three platoons of infantry scheduled for either 0, 1.5, or 3 h of sleep in every 24 h, and the second determined whether soldiers are likely to remain militarily effective during a period of partial sleep loss following a period with no scheduled sleep at all. To this end, 10 infantry soldiers were scheduled for 4 h of sleep in every 24 for a 6-d period following a 3.75-d period without any scheduled sleep. Performance, physical fitness, and mood were assessed throughout both exercises. Results indicated that the effects of sleep loss are psychological rather than physiological; soldiers are likely to be militarily ineffective after 48-72 h without sleep; and a small amount of recovery sleep relative to the amount lost has very beneficial effects.

Homosexual men and women who served their country

The present work examines the effectiveness of United States military policies in excluding homosexual men and women from the armed forces by comparing percentages of homosexuals who have served in the armed forces with matched samples of heterosexuals. Interview data on 1,456 respondents from 1969 and 1970 are reported. The data show that homosexual and heterosexual men seem equally likely to have served in the military, while lesbians were more likely than heterosexual women to have served. The data also indicate that the policies of excluding homosexuals from the services are ineffective. The explanation for this may be that many homosexuals may not be aware of their homosexuality at time of entry into the service, and, hence, cannot readily be identified either by themselves or others. It is also suggested that certain draft criteria have in fact increased the percentages of homosexuals serving in the military.

Psychiatric assessment of female fliers at the U.S. Air Force School of Aerospace Medicine (USAFSAM)

There were 17 female fliers referred for evaluation to the Neuropsychiatry Branch, Clinical Sciences Division, of the USAF School of Aerospace Medicine, Brooks AFB, TX, between October 1976 and September 1982: five primarily for emotional reasons; seven primarily for somatic disorders and only secondarily for emotional symptoms; two for entry to the Airsickness Rehabilitation/Treatment protocol; and three for routine evaluation in preparation for possible future space flight. This number is too small for any sort of statistical analysis, but one emerging theme has clinical importance. A significant number of male fliers tend to see these female fliers in stereotyped roles--mother, potential sexual partner, little sister, daughter--and then respond to the assigned role rather than to a real person. Whether a woman accepts this projected role as egosyntonic or rejects it as egosyntonic, its existence may affect her real-life role. For example, one woman pilot reported that her instructors seemed to make allowances for her sex by expecting less of her than they did of her male colleagues, "carrying" her along as if she were a little sister. While such role-casting may be carried on subconsciously, its behavioral manifestations are real and may have the potential for affecting flight safety. This study represents an initial approach to the data in this area, and is intended to alert flight surgeons to the implications of such role-casting in the flight environment.

Stress reactions among participants in mass casualty simulations

Specific stress reactions have been observed in health care providers involved in disaster relief and mass casualty care. To determine whether similar stress reactions occurred in mass casualty simulations, we observed the participants in five large military mass casualty simulations. Using a framework of specific questions, descriptive data were obtained using direct observation and discussion with participants by faculty present to evaluate the exercise. Observations revealed that stress reactions occurred consistently during these mass casualty simulations, and these reactions resembled those seen in health care workers involved in actual mass casualty care. Application of this information to disaster medicine training for emergency physicians is discussed.