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[Pages:10]You'd Better Sit Down: There's Been A Crash

No overall plan exists to deal with the psychological grief of survivors of U.S. air accidents, say the authors. They report on a program aimed at meeting the post-crisis needs of one group of U.S. airline employees and their families.

by

Linda F. Little, Ph.D. and

Irene C. Gaffney, M.S.

"What struck the Reverend ... most forcibly as he moved among relatives of the Pan Am Flight 103 casualties was their furious denial of the event. They shook their heads, pounded tables, pushed their fists in their eyes. One woman fell to the floor in the raw grip of hysteria, screaming, `My baby, my baby ... .'" (Newsweek, January 2, 1989, p. 21).

shock and aftereffects upon survivors, no data exist about how airline employees cope with an air crash within their own carrier or in the system at large. Few organized services at any of the major carriers are provided to assist employees though the post-crash period. Those known to exist within the U.S. are sporadic, and were developed in the aftermath of a specific crash.

According to U.S. National Transportation Safety Board statistics, there were 33 accidents involving U.S. scheduled airlines in 1987, 29 in 1988 and two, at the time of writing this article, in early1989. The grief of surviving family members has been chronicled for the public to observe in various forms of media presentations. It has been called, "the cruelest kind of grief," (Newsweek, January 2, 1989), since it occurs when relatives are anticipating a homecoming. Rather, they are faced with ruin.

The American Red Cross, airline managements, employee groups and various other groups have begun to intervene with the waiting relatives within hours after a disaster's occurrence. However, no overall disaster plan which deals with the psychological grief of survivors -- of passengers and relevant aviation personnel -- currently exists within the U.S. aviation community.

Although there is extensive research about human reactions to disasters (earthquakes, floods, bombings, etc.) and what types of services are needed to minimize the

After the Crash: What if Employees Don't Cope?

Companies, much like individuals, are equally vulnerable to sudden death and disaster that involves members of their group. Management and employee groups need to experience a healing process for ultimate adaptation.

If grief is resolved at the corporate level, companies could expect to experience higher incidences of stressrelated symptoms within the employee groups. These symptoms include absenteeism, psychosomatic illnesses, actual increases of physical illnesses, drug and alcohol abuse, increased medical expenses, increased grievances, co-worker and worker-supervisor problems, employee attrition, and deterioration of morale for the entire work force. Such symptoms can occur from six months to two years following a tragedy, and in many cases are not linked in the minds of the employers or employees to the unfortunate event.

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How to Intervene

This article will focus on part of a systemic approach that was utilized for intervention with airline pilot groups following two major air crashes involving U.S. carriers. Although targeted for a specific employee group, implications are relevant for management teams, ground crew and other flight crew personnel.

This system was implemented by PIERRS (Professional Information, Education, Resources, and Referral Services) specifically to meet the post-crisis needs of commercial airline pilots and their families. All services were oriented toward enhancing aviation safety.

For a 30-day period after each crash, pilots and family members had access to a 24-hour toll-free crisis counseling line. The line was staffed by trained counselors who were knowledgeable about current working conditions in the larger aviation community and within specific carriers. They were also professionally trained in coping with grief and loss. The telephone counseling was backed by a national referral network of licensed mental health professionals. These professionals were available to provide services for employees who wanted grief-related counseling in their local area.

Contact was made by counseling staff with the go-team pilots assigned to work with the various accident investigating teams throughout the aftermath of both disasters, and with eyewitness pilots. All other contacts were initiated by those who wished the services.

Staff also developed an educational document, "You'd Better Sit Down: There's Been a Crash," which was mailed to the homes of pilots. The document informed the pilots and their families of the available counseling resource. The primary purposes were to educate the employee group about typical responses to an unexpected tragedy, and to provide a mourning ritual through which pilots and their families could begin the healing process.

A Caveat to Consider

Grief is a universal phenomenon. Expressions of grief and rituals that are designed to heal the loss are, however, cultural specific. It is hoped that the educational approach outlined here could be reviewed within the aviation communities from other countries so that its application could be adjusted and made culturally relevant. The larger context would change. The ritual provided might need to be adjusted, but the goals remain the same: (1) to enable those who work within the aviation community to acknowledge the loss and their connectedness to it, (2) to provide a means by which they could honor the dead, (3) and to encourage individuals and working groups to find support from

others and within themselves so that they could move beyond the loss and continue their personal and professional lives.

The Larger Work Environment: The Backdrop to a Crash

The crash event must be viewed from the larger context. The pilots from the airlines with which we intervened were like many pilots in the U.S. "Deregulation Era." Many had been employed by one or several airline companies which had undergone acquisition, merger, sale, or bankruptcy. They experienced the stress associated with job and career instability, financial insecurity and absorbing, or being absorbed, into another pilot group and corporate culture. The backdrop of their work environment included: a recent merger that was in an initial adjustment period, air traffic control problems, problems with scheduling, delays, consumer complaints, maintenance and safety issues, strained labormanagement relationships, strained relations within labor groups and long commutes due to domicile closings. The identity of the specific airline carrier and the relevant crash are purposely omitted here as these facts are secondary to the process of the intervention presented.

The original version of "You'd Better Sit Down: There's Been a Crash" was written for a specific audience of pilots/families at a specific point in U.S. history. The characteristics of pilots and the descriptions of the larger working environment which are included should not be interpreted as suggesting that all pilots are like those described in the paper nor that all carriers have similar histories, issues and cultures. The pilots killed in this crash were males. The press immediately suggested that the cause of the crash was most likely due in part to pilot error. These specifics are reflected in the intervention. A similar intervention has been adapted for other groups of pilots who also experienced a crash. It could again be redesigned for relevance with management and other aviation employee groups who experienced a crash. The following material was mailed to the homes of pilots by the affected carrier:

"You'd Better Sit Down: There's Been a Crash"

We are responding to the tragedy of Flight ... . You have lost fellow pilots, other flight crew members, and an estimated ... (number of) fellow human beings in an accident. The nation at large feels the impact of your carrier's losses. The media has quickly attributed the cause of this tragedy, at least in part, to pilot error. The families of the pilots killed in the crash had no time to prepare for their loss, no time to say good-bye, no time to anticipate the grief that would befall them. The lives

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of their loved ones were interrupted in their prime when the deceased had major responsibilities (emotional, financial) and vital roles (husband, father, pilot, friend). Victims who die suddenly in their prime leave the biggest holes in families. They cannot easily be replaced. Life is interrupted, tasks to meet and dreams to be fulfilled are instantly halted.

Family members are most likely in a stage of shock -- an alarm has sounded to which they need to respond. Over the coming days, weeks and years they will experience an interruption in their lives, the magnitude of which could not be anticipated, and a series of emotional reactions to their loss that will be intense, prolonged and repetitive.

How People Respond to Loss

Adults experience a whole variety of thoughts, physical reactions and emotions after the death of a loved one or close friend including:

? Guilt associated with the last contact, with unfulfilled wishes and dreams, with conflict and anger, with being left alive.

? Change in appetite.

? Tremors, clammy skin, sweating or chills, difficulty breathing, overwhelming tiredness, body aches, increased heart rate, breathing rate, and abnormal blood pressure levels.

? Decreased abilities to think clearly, to make decisions and to solve problems. It is as if all cognitive facilities have gone into slow motion. The survivor feels disoriented, confused, unable to get his or her bearing.

? A great desire to not feel -- to not think -- to escape all responsibilities and to avoid contact with others who have strong emotional ties. It is not uncommon (while it is potentially damaging) for parents to want to avoid their children during this time. Just as love has no bounds, grief also knows no bounds, and the strong feelings of attachment felt with those still living are difficult to separate from those felt for the recently dead.

? Memories.

? Remorse about topics left unsettled, unsaid, unresolved.

? Anger at being deserted.

? Aloneness, isolation.

? Idealization/bastardization. Strong conflicting feelings of love and hate felt for the victim(s) can vie for attention.

? Shame about living. The survivor might question how long he or she should feel bad. How can they cope with any joy, any enjoyment of life? How long do they need to remain in constant misery?

? Being overwhelmed by the nature and the magnitude of the loss. All else pales in its wake. The agendas and routines that are a part of normal day-to-day living (schedules, appointments, chores) now seem insignificant.

? Longings.

? Inability to be comforted. Contact with others seems odd. There is emotional distancing from those who remain.

? Fear of the present and of the future.

? Shoulds. I should have ... . He should have ... .

? If onlys. If only I had ... . If only he had ... . If only they had ... .

? A sense of unreality. Time is distorted.

? Frightening dreams occur. The survivor may begin to fear sleep. At later stages of grieving, the dead loved one often reappears in dreams in a comforting manner. Those who have reconciled their loss, can experience these contacts as support, as assurances that they are at some level still connected.

? Enmeshment. A part of the survivor's self died with the victim. It is difficult to establish the boundaries that separate the two.

? Questioning of religious and spiritual beliefs. A quest for answers.

? Physical symptoms may be frightening. It is typical for survivors to experience physical symptoms and to wonder at their seriousness. The possibility of one's own death takes on a new reality. Typical symptoms that may occur following a severe trauma include:

How Peers Respond to Loss

Those affected by an air tragedy extend beyond the immediate families of the victims to include fellow pilots at their carrier and throughout the aviation community. At some level, each pilot has acknowledged

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the possibility that his or her life could end this way. Each pilot's family has imagined a similar scenario. Because grief has no time limits, when a disaster occurs, it can remind people of their own past losses, making the tragedy very personal.

Employees' responses to a tragedy that involves coworkers often depend upon other work stressors that they may be experiencing. Employees whose professional attitudes and behavior change in negative ways, as a result of work-related frustrations and job strain, usually choose to totally distance themselves from the losses of a work-related tragedy. They can pretend that it wasn't real people who lost their lives. The cynicism, anger, hopelessness and helplessness so typical of stressed employees can be reflected in a "so what" attitude. Off-colored jokes about the tragedy may be told, slurs against individuals may be made, and the victims themselves may be blamed for somehow "causing" the tragedy. The strong emotions one might feel are attributed to other causes and not to the grief that the individual, at some level, is experiencing.

Such employees are extremely vulnerable to experiencing strong post-traumatic reactions when a work-related tragedy occurs. As observed by experts from the U.S. National Institute of Mental Health (NIMH):

"Since experiencing both types of stressors (work stress and catastrophe) lowers a worker's psychological defenses, it seems reasonable to expect that suffering from both sources of stress in the same disaster would be very damaging to the worker's health and wellbeing. The interaction of the two stress patterns, in other words, may enhance the effects of each, so that a worker already at risk from one is highly vulnerable if exposed to the other (Hartsough, D.M., & Myers, D.G., p. 34)."

Peers can also experience grief symptoms, which can be experienced at varying degrees of intensity and duration. Remember that grief is a positive, healing human response. It occurs when a human being acknowledges the value of human relationships, the value of life and the loss that is created when attachments are severed. Grief is highly correlated with caring for others. The absence of an immediate grief response (denial, anger, bargaining, depression and acceptance) says something about both the overwhelming nature of the tragedy just experienced and one's ability to tolerate additional emotional trauma and stress.

A pilot might think it desirable to find a way to not feel any emotional reaction to a crash -- "to take a pill," to get back to work and push aside any feelings, so that the strong emotions following the tragedy are not expe-

rienced. Such a solution has far reaching ramifications for all other relationships in the pilot's life.

One characteristic of stressed employees is isolation. Isolation for pilots can easily become a way of life. Many pilots commute to their assigned trips and rarely fly with the same crew. After a crash, pilots may perceive demonstrations of caring and support offered by others as expressions of sympathy or pity. Outwardly, at least, they might suggest that they do not want to be pitied. After years of work stress, they have increasingly shielded themselves against being hurt by others, and they also have shielded themselves from being touched and comforted by others. Expressions of caring may be responded to with anger, denial and often cynicism. The person broods that "nobody cares," and that his feelings "don't matter" to others, yet overtures of caring are actively rejected. This perpetuates the feeling of isolation. Out of fear of receiving hostile responses, good-intentioned people learn not to reach out. They learn that any response they make may be taken as a wrong response. And, the stressed pilot remains alone.

The Impact of Human Error

How does the concept of human error or pilot error impact on pilot responses to the air crash? Following the crashes of several major air carriers, counselors talked with hundreds of pilots and reported a range of responses that included:

Disbelief

Anger

? at those who point to pilot error; ? at the evidence that supports human error as a

contributing factor to the accident; ? at the press who declares a "cause" before all

evidence is gathered; ? that fellow pilots could have, in some way, made

an error that contributed to the disaster; ? at the charges that have been levied against pi-

lots in general as "complacent and bored;" and, ? at the few people who have come to the defense

of airline pilots as trained professionals dedicated to protecting the lives and safety of passengers and crew members.

Bargaining

? I can accept this if ... . ; ? I can continue to fly if ... . ; and, ? I can continue to feel good about myself and my

profession if ... .

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Depression

? about the actual accident and the losses that follow;

? about the state of affairs for airline pilots as, "professionals;" and,

? about your own life, dreams and goals.

Research and observations of those who have survived a tremendous personal loss suggest that acceptance occurs when:

? the losses have been accepted as real; ? the varying emotions that accompanied the loss

have been accepted as valid; ? help and comfort have been accepted from, and

offered to, others; ? self-dignity remains intact; and, ? the person is reenergized to reinvest and take

active control of his or her life.

Attributing an accident to human error is a very simplistic solution to a very complex process. As stated by a major air carrier's spokesperson, "Nobody is infallible. ... What we try to do is have enough backup systems in place. Hardly any accident occurs that there aren't a whole chain of events that occurred. If you can break that chain you have a safe operation." [emphasis added]

If human error were to exist, it must be established which events outside the cockpit contributed to that error. If you believe, as many mental health experts do, that any behavior makes sense as an attempt to problem-solve and to cope with all the factors that determine one's current situation, then you must look to the larger environment to see what contributes to mistakes, poor judgment and lack of concentration. In everyday life, what events cause one to drive off with a car door open? It, or something similar, such as leaving a coffee cup on top of the car or locking keys in a car, has most likely happened to each of us at one time in our lives. When? When we were distracted, preoccupied, worried, or distressed. Mistakes are a human response when one can't concentrate, focus or screen out disturbing thoughts. All of these reactions are common coping mechanisms used to deal with stress when the demands of one's environment exceed one's coping skills.

Pilots, like all humans, experience stress. Without some amount of stress we couldn't exist. But when life events place demands on us that exceed our ability to adapt we experience dis-stress. Loss of a loved one, divorce, separation, change in work status, work expectations, corporate mergers and acquisitions all are recognized as life events that can, singly and in tandem, trigger stress-related symptoms (emotional/psychological, physical, behavioral). It is important to remember

that stress is cumulative. It can be the result of intense, sudden events or ongoing, chronic conditions that wear down the individual until symptoms develop. It is equally important to keep in mind that symptoms may develop up to two years after a single stressful event.

Aircraft accidents can't be laid solely at the feet of individual pilots. The larger context has to be explored.

In 1986 and 1987, a team of psychologists, therapists and researchers at Virginia Polytechnic Institute and State University, Blacksburg, Va., U.S., investigated the reported stress levels of pilots from one carrier with long term, unstable working conditions and compared those responses to those of pilots from two stable carriers (June 1987 issue of Air Line Pilot Magazine, "Deregulation Aftermath"). The differences between the reported levels of stress and well-being between pilot groups were significant. For example, pilots from the two categories of carriers (stable and unstable) differed significantly in the degree of physical symptoms experienced, perceived mental health functioning, level of symptoms of depression, financial worries, levels of marriage and family conflict, self-esteem, optimism about career futures, and the degree to which they felt they could control work-related events. The work environment can strengthen an individual's ability to cope with the rest of the demands of living, or the work environment can be so stressful that demands on the person at work spill over and impact all other areas of the person's functioning.

What Are Valued Characteristics of Commercial Airline Pilots?

Commercial pilots are professionals:

? trained; ? checked regularly for competence and health; ? loyal and dedicated; ? perfectionistic; ? threatened when their competency, their profes-

sion or their security is attacked; and, ? tied to family responsibilities, financial respon-

sibilities, a professional image with standards, status, and expectations.

Equally, pilots are imperfect humans in an imperfect system!

When threatened they experience stress:

? internally; ? interactionally; ? in job performance; ? in enthusiasm; and, ? in self-esteem.

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