msnbc.com (oberg): Veteran NASA doctor says agency must do more

Personal situations could detract from ability to handle stressful jobs

http://www.msnbc.msn.com/id/17049013/

By James Oberg, NBC News space analyst // Special to MSNBC

February 8, 2007

A NASA astronaut flying a T-38 jet in May of 1989 came within a hundred feet of hitting a Pan American passenger jet, barely avoiding a colossal tragedy. The astronaut, David Walker, had just returned from commanding his first space shuttle mission — and was reportedly involved in a bitter divorce.

Although NASA never made any official mention of his stressful family situation, it clearly considered him at fault. He was grounded and removed from command of a later scheduled shuttle flight. The flying ban was eventually rescinded and Walker went on to command two more missions safely before retiring in 1996. He died in 2001.

Serious questions are being raised this week about how closely NASA monitors the mental health of its astronauts, particularly regarding personal situations that could detract from their ability to handle their stressful jobs. NASA Administrator Mike Griffin has ordered a full review of current procedures and an assessment of potential improvements to them.

Veteran NASA flight surgeon and professional psychiatrist Patricia Santy worked at NASA's Johnson Space Center in Houston from 1984 and 1991. She talked to MSNBC.com about NASA practices and her thoughts about potential improvements to the screening process.

Working at NASA’s Johnson Space Center in Houston from 1984 and 1991, Santy eventually became a flight surgeon, or flight doctor, at Mission Control Center. She also is a board-certified psychiatrist, and helped develop psychiatric standards used to assess astronaut applicants in that period.

Santy literally wrote the book on the physiological analysis involved in choosing space flyers titled "Choosing the Right Stuff: The Psychological Selection of Astronauts and Cosmonauts." She is widely regarded as a leading authority on the psychology of human spaceflight.

Santy says she considers crew mental health to be just as important an aspect of flight safety as physical health and hardware function — and deserving of just as serious consideration. Although, she says, that's hardly the case. “NASA won't even launch the shuttle if a screw is out of place in its hardware,” she said, “but they don't think that this kind of interpersonal stress can result in catastrophic failure in the human element of their space system.”

Santy said there has been progress, but that there’s a long way to go. “It is better than it was in the past, but as an institution, NASA tends to deny behavioral issues are a big problem for astronauts,” she said.

NASA needs to go further

Santy believes that the selection procedures, which screen for psychiatric disorders, are sufficient. But they should go further. “No selection procedure — no matter how good — can serve to identify future problems,” she said. “The problem for NASA is that there is no routine follow-up of the psychiatric or psychological evaluation after selection.” The space agency, she believes, “has always had a lot of hubris in this area.”

“People who make good astronauts are not particularly insightful individuals in general,” she said. “They have what can be called an ‘anti-psychological’ attitude and believe that they can cope with anything on their own.”

This can become a problem because “while astronauts are in general very stress tolerant, they are hardly immune from developing problems in their lives that can affect their performance both in their ground-based roles and their space roles.”

She said that has led to bad policies on astronaut mental health. “NASA's failure in this area has always been an overreliance on astronaut's own assessment of their mental health and their inability to recognize that interpersonal issues, stress and psychological factors can have a profound impact on performance.”

This reticence to submit to formal psychological support programs can lead, Santy argues, to a worrisome practice — secret, private counseling shielded from NASA.

“When either medical or psychiatric issues arise, astronauts will surreptitiously go outside the system because they know it will cause them to get grounded. When that is discovered — and it usually is — there have never been any serious consequences.” This practice has reportedly gone back decades, to the very beginning of the astronaut program.

Santy said NASA needs to take control over backdoor counseling and employ a defensive screening program of its own. “NASA needs to be able to identify such problems early and intervene both for the sake of the individual and for the sake of the program,” she said. “The psychological evaluation should be a standard part of all the annual medical evaluations and not just at selection.

"Astronaut managers and flight surgeons should make sure that psychosocial events have not occurred in the astronaut's life that could have an impact on his or her performance as an astronaut — and they should not just take the astronaut's word that they haven't.”

Conflict of interest

But leaving the process entirely in the hands of flight surgeons at the Johnson Space Center, she said, has a number of serious weaknesses.

First, many medical specialists in the flight surgeon office are personally campaigning to be selected as astronauts — and senior astronauts sit on the selection boards.

“This presents a conflict of interest,” Santy said. “And the culture will strongly be biased against a flight surgeon who makes an unpopular decision regarding an astronaut's flight status — their future career as an astronaut is decidedly jeopardized.”

And it’s not just threats of retribution. “NASA does bully flight surgeons when they don't come up with the decision to allow an astronaut to fly,” she said.

One incident during her tour of duty involved a mission commander who was undergoing secret (non-NASA) treatment for kidney stones, a problem that officially called for removal from flight status. “He should have been grounded,” Santy said. “That was part of the medical standards.”

Instead, because he was on a high-profile flight, the doctors were overruled. “It was decided that NASA scientists had it all wrong about kidney stones being a problem for space flight,” she explained. “Maybe they did, but just prior to a flight was not the time to suddenly change the conventional scientific issue and decide differently.”

Look to the military, private sector

Santy said NASA should take lessons from more rigorous psychological screening programs conducted by some military organizations or commercial high-tension professions.

“NASA could look at the procedures for referring problems to the flight surgeon or the flight psychiatrist that are used in the U.S. military,” she said. “They should make psychological monitoring a part of ongoing NASA operations.”

So far, there are no signs that this has ever been done at NASA. “But it has been done in the old Soviet space program and is done in the Russian and European programs today,” she said.

“One astronaut told me once that he didn't see how crews could possibly have interpersonal problems when they train so long together,” she recalled, adding that such a statement “betrays a significant degree of psychological naivete.” It's just the kind of ‘hubris’ she is worried about.

“Astronauts may in many ways be extraordinary people, but they are human beings,” she said. “They have interpersonal conflict with their spouses, their kids, their colleagues. They experience love and hate. They fight with their colleagues just like everyone else does. When they do have strong emotions it can negative effect their judgment — just like anyone else.”

That makes it NASA's responsibility “to determine if any of that — or any other interpersonal stress — is having an effect on the astronaut's performance and judgment.”

NASA’s reaction to the David Walker near-collision in 1989, is still unusual — and ambiguous. As it turns out, there was a certain degree of air-controller error involved in that incident, but Walker was the one who was acting distracted. Why it happened — and what to change to make sure nothing like it ever happened again — was never understood.

link to description, discussion of her book

http://photos1.blogger.com/img/73/1394/640/5.jpg
Dr. Pat Santy in Mission Control, Houston
photo courtesy "Dr. Sanity" blog
http://drsanity.blogspot.com/