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The "Break-Off" PhenomenonA Precipitant of Anxiety in Jet Aviators

JOHN A. SOURS, MD, PENSACOLA, FLA

. . ..Icarus, flushed with excitement and exhilara-tion, soared even higher toward the sun\p=m-\despitethecries and warnings of his father. At last he flew so

high that the heat of the sun melted the wax, and offdropped the wings.

CONTEMPORARY developments inbioastronautics have challenged the once heldassumption that "man is a sea-level, low-speed, one G, 12-hour animal." 49 The physi-cal dangers of space flight for the astronautpreviously anticipated with uncertainty,have thus far been technologically over-

come.2,4,7,9 But even after the successes ofrecent short-term space explorations,26,27 thequestion of man's capacity to withstand theemotional and psychological effects of sen-

sory isolation and deprivation is not fullyanswered.* It is now thought, however, thatthe use of two-man teams will obviate inlarge part the hazards of acute sensorydeprivation.52

In 1957, Clark and Graybiel found intheir study of the "break-off" phenomenonthat sensory isolation and confinement are

stresses even for jet aviators flying at theupper margins of military aviation.8 Theycharacterized the "break-off" phenomenonas a feeling of physical separation from theearth experienced by jet aviators flyingalone at high altitudes and relatively un¬

occupied with flight details. In their study"break-off" experiences were reported by35% of jet aviators flying above 13,000feet. Clark and Graybiel found that some

jet aviators reported feelings of detach¬ment, exhilaration, and exalted power, as

well as vivid fantasies and dreamy twilightstates, which they had regarded as pleasur¬able. A few aviators had even been enthralledby their "break-off" experiences, and theydescribed them as blissful reveries. On theother hand, 13% indicated that they hadendured highly unpleasant affects, thoughts,and perceptions: loneliness, anxiety, giddi¬ness, bewilderment, spatial disorientation,depersonalization, derealization, and pseudo-hallucinations.

Causative factors thought to be associatedwith the "break-off" phenomenon wereidentified as those of isolation, high alti¬tude, relative unconcern with routine opera¬tional flight details, acrobatics, and physicaldebilitation.3·8·24·32·38·45 Frequently aviatorsattributed their "break-off" experiences to"having time on (their) hands with littleto do" during an uneventful flight. Effortsat becoming involved in some operationalaspect of flying, such as scrutiny of instru¬ments, joining up with another aircraft, or

returning to a lower altitude, abolished theseunpleasant affects and perceptions. Anytask which called on a major part of theaviator's attention seemed to relieve "break-off" experiences. As suggested by theanecdotal reports of solitary night drivers,radar observers, and oceanauts who hadexperienced various mental symptoms dur¬ing isolation and confinement, the mainte¬nance of vigilance appeared to be an

essential deterrent to the "break-off" phe¬nomenon.

Clark and Graybiel suggested that the"break-off" phenomenon is related topersonality factors, as well as those of highaltitude, isolation, and monotony. The re¬sults of their study indicated that the phe¬nomenon is most apt to be encountered byemotionally unstable individuals.8 In anothersimilar study of aviators, Bennett reportedseveral instances of acute anxiety reactions

Submitted for publication April 27, 1965.Read in part before the 36th Annual Meeting of the Aero-

space Medical Association, April 26, 1965, New York.From the Department of Psychiatry and Neurology, US

Naval School of Aviation Medicine, US Aviation MedicalCenter. Dr. Sours is currently at the Department ofPsychiatry, Columbia-Presbyterian Medical Center, andN.Y.S. Psychiatric Institute.

The opinions and conclusions expressed in this paper are

those of the author and do not necessarily reflect the viewsor endorsements of the US Navy Department.

Reprint requests to 722 W 168th St, New York, NY 10032.* References 1, 2, 12, 13, 19, 25, 33, 34.

Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Pittsburgh User on 09/07/2013

Table 1.—let Aviators With Positive Psychiatric

No. Age Ear.kReason for

Referral Prop

Total Hours Break-Off Phenomenon

Jet35-50,000 50,000+ Greatest Greatest Other Personal

Ft Ft Altitude Speed Aviators Experience

1011121314151617

1/Lt USMCNavCadLCdrCapt USMCLCdrCdrLt

42 LCdr30 Lt

LCdrLtEnsLCdrLCdrLtLCdrCapt, USMC

EvaluationSBFS *: RenalSBFS: EyeSBFS: NPEvaluationSBFS: NP, medSBFS: NPSBFS: NP, medSBFS: EyeSBFS: EyeSBFS: NP, EyeEvaluationEvaluationEvaluationEvaluationEvaluationEvaluation

55037

2,100176

4,7752,800

4003,6001,9302,6361,100

40900

1,600500500

1,350

7502.000

400830

251,7001,000

10091

871650315

2,8001,4001,6501,7501,365

350350200800

2500200300

5100100

101,0001,000

600400375

0.000.000.000.000.000.160.004.000.005.00

10.000.005.000.002.002.00

25.00

50,00047,50049,00043,00040,00052,00040,00052,00035,00072,00052,80046,00055,00050,00055,0065,00062,000

1.65 M t1.20 MLOOM1.30 M250 1150 1.20 M650 550 2.10 M1.40 M1.30 M1.90 M1.90 M2.37 M2.20 M2.20 M

NoNoNoYesNoYesNoYesNoYesNoNoNoNoYesNoNo

YesNoNoYesNoYesNoYesNoYesNoNoNoNoYesNoNo

* SBFS, Special Board of Flight Surgeons,t M indicates mach and K, knots.

occurring in emotionally unstable aviatorsflying alone at high altitudes.3 He attributedtheir panic reactions to solitary high alti¬tude flying which, he thought, had been "aprecipitant factor in the development of(their) anxiety state."3 No explanation,however, was given for aviators who hadencountered "break-off" experiences with-1out significant concomitant anxiety, diminu¬tion in flight performance, or motivation forflying.

The purpose of this study was to delin¬eate further the phenomenology and fre¬quency of the "break-off" phenomenon inexperienced jet aviators. The role ofpersonality factors in the precipitation of"break-off" experiences was assessed. Itwas postulated that the "break-off" phe¬nomenon can precipitate an acute anxietyattack with phobic and psychophysiologicalmanifestations and lead to the developmentof a fear of flying reaction.49 As a corollary,it was also postulated that the "break-off" phenomenon occurs more often in jetaviators with emotional and personalitydisorders. In addition, the "break-off"phenomenon is more apt to be reported byexperienced jet aviators who have greatercontact with high altitude solitary flying.

The findings are discussed in relation tothe proposed postulates and the psychiatricdisorders encountered in a\dation medicine.Pertinent psychological and psychiatricliterature is cited.

MethodDuring a six-month interval in 1962 all designated

naval and marine jet aviators referred for neuro¬psychiatrie consultation were questioned in regardto the "break-off" phenomenon. In some instancesthey had been referred by the Bureau of Medicineand Surgery to the Special Board of Flight Sur¬geons (SBFS) for evaluation of a medical disorderfirst diagnosed by a flight surgeon in the fleet.2*·30The other aviators had been administratively re¬ferred for a comprehensive medical evaluation inorder to determine their overall medical eligibilityfor advanced technological training. These aviatorshad been selected because of previous accomplish¬ments in technical and performance aspects of jetaviation; selection had not been made on the basisof flight time logged in jet flying.

Each aviator was routinely evaluated in an open-ended psychiatric interview. A psychological testbattery was administered to the 11 aviators referredfor comprehensive medical evaluation. Only whenindicated was the battery given to aviators referredto the SBFS. Psychological tests consisted of theHuman Figure Drawing, Rorschach Psycho-Diag¬nostic Test, and Minnesota Multiphasic PersonalityInventory (MMPI). Prior to psychiatric interview,each aviator completed an unofficial aviation re¬search questionnaire^ detailing various facets offlight performance and experience, as well as aware¬ness of and personal familiarity with the "break-off" phenomenon.

Results

During the period of study, 37 jet avia¬tors were evaluated. Analysis of the datarevealed that they could be divided into twogroups on the basis of presence or absence

\s=d\Captain Ashton Graybiel, MC, USN, Director of Re-search, US Naval School of Aviation Medicine, Pensacola,Fla, allowed use of the questionnaire which he devised forhis study of the "break-off" phenomenon.8


Findings, N=17

Diagnosis

Acute anxiety reactionHydronephrosis: obessional personalityGlaucoma; passive-dependent personalityObsessional personality, syncope, psychogenicAlcoholism, passive-aggressive personalityAcute anxiety reactionNeurotic depressive reactionAcute anxiety reactionObsessional personality: myopiaObsessional personality: retinal arteriolar spasm ODEsotropia, VA complaint: conversion reactionNeurotic character disorderUlcerative colitis: Cyclothymic personalityObsessional personalityLabile hypertension: passive-aggressive personalityHeterophoria: schizoid personalityParanoid personality

of significant psychopathology. In regardto the group of aviators with psycho-pathology Table 1 indicates that there were

17 aviators (46%) with psychiatric findings.These findings included the following: acuteanxiety reactions, neurotic depressive reac¬

tion, visual conversion reaction, neuroticcharacter disorder, psychogenic syncope,chronic alcoholism, and a variety of per¬sonality disorders. The second group—aviators with no significant psychopathology—was noted to have various medical find¬ings and disorders (Table 2). General medi¬cal and specialty evaluations failed to revealany medical findings in five aviators.

Comparison of the two groups of avia¬tors (Tables 1 and 2) shows that of the 17aviators with positive psychiatric findingsthere are six men who experienced the"break-off" phenomenon on at least one

occasion. On the other hand, the secondgroup of aviators (Table 2) was strikinglydifferent in regard to the "break-off" phe¬nomenon. Two aviators in group 2, how¬ever, were familiar with the "break-off"phenomenon, one of whom had had such an

experience while flying at high altitude. Hefound the "break-off" phenomenon "ex¬hilarating"; he recalled that he had beenacutely aware of himself and the aircraftand had desired intensely to fly even higher.His euphoria, however, had been temperedby the awareness that giving way to such a

whim would have taxed the capabilities of

his aircraft. Psychiatric evaluation of thisaviator failed to reveal any deficits in egoorganization. Both aviators had been raisedin nurturant homes where they were ex¬

posed to healthy parental models for identifi¬cation. These aviators expressed satisfactionwith their gender role and self-image, andtheir self-esteem was congruent with theiroverall sense of competence.

Only one aviator in the group with posi¬tive psychiatric findings (Table 1) hadfound the "break-off" phenomenon entirelypleasurable. He stated that his several"break-off" experiences had given him adesire to fly "higher and faster," hadmarkedly alerted him and forced him toassume greater control of the aircraft. Hefurther revealed that when flying alone athigh altitudes he felt aggressive and in¬vulnerable. "Flying high makes me feel likea 'real tiger.' " Psychiatric evaluationdemonstrated that this aviator shunned anydegree of closeness in his interpersonalrelationships. On the ground, he was, ingeneral, aloof from and cautious withpeople, reluctantly expressing anger evenwhen justified in realistic circumstances.His passive-aggressive traits were mostmarked in his transactions with superiorofficers. During his overall medical evalua¬tion he was tense, apprehensive, unassertive,and acutely aware of the competitive situa¬tion—factors thought to be partly respon¬sible for his labile blood pressure.

Another aviator, an intellectual andobsessional individual, referred to the SBFSbecause of retinal arteriolar spasm, alsodescribed his "break-off" experiences as

pleasurable to a point. "It's hard to describe. .

.

almost like leaving the world of 'mortals'and sensing you're indestructible; but youknow it's not true." He remarked that the"break-off" experience became alarmingafter a point; it would then make him"jumpy and too alert." He would thenreassure himself that "everyone feels funnyat high altitudes" and "try to forget it" byturning his attention to the immediate flyingtasks before him.

Yet another aviator, evaluated for epi¬sodes of psychogenic syncope unrelated tooperational flying, remarked that his reac¬tion to high altitude solitary flying had beensolely one of increased arousal without anyawareness of anxiety. His use of denial andisolation, although quite effective for flying


Table 2.—Jet Aviators With Negative Psychiatric

No. Age RankReason forReferral Prop

Total Hours

Jet35-50,000

Ft50,000+

FtGreatestAltitude

GreatestSpeed

1011121314151617181920

4038264142292539382432233227344032343736

Major, USMCCdrNavCadCdrCdrLtLtMajor, USMCLtCol, USMCEnsLtLt (jg)Capt USMCLtLCdrCdrLtLCdrCdrMajor, USMC

SBFS: CardiacSBFS: NPSBFS: MedSBFS: MedSBFS: MedSBFS: NPSBFS: EyeSBFS: CardiacSBFS: EyeSBFS: EyeSBFS: EyeSBFS: EyeSBFS: NPSBFS:NPSBFS: CardiacSBFS: NPEvaluationEvaluationEvaluationSBFS: Cardiac

5,0003,500

303,9504,5902,100

8003,3003,505

302,8001,2502,4001,1503,2703,7002,8002,500

9602,200

2,00050

100191

10100

1,050160630300200

27300

25550

1,0!>0350

1,3001,116

50

35020

020

930

60020

250210

501530

350800250700500

£0

0.000.000.000.000.000.000.250.000.000.000.000.000.000.000.005.000.002.00

15.0020.00

47,50042,00012,00042,00040,00045,00051,00043,00050,00043,00042,09040,00042,00032,00046,00056,00045,00080,00071,00045,000

1.20 M t0.98 M350 1.00 M1.10 M1.00 M1.40 M1.00 M1.50 M1.20 M600 800 500 400 1000 2.1 1.95 2.20 2.10 0.94

* SBFS, Special Board of Flight Surgeons,t M indicates mach and K, knots.

stresses, had failed him in a hostile, de¬pendent relationship with his wife.

On the other hand, the remaining threeaviators reporting "break-off" experienceshad been patently upset by them. They de¬scribed them as "dreamy states." One avia¬tor was referred because of frequentanxiety attacks with hyperventilation oc¬

curring both on the ground and in flying.He had observed that prior to the onset ofacute symptoms he had first noticed anxietywhile flying alone at high altitudes. Severalmonths later he developed acute anxietyafter take-off for what was to be a shortflight at low altitude. Two aviators hadacute anxiety attacks with hyperventilationsymptoms while flying at high altitudes.There was no indication that they hadhyperventilated to the point of hypoxia.Preceding the attacks they had been keenlyaware of intense loneliness, isolation, and a

sense of "being out of reach." They hadinitially described their reactions to theflight surgeon in terms of shortness ofbreath. Thorough check of oxygen equip¬ment and carbon monoxide hazards was

unrevealing. They were then referred formedical evaluation of possible bronchialasthma. Diagnostic evaluation including pul¬monary function studies failed to demon¬strate any pathophysiological explanationfor their shortness of breath at high alti-

tudes. In the course of several months theiranxiety had spread to all flying situations.These aviators had developed neurotic reac¬tions to flying which had been precipitatedin part by solitary flying.

The following clinical vignette illustratesthe insidious onset of anxiety in solitary fly¬ing which occurred after the aviator hadbeen given command of a fighter squadron.

A 37-year-old, married Commander was referredto the Special Board of Flight Surgeons because ofa history of bronchial asthma associated with flying.He first experienced difficulties with breathing whilehe was at the Naval Air Station, Corpus Christi. Hewas told by a medical officer that his "asthmatic"breathing was probably due to climatic conditions,although he had similar symptoms several yearsbefore while in a dry climate. He was subsequentlyguarded in discussing his symptomatology withmedical officers for fear that his medical problemmight jeopardize his aviation career.

He thought that he had had his first significantdifficulty in regard to breathing in 19S6, when at thealtitude of 45,000 feet he had experienced a fright¬ening feeling of detachment which he later ascribedto the "break-off" phenomenon. He then attributedthis difficulty, however, to "insufficient oxygen."While on a crosscountry flight in 1957 in a F9F-AP,he again noted shortness of breath which he relatedto hyperventilation. Because of several similar epi¬sodes in flying a F9F at high altitudes he preferredto fly at lower altitudes.

After an enjoyable tour of duty at the ArmedForces Staff College, he reported to a fighter squad¬ron as commanding officer. He was sent immediatelyfor carrier qualifications. He again noticed diffi¬culty in breathing at high altitudes. This caused hima great deal of anxiety with palpitations, dyspnea,


Findings, N=20

Break-Off Phenomenon

Other PersonalAviators Experience Diagnosis

No No Abnormal EKGNo No Fracture L-3No No Rheumatoid arthritisNo No HCVDNo No NoneNo No NoneNo No MyopiaNo No Abnormal EKGNo No MyopiaNo No EsophoriaYes Yes MyopiaNo No MyopiaNo No Cerebral concussionNo No Syncope vasovagalNo No RHD, Mi-compensatedNo No Solitary seizure ? etiolNo No NoneNo No NoneYes No NoneNo No Abnormal EKG

and hyperventilation which resulted in very unsteadyhandling of the aircraft. Often he was concernedabout getting his plane back safely. The patientindicated that because of his "breathing problem"he did not feel himself qualified to assume the re¬

sponsibilities of commanding officer of the squad¬ron. He was referred to a psychiatrist to whom herelated the opinion that no psychological reason laybehind his reluctance to assume his new commandor to fly at high altitudes. He once again stated thathe thought a "breathing problem" was the maindeterrent to his flying.

Complete medical evaluation did not reveal anysignificant cardiopulmonary findings. He was re¬turned to his ship. When an opportunity to fly againwas given to him, he declined because of "a knotin (his) stomach and not just feeling quite well."His symptoms persisted into the next day when hewas again reluctant to fly because of a low ceilingand the possibility that he would have to go to highaltitudes in order to return to the ship. The patientwas then ordered to the Special Board of FlightSurgeons for further evaluation.

During the course of this psychiatric evaluationthe patient attempted to control feelings of resent¬ment and anger toward both his superiors and hispeers. Frequently in the interview it was noted thatat times of stress—particularly when he displayedangry feelings—he hyperventilated. He was unawareof his abnormal breathing until it was pointed outto him. It was further noted that he was moderatelydepressed. He felt "persecuted" because of his in¬ability to fly at high altitudes, although he laterremarked that flying in general had less interest forhim and was less gratifying.

It was thought that the patient was ambivalenttoward accepting a passive role. He had identifiedwith a father, a caricature of masculine aggressive¬ness and abject ineffectuality. He had strong aggres¬sive impulses which in the face of assumingcommand of a fighter squadron caused him consider¬able anxiety. On the other hand he was undecidedwhether to follow his aggressive impulses and

risk the chance of acute distress and possibleself-destruction at high altitudes or to assume apassive-reluctant role and face the prospects offurther loss of self-esteem. Projective psychologicaltests demonstrated these contrapuntal impulses andstrong feelings of masculine inferiority and damagefor which the patient attempted to compensatethrough projection, coercive manipulation, and pseu-doaggressivity. It was thought that the anxiety, nolonger controlled by his defenses and previouslyhigh motivation, had given rise to hyperventilationsymptoms. Medical consultants suggested that thepatient had had in 1956 severe episodes of asthmaticbronchitis. There was, however, no historical evi¬dence of cardiopulmonary findings to substantiatea diagnosis of bronchial asthma or emphysema.

In comparing the seven aviators who re¬

ported the "break-off" phenomenon withthose who never had encountered such flyingexperiences, the only comparison which yieldsclear-cut results is the one for the greaterincidence of the "break-off" phenomenonamong aviators with positive psychiatricfindings (Table 3). In this respect thedifference between the two groups of avia¬tors is significant (P<0.05). Thus thesecond hypothesis is verified. Whether thefirst hypothesis is also verified depends on

psychiatric factors that can be attributed tothe failure of the three aviators who de¬veloped fear of flying reactions. Since thethree aviators were in the group with posi¬tive psychiatric findings, it is likely that thepresence of emotional problems led to theirfailure by way of occurrence of the "break-off" phenomenon. In other words, the"break-off" phenomenon served only to

precipitate an inevitable fear of flying. The"break-off" phenomenon per se is not a

sufficient cause for anxiety in high altitudeflying.

It was further postulated that the "break-off" phenomenon is apt to be reported byexperienced jet aviators who have greatercontact with high altitude solitary flying.Within each group of aviators, those whoreported this phenomenon had more hoursof flying propeller aircraft, less hours injet aircraft, and less hours above 50,000feet. For the other two measures, namely,hours in flight between 35,000-50,000 feetand greatest altitude, the means are criss¬crossed. These results run counter to thepredicted direction. In spite of this, had thethird hypothesis been correct, the differenceswithin the two groups would have beenexpected to lie in the opposite direction. Itis thus quite unlikely that the third hypothe¬sis is true.


Table 3.—Comparison of Two Groups of Aviators in Regard to"Break-Off" Experiences at High Altitudes

Flight Time

Jet Aviators

Break-off experience reported, iV=7

Not reported, N=30

TotalMean .-·-. FlightAge Prop Jet 35-50,000 50,000+ Ft Time

33.0 1,710.3 983.5 441.7 1.86 2,737

32.5 1,339.3 1,072.4 331.1 3.82 2,746

Highest MaximalAltitude Speed

54,000 1.86 M *

800 49,300 1.47 M

550

' indicates mach and , knots.

CommentIn the present study seven aviators re¬

ported the "break-off" phenomenon, threeof whom had experienced varying degreesof anxiety. The incidence of the phe¬nomenon in the present study is lower thanthat of previous studies.8'24 Perhaps per¬sonal, procedural, or motivational variablescan account for the difference. It is possiblethat the aviators studied elsewhere hadflown for longer periods of time at highaltitudes, with a greater reduction in aware¬ness.8 This might account for the higherincidence of the phenomenon, as well as thefrequency of altered states of consciousnessand depersonalization. The anxiety associ¬ated with psychiatric evaluation may haveled the aviators to suppress information forfear that reports of unusual affects andperceptions might put their careers injeopardy. It is also possible that in orderto identify the "break-off" phenomenon itis necessary for an aviator to have heardor read about it. It is conceivable that know¬ing about the phenomenon can foster itsoccurrence by suggestion.22'23,31

Again comparing the results of this studywith previous investigations3'8,24 other phe-nomenological differences are apparent. Inseveral studies mental confusion and alteredstates of consciousness, varying fromobnubilation to unconsciousness, werefound. In the present study there were no

reported instances of pseudohallucinations,dreams, confusion, or loss of consciousness.The predominant findings were affective,either arousal or exhilaration resulting ina desire to fly higher or faster; or, on theother hand, reduced awareness, apprehen¬sion or frank anxiety associated with feel¬ings of detachment, isolation, or physicalseparation. Not one aviator reported actualspatial disorientation.

Why should these more severe perceptualand cognitive disturbances have been re-

ported in other studies ? For instance, one

study reports five aviators who had de¬veloped altered states of consciousness withakinesia and mutism.45 One suspects thatvariables over and above those of alteredsensory input are involved. When acrobaticspreceded the onset of symptoms, G-effectscould have been operative, as well as thoseof fatigue and hypoglycemia.40,46,47 It is alsoconceivable that aviators reporting severe"break-off" experiences had hyperventilatedto the point of hypoxia and diminishedconsciousness, Hyperventilation states lead¬ing to hypoxia and the psychophysiologicalaberrations connected with G-intolerancesyncope can result in disturbances of con¬

sciousness with depersonalization and de-realization.29,36,42

The affective accompaniments of the"break-off" phenomenon seem to be themost important effects of this type ofaltered sensory input situation. As a sen¬

sory deprivation experience, the effects ofsolitary flying are not as far-reaching asthose of experimental situations in whichthe level of intensity or patterning of sen¬

sory stimuli is maximally reduced.19,31,39 Asan experimental model the "break-off"phenomenon comes closest to resembling an

altered sensory environment in which thereis a reduction of patterning and organiza¬tion of sensory input.48,52,53

The jet aviator flying straight and levelhas little to do, particularly if the aircraftis well-trimmed. Movement within the air¬craft is limited to slight variations in theinstruments. There is minimal sensation ofspeed at high altitudes. In flying straightand level in nonturbulent air there is littleexogenous stimulation of the otolith andsemicircular canal systems. The aviator issecured to his seat in heavy clothing andaccoutrements, has a limited view of theaircraft's wings and nose, is subjected tomonotonous background white noise of the


jet engine, and oxygen equipment and has a

relatively unvarying view from his "canopyin the sky." The aviator is thus exposed toa reduction in patterning and organizationof sensory input, while at the same timesubjected to greater than usual stresses ofmilitary flying.

The "break-off" phenomenon, therefore,can be regarded as an attenuated perceptualdeprivation experience fostering varyingdegrees of wakefulness and awareness.

Little research, however, has been done interms of specific effects of perceptual dep¬rivation over several hours duration.51Furthermore, the reported effects attributedto short-term sensory input patterning havebeen questioned.22,52,53 Studies of eye-patched subjects suggest that reducedawareness is the necessary but not sufficientcause of the symptoms of sensory depriva¬tion.40,52 Shurley has challenged this view¬point by stating that the mental symptomsof sensory deprivations occur in alert con¬

sciousness.52In the present study high altitude is not

the necessary condition for the occurrenceof acute anxiety in flight. Furthermore,acute anxiety attacks occur in a variety ofsolitary flying situations where there is no

significant alteration of sensory input,awareness, and wakefulness. In addition,these anxiety attacks are not appreciablydifferent from those precipitated by the"break-off" phenomenon.e,41,4a

A report of a student naval aviator,evaluated independently of this study, isrevealing in this respect.

This 23-year-old ensign was referred for psy¬chiatric evaluation because of anxiety and tensionrelated to flying above 10,000 feet with heavy cloudlayers beneath. He had become anxious when he"realized for the first time how high (he) was."The acute anxiety attack dated from his first flyingexperience in an 0.8 cloud coverage with cloudsranging from 3,500 to 13,000 feet. This flight madehim apprehensive and short of breath, because "theclouds were (his) only visual reference point ; other¬wise, (he) was lost." He had previously flown 30hours in the T2J.

He asserted that on the day of the acute anxietyattack he had been flying solo. His instructor hadindicated later that "a dual hop should have beenflown because of poor visibility that day." He hadnot used instruments and had not been able to see hisusual ground references. The patient had not be¬come disoriented but he had noticed a "foggy feel¬ing." He was able to return to the base by flyingthrough the first break in the clouds. He felt thatthe conditions the following day were very similarand that it would be "unwise to repeat the experi¬ence," so he declined his "hop."

Psychiatrie examination revealed that the patient'smotivation for flying was marginal and that heobtained minimal pleasure from flying. He hadentered flight training as a means of bolsteringhis inadequate sense of gender role so that he mightcome to grips with "this hostile world." He was apassive-dependent man who had been reared in afatherless home where he had beat entirely de¬pendent upon his mother. He feared an identificationwith a phallic mother and denied his identificationwith his impotent father, whom the mother haddivorced. Flying had put the patient into a situationwhere he felt isolated and helpless when left to hisown resources.

In solitary surface travel acute anxietyattacks are not uncommon. A not infrequentexample is that of a motorist travelingalone along a monotonous turnpike havinglittle to do but watch his speed limit. Thistype of driving fosters a sleep state andcan precipitate an altered ego state and acuteanxiety in individuals susceptible to fantasyelaborations of primary process material.And in the analytic situation, which allowsfor the return of the repressed, acuteanxiety attacks are by no means uncommon.

These examples also raise theoretical ques¬tions. Are neurophysiological theories 31,53

relating altered sensory input to afferentreduction in the reticular activating systemvalid for such short-term sensory ex¬

periences ?14 Are there individual differ¬ences in neural organization that bear on

vulnerability to altered sensory input anddecrease in vigilance?

The case material presented in this studysuggests that the "break-off" phenomenonrepresents various altered ego states whichresemble depersonalization and derealiza-tion: estrangement from self or objectassociated with strong affective and per¬ceptual changes. "Break-off" experiencesare the result of alterations in ego function.The effects of solitary flying are phe-nomenologically similar to those of severe

fatigue, hypnogogic states, drug intoxica¬tions, and toxic conditions, all of which can

result in a diminution in awareness of theenvironment, an adumbration of egoboundaries, and partial failure of the syn¬thetic function of the ego.21 Consequent tothe relaxation of attention, censorship issuspended allowing expression of fantasies,memory traces, and primitive body imagein disguise, formed from various levelsof ego development and consciousness. Asin hypnosis, a reversible libidinal andtopographical regression in the service ofthe ego occurs.18


Tolerance for splitting of the ego variesamong individuals. In this study severalaviators felt a sense of pleasure which theyassociated with heightened attention. Theywere able to relax and enjoy the novelty ofthe flying situation in a detached self-observational manner. They revelled infeelings of pleasure while at the same timeguarding with their observing ego and itseffective repertoire of ego defenses againsttotal surrender to the situation. On the otherhand, other aviators experienced reducedawareness and distinct displeasure. Theyambivalently feared passive surrender toemerging regressive feelings and percep¬tions. Their ego response to the dangersignal of anxiety was ineffectual, leading toincreased anxiety and physiological con¬

comitants. These aviators felt the need tojoin up with another aircraft or terminatethe flight. Omnipotence and magic controlwere shattered. Their loss of self-confidencecould be seen as a hunger for objects to

strengthen the self. Psychiatric evaluationof the aviators who experienced anxietywith estrangement revealed that they hadpoorly formed sex-role identities. Theirdifferential identifications with parents hadbeen made on contradictory or inadequatesex-typed models. Furthermore, they re¬

jected dependency strivings which in theflying situation were increased beyond thecapacity of ego defenses and led to disso¬nance between their ideal representation ofthe self and their actual self. In each casethe loss of proper esteem for the self-imagewas prominent.

The three aviators who poorly toleratedthe "break-off" phenomenon were paralyzedby acute anxiety in flying and developedfear of flying reactions.42 This behavioralpattern is characteristic of a neurotic fearof flying reaction which is typically usheredin by an acute anxiety attack and eventuatesin a phobia of flying. Précipitants of suchanxiety attacks can be a trivial accident or

a chance event connected with flying, whichthen weakens the aviator's sense of invul¬nerability. Bond and other investigatorshave described these patterns in militaryflying.6,17,41"43 To these sensory-symbolicprécipitants of anxiety in flying should beadded the "break-off" phenomenon.

In acute anxiety reactions in flying thereoccurs a phobic response with concomitantphysiological symptoms based on a reactiva-

tion through failure of ego defenses of anearlier neurosis involving conflicts of drives,identification, superego imperatives, and egoideals. A sense of internal fear stemmingfrom a neurotic conflict is displaced to anexternal object or situation, which is thenavoided with partial gain to the ego.Through symbolic substitution anxiety isfocused on the aircraft which then becomesthe phobogenic object.11,15 The aircraft isan apt object for displacement of neuroticconflict because of the qualities and symbol¬ism it possesses: a phallic instrument10 ofpower and destruction, as well as punish¬ment and retaliation, directly under the con¬trol and execution of the aviator in space.

In conclusion, this exploratory study ofthe "break-off" phenomenon points to theneed and opportunity for further researchin aviation psychiatry and sensory depriva¬tion, with particular attention to the dis¬crimination of individual vulnerability toaviation stresses.44 Research efforts in avia¬tion psychiatry should be more directed tostudies in psychoanalytic ego psychology,including the conflict-free areas of egofunction such as cognition and perception.io,35,eo -phg practical application of this re¬search to supersonic passenger transport,as well as future space exploration, isobvious. Supersonic passenger transporttravel (SST) will result in travel fatiguethrough increased restriction from seat beltwearing and abrupt changes in clock time.Take-offs and landings (seat-belt time) willbe longer in SST travel. The cabin staff willbe less able to interact with passengers dur¬ing seat-belt time because of restrictionsimposed upon them by acceleration andsteep floor angles. Consequently, SST pas¬sengers may be exposed to greater flyingstresses increasing the likelihood of neurotictravel sickness in predisposed passengers.It can, therefore, be anticipated that psy¬chiatrists will encounter more clinicalproblems related to flying in their everydaydiagnostic and therapeutic work.

SummaryThe "break-off" phenomenon, a feeling of

physical separation from the earth experi¬enced by jet aviators flying alone at highaltitudes and relatively unoccupied withflying details, has been well described.Several studies have suggested that the"break-off" phenomenon is related to the


personality of the aviator and is most apt tooccur in emotionally unstable aviators. Thepresent report is an exploratory study whichaims at an assessment of "break-off" ex¬

periences in aviators who demonstrate, on

psychiatric examination, signs and symp¬toms of a psychiatric disorder.

It is postulated than the "break-off"phenomenon can precipitate an acute anxietyattack with phobic and psychophysiologicalmanifestations and lead to the developmentof a fear of flying reaction. As a corollary,it is also postulated that the phenomenonoccurs most often in jet aviators with emo¬

tional and personality disorders. In addition,the "break-off" phenomenon is more apt tobe reported by more experienced jet avia¬tors who have greater contact with highaltitude solitary flying.

During a six-month interval all desig¬nated naval and Marine jet aviators re¬ferred for neuropsychiatrie consultationwere questioned in regard to the "break-off"phenomenon. Evaluations were done at theUS Naval School of Aviation, Pensacola,Fla, and included open-ended psychiatricinterviews, aviation research questionnairesand standard psychological batteries. In this

manner 37 jet aviators were evaluated; theycould be divided into two groups on thebasis of significant psychopathology.

It is found that there is a greater inci¬dence of "break-off" experiences amongaviators with positive psychiatric findings.The "break-off" phenomenon is shown to bea precipitant of acute anxiety attacks withphobic and psychophysiological manifesta¬tions, which leads to a fear of flying reac¬

tion. The third hypothesis is not proved;the "break-off" phenomenon is not neces¬

sarily related to greater contact with highaltitude solitary flying.

Representative case histories are pre¬sented to illustrate the personality andpsychodynamic factors thought to be associ¬ated with adverse reactions to the "break-off" phenomenon. The mechanisms ofphobic anxiety in high altitude solitary fly¬ing are discussed. The results of low sen¬

sory input studies are reviewed in an attemptto demonstrate that anxiety reactions associ¬ated with the "break-off" phenomenon aredetermined by multiple factors, both intra-psychic and environmental, which warrantmore intensive investigation in aviationpsychiatry.

REFERENCES1. Barnard, G.W.; Wolff, H.D.; and Graveline, D.E.:

Sensory Deprivation Under Null-Gravity Conditions, AmerJ Psychiat 118:921-925, 1962.

2. Barr, N.L. ; Boas, R.B. ; and Zarczower, M.: Psycho-logical Factors in Space Flight, Monograph Series No. 5,Washington, DC: American Psychiatric Association MentalHospital Service, 1959.

3. Bennett. A.M.H. : "Sensory Deprivation in Aviation,"in Solomon, P., et al (eds.) Sensory Deprivation, Cambridge,Mass: Harvard University Press, 1961, pp 161-173.

4. Bennett, G. : The Biology of the Astronaut, proc RoyInst Great Brit 39:232-239, 1962.

5. Bliss, E.L., and Clark, L.D.: "Visual Hallucinations,"in West, L. J., (ed.): Hallucinations, New York, Grune &Stratton, Inc., 1962, pp 29-107.

6. Bond, D.D.: The Love and Fear of Flying, New York:International Universities Press, 1952.

7. Brown, J.H.U. : Physiology of Man in Space, NewYork: Academic Press, 1963.

8, Clark, B., and Graybiel, A.: The "Break-Off" Phe-nomenon, J Aviat Med 28:121-126, 1957.

9. Clemedson, C-J. : Integrated Human Research andAerospace Medicine, Aerospace Med 35:511-518, 1964.

10. Cohen, S.I.; Silverman, A.J.; and Shavonian, B.M.:Psychophysiological Studies in Altered Sensory Environ-ment, J Psychosom Res 6:259-281, 1963.

11. Fenichel, O. : The Psychoanalytic Theory of Neurosis,New York: W. W. Norton

&Co., Inc., 1945, p 198.

12. Flaherty, B.E., et al: Psychiatry in Space Flight,Brooks AFB, Tex: School of Aviation Medicine, USAFAerospace Medical Center. 1960.

13. Flaherty, B.E. (ed.): Psychophysiological Aspects ofSpace Flight, New York: Columbia University Press. 1961.

14. Freedman, S.J.. et al: "Imagery in Sensory Depriva¬tion," in West, L. J., (ed.) : Hallucinations, New York:Grune & Stratton, Inc., 1962, pp 108-117.

15. Freud, S. : Analysis of a Phobia in a Five-Year-OldBoy," in Standard Edition, London: Hogarth Press, 1909, l 10, pp 3-149.

16. Freud, S.: Leonardo da Vince and a Memory of HisChildhood, Standard Edition, London : Hogarth Press, 1910,vol 11, pp 59-137.

17. Gatto, L.E. : Understanding the Fear of Flying Syn-drome, US Armed Forces Med J 5:1093-1116, 1267-1289,1954.

18. Gill, M.M., and Brenman, M. : Hypnosis and RelatedStates, New York: International Universities Press, 1959.

19. Heron, W.; Doane, B.K.; and Scott, T.H. : VisualDisturbance After Prolonged Perceptual Isolation, CanadJ Psychol 10:13-20, 1956.

20. Herzberg, M.J. : Classical Myths, Boston: Allyn &Bacon, 1946, p 60.

21. Jacobson, E. : The Self and the Object World, Psycho-anal Study Child 10:9-28, 1955.

22. Jackson, C.W.; Pollard, J.C.; and Kansky, E.W. : TheApplication of Findings From Experimental Sensory Dep-rivation to Cases of Clinical Sensory Deprivation, Amer JMed Sci 243:558-563, 1962.

23. Jackson, C.W., and Pollard, J.C. : Sensory Depriva-tion and Suggestion: A Theoretical Approach, Behav Sci7:332-342, 1962.

24. Lomonaco, T.: Il Fenomeno del "Break-Off," RevMed Aeronaut 21:236-242, 1958.

25. Magoun, H.W. : "The Neurophysiology of Stress," inFlaherty, . E. (ed.) : Psychophysiological Aspects of SpaceFlight, New York: Columbia University Press, 1961, pp 117-138.

26. Medvedeff, M. : Physiological Responses of the Astro-naut Glenn : Results of the First American Piloted SpaceFlight (February 20, 1962), Mercury-Atlas Mission orMA-6, Press M\l=e'\dicale(paris) 70:1717-1718, 1962.

27. Parin, V.V. : Information Gained From Soviet OrbitalFlight, Rev Med Aeronaut 1:9-11, 1962.

28. Phillips, P.B., and Bair, J.T. : Preventive Medicine inNaval Aviation Training, Arch Industr Health 17:53-57,1958.

29. Phillips, P.B., and Sours, J.A. : Pseudo-Organic Ill-


ness in the Failing Flyer, J Florida Med Assoc 50:127-130,1963.

30. Phillips, P.B. (ed.): Clinical Problems in AviationMedicine, Aerospace Med 34:236-246, 1963.

31. Pollard, J.C.; Uhr, L.; and Jackson, C.W.: Studies inSensory Deprivation, Arch Gen Psychiat 8:435-454, 1963.

32. Ross, M.D., and Lewis, M.L.: The Strata-Lab Bal-loon System for High Altitude Research, J Aviat Med 29:375-385, 1958.

33. Ruff, G.E., and Levy, E.Z.: Psychiatric Research inSpace Medicine, Amer J Psychiat 115:793-797, 1959.

34. Ruff, G.E.; Levy, E.Z.; and Thaler, V.H.: Studies ofIsolation and Confinement,J Aviat Med 30:599-604, 1959.

35. Schwitzgebel, R. : A Comparative Study of Zulu andEnglish Reactions to Sensory Deprivation, Int J Soc Psychiat7:220-225, 1962.

36. Silverman, A.J.; Cohen, S.I. ; and Zuidema, G.D. :

Psychosomatic Factors in "Black Out," J Nerv Ment Dis125:64-68, 1957.

37. Silverman, A.J., et al : "Hallucinations in SensoryDeprivation," in West, L. J. (ed.) : Hallucinations, NewYork: Grune & Stratton, Inc., 1962, pp 125-134.

38. Simon, D.G. : "The 'Break-Off' Phenomenon DuringBalloon Flight in the Stratosphere," in Schaefer, K. E.(ed.): Environmental Effects on Consciousness, New York:MacMillan Co., 1961, pp 86-92.

39. Solomon, P., et al: Sensory Deprivation: A Review,Amer J Psychiat 114:357-363, 1957.

40. Sours, J.A., and Phillips, P.B. : Psychosomatic As¬pects of Aviation Medicine: Implications for Space Flight,Acta Psychother 11:274-304, 1963.

41. Sours, J.A., and Erdbrink, W.L. : PsychophysiologicalFalse Myopia: A Parasympathetic Depressive-WithdrawalReaction, Aerospace Med 33:48-52, 1964.

42. Sours, J.E.; Ehrlich, R.; and Phillips, P.B.: The Fearof Flying Syndrome: A Re-Appraisal, Aerospace Med 35:156-166, 1964.

43. Tempereau, C.E.: Fear of Flying in Korea, Amer JPsychiat 113:218-222, 1956.

44. Tranel, N.: Effects of Perceptual Isolation on Intro-verts and Extroverts, J Psychiat Res 1:185-192, 1962.

45. Van Wulfften Palthe P.M.: Psychological Causes inAircraft Accidents, Aeromed Acta 6:69-80, 1958.

46. Van Wulfften Palthe, P.M.: Fluctuations in Level ofConsciousness Caused by Reduced Sensorial Stimulation andby Limited Motility in Solitary Confinement, Aeromed Acta8:47-78, 1961-1962.

47. Van Wulfften Palthe, P.M.: Sensory and MemoryDeprivation as a Psychopathological Stress, Folia psychiat5:407-415, 1959.

48. Wexler, D., et al: Sensory Deprivation, Arch NeurolPsychiat 79:225-233, 1958.

49. White, T.D.: The Inevitable Climb to Space, Air UnivQuart Rev vol 10, No. 4, 1958-1959.

50. Witkin, H.A., et al: Psychological Differentiation\p=m-\Studies of Development, New York: John Wiley & Sons,Inc., 1962.

51. Ziskind, E., et al: "The Hypnoid Syndrome in SensoryDeprivation," Wortis, J. (ed.): Recent Advances in Biologi-cal Psychiatry, New York: Grune & Stratton, Inc., 1963,vol 5.

52. Ziskind, E.: An Explanation of Mental SymptomsFound in Acute Sensory Deprivation: Researches 1958-1963, Amer J Psychiat 121:939-946, 1965.

53. Zubek, J.P.: Effects of Prolonged Sensory and Percep-tual Deprivation, Brit Med Bull 20:38-42, 1964.


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