For flight attendants, whose job it is to take to the skies several times a week or even multiple times a day, the aftermath of a tragedy like last week's crash in Ukraine can be excruciating. And, in the case of MH17, says Jeffrey M. Lating, a professor of psychology at Loyola University Maryland who studied how flight attendants coped following 9/11, the particulars of the crash—the second in one year for the same airline, and the result of human action—may make it all the more difficult.
Lating says that the lifetime prevalence rate of posttraumatic stress disorder (PTSD) is around 10 percent, though that can vary given the type of vocation (e.g., military, police, and firefighters frequently have higher-than-average PTSD rates) and type of incident (rape and torture produce PTSD at greater rates than other types of trauma). When researchers looked at rescue workers at the site of the Oklahoma City bombing, Lating told me, they found rates of probable PTSD at around 13 percent.
For flight attendants who worked at American Airlines on 9/11, the rates were even higher—just over 18 percent. This number is so high, Lating says, it is comparable to the rates seen among people living south of Canal Street in Manhattan, the neighborhoods closest to Ground Zero.
Lating and his colleagues found no statistical difference in probable PTSD rates between West Coast flight attendants and East Coasters, who were much more likely to have known the flight attendants killed on 9/11. For flight attendants, it seems that the trauma they experience following a crash comes not only from the loss and tragedy itself, but also from a deep sense of vulnerability. A follow-up study in 2006 found similarly high rates of probable PTSD at another airline, further suggesting that "it didn't matter what airline you worked for," says Lating. "The virulent factor in this was, 'I wonder if I could possibly be next.' "
"I think that part of the difference, one potential difference, is that, for rescue workers in Oklahoma City, the threat was probably gone at that point," Lating speculates. "But when we were assessing flight attendants, close to nine months after the event, they still may have felt that they could be next."
Those fears can make just doing one's job as a flight attendant incredibly challenging. Many suffering from PTSD try to avoid sights and triggers that recall the initial trauma. But for flight attendants, those reminders are unavoidable, part of the work itself. To have to work through that anxiety, all the while servicing others and maintaining a sense of calm on a flight—"you could imagine how uncomfortable that would be," Lating says.
All of this would be present following any air disaster, but Lating suspects that crashes that result from human agency—acts of terrorism or war—"are potentially more psychologically pathogenic" because they seem to have an even greater effect on people's sense of vulnerability.
"One of the interesting things that we were told, anecdotally, by some of the flight attendants from 9/11, was that they considered themselves to be on the weapon of mass destruction," he said. That feeling, of the plane itself being "an intended target," would make people feel even more at risk.
To make matters worse, in this instance, is that this comes as the second major tragedy for Malaysia Airlines this year. Lating says that there can be a "dose-response relationship"—that the more you are exposed to something, the greater the chance of a certain response. Two tragedies in such close proximity may have compounding effects and lead to even greater rates of PTSD. How will the timing of this second crash affect flight attendants? Will PTSD rates be higher for those who work at Malaysia Airlines specifically? Those are empirical questions, Lating says, that can be answered down the road.
Lating says that at work in the fallout from a disaster is what some researchers call "the iceberg effect"—as he describes it, "that oftentimes there are more psychological than physical casualties."
"I think," he says, "that we need to try to be aware of that."