Behavioral Health and Human Interactions in Space 3031167228, 9783031167225

Table of contents :
Foreword
Preface
General Issues in Human Spaceflight
Use of Space Analogs and Simulators
From the Archives Sections
From the Archives: Introduction [23]
Chapter Organization
References
Acknowledgments
Contents
Author Biography
Glossary and Acronyms
Chapter 1: Stress, Sleep, and Cognition in Microgravity
1.1 From the Archives: Stress and Its Measurement [1]
1.1.1 Stress and Stressors
1.1.2 Measurement of Psychological and Social Stress
1.2 Stressors in Space
1.3 From the Archives: Weightlessness and Low Sensory Input [1]
1.3.1 Weightlessness
1.3.2 Hypodynamia Studies
1.3.3 Weightlessness and Hypodynamia
1.3.4 Weightlessness and the Astronaut
1.3.5 Artificial Gravity
1.3.6 Exercise
1.4 Coping with Microgravity
1.5 Psychophysiological Stress
1.6 From the Archives: Circadian Rhythms and Sleep [1]
1.6.1 Circadian Rhythms
1.6.2 Circadian Rhythms and Performance
1.6.3 Circadian Rhythms in Space
1.6.4 Work/Rest Cycles
1.6.5 Sleep
1.6.6 Sleeping in Space
1.7 Circadian Rhythms and Sleep: Current Status
1.7.1 Circadian Rhythms
1.7.2 Sleep
1.8 Cognition and Performance
1.8.1 Theoretical Issues
1.8.2 In-Flight Monitoring of Crewmember Attention and Cognition
1.8.3 Cognition and Performance in Space: Current Status
1.8.4 Russian Pilot-T Study
1.9 Points to Remember
1.10 Food for Thought
References
Chapter 2: Living and Working in Space
2.1 From the Archives: Behavioral Issues [1]
2.1.1 Confinement, Isolation, and Monotony (See also Sect. 3.5.1)
2.1.1.1 Antarctic Data
2.1.1.2 Submarine Data
2.1.1.3 Space Simulation Data
2.1.1.4 Generalizations
2.1.2 Stages of Reaction to Isolation (Rohrer)
2.2 Psychological Stress in Near-Earth Missions
2.3 Initial Adjustment
2.4 Habitability
2.5 Work
2.5.1 General Issues
2.5.2 Manzey’s Work Strategies in Space
2.6 Mission Stages and the Third Quarter Phenomenon
2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents
2.7.1 Preliminary Study in the Mir Space Station Simulator (HUBES)
2.7.2 Methodology of the Mir and ISS “Interactions” Studies
2.7.3 Time Findings
2.7.3.1 Mir Study (Fig. 2.5)
2.7.3.2 ISS Study (Fig. 2.6)
2.7.3.3 Time Conclusions
2.7.4 Critical Incident Log Findings
2.7.4.1 Mir Study
2.7.4.2 ISS Study
2.7.4.3 Critical Incident Log Conclusions
2.7.5 A Kanas et al. Interactions Replication Study from China—Time Findings
2.8 ISS “Journals” Study
2.8.1 Preliminary Study During Long-Duration ICEs (French Diaries Study)
2.8.2 ISS “Journals” Study
2.9 Points to Remember
2.10 Food for Thought
References
Chapter 3: Emotional Highs and Lows
3.1 Positive Experiences in Space
3.2 The Overview Effect: Spirituality and Humanism
3.3 Salutogenesis and Resilience
3.4 Changes in Value System
3.5 From the Archives: Psychiatric Issues [33]
3.5.1 The Magnitude of the Problem (See Also Sect. 2.1.1.1)
3.5.2 Reaction to Danger
3.5.3 Tension Reduction
3.5.4 Psychotherapy in Space
3.6 Psychiatric Problems in Space
3.6.1 Frequency of Psychiatric Problems
3.6.2 Adjusting to Space and Adjustment Disorders
3.6.3 Asthenia
3.6.4 Other Psychiatric Disorders
3.7 Treatment Considerations
3.7.1 Psychoactive Medications
3.7.2 Counseling and Psychotherapy
3.7.3 Operational and Family Support
3.7.4 Cognitive Emotion Regulation Strategies
3.8 Points to Remember
3.9 Food for Thought
References
Chapter 4: Crewmember Selection, Ground and Family Support
4.1 From the Archives: Predicting Action from Personality [1]
4.2 From the Archives: Crew Selection [1]
4.2.1 Jobs in Space
4.2.2 Pilots Versus Scientists
4.2.3 Women in Space
4.2.4 Mixed-Nationality Space Crews
4.2.5 Astronaut Selection
4.3 Personality Characteristics and Crewmember Selection
4.3.1 Astronaut Selection
4.3.1.1 Select-Out: Avoiding Psychopathology
4.3.1.2 Select-In: Personality Testing and the “Right Stuff”
4.3.2 Crew Selection
4.4 Crewmember-Mission Control Relationship
4.4.1 Gushin et al. Crew-Ground Communication Studies
4.4.2 Kelly and Kanas Communication Study: Crew-Ground Findings
4.4.3 ISS Operations Challenges Seen by Mission Control Personnel
4.5 From the Archives: Separation Reactions of Married Women [1]
4.6 Family Issues
4.7 Returning Home
4.8 Points to Remember
4.9 Food for Thought
References
Chapter 5: Human Interactions, Culture, and Team Behavior
5.1 From the Archives: Sociological Considerations [1]
5.1.1 Sociological Stressors
5.1.2 Group Size
5.1.3 Group Structure
5.1.4 Leadership
5.1.5 Reduction of Social Roles
5.1.6 Relationship with the Ground Personnel
5.1.7 Interpersonal Compatibility
5.1.8 Preventing Interpersonal Strife: (i.e., Crew Compatibility—NK)
5.1.9 Preventing Interpersonal Strife: (i.e., Displacement—NK)
5.2 Team Cohesion in Space
5.2.1 Effect of Team Tension
5.2.2 Team Size
5.2.3 Team Composition
5.3 Individual Crewmember Issues Affecting Team Behavior
5.3.1 Personality Conflicts
5.3.2 Differing Career Motivations and Life Experiences
5.3.3 Male-Female Differences
5.3.4 Sexual Relationship Issues
5.4 Interpersonal Group Issues Affecting Team Behavior
5.4.1 Territorial Behavior and Withdrawal
5.4.2 Subgrouping and Scapegoating
5.4.3 Displacement
5.4.4 Unclear Leadership Roles
5.5 Cultural and Language Issues
5.5.1 Cultural Challenges for Space Crews
5.5.2 Types of Culture in Human Space Missions
5.5.3 Cultural Issues in Space: Surveys
5.5.4 The Importance of a Common Language
5.5.5 Kelly and Kanas Communication Study: Intra-Crew Findings
5.6 Mir and ISS “Interactions” Studies: Displacement, Leadership, and Culture
5.6.1 Displacement
5.6.1.1 Preliminary Study in the Mir Space Station Simulator (HUBES)
5.6.1.2 Mir and ISS “Interactions” Displacement Findings
5.6.2 Leadership
5.6.2.1 Preliminary Study in the Mir Space Station Simulator (HUBES)
5.6.2.2 Mir and ISS “Interactions” Leadership Findings
5.6.3 Culture
5.6.3.1 Mir and ISS “Interactions” Culture Findings
5.6.3.2 ISS Culture and Language Questionnaire Findings
5.7 Related Studies
5.7.1 A Kanas et al. “Interactions” Replication Study from China: Displacement and Leadership Findings
5.7.2 Gushin et al. Communication Validation Study
5.7.3 Gushin et al. Interactions Studies
5.7.4 Gushin et al. Content Study
5.7.5 Asthenia and Culture Study
5.7.6 Multiteam CELSS Study
5.7.7 Ethology in Lunar Palace I
5.8 New Approaches of Studying Team Dynamics in Space
5.9 Points to Remember
5.10 Food for Thought
References
Chapter 6: Countermeasures for Near-Earth Space Missions
6.1 Pre-launch Training
6.1.1 Training Topics
6.1.2 Kinds of Training
6.2 Space Crew Monitoring and Support from the Ground
6.2.1 Psychological Support Groups
6.2.2 Private Conferences with People on Earth
6.2.3 Family Support and Holidays
6.2.4 Voice Frequency Analysis
6.3 From the Archives: Monitoring Instruments [46]
6.4 Intra-crew Monitoring, Support, and Coping During the Mission
6.4.1 Actiwatch and Oura Rings
6.4.2 Team Self-monitoring, Bull Sessions, and Debriefs
6.4.3 Individual Cognitive Self-monitoring
6.4.4 Suedfeld et al. Coping Strategy Studies
6.4.4.1 General Coping Strategies
6.4.4.2 Humor as a Coping Strategy
6.4.5 Virtual Reality
6.5 From the Archives: Leisure Time–Submarines and Antarctica [46]
6.6 Leisure Time in Space
6.6.1 Kelly and Kanas Communication Study: Leisure Time Findings
6.6.2 Stuster “Journals” Study: Leisure Time Findings
6.6.3 Stocking for Flexibility
6.7 Post-mission Readaptation
6.7.1 Individual Issues
6.7.2 Family Issues
6.8 Points to Remember
6.9 Food for Thought
References
Chapter 7: Commercial Human Spaceflight
7.1 Suborbital Missions
7.1.1 Early History: The Ansari X Prize
7.1.2 Richard Branson’s Virgin Galactic
7.1.3 Jeff Bezos’ Blue Origin
7.1.4 Suborbital Pre-Launch Training and the Mission Experience
7.1.5 Medical and Psychological Issues for Suborbital Missions
7.2 Orbital Missions
7.2.1 Early History: Space Station Missions
7.2.2 United Launch Alliance
7.2.3 Elon Musk’s SpaceX
7.2.4 Russian Soyuz Program (See Also Sect. 7.2.1)
7.2.5 Robert Bigelow’s Inflatable Habitats
7.2.6 Axiom Space, Inc.
7.2.7 Orbital Pre-launch Training and the Mission Experience
7.2.8 Medical and Psychological Issues for Orbital Missions
7.3 The Market for Commercial Human Spaceflight
7.4 Legal and Environmental Issues
7.5 Lunar and Solar System Missions
7.6 Points to Remember
7.7 Food for Thought
References
Chapter 8: Artemis and the Psychosociology of Lunar Colonies
8.1 Why Go Back to the Moon?
8.2 Artemis Program
8.2.1 Artemis I
8.2.2 Artemis II
8.2.3 Artemis III
8.2.4 Artemis IV
8.2.5 Artemis V
8.2.6 Artemis Base Camp
8.2.7 Multinational Participation in Artemis: Legal and Other Issues
8.3 Space Colonies
8.3.1 O’Neill Cylinders
8.3.2 Stanford Torus
8.4 Lunar Colonies
8.4.1 Constructing and Populating a Permanent Lunar Colony
8.4.2 Colonizing the Moon: Psychosocial Lessons from Science Fiction
8.4.3 Colonizing the Moon: Psychosocial Lessons Based on Earth Experiences
8.4.4 Colonizing the Moon: Psychosociological Conclusions
8.5 Points to Remember
8.6 Food for Thought
References
Chapter 9: Expeditions to Mars and Beyond
9.1 Going to Mars
9.2 Distance: A Behavioral Game Changer
9.2.1 Psychological Stressors
9.2.2 Interpersonal Stressors
9.3 Autonomy
9.3.1 General Issues
9.3.2 Studies of High Versus Low Autonomy
9.4 Communication Delays
9.4.1 General Issues
9.4.2 Studies of Delayed Communication
9.5 Mars 500 Project
9.6 Countermeasures for a Mars Expedition
9.6.1 Pre-Launch Selection
9.6.2 Pre-Launch Training
9.6.3 Intra-Crew Monitoring, Support, and Coping During the Mission
9.6.4 Post-Mission Readaptation (See Also Sect. 6.7)
9.7 Colonizing Mars
9.7.1 Colonizing Mars: Psychosocial Lessons from Science Fiction
9.7.2 Colonizing Mars: Psychosocial Issues Based on Earth Experiences
9.7.3 Colonizing Mars: Cognitive Shifts
9.7.4 Colonizing Mars: Large Simulator Studies on Earth
9.7.5 Colonizing Mars: Psychosociological Conclusions
9.8 Interplanetary Expeditions Beyond Mars
9.9 Points to Remember
9.10 Food for Thought
References
Chapter 10: Appendix. Introductory Quotations and Conclusions from NASA TM X-58067 (1971): Behavioral, Psychiatric, and Sociological Problems of Long-Duration Space Missions (N.A. Kanas & William E. Fedderson)
10.1 Summary
10.2 Conclusions on Stress and Its Measurement
10.3 Conclusions on Weightlessness and Low Sensory Input
10.4 Conclusions on Circadian Rhythm and Sleep
10.5 Conclusions on Confinement, Isolation, and Monotony
10.6 Conclusions on Psychiatric Considerations
10.7 Conclusions on Sociological Considerations
10.8 Conclusions on Crew Selection
10.9 Concluding Remarks
References
Index
Untitled

Citation preview

Nick Kanas

Behavioral Health and Human Interactions in Space

Behavioral Health and Human Interactions in Space

Nick Kanas

Behavioral Health and Human Interactions in Space

Nick Kanas University of California, San Francisco San Francisco, CA, USA

ISBN 978-3-031-16722-5    ISBN 978-3-031-16723-2 (eBook) https://doi.org/10.1007/978-3-031-16723-2 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

This book is dedicated to my wife Carolynn, who for 50 years has supported my work with patience and encouragement. I am grateful for her support.

Foreword

Exploration is in our nature. We began as wanderers, and we are wanderers still. We have lingered long enough on the shores of the cosmic ocean. We are ready at last to set sail for the stars. —Carl Sagan, Cosmos

I met Dr. Nick Kanas when I came to work at NASA as an aerospace psychiatrist in June, 2021. I became acquainted with Nick’s work addressing psychological factors in human spaceflight. I was immediately intrigued. You see, there are not many psychiatrists who venture into the aerospace world, yet human factors are a seminal part of mission success, and as humans venture out farther for longer periods of time, there will be a need for more trained mental health professionals who have an understanding of the psychological challenges inherent in the aerospace environment. My conversations with Nick covered a wide range of topics to include behavioral health and science fiction. There was lighthearted simplicity along with sublime reflection. What was very apparent was that we shared a mutual desire to promote learning and guide those seeking to have a deeper understanding about how humans adapt to live and work in space. I continue to learn from Nick; he has more than 50 years of experience writing, researching, and consulting in public and private space activities and is well established as an expert in the field of human factors and psychological adaptation in space. To date, not a lot has been written that provides a comprehensive approach to behavioral health and human interactions in space. This is an inchoate and extremely relevant field. Nick’s book on behavioral health and human interactions in space covers the full spectrum of human psychological adaptation in this unique environment. His topics are well organized, cogent, and span the full gamut from astronaut selection, team training, and leadership qualities to mission preparation, recreational space travel, our return to the Moon, and future expeditions to Mars. Additionally, Nick addresses the challenges inherent in establishing colonies on both the Moon and Mars, with some reflections on psychosocial lessons based on terrestrial knowledge and from science fiction. We are at the forefront of an exciting era in the history of human spaceflight. We have now flown our first commercial crews to the ISS, will soon return to the Moon vii

viii

Foreword

with the Artemis program, and have begun the era of the private, non-professional astronaut. In the decade to come, we will see low Earth orbit become open to commercialization and the creation of a new technology corridor burgeoning with possibility. Additionally, recreational space travel will open new opportunities for those curious souls who dare to venture out to get a glimpse of the beauty and wonder of space. Nick’s work is extremely beneficial for all who are involved in the aerospace medical field seeking to have a deeper understanding of human psychological adaptation and functioning in space. Furthermore, the fields of aerospace psychiatry/ psychology are in their infancy, and Nick’s book will be a primary textbook for these evolving fields in aerospace medicine. Aerospace Psychiatrist, UTMB/HHPC Charles H. Dukes, M.D., FAPA NASA Johnson Space Center  Houston, TX, USA

Preface

The year 2021 was a big one for human space travel. On July 11, Richard Branson’s Virgin Galactic sent two pilots and four civilian, non-astronaut passengers (including Richard Branson himself), on a suborbital mission into space. Nine days later, on July 20, Jeff Bezos and three other civilian passengers did the same thing atop a Blue Origin rocket. On September 15, Elon Musk’s SpaceX launched four civilians on the first orbital mission into space that did not involve a space station as a destination. Furthermore, SpaceX continues to fly astronauts and supplies to the International Space Station (ISS). On October 5, a Russian Soyuz rocket carried a Russian film director and an actress to the ISS to film part of a movie. On June 17, China sent three taikonauts to the core module of its new space station, Tiangong. Throughout the year, NASA continued working on its Artemis Program to the Moon, including the development of the Block 1 variant of its Space Launch System. As 2022 began, both the private and public space programs continued to make progress, with NASA delivering a completed Block 1 rocket to Cape Kennedy in March. Artemis I was successfully launched on November 16. However, the Russian invasion of Ukraine began to alter the space landscape, with Russia and the West severing cooperation on some of their space activities and Russia continuing to move away from participation in the Artemis Program in favor of establishing a lunar base with China. As this book goes to press, things are still fluid in these areas of international cooperation. Nevertheless, one hopes that plans to colonize the Moon and Mars will continue despite delays due to external political factors.

General Issues in Human Spaceflight To mount a successful expeditionary human space program (say to Mars), an incremental approach is needed. This implies that studying human factors (e.g., behavioral and interpersonal issues) on the ground in environments with features similar to those encountered during the mission is a good first step, not only in exposing possible risks, but also in testing appropriate countermeasures to deal with these ix

x

Preface

risks. Then, examining elements of an expeditionary mission in space in a closer and safer facility, such as the ISS or a cis-lunar facility like a space station orbiting the Moon, would be a reasonable next step. Appropriate financial and human resources to conduct such a mission are necessary. But these resources need to be stable for years, not changing with every political election where they are reprioritized with other activities competing for the same money. The U.S.A. committed itself to a decade of appropriate and constant funding to reach the Moon, and its efforts were successful. To succeed, NASA made engineering its first priority, with other considerations being secondary, including human factors. For survival, let alone mission success, a fully functional launch system was necessary. This priority is critical for mission success, but not sufficient. For future human expeditionary space missions, crewmembers need to be prioritized as critical components, and their needs and well-being must be given top priority in planning physical space, resources, privacy, and other human needs. This will take money and creative thinking in human factors engineering, but the result will be a mission that successfully achieves its goals and maximizes human comfort. Since ambitious space missions are costly and complex, they likely will be multinational in scope. Psychological, social, and cultural factors involving the women and men of the mission need to be addressed openly, not only within the crew but also in mission control and from the various participating agencies. Space is a hostile place for humans, given its unique set of physical hazards. Schorn and Roma [1] have categorized these in five ways, which can be remembered by the simple acronym RIDGE: Radiation, Isolation and confinement, Distance from Earth, Gravity alterations (e.g., microgravity), and Environment that is hostile. Elsewhere, I have discussed these stressors as three potential show-stoppers for future long-duration expeditionary space missions [2]: The first deals with the effects of microgravity on human physiology, such as bone loss and muscle atrophy. Although with proper exercise people have survived physically on orbit for up to14 months, it is difficult to predict how they will do during an expeditionary mission to a planet like Mars that will last much longer. It is possible that a midmission stay in a partial gravity environment, such as the Moon (1/6 Earth gravity, or g) or Mars (3/8 g), will be restorative, but currently there is insufficient data to make this prediction. A second possible show-stopper has to do with exposure to radiation from galactic cosmic rays and solar particle events. During orbital missions, astronauts receive protection from the Earth’s Van Allen Belts, but leaving the near-Earth confines exposes space travelers to ionizing radiation from space. The third possible show-stopper will be the subject matter of this book: the behavioral and interpersonal aspects of human space travel. Individual behavioral health and performance (BHP) and the interactions of crewmembers with each other and with people on the outside are important issues. For example, in a recent review of spaceflight medical conditions, it was found that 98% included at least one BHP-relevant symptom, and 73% of spaceflight medical treatments produced at least one BHPrelevant effect [3]. In this book, I will be focusing on the I, D, and E components of the RIDGE acronym, although in Chap. 1 I also will consider the impact of R and G on human cognition and performance.

Preface

xi

Use of Space Analogs and Simulators The content of this book will be drawn from both anecdotal material and empirical research, both from space and from settings on Earth that have many features in common with the space environment. Anecdotal material includes documents such as space agency debriefings, diaries kept during a space mission, media interviews, and books written by astronauts or about astronauts by flight surgeons, biographers, etc. [Note: there are many terms for people who fly in space, such as astronaut (the USA, Canada, Europe), cosmonaut (Russia), and taikonaut (China). In this book, when a generic space traveler is being referred to, I will use the general term “astronaut.”] Since anecdotal material reflects the feelings and thoughts of people who have been in space, this source can provide valuable direct and first-hand information of what it is like to live and work in this unique environment. In this book, many reviews are cited of empirical research that is related to human behavior and human interactions in space. Empirical research implies the testing of hypotheses by using rigorous methodology and the evaluation of the results based on appropriate statistical analyses. If these findings are published in peer-reviewed journals and replicated in follow-up studies, then confidence in them grows even more. Studies following these principles will be considered the “gold standard” in this book, although other sources of information, such as the anecdotal material referred to above, historical information, and expert opinion, also will be included. Space-related empirical research can be done in space (such as on the ISS) or on the ground in settings that have features in common with space. In terms of the latter, Cromwell and Neigut [4] have made a distinction between isolated, confined, and extreme environments, and isolated, confined, and controlled environments, which I will label as ICEEs and ICCEs. ICEEs are space analogs that take place in an extreme environment, have primary mission goals other than research, have limited or no experimental control of conditions, and have variable crew sizes selected for field work or training purposes. ICCEs often take place in an environment that is designed to be a simulation of a space mission, where research is a main goal of the mission, where conditions are partially experimentally controlled, and where the crew size is regulated and selection is made to meet astronaut criteria. These environments and the studies they have generated are innumerable [4–15], but a representative list is given in Table 1. Most of these are supported by public funds, but the private sector increasingly is becoming involved in space, and many companies are using their own test facilities. Note that in this book, I will use the term isolated and confined environments (ICEs) when speaking generically about both types. What are the pros and cons of space analog and simulation missions? In terms of the pros, since space activities are expensive and dangerous, testing a new mission in a space-like environment on the ground is more economical and safer than it is in space, although such environments may have their own safety concerns [16]. Also, since variables can be controlled, confounds can be minimized, and the focus can be on important factors related to the study. Large sample sizes amenable to statistical analyses can be achieved safely and affordably in ground-based settings using

xii

Preface

Table 1  ICEEs and ICCEs, including study examples ICEE analogsa Old polar expeditions (Nansen, Peary, Amundsen, Scott, Shackleton) Antarctic and Arctic stations (FMARS, McMurdo, Concordia, Alert, Eureka) Ships and submarines (Nautilus, Tara)

Sea-based oil-drilling platforms High mountains and remote jungles Prisons Caves

ICCE simulatorsa Enforced bed rest (hypodynamia studies)

Airplane/spaceship cockpit simulators

Land-based confined habitats (ISEMSI, EXEMSI, HUBES, ECOPSY, Biosphere2, CAPSULS, Tsukuba Simulator, CELSS, SFINCSS, HERA, NEK: Mars 105 and Mars 500 Programs, SIRIUS) Land-based open but isolated habitats (Haughton-Mars, NASA Desert (D-) RATS, MDRS, LunAres (Poland), HI-SEAS) Undersea isolated habitats (Sealab, Tektite, Aquarius/NEEMO) Neutral buoyancy tanks (NASA, ESA, Roskosmos, Chinese Astronaut Center, etc.) Microgravity facilities (ARGOS, planes flying parabolic flights: “vomit comet”)

Adapted from Refs. [4–15] a See Glossary and Acronyms for full name and details of facility/study

non-­astronaut subjects. Finally, new methods and equipment can be tried out, including those whose weight or volume would restrict them from flight [12]. In terms of cons, no analog or simulation environment can completely reproduce the environment of space in terms of physical, physiological, social, or psychological factors. For example, no space-like environment on Earth can produce microgravity for extended periods of time (e.g., the “vomit comet” airplane flying parabolic arcs in the sky produces weightlessness for less than a minute). Many of these space-like settings fail to produce confinement, lack of breathable oxygen, and true danger. Also, the excitement of being on an actual mission and seeing the Earth from space is lacking in land- or sea-based simulations. Finally, personality studies that involve people in space analog and simulation settings (Antarctica, airline cockpits) need to be evaluated carefully since there are significant psychological differences between people in Earth-bound ICEs and people in the astronaut corps (see Sect. 4.3.1.2). As regards behavioral and interpersonal issues, analog and simulation environments have been used to explore a number of factors, such as social and cultural issues, career motivation, monotony and boredom, leadership roles, and the relationship between crewmembers and ground personnel [17]. Bishop [18] has outlined four critical psychosocial issues that can be studied in space analog and simulation environments. The first relates to crewmember selection (e.g., how do personal factors such as professional skills and social ease affect work and leisure time activities?). The second concerns the impact of moderator variables on human behavior (e.g., how does the inability to evacuate an injured person during the Antarctic winter-over period affect group morale?). The third critical area relates to

Preface

xiii

identifying processes that affect group cohesion and conflict (e.g., what are the effects on cohesion of different crew compositions, work schedules, privacy conditions, and leadership styles?). Lastly, how does varying a number of individual and group factors affect work performance and the accomplishment of mission goals? Suedfeld [19] has argued that in psychological research, it is not the physical environment per se but the psychological meaning of that environment that is important. Sandal et al. [20] supported this notion in an analysis they performed of different simulation studies. They found differences between studies conducted in land-based confined habitats, where there was no real danger and easy evacuation in case of emergencies, versus real missions in polar settings, where danger and true isolation existed. People working in the former experienced low overall anxiety and a steady decrease in anxiety over time, whereas people working in the latter showed higher levels of anxiety, especially in the first and third quarters of the mission. Smith et al. [21] reviewed the results from studies of personal values of subjects who completed Schwartz’s Portrait Values Questionnaire (PVQ) in four ICE settings: mountaineers (n = 59), military personnel (n = 25), Antarctic over-winterers (n = 21), and Mars mission simulation participants (n = 12; for examples of Mars simulators, see Sects. 9.3.2 and 9.5). All groups identified Self-direction, Benevolence, Universalism, and Stimulation as being most concordant with their own value system (i.e., ranked in the top 5), and all but one group rated Power as least concordant, followed by Tradition, Security, and Achievement. However, there were significant between-group differences on 5 of the 10 value scales. The authors concluded that it is important to consider the extreme settings with respect to the specific population being studied before coming to any general conclusions.

From the Archives Sections In several of the chapters in this book, there is a section labeled FROM THE ARCHIVES, which is set off by a gray background. These sections include excerpts from the following document: “Kanas, N. A., & Fedderson, W. E. (1971). Behavioral, psychiatric, and sociological problems of long-duration space missions. NASA Technical Memorandum, NASA TM X-58067. National Aeronautics and Space Administration Manned Spacecraft Center. https://ntrs.nasa.gov/api/citations/19720008366/downloads/19720008366.pdf.” This is a document I wrote in 1970 during a UCLA senior medical student elective at the NASA/Johnson Space Center in Houston, TX.  My supervisor was NASA psychologist William E. Feddersen (note the correct spelling of his name, which erroneously has an “o” in the NASA TM). This information formed the basis for my later research and publication activities, and much of what was said then is applicable now. It also contains descriptions of early space-relevant studies from submarines, polar regions, and spacecraft simulators that appeared in journals, government documents, and other sources that are hard (if not impossible) to find these days. Although out of

xiv

Preface

print, the interested reader can review a copy of this NASA TM on-line at the above URL. As a NASA document, this TM is in the public domain. I also received permission from NASA to quote extensively from the TM in this book. I decided to do so for two reasons. First, the excerpts contain descriptions of early studies from the 1950s and 1960s that informed later work by me and others, and as such they have great historical value. They describe actual people observing behavior in real settings. Second, they also extend the scope of this book back in time, which, when combined with more current material, describe space-related studies conducted for more than 70 years. I believe that we can learn from the past, so long as we factor in that acceptable research criteria may change somewhat over time. In sum, I believe that this excerpted material needed to be included in a more modern venue, since it contains a sense of the past that when incorporated with the present gives us a better perspective for the future in terms of human behavior and interactions in space. Perhaps the following quote says this best: “Whatever one does, one always rebuilds the monument in his own way. But it is already something gained to have used only the original stones” [22, p. 341]. In scrutinizing these reprinted archival sections, the reader will notice the preponderance of male pronouns and referents. This reflects the fact that in the 1950s and 1960s, participants in ICEs mainly were men, but it also reflects linguistic style based on cultural preferences and biases. These days, women have joined men in ICE-related activities, and this is illustrated in the language used in the non-archival sections of this book. I have discussed the interactions of men and women in ICEs and issues related to sexual stereotyping in Sect. 5.3.3. Comments from me in the archival sections are underlined and in italics, including the brief introductory paragraphs that also are followed by my initials: —NK. In some cases, I have made minor editorial changes (such as altering the verb tense for consistency) or moving some of the material to match the chapter outline in this book (especially where there was both psychological and psychiatric material in a study). Textual additions also are underlined and in italics, as are see… or see also… comments referring the reader to another section. Quotes from the TM material are preserved, although there are no source page numbers in keeping with the original TM format. Note that much of this material is anecdotal or of a survey nature, rather than formal research, but it reflects observations made at the time in naturalistic settings. Readers of this book can either include or exclude the TM excerpts in gray without affecting the flow of the current narrative. To the Introduction of this current book, I now will add the Introduction to the NASA Technical Memorandum:

Preface

xv

From the Archives: Introduction [23] This is the original Introduction to the NASA Technical Memorandum (TM) that I wrote with Bill Feddersen. published in 1971. Some of the events mentioned are not current, and the overuse of the male pronoun reflects the fact that at the time there were not many women who had flown into space, or even minorities in the American program. In addition, a number of simulators have been constructed since that time that more accurately represent conditions of human space flight. At the time of writing the TM, Russia was part of the U.S.S.R.—NK The year 1971 marks the 10th anniversary of Yuri Gagarin’s suborbital space flight and the second year since Neil Armstrong and Edwin Aldrin first set foot on the Moon. The U.S. manned space program has concerned itself with the engineering technology required to place a man on the Moon, with the medical requirements for survival being an important allied part. However, basic biological research has played only a secondary role, and the social sciences have been comparatively ignored. The U.S.S.R. program has accomplished more in the biological realm but has, likewise, produced little social science data. The reasons for this are obvious: the longest flight lasted 18 days (Soyuz 9), and the greatest number of men in a capsule has been three. The workloads have been generally heavy with clearly defined tasks and goals, and all the men have been highly motivated test pilots accustomed to stress and danger. Because no serious behavioral or psychiatric problem reported by either the Russians or the Americans has interfered with performance or mission success, one may conclude erroneously that the social sciences do not belong in space! This is possibly true for short-term missions but may not be true for a long-duration mission involving 2 years and 8–12 men, a workload admixed with much free time, a goal not to be attained before several months, and a mixture of pilots and scientists with different backgrounds and interests. Behavioral and psychiatric factors of the men involved in long-duration space missions are extremely important and must be investigated in future flights. Kubis and McLaughlin [24] also express this need. “It is well known that energies can be mobilized, stress can be adapted to, and discomfort can be tolerated for short periods of time. But under conditions of continuous long term mobilization of effort against unrelenting stresses, there may well be a degradation of the resistance and adaptability of the astronaut despite the superb conditioning which he has acquired in training.” Is manned space flight necessary? The Soviet successes with lunar robots and the abundance of data acquired by both U.S.S.R. and U.S. deep-space probes have shown that nonmanned flights do contribute to space programs. However, machines are limited. For example, no photoelectric cell has ever been devised that can improve upon the versatility of the human eye [25]; (continued)

xvi

Preface

likewise, no computer has man’s ability to react, evaluate, and act upon unprogramed inputs. Kubis and McLaughlin [24] estimate that half of the preApollo space missions would have failed were it not for astronaut reaction to emergency situations. They state that “The success of a space mission is intrinsically dependent on the information-processing, decision making, and highly adaptive capabilities of the astronaut who is required not only to manage and control the spacecraft and its systems, but also, in an emergency, to insert himself as an intelligent override within those automatic but not perfectly reliable systems.” Modern cybernetics recognizes the advantages of the man-machine combination in providing redundancies contingent upon each other to increase the chances of mission success. Some advantages and disadvantages of man and machine in such systems are given in table I (see Table 2). Finally, men derive satisfaction in conquering the unknown (the “because it is there” drive of mountain climbers). Man, master of both his fate and his machines, grows by conquering his environment and by taming his frontiers, Table 2  Advantages and disadvantages of man and machine in man-machine systems Man Can acquire incidental data and report unexpected events Cannot be jammed by electromagnetic radiations

Machine Unable to detect or sense phenomena beyond design limits Can be disrupted or degraded by electromagnetic radiation, especially in the radio-frequency range Can detect primary signals masked in Difficulty in detecting primary signals in a extraneous noise noisy environment Relatively slow and inaccurate in High-speed mathematical computation with mathematical computations great accuracy Long-term storage of large amounts of Short-term storage of limited amounts of information with variable recall time information with very fast recall time Performance deteriorates with time; Performance is not time dependent; requires requires rest for optimum performance periodic inspection and maintenance Sensitive to various stressors of space Can be designed for optimum performance flight and environment under most space conditions Lightweight and low power consumption Weight increases with complexity of tasks and reliability required; modest to high power consumption Emotional and easily bored; Expendable and has no feelings nonexpendable Large available supply but requires long Must be designed and manufactured to order programing and training time Can communicate both subjective and Can communicate only information for which objective experiences it is specifically instrumented Significant time lag in response to stimuli Responds almost instantaneously to signals Adapted from Ref. [25]

(continued)

Preface

xvii

and space is a new frontier. All people shared excitement and unity when Neil Armstrong first stepped on the Moon. Thus, man belongs in space, and, for this reason, the psychosocial characteristics of the species in this environment deserve study. Many problems inherent to long-duration space missions would be alleviated with the perfection of techniques in anabiosis, consisting of induced hibernation and deep hypothermia. Anabiosis, by slowing down metabolic processes, would diminish the effects of psychological and social factors because the men would spend much of the time in a state of suspended animation. However, several practical problems exist that would preclude anabiosis being used on the first long-duration space missions. Also, although many psychosocial problems would be eliminated, new ones may result from the procedure itself. Finally, under these conditions, man is no longer a part of the man-­machine process, and many of the advantages he brings to such a mission would be gone. Therefore, a closed ecosystem approach will probably be enforced, with the men awake and interacting much of the time. A trip to Mars is, perhaps, the most practical and realistic example of a long-­duration space mission. Hyatt [26] estimates the length of such a trip at 500 days, assuming moderate energy expenditure, with a visiting time of 25 days. Price et al. [27] describe a Mars mission, with a Venus flyby, that would last 450–510 days. They propose a Mars landing, lasting from 1 to 60 days, which would use a Mars excursion module. The mission activities can be classified under four headings: operational, scientific, human support, and maintenance. The 10-man crew would live in the center section of the space vehicle with facilities for work, recreation, hygiene, and dining located around the perimeter. Both of the preceding sources describe a trip involving one spacecraft. Some proposals involve more than one vehicle. Sharpe [25] discusses this idea in terms of the redundancy concept: “The process of redundancy can be carried even further to increase the probability of a successful mission on very long-range projects such as a voyage to Mars. We should launch more than one vehicle so that they can travel like the Nina, Pinta, and Santa Maria during a far more hazardous exploration in the 15th century (sic), which ended successfully when two out of the three ships returned safely.” The important aspect of these proposals is that the estimated time to Mars is approximately 8 months. During this time, men must interact under conditions of weightlessness, monotony, isolation, possible danger, and an abundance of free time. After a “breather” on Mars, they must then face the same conditions during their return to Earth. No space mission to date has provided enough information to truly analyze any of these factors. The U.S. Skylab missions of 28 and 56 days, to be launched early in this decade, will provide some answers concerning men working for nearly 2 months in a weightless environment. This, however, represents only one-fourth of the total trip time to Mars. Obviously, a space station or lunar laboratory would be much better, but at present these (continued)

Preface

xviii

Table 3  A ranking of social systems similar to long-duration space missions System Submarines Exploration parties Naval ships Bomber crews Remote duty stations POW situations Professional athletic teams Mental hospital wards Prison society Industrial work groups Shipwrecks and disasters

Rank 1 2 3 4 5 6 7 8 9 10 11

Similarity score 79 68 61 60 59 39 37 23 20 16 11

Modified from Sells. Adapted from Ref. [28]

structures are still “on the drawing boards.” Therefore, data must be obtained from short-duration space missions, long-duration space simulators located on Earth, and various social systems that have characteristics common to longduration space missions. Hopefully, by extrapolation, some meaningful trends may be exposed, although these must be taken as extrapolated probabilities, not fact. Sells [28] has done an interesting study of 11 social systems he regards as pertinent to long-duration space flight. He first developed 56 characteristics of such flights, then scored his social systems on each characteristic according to a scale of 2 (highly similar), 1 (moderately similar), and 0 (dissimilar or unrelated). The results are presented in table II (see Table 3). A large break appears between the first five systems and the next six, implying that systems 1–5 provide the best data for extrapolation to long space missions. Short-duration space flights, space simulators, weightlessness, and the recent hypodynamia studies, which are not included in Table 3, would undoubtedly alter the ranking. Sells’ systems do not include many important variables and none of the systems even nearly approach an ideal score of 112, showing that they are at best only approximations to the actual missions. With regard to systems that Sells omitted, similar faults may be found. A comparison of these sources of information is given in table III (see Table 4), which indicates that these other systems do not truly represent an accurate picture of long-duration space missions. One report [29] helps to put the picture in proper perspective: “…no ‘simulation experiments’ land based, submerged, or even a short or long term orbital laboratory can serve as an absolute predictor of future long-range missions. Simulation studies can only provide relative or trend data.” (continued)

Preface

xix

Table 4  A comparison of long- and short-duration space missions, space simulators, and hypodynamia Factor Weightlessness Crew size Duration

Long-duration mission Present 8–12 17 months

Danger Rescue Confinement Free time

Present Unlikely Present Present

Short-duration mission Present 1–3 Less than 3 weeks Present Unlikely Present Absent

Space simulator Absent Varied Less than 12 months May be present Possible Present Present

Hypodynamia Absent Varied Less than 3 months Absent Possible Present Present

Chapter Organization The next nine chapters of this book will deal with topics related to behavioral and interpersonal issues in space. For abbreviated versions of this material, the reader is referred to other aerospace books and textbook chapters [2, 30, 31], and review articles [32, 33]. Each chapter in this book ends with a chapter summary (Points to Remember), two or three problems to think about (Food for Thought), and a list of References. Relevant sections from the NASA TM document are reprinted in gray and labeled FROM THE ARCHIVES. Introductory quotations and conclusions from each section of the TM are found in a special Appendix at the end; the reader can judge how accurately they reflect the situation today. In the contemporary sections of this book, most of the studies that were reviewed used rigorous methodology, tested the findings using appropriate statistical analyses, and appeared in peer-reviewed journals. Priority was given to studies conducted in space. A Glossary and Acronyms section (see page xxxv) and an Index complete this book. Enjoy! San Francisco, CA, USA  Nick Kanas

References 1. Schorn, J. M., & Roma, P. G. (2021). Physical hazards of space exploration and the biological bases of behavioral health and performance in extreme environments. In L.  B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, vol. 1: Research at the frontier (pp. 1–22). CRC Press. 2. Kanas, N. (2015). Humans in space: The psychological hurdles. Springer International Publishing AG.

xx

Preface

3. Roma, P. G., Schneiderman, J. S., Schorn, J. M., Whiting, S. E., Landon, L. B., & Williams, T. J. (2021). Assessment of spaceflight medical conditions’ and treatments’ potential impacts on behavioral health and performance. Life Sciences in Space Research, 30, 72–81. 4. Cromwell, R. L., & Neigut, J. (2021). Spaceflight research on the ground: Managing analogs for behavioral health research. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, vol. 1: Research at the frontier (pp.  23–45). CRC Press. 5. Stuster, J. (1996). Bold endeavors: Lessons from polar and space exploration. Naval Institute Press. 6. Stuster, J. W. (2021). Behavioral challenges of space exploration. In L. R. Young & J. P. Sutton (Eds.), Handbook of bioastronautics (pp. 385–397). Springer Nature Switzerland AG. 7. Tafforin, C. (2015). Isolated and confined environments. In D. A. Beysens & J. J. W. A. van Loon (Eds.), Generation and applications of extra-terrestrial environments on earth (pp. 173–181). River Publishers. 8. Driskell, J.  E., Salas, E., & Driskell, T. (2021). Research in extreme real-world environments: Challenges for spaceflight operations. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, vol. 1: Research at the frontier (pp. 67–86). CRC Press. 9. Gerzer, R., & Cromwell, R. L. (2021). Spaceflight analogs: An overview. In L. R. Young & J. P. Sutton (Eds.), Handbook of bioastronautics (pp. 457–467). Springer Nature Switzerland AG. 10. Gushin, V. (2021). Isolation chamber studies. In L. R. Young & J. P. Sutton (Eds.), Handbook of bioastronautics (pp. 499–514). Springer Nature Switzerland AG. 11. Choukér, A., & Stahn, A. C. (2020). COVID-19—The largest isolation study in history: The value of shared learnings from spaceflight analogs. NPJ Microgravity, 6, 32, 1–7. https://doi. org/10.1038/s41526-­020-­00122-­8 12. Yusupova, A., Ushakov, I., & Gushin, V. (2010). Communication in long-term space flights and space simulations. Lambert Academic Publishing. 13. Ponomarev, S., Kalinin, S., Sadova, A., Rykova, M., Orlova, K., & Crucian, B. (2021). Immunological aspects of isolation and confinement. Frontiers in Immunology, 12, 1–16. https://pubmed.ncbi.nlm.nih.gov/34248999/ 14. Cromwell, R. L., Huff, J. L., Simonsen, L. C., & Patel, Z. S. (2021). Earth-­based research analogs to investigate space-based health risks. New Space, 9, 204–216. 15. Landon, L.  B., Slack, K.  J., & Barrett, J.  D. (2018). Teamwork and collaboration in longduration space missions: Going to extremes. American Psychologist, 73, 563–575. 16. Posselt, B. N., Velho, R., O’Griofa, M., Shepanek, M., Golemis, A., & Gifford, S. E. (2021). Safety and healthcare provision in space analogs. Acta Astronautica, 186, 164–170. 17. Kanas, N. (1997). Psychosocial value of space simulation for extended spaceflight. In S. L. Bonting (Ed.), Advances in space biology and medicine (Vol. 6). JAI Press. 18. Bishop, S. L. (2013). From earth analogues to space: Learning how to boldly go. In D. A. Vakoch (Ed.), On orbit and beyond: Psychological perspectives on human spaceflight. Springer-Verlag. 19. Suedfeld, P. (1991). Groups in isolation and confinement environments and experiences. In A.  A. Harrison, Y.  A. Clearwater, & C.  P. McKay (Eds.), From Antarctica to outer space. Springer-Verlag. 20. Sandal, G. M., Vaernes, R., Bergan, T., Warncke, M., & Ursin, H. (1996). Psychological reactions during polar expeditions and isolation in hyperbaric chambers. Aviation, Space, and Environmental Medicine, 67, 227–234. 21. Smith, N., Sandal, G. M., Leon, G. R., & Kjaergaard, A. (2017). Examining personal values in extreme environment contexts: Revisiting the question of generalizability. Acta Astronautica, 137, 138–144. 22. Yourcenar, M. (1974). Memoirs of Hadrian (transl.). Farrar, Straus & Giroux, Publications. 23. Kanas, N.  A., & Fedderson, W.  E. (1971). Behavioral, psychiatric, and sociological problems of long-duration space missions. NASA Technical Memorandum, NASA TM X-58067.

Preface

xxi

Houston, TX: National Aeronautics and Space Administration Manned Spacecraft Center. https://ntrs.nasa.gov/api/citations/19720008366/downloads/19720008366.pdf 24. Kubis, J. F., & McLaughlin, E. J. (1967). Psychological aspects of space flight. Transactions of the New York Academy of Science, Series 11, 30(2), 320–330. 25. Sharpe, M.  R. (1969). Living in space: The astronaut and his environment. Doubleday and Co., Inc. 26. Hyatt, A. (1962). Planning for the future goals of NASA. In Proceedings of the NASA University Conference on the Science and Technology of Space Exploration (Vol. 11, pp. 15–24). NASA. 27. Price, H. E., et al. (1965). A final report of a study of crew functions and vehicle habitability requirements for long-duration manned space flights (Vol. 1). Serendipity Associates. 28. Sells, S. B. (1966). A model for the social system for the multiman extended-­duration space ship. Paper presented at the AIAA/AAS Stepping Stones to Mars Meeting, Baltimore, MD, March 28–30, pp. 433–438. 29. Anon. (1968, March 11). Feasibility of using undersea facilities to provide psychological and physiological data applicable to lengthy space missions. NASA CR-94259. 30. Sipes, W. E., Polk, J. D., Beven, G., & Shepanek, M. (2016). Behavioral health and performance. In A.  E. Nicogossian, R.  S. Williams, C.  L. Huntoon, C.  R. Doarn, J.  D. Polk, & V. S. Schneider (Eds.), Space physiology and medicine: From evidence to practice (4th ed., pp, 367–389). Springer Science+Business Media, L.L.C. 31. Sipes, W. E., Flynn, C. F., & Beven, G. E. (2019). Behavioral health and performance support. In M. R. Barratt, E. S. Baker, & S. L. Pool (Eds.), Principles of clinical medicine for spaceflight (2nd ed., pp. 761–792). Springer Science+Business Media, L.L.C. 32. De La Torre, G. G., van Baarsen, B., Ferlazzo, F., Kanas, N., Weiss, K., Schneider, S. & Whiteley, I. (2012). Future persepctives on space psychology: Recommendations on psychosocial and neurobehavioural aspects of human spaceflight. Acta Astronautica, 81, 587–599. 33. Smith, L. M. (2022). The psychology and mental health of the spaceflight environment: A scoping review. Acta Astronautica, 201, 496–512.

Acknowledgments

Writing this textbook was no easy task, and I received a lot of help along the way that helped shape my thinking. I first entered the space research field in 1969, when I worked with Anthony Kales on a NASA-funded sleep research project at the UCLA School of Medicine. That year, I also was a teaching assistant for the UCLA Summer Space Biology Institute for college undergraduates, another NASA-funded project directed by John Hanley. My first research investigator opportunity was a research contract from ESA to conduct a study during their HUBES simulation in 1994–5. Starting in 1995, I spent more than 15 years as a principal investigator for space projects funded by NASA and the National Space Biomedical Research Institute (NSBRI). This work could not have been done without the encouragement of my chief, Craig Van Dyke, and my research colleagues at the University of California and the Veterans Affairs Medical Center in San Francisco: Alan Bostrom, Jennifer Boyd, Ellen Grund, Millie Hughes-Fulford, Eva Ihle, Charles Marmar, Thomas Neylan, Philip Petit, Stephanie Saylor, and Daniel Weiss. We had a wonderful research collaboration with colleagues at the Institute for Biomedical Problems in Moscow: Vadim Gushin, Olga Kozerenko, Vyacheslav Salnitskiy, and Alexander Sled. I want to thank people at NASA and the NSBRI who funded our projects and were supportive of our work, especially Pamela Baskin, John Charles, Chris Flynn, Guy Fogleman, Mary Ann Frey, Cindy Haven, Lauren Leveton, Charles Sawin, Victor Schneider, Marc Shepanek, Scott Smith, Jeff Sutton, David Tomko, John Uri, Joan Vernikos, Alexanda Whitmire, and Tom Williams. Ruilin Wu and Fengyuan Zhuang were helpful in exposing me to Chinese space research. My collaborations with Alan Kelly and Anna Yusupova also were meaningful. And of course, I would like to thank all the astronauts, cosmonauts, and mission control personnel who participated in our studies. The backbone of this book resulted from three earlier publications. Bill Feddersen was a helpful mentor and co-author of the first, a NASA Technical Memorandum published in 1971, parts of which are reproduced in the current treatise. Dietrich Manzey was a valuable co-author in the second book (Space Psychology and Psychiatry), especially his expertise in the cognitive and work areas. I wrote the xxiii

xxiv

Acknowledgments

third book on my own (Humans in Space: The Psychological Hurdles), and in a sense it is a shorter version of the present treatise that was written for a more general audience. Several people read and commented on chapter and section drafts for the current book, and I am grateful for their help. They are: Laura Barger, Mike Barratt, Suzanne Bell, Gary Beven, Charles “Chip” Dukes, Ute Fischer, Vadim Gushin, Phyllis Johnson, Dietrich Manzey, Kathleen Mosier, James Picano, Gro Sandal, Marc Shepanek, Jack Stuster, Peter Suedfeld, Steve Vanderark, and Jim Vanderploeg. Of course, I am ultimately responsible for all the comments and opinions expressed in the final version of this book. Finally, I would like to acknowledge and thank my Springer Publication colleagues: Hannah Kaufman, Ramon Khanna, Michael Maimone, Ragavendar Mohan, Maury Solomon, and Vinesh Velayudham. December 2022

Nick Kanas

Contents

1

 Stress, Sleep, and Cognition in Microgravity����������������������������������������    1 1.1 From the Archives: Stress and Its Measurement [1] ������������������������    2 1.1.1 Stress and Stressors��������������������������������������������������������������    2 1.1.2 Measurement of Psychological and Social Stress����������������    3 1.2 Stressors in Space ����������������������������������������������������������������������������    8 1.3 From the Archives: Weightlessness and Low Sensory Input [1]������    9 1.3.1 Weightlessness����������������������������������������������������������������������   10 1.3.2 Hypodynamia Studies ����������������������������������������������������������   12 1.3.3 Weightlessness and Hypodynamia����������������������������������������   15 1.3.4 Weightlessness and the Astronaut����������������������������������������   16 1.3.5 Artificial Gravity������������������������������������������������������������������   17 1.3.6 Exercise��������������������������������������������������������������������������������   17 1.4 Coping with Microgravity����������������������������������������������������������������   18 1.5 Psychophysiological Stress��������������������������������������������������������������   20 1.6 From the Archives: Circadian Rhythms and Sleep [1]���������������������   20 1.6.1 Circadian Rhythms���������������������������������������������������������������   20 1.6.2 Circadian Rhythms and Performance ����������������������������������   21 1.6.3 Circadian Rhythms in Space������������������������������������������������   22 1.6.4 Work/Rest Cycles������������������������������������������������������������������   23 1.6.5 Sleep��������������������������������������������������������������������������������������   25 1.6.6 Sleeping in Space������������������������������������������������������������������   26 1.7 Circadian Rhythms and Sleep: Current Status����������������������������������   27 1.7.1 Circadian Rhythms���������������������������������������������������������������   27 1.7.2 Sleep��������������������������������������������������������������������������������������   29 1.8 Cognition and Performance��������������������������������������������������������������   33 1.8.1 Theoretical Issues�����������������������������������������������������������������   33 1.8.2 In-Flight Monitoring of Crewmember Attention and Cognition������������������������������������������������������������������������   36 1.8.3 Cognition and Performance in Space: Current Status����������   37 1.8.4 Russian Pilot-T Study ����������������������������������������������������������   41

xxv

xxvi

Contents

1.9 Points to Remember��������������������������������������������������������������������������   42 1.10 Food for Thought������������������������������������������������������������������������������   43 References��������������������������������������������������������������������������������������������������   44 2

 Living and Working in Space������������������������������������������������������������������   51 2.1 From the Archives: Behavioral Issues [1]����������������������������������������   52 2.1.1 Confinement, Isolation, and Monotony��������������������������������   52 2.1.2 Stages of Reaction to Isolation (Rohrer)������������������������������   57 2.2 Psychological Stress in Near-Earth Missions ����������������������������������   58 2.3 Initial Adjustment�����������������������������������������������������������������������������   59 2.4 Habitability ��������������������������������������������������������������������������������������   60 2.5 Work��������������������������������������������������������������������������������������������������   64 2.5.1 General Issues ����������������������������������������������������������������������   64 2.5.2 Manzey’s Work Strategies in Space��������������������������������������   65 2.6 Mission Stages and the Third Quarter Phenomenon������������������������   67 2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents��������������������������������������������������������������������������������������������   72 2.7.1 Preliminary Study in the Mir Space Station Simulator (HUBES)������������������������������������������������������������������������������   72 2.7.2 Methodology of the Mir and ISS “Interactions” Studies������   74 2.7.3 Time Findings ����������������������������������������������������������������������   76 2.7.4 Critical Incident Log Findings����������������������������������������������   80 2.7.5 A Kanas et al. Interactions Replication Study from China—Time Findings����������������������������������������������������������   82 2.8 ISS “Journals” Study������������������������������������������������������������������������   82 2.8.1 Preliminary Study During Long-Duration ICEs (French Diaries Study)����������������������������������������������������������   82 2.8.2 ISS “Journals” Study������������������������������������������������������������   83 2.9 Points to Remember��������������������������������������������������������������������������   87 2.10 Food for Thought������������������������������������������������������������������������������   88 References��������������������������������������������������������������������������������������������������   89

3

 Emotional Highs and Lows ��������������������������������������������������������������������   93 3.1 Positive Experiences in Space����������������������������������������������������������   94 3.2 The Overview Effect: Spirituality and Humanism����������������������������   96 3.3 Salutogenesis and Resilience������������������������������������������������������������   99 3.4 Changes in Value System������������������������������������������������������������������  101 3.5 From the Archives: Psychiatric Issues [33]��������������������������������������  102 3.5.1 The Magnitude of the Problem ��������������������������������������������  103 3.5.2 Reaction to Danger ��������������������������������������������������������������  104 3.5.3 Tension Reduction����������������������������������������������������������������  105 3.5.4 Psychotherapy in Space��������������������������������������������������������  106 3.6 Psychiatric Problems in Space����������������������������������������������������������  107 3.6.1 Frequency of Psychiatric Problems��������������������������������������  108 3.6.2 Adjusting to Space and Adjustment Disorders ��������������������  110

Contents

xxvii

3.6.3 Asthenia��������������������������������������������������������������������������������  112 3.6.4 Other Psychiatric Disorders��������������������������������������������������  114 3.7 Treatment Considerations ����������������������������������������������������������������  115 3.7.1 Psychoactive Medications����������������������������������������������������  115 3.7.2 Counseling and Psychotherapy ��������������������������������������������  118 3.7.3 Operational and Family Support������������������������������������������  120 3.7.4 Cognitive Emotion Regulation Strategies����������������������������  121 3.8 Points to Remember��������������������������������������������������������������������������  121 3.9 Food for Thought������������������������������������������������������������������������������  122 References��������������������������������������������������������������������������������������������������  123 4

 Crewmember Selection, Ground and Family Support������������������������  129 4.1 From the Archives: Predicting Action from Personality [1] ������������  130 4.2 From the Archives: Crew Selection [1]��������������������������������������������  131 4.2.1 Jobs in Space������������������������������������������������������������������������  131 4.2.2 Pilots Versus Scientists����������������������������������������������������������  132 4.2.3 Women in Space ������������������������������������������������������������������  134 4.2.4 Mixed-Nationality Space Crews ������������������������������������������  135 4.2.5 Astronaut Selection��������������������������������������������������������������  136 4.3 Personality Characteristics and Crewmember Selection������������������  138 4.3.1 Astronaut Selection��������������������������������������������������������������  139 4.3.2 Crew Selection����������������������������������������������������������������������  147 4.4 Crewmember-Mission Control Relationship������������������������������������  149 4.4.1 Gushin et al. Crew-Ground Communication Studies ����������  150 4.4.2 Kelly and Kanas Communication Study: Crew-Ground Findings��������������������������������������������������������������������������������  156 4.4.3 ISS Operations Challenges Seen by Mission Control Personnel������������������������������������������������������������������������������  157 4.5 From the Archives: Separation Reactions of Married Women [1]����������������������������������������������������������������������������������������  159 4.6 Family Issues������������������������������������������������������������������������������������  159 4.7 Returning Home��������������������������������������������������������������������������������  160 4.8 Points to Remember��������������������������������������������������������������������������  162 4.9 Food for Thought������������������������������������������������������������������������������  163 References��������������������������������������������������������������������������������������������������  164

5

 Human Interactions, Culture, and Team Behavior������������������������������  169 5.1 From the Archives: Sociological Considerations [1]������������������������  170 5.1.1 Sociological Stressors ����������������������������������������������������������  170 5.1.2 Group Size����������������������������������������������������������������������������  170 5.1.3 Group Structure��������������������������������������������������������������������  172 5.1.4 Leadership����������������������������������������������������������������������������  172 5.1.5 Reduction of Social Roles����������������������������������������������������  173 5.1.6 Relationship with the Ground Personnel������������������������������  173 5.1.7 Interpersonal Compatibility��������������������������������������������������  174

xxviii

Contents

5.1.8 Preventing Interpersonal Strife: (i.e., Crew Compatibility—NK)��������������������������������������������  176 5.1.9 Preventing Interpersonal Strife: (i.e., Displacement—NK)������������������������������������������������������  176 5.2 Team Cohesion in Space������������������������������������������������������������������  177 5.2.1 Effect of Team Tension ��������������������������������������������������������  178 5.2.2 Team Size������������������������������������������������������������������������������  179 5.2.3 Team Composition����������������������������������������������������������������  180 5.3 Individual Crewmember Issues Affecting Team Behavior ��������������  182 5.3.1 Personality Conflicts ������������������������������������������������������������  182 5.3.2 Differing Career Motivations and Life Experiences������������  183 5.3.3 Male-Female Differences������������������������������������������������������  184 5.3.4 Sexual Relationship Issues����������������������������������������������������  186 5.4 Interpersonal Group Issues Affecting Team Behavior����������������������  187 5.4.1 Territorial Behavior and Withdrawal������������������������������������  187 5.4.2 Subgrouping and Scapegoating��������������������������������������������  188 5.4.3 Displacement������������������������������������������������������������������������  189 5.4.4 Unclear Leadership Roles ����������������������������������������������������  192 5.5 Cultural and Language Issues ����������������������������������������������������������  193 5.5.1 Cultural Challenges for Space Crews ����������������������������������  194 5.5.2 Types of Culture in Human Space Missions������������������������  195 5.5.3 Cultural Issues in Space: Surveys ����������������������������������������  198 5.5.4 The Importance of a Common Language ����������������������������  199 5.5.5 Kelly and Kanas Communication Study: Intra-Crew Findings��������������������������������������������������������������������������������  200 5.6 Mir and ISS “Interactions” Studies: Displacement, Leadership, and Culture����������������������������������������������������������������������������������������  202 5.6.1 Displacement������������������������������������������������������������������������  202 5.6.2 Leadership����������������������������������������������������������������������������  204 5.6.3 Culture����������������������������������������������������������������������������������  205 5.7 Related Studies����������������������������������������������������������������������������������  209 5.7.1 A Kanas et al. “Interactions” Replication Study from China: Displacement and Leadership Findings�����������  209 5.7.2 Gushin et al. Communication Validation Study��������������������  209 5.7.3 Gushin et al. Interactions Studies�����������������������������������������  210 5.7.4 Gushin et al. Content Study��������������������������������������������������  211 5.7.5 Asthenia and Culture Study��������������������������������������������������  212 5.7.6 Multiteam CELSS Study������������������������������������������������������  213 5.7.7 Ethology in Lunar Palace I ��������������������������������������������������  215 5.8 New Approaches of Studying Team Dynamics in Space������������������  215 5.9 Points to Remember��������������������������������������������������������������������������  216 5.10 Food for Thought������������������������������������������������������������������������������  219 References��������������������������������������������������������������������������������������������������  220

Contents

xxix

6

 Countermeasures for Near-Earth Space Missions��������������������������������  227 6.1 Pre-launch Training��������������������������������������������������������������������������  228 6.1.1 Training Topics ��������������������������������������������������������������������  229 6.1.2 Kinds of Training������������������������������������������������������������������  230 6.2 Space Crew Monitoring and Support from the Ground��������������������  233 6.2.1 Psychological Support Groups����������������������������������������������  233 6.2.2 Private Conferences with People on Earth����������������������������  234 6.2.3 Family Support and Holidays ����������������������������������������������  235 6.2.4 Voice Frequency Analysis����������������������������������������������������  236 6.3 From the Archives: Monitoring Instruments [46] ����������������������������  238 6.4 Intra-crew Monitoring, Support, and Coping During the Mission ��������������������������������������������������������������������������  241 6.4.1 Actiwatch and Oura Rings����������������������������������������������������  241 6.4.2 Team Self-monitoring, Bull Sessions, and Debriefs������������  241 6.4.3 Individual Cognitive Self-monitoring ����������������������������������  243 6.4.4 Suedfeld et al. Coping Strategy Studies��������������������������������  245 6.4.5 Virtual Reality����������������������������������������������������������������������  247 6.5 From the Archives: Leisure Time–Submarines and Antarctica [46]����������������������������������������������������������������������������  249 6.6 Leisure Time in Space����������������������������������������������������������������������  251 6.6.1 Kelly and Kanas Communication Study: Leisure Time Findings��������������������������������������������������������������������������������  251 6.6.2 Stuster “Journals” Study: Leisure Time Findings����������������  253 6.6.3 Stocking for Flexibility ��������������������������������������������������������  255 6.7 Post-mission Readaptation����������������������������������������������������������������  255 6.7.1 Individual Issues ������������������������������������������������������������������  256 6.7.2 Family Issues������������������������������������������������������������������������  257 6.8 Points to Remember��������������������������������������������������������������������������  257 6.9 Food for Thought������������������������������������������������������������������������������  259 References��������������������������������������������������������������������������������������������������  259

7

Commercial Human Spaceflight������������������������������������������������������������  265 7.1 Suborbital Missions��������������������������������������������������������������������������  267 7.1.1 Early History: The Ansari X Prize����������������������������������������  267 7.1.2 Richard Branson’s Virgin Galactic����������������������������������������  269 7.1.3 Jeff Bezos’ Blue Origin��������������������������������������������������������  269 7.1.4 Suborbital Pre-Launch Training and the Mission Experience����������������������������������������������������������������������������  271 7.1.5 Medical and Psychological Issues for Suborbital Missions��������������������������������������������������������������������������������  272 7.2 Orbital Missions��������������������������������������������������������������������������������  274 7.2.1 Early History: Space Station Missions ��������������������������������  274 7.2.2 United Launch Alliance��������������������������������������������������������  276 7.2.3 Elon Musk’s SpaceX������������������������������������������������������������  276 7.2.4 Russian Soyuz Program��������������������������������������������������������  280

xxx

Contents

7.2.5 Robert Bigelow’s Inflatable Habitats������������������������������������  280 7.2.6 Axiom Space, Inc.����������������������������������������������������������������  281 7.2.7 Orbital Pre-launch Training and the Mission Experience����������������������������������������������������������������������������  283 7.2.8 Medical and Psychological Issues for Orbital Missions ������  284 7.3 The Market for Commercial Human Spaceflight������������������������������  287 7.4 Legal and Environmental Issues ������������������������������������������������������  290 7.5 Lunar and Solar System Missions����������������������������������������������������  291 7.6 Points to Remember��������������������������������������������������������������������������  293 7.7 Food for Thought������������������������������������������������������������������������������  294 References��������������������������������������������������������������������������������������������������  295 8

 Artemis and the Psychosociology of Lunar Colonies����������������������������  299 8.1 Why Go Back to the Moon? ������������������������������������������������������������  300 8.2 Artemis Program������������������������������������������������������������������������������  302 8.2.1 Artemis I ������������������������������������������������������������������������������  302 8.2.2 Artemis II������������������������������������������������������������������������������  304 8.2.3 Artemis III����������������������������������������������������������������������������  304 8.2.4 Artemis IV����������������������������������������������������������������������������  308 8.2.5 Artemis V������������������������������������������������������������������������������  308 8.2.6 Artemis Base Camp��������������������������������������������������������������  310 8.2.7 Multinational Participation in Artemis: Legal and Other Issues��������������������������������������������������������������������  311 8.3 Space Colonies����������������������������������������������������������������������������������  312 8.3.1 O’Neill Cylinders������������������������������������������������������������������  313 8.3.2 Stanford Torus����������������������������������������������������������������������  315 8.4 Lunar Colonies����������������������������������������������������������������������������������  317 8.4.1 Constructing and Populating a Permanent Lunar Colony����  317 8.4.2 Colonizing the Moon: Psychosocial Lessons from Science Fiction ������������������������������������������������������������  320 8.4.3 Colonizing the Moon: Psychosocial Lessons Based on Earth Experiences������������������������������������������������������������  322 8.4.4 Colonizing the Moon: Psychosociological Conclusions������  324 8.5 Points to Remember��������������������������������������������������������������������������  325 8.6 Food for Thought������������������������������������������������������������������������������  326 References��������������������������������������������������������������������������������������������������  327

9

 Expeditions to Mars and Beyond������������������������������������������������������������  331 9.1 Going to Mars ����������������������������������������������������������������������������������  332 9.2 Distance: A Behavioral Game Changer��������������������������������������������  336 9.2.1 Psychological Stressors��������������������������������������������������������  337 9.2.2 Interpersonal Stressors����������������������������������������������������������  339 9.3 Autonomy ����������������������������������������������������������������������������������������  340 9.3.1 General Issues ����������������������������������������������������������������������  340 9.3.2 Studies of High Versus Low Autonomy��������������������������������  342 9.4 Communication Delays��������������������������������������������������������������������  347

Contents

xxxi

9.4.1 General Issues ����������������������������������������������������������������������  347 9.4.2 Studies of Delayed Communication ������������������������������������  347 9.5 Mars 500 Project ������������������������������������������������������������������������������  350 9.6 Countermeasures for a Mars Expedition������������������������������������������  355 9.6.1 Pre-Launch Selection������������������������������������������������������������  355 9.6.2 Pre-Launch Training ������������������������������������������������������������  356 9.6.3 Intra-Crew Monitoring, Support, and Coping During the Mission����������������������������������������������������������������������������  357 9.6.4 Post-Mission Readaptation ��������������������������������������������������  362 9.7 Colonizing Mars��������������������������������������������������������������������������������  362 9.7.1 Colonizing Mars: Psychosocial Lessons from Science Fiction ������������������������������������������������������������  363 9.7.2 Colonizing Mars: Psychosocial Issues Based on Earth Experiences������������������������������������������������������������  366 9.7.3 Colonizing Mars: Cognitive Shifts ��������������������������������������  368 9.7.4 Colonizing Mars: Large Simulator Studies on Earth������������  369 9.7.5 Colonizing Mars: Psychosociological Conclusions��������������  370 9.8 Interplanetary Expeditions Beyond Mars ����������������������������������������  371 9.9 Points to Remember��������������������������������������������������������������������������  374 9.10 Food for Thought������������������������������������������������������������������������������  377 References��������������������������������������������������������������������������������������������������  377 10 Appendix.  Introductory Quotations and Conclusions from NASA TM X-58067 (1971): Behavioral, Psychiatric, and Sociological Problems of Long-­Duration Space Missions (N.A. Kanas & William E. Fedderson)��������������������������������������������������������������������������������������������  385 10.1 Summary ����������������������������������������������������������������������������������������  386 10.2 Conclusions on Stress and Its Measurement����������������������������������  386 10.3 Conclusions on Weightlessness and Low Sensory Input����������������  387 10.4 Conclusions on Circadian Rhythm and Sleep��������������������������������  387 10.5 Conclusions on Confinement, Isolation, and Monotony����������������  388 10.6 Conclusions on Psychiatric Considerations������������������������������������  388 10.7 Conclusions on Sociological Considerations����������������������������������  389 10.8 Conclusions on Crew Selection������������������������������������������������������  390 10.9 Concluding Remarks����������������������������������������������������������������������  390 References��������������������������������������������������������������������������������������������������  391 Index������������������������������������������������������������������������������������������������������������������  393

Author Biography

Nick  Kanas, M.D.,  is Emeritus Professor of Psychiatry at the University of California, San Francisco (UCSF). He trained at Stanford University (B.A. Psychology 1967), UCLA Medical School (M.D. 1971), University of Texas Medical Branch in Galveston (Internship 1972), and UCSF (Psychiatry Residency 1975). After serving in the USAF as a psychiatrist from 1975 to 1977, he joined the faculty at UCSF and the affiliated San Francisco VA Medical Center, where he conducted clinical and research work on people suffering from stressful conditions. He has more than 220 professional publications and is the recipient of the Dr. J. Elliott Royer Award for academic psychiatry. Dr. Kanas has studied and written about psychological and interpersonal issues affecting people working in space for more than 50 years. As a medical student, he was a teaching assistant for the NASA-supported UCLA Summer Space Biology Institute in 1969, and he participated in a NASA-funded sleep research project. Following a fellowship at NASA/Johnson Space Center in 1970, he was the senior author with Dr. Bill Feddersen of the 1971 monograph Behavioral, Psychiatric, and Sociological Problems of Long-Duration Space Missions (NASA TM X-58067). He has initiated space-related research projects since the early 1990s, including a psychosocial study of people participating in the European Space Agency HUBES space simulation program. For more than 15 years thereafter, he was an NSBRI and NASA-funded principal investigator, doing psychological and interpersonal research with astronauts, cosmonauts, and mission control personnel during missions on the Mir and International Space Stations. He also directed research investigations involving three space simulation projects: NEEMO submersible missions, Haughton-Mars Project in Canada, and the pilot phase of the Mars 500 Program in Moscow. In 1999, Dr. Kanas received the Aerospace Medical Association Raymond F.  Longacre Award for Outstanding Accomplishment in the Psychological and Psychiatric Aspects of Aerospace Medicine. In 2008, he received the International Academy of Astronautics Life Science Award. He also is a member and former trustee of the International Academy of Astronautics, and he has been a consultant for movies and private space firms. xxxiii

xxxiv

Author Biography

Together with Dr. Dietrich Manzey, he is the co-author of the book Space Psychology and Psychiatry (now in its second edition), which was given the 2004 International Academy of Astronautics Life Science Book Award. He authored the book Humans in Space: The Psychological Hurdles, which was given the 2016 International Academy of Astronautics Life Science Book Award. He also has published two books on group therapy with psychotic patients, two books on celestial cartography, and three science fiction novels. He continues to write and consult on the behavioral and interpersonal aspects of human space travel. Website: http://nickkanas.com/. E-mail: [email protected].

Glossary and Acronyms

H or Helium-3 A light, stable isotope of helium with two protons and one neutron that can be used to power a fusion reactor. Actigraphy A non-invasive method of monitoring human rest and activity. Actiwatch A device worn like a wristwatch that records motion and light that provides information about activity and sleep/wake patterns. Agent-based modeling (ABM) A computational model for simulating the interactions of autonomous agents (e.g., individuals, groups) in order to understand their behavior as a total system. ANSMET Antarctic Search for Meteorites polar field expedition. Apogee The point in the orbit of the Moon or a satellite at which it is furthest from the Earth. ARGOS Active Response Gravity Offload System. Artemis Program The current NASA plan to return to the Moon and use it as a staging area for a mission to Mars. Asthenia An adjustment reaction to the conditions of space that has been identified by Russian flight surgeons as occurring in many of their cosmonauts. It manifests itself as fatigue, tiredness, loss of strength, low sensation threshold, unstable mood, and sleep disturbance. Its symptoms are similar to those seen in neurasthenia, a more severe neurotic condition. 3

xxxv

xxxvi

Glossary and Acronyms

Autonomization  A process of increasing egocentricity in members of a group living in an isolated and confined environment, such as in a space vehicle. Autonomy The level of discretion and freedom an indi­ vidual or team is given to perform tasks, including decision-making and problem-solving. Back room  People working in the Mission Control Center who are not visible to public view and who support those in the front room (see below). Biosphere 2  A scientific research facility located in Arizona that was designed as a closed ecological system to support and maintain human life by emulating Earth’s environment. It supported two crewed missions in the early 1990s that ran into a variety of engineering and group dynamic problems. Braiding  An application technology that structures communication between remote team members into revolving “braids” (i.e., topics) in order to help them keep track of their conversation. Bull session (or unguided debrief) The gathering of a group of people to discuss their situation without a specific agenda or involvement from outside people and where the facilitator is a member of the group. Capcom The “capsule communicator,” traditionally a US astronaut who serves in the Mission Control Center as a liaison with astronauts in space. CAPSULS Canadian Astronaut Program Space Unit Life Simulation. CELSS Controlled Ecological Life Support System (Chinese isolation facility, Space Institute of Southern China, Shenzhen, 4-person missions up to 6 months). Chatbot A computer program designed to simulate conversation with human users via voice commands or text chats. Chronodeficiency planning The revision of a schedule of activities for a space mission based on reports from astronauts and cosmonauts that they don’t have enough time to do their activities.

Glossary and Acronyms

xxxvii

Cognition test  A cognitive test battery composed of ten computerized neuropsychological tests that are thought to engage specific brain regions. Compensatory control model A model of the system the body uses to regulate human performance under stress and high workload. Concordia  French-Italian research station in the Antarctic. Cosmonaut  The Russian term for an astronaut in the Russian Federal Space Agency. CubeSat  A small research spacecraft with specific dimensions that is part of the nanosatellite class (i.e., weighing less than 10 kg). Debrief The gathering of a group of people to discuss a specific incident or situation where external people (such as members of the Mission Control Center) are involved, one of whom is the facilitator or co-facilitator along with a designated crewmember. Demand characteristic bias A bias created when a respondent answers a survey in accordance with a preset expectation of what the survey or surveyor wants. Desert RATS  Desert Research and Technology Studies (NASA habitat). Displacement The directing outwardly of tension and other unpleasant emotions from a person in an isolated group to a person outside the group who is a safe target. DLR  Deutsches Zentrum für Luft- und Raumfahrt (German Aerospace Center), Cologne, Germany Dysphoria A state of unease or dissatisfaction. Earth-out-of-view phenomenon The psychological ramifications of seeing the Earth as an insignificant dot in space. ECOPSY Ecology and Psychology (90-day isolation study of 3 men at the IBMP from Oct. 21, 1995, to Jan. 22, 1996) Entrainment Something that becomes synchronized with something else, such as a biological rhythm with phases of light. EVA (extravehicular activity Any activity done by an astronaut outside a or spacewalk) spacecraft beyond the Earth’s atmosphere.

xxxviii

Glossary and Acronyms

EXEMSI  Experimental Campaign for the European Manned Space Infrastructure (60-­day isolation study of 3 men and 1 woman at the German Aerospace Center (DLR) in Cologne from Sept. 7 to Nov. 6, 1992). Exoplanet A planet orbiting a star other than our Sun. FMARS  Flashline Mars Arctic Research Station (Mars Society Habitat, Devon Island, Canada, 6-person missions of up to 1 year). Founder effect  A reduction in genomic variability that occurs when a small group of individuals becomes separated from a larger population. This can result in a tendency toward genetic divergence from the original population. Front room  People working in the Mission Control Center who are visible to public view. g The abbreviation for the unit of force that is equal to the force exerted by the Earth’s gravity. Gateway A space station that will orbit the Moon in a Near Rectilinear Halo Orbit (see below) as part of the Artemis Program (see above) that will serve as a relay station for trips to the Moon and Mars. Genetic drift A mechanism of evolution that is characterized by random fluctuations in the frequency of a particular version of a gene in the population. This can lead to a reduction in genetic variation. GES  A psychological test called the Group Environment Scale that measures the general interpersonal climate of a group of people along various dimensions (e.g., cohesion, leader support). Groupthink The tendency of a group to strive for consensus at the cost of considering alternative courses of action. Habitable Zone The distance from a star where the temperature is such that water on an orbiting planet can exist in liquid form. HERA Human Exploration Research Analog (NASA isolation facility, Johnson Space Center, 4-person missions up to 45 days).

Glossary and Acronyms

xxxix

HI-SEAS  Hawaii Space Exploration Analog and Simulation (NASA isolation facility, Hawaii, 6-person missions up to 1 year). HTO Vehicle A flying vehicle that takes off horizontally, like an airplane. HUBES  HUman Behavior in Extended Spaceflight (135-day isolation study of 3 men at the NEK facility from Sept. 1, 1994, to Jan. 13, 1995) Human Landing System A lunar lander variant of the SpaceX Starship (or SpaceX Starship HLS) spacecraft that will transfer astronauts from a lunar orbit to the surface of the Moon and back. It is part of the Artemis Program (see above). Human System Integration  A technical and management process that designs and develops a system that effectively and affordably integrates human capabilities and limitations. IBMP  Institute for Biomedical Problems, Moscow, Russia. ICCE An isolated, confined, and controlled environment primarily used as a space simulator. Examples include enforced bed rest and land- and sea-based habitats. ICE  An isolated and confined environment (a generic term for ICCEs and ICEEs). ICEE An isolated, confined, and extreme environment used as a space analog but with its own separate non-space related mission. Examples include polar expeditions, Antarctic stations, or submarines. Information-splitting Instances where remote team members present related information in separate turns (see below), especially when they communicate via texting. ISEMSI  Isolation Study for the European Manned Space Infrastructure (28-day isolation study of 6 men at NUTEC in Bergen, Norway, in 1990). Kármán (or Von Kármán) Line According to international standards, the altitude at which space begins, which is 100 km (62 miles) above sea level. Kuiper Belt A flat ring in the outer Solar System in which reside the nuclei of short-period comets. LDSE Long-distance space exploration.

xl

Glossary and Acronyms

Long-eye phenomenon In isolated groups living in the Antarctic, the term given to people who stare off into space and experience dissociation and even psychosis as a result of being excluded from the group. Mars 105 Program 105-day isolation study of 6 men at the NEK facility from March 31 to July 14, 2009 Mars 500 Program 520-day isolation study of 6 men at the NEK facility from June 3, 2010, to Nov. 4, 2011. Mass driver  A type of electromagnetic catapult that, through the sequential firing of a row of electromagnets, can accelerate a metal container with payload along a path to high speeds, ultimately reaching lunar escape velocity. MDRS Mars Desert Research Station (Mars simulation habitat located in the Utah desert, USA, operated by the Mars Society, 6-person missions up to 15 days). Microgravity  The near-zero gravity condition found in space. Mission Control Center The operations center for a space mission, (MCC, or Mission Control) usually located at a specific place in the country most responsible for the mission, such as the USA or Russia. MRAB A self-assessment test called the MiniCog Rapid Assessment Battery that has been developed to help crewmembers evaluate their cognitive functioning while in space. Multiteam system A network of interrelated teams united by common purposes (e.g., astronauts + Mission Control Center + space agency). Near Rectilinear Halo Orbit An eccentric orbit around the Moon that is (NRHO) part of the Artemis Program (see above). NEEMO  NASA Extreme Environment Mission Operations (NASA submersible facility “Aquarius” off the coast of Florida, 6-person missions up to 3 weeks). NEK  Nezemnyy Eksperimental’nyy Kompleks (isolation facility, IBMP, Moscow, Russia).

Glossary and Acronyms

xli

 personality test developed by Costa and A McCrae that characterizes people in terms of five major dimensions (the so-called “Big Five”): Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. NUTEC Norwegian Underwater TEchnology Center, Bergen, Norway. O’Neill Cylinder  A giant rotating and manned cylindrical space facility located near the Earth that was proposed by Princeton Physicist Gerard O’Neill. Oort Cloud A spherical area in the outer Solar System in which reside the nuclei of long-period comets. Orion capsule A larger Apollo-like space vehicle that in its crewed configuration will carry astronauts to the Moon as part of the Artemis Program (see above). It is supported by an ESA-built Service Module (see below). Oura ring A sensory ring that monitors vital signs (e.g., heart rate, body temperature) and reports these data via a smartphone app. Overview Effect A term coined by Frank White describing the reaction of people seeing the Earth from space that is characterized by a feeling of awe for the planet, an understanding of the interconnection of life, and a sense of responsibility for taking care of the environment. Panopticon  Originally, a circular prison with cells arranged around a central well, from which prisoners could be observed at all times. In its use as a space habitat, it consists of private individual rooms that ring around a central area that is used for communal activities. Perigee The point in the orbit of the Moon or a satellite at which it is closest to the Earth. Personal Characteristics A personality test developed by Spence and Inventory (PCI) Helmreich that categorizes people in terms of several scales, two of which are Instrumentality (related to goal-seeking and achievement motivation) and Expressivity (related to interpersonal sensitivity and concern). NEO-Personality Inventory

xlii

Glossary and Acronyms

POMS  A psychological test called the Profile of Mood States that measures a person’s emotions along various dimensions (e.g., tensionanxiety, depression-dejection). Private space traveler (PST) A person using private funds to pay for a trip into space, generally conducted by a commercial entity like an aerospace company. Proximity bias Inclination by team members to neglect the impact of communication delays. As a result, they mistake a remote partner’s communication that immediately follows their own transmission as a response to it. Psychological closing The filtering of information that a space crew divulges to people on the outside. Psychomotor Vigilance Test  A sustained-attention, reaction-timed test that measures response to a visual stimulus. Psychosocial education training A training program that addresses individual (PET) and group problems and discusses relevant countermeasures for dealing with them. Psychosociology The study of problems common to psychology and sociology. Resilience The ability to deal with and recover quickly from stressful conditions. RIDGE Five stressors of space--Radiation, Isolation and confinement, Distance from Earth, Gravity alterations (e.g., microgravity), and Environment. Salutogenesis  The health-promoting, growth-enhancing effects of a challenging situation. Scapegoat A person who is singled out by the other members of a group who is blamed for problems or is the object of irrational hostility. Service Module (Orion) The ESA-built component of the Orion system that provides the crew-carrying Orion capsule (see above) with electricity, propulsion, thermal control, air, and water. It is part of the Artemis Program (see above). SFINCSS Simulation of Flight of International Crew on Space Station (240-day, 110-day, and 110day isolation missions of crews of 4 men, 4 men, and 3 men plus 1 woman, respectively, at the IBMP from July 2, 1999, to March 22, 2000. There also were visiting crewmembers.)

Glossary and Acronyms

xliii

SFMTS (Spaceflight Multiteam In international space missions, a muliteam System)  system (see above) where astronauts must interact with more than one mission control group. SIRIUS Scientific International Research in Unique Terrestrial Station (NEK facility, 6-person mixed-gender crews in missions up to 1 year). Space Adaptation Syndrome The “space sickness” experienced by many astronauts as they adapt to microgravity during a space mission. Space fog (or space stupids) A state of cognitive deficiency that occurs in microgravity during space missions, including impairments in time sense, perceptual sensitivity, spatial orientation, attention and concentration, memory, or psychomotor ability. Space Launch System (SLS) The giant rocket system that will launch the Orion capsule and Service Module (see above) to the Moon as part of the Artemis Program (see above). Space tourist A private space traveler (see above) who goes into space for the experience or for recreation and who does not engage in a specific project or activity. Spaceflight Participant (SFP) A private space traveler (see above) who engages in a project or activity that is not related to a critical operational duty which is the purview of an astronaut, such as piloting or engineering. Stanford Torus  A giant rotating and manned ring-shaped space facility located near the Earth that was proposed in 1975 at a NASA-supported summer workshop at Stanford University. Status leveling The spreading of authority among the members of a group in order to promote good will or complete a task. Step-ons  Instances in which communications by remote team members overlap, i.e., while one team member is speaking, he or she receives a communication from their remote partner. Stress The effects of a stressor on someone. This can be physical, psychological, or interpersonal.

xliv

Glossary and Acronyms

Stressor A characteristic of the environment, physical, psychological, or interpersonal, that impacts on someone. Subgroup A small group of people within a larger group who are bound together by social, national, occupational, or personal interests. Submariners’ Wives Syndrome A family readjustment problem first noticed in the wives of submariners whereby they experienced depression and marital problems after their husbands returned home from long sea duty. Suspended animation (see torpor). Tara expeditions Oceanographic and environmental scientific expeditions conducted in polar regions on the 36-m schooner Tara that can be used as space analog missions. Third quarter phenomenon An increase in emotional problems experienced by some people working in an isolated and confined environment after the halfway point of their mission. Torpor (or suspended animation) A condition of hypometabolism in an organism, leading to physical or mental inactivity (but not death). Turn A unit in communication that pertains to a segment of uninterrupted speech by a conversational partner. Two-of-a-kind rule In order to discourage isolation and scapegoating, the policy that in a group of people, it is best to have at least two sharing a common demographic characteristic (e.g., sex, nationality, education, or training). Van Allen Belts Two regions of intense radiation partly surrounding the Earth at heights of several thousand kilometers. VIIP Visual Impairment and Increased Intracranial Pressure, which along with other ocular changes, have been found in many astronauts returning from space. The syndrome is thought to be caused by microgravity and other stressors of space travel. VTO vehicle A flying vehicle that takes off vertically, like a rocket.

Glossary and Acronyms

xlv

WES  A psychological test called the Work Environment Scale that measures the workrelated interpersonal climate of a group of people along various dimensions (e.g., work pressure, supervisor support). WinSCAT A self-assessment test called the Spaceflight Cognitive Assessment Tool for Windows that has been developed and implemented by NASA to help crewmembers evaluate their cognitive functioning while in space. Yerkes-Dodson Law  The relationship between arousal from a stressor and its impact on performance, often graphed as an “inverted U,” with performance (on the Y-axis) being low under low and high arousal (on the X-axis) and high under moderate arousal. Zeitgeber An environmental cue (such as light) that synchronizes an organism’s biological rhythms to a period of time, such as the Earth’s 24-hour day-night cycle.

Chapter 1

Stress, Sleep, and Cognition in Microgravity

Contents 1.1  From the Archives: Stress and Its Measurement [1] 1.2  Stressors in Space 1.3  From the Archives: Weightlessness and Low Sensory Input [1] 1.4  Coping with Microgravity 1.5  Psychophysiological Stress 1.6  From the Archives: Circadian Rhythms and Sleep [1] 1.7  Circadian Rhythms and Sleep: Current Status 1.8  Cognition and Performance 1.9  Points to Remember 1.10  Food for Thought References

   2    8    9  18  20  20  27  33  42  43  44

After the launch of the first satellite into space by the Soviet Union on October 4, 1957, there was no question but that humans would follow. There were a number of milestones in human flight, beginning with the launch of the first man, Yuri Gagarin, on April 12, 1961, and the first woman, Valentina Tereshkova, on June 16, 1963. The United States sent up the first American into space, Alan B. Shepard, on May 5, 1961. This was part of the Mercury Program (1958–1963), which consisted of seven astronauts who flew singly on short on-orbit missions. During the Gemini Program (1962–1966), two-person missions occurred, and during the Apollo Program (1963–1972), aimed at sending humans to the Moon, three-person flights took place. The culmination was the first lunar landing on July 20, 1969, which involved astronauts Neil Armstrong, Edwin “Buzz” Aldrin, and Michael Collins. Although they were beaten in the Moon race, the Soviets launched their first space station, Salyut 1, on April 19, 1971. The pinnacle of the Soviet space station program in the twentieth Century was Mir, the construction of which began in 1986. It was deorbited in 2001 for budgetary reasons and to make way for the International Space Station, which still is in in orbit. The ability of humans to tolerate the stressors of space was of great interest from the beginning. Would humans survive the force of the launch acceleration, followed by the effects of microgravity on their bodies as they entered space? Would they © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 N. Kanas, Behavioral Health and Human Interactions in Space, https://doi.org/10.1007/978-3-031-16723-2_1

1

1  Stress, Sleep, and Cognition in Microgravity

2

become psychotic from the isolation and separation from family and friends on Earth? No one knew for sure what would happen. Programs were set up to simulate some of these stressors in analog environments on Earth, and early space travelers also were monitored physiologically and psychologically. In this chapter, we will examine some of the psychophysiological stressors and the resultant stress on the human body of being in space. Particular attention will be given to issues with behavioral implications: circadian rhythms, sleep, cognition, and performance.

1.1  From the Archives: Stress and Its Measurement [1] Space missions are stressful, a fact recognized in the missions mentioned above. Early attempts to categorize and measure stressors are described below. Many of these still have relevance today.—NK

1.1.1 Stress and Stressors The concept of stress means different things to different disciplines. Stress may connote either a cause or an effect. For example, rotating in a centrifuge may be considered as a stress; likewise, the physiological mechanisms causing a person to black out at high g-loads are also considered as a stress. Therefore, a stress will be defined as any change in an organism produced by a stressor (e. g., blacking out). A stressor is some condition(s) affecting an organism (e. g., rotating in a centrifuge). There are four types of stressors: physical, physiological, psychological, and social. The U.S. manned space program has largely concerned itself with the first and second types, for these have been of major concern so far. However, the advent of long-duration missions requires that the latter two types of stressors be considered. Dunlap [2] has stated that “the long duration of a Mars mission, the great distance the crew will be from the vicinity of Earth, the vastness and hostility of outer space, and man’s lack of knowledge about outer space are factors which make it unwise to extrapolate from our current experiences and predict that psychological and social stressors will not seriously affect the probability of mission success.” At the 21st Congress of the International Astronautical Federation, Charles A. Berry stated [3] that problems concerning confinement and group interaction will be a critical factor in the crew’s ability to work and get along together. It is important to realize that all types of stressors may affect the behavior of the crewmen. For example, Yuganov et  al. [4] found that, in simulated space flights lasting as long as 60 days, background noises of a 75-decibel (continued)

1.1  From the Archives: Stress and Its Measurement

3

intensity produced tinnitus, headaches, lack of sleep, and fatigue. Dunlap states [2] that “the presence of environmental stressors, such as weightlessness, ionizing radiation, and atmospheric contaminants, can lower the threshold of tolerance to psychological and sociological stressors.” In one simulation study, a moderate increase of cabin carbon dioxide (as much as 3%) was found to increase alertness and performance [5], but a review of submarine literature has shown that higher-than-ambient carbon dioxide levels can cause headaches [6]. Physical and physiological stressors that affect man’s behavior and state of mind are acceleration, vibration, lighting, temperature, radiation, magnetic fields, noise, weightlessness, atmosphere, food, liquids, waste removal, instrument display, disruption of circadian rhythms, and lack of sleep. Physical and physiological stressors are not minimized, but this report will assume that they will be resolved to tolerable limits by the time a longduration space mission is undertaken. The psychological and social stressors, the main concern of this report, are low sensory input, lack of motivation, confinement, isolation, monotony, free time, unconscious conflicts, blocked drives, dangers and emergencies, interpersonal relationships, crew size, and crew structure…. Hartman and Flinn [7] reported on a review of anecdotal literature that nonadaptive behavior can occur during catastrophes and acute stress and may lead to group disintegration. However, when the men were highly trained and the crew structure was clearly defined, this possibility was unlikely. Hartman and Flinn defined three potential problem areas: (1) possible panic situations, (2) situations with an unstable reward structure that may lead to uncooperative behavior, and (3) potentially unstable situations.

1.1.2 Measurement of Psychological and Social Stress Psychological and social stressor effects are, in general, measured by psychophysiological, psychological, and social tests. The psychophysiological tests measure emotion, arousal, or excitation. According to Ruff [8], the tests are based on three concepts. The first of these is the idea that the “fight or flight” reaction to an emergency is mediated through the sympathetic nervous system. For example, responses involving fear are associated with epinephrine release and those of anger are associated with norepinephrine secretion. The second concept, the “general adaptation syndrome,” is that stressors such as cold and infection cause adrenal corticosteroid secretion through the action of pituitary adrenocorticotropic hormone. The third idea is that stressors cause cortical arousal by way of the ascending reticular activating system in the brain stem and its thalamic extensions. Wang [9] and Burch [10] have confirmed this concept and shown that the galvanic skin response is also a good (continued)

1  Stress, Sleep, and Cognition in Microgravity

4

Table 1.1  Psychophysiological tests and psychic correlates Test Catecholamines (urine or blood)

ACTH or adrenal corticosteroid levels (urine or blood) Protein-bound iodine (serum) Skin resistance Heart rate Blood pressure Respiratory rate Electromyogram Electroencephalogram

Psychic correlate Increased norepinephrine—anger Increased epinephrine—fear Increased levels in stress Increase related to anxiety Decrease with arousal Usually increase in stress Variable Increase in fear or anger Related to motivation Alertness related to frequency

Adapted from Ruff [8]

indicator of cortical arousal. Some representative psychophysiological tests and typical psychic correlates are given in table IV (see Table 1.1). Several of these tests have been used on manned space missions. For example, on the Gemini VII and IX missions, urinary catecholamines, heart rate, and respiratory rate were measured as an indication of short- and long-term stress. On the Gemini VII mission, Frank Borman was connected to an electroencephalograph (EEG) transmitter, and data were collected concerning his general activity patterns and sleep state. Russian scientists have used these same tests. It has been found that the psychophysiological tests occasionally give varying results. For example, Lacey and Lacey [11] tested several subjects on a variety of stressors and found that each subject was overactive in some physiological responses, average in others, and underactive in still others. They found [11] that “these patterns of response tend to be reproduced from one stressor episode to another.” Therefore, any one physiological measure may not be a good indicator of stress in a particular individual. Consequently, when individuals are compared in an experiment involving one stress measure, the differences observed may be due to individual idiosyncracies and not to the experimental variables. In addition, Ruff [8] points out the importance of considering what a particular stressor means symbolically to an individual. He states [8] that external dangers may be met with immediate, uncomplicated responses but that “when danger is internal, symbolic, and anticipated, a variety of psychological defense mechanisms are called into play…The result may be a breakdown in performance that would be unpredicted if the total meaning of an unusual environment were not considered.” As an example, using heart rate, Ruff [8] cites the following report: “Lacey (1959) has shown that if a subject is required to note and detect what is going on in the environment, cardiac deceleration is the rule. Where he must concentrate on internal symbolic manipulations or is exposed to stimuli in which mechanisms to reduce environmental intake would be useful, cardiac acceleration is the rule.” Thus, (continued)

5

1.1  From the Archives: Stress and Its Measurement

Table 1.2  Psychological tests Test type Perceptual

Cognitive

Motor

Perceptual-motor Personality

Stressor Threshold Flicker fusion Perceptual speed Perceptual retention Attention Discrimination Problem solving Concept formation Conditioning and learning Steadiness Tracking Coordination Reaction time Direct observation and interviewing Self-ratings (e.g., MMPI, Edwards Personal Preference Schedule Projective tests (e.g., Rorschach, TAT)

it appears that psychophysiological tests measuring external stressors must also take into account internal stressors rooted in the personality of the subject. Psychological tests often give a good picture of internal stressors. They are especially useful to describe a person’s reasoning ability, general intelligence, personality, emotional state, and unconscious drives. A classification of these tests is given in table V (see Table 1.2). Both psychological and psychophysiological tests have given varying results to the same stressors because they are very subjective and difficult to interpret, especially the personality tests. However, when used in conjunction with more objective data, more meaningful interpretations can be made [8]: “Performance and physiological variables are well-suited for serving as criteria of stress and for measuring its magnitude, but they are usually nonspecific…Personality variables, on the other hand, tell us what kind of stress, but seldom indicate its degree. By combining both categories of tests, we can learn something about the nature and degree of stress – both as imposed by the environment and as perceived by the subject.” In fact, personality tests can also reveal conditions not externally present. For example, in a space simulator study by Flinn et al. [12], these tests, plus diary information revealed that the subjects harbored extremely hostile feelings despite behaving in a calm, business like manner. Before leaving the subject of psychological tests, a problem that exists with any sort of test should be noted. Ebersole states, [6] “It is my opinion, after 5 years of sea duty in submarines, that in such an isolated group the use of interviews, projection technics and gadget tests so perturb the subjects that the findings are without validity…The use of formal psychologic testing may (continued)

6

1  Stress, Sleep, and Cognition in Microgravity

convince the group that there is a limit to its endurance about which to be concerned.” Therefore, any type of experimental constraint may introduce a bias, which is a concern in psychosocial testing, and the experimenter must caution against a too aggressive experimental approach. A good experiment is one in which the subject forgets that he is being experimented upon. The social tests (measures of group behavior) are few in number. One reason for this, no doubt, is the difficulty in devising a test that can account for all the variables present in a group interaction. The following is a listing of some of these tests: (1) direct observation, (2) Bales Interaction Process Analysis (BIPA), (3) Rankin Scales, and (4) Interpersonal Projection Test. One of these tests that has been used in some simulator studies [12, 13] is the BIPA.  Using this method, every observed verbal and nonverbal interaction between the members of a group is classified according to the categories listed in table VI (Not shown here. Listed in the table are: positive reactions: showing solidarity, tension release, and agreement; problem-solving attempts {task neutral area}: giving suggestion, opinion, and orientation or information; questions {task neutral area}: asking for orientation or information, opinion, and suggestion; and negative reactions: showing disagreement, tension, and antagonism.)–NK All interactions are tabulated within each category, and a profile is prepared that indicates the interaction pattern for the group. Flinn et al. [12] and Hagen [13] used this test in evaluating the interaction of four pairs of subjects who spent 14–30  days in the School of Aviation Medicine (SAM) two-man Space Cabin Simulator (SCS). The results were compared with an average profile from 21 other small-group studies reported in the literature. The comparison is shown in Fig. 1.1 The experimental profile differed greatly from the “control” because the more formal, task-neutral categories were much higher and the positive and negative categories much lower. In fact, Hagen found that interactions in categories 5–8 accounted for 83% of the total, and that the changes from the control in categories 1, 3, 10, and 11 were statistically significant. These results indicate that the men limited their interactions to those useful in completing the mission. Also, no evidence of extreme friendliness or hostilityexisted between the men. However, the data reveal some interesting trends. For example, the number of interactions scored as giving opinion increased with time, whereas those giving information decreased. No relationship was evident between giving information and asking for information and asking for opinion [13]. Finally, Fig. 1.1 shows that giving opinions and information is much more common than asking for opinions and information. The mens’ diaries and poststudy debriefings indicated that the men held covert hostilities toward one another not manifested overtly for the sake of the mission. Although the men underwent extensive psychological and psychiatric testing before the missions, they were paired off essentially at random. However, the hostilities that resulted could be predicted from these tests. To quote from Flinn et al. [12], “In each flight, some feelings of resentment have occurred due to differing behavioral characteristics of the two subjects which (continued)

7

1.1  From the Archives: Stress and Its Measurement

Fig. 1.1  Comparison of interactions in the Space Cabin Simulator with average interaction in 21 other studies. (Adapted from Flinn et al. [12])

were readily identified in the preflight assessment. For example, a taciturn individual may be irritated by the continual conversation of a talkative crew-­ mate, while the latter feels rebuffed when his comments are ignored…seemingly innocuous habits and mannerisms may eventually become irritating.” The men failed to recognize the source of their hostile feeling, and they often displaced their anger to the outside monitoring personnel. Again from Flinn et al.: “Often the subjects have failed to realize the extent or force of irritation displayed by their crewmate. For example, Subject A may assume that his crewmate is short tempered and irritable because of his annoyance with monitors outside the chamber, while actually Subject B’s growing irritation is the result of dislike or disgust toward some mannerism of Subject A himself. (Nice example of displacement, to be considered later—NK) Combining this information with the Bales Interaction Process Analysis, a complete picture of the men’s internal feelings and external behavior results [12]: “In the space cabin study, the more neutral categories in the middle…dominate the profile, while the extreme, more emotionally tinged categories are not well represented. This was consistent with subjective observations during the flight that the relationship between the subjects was quite formal and polite. They consciously refrained from expressing very much negative feeling for fear of disrupting their relationship. Much of the negative feeling expressed was displaced and directed toward monitoring (continued)

8

1  Stress, Sleep, and Cognition in Microgravity

personnel outside the chamber.” In addition, the peculiar trends mentioned previously became clear [13]: “The most obvious interpretation of this phenomenon is that it represents evidence of increasing psychic distance between the subjects, and the loss of sensitivity to the other’s feelings and thoughts. It seems to reflect the general increase in covert hostility the subjects felt about each other during this time.” The results of this experiment demonstrate the utility of the Bales Interaction Process Analysis in evaluating group interactions. However, an objective test like this, which gives quantitative information only about stress, must be used in conjunction with more subjective psychological tests. Thus, a more complete picture would emerge, and both the behavioral “what” and psychic “why” become evident. The experiment also demonstrates the predictive value of psychological and psychiatric tests.

1.2 Stressors in Space A stressor is a physical or psychological characteristic of the environment that impacts on someone in a strong, usually negative manner. They can be either hyperarousing (e.g., fire, loud noises) or hypoarousing (e.g., isolation, darkness). Stress pertains to the effect of a stressor on the human organism, either at the individual or the group (or team) level. The impact of stress on various body systems (e.g., cardiovascular, neuroendocrine) also have been described, as well as its effect at the cellular level. For example, humans and rodents returning from space, and humans undergoing long-term bedrest, have shown blood, urine, and cellular changes suggestive of oxidative stress due to microgravity, ionizing radiation, or the impact on the body of returning to a 1 g environment [14]. “Oxidative stress is essentially an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants. Disturbances in the normal redox state of cells can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins, lipids, and DNA.” [14, p. 240]. Such changes have been implicated in a number of pathological changes, including cardiovascular disease, cancer, and neurodegenerative disease. In regards to on-orbit space missions, there are four types of stressors that can impact on people working in space: physical, habitability, psychological, and interpersonal [15]. Examples are shown in Table 1.3. Physical stressors are due to the effects of the space environment itself. Habitability stressors result from living in a habitat designed to protect the crew from physical stressors. Psychological stressors are due to personal issues within the individual. Interpersonal stressors stem from

1.3  From the Archives: Weightlessness and Low Sensory Input

9

Table 1.3  Examples of stressors encountered during human space missions Physical High acceleration getting to space Microgravity Ionizing radiation Meteroid impacts No atmosphere

Habitability Poor human-machine interphase Cramped quarters Ambient noise Vibration Poor air quality

Psychological Isolation from family and friends Confinement Danger High workload Monotony

Low temperature

Low lighting

Duration of mission

Interpersonal Personality conflicts Sex differences Sexual tensions Crew size Leadership issues Culture/language

people working as a group or team. These last two stressors and their effects will be described in detail in later chapters. The impact of such stressors have been summarized by Dinges [16] into four behavioral health and performance domains: “(1) neurobehavioral deficits in the ability to engage, comprehend, and perform tasks at a consistently high level due to biological challenges in space (e.g., deficits due to inadequate sleep, poor circadian entrainment, visual impairment); (2) deficits in specific cognitive functions subserved by particular brain areas, neural pathways, or cortical networks adversely affected by environmental conditions (e.g., deficits due to excessive carbon dioxide, hypoxia); (3) alterations of psychological states related to mental and emotional processes (e.g., disorders of depression, anxiety, and psychosis); and (4) psychosocial dysfunction among crewmembers and/or with mission control, which includes loss of crew coordination and team cohesion (e.g., due to interpersonal conflicts, scapegoating, failure to follow procedures).” [16, p.  380]. These stresses will be discussed later in this and subsequent chapters. The effects on humans resulting from physical and habitability stressors largely have been mitigated by engineering advances in the construction of space habitats, and pertinent habitat issues will be discussed in Chap. 2. A major stressor greatly impacting on humans in space is microgravity (commonly called weightlessness).

1.3  From the Archives: Weightlessness and Low Sensory Input [1]

This section covers material from early studies that were aimed at better understanding the effects of microgravity on the body (particularly the central nervous system), including work from pioneering space missions and hypodynamia (or bed rest) experiments. Artificial gravity and exercise also are considered.–NK

10

1  Stress, Sleep, and Cognition in Microgravity

1.3.1 Weightlessness

Weightlessness cannot be studied for any length of time on Earth. True weightlessness can be produced for as long as a minute in aircraft flying Keplerian trajectories, but minimum information concerning long-duration space missions can be obtained from such a short time period. The U.S. space program uses water immersion techniques to simulate weightlessness; however, Henry [17] has described one serious disadvantage to this approach: “A man may try to initiate weightlessness by floating in water. Although the water exerts an upward buoyant force on his body in such a case, any heavy object within his body is pulled down onto the wall of its containing cavity by the force of gravity. Thus, a steel ball swallowed by a man in a weightless state will drift about freely within his stomach, but if swallowed while he is floating in water, the ball continues to press on the stomach wall. The tiny otoliths in the horizontal utricle and vertical saccule of the labyrinth of the ear are like this steel ball. In the weightless state the otoliths float free.” A more accurate picture of the effects of this phenomenon on a human being is available only from space experiences. However, in space capsules, many factors are interacting (weightlessness, confinement, danger, etc.), and an observed effect is difficult to attribute to any single cause. The U. S. and U.S.S.R. reports on the physiological effects of orbital and lunar flights [18–22] show that weightless conditions have a definite effect on the human body. Some of these are (1) muscle atrophy (including the heart); (2) weight loss; (3) moderate cardiovascular deconditioning; (4) moderate loss of exercise capacity; (5) minimal loss of bone density, calcium mobilization, and formation of urinary stones; (6) loss of catecholamines and aldosterone in the urine; (7) moderate loss of red blood cell mass; (8) depression of blood clotting ability; and (9) catarrhal and urinary infections from opportunistic invaders because of general lowered immune response. However, the U.  S. program to date has found no serious decrement in performance because of any of these factors. Charles A. Berry [18] concludes that “the crews have adapted extremely well to the weightless environment, have found the environment pleasant, and used the environment to assist them in accomplishing inflight activities.” (continued)

1.3  From the Archives: Weightlessness and Low Sensory Input

11

Weightless conditions likewise have had a minimal effect on the neuropsychological functioning of the crews. Visual acuity tests conducted during the Gemini V and IX missions and measurements of otolith functioning, preflight and postflight, have shown no apparent decrement [23]. Some disorientation has been noted as a result of suppression of vestibular and kinesthetic sensations, but the men have been able to compensate adequately by using visual and tactile cues [17, 24]. Electroencephalographic recordings of Frank Borman during the Gemini VII mission showed a high preponderance of theta waves (4–7 Hz), which have been interpreted as demonstrating an adaptation to the weightless condition [25, 26]. Also, some disruption of sleep occurred on this mission. One U.S.S.R. cosmonaut has experienced severe nausea in flight  – Gherman Titov during the Vostok 2 mission. Boris Yegorov noted some feelings of being upside down, occasional dizziness, and anorexia during the Voskhod 1 flight. Several U. S. astronauts have experienced head stuffiness during the first 24 hours that has not been accompanied by skin flushing, reddening of the eyes, or a pounding pulse [22, 27]. Nausea and mild disorientation have been reported by several Americans in space. Andrian Nikoleyev experienced no problems with the Kraepelin mental arithmetic test or with distinguishing geometrical designs [22]. No U. S. astronaut has experienced hallucinations, delusions, depersonalization, or any other psychiatric problem. However, several U.S.S.R. cosmonauts have reported an initial fear caused by a sense of falling down that was followed by feelings of joy, gaiety, and euphoria. Simonov [28] interprets this feeling of joy: “This emotion is a result of the comparison of expected danger (falling down is usually associated with danger–stroke, death, etc.) with the experienced safety of the state of weightlessness, The person comes to the latter conclusion several seconds after the development of weightlessness.” Both U.S. and U.S.S.R. pilots have described extravehicular activity as a pleasant, almost euphoric experience with no resulting problems in orientation or emotion. Cosmonaut A. Leonov [17] summarizes the impression: “As for the so-called psychological barrier that was supposed to be insurmountable by man preparing to confront the cosmic abyss alone, I not only did not sense any barrier, but even forgot that there could be one.” Despite a generally rosy picture painted by artist-spacemen, there is some indication on the longer flights that physiological and psychological breakdown was occurring as a result of weightlessness. Following the 18-day, two-­ man Soyuz 9 mission, the cosmonauts reported difficulty adapting to one-g conditions. Both men experienced problems with posture and gait for several days, had the feeling that they were in a centrifuge “under the effect of two–or slightly more–g’s” for as long as a week, and experienced sleeping difficulties for 5 days [29]. (continued)

12

1  Stress, Sleep, and Cognition in Microgravity

During the flight, Andrian Nikolayev lost nearly 6 pounds, and both men experienced muscle atrophy and heavy calcium losses from their bones [30]. He concludes [29]; “…apparently, manned flights of several months’ duration will require development of special measures and means to prepare the organisms (sic) of cosmonauts to withstand re-entry g-loads and to facilitate readaptation to the earth gravity conditions…Probably, for interplanetary flights, spacecraft should be provided with artificial gravitation facilities.” The U. S. Gemini VII crew experienced difficulty sleeping, averaging only 5.3 hours per night and less than 5 hours per night on each of the last 4 nights. Both men felt fatigued and, during the last 2 days of the mission, exhibited irritability and loss of patience [20]. There was no observable decrement in performance, but the men were obviously under increased psychological stress during the later days of the flight.

1.3.2 Hypodynamia Studies During 1968, U. S. S. R. scientists concluded a series of five hypodynamia experiments. Sixteen healthy male subjects, between 21 and 23, were confined in bed for 70 days. The five series are summarized as follows: Series I: Strict bedrest (four subjects); Series II: Strict bedrest with mixed medication (securinine, caffeine, and amphetamine given on a definite schedule) (three subjects); Series III: Bedrest with mild physical activity allowed (three subjects); Series IV: Bedrest with moderate physical activity (three subjects); Series V: Bedrest with complex physical activity (three subjects). The subjects were given physiological and psychological tests before and after the experiment, and in some cases at 10-day intervals. The psychological tests measured task performance, emotional stability, memory, mental efficiency, and intelligence. In addition, the subjects were observed clinically throughout the study. The results of these studies are presented in Refs. [31–33]. Physiologically, the subjects experienced little difficulty during the first 2 weeks, with the exception of mild pallor, muscle weakness, and pain around the waist. Later, several functional problems developed. Sorokin et al. [33] describe some of these problems, which were (1) muscle atrophy and decreased tone (most subjects); (2) weight loss (14 subjects); (3) joint pains (all subjects at end); (4) cardiovascular difficulties (systolic murmur, pains over the heart, palpitations) (five subjects); (5) tachycardia and increased blood pressure (average of all subjects, but especially groups 1 and 2); (6) decreased exercise tolerance (one subject); (7) decreased clotting ability (five (continued)

1.3  From the Archives: Weightlessness and Low Sensory Input

13

subjects); (8) catarrhal and urinary infections caused by lowered immune response (six subjects); and (9) gastrointestinal complaints (spastic colon, constipation, anorexia) (most subjects). Many obvious similarities are apparent when these results are compared with those produced during weightless conditions. The degree of symptomatology in the U.S.S.R. studies was much greater (including two cases of appendicitis and one subject being dropped from the experiment for psychological reasons); however, the subject’s test duration was four times as long as the duration of space flights of the past. An interesting idea arises from the preceding comparison: do the weightlessness findings resemble those of the hypodynamia studies because astronauts and cosmonauts are largely confined to their seats, or do weightlessness and hypodynamia share some common characteristics? Although the former idea is in part true, the latter concept leads to more fruitful discussion. The psychological and psychiatric results of these hypodynamia studies are interesting. The subjects generally performed various tests with no decrement observed. Also, no decrement was noted in intelligence quotient, memory, attention stability, or problem solving. However, some subjects did not do as well on the time-interval tests, often giving premature reactions, Also, the subjects scored lower in tests measuring emotional stability, especially two subjects who were considered to have inadequate emotional stability and “weak inhibitory processes” before the study.The series I subjects were observed clinically to be irritable at times, and all expressed a desire to terminate the experiment. In fact, one did. After 45 days two subjects experienced mood swings accompanied by irritability and neurotic reactions, exhibiting a negative attitude toward certain tests and toward personnel. One subject evidenced severe psychiatric disturbances: headaches, nausea, dizziness, inability to think, depression, and lassitude. The series II subjects also showed mood swings and had difficulty sleeping. The subjects in series III and IV, however, experienced only minimal emotional problems. Bogachenko [31] summarizes these results in the following way: “Thus, manifest changes in psychic state arose during hypodynamia in the series I subjects, who were strictly confined to bed, and in the individuals who received the mixed medication (series II). These disturbances were less pronounced among the volunteers who were allowed physical exertion in series III, and practically absent in series IV and V, where a more complicated physical load was imposed.” Similar results were observed in another set of U.S.S.R. hypodynamia experiments by Purakhin and Petukhov [34]. In this study, six males between 20 and 35 underwent 62 days of bedrest. Group 1 (three subjects) was allowed to participate in physical work (bicycle ergometer, rubber stretchers, static exercises), while group II (three subjects) spent the entire time in bed. This study was concerned mainly with neurological changes, and the results are (continued)

14

1  Stress, Sleep, and Cognition in Microgravity

Table 1.4  Neurological response to hypodynamia Factor Neurologic exam

Behavior

Autonomic nervous system

Work capacity

Electroencephalograph

a

1–2 weeks Asthenica reactions (brisk tendon reflexes, problems with coordination, nystagmus, pathological reflexes) Nervousness, increased hostility, sleep disruption (not refreshing, superficial, bad dreams), somnolence during the day Tachycardia, increased heart rate, diaphoresis, tremor, vascular dystonia Decreased, with accompanying decrease in desire to study academic subjects No change

3–9 weeks Aggravation of asthenica reactions (especially Group II)

Recovery Improved, but gait disturbances and muscle pain took 2–7 days

Improved Nervousness, increased hostility, sleep disruption (not refreshing, superficial, bad dreams), somnolence during the day Improved Aggravation of symptoms (especially Group II) Improved Decreased, with accompanying decrease in desire to study academic subjects Shift toward slower Improved frequencies (4–7 Hz) and decreased formation of cortical time shifts to indifferent stimulus

See Sect. 3.6.3 for a discussion of asthenia/neurasthenia–NK

summarized in table VII (see Table 1.4). In this study, definite neurological and emotional responses were observed from prolonged bedrest. In addition, exercise helped to decrease the symptomatology. Also interesting was the finding of theta waves (4–7 Hz) in this experiment, the same waves that were present in the Frank Borman study of the Gemini VI1 mission. The hypodynamia studies present some interesting conclusions. First, as noted in the previous section, clinical observations definitely play a role in supplementing and clarifying the results of psychological testing. Second, the need for exercise in maintaining physiological and psychological well-being must not be minimized. Third, prolonged inactivity causes increasing emotional problems, as has been implied during the Gemini VI1 mission; however, performance is only slightly affected. Fourth, prolonged bedrest produces definite physiological and neurological changes. Finally, there are striking similarities between hypodynamia and weightless conditions. (continued)

1.3  From the Archives: Weightlessness and Low Sensory Input

15

Purakhin and Petukhov [34] give an interesting neurological explanation for the results of the hypodynamia studies. “A decrease in work capacity, changes in behavior and the rhythm of sleep, paradoxical reactions during examination (dropping off to sleep when exposed to stimuli during electroencephalographic examination), and ‘explosiveness’ in behavior all indicate a decrease in the tone of the cerebral cortex and impairment in the excitation and inhibition process. The appearance of slow waves on the EEG and a decrease in the rate of formation of cortical time shifts confirm this. The reason for the changes described above is a constant restraint of customary actions and suppression of emotions, resulting in an overstraining of the inhibitory process, which is the basic cause of neurasthenia.” The cerebral cortex exhibits a well-­known inhibitory influence on the spinal cord; should this be broken (e.g., by an upper motor neuron lesion), general hyperreflexia results. In effect, Purakhin and Petukhov state that decreased sensory input from prolonged hypodynamia causes a general decrease in cortical tone, which results in a functional upper motor neuron lesion by inhibiting the cortical inhibitory process. The addition of exercise, however, increases the total stimulation to the brain, which helps to maintain cortical tone and, in turn, preserves the inhibitory process and causes a decrease in symptomatology.

1.3.3 Weightlessness and Hypodynamia Goshen [35] speculates that man’s upright posture requires numerous proprioceptive and muscular adjustments, which in turn give him a high degree of incoming sensory stimulation. When man is placed in a position where he does not have to battle gravity (such as horizontally), he loses many of these inputs, and lethargy, sleep, or pathological responses may occur. This mechanism of sleep is certainly not new, but hypodynamia experiments confirm Goshen’s ideas regarding pathological deficits. Extending this concept to the weightless state, where man has to battle gravity even less than when horizontal on the Earth, it seems reasonable to view weightlessness as simply another condition of reduced sensory stimulation. In fact, it is this “essence” which weightlessness and hypodynamia share in common. Of course, each of these conditions possesses mutually exclusive characteristics, but both can be placed on a “sensory stimulation scale” and be quantified. The problem, however, is that man is bombarded by a variety of stimuli that help to maintain his cerebral tone through the reticular activating system, and the effect of these stimuli is additive. Hypodynamia alone causes some pathological responses, whereas hypodynamia plus occasional activity is less severe. The combination of weightlessness and hypodynamia would be expected to cause more severe responses than either alone. (continued)

16

1  Stress, Sleep, and Cognition in Microgravity

In space flights to date, all space pilots have been kept extremely busy so that their level of sensory stimulation has been high despite the presence of weightlessness. Eberhard [36] has stated that the crew of long-duration missions will have more than 10 hours of free time each day, much of which will be spent doing low-stimulating work such as monitoring data. Consequently, unless other sources of sensory stimulation can be found, levels of sensory input will be low and may approximate those in the hypodynamia studies. The next sections in the TM dealt with studies of people undergoing total sensory isolation, resulting in depersonalization and hallucinations in some cases. Given the questionable relevance of this work to modern day space missions, and to save space in this book, I will omit this material here and refer the interested reader to [1, pp. 15–17].–NK

1.3.4 Weightlessness and the Astronaut During an orbital flight, the men are kept busy monitoring instruments, communicating with the ground, conducting experiments, handling emergencies, performing for television, et cetera. Despite the weightless condition, the total sensory input is adequate to prevent psychological problems (That is, in short-­ term missions.—NK) However, conditions on a long-duration mission will be different. Although there will still be many activities, they will become routine as the time scale is expanded. Much of the astronaut’s time will be spent monitoring instruments, which Davies [37] describes as being of very low sensory input. In addition, the men will have more than 10 hours a day free time (according to Eberhard [36]. The mission goals will be 8 months away (e.g., in a mission to Mars—NK), and even the most highly motivated man will probably suffer loss of motivation. Some of the men will be scientists whose primary talents will not be used until the goal is reached. Finally, the space capsule will be confining and monotonous. The additive effect of all these factors will be one of low sensory stimulation and cortical arousal. Superimposed on this will be a state of weightlessness. Something can be done about the other factors, but what can be done about the weightless state?

1.3  From the Archives: Weightlessness and Low Sensory Input

17

1.3.5 Artificial Gravity Nikolayev [29] suggests the use of “artificial gravitation facilities” for interplanetary flight. This is not a new idea, and Goshen [35] describes the most practical approach: “To provide artificial gravity would require…a very large wheel-like structure rotating about its central axis, with crew located at the periphery where centrifugal force would serve as a gravity substitute.” Many people become motion sick in such rotating systems because of rotational forces on the vestibular system, particularly on the semicircular canals. Guedry [38] and Graybiel et al. [39] observed subjects in a rotating room and found that they exhibited a variety of symptoms, ranging from nystagmus and unusual sensations to nausea, when they moved their heads in any direction other than parallel to the axis of rotation. However, as the subjects became habituated to the effects, the symptoms disappeared. Within a few hours, most of the men experienced no difficulties. Interestingly enough, following habituation to the rotating conditions, the men experienced similar symptoms when the room was stopped in its rotation, and it took them a few hours to become readjusted to the nonrotating state. Thus, from these studies, one could conclude that man can tolerate a rotating system for a long period of time. Of more important concern are the technological difficulties and cost in creating such a system. Goshen [35] states that “if artificial gravity were provided for, the state of the art would have to make substantial progress before design decisions could be put into effect.” Thus, barring any radical fund allocations or engineering developments, the first long-duration space crews will probably have to function under weightless conditions, despite the advantages of artificial gravity.

1.3.6 Exercise Exercise is advocated to minimize the effects of weightlessness. Korobkov [40] emphasizes the positive role exercise plays in space. He believes that exercise causes better stability of the conditioned reflex and higher central nervous system tone because of improved sympathetico-adrenal functions and reticular activation. He lists four effects of exercise: better adaptability to stress and emergency situations, better psychological conditioning, better physiological conditioning, and more rapid recovery to one-g postflight conditions. He cites evidence from a 40-day bedrest study that athletes exhibited higher performance and better endurance than untrained persons. He also states that, in centrifuge rotations, resistance was found to be better in subjects (continued)

1  Stress, Sleep, and Cognition in Microgravity

18

given “exercises used in the training of gymnasts, wrestlers, acrobats, weightlifters, and mountain climbers.” Davies [37] states that mild exercises improves performance on vigilance tests: “An increase in sensory variation, whether provided externally, as in conversation, or internally by proprioceptive feedback to the brain from the body’s joints and muscles, as in mild exercise, probably increases the level of arousal of the central nervous system and in this way promotes better performance.” Finally, the results from the Apollo missions indicate that 12 of 15 crewmen tested experienced decrement in exercise capacity as measured by a bicycle ergometer postflight, but recovered after 36  hours on Earth [18]. Therefore, a regular routine of exercise is a “must” on long-duration space missions.

1.4 Coping with Microgravity Microgravity continues to be a problem. Some of the physiological effects of microgravity are summarized in Table 1.5 and were discussed in Sect. 1.3 as they related to early space missions and hypodynamia (bedrest) studies. One new area needing further attention pertains to the possible relationship between ocular changes, visual impairment, and elevated intracranial pressure, the Visual Impairment Intracranial Pressure (VIIP) phenomenon, now called Spaceflight-Associated Neuro-ocular Syndrome (SANS), which affects two-thirds or more of returning ISS astronauts [41, 42]. Microgravity has been implicated as an important causal agent, but other factors also may be related (e.g., radiation, heavy resistive exercise, high sodium diet, increased levels of spacecraft CO2) [42–44]. The potential impact of this phenomenon on health and cognitive functioning needs to be examined in future studies. Some of the negative effects of microgravity are mitigated by medications and physical exercise (Fig. 1.2–see also Sect. 1.3.6); these help but do not completely eliminate the problem. A detailed discussion of physiological effects goes beyond the scope of this book. The interested reader is referred to [45–50]. The only way to avoid the effects of microgravity is to establish some sort of artificial gravity system [51]. For example, a spacecraft can be accelerated with a

Table 1.5  Common physiological stresses encountered during microgravity Space adaptation syndrome (motion sickness) Bone loss Muscle atrophy Fluid shifts and their sequelae (e.g., cardiac, renal) Vestibular problems Lowered immune response

1.4  Coping with Microgravity

19

Fig. 1.2  Bone loss and muscle atrophy commonly occur in microgravity, which produces a nearly weightless state. To slow down this process in space, it is important for crewmembers to exercise, such as on this bicycle ergometer used on the Skylab 2 Space Station. (Credit: NASA)

force equal to one Earth gravity as it moves outward to its destination, or it can be connected to another vehicle by a long tether with the two of them rotating around a common center of gravity with centrifugal force of 1 g. The same effect can be achieved on-orbit by having the crew housed in a giant wheel that rotates around a core with a speed producing 1  g for the inhabitants at its rim (see Sect. 1.3.5). However, these artificial gravity solutions come with high engineering downsides in terms to developing a strong enough tether to work and costs related to constructing wheels large enough to produce Earth-like gravity at the periphery. In addition, these solutions may produce their own stressors, such as inner ear disturbances resulting from Coriolis forces from a rotating wheel. People have tolerated microgravity for up to 14 months, and a flight to and from Mars is projected to take about 7 months each way. The question arises as to whether or not a long stay on the Moon at .16 g (or 16% Earth gravity) or on Mars at .38 g would physiologically be restorative after the flight in microgravity to reach these destinations. We know that Apollo astronauts who spent some time on the Moon showed the same amount of orthostatic intolerance and balance problems after returning to Earth as their colleagues who orbited but did not land on the lunar surface [51]. This would suggest that a brief period of partial gravity restoration on the Moon was not enough to counter the effects of anti-gravity muscle atrophy and cardiovascular and vestibular deconditioning that resulted from microgravity. Confounding this interpretation is the fact that both astronaut groups spent 3 days together in microgravity on the return home. There is some evidence that there might

1  Stress, Sleep, and Cognition in Microgravity

20

be a threshold of around .2 g for neurovestibular and other sensorimotor effects to become restored [51]. If true, this would not rule out the possibility that the gravity of Mars might be restorative during the 2–2½ years being planned for such an expedition. But we just don’t know if this might be the case, or how long a stay on the Moon or on Mars might be necessary to undo the physiological effects of in-flight microgravity. More study is needed, perhaps using a centrifuge at a lunar base or in space that can produce varying forces from 0–1 g whose effects can be tested.

1.5 Psychophysiological Stress Besides physiological stress, the stressors of space travel can produce a variety of psychophysiological, psychological, and interpersonal stress on astronauts. The last two types will be discussed in great deal in subsequent chapters. The remainder of this chapter will deal with psychophysiological stress. Like other organ systems, microgravity can directly affect the central nervous system, especially the brain. Besides microgravity, other factors may play a contributing role, such as high CO2 levels in the atmosphere [43], lighting and noise in the space habitat, and fatigue due to workload demands. There are two major psychophysiological areas that relate to human behavior: circadian rhythms and sleep, and cognition and performance.

1.6  From the Archives: Circadian Rhythms and Sleep [1]

In the early days of human space travel, there was much interest in how microgravity affected circadian rhythms and sleep. Some of this early research from the Gemini and Apollo programs is presented below, and it still has relevance today.–NK

1.6.1 Circadian Rhythms

During evolution, plants and animals became physiologically adapted to periodic environmental changes associated with rotation of the Earth. Most of these adaptations vary with a 24-hour rhythm; hence, the name circadian rhythm. Examples of circadian rhythms include sleep/wakefulness, body temperature, heart rate, urinary excretion, and numerous other physiological (continued)

1.6  From the Archives: Circadian Rhythms and Sleep

21

functions. A more complete list is described by Rummel [52]. Most of these rhythms are endogenous but may be influenced by a variety of exogenous synchronizing factors called “Zeitgebers.” Although the most important Zeitgeber is light, cosmic rays and the Earth’s electromagnetic field may be factors. Morey [53] believes that these latter factors may be even more important in space conditions because of the constancy of light. A magnetic storm might be significant. The exact mechanism by which Zeitgebers influence body rhythms is not known, but the pineal gland has been implicated [53]. Mikushkin [54] emphasizes the role of the endocrine glands and autonomic nervous system. Finally, Folk [55] describes three theories of circadian rhythm development, the most likely of which states that each rhythm is genetically determined by centuries of evolution. Disruption of circadian rhythm is called desynchronization. The most obvious example of this occurs in travelers flying across several time zones. Symptoms include malaise, insomnia, appetite loss, inability to work, and nervous stress. Increasing the intensity of light generally shortens the circadian rhythm in man; likewise, low light intensity increases these time intervals. This phenomenon provides a possible explanation for the apparent increase in time perception observed by speleologists under conditions of weak illumination [54].

1.6.2 Circadian Rhythms and Performance Attempts have been made in several studies to analyze the effect of circadian rhythmicity on performance. Flinn et al. [56] demonstrated the existence of a diurnal variation in performance in the SAM one-man Space Cabin Simulator. Three subjects who started at different times showed a performance decrement at approximately the same time the following morning. Frazier et al. [57] report that three subjects who spent 14  days confined to a chamber revealed period shifts and showed task performance deterioration in systems monitoring, visual reaction time, communications, and imbalance matching. The results indicated that circadian rhythmicity was often found to be a major source of performance variation. The 15-day Lockheed study [58] revealed performance peaks between 7 and 10 p.m. during the first 5 days, with the worst performance occurring during the early morning hours. During subsequent days, there was a time shift toward later hours; and, during the last few days, the subjects performed best shortly after midnight. However, the author suggests an interesting explanation for this result: “the study began at 0930  hours which was approximately 3-1/2  hours after waking. During the course of the study, however, the work (continued)

22

1  Stress, Sleep, and Cognition in Microgravity

period which began at 0930 became a reference point for the beginning of another day, and corresponded psychologically more closely to the subjects’ normal hour of arising. In this sense, the subjects’ ‘day’ shifted to a new time zone.” Finally, Chiles et al. [59] report a study in which the subjects were shown previous performance curves during a similar experiment and were encouraged to put extra effort into performance whenever they sensed a lowering of their “sharpness.” The results showed no significant diurnal variation. The authors concluded that “when subjects are tested around the clock…they exhibit circadian periodicities in their performance….The magnitude of these fluctuations can be substantially reduced by instructing subjects to consciously attempt to raise their performance during ‘low’ periods.” Morey [53] describes the effects of motivation in modifying the circadian rhythmicity of performance: “For animals, the physical factors (light, temperature, etc.) are of principal significance in the re-arrangement of the diurnal regime; for humans the psychic activity, the will power to accomplish the day’s schedule and the ability to reorganize rapidly in relations to a change in a situation are essential.” Thus, performance as measured on standard tests shows circadian rhythmicity. The best performance occurs between 7 and 10 p.m.; the worst between 2 and 8 a.m. Without the effect of a strong Zeitgeber, these times shift toward later hours in subsequent days. Performance rhythmicity will disappear when knowledge of the performance cycles is coupled with high motivation.

1.6.3 Circadian Rhythms in Space Circadian rhythms have been observed in space. On Gemini VII, Frank Borman’s heart rate was observed to drop regularly during the Kennedy Space Center night [27]. In addition, heart-rate rhythms have been observed to increase steadily in periodicity with time [60]. Interesting information regarding rhythms was obtained during the Gemini missions [20]. The men of Gemini IV had great difficulty sleeping. The longest consecutive sleep period was 4 hours, and the command pilot slept less than 8 hours altogether. The sleep schedules on this flight were staggered, and it was believed that noises caused by the onduty member kept the other awake. On Gemini V, the sleep periods were programed to coincide with the Kennedy Space Center night; however, they were still staggered, one man sleeping from 6 to 12 p.m. and the other from 12 p.m. to 6 a.m. Again, the onduty member kept the other from sleeping. However, there was a tendency for both men to sleep during the 12 p.m. to 6 a.m. period. There was no tendency to sleep during the earlier 6 hours. Therefore, the sleep-wake rhythm the men had on Earth seemed to manifest itself in space. To verify this, the Gemini VII crew’s sleep time was not staggered and corresponded to that of the men at Cape Kennedy. The crew slept much better; however, their sleep was still not as good as on Earth. (continued)

1.6  From the Archives: Circadian Rhythms and Sleep

23

A similar sequence occurred during the Apollo missions [18]. On Apollo 7, the sleep periods were staggered, and the crew reported unsatisfactory sleep periods. One man fell asleep during one watch and took 5 milligrams of Dexedrine to keep awake during another. Similar problems occurred during the Apollo 8 mission, and it was believed that “crew performance was slightly degraded, and minor procedural errors were committed” [18]. During Apollo 9, however, the men slept simultaneously at a time following their normal circadian rhythms. The results are summarized as follows: “A definite improvement over the previous two missions in both quantity and quality of sleep was noted, and a lack of postflight fatigue was evident during the recovery-­day physical examination” [18]. A similar policy was followed on the Apollo 10 and 11 missions, with good results. During the latter mission, however, the crew reported difficulty sleeping while in the cold, noisy, cramped conditions of the lunar module. Therefore, circadian rhythms occur in space in a manner similar to that on Earth, provided an appropriate Zeitgeber is present. This means that spacemen can simulate conditions on Earth by controlling such factors as light intensity and sleep-wake regimes. Periodicities may be lengthened or shortened by decreasing or increasing Zeitgebers (light intensity, for example). Of course, certain Zeitgebers may play a more important role in space than on Earth. Also, circadian rhythms in space have not been observed over long periods of time. These problems have been summarized by Morey [53]: “An astronaut will be subjected to an environment entirely different from the one to which he has become adapted by heredity. The 24 hour rhythm may free run causing external and internal desynchronization. It may be necessary to install special cues to prevent such asynchrony. He may be subjected to Zeitgebers which are not present on earth such as high magnetic fields, differing UV radiation and cosmic showers as well as marked variations in light-­ dark cycles… The determination of all Zeitgebers (synchronizers) that can affect an astronaut is a necessary condition prior to the start of long term flights. The constant monitoring of astronauts in short-term flight is mandatory in order to predict long term effects.”

1.6.4 Work/Rest Cycles The Apollo astronauts generally scheduled 12 hours of work, 8 hours of sleep, and 4  hours of relaxation each day [18]. However, their days were busy and interesting. For more routine, long-term space-mission conditions, shorter work/ rest cycles may be preferred [58, 59, 61]. Chiles et al. [59] found in their studies that “with tasks that are not intrinsically interesting (such as those used in these (continued)

24

1  Stress, Sleep, and Cognition in Microgravity

studies) the briefer work periods (e.g., 4 hours) are preferred, and subjects generally predicted that duty periods longer than 4 hours would lead to decrements over any prolonged period of testing.” Naturally, these work/rest schedules would have to be modified somewhat to fit into the sleep/awake rhythm for the crew. Andrezheyuk et al. [62] report on three test subjects involved in two 15-day isolation-chamber experiments. The first study placed the men on staggered 16/8-hour work/rest schedules. In the second study, the men were placed on a 12/6-hour work/ rest schedule in an attempt to enforce an 18-hour circadian pattern. The authors found that the men adapted to the first condition (the man who was awake “at night” habituated himself within a few days). However, the second routine was more difficult for all the men [62]: “There was an increase in number of mistakes and in the time required for the concentration tests, a deterioration in the accuracy of reproduction and decrease in the amount of material remembered, an increase in the latency of response, and decrease in muscular strength and endurance. All these changes were more pronounced in the second experiment than in the first.” In addition, the men were drowsy when awake and slept poorly. Biochemical tests confirmed evidence of strain caused by desynchronization. Therefore, it appears that trying to enforce an 18-hour cycle on man has a much greater deleterious effect than simply staggering his normal 24-hour period. Despite the circadian advantages of similar sleep-awake cycles for the men, a staggered schedule has been proposed. Thus, a man would be awake at all times to handle any emergency situation. Seminara and Shavelson [63] confined four subjects in a simulated lunar shelter for 5 days. The performance of the subjects when they had just been awakened and when they had been awake for some time was compared. Significant (p 100 days) space simulation environments” [56, p. 292]. In their review of 26 reports that met these criteria, 13 found no measurable change in negative emotions over time. The remaining 13 studies showed either decrements or improvements in negative emotions in one or another quarter of the mission. Thus, there was no evidence to support the existence of a universal third quarter phenomenon in ICEs. Alfano et  al. concluded that “evidence for a third quarter effect is primarily limited to anecdotal reports and broad-based assessments of various domains of psychological functioning. As such, the presence of increased levels of emotional distress during this specific period, or any other for that matter, remains to be confirmed” [56, p. 296]. Thus, despite over 30 years of empirical work, there is little evidence suggesting that a time-dependent third quarter phenomenon typically affects people in space or in space analog environments. Although some people may experience a drop in mood and morale after the halfway point, others don’t, or they have problems during another quarter of their mission. So, how can we account for the great variability of findings across studies as regards the third quarter phenomenon? My colleagues and I have addressed this issue before [57, 58], and some of the reasons are summarized in Table 2.3.

Table 2.3  Reasons for the variability of third quarter phenomenon findings 1. Demand characteristic and self-evaluation biases in subjects. 2. Expectation bias in investigators. 3. Improper selection and training of crewmembers 4. Insensitive or biased behavioral measures 5. Inadequate or no use of statistics 6. Mission events that interfere with stage sequence

70

2  Living and Working in Space

As we saw earlier, a possible demand characteristic bias in subjects was acknowledged by Bechtel and Berning. Another subject bias relates to the self-evaluation methodology typically used in third quarter studies [55], which often depends on informal reports or subjective and variable diary entries for information where subjects have been informed about the possibility of the phenomenon. Expectation bias in investigators also can occur. The third quarter phenomenon is widely known, and if experimenters are consciously or unconsciously aware of it, this might influence their analyses or coding of responses for this time period, particularly when diaries or journals are being evaluated. Care must be taken to remove such biases and idiosyncratic scoring [28]. Third, improper selection and training of crewmembers may produce problems during an ICE mission. If the personality styles of crewmembers do not make them good team members, or if they are not trained to be sensitive to group dynamic issues and conflicts are allowed to fester over time, this can affect morale and relationships as time goes on, becoming apparent in the third or fourth quarters of a long-duration mission. Also, the measures used to evaluate the mood and interpersonal climate of a group of people working in an ICE is important. Most would agree that objective measures such as blood pressures or cortisol levels are useful indicators of stress and physiological state. More subjective measures also can be useful, but their validity and reliability may be more questionable. For example, those that depend on formal scales of items that combine to produce subscales of interest (e.g., Profile of Mood State) and that are backed by solid validity and reliability testing may be less prone to subjective bias than the content analysis of material entirely provided by the subjects. Although the latter material might be sensitive to psychological state, it also may be more affected by the demand characteristics of the study. Fifth, the use of statistics to help put findings in perspective is a scientific requirement. Many studies of the third quarter phenomenon depend on the “eyeball test”: plots are made of data over time, and a drop that occurs in the third quarter is used as proof that this phenomenon is present without putting the actual data to a statistical test (e.g., analysis of variance, time series regression analysis). Also, what is the best way to reference a third quarter change: from the second quarter values, from the first quarter values, or from some kind of baseline taking into account the levels of the first, second, and fourth quarters? Even Bechtel and Berning reported that their subjects reached a nadir in their studied variables in the third quarter [53] without clarifying what they were comparing this change to. A third statistical problem is that in much third quarter research, many variables are evaluated, reflecting the broad definition of the phenomenon. Since one would expect 1 out of 20 measures to produce a significant finding of 0.05 by chance alone, it is important to correct for Type I errors to control for the emergence of false positive findings. The final issue related to a possible third quarter effect is the impact of mission events on what otherwise might have been seen as a time-dependent stage sequence. This issue has not been properly appreciated. An example is the impact of the austral winter at Antarctic bases, which produces dramatic changes in the behavior of

2.6 Mission Stages and the Third Quarter Phenomenon

71

the more confined personnel and also happens to overlap with the third quarter of their mission. The arrival of replacement personnel also may produce tension at a base. In addition, as we shall see in Sect. 2.7.1, a mid-mission resupply of favorite food, letters from home, and equipment components can dramatically improve morale and lower the general stress level of a crew in a space station simulator. Also, in a 520-day Mars expedition simulation project that took place in Moscow (see Sect. 9.5), several investigators found no evidence for a third quarter phenomenon, but some felt that the simulated Mars landing event that occurred mid-way in the mission produced changes indicating emotional activation and stress. This raises the question of what exactly is the third quarter of a Mars expedition, since there are three phases to the mission: outbound to the Red Planet, Mars landing and exploration, and return to Earth. Is the third quarter best described in terms of the entire mission or within each of these phases? After all, each phase might have its own unique time characteristics or stressors (e.g., boredom, communication delay with the Earth) [57, 58]. But even if there is some evidence to support the existence of a third quarter phenomenon in space, does it really matter? In medicine, we make a distinction between findings that occur but don’t affect the patient, and findings that do, which are called clinically significant. This may be pertinent to the third quarter construct. For example, in one study of 119 men and women who overwintered in Antarctica, Palinkas, Cravalho, and Browner [59] found that significant increases in global depression scores occurred, along with several individual symptoms associated with winter depression. However, only 5.6% of the subjects that had data available exhibited symptoms of the winter-over depression syndrome that were severe enough to require clinical intervention. For near-Earth missions, astronauts and cosmonauts are well-briefed these days on psychological and interpersonal stressors and are well-supported by space psychologists and flight surgeons in mission control. Space travelers also have access to means of communicating privately with family and friends on Earth 24/7. Resupply of favorite foods and pastime equipment like musical instruments can occur frequently. The ISS is much roomier and habitable than earlier space habitats. In many ways, astronauts are less stressed and psychologically isolated by their space environment than submariners or personnel in the Antarctic during austral winter. The effects of a possible third quarter phenomenon are much less than in the days of Bechtel and Berning, and the supportive countermeasures for isolated and confined individuals are much better. Of course, these positive conditions will change during a 2 1 2 -year expedition to Mars, as we shall see in Chap. 9, given the effects of the great distance to the Red Planet and the resulting lack of frequent resupply and the communication delays with people on Earth. We must keep an open mind and test for possible third quarter and other time effects on such a distant mission.

2  Living and Working in Space

72

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents 2.7.1 Preliminary Study in the Mir Space Station Simulator (HUBES) My colleagues and I were interested in studying time effects and crewmember interactions in a space-like environment. We submitted a proposal to ESA and were accepted to participate in the HUman BEhaviour Study (HUBES), which was sponsored by the European and Russian Space Agencies. The study took place at the Institute for Biomedical Problems (IBMP) in Moscow and involved three male Russian physicians (two of whom were cosmonauts) in their thirties who were isolated in the Mir space station simulator for 135 days [60]. On a weekly basis before, during, and after the isolation, the subjects competed a critical incident log of important events and three measures that have shown good validity and reliability in numerous studies on Earth: the Profile of Mood States (POMS), the Group Environment Scale (GES), and the Work Environment Scale (WES). The POMS is a standard affect scale consisting of 65 adjectives describing various mood states (e.g., “tense,” “sad,” cheerful”), which the subjects rate as they apply to them on 5-point Likert Scales, from “1” (Not at all) to “5” (Extremely). The GES and WES consist of statements that the subjects rate as being either true or false of their group social environment. On all three measures, a set of items cluster together to form one of many subscales that describe a specific affect state or group climate element. The subscales are shown in Table 2.4. We used all of the available subscales of the POMS and GES and four of the 10 subscales of the WES (the other six were redundant to GES subscales and were omitted). The Physical Comfort subscale was used in HUBES and a later Mir study but was omitted in a follow-up ISS study (see below), since it was not found to be useful, and its omission would save subject time based on feedback from returning Mir subjects. Note that the Table 2.4  POMS, GES, and WES subscales Profile of mood states Tension-anxiety Anger-hostility Vigor-activity Depression-dejection Fatigue-inertia Confusion-­bewilderment Total mood disturbance

Group environment scale Cohesion Expressiveness Independence Self-discovery Innovation Order & organization Task orientation Leader control Leader support Anger & aggression

Work environment scale Work pressure Managerial control Supervisor support Physical comfort (HUBES and Mir studies only—not in ISS study)

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents

73

Leader Control and Leader Support subscales refer to the task and support roles of the crew commander, whereas the Managerial Control and Supervisor Support subscales refer to similar roles of the supervisory staff in mission control. The key issue in HUBES was an examination of changes in mean subject mood state and group environment ratings over time. We were especially interested in changes between the first half (9 weeks) and second half (10 weeks) of the isolation. We used an interrupted time-series analysis for repeated measures which had good power, was conservative with respect to Type I (false positive) errors, and provided a correction for autocorrelation effects. In addition to time effects, we also were interested in studying the possible displacement of intra-crew negative mood to people in mission control and the impact of the task and support roles of the crew commander on group cohesion. We found that the levels of some of our measures (Tension-Anxiety, Total Mood Disturbance, Leader Control) were higher in the first half vs. the second half of the mission, with a dramatic drop at the halfway point between weeks 9 and 10. It was at this time that a resupply occurred where the crew received some additional food that had been requested, letters from family and friends, and components for equipment that wasn’t working. It is likely that these events dramatically improved morale and lowered the general stress level. Although there were no absolute differences in Cohesion scores between the first and second halves of the mission, Cohesion scores showed a significant negative drop during the last 8 weeks of the mission, suggesting some impact of the long duration of the mission on crewmember relationships. However, there was no evidence of a third quarter phenomenon. Finally, the Tension-­ Anxiety scores were higher and the Expressiveness and Self-Discovery scores were lower during the pre-isolation training phase than during the mission itself, suggesting that there was more stress before than during the isolation period and that the crewmembers found the seclusion somewhat productive and rewarding. Forty-six percent of the days where at least one entry was made in the critical incident log were accounted for by one subject. The other two members accounted for 29% and 25% of the log entry days. The entries indicated that there were problems with the hardware in the simulator during the first 3 weeks of the seclusion. Two of the crewmembers reported having excessive workloads and being fatigued during the simulated docking and sleep deprivation period in the fourth week. The logs also indicated the presence of dysphoria during the last month of the seclusion, with entries citing arguments over a political situation in Chechnya, melancholia, and tense anticipation of the end of the mission. Thus, the mood of the subjects was affected by internal and external events that occurred, not simply by the effects of time per se. We also studied the displacement of negative affect in the crew to the outside monitoring personnel and the relationship between leadership roles and team cohesion. These results will be presented and discussed in Chap. 5. Although generalizations from this study are limited due to the small number of subjects (all of whom were Russian men) and the fact that only one simulation mission was examined, many of the findings reached statistical significance and allowed us to form hypotheses for our future work. In addition, we were able to test our methodology and gain experience using three very robust measures with excellent

74

2  Living and Working in Space

Fig. 2.4  The International Space Station in its current configuration back-dropped by the Earth. This multinational habitat allows crewmembers to live and work in space for long periods of time. It is an excellent research and training facility to prepare crews for the outbound and return phases of an interplanetary mission, such as an expedition to Mars. (Credit: NASA)

validity and reliability scores that were to be used in our two follow-up studies on the Mir and International Space Stations, which will now be discussed.

2.7.2 Methodology of the Mir and ISS “Interactions” Studies Both of these studies received NASA support and were intended to be a collaboration between American and Russian scientists in advance of later astronaut and cosmonaut participation on the ISS.1 The first study took place on the Russian Mir space station (Fig. 2.2), and the second on the International Space Station (Fig. 2.4). The two studies occurred from 1995 to 2006 and investigated two groups of subjects: American astronauts and Russian cosmonauts in space, and Americans and  The international investigative team members were from the University of California and the Veterans Affairs Medical Center in San Francisco (Nick Kanas, M.D., Principal Investigator; Charles Marmar, M.D.; Daniel Weiss, Ph.D.; Jennifer Boyd, Ph.D.; Alan Bostrom, Ph.D.; Ellen Grund, M.S.; Philip Petit, M.S.; and Stephanie Saylor, M.S.); and the Institute for Biomedical Problems in Moscow (Vyacheslav Salnitskiy, Ph.D., Russian Head; Vadim Gushin, M.D.; Olga Kozerenko, M.D.; and Alexander Sled, M.S.). 1

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents

75

Table 2.5  Differences between the Mir and ISS studies Mir study Mission duration: 4–7 months Crewmembers launch staggered Permanent crew size: 3 people Commander: always Russian Total crew sample: 5 American, 8 Russian American MC sample (42 at TsUP) Russian MC sample (16 at TsUP)

ISS study Mission duration: 4–7 months Crewmembers launch together Permanent crew size: 2 or 3 people Commander: Russian or American Total crew sample: 8 American, 9 Russian American MC sample (108 at JSC & MSFC) Russian MC sample (20 at TsUP)

Russians in Mission Control Centers on Earth. Four areas were examined: (1) the effects of time on subject emotional state and group interactions; (2) the presence of displacement of negative emotions from people in space to Mission Control, and from people in Mission Control to space agency management; (3) the relationship between the task and the support roles of the leaders (e.g., mission commander, Mission Control team leader) to cohesion in the group they led; and (4) cultural differences between American and Russian subjects, both in space and on the ground. Each week before, during, and after the missions, subjects in space and on the ground completed the POMS, GES, WES, and a critical incident log. A culture and language questionnaire was added for the ISS study. Measures were translated and back-translated from English to Russian and were available in both computerized and hard copy versions. Data were analyzed using regression, analysis of variance (ANOVA), and t-test procedures. Because of the large number of subscales analyzed, corrections were made to control for possible Type I (false positive) errors. For analyses using regression techniques, normally distributed or transformed subscales were analyzed using a mixed model procedure. Non-normally distributed subscales were dichotomized into high and low scores and analyzed using a General Estimating Equation. For details on our methods of statistical analyses, see [61] and [62]. Differences between the Mir and ISS studies are shown in Table 2.5. Missions in both studies lasted 4–7 months, with 6 months being typical. In the Mir study, crewmembers were launched in a staggered manner, with new people replacing returning people to keep a permanent crew size of three (there also were visitors who had a stay of less than 30 days who weren’t enrolled as subjects). In the ISS study, entire crews would launch together, with 2 or 3 remaining for the mission duration (plus occasional shorter-term visitors). Thirteen astronauts and cosmonauts in space for more than 30 or more days were crew subjects in the Mir study, and 17 crewmembers were subjects in the ISS study. American and Russian subjects made up the Mission Control sample at TsUP in Moscow and Johnson and Marshall Space Flight Centers in the United States (Johnson was the operations center, and Marshall handled the payloads). Time-related findings from the Mir and ISS studies will be presented below. Displacement, leadership, and cultural findings will be presented in Chap. 5.

76

2  Living and Working in Space

2.7.3 Time Findings 2.7.3.1 Mir Study (Fig. 2.5) We hypothesized that there would be decrements in the second half of the missions on subscales measuring tension, cohesion, and leader and management support. Using a piecewise linear regression analysis and correcting for Type I errors, only one of the 14 subscales that we used to test for the hypothesized second half score decrements resulted in a significant finding [62]. That subscale was the measure testing for commander support, suggesting that the Russian commanders may not have seen the need to be especially supportive during the last part of the missions. Time effects other than first half/second half also were tested for crewmembers using regression techniques. Neither a high-low-high “U-shaped” pattern nor an overall linear increase or decrease in the scores over time was found on any subscale for all crewmembers or for Russians alone. However, for the Americans alone, the subscale for Order & Organization showed a significant triphasic U-shaped pattern, indicating higher scores at the beginning and the end of the missions. In addition, for the Americans alone, there was a significant linear decline in Cohesion as the

Fig. 2.5  Patch given to subjects who participated in the Mir study. The blue and gold colors follow the scheme adopted by the University of California. At the top appear “NASA” and “Mir” (in Russian). In the left rim is the name of the project: “Human Interactions,” which is translated into Russian in the right rim. In the center top is a U.S. Space Shuttle docked to the Mir Space Station, with three astronaut/cosmonaut figures symbolized on board. Below on Earth are the American and Russian flags and three Mission Control subjects. (Credit: The author)

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents

77

mission progressed, and significant non-linear declines in Task Orientation and Self Discovery during the middle and end of the missions [61]. These findings suggested that a novelty effect occurred for the Americans as they adjusted to being on a Russian spacecraft where their role was unclear. This is reminiscent of the experiences of Norm Thagard, the first astronaut sent up to the Mir [25]. Scores on these measures tended to decrease as the astronauts became more familiar with their tasks and the on-orbit environment. Using one-way ANOVAs, scores also were examined for the 21 subscales across the four quarters of the missions to look for the third quarter phenomenon (see Sect. 2.6) and to see if any single quarter gave unique scores. There were no significant quarter differences for all crewmembers or for Russians alone [62, 63]. American crewmembers had significantly higher mean scores in the earlier versus later quarters for Task Orientation and Self Discovery, a pattern that again suggest an adjustment reaction for the U.S. astronauts due to the novelty of their situation. Using one-way ANOVAs, crewmember responses for the 21 subscales during the on-orbit phase of the missions were compared to their pre-launch baseline scores and to their post-return scores. There were no significant differences between these three time periods in POMS subscales for all subjects or for the Americans and Russians taken separately [61]. However, the crewmembers reported higher levels of Self-discovery and Innovation prior to launch, and higher levels of Work Pressure during the missions [64]. 2.7.3.2 ISS Study (Fig. 2.6) As the Shuttle/Mir Program was winding down, an opportunity presented to replicate this study during the construction of the International Space Station. In addition, with plans to expand the crew of the ISS to include participants from countries other than the United States and Russia, it became important to study the impact of language and culture on mission performance. To accomplish these goals, our team submitted a new research proposal that was accepted and funded by NASA. Many of the hypotheses and procedures for this study were similar to the previous study, except that based on the Mir findings, we no longer were predicting decrements in the second half of the missions. Other differences are shown in Table 2.5. Due to the Columbia Space Shuttle accident and other delays that impacted on the construction schedule, missions could not be studied that involved non-U.S. and non-Russian participants on-board for 30 or more days. Second half time effects, displacement, cultural differences, and leadership role were analyzed using methods similar to those used in the Shuttle/Mir study. None of the ISS variables required transformation because the residuals from mixed model analyses were normally distributed. Corrections to reduce the risk of Type I errors were employed as before. Using a mixed-model linear regression analysis, none of the slopes for the subscale regression lines used to measure crewmember tension, cohesion, or leader support showed a significant deviation from a horizontal line with a slope of zero in

78

2  Living and Working in Space

Fig. 2.6  Patch given to subjects who participated in the ISS study. The blue and gold colors follow the scheme adopted by the University of California. In the rim appear “International Space Station Human Interactions,” which is the name of the study. In the top center is an image of the ISS along with three astronauts/cosmonauts, and in the lower center is the Earth with six figures representing Mission Control subjects. (Credit: The author)

either the first or second halves of the missions [65]. These results suggested the absence of second half (and first half) decrements during the course of the missions. In further analyses using ANOVAs, there were no differences in mean crewmember scores in any of the 20 subscales across the four quarters of the missions. In comparing the third quarter means against the means for the other three quarters pooled together, there again were no significant differences in the third quarter, except for the Independence subscale, which was higher in the third quarter (the opposite of what would be predicted by the third quarter phenomenon). The failure to find time dependent findings replicated the time results from the Mir study. Unlike the Mir study, there was no evidence to suggest the presence of a novelty effect in our ISS study for the American (or Russian) crewmembers, likely because the ISS missions were more international in scope: the station was not seen as belonging to any one country, the mission commanders could be either American or Russian, both the English and Russian languages were spoken, and the roles of both Americans and Russians were clearer and equally important. In addition, the ISS crewmembers scored more positively on the POMS subscales and lower on the Work Pressure subscale, suggesting a better work environment on the ISS [64]. Exploratory analyses were conducted to look for a relationship between subscale scores and mission duration. Pearson correlations indicated that there was no significant relationship between the length of the missions (within the 4–7  month

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents

79

range) and average scores on the 20 subscale measures [65]. Descriptively, none of the corresponding scatter plots showed signs of any meaningful relationship. These analyses suggested that it was unlikely that differential time effects existed between the longer and shorter missions that were included in the study. 2.7.3.3 Time Conclusions An examination of the results from both the Mir and ISS “Interactions” studies shows remarkable similarity in terms of time effects [66]. Initially, we hypothesized that there would be evidence for negative psychological changes between the first and second halves of the missions, especially in the third quarter. However, we found no significant changes in subscale scores measuring mood, crew cohesion, or interpersonal climate over time, in either the Mir or ISS study. An example of this lack of change for the Cohesion subscale is shown in Fig. 2.7. This suggests that people who live and work on-orbit do not routinely experience meaningful time-­ dependent changes in their emotional state or their perception of group climate. It also suggests the absence of a general third quarter phenomenon. Taken together, our Mir and ISS subjects were remarkably stable emotionally throughout the

Fig. 2.7  The data plot for the GES Cohesion subscale from one of the missions. On the Y-axis is the mean score value from all three crewmember subjects. On the X-axis are all of the weeks of this mission, with “−13” being the first week, “0” being the halfway point, and “+13” the last week. Note that the scores tend to be on the high end of the scale, which is typical for an astronaut/cosmonaut population that perceives things positively. Despite some variation, none of the scores show significant differences from week to week, and there is no indication of a third quarter phenomenon. (Credit: The author)

80

2  Living and Working in Space

missions, probably due to support they received from the ground. This is not to say that an occasional crewmember didn’t experience a second half or third quarter decrement in mood. In fact, some individual crewmembers did show measurable negative emotional sequelae at these times. But such drops were countered by other crewmembers who showed more positive emotional reactions in the third or fourth quarters, or who showed decrements in the first quarter, or the last quarter, etc. The point is: our findings did not show evidence for a significant, meaningful timedependent problem that was in any quarter of the missions. The only significant time-related difference we found was the novelty effect shown by the American subjects in the Mir study. Recall that in this program, the language used and the nationality of the commander were always Russian, the American astronauts were seen as “guests” without meaningful tasks to perform, and they were outnumbered 2:1 by their Russian hosts. The Americans were new to space station missions and were thus introduced to a novel on-orbit environment that was already known to their Russian counterparts. This was reflected in several subscale scores related to work organization and self-learning, but these scores dropped as the mission continued and the Americans became more familiar with their surroundings (plus, their role was better identified). This initial American/ Russian difference did not occur in our ISS study, probably because the crewmembers from the two countries were seen as equally vital to the mission; both English and Russian were spoked by commanders, whose nationality alternated between the two countries; and all crewmembers had equivalent training and exposure to their space habitat. Thus, specific situations and events that occur in space can impact on individual and interpersonal reactions in ways that are more important that the impact of time per se.

2.7.4 Critical Incident Log Findings 2.7.4.1 Mir Study A content analysis was made of results from the critical incident logs [63]. Crewmembers contributed 4% of the total number of critical incidents, and Mission Control subjects contributed 96%. Since completion of this log was voluntary, the responses were skewed, in that a few of the more verbal participants contributed over half of the responses. Also, subjects sometimes gave more than one response per questionnaire. For these reasons, it was not possible to statistically test for critical incident effects, and the results will be presented descriptively. Seven of the thirteen incidents reported by the U.S. astronauts concerned interpersonal problems, such as feeling unsupported by other crewmembers or having conflicts with Mission Control personnel. Six more items pertained to negative events on-board the Mir, such as accidents and equipment failures. The only two Russian cosmonaut responses were from the same person, who cited two negative events on-board related to the physical environment. For the American Mission

2.7 MIR and ISS “Interactions” Studies: Time and Critical Incidents

81

Control respondents, 49 of their 106 reported incidents were related to interpersonal problems involving disagreements with each other, the leader, crewmembers, or Russian colleagues, and 16 pertained to negative events on-board the Mir, such as accidents or equipment failures. For the Russian Mission Control respondents, 86 of their total of 273 responses were related to negative events onboard the Mir, such as accidents or equipment failures, and 60 pertained to inadequate resources and delays in receiving their salary due to fiscal problems. 2.7.4.2 ISS Study Only 8 of 17 crewmember subjects from both countries provided log entries, and one of these accounted for 59% of the responses. This skewed response sample prevented us from applying statistical analyses to these data. Of the 92 critical incident ratings, 21% made reference to positive events, such as holiday celebrations or activities that enhanced team cohesion; 17% referred to expected onboard events, such as dockings or EVAs; 55% referred to incidents having negative attributes, such as interpersonal or psychological problems; and the remaining 7% contained either neutral ratings or not enough information to analyze. Of the 51 negative responses, 24 (47%) referred to interpersonal problems involving the crew or crewmembers or people on the ground, and 9 (18%) dealt with psychological problems, such as anxiety or depression [37]. In response to a question asking how much the incident affected either their personal level of tension or the team tension, both were rated as “no change” or “increased a little.” 2.7.4.3 Critical Incident Log Conclusions In the Mir study, all subject groups listed negative events on the aging Mir Space Station as an important source of critical incidents. American crewmembers and Mission Control personnel also cited interpersonal problems as being important. This might have been due to the fact that they were working in a program managed operationally by people from another culture. Russian Mission Control personnel mentioned resource and salary delays as important, which reflected real issues related to political changes in Russia. These findings support the notion that negative emotions that occur during space missions may be related to stressors stemming from specific mission-related factors rather than simply the passage of time in isolation. Things were better on the ISS. Nearly half of the responses from the crewmembers mentioned neutral or positive events, possibly reflecting the new space station environment and the more international emphasis of the missions. The majority of the critical incidents that reflected operational issues were expected (e.g., dockings, EVAs), and there was a notable lack of emergencies or accidents on board in comparison to the Mir. Nearly two-thirds of the negative events were due to interpersonal or psychological problems.

82

2  Living and Working in Space

2.7.5 A Kanas et al. Interactions Replication Study from China—Time Findings Science moves ahead when findings from one study are replicated by others. In a sense, our ISS study was a replication of our Mir study. However, it is more meaningful when the same results are found by a different team. Wu and Wang in China read about our Mir and ISS studies in the Chinese edition of a book I co-authored with Dietrich Manzey [37]. They translated the POMS, GES, and WES into Mandarin and applied our methodology to an 80-day isolation study in a space station simulator called Lunar Palace I located at Beihang University in Beijing. They also conducted a post-mission interview. Despite having only three subjects (one male, two females), they were able to replicate many of our findings [67, 68]. Using an ANOVA, there was evidence to support an initial adjustment reaction, with scores on the Fatigue, Cohesion, and Autonomy scales being highest in the first quarter. This might have been due to the fact that the crewmembers reported very heavy workloads in the first few weeks, with little time for relaxation or entertainment. As time went on, the workload stabilized, and the scores on these subscales dropped. There was no evidence for a third quarter phenomenon. In fact, correlational analyses found a tendency for positive emotions and cohesion to improve as time went on and the crewmembers became more comfortable with the mission [67]. The displacement and leadership findings from this study will be presented in Chap. 5.

2.8 ISS “Journals” Study 2.8.1 Preliminary Study During Long-Duration ICEs (French Diaries Study) Another person who has studied time effects in space is Jack Stuster. His work stemmed from a previous study of behavioral issues during nine long-duration ICE missions at three French remote duty stations on small islands in the South Indian Ocean and at the French Dumont d’Urville Antarctic station. The Antarctic station was considered harsher, with worse weather and only two ship resupply visits per year in the austral summer versus nearly monthly visits at the insular stations. Together with his colleagues [69], Stuster examined the diaries of nine leaders and physicians of nine expeditions and used a content analysis procedure to explore important behavioral issues. To increase the useful content, the participants were sensitized to relevant behavioral and human factors issues and were encouraged to discuss them in their diaries. The durations of the missions ranged from 69 to 363 days. The investigators made the assumption that the frequency with which an issue was mentioned reflected its importance to the diarist. All entries were categorized as positive, negative, or neutral, and a metric called Net Positivity/Negativity

2.8 ISS “Journals” Study

83

(NPN) was calculated by subtracting the proportion of negative entries from the proportion of positive entries. Inferential tests of significance were not performed, as the experimenters believed them to be “inappropriate” due to the large number of behavioral categories, the small number of diarists, and the amount of individual differences that were found. The content analysis isolated 22 categories, with topics related to Group Interactions (e.g., interpersonal conflicts, celebrations) mentioned 20.7% of the time; followed by Outside Communications (e.g., visitors or information from the outside), 12.7%; Workload (e.g., description of tasks, teamwork), 11.9%; and Recreation & Leisure (e.g., special meals, physical activity), 11.2%. Many of the entries concerning interpersonal conflicts occurred between members of subgroups (e.g., support personnel, military personnel, scientific staff). The other categories were mentioned less than 10% of the time. Based on a visual examination of the quarterly score pattern for all entries, the experimenters concluded that the NPN scores were lowest in the third quarter of the missions. Surprisingly, three short missions (180 days or less duration) generated more negative reactions than six long missions (230-day minimum), and diaries from the sub-Antarctic island stations were more negative those from the harsher Antarctic station. However, an examination of the pattern showed that the overall NPN scores for the third and fourth quarters were lower in the Antarctic than the insular stations. Finally, the physician subjects scored lower overall in the NPN and experienced a third quarter effect, whereas the leaders showed a decline during the second quarter. In terms of the Workload category, the experimenters state: “A sharp third-­quarter decline in the Workload NPN in the Antarctic diaries corresponds with the austral winter and the resulting decline in work tempo at Dumont d’Urville” [69, p. A22], which might have contributed to the drop in the overall Antarctic NPN score. There also was a drop in NPN value for entries in the Adjustment category during the third quarter, which remained low through the end of the mission. The experimenters believed this reflected the cumulative effects of mission duration.

2.8.2 ISS “Journals” Study The French diaries study formed the basis for a study conducted by Jack Stuster on the ISS, which was funded by NASA and labeled the “Journals” study. Stuster used a content analysis procedure to examine the personal journals of 20 astronauts who flew on the ISS, the first 10 as part of two and three person crews (Phase 1), and the last 10 as part of six person crews (Phase 2). The results were published in two NASA documents [70, 71] and have not appeared in peer-reviewed scientific journals. The methodology was similar to that in the French study. Participants were told to make journal entries at least three times per week and to address topics that were most salient to them, both positive and negative. The mean duration on the ISS for the first 10 subjects averaged 187.7  days, and the duration for the next 10

84

2  Living and Working in Space

subjects was 158.8 days. For some examinations, proportions of subject responses were used in each journal to control for differential amounts of journal activity. In other cases, the total number of responses were used, which amounted to 4,247 separate statements for the first 10 participants and 3,998 statements for the second 10. Responses were coded as being positive, negative, or neutral in tone. Codings were made by Stuster, but samples were sent to a member of the French diaries team to test for inter-rater reliability, which was 94% for tone and 89% for category. Like the French diaries study, statistical tests were not used in the space experiment, with the following statement: “It was judged to be inappropriate to subject the data to inferential tests of significance, because of the large number of behavioral categories, the relatively small number of study participants, and the individual differences among them” [71, p. 9]. The first level of analysis identified the relative salience of 24 major categories of issues that had behavioral implications. The second level of analysis identified more than 100 subcateories within the major categories. The third level of analysis focused on the tone of the entries and defined the NPN metric, which like in the French diaries study was calculated by subtracting the proportion of negative entries from the proportion of positive entries within each category. There also were questionnaires that included five items with 1–7 Likert scales that asked the subjects how difficult they thought the mission would be before they launched and how difficult it actually was during and after the mission in terms of: physical, mental, equipment, organizational, and interpersonal problems. The questionnaire also included two open-ended questions asking the subjects to write about the most difficult and the most enjoyable aspects of their jobs, with ratings made before, during, and after the missions. The first report [70] focused on the results from Phase 1, and the second [71] from both Phase 1 and Phase 2. The rank order of the categories in the two phases of the study calculated from the coded journal statements are shown in Table 2.6, in descending order of frequency. Stuster states that the rankings from the groups of astronaut responses are “remarkably similar.” For example, the same categories appear in the top 6 and in the bottom 8 for both phases of the study, and 9 of the top 10 Phase 1 categories were in the top 10 during Phase 2. The top four categories received 59% of all primary, secondary, and tertiary category assignments, and the top 10 categories accounted for 88%. Both reports include detailed description of the categories, and within each are charts showing bar graphs for important subcategories broken down by numbers of statements for each of the four quarters. In addition, there are numerous journal statements listed for each subcategory that follow each chart. The reader is referred to the original reports, but I will give a few highlights from the first four categories. Journal statements assigned to Adjustment encompassed references to factors that contributed to successful adaptation to the ISS, descriptions of physical and cognitive problems, fatigue, and comments related to both high and low morale. Work comments were dominated by references describing tasks performed by the crews, such as references to teamwork, positive work experiences, work schedules, and work-related problems (including equipment malfunctions, procedural errors,

2.8 ISS “Journals” Study

85

Table 2.6  Rank order of categories from the “Journals” experiment Phase 1: 10 astronauts in 2–3 person crews Work Outside communications Adjustment Group interaction Recreation/leisure Equipment Event Organization/management Sleep Food Logistics/storage Exercise Procedures/rituals Leadership Safety Medical Waste management Privacy/personal space Clothing Personnel selection Internal communications Habitat aesthetics Personal hygiene Habitat hygiene

Phase 2: 10 astronauts in 6 person crews Adjustment Work Outside communications Group interaction Equipment Recreation/leisure Food Event Exercise Organization/management Sleep Procedures/rituals Logistics/storage Medical Safety Leadership Waste management Habitat hygiene Personal hygiene Clothing Internal communications Personnel selection Privacy/personal space Habitat aesthetics

Taken from Stuster [71]

and astronaut errors related to the “space stupids” or “space fog”). Outside Communications dealt with interactions between the crewmembers and family and friends, mission control, and management personnel on Earth. Group Interaction statements related to interpersonal comments that were concerned with the ability of the crewmembers to get along. Overall, astronaut-cosmonaut relations were good, especially in Phase 2 where each group could retreat to their own ISS section to do work as the station volume increased. Stuster identified a number of important implications from his subcategory analysis. First, astronaut comments identified work pressures that were based on unrealistic time estimates made by mission planners who overscheduled timelines. Second, the shift to larger crews allowed the scheduler to distribute tedious tasks (e.g., conducting inventories, housekeeping chores) among more people, which improved morale. Third, like in other ICEs, trivial issues were sometimes exaggerated, but both astronauts and ground personnel actively worked to keep good relationships; in Phase 1, this was handled by “praise inflation,” but in Phase 2 there seemed to be a maturing of the crew-ground relationship. Finally, providing an appropriate habitat

86

2  Living and Working in Space

and meaningful work (e.g., EVAs, science experiments, Earth photography) helped the astronauts adjust to their ICE space environment. Having sufficient time in the schedule to do the work properly was the most important aid to adjustment that was mentioned by the subjects, followed by having compatible and helpful crewmates. The questionnaire results suggested that life on the ISS was not as difficult as expected before launch. Overall, the mid-mission responses to the five Likert scale questions were 24% lower than pre-mission estimates in Phase 1 and 20% lower in Phase 2. For all five questions, the mid-mission and post-mission values were lower than pre-launch expectations, with the exception that the post-mission Physically Difficult value equaled the pre-launch expectation score. The pre-, mid-, and post-­ mission scores for Interpersonal Problems in both phases were the lowest of the five measures and showed the greatest mid-mission decline in terms of percentage drops. In terms of the open-ended questions, five astronauts listed handling the work as the most difficult aspect of life on the ISS, followed by four who listed dealing with NASA management and the astronaut office, and three who listed adapting to the social and physical conditions. In terms of the most enjoyable aspects, eight listed successfully performing their work, followed by five each who listed ­camaraderie/ crew solidarity and the unique features of living in space (e.g., weightlessness, views of the Earth). In terms of the NPN findings, Stuster presented a number of charts breaking down the findings for the four quarters of Phase 1 and 2 missions in terms of all categories combined and Adjustment only [71]. He singled out Adjustment because he believed it most accurately depicted individual attitudes and morale and was most in keeping with the third quarter phenomenon of Bechtel and Berning) [53]. By examining the plots for each subject, he concluded that 14 out of 20 subjects (70%) showed declines in average NPN during the third quarter (6/10 in Phase 1 and 8/10 in Phase 2). For the Adjustment category alone, this number rose to 17 out of 20, or 85% (9/10 in Phase 1 and 8/10 in Phase 2). These findings were based on a visual inspection of the plots, and no statistical analyses were reported. It appears that a drop was counted if the third quarter score was less (i.e., lower on the plot) than the second quarter score, not if it was lower than the first or fourth quarters or some composite of quarters 1, 2, and 4. An average measure of NPN was calculated for the top 18 major categories in Phase 1 and Phase 2 and found that journal statements concerning Recreation and Leisure to be the most positive in tone and those in Organization and Management to be the most negative in both Phase 1 and Phase 2. The Phase 1 report published in 2010 [70] showed an interesting chart that is reproduced in Fig. 2.8. This depicts the combined NPN data for all categories (4,215 entries) by quarter for Phase 1 subjects. The figure suggests a small drop in the third quarter for these data of unknown statistical significance. The “Journals” study produced a wealth of data about important behavioral and interpersonal issues that affect astronauts working and living on the ISS, although the interpretation of some of these data is hindered by the lack of statistical analyses in the two NASA reports. Particularly valuable are the verbatim comments made by the subjects describing what it is like to live and work in an on-orbit space station.

2.9 Points to Remember

87

Fig. 2.8  Plot showing NPN scores for all categories combined in Phase 1 by mission quarter. (Credit: Figure taken from Stuster [70], a NASA document in the public domain)

2.9 Points to Remember • There are a number of psychological stressors in space that produce psychological stress. • The vast majority of astronauts and cosmonauts adjust to their new environment successfully in the first few weeks. • Habitability refers to the physical interface between the environment and the human being, often using principles of Human Systems Integration. When the living quarters are pleasantly laid out, the on-board equipment and displays are user-friendly, and the lighting and noise are optimal for human comfort, then this can improve the well-being of the inhabitants. Particularly important is the interface between crewmembers and computers. • On long-duration space missions, such as an expedition to Mars, an unprecedented level of interaction between humans and automated or robotic systems will occur. In one study, the majority of participants preferred a system where they shared work with an automation condition. • Along with social factors, occupational issues were related to adaptability and the maintenance of crew cohesion. Feeling competent on the job is very important to astronauts. • Work transitions that involved a loss in autonomy are more challenging than transitions that result in more autonomy. • A good work strategy involves neither overloading nor underloading crewmembers, providing them with a stable 24-hour work-rest schedule, and giving them as much freedom to do their work as possible. Autonomy in conducting a variety of important tasks is seen as valuable in making the space experience meaningful.

88

2  Living and Working in Space

• Time-dependent mission stages are thought by many to occur during long-­ duration space missions, with declines in behavior and performance occurring in the second half, especially the third quarter. The negative sequelae of this stage have been called the third quarter phenomenon. • Although many people in ICEs experience the third quarter phenomenon, others don’t or have problems in another mission stage. The universality of the third quarter phenomenon has not been demonstrated in over 30 years of study. • A number of factors account for the variability in third quarter findings, including: demand characteristic and self-evaluation biases in subjects, expectation bias in investigators, improper selection and training of crewmembers, insensitive or biased behavioral measures, inadequate or no use of statistics, and mission events that interfere with stage sequence. • The impact of mission events on crewmember personal and interpersonal climate has been poorly studied. It will have particular relevance for an expedition to Mars, given the obvious impact of the Mars landing and exploration mid-way in the mission. • Issues involving problems in the aging Mir Space Station and other mission-­ related stressors contributed to feeling of dysphoria in both crewmembers and Mission Control support personnel. • The Mir and ISS “interactions” studies did not provide evidence for the third quarter phenomenon; neither did a study by a team in China using a similar methodology. • The ISS “journals” study allegedly did provide such evidence, but the data were not evaluated statistically. However, important behavioral issues in space were described and supported by a plethora of enlightening brief vignettes from the astronaut subjects.

2.10 Food for Thought 1. You have been asked to give advice for the design of a new rocket that will take a human crew on the first expedition to Mars. Which habitability features would you like to see included? Which would you absolutely not want to be incorporated into the spacecraft’s design? 2. You are in the sixth month of a 1 year on-orbit space station mission. You are doing fine, but you have heard about the third quarter phenomenon. Determined not to have behavioral problems after the halfway point of your mission, what would you do to keep your morale up? How would you use the resources that allow you to modify the on-board conditions and communicate with family and friends on Earth? What sorts of presents would you request be sent to you on the next resupply rocket? 3. You have been working hard on your on-orbit mission, but you never seem to have enough scheduled time to finish all your tasks. Would you be willing to spend some of your free time to complete these tasks? How would you stretch the timeline? Would could Mission Control do to give you some respite?

References

89

References 1. Kanas, N.  A., & Fedderson, W.  E. (1971). Behavioral, psychiatric, and sociological problems of long-duration space missions (NASA Technical Memorandum, NASA TM X-58067). National Aeronautics and Space Administration Manned Spacecraft Center. https://ntrs.nasa. gov/api/citations/19720008366/downloads/19720008366.pdf 2. Pope, F. E., & Rogers, T. A. (1968). Some psychiatric aspects of an Arctic survival experiment. Journal of Nervous and Mental Disease, 146, 433–445. 3. Smith, W. M. (1966). Observations over the lifetime of a small isolated group. Psychological Reports, 19, 475–514. 4. Weybrew, B. B. (1957, February 18). Psychological and psychophysiological effects of long periods of submergence. Analysis of data collected during a 265-hour, completely submerged, habitability cruise made by the U.S.S. Nautilus (Naval Medical Research Laboratory Report No. 281). 5. Kinsey, J. L. (1959). Psychological aspects of the “Nautilus” transpolar cruise. U.S. Armed Forces Medical Journal, 10, 451–462. 6. Weybrew, B. B. (1961). Impact of isolation upon personnel. Journal of Occupational Medicine, 3, 290–294. 7. Weybrew, B.  B. (1963). Psychological problems of prolonged marine submergence. In N. E. Burns (Ed.), Unusual environments and human behavior. Free Press of Glencoe. 8. Kubis, J. F., & McLaughlin, E. J. (1967). Psychological aspects of space flight. Transactions of the New York Academy of Science, Series 11, 30(2), 320–330. 9. Ebersole, J. H. (1960). The new dimensions of submarine medicine. New England Journal of Medicine, 262, 599–610. 10. Serxner, J. L. (1968). An experience in submarine psychiatry. American Journal of Psychiatry, 1, 25–30. 11. Flinn, D. E., Monroe, J. T., Cramer, E. H., & Hagen, D. H. (1961). Observations in the SAM two-man space cabin simulator. Behavioral factors in selection and performance. Aerospace Medicine, 32, 610–615. 12. Ferguson, M. J. (1970). Use of the Ben Franklin submersible as a space station analog, Vol. I. Summary technical report (OSR-70-4, NAS 8-30172). 13. Cramer, E. H., & Flinn, D. E. (1963). Psychiatric aspects of the SAM two-man space cabin simulator (SAM TDR 63-27). 14. Adams, O. S., & Chiles, W. D. (1963). Prolonged human performance as a function of the work-rest cycle. Aerospace Medicine, 34(2), 132–138. 15. Simmons, D. G., Flinn, D. E., & Hartman, B. C. (1963). The psychophysiology of high altitude experience. In N. E. Burns (Ed.), Unusual environments and human behavior. Free Press of Glencoe. 16. Ruff, G.  E., Levy, E.  Z., & Thaler, V.  H. (1959). Studies of isolation and confinement. Aerospace Medicine, 30, 599–604. 17. Dushkov, B. A., Znachko, V. A., Kozar’, M. I., Kosmolinskiy, F. P., & Zolotukhin, A. N. (1968). Functional changes in chamber tests (transl.). In V. V. Parin & I. M. Khazen (Eds.), Selected translations from aerospace medicine (pp. 64–72). JPRS46751. 18. Gerathewohl, S. J. (1959). Work proficiency in the space cabin simulator. Aerospace Medicine, 30, 722–735. 19. Burnazyan, A.  I., Parin, V.  V., Nefedov, Y.  G., Adomovich, B.  A., Maksimov, S.  B., Gol’dshvend, B.  L., Samsonov, N.  M., & Kirikov, G.  N. (1969). Year-long bioengineering experiment in a ground complex of life-support systems (transl.). Environmental Space Sciences, 3, 6–14. 20. Wise, H. G., Jr. (1966). Analysis of anticipated problems, effects of confinement of long duration manned space flights. Paper presented at NASA Symposium, Part 2, November 17. 21. Rohrer, J. H. (1961). Interpersonal relationships in isolated small groups. In B. E. Flaherty (Ed.), Symposium on psychophysiological aspects of space flight (pp.  263–271). Columbia University Press.

90

2  Living and Working in Space

22. Dunlap, R.  D. (1966). Psychology and the crew on Mars missions. Paper presented at the AIAA/AAS Stepping Stones to Mars Meeting, Baltimore, MD, March 28–30, pp. 441–445. 23. Rasmussen, J. E., & Haythorn, W. W. (1963). Selection and effectiveness considerations arising from enforced confinement of small groups. Paper presented at Second Manned Space Flight Meeting, AIAA, Dallas, TX. 24. Rohrer, J. H. (1958). Some impressions of psychic adjustment to polar isolation. U.S. Navy Bureau of Medicine and Surgery. 25. NASA. (2021). Shuttle-Mir long duration psychology (NASA SP-4225). Retrieved October 29, 2021, from https://history.nasa.gov/SP-­4225/long-­duration/long.htm 26. NASA. (2021). Shuttle-Mir Bilingual Blues (NASA SP-4225). Retrieved October 29, 2021, from https://history.nasa.gov/SP-­4225/bilingual/bb.htm 27. Associated Press. (1997, January 22). Astronaut tells of down side to space life. The New York Times. https://www.nytimes.com/1997/01/22/us/astronaut-­tells-­of-­down-­side-­to-­space-­ life.html 28. Suedfeld, P., Wilk, K., & Cassel, L. (2011). Flying with strangers: Post-mission reflections of multinational space crews. In D. Vakoch (ed.), Psychology of space exploration: Contemporary research in historical perspective (pp. 143–175). : NASA. Reprinted in Vakoch, D. A. (Ed.). (2013). On orbit and beyond: Psychological perspectives on human spaceflight. Springer. 29. Holden, K., Vos, G., & Marquez, J. J. (2021). The human factors of design for spaceflight. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, Vol. 2: Extreme application (pp. 205–224). CRC Press. 30. Raybeck, D. (1991). Proxemics and privacy: Managing the problems of life in confined environments. In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space (pp. 317–330). Springer. 31. Stuster, J. (1996). Bold endeavors: Lessons from polar and space exploration. Naval Institute Press. 32. Haines, R. F. (1991). Windows: Their importance and functions in confining environments. In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space (pp. 349–358). Springer. 33. Wolfe, T. (1980). The right stuff. Bantam. 34. Lebedev, V.  V. (1988). Diary of a cosmonaut: 211 days in space. PhytoResource Research Information Service. 35. Kelly, A. D., & Kanas, N. (1992). Crewmember communication in space: A survey of astronauts and cosmonauts. Aviation, Space, and Environmental Medicine, 63, 721–726. 36. Jiang, A., Foing, B. H., Schlacht, I. L., Yao, X., Cheung, V., & Rhodes, P. A. (2022). Colour schemes to reduce stress response in the hygiene area of a space station: A Delphi study. Applied Ergonomics, 98, 103573. https://www.sciencedirect.com/science/article/pii/ S0003687021002209 37. Kanas, N., & Manzey, D. (2008). Space psychology and psychiatry (2nd ed.). Microcosm Press/Springer. 38. Clearwater, Y. A., & Coss, R. G. (1991). Functional esthetics to enhance well-being in isolated and confined settings. In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space (pp. 331–348). Springer. 39. Holden, K., Marquez, J. J., Vos, G., & Cross, E. V., II. (2021). Human interaction with space-­ based systems. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, Vol. 1: Research at the frontier (pp. 259–294). CRC Press. 40. Rochlis, J., & Love, S. (2021). Flying to Mars is hard. In L. R. Young & J. P. Sutton (Eds.), Handbook of bioastronautics (pp. 817–830). Springer Nature Switzerland AG. 41. Schreckenghost, D., Holden, K., Greene, M., Milam, T., & Hamblin, C. (2022). Effect of automating procedural work on situation awareness and workload. Human Factors. https://doi. org/10.1177/00187208211060978 42. Nicolas, M., Bishop, S. L., Weiss, K., & Gaudino, M. (2016). Social, occupational, and cultural adaptation during a 12-month wintering in Antarctica. Aerospace Medicine and Human Performance, 87, 781–789.

References

91

43. Galarza, L., Steinke, J. A., & Barrett, J. D. (2021). Out of this world jobs: Alternative work analysis and validation methods in extreme environments. In L.  B. Landon, K.  J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, Vol. 2: Extreme application (pp. 35–61). CRC Press. 44. Mesmer-Magnus, J., Lungeanu, A., Harris, A., Niler, A., DeChurch, L.  A., & Contractor, N. (2021). Working in space: Managing transitions between tasks. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, Vol. 2: Extreme application (pp. 179–203). CRC Press. 45. Landon, L. B., & Paoletti, J. (2021). Extreme roommates: Exploring group-living skills as a unique team skill area. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs, Vol. 1: Research at the frontier (pp. 217–236). CRC Press. 46. Kubis, J.  F., McLaughlin, E.  J., Jackson, J.  M., Rusnak, R., McBride, G.  H., & Saxon, S. V. (1977). Task and work performance on Skylab missions 2, 3, and 4: Time and motion study – Experiment M151. In R. S. Johnston & L. F. Dietlein (Eds.), Biomedical results from Skylab (NASA-SP377) (pp. 136–154). National Aeronautics and Space Administration. 47. Nachreiner, F., Akkermann, S., & Haenecke, K. (2000). Fatal accident risk as a function of hours into work. In S. Hornberger & P. Knauth (Eds.), Shiftwork in the 21st century. Challenges for research and practice. Lang. 48. Nechaev, A. P. (2001). Work and rest planning as a way of crew member error management. Acta Astronautica, 49, 271–278. 49. Herring, L. (1997). Astronaut draws attention to psychology. Journal of Human Performance in Extreme Environments, 2, 42–47. 50. Britt, T. W., Sytine, A., Brady, A., Wilkes, R., Pittman, R., Jennings, K., & Goguen, K. (2017). Enhancing the meaningfulness of work for astronauts on long duration space exploration missions. Aerospace Medicine and Human Performance, 88, 779–783. 51. Sipes, W. E., Flynn, C. F., & Beven, G. E. (2019). Behavioral health and performance support. In M. R. Barratt, E. S. Baker, & S. L. Pool (Eds.), Principles of clinical medicine for spaceflight (2nd ed., pp. 761–792). Springer Science+Business Media, L.L.C. 52. Douglas, W.  K. (1991). Psychological and sociological aspects of manned spaceflight. In A.  A. Harrison, Y.  A. Clearwater, & C.  P. McKay (Eds.), From Antarctica to outer space (pp. 81–87). Springer. 53. Bechtel, R. B., & Berning, A. (1991). The third-quarter phenomenon: Do people experience discomfort after stress has passed? In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space (pp. 261–265). Springer. 54. Palinkas, L. A., & Houseal, M. (2000). Stages of change in mood and behavior during a winter in Antarctica. Environment and Behavior, 32, 128–141. 55. Décamps, G., & Rosnet, E. (2005). A longitudinal assessment of psychological adaptation during a winter-over in Antarctica. Environment and Behavior, 37, 418–435. 56. Alfano, C. A., Bower, J. L., Cowie, J., Lau, S., & Simpson, R. J. (2018). Long-duration space exploration and emotional health: Recommendations for conceptualizing and evaluating risk. Acta Astronautica, 142, 289–299. 57. Kanas, N. (2015). Humans in space: The psychological hurdles. Springer International Publishing. 58. Kanas, N., Gushin, V., & Yusupova, A. (2021). Whither the third quarter phenomenon? Aerospace Medicine and Human Performance, 92, 689–691. 59. Palinkas, L. A., Cravalho, M., & Browner, D. (1995). Seasonal variation of depressive symptoms in Antarctica. Acta Psychiatrica Scandinavica, 91, 423–429. 60. Kanas, N., Weiss, D. S., & Marmar, C. R. (1996). Crewmember interactions during a Mir space station simulation. Aviation, Space, and Environmental Medicine, 67, 969–975. 61. Kanas, N., Salnitskiy, V., Grund, E.  M., Weiss, D.  S., Gushin, V., Kozerenko, O., Sled, A., & Marmar, C.  R. (2001). Human interactions in space: Results from Shuttle/Mir. Acta Astronautica, 49, 243–260. 62. Kanas, N., Salnitskiy, V., Weiss, D.  S., Grund, E.  M., Gushin, V., Kozerenko, O., Sled, A., Bostrom, A., & Marmar, C. R. (2001). Crewmember and ground personnel interactions over

92

2  Living and Working in Space

time during Shuttle/Mir space missions. Aviation, Space, and Environmental Medicine, 72, 453–461. 63. Kanas, N., Salnitskiy, V., Grund, E.  M., Weiss, D.  S., Gushin, V., Bostrom, A., Kozerenko, O., Sled, A., & Marmar, C. R. (2001). Psychosocial issues in space: Results from Shuttle/Mir. Gravitational and Space Biology Bulletin, 14, 35–45. 64. Ritsher, J. B., Kanas, N. A., Ihle, E. C., & Saylor, S. A. (2007). Psychological adaptation and salutogenesis in space: Lessons from a series of studies. Acta Astronautica, 60, 336–340. 65. Kanas, N. A., Salnitskiy, V. P., Boyd, J. E., Gushin, V. I., Weiss, D. S., Saylor, S. A., Kozerenko, O. P., & Marmar, C. R. (2007). Crewmember and mission control personnel interactions during International Space Station missions. Aviation, Space, and Environmental Medicine, 78, 601–607. 66. Kanas, N.  A., Salnitskiy, V.  P., Ritsher, J.  B., Gushin, V.  I., Weiss, D.  S., Saylor, S.  A., Kozerenko, O. P., & Marmar, C. R. (2006). Human interactions in space: ISS vs. Shuttle/Mir. Acta Astronautica, 59, 413–419. 67. Wu, R., & Wang, Y. (2015). Psychosocial interactions during a 105-day isolated mission in Lunar Palace 1. Acta Astronautica, 113, 1–7. 68. Wang, Y., & Wu, R. (2015). Time effects, displacement, and leadership roles on a lunar space station analogue. Aerospace Medicine and Human Performance, 86, 819–823. 69. Stuster, J., Bachelard, C., & Suedfeld, P. (2000). The relative importance of behavioral issues during long-duration ICE missions. Aviation, Space, and Environmental Medicine, 71(9 Suppl), A17–A25. 70. Stuster, J. (2010). Behavioral issues associated with long duration space expeditions: Review and analysis of astronaut journals, experiment 01-E104 (journals): Final report (NASA/TM-2010-216130). Johnson Space Center. https://lsda.jsc.nasa. gov/lsda_data/dataset_inv_data/ILSRA_2001_104__1740256372_.pdf_Expedition_8_ ILSRA-­2001-­104_2011_31_010100.pdf 71. Stuster, J. (2016). Behavioral issues associated with long duration space expeditions: Review and analysis of astronaut journals, experiment 01-E104 (journals), phase 2, final report (NASA/TM-2016-218603). Johnson Space Center. https://www.academia.edu/33059049/ Behavioral_Issues_Associated_With_Long_Duration_Space_Expeditions_Review_and_ Analysis_of_Astronaut_Journals_Experiment_01_E104_Journals_Phase_2_Final_Report

Chapter 3

Emotional Highs and Lows

Contents 3.1  Positive Experiences in Space 3.2  The Overview Effect: Spirituality and Humanism 3.3  Salutogenesis and Resilience 3.4  Changes in Value System 3.5  From the Archives: Psychiatric Issues [33] 3.6  Psychiatric Problems in Space 3.7  Treatment Considerations 3.8  Points to Remember 3.9  Food for Thought References

   94    96    99  101  102  107  115  121  122  123

Most astronauts have reported that their space mission was a positive experience. Some return with a new look on life or state they had a transcendental or religious experience [1, 2]. They may engage in volunteer work or start a foundation to help others. For example, after leaving NASA, Alan Bean became a professional artist, Edgar Mitchell founded the Institute of Noetic Sciences, and Ronald Garan Jr. became involved with a number of environment-friendly enterprises, such as the Fragile Oasis [3]. From space, the Earth may be perceived as a precious, fragile place, without political boundaries or reasons for national strife (Fig. 3.1). There is a sense that humankind is one united species making its way in the Universe. Occasionally, preoccupation with the enchantment of space has caused problems during space missions. For example, one Salyut 6 cosmonaut became so enraptured with his view of the heavens that he is said to have floated out of an open air lock without attaching his safety line [4], and an astronaut perturbed the gyroscopic system of the Skylab orbiting facility when he excitedly left his workstation to get a better view of the Earth [5]. On the negative side, depression and other psychiatric problems have occurred as well. Let’s explore the ups and downs of being in space.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 N. Kanas, Behavioral Health and Human Interactions in Space, https://doi.org/10.1007/978-3-031-16723-2_3

93

94

3  Emotional Highs and Lows

Fig. 3.1  The Earth presents as a beautiful, almost mystical, entity floating in space as it rises over the Moon. It appears to have no political boundaries or international strife. This iconic photograph was taken from Apollo 8 on 24 December 1968. (Credit: NASA)

3.1 Positive Experiences in Space My colleagues and I have been interested in studying the positive aspects of manned space missions. In one survey of 54 astronauts and cosmonauts who had flown in space, Alan Kelly and I found that the subjects rated the positive excitement that was related to their mission as a major factor in enhancing interpersonal communication, both within the crew [6] and between the crewmembers and Mission Control personnel on the ground [7]. This is important, since good communication is essential for crew safety and mission success during on-orbit space missions. In a space simulation study of three crewmembers who were isolated for 135 days in the Mir space station simulator in Moscow, we found that the crewmembers experienced significantly less tension and more expressiveness and self-discovery during their seclusion period than during their pre-confinement training period [8]. This suggested that leaving the rigors of training and being in an isolated and confined environment with other people may itself produce a positive experience, possibly because one got a chance to bond with colleagues during an interesting mission. In addition, isolation in a simulator was a kind of vacation from the stressors experienced in everyday life (e.g., no traffic jams or taxes to pay). This raises the issue of whether it was the isolation per se or aspects of the space experience (e.g., microgravity, seeing the Earth in its totality) that was important in accounting for the positive reports given by returning astronauts. A more extensive examination of the positive aspects of space travel seemed to be warranted.

3.1  Positive Experiences in Space

95

In an attempt to do this, our team conducted a questionnaire study involving astronauts and cosmonauts who had participated in at least one space mission [9, 10]. Subjects were recruited from the Association of Space Explorers (an organization of people who had flown in space) and the NASA astronaut corps at the Johnson Space Center. The final sample consisted of 39 respondents who then completed our Positive Effects of Being in Space Questionnaire, a measure specifically developed for this study that borrowed elements from the Post-Traumatic Growth Inventory as well as elements we designed specifically for space experiences. There were a total of 36 items reflecting changes as a result of being in space that were rated on Likert-­ type scales from “0” (no change) to “5” (very great change) [10]. The results revealed that every respondent reported at least some positive change from their space experience. The overall score of 1.72 for all items approached a “small” degree of change. The items clustered into eight subscale categories, which are shown in Table 3.1. Only one of the subscale scores differed significantly from the others and produced a “moderate” level of change in the subjects: Perceptions of Earth. One item from this subscale, “I gained a stronger appreciation of the Earth’s beauty,” had the highest mean score: the average rating translated into a “great degree” of change. Although not significantly different from the other items, perceiving the wonders of space was rated second. In contrast, relating to other crewmembers was low in this list. These findings suggest that it is the unique features of the space environment (particularly seeing the Earth), not simply being confined and bonding with others, that accounts for the positive experience. Note that spiritual changes were rated last in this listing—more will be said about religious and spiritual issues below. For some of the questionnaire items, attitude change translated into behavioral change after the respondents returned to Earth. For example, three of the items (“I realized how much I treasure the Earth,” “I learned to appreciate the fragility of the Earth,” and “I gained a stronger appreciation of the Earth’s beauty”) were significantly associated with the behavioral item “I increased my involvement in environmental causes” after returning. Although we did not track post-return activities to see if the subjects followed through on their intended behaviors, these results still suggested a link between attitude change as a result of traveling in space and the subjects’ belief that they had acted on these changes after returning. Table 3.1  Positive change subscales Subscale Perceptions of Earth Perceptions of Space New Possibilities Appreciation of Life Personal Strength Changes in Daily Life Relating to Others Spiritual Change Adapted from Ritsher et al. [9]

Mean Change Score 2.94 1.97 1.84 1.79 1.69 1.34 1.30 0.89

96

3  Emotional Highs and Lows

Ten of the respondents indicated that they were reporting no change on an item because no further shift was possible. That is, the described experience was already optimal for them, and it could not be enhanced further by being in space or any other factor. The item most frequently endorsed as unchangeable was “I became more excited about space exploration,” followed by two items from the Spiritual Change subscale: “I have a better understanding of spiritual matters,” and “I have a stronger religious faith.” Although no differences could be found among the respondents along demographic lines, cluster analysis revealed that 23 subjects segregated into those with an overall low change score, and 15 into an overall high change score. Both rated Perceptions of Earth as their top category, but the high change group rated Perceptions of Space second, and the low change group rated Appreciation of Life second. This split may have been due to differences in personality or cognitive styles. Understanding the reasons for such a split may lead to information that will help crewmembers use more relevant coping strategies during future long-duration missions. For example, during the outbound phase of a future mission to Mars, as the Earth becomes an insignificant dot in the heavens due to its increasing distance, more reactive, high change crewmembers may find solace from viewing the growing Martian disk or stars in the heavens as a suitable replacement. In contrast, low change individuals may benefit more from coping strategies that are inner-focused and life-oriented. Such differences in coping styles need to be investigated further in order to enhance individual well-being, improve crew morale, and increase the odds of having a successful mission.

3.2 The Overview Effect: Spirituality and Humanism Since the late 1980s, Frank White has written about a phenomenon he calls the Overview Effect. He describes this as “a feeling of awe for the planet, a profound understanding of the interconnection of all life, and a renewed sense of responsibility for taking care of the environment” [3, p. 2]. It represents a cognitive shift in awareness as a result of seeing the Earth as a fragile ball of life in the Heavens, without natural boundaries or a sense of separateness of its people into national groups. In some cases, the experience expands to a sense that Earth and humankind are not isolated but are a part of the entire Solar System, or even the Universe. Indeed, since the days of human space travel, astronauts and cosmonauts have reported viewing the Earth from space as a favorite leisure time activity (Fig. 3.2). Some astronauts interpret the Overview Effect in spiritual or religious terms. For example, Saudi Prince Sultan Bin Salman al-Saud, who flew on a Space Shuttle mission as a payload specialist in June 1985, described his experience in this way: “I just said, in Arabic, ‘Oh, God,’ or something like ‘God is great,’ when I saw the view … I think it has changed my insight into life. I’ve got more appreciation for the world we live in … I think God has given us so much to be thankful for, and we are wasting so much time trying to destroy it” [3, pp. 241–242]. In contrast, other astronauts describe their experience in more humanistic terms that don’t necessarily

3.2  The Overview Effect: Spirituality and Humanism

97

Fig. 3.2  A favorite pastime for astronauts is looking at the Earth from space. Here an astronaut gazes at our home planet from the cupola of the ISS. (Credit: NASA)

imply a metaphysical causality or a religious belief system. For example, Gemini 10 and Apollo 11 astronaut Michael Collins described his experience in this way: “I really believe that if the political leaders of the world could see their planet from a distance of … 100,000 miles, their outlook would be fundamentally changed. That all-important border would be invisible, that noisy argument suddenly silenced. The tiny globe would continue to turn, serenely ignoring its subdivisions, presenting a united facade that would cry out for unified treatment” [3, pp. 182–183]. Don Lind, who served as a mission specialist during the Spacelab 3 mission in 1985, polled a number of his fellow astronauts and concluded that there were two universal reactions to seeing the Earth. He stated: “People who had a religious background expressed it in religious terms, and people who didn’t expressed it in more humanitarian terms” [3, p. 237]. He didn’t believe that the experience changed anyone’s views, especially on spiritual matters, after they returned home. Gallagher et al. [11] analyzed 17 in-flight journals and 34 post-flight interviews from 45 Space Shuttle and ISS astronauts and found many examples of the Overview Effect. The most frequent responses were placed in categories of “aesthetic appreciation” (10.3%), “overwhelmed” (6.7%), and “perspectival change (spatial)” (6.1%). I took a closer look at the findings from our positive effects in space study mentioned above [9, 10] to look for evidence of the Overview Effect. The results were supportive of this construct [12]. For example, the four items comprising the Perception of Earth subscale, which scored significantly higher than the other subscales in terms of personal change, all dealt with Overview Effect notions (Earth’s beauty, fragility of Earth, treasuring the Earth, involvement in environmental causes). The items in the second scale, Perception of Space, addressed White’s expanded Overview Effect (wonder of the universe, excitement about space

98

3  Emotional Highs and Lows

exploration, boundlessness of the Cosmos, life on other planets). At the other end of the ranking, the scores for Spiritual Change (e.g., better understanding of spiritual matters, stronger religious faith), were significantly lower than the next lower item using conventional standards (p = .024), but this difference lost its significance after we applied a Bonferroni correction to control for the possibility of “false positive” Type I errors (which produced a new p-threshold of .007). The two items in the Spiritual Change subscale also were rated in the top three items that couldn’t be changed as a result of the space experience because they were already maximally rated in importance before launch, and there was no room for improvement. These findings seem to echo the comments made by Lind, above. People with a humanistic orientation pre-launch will experience the Overview Effect in humanistic terms, and people with a strong religious bent describe it in religious terms, with no room to change their belief system. For those space travelers who are assigned or like taking photographs from space, the Earth has represented a favorite target. In his diary, cosmonaut Valentin Lebedev stated that his Earth photography experiences on the Salyut 7 space station were restful and positive, and he hoped that they would help him gain an advanced degree in photography after he returned from his 211-day mission [13]. Others also have engaged in this activity (Fig. 3.3). This link between Earth observation and photography was studied by Robinson et al. [14] in a retrospective survey of 19 astronauts and cosmonauts who had flown on eight ISS missions. They found that of more than 144,000 photographs taken, 84.5% were crew-initiated. Even in cases where these were part of a crewmember’s duties, they typically took additional pictures for their own enjoyment. Self-initiated

Fig. 3.3  Although photographing the Earth is often part of the mission objectives, some astronauts develop an interest in photography as a result and prefer to engage in this activity during their leisure time. Here, a mission specialist examines her camera equipment during a Space Shuttle mission. (Credit: NASA)

3.3  Salutogenesis and Resilience

99

photographs were more likely to occur during free time than during work time. The investigators concluded that Earth photography seemed to be a positive activity that increased well-being during long-duration missions, and they recommended that it should be encouraged during future near-Earth space missions.

3.3 Salutogenesis and Resilience Individuals who successfully deal with stress can gain strength and wisdom as a result. They not only learn something new from the process, but the confidence they get from this mastery serves them well in dealing with future problems. Thus, negative stressors can produce positive change [15–17]. This process has been called salutogenesis. Salutogenesis refers to the health-promoting, growth-enhancing effects of a challenging situation. Obviously, the challenges must not be so severe as to overwhelm the person, either physically or mentally. But positive changes in response to adverse conditions have been well described in polar environments [16, 17]. For example, some returning explorers have experienced increased fortitude, perseverance, independence, self-reliance, ingenuity, and comradeship as a result of being on the ice. Peter Suedfeld has been a leader in this area, and he has argued that we need to pay more attention to positive psychology and salutogenesis in planning for future space missions [17–19]. In one study, he and his colleagues found that 20 retired male Mir and ISS cosmonauts reported a number of positive changes on measures of personal growth as a result of flying in space [20]. When compared with two groups on Earth who had experienced stressful events (first-time mothers and trauma survivors), the cosmonauts scored especially high on measures of personal strength and the realization of new possibilities. Cosmonauts who were more likely to report positive change in their appreciation of life were those who had spent more than a year in space and had flown on both Mir and the ISS, thus increasing their ability to adapt to different space environments. The cosmonauts were evaluated for coping strategies that they found effective in dealing with the stress of being in space, and it was found that they preferred problem-oriented coping strategies rather than emotion-oriented ones. The three most mentioned coping strategies were seeking social support, planful problem-solving, and persevering to meet the demands [21]. In a study of 17 crewmembers who participated in missions to the International Space Station, my colleagues and I found that they recorded higher negative dysphoria scores during their pre-launch training on several subscales of the Profile of Mood States (Tension-Anxiety, Depression-Dejection, Anger-Hostility, Fatigue-­ Inertia, Confusion-Bewilderment, and Total Mood Disturbance) than they recorded during the mission itself, despite performing successfully in space [22]. Scores on measures of Self-Discovery and Innovation also were higher pre-mission, both in these subjects and in 13 astronauts and cosmonauts who participated in missions to the Russian Mir Space Station. The Mir subjects reported more Work Pressure in space versus pre-launch, although this could have been due to social stressors

100

3  Emotional Highs and Lows

related to Americans and Russians learning to work together for the first time in a space station. Nevertheless, these findings suggest that pre-mission training can be emotionally challenging yet lead to personal growth in some astronauts and cosmonauts, thus adding support to the concept of salutogenesis in space travelers. However, caution must be raised in this interpretation, since it is also possible that the joys of the mission itself (e.g., microgravity, seeing the Earth from space) led to a positive increase in emotional state, although one would expect that Self-Discovery and Innovation also would have been increased by the space experience. More work remains to be done on salutogenesis as it pertains to the space mission experience. Related to salutogenesis is resilience, or the ability to deal with and recover from stressful conditions. Vanhove et al. [23] characterized resilience as a positive adaptation to adversity. They conducted a literature review of studies related to resilience and growth in people during long-duration isolated, confined, and extreme missions and came up with a number of conclusions and recommendations relevant to human spaceflight. They felt that resilience in dealing with adversity and stress generally was related to a number of protective factors, including perceived social support, problem-focused coping, and positive cognitive reappraisal. However, in some cases, avoidant coping helped to maintain psychosocial functioning, and social support-­seeking coping behavior was negatively related to resilience. Pre-flight assessment of these protective factors and team compatibility on psychosocial characteristics (such as personality and values) were thought to reduce later crew conflict and lead to greater levels of resilience and growth. Resilience-building training programs were shown to be effective among a wide range of non-ICE populations, suggesting that they also may be useful for people undergoing ICE missions. Interviews with ten subject matter experts aligned well with the conclusions of this literature review [23]. Group and interpersonal aspects of resilience were believed to have special importance in space-like environments. Resilient crews were those where each individual member understood his or her role and responsibilities, supported team goals and objectives, had trust and confidence in his or her fellow crewmembers, and was willing to help others. Families were thought to encourage resilience in crewmembers by being supportive, keeping them informed about family issues, and not burdening them with family problems that they could not control while in space. Mission controllers supported crewmember resilience by acting in an honest, trustworthy, and efficient manner, and by understanding and being sympathetic to the stressors associated with spaceflight. Opportunity should exist for crewmembers to familiarize and adjust to one another and to personnel in mission control prior to launch. Psychosocial education training (PET) aimed at supporting individual, resilience-based protective factors and team compatibility issues should be provided to crewmembers, families, and mission control personnel, both pre-launch and during the mission. There should be consistency in themes and common language across countermeasure training for these three groups. Such training should include interactive and self-administered computer-based modules. As can be seen, resilience is an important topic for both individual and interpersonal or team performance. Studies have shown that resilience is positively related to well-being and negatively related to indicators of distress, and it seems to be

3.4  Changes in Value System

101

protective in making people more prone to recover quicker after adversity [24]. A number of devices have been developed to assess resilience that are wearable, unobtrusive, and designed for remote work, such as during long duration space missions [25]. These include measures of physiological activity, linguistic and paralinguistic communication, and geospatial positioning and activity. Such measures are useful in minimizing, managing, and mending the impact of stressors. NASA has developed a set of standardized measures to assess behavioral health and performance related to spaceflight called the Human Factors and Behavioral Performance Exploration Measures (HFBP-EM) suite that has been tested across spaceflight analogs (e.g., HERA, SIRIUS-19) and the ISS [26]. Data from these measures were collected from the HERA 4 and 5 analog campaigns and involved 32 subjects (22 male, 10 female) during eight 45-day missions who performed twice weekly operational tasks using the research version of the Robotic On-Board Trainer (ROBoT-r), which simulated a docking procedure using the ISS robotic arm and measured cognitive and hand-eye coordination. On one of the HFBP-EM measures, the Profile of Mood States, the subjects reported higher scores over time on subscales measuring fatigue, confusion, tension, anger, and depression. But at the same time, they maintained accuracy and even showed improvement in ROBoT-r completion times as the missions progressed [27]. The investigators interpreted these results as an indication that the subjects were demonstrating resilience in accomplishing this mission task despite scoring relatively high on measures of dysphoric affect.

3.4 Changes in Value System Space travelers sometimes experience changes in core values as a result of flying in space. Suedfeld and his colleagues conducted a Thematic Content Analysis (TCA) of the values and emotions mentioned in the memoirs of four pioneering astronauts [28]. Three of them indicated that they experienced an increase in the value of a measure of Universalism (i.e., a greater appreciation for other people and nature), both during and after their mission, and all four reported an increase in Spirituality post-return. Suedfeld and his colleagues followed up this work with a larger study that content analyzed the published memoirs of 125 American and Russian space travelers [29]. They again found that as a result of being in space, astronauts and cosmonauts reported positive changes in measures of Universalism and Spirituality, as well as an increase in Power. Cultural differences also were found: Russian space travelers scored higher in measures of Achievement and Universalism and lower in Enjoyment than Americans. Using the same methodology in evaluating the public records of Canadian astronauts who had been in space, Brcic and Della-Rossa [30] found indications of Universalism to be high and Enjoyment low in these documents. Achievement, Security, and Self-direction also were frequently mentioned as being important values. Vinokhodova and Gushin [31] studied 12 ISS cosmonauts using the Personal Self Perception and Attitudes (PSPA) test in order to assess their attitudes toward

102

3  Emotional Highs and Lows

their social environment (both within the crew and with Mission Control). The investigators also performed a content analysis of the subjects’ communications to examine interpersonal perceptions. They found that the cosmonauts’ system of values and personal attitudes remained stable as a result of flying in space. Personal traits that were most valued were those that led to the successful fulfillment of the cosmonauts’ professional work and those that helped them achieve positive social relationships. Solcova’, Vinokhodova, and Gushin [32] studied personal growth and changes in values in crewmembers during two spaceflight simulation studies, SIRIUS-17 (17-­ day mission, 3 Russian women, 2 Russian men, 1 German man) and SIRIUS-19 (120-day mission, 3 Russian women, 1 Russian man, 2 American men)–see Sect. 4.4.1 for mission details. Using the Stress-Related Growth Scale and the Portrait of Values Questionnaire, they found that personal growth occurred in all crewmembers in both experiments, with perceived growth being higher than anticipated growth. In both studies, a qualitative analysis found that the highest personal growth was reported in the social area (regardless of sex or background culture), followed by the cognitive/affective area. A zero score was recorded in both studies regardless of sex or culture on the item: “I developed/increased my faith in God” (see Sect. 3.2). There was an increase in both sexes in the values of Universalism, Benevolence, Hedonism (enjoying life), Tradition, Power, and Stimulation (men only). Gro Sandal has been active in the area of personal values. Some of her work is presented in Sects. 5.7.6, 9.3.2, and 9.5.

3.5  From the Archives: Psychiatric Issues [33] People living and working in isolated and extreme environments have experienced psychiatric problems going back to the days of the early explorers [34]. These have included episodes of depression, violence, suicide, and disintegration of team cohesion. This section discusses the frequency of psychiatric problems in Antarctic and submarine environments, which agrees well with more recent estimates. To save space, a description of Freudian theory in the original document [33, pp. 33–35] is omitted here. The ways that people have dealt with the dangers of ICE environments also are discussed, including the stage models proposed by Ruff et al., and Smith. Coping strategies to reduce tension are considered, such as the sublimation of tension, the pinging activity reported on some submarines, and increased interest in food. Psychotherapeutic approaches are proposed, such as communication with supportive people on Earth and sensitivity training (both used extensively today), hypnosis, and the novel cyborg device implanted in the body.—NK

3.5  From the Archives: Psychiatric Issues

103

3.5.1 The Magnitude of the Problem (See Also Sect. 2.1.1.1) For several years after the International Geophysical Year (from July 1957 to December 1958), Rasmussen and Haythorn [35] conducted a study assessing the wintering-over periods of men at five U.S. Antarctic stations. During this time, not one man was hospitalized for psychiatric reasons. However, several behavioral problems were noted. For example, table VIII (see Table 3.2) presents the results from one small station reported by the U.S. Navy Medical Neuro-psychological Research Unit in San Diego. In general, the symptoms seem to be a function of time; however, the sleep pattern of the men in this study adapted to the environment after 8 months. In another study, conducted during the same time period, Gunderson [36] reports on several U.S. Antarctic stations. He found a higher incidence of psychiatric problems among naval personnel stationed in the Antarctic than in naval personnel elsewhere (3% to 1%). In addition, he found that from 1964 to 1966, the number of cases of insomnia, depression, anxiety, and hostility increased by as much as 40% during the wintering-over months for naval personnel. The increases were much less than for the civilian population. Gunderson also found that the motivation of the men was related to their work.Pope and Rogers [37] reported depression a common reaction in their Antarctic study. In fact, most of the studies examined reveal behavioral or sleep disorders present under confining conditions, which could indicate an underlying personality weakness. Serxner [38] reported 5% of the men on two Polaris cruises were treated for psychological or psychiatric problems. These consisted of minor anxiety reactions (insomnia, headaches, somatic concerns, anxiety attacks), depressive reactions (anorexia and weight loss, unsatisfied dependency needs), and one full-blown psychotic episode. On the 83-day Triton cruise, four of the crewmembers experienced anxiety reactions or obsessive thinking [39]. Table 3.2  Behavioral incidents reported at one Antarctic station Behavior Disruption of sleep cycle Apathetic, indifferent Tense, restless Complaining, whining Irritable, hypertensive Suspicious, mistrustful Uncooperative

1–4 months 2 1 3 0 6 0 1

5–8 months 15 5 8 1 9 7 2

9–12 months 3 1 19 3 13 16 13

Adapted from Rasmussen et al. [35]

(continued)

104

3  Emotional Highs and Lows

Ruff et al. [40] report on subjects who have undergone sensory and social isolation ranging from 3 hours to 7 days. In this short time, they have isolated a characteristic pattern of adjustment expressed in terms of personality variables. Phase I consists of initial anxiety followed by relief of anxiety “as defense mechanisms become effective.” Phase II is a time of exaggeration of customary defense mechanisms and is described by Ruff et al. as follows: “An obsessive-compulsive person…adopts a repetitive pattern of thought or activity. The passive-aggressive individual may view the experiment as a battle and try to ‘beat’ the experimenters.” During Phase III, anxiety reappears and defenses became more primitive. Unconscious material threatens to erupt, and thinking became disorganized. The stages of Ruff et al. and Rohrer [41] (see Sect. 2.1.2) are nearly identical except that Ruff et al. do not mention the occurrence of depression during Phase II. Phase I in both schemata is nearly the same. The primitive mode of thinking and threatened eruption of unconscious described by Ruff et al. may well be the cause of the hostility, aggressiveness, and performance breakdown characterized by Rohrer’s period of anticipation.

3.5.2 Reaction to Danger Danger is another stressor that can lead to psychiatric difficulties. Dangerous situations are especially important because they involve both the intellect and emotions, and the latter must not interfere with the former during these times. Response to danger varies. For example, Cramer and Flinn [42] report on an unprogramed fire that occurred in the SAM two-man Space Cabin Simulator: “During the fire…one subject became very anxious and ineffective, whereas his partner took calm and appropriate action.” Danger may thus uncover an underlying psychiatric problem. Smith [43] describes the reactions of a seven-man group to danger conditions in the Antarctic and reported two distinct phases. The first phase lasted approximately a day and was composed of three stages: (1) an initial inability to perceive the danger (the men traveled as if there were no threat and took no safety precautions); (2) a complete attention to obstacles, but with efforts being chaotic and unorganized and safety precautions hurried and impractical; and (3) a general cessation of activities. Smith’s second phase began the second day the group was in danger. Whereas the first phase was chaotic, irrational, and anxious, the second was almost the direct opposite; the men realized the danger they were in, traveled slowly and carefully, and took safety precautions. Their efforts were no longer (continued)

3.5  From the Archives: Psychiatric Issues

105

chaotic and disorganized. The men apparently “buttressed up” their defense mechanisms against the anxiety of the first phase and were able to act rationally and calmly.Before the expedition, Smith had made three hypotheses regarding the reaction to danger. One of these was borne out [43]: “…while experiencing danger, there was a noticeable decrease in verbal interaction and an increase in irritability, shown by sharp, brief, personal exchanges.” Smith had believed that men would show extreme depression just before and after entering the known danger area, but that did not occur.

3.5.3 Tension Reduction The “pinging” activity described aboard the submarine Seawolf (see Sect. 2.1.1.2) and the aggressive behavior, preoccupation with sexual thoughts, and joking that is observed on many submarine and Antarctic missions demonstrate the need for tension reduction and the release of libidinal and aggressive psychic energy. Cramer and Flinn [42] also noticed this in the SAM two-man Space Cabin Simulator: “Tension reduction mechanisms were very prominent throughout every flight; one common example was by means of sudden verbal exclamation, loud shouts, cries, or shrieks. In addition, frequent swearing was noted and seemed to serve this purpose… Another form of gratification of needs was fantasy and dream content which generally were wishfulfilling in nature.” This is compatible with dynamic theory, which states that a particular tension, if not relieved in its most direct way, will find another outlet for its energy; this is the process of sublimation. The frustrated lover who burns off his sexual tensions in the form of work is an example of sublimation. Men are apparently able to find successful means to release tension under conditions of long-duration confinement. Sexual tensions are an important practicl example. Cramer and Flinn [42] found that, while all the men had sexual fantasies, it took 10 to 14 days before these became frequent. Before this time, the men were able to sublimate their erotic feelings into the mission. The sexual fantasies apparently developed as sublimation became less effective. In addition, three men experienced nocturnal emissions. Ruff et al. [40] found an increased interest in food in two of three groups studied under isolated conditions. They attributed this interest to drive reduction. “When cut off from many of their usual outlets, these subjects emphasized eating and activities associated with food. Plans to use algae for a (sic) nutrition, should thus take into account the advisability of making the product as tasty as possible.” Eberhard [44] cautions that “the discretionary activity value of eating should not be overlooked since men in confinement take (continued)

106

3  Emotional Highs and Lows

almost twice as long to eat.” Finally, Rohrer [41] summarizes: “With the rather intense repression of sex impulses that occurs in isolated small groups of the same sex, there is a corresponding increase in the importance of oral gratification…weight gains are reported by nearly all, and food preparation is more important than it is in normal society. Correspondingly, the social status of the cook in these isolated small groups reaches heights unknown to a cook in our more complex society.” Ferguson [45] reported that as the Ben Franklin mission progressed, food provided a topic for conversation and allowed “sublimation of psychological stress.”

3.5.4 Psychotherapy in Space Despite special precautions, psychiatric problems may develop during a space mission. If, on a long-duration space mission a crewmember should have a psychotic break, restraint would be difficult and evacuation for hospital treatment would be impossible. This dilemma faced Serxner when a Polaris submarine crewman experienced an acute paranoid-schizophrenic break 5 weeks into the mission [38]. Serxner kept the man under control and functioning using a combination of drugs, supportive therapy, and the help of the crew. In addition, the effect on the crew was held to a minimum and they performed satisfactorily. Flinn et al. [46] report on the successful use of phenothiazines, over a 2-year period, to control psychiatric patients who were air evacuated. Weightlessness is one variable not yet fully studied psychiatrically. Not only might this condition aggravate any mental problems, but its effect on a patient using psychiatric drugs is unknown. U.S.S.R. studies [47] show that many common central-nervous system stimulants do not increase the working capacity of the human body under difficult circumstances; in fact, they may act adversely during periods of anoxemia. Parin et al. [47] state, “It may be expected that the abrupt reduction in the volume of information will induce in the astronauts a tendency toward inhibition, depression with distortion or weakening of the action of drugs exciting the central nervous system and strengthening of those depressing it.” Thus, further study in space pharmacology is needed to resolve problems of drug effectiveness and drug dosage. Since a psychiatrist might not be with the first few long-duration space missions, preparation must be made prior to a mission to prepare for psychiatric problems. A physician or social scientist aboard, along with the rest of the crew, should be well-versed in psychotherapeutic techniques. Flinn [48] has categorized the various states of altered awareness found most commonly in pilots. Those applicable to long-term space flights are: (1) states related to impoverished environment (e.g., lowered proficiency), (2) anxiety states (e. g., (continued)

3.6  Psychiatric Problems in Space

107

depersonalization), (3) states related to fatigue and drowsiness (e. g., sleep), (4) states related to sensory input overload (e.g., panic), (5) states related to narrowed attention (e. g., instrument fascination), (6) states related to underlying psychopathology (e. g., dissociative reaction), and (7) states related to temporal lobe epilepsy (e.g., frequent deja vu experiences). Other techniques may be used to alleviate psychiatric stresses. One practical suggestion made by Solomon [49] is: “Prophylactically, during the course of space travel, every effort should be made to keep the voyager not only in constant communication with his scientific monitors on earth, but with close members of his family and friends.” Regular psychotherapy, using television, with a psychiatrist on Earth may help to resolve problems before they become serious. Pope and Rogers [37] state the presence of a psychiatrist on their mission permitted the men to vent their hostilities before they became serious.Dunlap [50] describes the advantage of sensitivity training for recognizing and handling interpersonal stresses. Flinn et  al. [51] and Hagen [52] recommend a diary for good surrogate therapy.Hypnosis is proposed as a method to relieve anxiety and other painful states. Sharpe [53] has proposed eight applications for hypnosis. (1) Selecting candidates for astronaut training; (2) Creating an illusion of realism during astronaut training; (3) Focusing attention on critical tasks during periods of psychophysiological stress; (4) Reducing the metabolic rate of the crew to reduce in turn the amount of oxygen, food, and water required; (5) Reducing fear and anxiety among astronauts during very long voyages; (6) Reducing boredom by compressing off-duty time and creating the illusion of stimuli to occupy time; (7) Training astronauts to induce self-hypnosis so that they can go to sleep on schedule and awake refreshed; (8) Maintaining uncomfortable positions for long periods of time. Unfortunately, hypnotic susceptibility varies with personality and is not successful on all people.A final technique is the cyborg, or cybernetic organism [50]. This fascinating man/machine concept, not probable in the near future, would use a small sensing arrangement to detect certain chemical or hormonal products secreted as a result of stress. An osmotic pump would release drugs in the proper concentration and the proper rate to counteract the stress effects; to calm or arouse man, as the case may be. This devise could be small enough to implant under the skin.

3.6 Psychiatric Problems in Space Most of this book deals with the normal psychological and interpersonal reactions humans experience in response to the abnormal stressors of space. Occasionally, people traveling in space experience pathological reactions that fall into the realm of psychiatry. Most of these reactions represent the interaction of the stressful space environment with genetic or early life predispositions to mental illness. Because astronauts are given psychological tests and screened for personal or family histories of psychiatric disorders at the time they enter the corps, the likelihood of

108

3  Emotional Highs and Lows

behavioral health problems developing is less than in the general population. But since some psychiatric disorders may occur later in life after selection (e.g., bipolar disorder), they still may occur, although some psychiatric screening is done as part of the yearly physical. In addition, everyone has their breaking point when exposed to severe stressors, so no one is completely immune to having psychotic or suicidal/ homicidal reactions in space. Longer duration space missions may predispose people to develop psychiatric problems. NASA space psychiatrist Gary Beven has stated that it wasn’t until Russian cosmonauts began spending 6 months or more on the Salyut 6 and 7 space stations that they began reporting significant psychological health decrements [54]. This led to the formation of a Russian psychological support group, which was replicated later by NASA as astronaut missions began increasing in length. NASA began employing full-time civil servant psychiatrists in the 1980s. Certainly, more attention needs to be paid to astronaut affective health, particularly during long-­ duration space missions [24].

3.6.1 Frequency of Psychiatric Problems As mentioned above in the archival Sect. 3.5, severe behavioral problems have occurred in the less carefully screened populations in space analog settings. Gunderson found a 3% incidence in his Antarctic sample [36] and Serxner a 5% incidence in his submarine sample [38]. In his review of the Australian Antarctic experience, Lugg [55] concluded that there was a 4–5% incidence of psychiatric problems, although severe psychotic and neurotic illnesses were much lower than 4%. Palinkas and his colleagues [56] reported on 313 military and civilian personnel who spent an austral winter at South Pole Station and McMurdo Station in Antarctica. They found that 5.2% of the subjects had symptoms of a psychiatric problem. Mood disorders accounted for 30.2% of all diagnoses, adjustment disorders for 27.9%, sleep-related problems for 20.9%, personality disorders for 11.6%, and substance related disorders for 9.3%. Interestingly, these problems developed despite the fact that all subjects had passed a psychiatric and psychological screening procedure prior to their assignment for remote duty in the Antarctic. In a review of 30 years of research involving nuclear submarines, Weybrew [57] concluded that the incidence of acute and chronic psychopathology during the longer missions was 1–4%. Anxiety and depressive reactions were most frequent, followed by personality disorders and psychophysiological reactions. In a review of nuclear submarine missions [58], 1.2% of the men suffered from severe psychiatric problems: 50% were related to severe anxiety, 39% to interpersonal difficulties, and 29% to depression. Thus, the incidence of symptoms suggesting the presence of psychiatric disorders during submarine and polar missions ranges from 1% to 5%. In terms of space missions, the frequency of reported psychiatric disorders is complicated. In a summary document, NASA has reported no incidents of a formal psychiatric disorder during either Space Shuttle or ISS missions. This document

3.6  Psychiatric Problems in Space

109

states that “astronauts do report that they perceive greater stress on longer missions, but that stress has not manifested in clinically significant, mission jeopardizing mental disorders [italics mine, 59, p. 13].” The report further clarifies that “NASA differentiates between an adverse behavioral condition and a psychiatric disorder in the following manner: a behavioral condition is any decrement in mood, cognition, morale, or interpersonal interaction that adversely affects operational readiness or performance; whereas a psychiatric disorder is one that meets the DSM criteria for diagnosis of a disorder [59, p. 17].” Despite the lack of formal diagnoses using the American Psychiatric Association Diagnostic and Statistical Manual (DSM) system [60], behavioral issues have occurred in space that have impacted on astronaut mental health and performance. For example, during the Space Shuttle program, there was an incidence rate of behavioral problems of 0.11 for a typical 14-day mission, or approximately one episode per every 2.87 person-year. The behavioral symptoms most commonly reported were anxiety and annoyance [59]. Shepanek [61] reported 34 negative behavioral signs and symptoms that took place during Space Shuttle missions, and two behavioral episodes that affected the seven American astronauts who flew on the Mir space station from 1995 to 1998. These difficulties included anxiety and depression, memory and problem-solving impairments, withdrawal, and interpersonal conflicts. In some cases, productivity was affected. Santy [62] reported that the incidence of psychiatric disorders in a study of 223 astronaut applicants was 9%. Of these 20 affected individuals, five had family problems, four had a personality disorder, three had a life circumstance problem, and two each suffered from bereavement, anxiety disorder, adjustment disorder, or major depression. None of these people had schizophrenia. More recently, Alexander reported the frequency of psychiatric problems on the ISS at 0.62 incidents per year [63]. Severe stress was noted during the Shuttle-Mir program as U.S. and Russian crewmembers tried to find ways to work with each other, and some astronauts experienced situational depressive and anxiety symptoms (see Sect. 2.3). Such psychosocial adaptation difficulties can result in deteriorations in motivation and crew cohesion, and they can be compounded by crewmember cultural differences. Russian space mission aborts officially have been related to chronic headaches, cardiac arrhythmias, and chronic prostatitis, but behavioral problems also may have played a role. For example, Alexander has stated that anecdotal reports suggest that behavioral health symptoms were severe enough to cause early mission terminations of the Soyuz-21, Soyuz-T-14, and Soyuz-TM-2 missions [63]. Sipes et al. [64] supported this notion and provided more information on these missions. During the 1976 Soyuz-21 mission to the Salyut-5 space station, the crew was brought home early after complaining of a pungent odor. No source was ever found, and no other crews reported the odor. Since the Soyuz-21 crewmembers had been having interpersonal conflicts, the belief was that the odor may have been a psychosomatic manifestation of crew interpersonal friction. In 1985, the crew of the Soyuz T-14 mission to Salyut-7 was brought home early because one of the cosmonauts feared he had a prostate infection. Although there was some evidence for this, the medical doctors believed that there were psychosomatic components due to his

110

3  Emotional Highs and Lows

reaction to the isolation, confinement, and interpersonal conflicts on-board. The Soyuz TM-2 mission in 1987 was similarly cut short because of adverse psychosocial issues, although the reason given was related to a cardiac dysrhythmia experienced by one of the crewmembers. Clark also highlighted psychological issues during the Soyuz-21 mission, saying that the crewmembers were sleep deprived and that mission psychologists believed that the crewmembers had “interpersonal issues” [65]. He also reported examples of behavioral issues related to stress that affected other space travelers, such as Salyut 7 crewmember Valentin Lebedev (withdrawal due to interpersonal strain with his crewmate), Shuttle-Mir astronaut John Blaha (depression due to isolation and language difficulties with his Russian crewmates), and Shuttle-Mir astronaut Jerry Linenger (withdrawal and decreased communication with Mission Control due to an on-board fire and decreased contact with his family on Earth). Issues involving Shuttle-Mir astronaut Norm Thagard were mentioned in Sect. 2.3. The most common behavioral health problem in space is sleep disturbance, as was discussed in Sect. 1.7.2, followed by adjustment disorders and asthenia, which will now be discussed.

3.6.2 Adjusting to Space and Adjustment Disorders Adjusting to the novelties of space is a common and expected occurrence that usually is transient and does not interfere with the mission. This adjustment has both physical and mental components (Fig. 3.4). But for some people, it is difficult and may result in a clinically significant adjustment disorder. According to the Fifth Edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [60, pp. 286–287], adjustment disorders are characterized by the development of emotional or behavioral symptoms in response to one or more identifiable stressors within three months of the onset of the stressor(s). These symptoms or behaviors may be clinically significant if evidenced by one or both of the following: marked distress that is out of proportion to the severity of the stressor (taking into account external context and cultural factors), and/or significant impairment in social, occupational, or other important areas of functioning. The disturbance should not meet the criteria for another mental disorder, is not an exacerbation of a preexisting mental disorder, and does not represent normal bereavement. Once the stressor or its consequences have terminated, symptoms do not persist for more than an additional 6 months. The DSM-5 goes on to specify subtypes characterized by: depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct, or unspecified symptoms. As mentioned above, NASA has reported that “clinically significant, mission jeopardizing mental disorders” have not been reported from space [59]. However, there have been some situations that bordered on this occurrence. For example, cosmonaut Lebedev [13] cited several problems he had in adjusting to the

3.6  Psychiatric Problems in Space

111

Fig. 3.4  An astronaut on the ISS discusses the distress that can occur when first exposed to microgravity and explains how to manage a “barf bag” to deal with space motion sickness. (Credit: NASA (Image taken from video))

monotonous conditions that occurred during his 211-day Salyut 7 mission. These included despondency, withdrawal, and tense relations with his crewmate. Also, astronauts Thagard and Blaha had adjustment problems on the Mir Space Station that resulted in feelings of isolation, homesickness, and depression [66]. Although these space travelers managed to work through their feelings to finish their mission, the behavioral impact was profound and led to much emotional distress. Adjustment problems also may result from tensions due to differences in crewmember personality, background, and attitudes, which can produce interpersonal stress. Space travelers highly value commonalities that they have with their fellow crewmates. In a questionnaire survey of 54 astronauts and cosmonauts who had flown in space, Alan Kelly and I [6] found that a sense of sharing common experiences and mutual excitement over the mission were two factors that were rated as significantly enhancing the crewmembers’ ability to communicate with each other in space. Sometimes the adjustment to space produces lowered morale and homesickness. For on-orbit missions, simple procedures such as increasing contact with family and friends on Earth or sending up presents via resupply spacecraft can counter this dysphoria (Fig. 3.5). But at other times, this adjustment may take on severe proportions that require medications and psychotherapy. In some isolated and confined environments on Earth, such as in submarines or Antarctic bases, adjustment symptoms have resulted in psychotic reactions and suicidal ideation, as will be discussed below.

112

3  Emotional Highs and Lows

Fig. 3.5  Crew care package contain items specially selected for an astronaut, as is shown here for some happy ISS crewmembers. Crew care packages are one means of keeping astronaut motivation and morale high, especially during long missions. (Credit: NASA)

3.6.3 Asthenia In 1963, the Institute for Biomedical Problems (IBMP) was established by the Ministry of Health of the Soviet Union in order to conduct ground-based and inflight research in the areas of cosmonaut health and working capabilities during spaceflight [67]. But as space missions began to increase in duration, the IBMP became responsible for the medical support of Soviet space crews as well. In order to deal with the psychological issues that occurred, a psychological support group was formed, and for some 40 years this group has been responsible for detecting behavioral and interpersonal problems and providing appropriate countermeasures for space crews. Members of this group in mission control monitor the speech patterns of their cosmonauts for signs of stress and hold private psychological conferences with them at least every 2 weeks. Countermeasures include increasing stimulation and novelty when crewmembers feel understimulated (e.g., increased contact from Earth with family, friends, or famous sports or media figures; sending surprise gifts and favorite food on resupply ships; providing news and current events), and decreasing stimulation on-board when the crew feels overstimulated (e.g., turning down the light intensity; encouraging the playing of soft music; relaxing the work schedule). NASA and other space agencies have been mindful of the success of the

3.6  Psychiatric Problems in Space

113

Russian psychological support group and have instituted similar groups in their programs. Russian psychological support group flight surgeons and psychologists have identified a type of adjustment reaction that they call asthenia (sometimes referred to as asthenization), which they believe affects over half of their cosmonauts during long-duration space missions [68]. It is defined as a “nervous or mental weakness manifesting itself in tiredness…and quick loss of strength, low sensation threshold, extremely unstable moods, and sleep disturbance. (Asthenia) may be caused by somatic disease as well as by excessive mental or physical strain, prolonged negative emotional experience or conflict [69, p. 28].” The hallmark of asthenia is excessive tiredness and fatigue. The concept originated from a neurotic condition called neurasthenia, which was first described by U.S. physician George Beard (1839–1883). He viewed it as an exhaustion of the central nervous system’s energy reserves and a typical American disorder that resulted from the dramatic social changes that were occurring in the United States during the nineteenth Century, which particularly affected the upper classes [70, 71]. Sigmund Freud embraced and expanded the concept. He popularized it in his writings about neurosis as caused by repressed libidinal  impulses and early life traumatic events [72]. Myasnikov et al. [73] have contrasted the clinical characteristics of neurasthenia on Earth with asthenia in space. They believe that the latter condition is a normal process produced by the stressors of space, sensory and social deprivation, and monotony. According to their ideas, a significant decrease in the usual external stimulation volume and variety due to a long stay in isolation with a closed artificial monotonous environment can cause a progressive weakening of the tone and vigor of the central nervous system (i.e., “a-sthenia,” or a decrease of bodily strength). The resulting sensory deprivation is an ineffective reaction to stimuli, with irritability, high sensitivity to noise and light, and a loss of concentration. Russian flight surgeons believe that the symptoms of asthenia in space are milder that those of neurasthenia for two reasons: cosmonauts are carefully screened for psychiatric problems pre-mission, and if the simple countermeasures discussed above are employed early, they can help to ameliorate the condition and avoid the need for medications and psychotherapy. Russian experts diagnose asthenia by analyzing verbal communications between crewmembers and personnel in Mission Control; by examining medical information sent to them from space; and by administering clinical scales that assess fatigue, somatic symptoms, sleep quality, and mood. The condition seems to be one of cumulative fatigue that develops over time. Aleksandrovskiy and Novikov [74] believe that a mild form of asthenia (which they call hyposthenia, or the process of asthenization) appears in many cosmonauts after 1–2 months. The state is characterized by fatigue, irritability, anxiety, decreased work capacity, sleep problems, autonomic disturbances (e.g., heart palpitations, perspiration), attention and concentration difficulties, and heightened sensitivity to bright lights and loud noises. Such perceptual changes have been reported empirically by space travelers. In our questionnaire study of 54 astronauts and cosmonauts

114

3  Emotional Highs and Lows

who had flown in space [6], the respondents stated that watching and listening activities significantly increased during both work and leisure time periods. This was reminiscent of reports that during Salyut 6 and 7, heightened perceptual sensitivities were noted after 2–5  months, with some cosmonauts stating that they became increasingly disturbed by loud sounds and the manner of verbal presentations from people in Mission Control [13, 75]. Symptoms and signs suggestive of asthenia have been reported by American astronauts who have flown in space during long-duration space missions [76–78]. However, as part of a general trend over the past several decades toward redefining neurotic diagnoses in the United States, neither asthenia nor neurasthenia is given official diagnostic status by the American Psychiatric Association, although these conditions still are recognized in Russia, China, and elsewhere in the world. For American mental health workers, the corresponding symptoms and signs are included in such entities as adjustment reactions, persistent depressive (dysthymia) or major depressive disorders, or chronic fatigue syndrome. In Sect. 5.7.5 we will examine further some cultural differences regarding asthenia in space. We conducted a retrospective analysis of the Profile of Mood States data from our Mir study (see Sect. 2.7) to look for changes suggestive of asthenia. Three of the study investigators independently identified eight items on the POMS as being characteristic of early asthenia [71]. Six Russian space experts, who were familiar with the symptoms and signs of asthenia and who had worked directly with cosmonauts for 10 years or more, provided hypothetical minimum scores on these items that they felt would be indicative of this condition. When compared with these prototype values, our subjects scored significantly lower on all eight items, suggesting an absence of asthenia. However, since the POMS could only evaluate the emotional and not the physiological aspects of asthenia, it might have been that these eight items were not sensitive enough to retrospectively identify characteristics of the syndrome. Despite the negative findings, the concept of asthenia warrants further study using a prospective methodology and measures targeted to the symptoms and signs of this condition.

3.6.4 Other Psychiatric Disorders When dealing with stress and anxiety, some astronauts experience them in terms of bodily symptoms. Such psychosomatic (or somatoform) problems include stomach upset, headaches, worries about cancer, or even toothaches. For example, one Salyut 6 cosmonaut wrote in his diary about having a fear of an appendicitis attack during the mission. He also reported having pain in his tooth after awakening from a dream of a toothache [79]. A Salyut 7 cosmonaut was brought back early from his mission for poor work performance due to fatigue, listlessness, and psychosomatic concerns related to perceived prostatitis and fears of impotence [78]. Another cosmonaut experienced tension, fatigue, and cardiac arrhythmias following a series of misfortunes and accidents involving the Mir space station. As a result, his work duties

3.7  Treatment Considerations

115

were altered, and he was prescribed sedatives [80]. Psychosomatic symptoms also have occurred during space analog missions. For example, Lugg [55] included psychalgia (tension headaches) as one of the most common mental problems reported during Australian Antarctic expeditions over a 25-year period. Weybrew [57] found that on an average day, a quarter of the men on submarine missions experienced headaches. Although environmental factors such as toxins in the atmosphere may have played a role, they alone could not account for the high incidence of concerns over physical issues that were reported by the crewmembers. The DSM-5 categorizes such problems as part of a somatic symptom disorder or an illness anxiety disorder if the duration of the illness preoccupation is present at least 6 months. The fact that in the cases mentioned above the psychosomatic concerns were reported in conjunction with working in stressful ICEs makes an adjustment disorder a more likely explanation. Feeling homesick and even transiently depressed is not unusual for people working in space. However, the full diagnostic spectrum of clinical depression (e.g., long periods of depressed mood, low energy, sleep and appetite problems, suicidal intent or plan) that requires psychotherapeutic and psychopharmacologic intervention is not common during space missions. Similarly, psychotic conditions such as bipolar (e.g., manic-depressive) disorder and schizophrenia have not been reported during space missions, likely because they have strong genetic components and tend to occur early in adulthood. Since astronaut candidates are carefully screened psychiatrically to rule out such problems before they enter the corps, one would not expect to find many people vulnerable for these conditions in the astronaut pool, although bipolar symptoms can first become manifest as late as the mid-40s [81]. However, anyone can experience a transient psychotic reaction if placed under enough stress, so psychosis or even suicidal or homicidal ideation during a space mission can’t be ruled out. Other psychiatric problems that can produce mood alterations or psychotic thinking, such as alcohol or drug abuse, are not present in space due to the unavailability of large amounts of the offending substances. However, as will be mentioned in Chap. 7, consideration is being given to providing alcohol to private space travelers, much as occurs in air travel on Earth. In addition, in colonies or mining habitats, where people will live and work in space for long periods of time, alcohol and drugs may be present, so the possibility of substance abuse needs to be considered.

3.7 Treatment Considerations 3.7.1 Psychoactive Medications In considering long-duration space missions, Santy [82] has written that a reasonable psychiatric formulary should consist of examples from each of the major psychoactive drug classes: antianxiety agents, antidepressants, antipsychotics, sedatives

116

3  Emotional Highs and Lows

Fig. 3.6  Space Shuttle crewmembers inspect the contents of their emergency medical and medication kits during a pre-launch review. Most astronauts take medications during a mission, especially for headaches and space motion sickness. (Credit: NASA)

and hypnotics, and medications to counter mania and other mood swings. This advice has been taken, since a variety of psychoactive medications have been available to crewmembers during space missions. When the Space Shuttle flights were taking place, the medications that were available on-board included: antianxiety medications, such as diazepam; antipsychotic medications, such as haloperidol; pain medications, such as codeine and morphine; medications for sleep, such as flurazepam and temazepam; stimulants, such as dextroamphetamine; and promethazine for space motion sickness (Fig.  3.6) [83]. Seventy-eight percent of Space Shuttle crewmembers took medications in space, primarily for space motion sickness (30%), headache (20%), insomnia (15%), and back pain (10%) [84]. Newer psychoactive medications also were included on some flights, such as the so-called “atypical” antipsychotics (e.g., olanzapine, risperidone) and the selective serotonin reuptake inhibitor (SSRI) antidepressants (e.g., fluoxetine, sertraline). Such medications also have been used in Russian space missions and have included antianxiety agents, such as diazepam and phenazepam; antidepressants, such as amitriptyline; antipsychotics, such as chlorpromazine and haloperidol; and stimulants [74]. Similar medications are being used on the ISS. These have included antianxiety

3.7  Treatment Considerations

117

(anxiolytic) medications (diazepam, lorazepam); antidepressants (sertraline, venlafaxine); antipsychotics (aripiprazole, ziprasidone); anticholinergics (diphenhydramine); sleep agents (melatonin, zaleplon, zolpidem); and wake agents (caffeine, modafinil) [85–87]. Together with pain medications and anti-manic/mood stabilizers such as divalproex and carbamazepine, a formulary like this might be used for a mission to Mars. The use of psychiatric medications should be monitored carefully, since a number of them have the potential for abuse and since novel effects may emerge in the space environment [86]. On one Russian space mission, for example, the commander suffered from insomnia and took too many sleeping pills without informing physicians in Mission Control. He subsequently developed a number of problems attributable to this action [74]. Thus, supervision of psychoactive drug usage in space by experts on the ground or medically-trained crewmembers in space is important. Physiological changes resulting from microgravity may alter the pharmacological characteristics of psychoactive drugs. For example, microgravity may alter the action of metabolic enzymes in the body that are involved with drug metabolism, such as CYP450 enzymes in the liver [88]. Microgravity also may influence medication dosage and route of administration. For example, decreased gastric emptying and lowered intestinal absorption may act to decrease the effect of medications that are administered by mouth. Psychoactive medications that are variably absorbed by the gut, such as chlorpromazine, flurazepam, and morphine, especially may be vulnerable to these changes. Fluid shifts may lower the blood-borne bioavailability of medications to the liver (the first pass effect), where they normally would be metabolized. Especially sensitive to this influence are morphine and many antidepressants [89]. Finally, due to the shift of blood and bodily fluids toward the head and upper body, injections of medications should not be given in the hip but in the arm to ensure more rapid absorption. Although these changes make sense physiologically, not enough empirical work has been done on the pharmacokinetics of medications under conditions of microgravity, and more pharmacological experiments in space need to be done. The same goes for the effects of microgravity on the stability of medications outside the body, although some studies have been done in this area. For example, there is some evidence that the psychoactive medications sertraline and temazepam exhibit increased potency loss after storage on the ISS when compared with ground control samples [86]. But in another study [87], many drugs, including one for sleeping (zolpidem) and one for alertness (modafinil), remained stable and potent after being stored on the ISS for 550 days, the current duration of a planned Mars expedition. However, another sleeping drug (melatonin) failed to meet USP standards for drug potency after this time. Interestingly, a study under centrifuge-­ induced hypergravity conditions has shown that unirradiated and laser irradiated chlorpromazine and promazine aqueous solutions were unchanged as measured by pH, spectroscopic, and chromatographic examinations [90].

118

3  Emotional Highs and Lows

3.7.2 Counseling and Psychotherapy During near-Earth missions, crisis intervention, counseling, and brief supportive psychotherapy can occur between individuals in the crew and therapists on the ground using private, two-way audiovisual links. In rare occasions, insight-oriented psychotherapy may be indicated. Crewmembers can be monitored from the ground for symptoms and signs of developing psychiatric emergencies due to illness (psychosis, suicidality) or medication side effects [85]. Crewmembers also can speak with family members at home for support as needed. At NASA’s Lyndon B. Johnson Space Center (JSC), many of these activities are provided by the Behavioral Medicine (BMed) Services, which is part of the Behavioral Health and Performance (BHP) Operations group [64, 91]. Responsibilities of BMed include assisting with selection and training, conducting annual and pre-flight behavioral medicine examinations, neurocognitive assessments using WinSCAT (see Sect. 6.4.3), and post-flight behavioral medicine assessments and neurocognitive testing. Providers also offer clinical psychiatric and psychological services to the astronauts on an elective basis. There are a number of behavioral training classes given by BHP Operations to astronaut candidates during the 2 years following their selection that gives us an idea of topics felt to be important for all astronauts [64]. Stress Resiliency is a short review of stress management techniques and expectations of the frustrations and rewards of a career at NASA, including its impact on family members. Cross-­ Cultural training is a 17-hour workshop that exposes U.S. astronauts to circumstances that can arise from multinational crew members and Mission Control personnel working together on complex projects, such as in the ISS. Conflict Management is a discussion-oriented course that introduces a three-point sequence of events that drives, escalates, and de-escalates conflict. The course reviews methods for breaking the cycle at each of the three points in order to resolve the conflict. Expeditionary Skills is a 24-hour, segmented practicum conducted by current astronauts. “Soft skills” topics, such as leadership/followership, small group living, teamwork, and self-care, are taught in conjunction with technical training trips that take place in remote field locations. An important in-flight service of the BMed program is the Private Psychological Conference (PPC), which is a critical component in assessing the well-being of astronauts and fellow crewmembers [64, 91]. Crewmembers on board the ISS have individual PPCs with their assigned aerospace psychiatrist and operational psychologist, who work together as a team. These are held via private 2-way video meetings as well as conferences using the IP phone (Fig. 3.7). They are confidential and not recorded. They typically last 15–20 minutes, occur biweekly, and cover topics that reflect the principle clinical and operational concerns of BHP. Topics that are discussed include: sleep quality and sleep shift issues; fatigue level; workload concerns; individual and crew morale; crewmember and crew-ground interactions; emotional state; family and personal relationships; environment and habitability issues; and preparation for important upcoming tasks, such as space walks. PPCs

3.7  Treatment Considerations

119

Fig. 3.7  An ISS astronaut uses a Softphone (as in “software”), also called an Internet Protocol or IP phone, to call his psychological support staff in Mission Control. This works through on-board laptop computers via Internet Protocol information packets, whereby communications with people on Earth are routed by way of satellites. (Credit: NASA)

may be discussed with the mission-assigned flight surgeons, who then consider and act upon any recommendations. BMed support services are also available upon request following unexpected or critical events, such as crew tensions and family crises. During future deep space missions (such as a trip to Mars), the great distance between the crewmembers and people on Earth will result in communication delays (see Chap. 9). This impedes the ability to monitor and to conduct counseling and psychotherapy sessions in real time. The long distances involved also impede supportive family-crewmember interactions and limit the ability to send morale-­ enhancing supplies and gifts up from Earth. As a result, the identification of psychiatric problems and their treatment will depend upon the skills of on- board crewmembers who are trained in counseling, psychotherapy, and the use of medications. Facilities also need to be available on board to seclude and restrain a potentially psychotic, suicidal, or violent crewmember, who could be quite disruptive [85, 92]. It is unlikely that a psychiatrist will be a member of the crew in early expedition involving a trip to a distant planet. However, it is likely that a physician will be present on board. In addition to medical and surgical skills, such a person should possess a knowledge of: (1) individual psychopathology and small group behavior; (2) the individual and interpersonal effects of stressors to be expected during the mission; (3) techniques involving crisis intervention, individual psychotherapy, and the facilitation of group awareness and team-building; and (4) the appropriate use of

120

3  Emotional Highs and Lows

tranquilizers and other psychoactive medications, including their usefulness and side effects under conditions of microgravity [93]. To protect the crew in the event that the physician develops a psychiatric (or medical) problem, at least one other person needs to be trained to deal with such issues. In addition, all of the crewmembers should be sensitized to important psychiatric and interpersonal problems that might occur during the course of long-duration space missions, as well as to basic interventions for dealing with such difficulties. A new measure for assessing the emotional state of people involved in long-­ duration space missions is the Mental Health Checklist (MHCL) [94]. Based on an extensive literature review and consultation with subject matter experts, this measure consists of 23 items measuring positive and negative emotional states, plus three subscales (positive adaptation, poor self-regulation, and anxious apprehension). It has been developed specifically for use in extreme environments (such as an expedition to Mars), where the number, intensity, and duration of stressors exceed those typically found in everyday life. The three subscales resulted from a factor analytic study involving 300 college undergraduate students, and the measure’s reliability and convergent validity were assessed from 110 subjects at two Antarctic bases, with good results. Further work continues to explore the psychometric properties of this promising measure.

3.7.3 Operational and Family Support Another BHP activity is to provide general support to astronauts and their families. Seen as non-clinical services, there are two programs involved: Operational Psychology (OpPsy) and the Family Support Office (FSO) [64, 95]. “OpPsy focuses on preparing mission-assigned astronauts and their families for the astronaut’s specific mission and then supporting them throughout the entire process from preflight to postflight. FSO focuses on the family regardless of whether an astronaut is assigned to a mission” [95, pp. 134–135]. OpPsy activities include training and support for the mission (offered preflight, on-orbit, and postflight), and outreach to family and friends. FSO activities work with the Astronaut Office and include family briefings, like planning for future flights, and support for the Astronaut Spouse Group. The latter is a volunteer-run organization made up of astronaut spouses who empathize with and support the significant other of an assigned astronaut. The Group also acts as an advocate and liaison between families and NASA and gives advice on NASA/Astronaut Office policies that impact on families. These activities have been well-received and help to humanize the astronaut program for participants and their loved ones.

3.8  Points to Remember

121

3.7.4 Cognitive Emotion Regulation Strategies An interesting approach to improving behavioral health in space is to use cognitive emotion regulation strategies. Alfano and her colleagues [96] studied the mental health status of 110 people across a 9-month period of time (including winter-over) at two Antarctic stations. They found linear decreases in positive adaptation scores and increases in poor self-regulation scores and severity of physical symptoms over time. They studied five cognitive response-focused strategies for regulating positive emotions and measured their effectiveness using the Difficulties in Emotion Regulation Scale (DERS). They found that two of the strategies thought to be maladaptive (dampening and suppression of positive emotions) correlated with high scores on the DERS, whereas three strategies associated with positive adaptation (savoring the moment, positive self-focused rumination, and constructive reappraisal of the situation) did not correlate with DERS scores. The use of such cognitive regulation strategies that are aimed at improving emotional state needs to be further developed and tested in the space environment.

3.8 Points to Remember • Most astronauts report that their space missions were a positive experience. This is based on the unique features of the space environment, not simply being confined and bonding with others. • The single most important contributor to space being a positive experience is viewing the Earth. • Those experiencing the most change as a result of being in space may be more outwardly focused on the beauty of the heavens, and those experiencing the least change may be more inwardly focused and life-oriented. • Frank White has described his Overview Effect as a feeling of awe for the Earth, a sense that it is a fragile place that needs protection. There are no national boundaries, and human and non-human life are interconnected. • People describe their experience of seeing the Earth in both spiritual and humanistic terms, depending on their beliefs before going into space. Although their views may be intensified, there is no evidence that people are converted from one to the other perspective as a result of their mission. • Salutogenesis refers to the health-promoting, growth-enhancing effects of a challenging situation. There is some evidence that pre-mission training can be emotionally arousing yet lead to personal growth in some astronauts and cosmonauts. • Resilience is an important factor that is positively related to well-being and negatively related to indicators of distress. Psychosocial education training (PET) aimed at supporting resilience-based protective factors and compatibility issues should be provided to crewmembers, families, and mission control personnel.

122

3  Emotional Highs and Lows

• A number of portable devices and standardized measures have been developed to measure behavioral health, which have shown that people in ICEs manifest great resilience despite the stressors they experience. • People who have been in space sometimes report changes in core values, especially universalism, in that they gain a greater appreciation for other people and nature. • The incidence of psychiatric problems during submarine and polar missions ranges from 1% to 5%. Using formal diagnostic criteria, NASA has reported no incidents of a psychiatric disorder during either Space Shuttle or ISS missions. However, severe behavioral problems have occurred that were related to stress in both the U.S. and Russian programs, and in some cases they resulted in early mission termination. • Anecdotal reports suggest that the most common behavioral health problem in space is insomnia, followed by adjustment disorders, which are characterized by the development of emotional or behavioral symptoms (e.g., anxiety, depression) in response to one or more identifiable stressors • Members of the Russian psychological support group believe that over half of their cosmonauts are affected by the asthenization process, a response to space conditions characterized by fatigue, anxiety, irritability, and other negative cognitive and psychophysiological changes. Countermeasures are aimed at increasing external stimulation volume and variety by regular provision of media content (e.g., audio and video, news), organization of contacts with important people on Earth, and surprise presents sent up on resupply spaceships • The psychoactive medication formulary in space includes a variety of antianxiety, antidepressant, antimanic, antipsychotic, and sedative and hypnotic medications. More work needs to be done on the pharmacological characteristics and stability of these medications in microgravity, both within and outside of the body. • Counseling and psychotherapy from the ground is available in real time during near-Earth missions, but it will be more difficult to provide on an interplanetary mission due to the presence of delayed communications. At NASA, activities of the Behavioral Health and Performance (BHP) Operations group provide behavioral training classes, private psychological conferences, and support for the families of astronauts. • During an expeditionary mission (e.g., to Mars), the crew physician needs to be trained to deal with behavioral problems and psychiatric emergencies (psychosis, suicidality, medication side effects).

3.9 Food for Thought 1. Imagine you are on-orbit and are profoundly affected by the beauty of the Earth. Would you interpret your reaction as an indication of the glory of God to celebrate, or as a sense that we are one common humanity that formed through the

References

123

good fortune of Earth’s evolution? In either reaction, how would you account for the development of political and national boundaries? How would your reaction affect your activities after returning back to Earth? 2. During a mission to Mars, a crewmember’s performance declines, and he reports being homesick and missing his family. As the mission physician, what interventions would you consider? What if he becomes worse and reports feeling depressed and having sleep problems? What treatment interventions would you consider then? What kind of emergency situation would you worry about?

References 1. Connors, M. M., Harrison, A. A., & Atkins, F. R. (1985). Living aloft: Human requirements for extended spaceflight. (NASA SP-483. NASA. 2. Kanas, N. (1990). Psychological, psychiatric, and interpersonal aspects of long-duration space missions. Journal of Spacecraft and Rockets, 27, 457–463. 3. White, F. (2014). The overview effect: Space exploration and human evolution (3rd ed.). American Institute of Aeronautics and Astronautics. 4. Oberg, J. E. (1981). Red Star in Orbit. Random House. 5. Pogue, W. R. (1985). How do you go to the bathroom in space? Tom Doherty Associates. 6. Kelly, A. D., & Kanas, N. (1992). Crewmember communication in space: A survey of astronauts and cosmonauts. Aviation, Space, and Environmental Medicine, 6, 721–726. 7. Kelly, A. D., & Kanas, N. (1993). Communication between space crews and ground personnel: A survey of astronauts and cosmonauts. Aviation, Space, and Environmental Medicine, 64, 779–800. 8. Kanas, N., Weiss, D. S., & Marmar, C. R. (1996). Crewmember interactions during a Mir space station simulation. Aviation, Space, and Environmental Medicine, 67, 969–975. 9. Ritsher, J. B., Ihle, E. C., & Kanas, N. (2005). Positive psychological effects of space missions. Acta Astronautic, 5, 630–633. 10. Ihle, E. C., Ritsher, J. B., & Kanas, N. (2006). Positive psychological outcomes of spaceflight: An empirical study. Aviation, Space, and Environmental Medicine, 77, 93–101. 11. Gallagher, S., Reinerman-Jones, L., Janz, B., Bockelman, P., & Trempler, J. (2015). A Neurophenomenology of awe and wonder: Towards a non-reductionist cognitive science. Palgrave Macmillan. 12. Kanas, N. (2020). Spirituality, humanism, and the overview effect during manned space missions. Acta Astronautica, 166, 525–528. 13. Lebedev, V. (1988). Diary of a cosmonaut: 211 days in space. Phytoresource Research Information Service. 14. Robinson, J. A., Slack, K. J., Olson, V., Trenchard, M. H., Wilis, K. J., Baskin, P. J., & Boyd, J. E. (2013). Patterns in crew-initiated photography of Earth from the ISS: Is Earth observation a salutogenic experience? In D. A. Vakoch (Ed.), On orbit and beyond: Psychological perspectives on human spaceflight (pp. 51–68). Springer. 15. Cordova, M. J., Cunningham, L. L. C., Carlson, C. R., & Andrykowski, M. A. (2001). Post-­ traumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20, 176–185. 16. Palinkas, L. A. (1991). Group adaptation and individual adjustment in Antarctica: A summary of recent research. In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space (pp. 239–251). Springer. 17. Suedfeld, P. (1998). Homo invictus: The indomitable species. Canadian Psychology, 38, 164–173.

124

3  Emotional Highs and Lows

18. Suedfeld, P. (2001). Applying positive psychology in the study of extreme environments. Journal of Human Performance in Extreme Environments, 6, 21–25. 19. Suedfeld, P. (2005). Invulnerability, coping, salutogenesis, integration: Four phases of space psychology. Aviation, Space, and Environmental Medicine, 76(6, Suppl), B61–B66. 20. Suedfeld, P., Brcic, J., Johnson, P. J., & Gushin, V. (2012). Personal growth following long-­ duration spaceflight. Acta Astronautica, 79, 118–123. 21. Suedfeld, P., Brcic, J., Johnson, P. J., & Gushin, V. (2015). Coping strategies during and after spaceflight: Data from retired cosmonauts. Acta Astronautica, 110, 43–49. 22. Ritsher, J. B., Kanas, N. A., Ihle, E. C., & Saylor, S. A. (2007). Psychological adaption and salutogenesis in space: Lessons from a series of studies. Acta Astronautica, 60, 336–340. 23. Vanhove, A. J., Herian, M., Harms, P. D., & Luthans, F. (2015). Resilience and growth in long-­ duration isolated, confined and extreme (ICE) missions: A literature review and selection, training and countermeasure recommendations. (Technical Report NASA/TM-2015-218566). Johnson Space Center. 24. Gatti, M., Palumbo, R., Di Domenico, A., & Mammarella, N. (2022). Affective health and countermeasures in long-duration space exploration. Heliyon, 8, e09414. https://doi. org/10.1016/j.heliyon.2022.e09414 25. Kazi, S., Khalenghzadegan, S., & Rosen, M.  A. (2021). Technological advances to understand and improve individual and team resilience in extreme environments. In L. B. Landon, K.  J. Slack, & E.  Salas (Eds.), Psychology and human performance in space programs (Research at the frontier) (Vol. 1, pp. 87–105). CRC Press. 26. Bell, S., Dev, S., Whiting, S., Landon, L., Miller, J., et al. (2022). Human factors and behavioral performance exploration measures: Assessing astronaut risk. (Aerospace Medical Association Scientific Meeting Abstract #114). Aerospace Medicine and Human Performance, 93, 189–190. 27. Dev, S., Whiting, S., Miller, J., Young, M., Roma, P., & Bell, S. (2022). The impact of mood and affect on operationally relevant performance among astronaut-like individuals in space analog settings. (Aerospace Medical Association Scientific Meeting Abstract #115). Aerospace Medicine and Human Performance, 93, 190. 28. Suedfeld, P., & Weiszbeck, T. (2004). The impact of outer space on inner space. Aviation, Space, and Environmental Medicine, 75(7, Suppl), C6–C9. 29. Suedfeld, P., Legkaia, K., & Brcic, J. (2010). Changes in the hierarchy of value references associated with flying in space. Journal of Personality, 78, 1–25. 30. Brcic, J., & Della-Rossa, I. (2012). Universal values of Canadian astronauts. Acta Astronautica, 80, 46–51. 31. Vinokhodova, A. G., & Gushin, V. I. (2014). Study of values and interpersonal perception in cosmonauts on board the international space station. Acta Astronautica, 93, 359–365. 32. Solcova´, I., Vinokhodova, A., & Gushin, V. (2021). Anticipated and perceived personal growth and values in two spaceflight simulation studies. Acta Astronautica, 179, 561–568. 33. Kanas, N.  A., & Fedderson, W.  E. (1971). Behavioral, psychiatric, and sociological problems of long-duration space missions (NASA Technical Memorandum, NASA TM X-58067). National Aeronautics and Space Administration Manned Spacecraft Center. https://ntrs.nasa. gov/api/citations/19720008366/downloads/19720008366.pdf 34. Stuster, J. (2011). Bold endeavors: Lessons from polar and space exploration. Naval Institute Press. 35. Rasmussen, J. E., & Haythorn, W. W. (1963). Selection and effectiveness considerations arising from enforced confinement of small groups. Paper presented at the AIAA Second Manned Space Flight Meeting, American Institute of Aeronautics and Astronautics, Dallas, TX. 36. Gunderson, E. K. (1968). Mental health problems in Antarctica. Archives of Environmental Health, 17, 558–564. 37. Pope, F. E., & Rogers, T. A. (1968). Some psychiatric aspects of an Arctic survival experiment. Journal of Nervous and Mental Disease, 146, 433–445.

References

125

38. Serxner, J. L. (1968). An experience in submarine psychiatry. American Journal of Psychiatry, 125, 25–30. 39. Weybrew, B. B. (1961). Impact of isolation upon personnel. Journal of Occupational Medicine, 3(1961), 290–294. 40. Ruff, G.  E., Levy, E.  Z., & Thaler, V.  H. (1959). Studies of isolation and confinement. Aerospace Medicine, 30, 599–604. 41. Rohrer, J. H. (1961). Interpersonal relationships in isolated small groups. In B. E. Flaherty (Ed.), Symposium on psychophysiological aspects of space flight (pp.  263–271). Columbia University Press. 42. Cramer, E. H., & Flinn, D. E. (1963). Psychiatric aspects of the SAM two-man space cabin simulator. (SAM TDR 63-27). Brooks Air Force Base School of Aerospace Medicine. 43. Smith, W. M. (1966). Observations over the lifetime of a small isolated group. Psychological Reports, 19, 475–514. 44. Eberhard, J. W. (1967). The problem of off-duty time in long-duration space missions (Vol. 2. NASA CR-96721). National Aeronautics and Space Administration. 45. Ferguson, M.  J. (1970). Use of the ben Franklin submersible as a space station analog. Summary technical report (Vol. 1). OSR-70-4, NAS 8-30172. 46. Flinn, D. E., Hartman, B. O., & Flaherty, B. E. (1964). Management of psychiatric patients during air evacuation: A study of three commonly used drugs. Aerospace Medicine, 35, 1133–1140. 47. Parin, V. V., Vinogradov, V. M., & Razumeev, A. N. (1969). Problems in space pharmaecology. Environmental Space Sciences (transl.), 3, 15–25. 48. Flinn, D. E. (1965). Functional states of altered awareness during flight. Aerospace Medicine, 36, 537–544. 49. Solomon, P. (1961). Motivation and emotional reactions in early space flights. In B. E. Flaherty (Ed.), Symposium on psychophysiological aspects of space flight (pp.  272–277). Columbia Uniersity Press. 50. Dunlap, R.  D. (1966). Psychology and the crew on Mars missions. Paper presented at the AIAA/AAS Stepping Stones to Mars Meeting, Baltimore, MD, 28–30 Mar, pp. 441–445. 51. Flinn, D. E., Monroe, J. T., Cramer, E. H., & Hagen, D. H. (1961). Observations in the SAM two-man space cabin simulator. Behavioral factors in selection and performance. Aerospace Medicine, 32, 610–615. 52. Hagen, D.  H. (1961). Crew interaction during a 30-day simulated space flight, preliminary study. SAM Report (pp. 61–66). 53. Sharpe, M.  R. (1969). Living in space, the astronaut and his environment. Doubleday and Company, Inc. 54. Inglis-Arkell, E. (2012). What does space travel do to your mind? NASA’s resident psychiatrist reveals all. Gizmodo—Tech. Science Culture, 11 Dec. https://gizmodo.com/ what-­does-­space-­travel-­do-­to-­your-­mind-­nasas-­resident-­5967408 55. Lugg, D. J. (1991). Current international human factors research in Antarctica. In A. A. Harrison, Y. A. Clearwater, & C. P. McKay (Eds.), From Antarctica to outer space. Springer. 56. Palinkas, L.  A., Glogower, F., Dembert, M., Hansen, K., & Smullen, R. (2004). Incidence of psychiatric disorders after extended residence in Antarctica. International Journal of Circumpolar Health, 63, 157–168. 57. Weybrew, B. B. (1991). Three decades of nuclear submarine research: Implications for space and Antarctic research. In A.  A. Harrison, Y.  A. Clearwater, & C.  P. McKay (Eds.), From Antarctica to outer space. Springer. 58. Boeing Aerospace Company. (1983). Space Station/nuclear submarine analogs. CCO271. National Behavior Systems. 59. Slack, K.  J., Williams, T.  J., Schneiderman, J.  S., Whitmire, A.  M., & Picano, J.  J. (2016). Human research program behavioral health and performance: Risk of adverse cognitive or behavioral conditions and psychiatric disorders. NASA Lyndon B. Johnson Space Center.

126

3  Emotional Highs and Lows

60. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Ed. (DSM-5). American Psychiatric Publishing. 61. Shepanek, M. (2005). Human behavioral research in space: Quandaries for research subjects and researchers. Aviation, Space, and Environmental Medicine, 76(6, Suppl), B25–B30. 62. Santy, P. A. (1997). Behavior and performance in the space environment. In S. E. Church (Ed.), Fundamentals of space life sciences (Vol. 2). Malabar, Krieger Publishing Company. 63. Alexander, D. J. (2021). Illnesses seen in spaceflight. In L. R. Young & J. P. Sutton (Eds.), Handbook of bioastronautics (pp. 573–592). Springer Nature Switzerland AG. 64. Sipes, W., Holland, A., & Beven, G. (2021). Managing behavioral health in space. In L.  R. Young & J.  P. Sutton (Eds.), Handbook of bioastronautics (pp.  425–436). Springer Nature Switzerland AG. 65. Clark, J.  B. (2021). Human spaceflight accidents: The USSR/Russian space program. In L.  R. Young & J.  P. Sutton (Eds.), Handbook of bioastronautics (pp.  781–796). Springer Nature Switzerland AG. 66. Inglis-Arkell, E. (2012, December 11). What does space travel do to your mind? NASA’s resident psychiatrist reveals all. Gizmodo. Retrieved 22 July 2019, from https://io9.gizmodo. com/5967408/what-­does-­space-­travel-­do-­to-­your-­mind-­nasas-­resident psychiatrist-­reveals-­all 67. Gushin, V., Shved, D., Vinokhodova, A., Bubeev, Y., Sсhastlivtceva, D., Yusupova, A., Karpova, O., & Chekalina, A. (2021). Selected Russian contributions to spaceflight. Part 1: Russian psychological support, monitoring, and inflight studies. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs (Extreme application) (Vol. 2, pp. 279–300). CRC Press. 68. Myasnikov, V. I, & Stepanova, S. I. (Eds.) (2000). Problema psichicheskoj astenizacii v dlitelnom kosmicheskom polete (p.  224). Slovo. (В.И. Мясников & С.И. Степанова. (2000). Проблема психической астенизации в длительном космическом полете. Москва: “Слово,” 224 c.). 69. Petrovsky, A. V., & Yaroshevsky, M. G. (1987). A concise psychological dictionary. Progress Publishers. 70. Beard, G.  M. (1905/1971). A practical treatise on nervous exhaustion (neurasthenia), its symptoms, nature, sequences, treatment (5th ed.) E.B. Treat & Company (1905). Reprinted by the Kraus Reprint Company, Kraus-Thomson Organization Limited (1971). 71. Kanas, N., Salnitskiy, V., Gushin, V., Weiss, D. S., Grund, E. M., Flynn, C., Kozerenko, O., Sled, A., & Marmar, C. R. (2001). Asthenia: Does it exist in space? Psychosomatic Medicine, 63, 874–880. 72. Erwin, E. (2001). The Freud encyclopedia: Theory, therapy, and culture. Routledge. https:// books.google.com/books?id=rX2w6QELtKgC&pg=PA362&lpg=PA362&dq=freud+neurasth enia+coitus&source=bl&ots=t8xg8MjzZ6&sig=JpinNvDo0RXuKn6bgFmSs2tmLo&hl=en& sa=X&ei=qTtiUKbFYrK9gS0moHwBQ&ved=0CC8Q6AEwAA#v=onepage&q=freud%20 neurasthenia%20coitus&f=false 73. Myasnikov, V. I., Stepanova, S. I., Salnitskiy, V. P., Kozerenko, O. P., & Nechaev, A. P. (2000). Problems of psychic asthenia in prolonged space flight. Slovo Press (In Russian). 74. Aleksandrovskiy, Y. A., & Novikov, M. A. (1996). Psychological prophylaxis and treatments for space crews. In A. E. Nicogossian, S. R. Mohler, O. G. Gazenko, & A. I. Grigoriev (Eds.), Space biology and medicine III: Humans in spaceflight. Book 2. AIAA. 75. Grigoriev, A. I., Kozerenko, O. P., Myasnikov, V. I., & Egorov, A. D. (1988). Ethical problems of interaction between ground-based personnel and orbital station crewmembers. Acta Astronautica, 17, 213–215. 76. Burrough, B. (1998). Dragonfly: NASA and the crisis aboard Mir. Harper Collins. 77. Freeman, M. (2000). Challenges of human space exploration. Springer-Praxis. 78. Harris, P. R. (1996). Living and working in space: Human behavior, culture and organization (2nd ed.). John Wiley & Sons. 79. Chaikin, A. (1985). The loneliness of the long-distance astronaut. Discover 1985. February, pp. 20–31.

References

127

80. Carpenter, D. (1997). Are blunders on Mir signs the stress is too great? San Francisco Examiner, 18 July, p. A-1. 81. Bolton, S., Warner, J., Harriss, E., Geddes, J., & Saunders, K.  E. A. (2021). Bipolar disorder: Trimodal age-at-onset distribution. Bipolar Disorders, 23, 341–356. https://onlinelibrary. wiley.com/doi/10.1111/bdi.13016 82. Santy, P. A. (1987). Psychiatric components of a health maintenance facility (HMF) on space station. Aviation, Space, and Environmental Medicine, 58, 1219–1224. 83. Pavy-Le Traon, A., Saivin, S., Soulez-LaRiviere, C., Pujos, M., Guell, A., & Houin, G. (1997). Pharmacology in space: Pharmacotherapy. In S. L. Bonting (Ed.), Advances in space biology and medicine (Vol. 6). JAI Press. 84. Santy, P. A., Kapanka, H., Davis, J. R., & Stewart, D. F. (1988). Analysis of sleep on shuttle missions. Aviation, Space, and Environmental Medicine, 59, 1094–1097. 85. Sipes, W. E., Flynn, C. F., & Beven, G. E. (2019). Behavioral health and performance support. In M. R. Barratt, E. S. Baker, & S. L. Pool (Eds.), Principles of clinical medicine for spaceflight (2nd ed., pp. 761–792). Springer Science+Business Media, L.L.C. 86. Friedman, E., & Bui, B. (2017). A psychiatric formulary for long-duration spaceflight. Aerospace Medicine and Human Performance, 88, 1024–1033. 87. Wotring, V. E. (2016). Chemical potency and degradation products of medications stored over 550 Earth days at the International Space Station. AAPS Journal, 18, 210–216. 88. Griko, Y. V., Loftus, D. J., Stolc, V., & Peletskaya, E. (2022). Private spaceflight: A new landscape for dealing with medical risk. Life Sciences in Space Research, 33, 41–47. 89. Saivin, S., Pavy-Le Traon, A., Soulez-LaRiviere, C., Guell, A., & Houin, G. (1997). Pharmacology in space: Pharmacokinetics. In S. L. Bonting (Ed.), Advances in space biology and medicine (Vol. 6). JAI Press. 90. Simon, A., Smarandache, A., Tozar, T., Andrei, I.  R., Stoicu, A., et  al. (2021). Photoactive chlorpromazine and promazine drugs exposed to hypergravity conditions after interaction with UV laser radiation. Acta Astronautica, 189, 260–268. 91. Sipes, W. E., Slack, K. J., & Beven, G. E. (2021). Behavioral health adaptation in ICE environments: Process and countermeasures for NASA astronauts. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs (Extreme application) (Vol. 2, pp. 115–132). CRC Press. 92. Kanas, N. (2014). The new Martians: A scientific novel (part I—The novel, part II—The science behind the fiction). Springer International Publishing. 93. Kanas, N. (1998). Psychosocial training for physicians on board the space station. Aviation, Space, and Environmental Medicine, 59, 456–457. 94. Bower, J.  L., Laughlin, M.  S., Connaboy, C., Simpson, R.  J., & Alfano, A. (2019). Factor structure and validation of the mental health checklist (MHCL) for use in isolated, confined and extreme environments. Acta Astronautica, 161, 405–414. 95. Hughlett, J. L., Turner, E. T., Slack, K. J., & Sipes, W. E. (2021). Space flight operational psychological support for astronauts and their families. In L. B. Landon, K. J. Slack, & E. Salas (Eds.), Psychology and human performance in space programs (Extreme application) (Vol. 2, pp. 133–154). CRC Press. 96. Alfano, C. A., Bower, J. L., Connaboy, C., Agha, N. H., Baker, F. L., Smith, K. A., So, C. J., & Simpson, R. J. (2021). Mental health, physical symptoms and biomarkers of stress during prolonged exposure to Antarctica’s extreme environment. Acta Astronautica, 181, 405–413.

Chapter 4

Crewmember Selection, Ground and Family Support

Contents 4.1  From the Archives: Predicting Action from Personality [1] 4.2  From the Archives: Crew Selection [1] 4.3  Personality Characteristics and Crewmember Selection 4.4  Crewmember-Mission Control Relationship 4.5  From the Archives: Separation Reactions of Married Women [1] 4.6  Family Issues 4.7  Returning Home 4.8  Points to Remember 4.9  Food for Thought References

 130  131  138  149  159  159  160  162  163  164

The selection of space crewmembers can be a tricky activity. Not only is it ­important to find people without obvious psychological problems, but it also is important to select people capable of achieving the mission goals. Issues to be considered include professional background and training that are congruent with these goals, along with dedication and persistence to get the job done. In addition, it is important to pick crewmembers who can get along with each other, form a compatible team, and enjoy each other’s company during meals, celebrations, and other social events. Hence, the two pillars of crewmember selection: the ability to work diligently in one’s area of expertise to accomplish the mission goals, and the ability to interact collegially and socially with one’s crewmates during work and leisure time activities. In this chapter, we will consider a number of important intrapsychic and interpersonal qualities that have been found to be necessary for mission success. Successful space missions are not only dependent on the performance of the crewmembers. Support from Mission Control personnel and family members and friends on Earth also play a role, especially during on-orbit and near-Earth missions to the Moon. Such support will be important during an expedition to Mars as well, but as we shall see in Chap. 9, the delayed communication resulting from the great distances involved between Earth and Mars will limit the effectiveness of this support.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 N. Kanas, Behavioral Health and Human Interactions in Space, https://doi.org/10.1007/978-3-031-16723-2_4

129

130

4  Crewmember Selection, Ground and Family Support

4.1  F  rom the Archives: Predicting Action from Personality [1]

There have been a number of attempts to predict the performance of people working in isolated and confined environments. Although psychological tests have been useful in “screening out” people with behavioral health problems, their ability to predict success in space is more limited. Nevertheless, their use has been documented in early space simulation studies. In addition, other factors have been considered in crewmember selection, such as work skills, experience, sex, nationality, and personality compatibility with other crewmembers. In terms of sex, only one woman had been in space at the time this document was written. At the present time, dozens of women have flown on space missions. They have served as mission commanders, and some have been in space for half a year or longer. The performance of female astronauts has equaled that of their male counterparts.—NK. It is impossible to predict a man’s exact reactions to stress situations over a prolonged period. However, numerous studies indicate that psychological tests are valuable tools to outline probable reaction patterns to known stressors. These tests aid in identifying individuals who possess possible psychological weaknesses. The Tektite II crew was carefully screened using a variety of personality tests (Cattell 16 PF, MMPI, etc.) [2]. The responses were compared with observed behavior. More than 50 correlations were found, which were significant at p