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near the 60 T point mark) and this, in turn, means that the captain has problems
with his somatic (physical) health caused by nervous and mental tension. We
should note that the first scale of the MMPI test is called "somatization of
anxiety" since it reveals a person's tendency to relieve nervous tension, not in all
Final Report
INTERGOVERNMENTAL AVIATION COMMITTEE
82
external behavioral reactions, but in internal somatic reactions of the organism,
which manifest in the form of vascular spasms, irregularities in cardiac rhythms,
increased stomach secretions, tremor of the limbs or muscular cramping, etc.
This tendency towards expressed psychosomatic reactions during nervous
tension is also confirmed by the Captain’s medical diagnoses. In 1983 he was
diagnosed with the cardiac type of neurocirculatory dystonia (NCD) and in 2002
with hypertensive disease. These two, as is known, fall under the category of
psychogenic illnesses.
There are medical facts confirming the appearance of strongly expressed
psychosomatic reactions to factors causing apprehension in the pilot while
undergoing physical examinations. In fact, in 2001 the CPEB discovered that the
pilot was suffering from the atypical Wolff-Parkinson-White syndrome on the
electrocardiogram when his heart was examined under physical exertion. This
could have further caused the pilot to worry about the results of the
veloergometric test (VET). It is probably for this reason that he had very high
indicators of arterial pressure (230/80) and cardiac rate (114) even under a minor
exercise ECG test (80 W), which prompted the stoppage of the bicycle
ergometry on May 13, 2002. It was altogether impossible to carry out
veloergometric testing three days afterwards: initial pressure was at the 180/90
level. The pilot was afterwards sent to undergo rehabilitation using sedative
medications (Annex 10) but even after this he was not authorized to undergo
VET on May 25, 2002 since his initial blood pressure was again very high -
200/90. For this reason, a neuropathologist sent the Captain in 2003 to be
examined by a PEB psychologist, given his strong psychoemotional reaction to
the VET and the discovery by the doctor of signs of heightened nervous tension
during the examination of the pilot (tremor of the cheeks and hyperhidrosis of
the palms).
However, the psychologist does not write anything in the conclusion
about the pilot’s increased tendency towards psychosomatic reaction and the
need for psychocorrective steps, in particular, the need for the pilot to learn
techniques of self-control (auto-training).
Note: The psychologist ought to have made an entry in the medical record
about the need for psychocorrective measures, in particular, those that are more
suitable in psychosomatics, in accordance with the "Guidelines for
psychological support...". The Guidelines state: "Depending on indicators from
personality testing, the psychologist is required to give an opinion about the
essence of observed deviations, their temporal (situational) or lasting nature,
the possible effect on professional activity and the somatic condition. If needed,
the issue of psychiatric examination is resolved in conjunction with a
neuropathologist. Indicators for psychological rehabilitation and correction
also need to be indicated and the method on how to execute them
recommended".
A similar situation involving the medical and psychological examination
of the Captain was repeated in 2004. Before going through the next PEB, the
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INTERGOVERNMENTAL AVIATION COMMITTEE
83
pilot undergoes rehabilitation treatment with sedatives but, in spite of this, he
exhibits an excessive heart rate (HR) indicator (164 beats per minute) during a
veloergometric test carried out on June 29, 2004. This rate is dangerous to
health. In view of this situation, the neuropathologist again sent him to be
examined by a psychologist but the latter's opinion again contains nothing about
the marked tendency towards psychosomatics and the need to undergo
psychocorrection. It is possible that the neuropathologist, dissatisfied with the
conclusions of the psychologist in 2003 and 2004, again sends the pilot back to
the psychologist in 2005 (we note that an annual checkup by a psychologist is
not mandatory for persons younger than 50 and is carried out only by special
referral from a neuropathologist). The medical history sheet does not contain the
results of his visit to the psychologist in 2005.
It is possible that the PEB psychologist did not initiate independent
psychological examination in December 2005 on the basis of the referral from
　
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