To many, the threat posed by a disturbance in an individual or in the relationship among individuals does not seem as serious as a threat posed by a physical event. However, such a disturbance in space could have a devastating effect on the entire crew and its mission. In this section we will consider some of the more serious breakdowns in personal or interpersonal functioning as they relate to extended spaceflight.
In speaking of a psychological episode in space, we are not making a clinical assessment, but rather are alluding to those kinds of personality disturbances which would be obvious to an involved layman. It is difficult to imagine a less desirable place for such a disturbance to occur than in a spacecraft thousands of miles from Earth. Although the likelihood of a full-blown psychiatric episode occurring in space is small, the costs associated with such an event could be extremely high and would present a serious challenge to the entire crew.
Experiences in confinement- Several episodes involving psychological disturbances have occurred on Antarctic wintering-over expeditions (Gunderson, 1968). One such episode took place at a two-man outpost located approximately 50 miles from the main camp. Duty at the outpost was rotated among the entire crew. Each man served 2 wk, overlapping for 1 wk with one crewmember, and for the second week with his replacement. On the occasion of interest, the supply plane arrived at the outpost, picked up the member who had served 2 wk, and dropped off the new man. During the night the new man became increasingly agitated. His companion tried to calm him, thought he had succeeded, and eventually fell asleep, only to awaken in the middle of the night to find his crewmate dressing for the outdoors. When asked what he was doing, the new member announced his intention to walk back to the base camp-a clearly impossible task. All of the partner's skills were needed to try to keep the disturbed man in the habitat while at the same time struggling to reach the base camp by radio. As soon as weather conditions permitted, the plane was dispatched and the disturbed individual was removed. In the case described, a failure to persuade the disturbed person would have resulted in his death. Under similar circumstances, another disturbed individual might have turned his anxiety against  his partner, or have included his partner in his fantasy, with potentially serious consequences for both individuals.
Such an event has been reported by Ordiway and Raymon (1974). A commander and a navigator took off in a two-seater fighter craft. The navigator soon observed that the commander was behaving erratically. The commander engaged in strange exchanges with flight control and flew the aircraft in a highly dangerous manner. He hallucinated a landing strip and prepared to land. The navigator succeeded in convincing the commander not to land, but to return to the home base. The plane eventually was landed safely, but only after several abortive attempts during which the commander and the navigator fought for control of the stick.
These two instances of psychiatric episodes in a confined space underscore the simple wisdom expressed by Hartman and Flinn in 1964, "there are many advantages to having two men in a space vehicle, except when one of them is psychotic" (p. 63).
It is not clear that confinement increases the frequency of psychological disturbance, although it is reasonable to expect that it does. It is known that psychological disturbances in confinement are not unusual: Six mentally disturbed persons were removed from the American Antarctic bases during the International Geophysical Year (Law, 1963); and on two cruises on the submarine Triton, approximately 5% of the crew of 137 were seen for some form of psychiatric disorder (Serxner, 1968). These crewmembers suffered either from anxiety or from depression and were treated primarily with drugs The submarine Triton also had one full- blown psychotic episode. The victim, a chief petty officer, experienced migraine headaches followed by hallucinations. The man was treated with phenothiazine and barbiturates by the medical officer, but was kept as much as possible in his normal activities, accompanied at all times by other chief petty officers. Significantly, this man's disturbance centered on his job, the inadequacy he felt in his performance, and the slights he felt, both from his superior officers and from his subordinates, in being excluded from decisionmaking sessions.
Nature and cause- It has been observed (S. Perry,1976) that a person experiencing a severe psychological disturbance will show impairment in at least one of four functions: thinking (disordered, as in schizophrenia); perception (distorted, as in paranoia); mood (elevated, as in mania or despondent, as in depression); and impulse  (violent, as in hebephrenic excitement or frozen, as in catatonic stupor) .
Impairment in mood expressed as depression is the most commonly observed form of psychological disturbance. Depression is frequently reported in confined groups (S. Smith, 1969), with depressive symptoms particularly marked among those isolated for long periods of time, such as Antarctic wintering-over parties or Polaris submarine crews (Earls, 1969). Depression is marked by lack of ability to concentrate, feelings of worthlessness, irritability, weight loss, hopelessness, guilt, etc. With depression, the individual suffers a diminution in relations with other people and with the outside world in general.
Akiskal and McKinney (1975) show that the various models of depression reflect one or more of five dominant schools of thought: psychoanalytic, behavioral, sociological, existential, and biological. Among the models based on the psychoanalytic school are those that describe depression as anger turned inward (see Freud's Collected Papers, 1950) or those that equate depression with a negative cognitive set (Beck, 1974). Behavioral models would include the theories of low positive reinforcement (Lazarus, 1968; Lewinsohn, 1974a, 1974b) and theories of learned helplessness (Seligman, 1974; Seligman, Klein, and Miller, 1976), where individuals perceive themselves to have no control over the events affecting their lives. The sociological school views depression as resulting from a loss of status (Bart,1974), whereas the existential school focuses on the loss of the meaning of existence (Becker, 1964). The biological models emphasize the roles of genetic or chemical factors in the onset of depression (Copper, 1967). In considering several suggested etiologies of depression, Blaney (1977) has noted that "it may well be that each element is sufficient to lead to depression but that none are necessary" (p. 218)
Akiskal and McKinney (1975) posit an integrative psychophysiological model of depression. In this view, various chemical experiential, and behavioral processes translate into the functional impairment of advanced depression or melancholia at the reinforcement center at the diencephalon. According to Akiskal and McKinney, once the individual reaches the melancholic phase, the disruption in functioning becomes "biologically autonomous" of the conditions which preceded it.
 Contributing factors- Whatever the primary cause of a disturbance, it has been found that events, or series of events, can aggrevate or trigger a psychological episode.
Events - Since the early work on life change scaling at the University of Washington (see, e.g., Holmes and Rahe, 1967), a positive correlation has been demonstrated between major life events and subsequent physical and psychiatric disturbances.6 (For a review of this work, see Rahe and Arthur, 1978.) These findings are m overall agreement with descriptions of the generalized stress response as outlined by Selye (1976). Although both welcome and unwelcome events can extract a toll, it is the negative event, and usually the "exit" event (e g., the death of a loved one, marital separation, the loss of a job, etc.) that gives rise to the greater problem and that has a particular relationship to the occurrence of severe depression (Paykel, 1974).
In extended spaceflight, one could readily see how conditions on-board could contribute to psychological disturbances, and especially to depression. For instance, as noted above, depression is sometimes interpreted as anger turned inward. Under normal Earth conditions, one might expect some individuals to turn their anger inward and other individuals to direct their anger toward others. In confinement, confrontation is studiously avoided. It is reasonable to assume, then, that even normally outward-directed individuals could be subject to depression in confinement. Other conditions, such as lack of control over the environment, loss of support of family members, or the loss of status also could contribute to a depressive response.
For future space travelers, an especially worrisome form of depression is one following the relational breakdown between the individual and the group. As described in chapter V (see Compliance, Conformity, and Independence), this breakdown could result in ostracism (Schachter, 1959) or in the quasi-psychotic symptoms associated with "long-eye" (Rohrer, 1961).It is significant that even the adoption of group norms may not fully protect a crewmember from social ostracism. Strange and Klein (1973) have found that separated groups tend to have at least one isolated member. It seems clear that all effort must be made to ensure that ostracism, "long eye," and related phenomena do not occur in space.
 Environmental adaptation - Presently at Ieast, some psychiatric conditions are thought to represent a failure of the individual to adapt to the environment. Investigation of the stress response (Selye, 1976) reveals a range of pathologies, both physical and psychological, that can follow an inadequate adjustment to one's environment. The stress literature provides some guidelines as to which factors might influence the adaptation process.
Andrews, Tennent, Hawson, and Vaillant (1978) suggest that events which have significance to the individual can lead to stress and that the ability to deal with stress is related to patterns of coping, to personality characteristics, and to social support. Patterns of coping refer to those particular ego defenses used to deal with stress. Vaillant (1976) has found that suppression, sublimation, humor, and altruism lead to a healthy adjustment; defenses such as fantasy, projection, or passive aggression can Iead to disruption in the individual's relationship to reality, to others, or to his or her own conscience. In terms of personality characteristics, Andrews et al. suggest that anxiety proneness, self-esteem, and perceived ability to control could be important predictors of adjustment. In support of the personality hypothesis, Kobasa, Hilker, and Maddi (1979) found that, among management personnel' those who have a sense of commitment, those who feel they have control over their own lives, and those who seek novelty and challenge remain relatively free of illness, even under considerable stress. The third determinant of the Andrews et al. model relates to the environment in which the individual operates. Although it is frequently suggested that the quality of social support is more important to successful adjustment than the quantity of support, Andrews et al. (1978) note that we have very little understanding of what constitutes quality support and, by implication, very little understanding of what constitutes an adequate social support system. However, we can say with certainty that crew interaction will be a powerful determinant of general adaptation since, as Selye (1974) has pointed out, the stress of living with one another~ is among the more significant causes of distress.
Based on the Andrews et al. model, one would advise that any attempt to analyze adjustment to space should include: the significance of the event(s) to the individual, the possible multiplier effect of the individual's personality, the effectiveness of the individual's coping patterns, and the support system available.
Selection- The first defense against the occurrence of a psychological disturbance in space is personnel selection. Psychological  assessment of astronaut candidates has historically been part of the medical evaluation. In the early space program, a fairly extensive battery of tests was used, along with interviews and observations, to arrive at a judgment concerning the candidates' abilities to withstand the rigors of space. Included in this battery were standard personality tests such as the Rorschach, the Thematic Apperception Test, and the Minnesota Multiphasic Personality Inventory, along with various tests of general intelligence and special aptitude. (For a review of the psychometric procedures used in the early space program, see Ruff and Levy, 1959; Hartman and McNee, 1977.)
At the time of preparation for the Shuttle program in 1977, ten years had passed since astronaut candidates had been selected. Psychological testing procedures were reassessed and the decision was made to drop the clinical battery, relying instead on psychiatric interviews, situation testing, and general observation. For the Shuttle, two psychiatrists with differing interview styles formed the primary team for the psychological screening of candidates. The recommendations of these psychiatrists became a part of the medical evaluation submitted to the Space Medicine Board for final selection. The same psychological evaluation techniques were used for the crew and for mission specialists.7
The NASA decision to drop the clinical battery portion of the psychological selection procedure was based on findings that the earlier psychometric data had contributed little to the selection process. In this connection, it should be remembered that standardized psychological tests are intended to select out individuals (i.e., to identify those with potential pathology). Yet with a large pool of prescreened candidates, NASA's primary task was to select in individuals (i.e., to identify those with high levels of physical and emotional health). Selecting for positive attributes is clearly the more difficult task. C. Perry (1965) found that, for a group of well- qualified applicants, there was greater agreement among evaluators on which candidates were (comparatively) less qualified than on which candidates were more qualified. In the future, as manned  spaceflight attempts to accommodate a wide variety of space travelers, techniques may be needed to select out individuals whose psychological makeup could lead to problems in space. However, for the foreseeable future, the need will remain that of identifying unusually sound individuals.
Just what is a mentally sound person? One suggestion comes from the work of Vaillant (1976) and of Lindemann (1979), both of whom link emotional stability with the concept of maturity Lindemann describes a mature person as one who is able to perform the required tasks, meet ordinary stresses of life without disintegration, operate without making others sick, and adapt his or her own perceptions to reality.
The concept of maturity provides at least a starting point in the search for positive qualities associated with space adaptation. An interesting aspect of the maturity/adaptation relationship is the observation that maturity is frequently linked to a balanced approach toward people and events. As Lindemann (1979) notes specialization, by consuming so much of an individual's energy, tends to be at odds with such balance. The need for special skills and for high levels of emotional stability will present a challenge in selection for extended spaceflight.
Treatment- If a person should experience psychological problems in space, the requirements of other crewmembers as well as the needs of the individual should be taken into account in selecting a treatment strategy. Because of the special interdependence of crewmembers, procedures must be developed and an understanding reached before flight as to just when and what kinds of measures are to be employed to control aberrant behavior. On Earth drugs are commonly used in treating both acute psychotic states and many chronic conditions. It can be expected that drugs will play a similar role in space. The following are some other possibilities for avoiding or dealing with potential psychological disturbances in space.
Psychotherapy - The value of psychotherapy has long been debated in medical circles. However, there is a growing literature indicating the efficacy of psychotherapy when used alone or in conjunction with drug therapy (Marshall, 1980). For psychotherapy to be carried out in the standard fashion, a trained therapist would have to be aboard the spacecraft. Pope and Rogers (1968) found that having a psychiatrist along on an Arctic mission provided a vehicle for crewmembers to vent their hostilities, averting psychological and  emotional problems. However, having a therapist aboard a space flight may not always be an option.
An interesting alternative is the use of two-way communication for remote counseling. In recent years, various experiments involving mediated therapy have been tried. These experiments range from totally impersonal computer counseling (where the individual interacts with a preprogrammed "therapist"), to telephone therapy (where the client speaks to a trained person while retaining his or her anonymity), to two-way video phone or closed- circuit TV sessions (where a client and a therapist meet in a one-to-one relationship, separated by the medium of contact). Since these situations are less intimate than the face-to-face encounter, and give the patient considerable control over the interaction, they frequently are preferred by clients (Lester, 1974). Although all of these techniques show promise, it is not well understood which therapeutic qualities can be mediated and which cannot. Depending on the flight, another barrier to remote counseling could be the delays involved in long-distance communication.
An option to the use of professionals, either aboard or remote, would be the selection of crewmembers with therapeutic-like qualities, trained in helping skills. Carl Rogers has identified characteristics which he believes are essential for such an individual. He or she should possess congruence (stability, personal integration), empathetic understanding, and the ability to convey unconditional positive regard (C. Patterson, 1980). The concept of training for supportive behavior has been gaining acceptance in the last decade. Using models by Carkhuff (1969) and others, Egan (1975) outlines an approach for training paraprofessionals. Egan's techniques borrow from learning theory, social influence theory, behavioral modification, skills training, and problem solving techniques. Significantly, Egan sees the small group as fundamental to the development of skilled helping behavior. This and related work appear extremely promising for addressing the needs of spacecrews on extended missions.
Awareness training - Awareness, sensitivity, and related training may be useful in avoiding relational problems or in dealing with such problems when they arise. Although extensive experience has been gained with these approaches in everyday situations, we need to understand the potential benefits and limitations for confined groups. In one case in which such training was given in preparation for confinement, the crew reported that it was not only helpful, but the most valuable part of their training program (Dunlap, 1968).
 Hypnosis - Serxner (1968) has reported some success in using hypnosis to treat psychological disorders during underwater cruises of the submarine Triton. Sharpe (1969) has suggested various ways in which hypnosis might prove useful in the space environment. However, to date, hypnosis has received little serious attention as a therapeutic device for space. Yet, as Orne (1959) points out, one of the characteristics of a hypnotic trance is the "potentiality for experiencing as subjectively real, distortions of perception, memory, or feeling based on 'suggestions' by the hypnotist rather than on objective reality" (p. 297). Although such techniques would have to be used judiciously, hypnosis might help to reduce anxiety or to direct attention to specific tasks to be performed under stress. Empirical evidence supports the notion that hypnosis could be useful in training individuals to sleep when desired, and to awaken in an alert condition (Dorcus,1961). This area of research deserves attention, particularly as it offers a viable option to drug therapy.
Meditation and exercise - As discussed in chapter III, exercise has been found to have positive therapeutic effects in helping an individual maintain a sense of vitality. Of late there has also been a surge of interest in meditation, with practitioners attesting to an increased sense of calm, greater control over their lives, and higher levels of awareness.
In discussing the relationship of both meditation and exercise to well-being, Schwartz, Davidson, and Goleman (1978) draw a distinction between cognitive distress ("I have difficulty concentrating") and somatic distress ("My heart beats faster"). Their research with meditators and exercisers shows that although both groups report similar levels of upset, exercisers report less somatic, and more cognitive, disturbance than meditators. Although far from clear, a possible conclusion of this research is that techniques such as meditation and exercise could be employed to prevent or to combat particular forms of distress. The roles of meditation and exercise in addressing specific distress symptoms need to be explored.
Other - Techniques now being used to control negative reaction to stress include progressive relaxation, autogenic training, and biofeedback. Progressive relaxation involves tensing and releasing muscle groups to teach the body how to relax. Autogenic training uses self-suggestion to help individuals gain voluntary control over bodily functions. Biofeedback employs instrumentation to tell the individual how well he or she is progressing in attempts at self- regulation. It would be desirable to know how these techniques could best  be used, either individually or as part of an integrated therapeutic program.
A common method of relieving psychological upset is to engage in distracting and rewarding activities. Although there is considerable overlap in the kinds of activities people engage in, there is also considerable individual difference (Rippere, 1977). As discussed in chapter III, effort should be made to match activity options to the preferences of particular spacecrews. However, in space, activity options will necessarily be limited and space travelers will probably have to Iearn new distraction/relaxation techniques. We do not yet know how successful such substitutions will be.
In terms of future spaceflight, the value of interacting with and caring for pets should be considered. Of late, pet therapy is receiving a great deal of attention, particularly as it applies to socially and emotionally isolated individuals.
The general question of consciousness alteration or transcendant experiences in space has been raised frequently, and several episodes have occurred that heighten interest in this question. On Soyuz 7 the flight engineer reported glancing at the Earth below and hearing the sounds of a dog barking and of a child crying (Leonov and Lebedev, 1975, p. 135). On Soyuz 26 the commander apparently decided to make an unauthorized extravehicular excursion. This in itself is surprising; more surprising is the fact that he failed to attach his space suit to the restraining device and was saved from being cast into space only by the quick action of his companion, who managed to grab him just before he floated away and return him to the vehicle (Oberg, 1981). One might argue whether this latter episode represents an altered state of consciousness or simply overexuberance. Whatever the explanation, such episodes should not be summarily dismissed. Mostert (1974) reports on a phenomenon found among sailors in which young men, otherwise apparently healthy both physically and mentally, answer the "call of the water" and quietly slip into the sea. The call of the water could have a direct corollary in the "call of space."
Clark and Graybiel (1957) describe a phenomenon in which jet pilots experience a pronounced feeling of physical unreality and of separation from the Earth. For some, this phenomenon was accompanied by feelings of exhilaration and exalted powers; for others the  sensations were unpleasant and fear-inducing. Clark and Graybiel call this experience "breakoff," and conclude that the effect occurs most frequently when a pilot is alone, is flying at high altitudes, and is relatively uninvolved with the details of flight. A phenomenon which can result in flight personnel feeling dissociated from Earth (not subject to its laws) should be of concern to astronauts and mission planners.
Sours (1965) tested the hypothesis that the experience of breakoff is related to emotional and personality disorders. He found a higher incidence of breakoff experiences among aviators with positive psychiatric findings (presence of symptoms) than among other naval and marine jet aviators. Among those with psychiatric symptoms, the breakoff phenomenon generally was anxiety-producing and unpleasant. Sours concluded that the breakoff phenomenon probably precipitates an anxiety reaction in susceptible individuals. Benson (1973) examined 78 aircrewmen referred for clinical assessment because of disorientation in flight. About 40% of these men had experienced the breakoff phenomenon, and in all cases the experience was one of unease and apprehension. Since in this study breakoff was experienced by helicopter and by fixed-wing pilots, it appears that high altitude, although a contributing factor, is not necessary to the effect.
While the etiology is thought to be different, a similar phenomenon has been observed among divers and others operating under the sea. This phenomenon is usually termed "nitrogen narcosis," although it has been observed with various gas mixtures. Like the breakoff phenomenon, it is sometimes accompanied by a feeling of general euphoria or intoxicated-like state, whereas some individuals become "aggressive, irritable, insolent, and fussy" (Adolfson, 1967 p. 43). Among the changes that have been noted are a diminishing of cognitive function, a decrease in audio perception, a deterioration of motor performance, and amnesia (Behnke, Thomson, and Motley, 1935; Adolfson, 1967; Bennett,1969; Miles, 1969).
It appears that the breakoff phenomenon and nitrogen narcosis have elements in common, and both bear an intriguing resemblance to general sensory isolation effects. If breakoff and similar phenomena are found to be associated with, or aggravated by, isolation and sensory deprivation or monotony, we might expect at least some related effects to occur in extended spaceflight.
 Much more needs to be known concerning the cause of breakoff and related phenomena. The physiological correlates of altered perceptions or unusual behaviors, possibly related to atmospheric pressure as well as environmental triggers, need to be understood. The suggested relationships between personality characteristics and both the incidence and the effects of breakoff and related phenomena also need to be explored.
One does not usually think of substance abuse in relation to spaceflight; the problem of access would seem to preclude this concern. Yet Shurley, Natani, and Sengel (1977), among others, believe that substance abuse is a potential problem in space. It is unlikely, although not impossible, that there will be problems with illegal drugs. More likely would be the abuse of drugs brought aboard for medical purposes, or of accepted recreational drugs.
All spaceflights carry a medical kit containing pharmacological agents for pain, for motion sickness, and for other uses. Two questions related to the use of medicines in space need to be addressed. The first involves the interaction of drugs and weightlessness. As discussed in chapter II, we have little information on how commonly used drugs might affect individuals in a weightless environment. More specifically, and in terms of the subject matter of this chapter, we have no first-hand information on the potential effects of drugs that might be used to control psychotic episodes in space.
The second and equally important question concerns how drugs themselves might precipitate a crisis in space. Among drugs to which spacecrews might find ready access are stimulants and tranquilizers. On occasion, both categories have been associated with psychiatric symptoms. If a drug gives rise to abnormal behavior (e.g., by releasing psychological controls) the delicate balance of the isolated and confined spacecrew could be disturbed.
Alcohol is presently the only drug fully accepted for recreational purposes in American society. In fact, alcohol is so much a part of our culture that its use is considered the norm. Only when alcohol intoxication results in familial or occupational disruption do we consider alcohol use a problem. With this level of cultural acceptance, alcohol could find its way into space when resupply arrangements are in place and when storage capacity is plentiful. I n its extreme form, the use of alcohol has been linked to dependency. The  user fears rejection or failure and uses alcohol, quite literally, to "feel no pain." His use of alcohol makes him disdained by others, which reinforces the cycle of dependence, fear of failure, and rejection. Alcohol abuse can result in physical distresses such as tremors or "shakes," in vomiting, and sometimes in seizures. It can also accompany or mimic the symptoms of psychiatric disorders.
Specific data on the use of alcohol in confinement are limited. In many isolation studies, alcohol has not been available; in other situations where alcohol or other drug use could have been observed, authors are surprisingly mute. One report of alcohol use (aboard a supertanker) appears similar to the better uses alcohol finds under Earth conditions (Mostert, 1974). Here, "pourout" or the evening happy hour was apparently a very important, though very controlled, occasion, used to promote relaxation and good fellowship. However, we know that alcohol has been widely, and apparently less efficaciously, used in the Antarctic.
In one laboratory study of confinement, tobacco and alcohol were employed as experimental variables (Rogers, 1973). In this study subjects were confined for 5 days under either high or lowdecor conditions. In the relatively plush surrounding, only about half as much was spent on tobacco and alcohol as was spent under the more austere conditions. With high decor, the largest percentage of the leisure activity budget was spent for music. With the more spartan surroundings, the importance of music fell, and tobacco and alcohol became the top priority items in the leisure budget. These findings are suggestive of the importance alcohol could play in a confined and limited environment.
We need to understand more fully the impact of drugs used for medicinal purposes, especially as they influence personality change. In terms of the use of drugs for recreational or nonmedicinal purposes, we need to understand how such drugs might be employed in space. We know that isolation and confinement lead to increased emphasis on food, and probably heighten oral needs generally. In space, stimulation is low and reports of monotony and boredom are to be expected in all but the briefest flights. It is reasonable to assume that substitute methods of gratification will be sought, perhaps including the use of alcohol or other diverting drugs Alternately, the self-censuring which restricts competitive interaction in confinement may also preclude the use of drugs. It would be helpful to understand how people, given the time and opportunity, would choose to use drugs in a confined and isolated environment, and  how such use could exacerbate, or perhaps relieve, the problems of living in space.
Grief can be experienced in response to any significant loss, such as the loss of status, the loss of income, or the loss of a valued possession. However, grief is most profoundly experienced in the loss of a relationship. This loss may be temporary, as occurs m sporadic separations, or it may be permanent, as in divorce or death. Grief m its extreme form (e.g., in response to the death of a loved one) is among the most profound of all physiological and psychological stressors. One might wonder what the response to such a loss would be in the confines of space.
Bereavement and recovery- Averill (1968) distinguishes between mourning behavior, which is determined by the customs and mores of the society, and grieving, a ubiquitous reaction to loss which is found in all human and in many animal societies. Grief is marked by such psychophysiological reactions as fatigue, sleep disturbance, loss of appetite, choking or shortness of breath, empty feeling in the abdomen, lack of muscular strength, apathy, and change in the level of activity. Numerous grief researchers have noted that, although grief is relieved by other relationships, the behavior during grief is antithetical to the formation or continuance of such relationships. Typically, the grieving individual withdraws from other relationships or is antagonistic to sympathetic others. The individual experiences a loss of warmth in relationship to others and responds to their offers of concern with irritability and anger.
In the normal course of events, grief reactions follow a well-defined sequence. In the most general terms, this sequence can be described as shock, followed by despair, and eventually by recovery. Some researchers divide the stages of grief more finely. For instance, Ramsey (1977) distinguishes phases of shock, denial, depression, guilt, anxiety, aggression, and reintegration, with considerable overlap among phases.
Behaviors associated with loss and the resultant grief are well documented (Vachon, 1976). Although mania has been reported as a response to bereavement (Rickarby, 1977), depression is the more common reaction. However, behavior during the initial stages of bereavement may not mimic the inactivity usually associated with depression. Lindemann (1979) reports that depression following a  crisis or loss is often accompanied by heightened (though non-directed) activity, increased speech, or increased hostility. An episode involving such hostility which occurred in an isolated group is reported by Shurley (see San Francisco Chronicle, Sunday Punch, Jan. 14, 1982, pp. 2 and 5). A member of a South Pole expedition who had recently received word of the death of his father got drunk and went on a rampage, smashing dishes and attacking other members of the expedition. Injuries were limited to gashes and bruises; however, it was several hours before order was restored. If alcohol or drugs were to be available in space, problems associated with grief responses could be aggravated.
In some cases bereavement can threaten the life of the grieving individual. Durkheim (1951) has called attention to the incidence of suicide among widows. However, the relationship between grieving and mortality goes beyond the incidence of suicide. In a review of the data on conjugal loss, Jacobs and Ostfeld (1977) found a significantly elevated mortality rate among survivors due to a variety of causes. This elevated rate was found to be more extreme for younger than for older persons, and for men than for women.8
The activity involved in recovering from a significant loss has been termed "grief work." Grief work is a staged process in which the survivor accepts the painful emotions associated with the loss, reviews the variety of experiences shared with the lost person, and gradually rehearses and tests new patterns of interactions and roles to replace those that are lost (Lindemann, 1979). Time for recovery varies with the severity of the loss. Many therapists consider that grief lasting a year or more is within normal limits.
Most students of bereavement agree that experiencing grief is essential to recovery (see, e.g., Hodge,1972). Because of the extreme pain of grief, many individuals employ any and all defenses to avoid it, resulting in delayed or distorted reactions. A treatment that is employed in therapy sessions with those experiencing pathological grief reactions is to break down their defenses and to force them to live through the pain of their loss. Such therapy is extremely distressing to patient and therapist alike.
 From the standpoint of spaceflight selection, Ramsey's (1977) analysis contains a clue as to who might pose special bereavement problems. This author draws a correlation between phobias and extreme depression following bereavement, both being suggestive of individuals whose inclination is o avoid confrontation and to escape from difficult situations. The relationship between phobic behavior and distorted grieving requires testing.
Since there is consensus that little can be done to help a person who is experiencing normal grief, space planners must concentrate on ensuring that, in the event of a loss, the grief of a crewmember follows a normal course. Just what is a normal course of grief for a space traveler can only be speculated upon. If a loved one at home should die, it can be assumed that the space traveler has already passed through some anticipatory grief in the process of prolonged separation (Moss and Moss, 1973); but a loss under these conditions can be expected to be accompanied by extreme feelings of helplessness and guilt. And, if bereavement occurs at a time when the person is confronted by important tasks, or when there is a necessity to maintain the morale of others (conditions likely in space), that person may postpone normal grief reaction for a prolonged period of time (Lindemann, 1977).
Death aboard the spacecraft- A death aboard the spacecraft can be expected to have a profound effect on the crew. Yet, as spaceflight continues to expand, it seems likely that a death will eventually occur away from the home planet. When this happens, crewmembers will be required to deal with both the physical and the psychological demands of the situation. If the person who dies is central to the operation, his or her passing can be expected to have dramatic repercussions throughout the system. In addition, there will be the factor of grief. Although one might expect that the grief associated with the loss of a crewmate would be less distressing than grief in response to the loss of a family member, this may not be the case. Lindemann (1977) points out that the strength of a grief reaction is directly related to the intensity of the interaction with the deceased before death and that this interaction need not have been positive. The interaction of crewmates may or may not be positive, but it is likely to be intense. These factors suggest that the death of a crewmember would be an extremely traumatic event, affecting the surviving crewmembers on many levels, both practical and emotional.
 Cohen (1976) provides insight into the aftereffects of such a loss. At the sudden death of one of their members, a therapy group first reacted with shock and sadness. This period was brief and rapidly was replaced by normal group activity. However, the group remained resistant to any activity which related to their deceased member. Three attempts to introduce a new member to the group met with failure. Cohen concludes that the unresolved feelings of responsibility for, and guilt concerning, the death of the lost member were sufficiently strong that the group members were unwilling to risk accepting a new member. A similar rejection could occur in space if a new crewmember were introduced to replace a deceased member.
Homicide and suicide - Chapter I has described how tendencies to act out are dealt with in confinement. Oversimplified, such tendencies are consciously suppressed. When they do occur, they appear in altered forms, such as the "pinging" or taunting behavior observed among members of the submarine Seawolf (Ebersole, 1960), or the loud cries and shrieks displayed during runs on the SAM two-man space cabin (Cramer and Flinn, 1963). Confined groups appear to be painfully aware of the costs of allowing violent tendencies to surface, and seek to avoid confrontation, even if this means curtailing activity. The reverse side of this relationship has also been observed. Mostert (1974), reporting on life on a supertanker, notes that whenever the level of energy was allowed to rise, as during pool games, the activity turned violent.
Much work needs to be done to determine how acting-out tendencies can be dissipated safely in extended spaceflight. However, it seems unlikely that a serious physical attack by one crewmember upon another would occur in any but the most prolonged space missions. (The issue of the special juridical requirements of space is considered in chapter VIII.)
The likelihood that a crewmember would injure himself or herself does seem significant, and the possibility of a suicide occurring on an extended flight should be considered. Breed (1972) provides insight into the characteristics that might help identify a potential suicide. Noting the convergence of his research results and those of Miller (1967) and Miller and Goleman (1970), Breed suggests that the typical suicide victim is a rigid person of high commitment, who, on meeting serious failure, experiences shame and eventually becomes socially isolated. Such individuals, like all committed persons, set high standards for themselves and identify strongly with their goals. However, because they are rigid, they are unable to  shift their goals. Since they see society as incapable of supplying needed regulation, they respond with excessive self-regulation. Breed reports that many of the suicide cases he studied were described as overly neat, meticulous perfectionists who gave scrupulous attention to personal tradition. After Neuringer (1964), Breed uses the term "brittleness" to describe the affective and cognitive orientations of these individuals. Failure is identified as a central factor in suicide, with shame the perfectionist's response to failure. Failure-shame act as the precipitating force which mobilizes the person toward the suicide response.
The final component in the suicide syndrome is social isolation. The individuals perceive negative reactions or labeling from those around them. This process is so painful to them that they withdraw from their present associations. These individuals do not seek new contacts, since they believe such contacts will also condemn them. Such persons become isolated and are unable to receive the legitimization and validation necessary for any individual to function. Significantly, this description of the would-be suicide does not rest on the concept of mental illness. Although the individual is depressed, the depression is less important than his or her inability to consider other solutions.
As applied to space, Breed's analysis suggests some selection guidelines. The inflexible, single-goal-oriented individual described is extreme, but is recognizable as a hard-working, self-directed, high achiever. These are qualities that would lead an individual into, and make him or her a valued member of, a space mission. But it is fair to say that, given the pressures of space, these qualities are not enough. For extended spaceflight, individuals must be competent and committed; they must also be capable of dealing with the inevitable failures in a nondestructive manner.
Again, the possible compounding effects of alcohol and drugs must be considered. It is perhaps significant that the one homicide that has occurred in recent history among isolated teams developed from a dispute over the distribution of wine (Time, Sept. 28,1970). Excessive alcohol use has been related to depression, with high rates of suicide being recorded by alcohol abusers (Zimberg, 1976). Among drugs, barbiturates are the most commonly employed agents in suicide attempts (Robbing, Angus, and Stern,1976).
It is axiomatic that a threat of suicide probably means serious intent. There are other signs that a person is contemplating or has  decided to make a suicide attempt. Among these signs are making plans to give away or actually giving away valued possessions, and the sudden and unexplained onset of calm in an individual who has been distraught. Space travelers should be taught to recognize the significance of these behaviors.
Crisis intervention techniques seem particularly well suited for dealing with the immediate responses to crises that could arise in space. (For a description of the theory and methodology of crisis intervention, see Aguilera and Messick, 1974.) Crisis intervention has evolved from the community health medicine field and therefore is structured to operate in an environment with limited resources. Crisis intervention recognizes that there are patterns of behavior in many crisis situations, and focuses attention, not on the psychodynamics of the person, but rather on helping the individual to deal with the immediate problem.
Steps in crisis intervention are
1. Assessment of the problem and the person's response to it. Although the cause of the individual's distress may be obvious, the therapist must take into consideration the likely responses of the individual.
2. Planning of therapeutic intervention. At this stage the therapist explores with the individual the disruption to the person's life and the lives of others, as well as what strengths, coping skills, and supports the individual may be able to bring to the situation.
3. Intervention. Here, the therapist aids the individual in understanding the event, in expressing his or her feelings about it, in exploring and testing coping strategies, and in replacing some of the roles disrupted by the loss.
4. Reaffirmation of the progress made. The final stage reviews the strategies that have been successful and helps the individual plan for the future (Morley, Messick, and Aguilera, 1967).
The goal of crisis intervention is a rapid return of the individual to a state of equilibrium. The length of time usually required for intervention is about 4-6 wk (Jacobson, 1965). Most important to the requirements of space, this approach to crisis intervention is  designed to be carried out by non-health-professionals. Some or all crewmembers could receive intervention training as part of their overall orientation.
Implications for Space
A crisis in space could arise from any of a number of psychological and/or relational disruptions occurring within the spacecrew. Of the various psychological factors that could menace the integrity of the crew, depression poses a particular threat. Of those factors that could lead to a depressive response, the relationship of the individual to the group appears the most volatile. Being ostracized from a group that is itself isolated can be expected to result in severe, and potentially unbearable, pressures on a space traveler. Ostracism must be actively planned against. One suggestion is the use of a "buddy" system, where each individual is assigned a partner whose responsibility it is to understand that person's perspective and to defend him or her, if needed, to the larger group. However, the more important need is to understand more fully the factors that contribute to the occurrence of ostracism.
Closely related to the issue of psychological well-being is the question of how well an individual performs a work assignment. Even in the enriched environment of Earth, the relationship of an individual to his or her work takes on special significance (Breed, 1972). Rushing (1968), Maris (1969), and Richman and Rosenbaum (1970) all have noted the primacy of job failure in the syndrome of suicide. In isolation, work takes on an added significance. We can reasonably expect that if job-related failure should occur in space, it would place a severe strain both on the individual and on his or her relationship to the rest of the crew.
6 Recent work emphasizes the role of minor as well as major events in physical and psychological illness (Lazarus Richard S; Little Hassles Can Be Hazardous to Health . Psychology Today (July 1981).
7 It should be noted that NASA selects only NASA astronauts The Department of Defense will select its own payload specialists for Shuttle f-lights European payload specialists who are part of the cooperative NASA-European Spacelab Program are selected through the European Space Agency which employs its own selection procedures (Shapland D J J DeWaard and G Nichols; Choosing ESA's First Astronaut ESA Bulletin No 13 21-28 May 1978).
8 Lindemann (1977) notes that one of the distorted reactions to grief is the adoption of symptoms associated with the last illness of the deceased. Perhaps related is the tendency noted by Parkes et al. (Parhes, C. M., B. Benjamin and R. G. Fitzgerald; Broken Heart: A Statistical Study of Increase of Mortality Among Widows. British Medical Journal , 1, 740-743, 1969) for bereaved widows to die of the same illness that claimed their spouses.