Fall 2011’s Alert Diver Magazine features a piece entitled ‘Psychiatric Fitness to Dive’, authored by Adam Roth MD. I was pleasantly surprised to find the article, as the issue of mental health is a critical one with regard to not only overall ‘fitness to dive’, but also day to day decision making by the individual taking on a diving activity.
The article goes on to list several psychiatric disorders including depression, bipolar disorder, anxiety, post-traumatic stress disorder, and schizophrenia – all as biological psychiatric disorders needing consideration when diving. The article goes on to suggest that as high as 50% of Americans have had episodes of these illnesses in varying degrees of severity.
Now, of course, complicating the activity of diving is that our fundamental needs for survival are challenged – breathing. We have to maintain the wherewithal to manage an artificially supplied breathing medium, and this is regardless of any factors contributing to elevated levels of stress. Many of these stressors are inherent to the activity – gas supply, narcosis, depth and time limits, location of the boat and one’s dive partner, and so one. It goes without saying that having a clear head before diving is a necessary thing.
So, assessing fitness to dive when considering psychiatric illness remains a complicated task. Do any of the above factors trigger anxiety or depression? to what extent? are medications needed? could these medications trigger physiological problems or other responses due to effects of pressure? The answers are that we just don’t know everything we need to know about mental health and diving.
My opinion is that the examining physician needs to determine if the individual can exercise sound judgment in exposing him/herself to this uniquely stressful environment and make the decision to terminate the dive before the viscious cycle of stress-anxiety-panic sets in. Conditions requiring some medications may be contraindications to this, as are severe panic disorders.
Complicating this mental fitness to dive is for us diving professionals. In recreational and scientific diving, making the dive is the choice of the diver, and this decision cannot be refuted. Commercial divers are often in difficult situations where not making the dive costs the employer or project significant setbacks – both productively and financially. Of course, this attitude subjects all to greater risk, as dives are often made where the diver questions his/her willingness, interest, or abilities to make this dive, but ‘its part of the job’.
I’ve had my share of mornings where I just don’t want to go to work. Unlike many however, where the option may be to zone out behind a desk in the relative comfort of terrestrial space, my only option is to still perform in an extreme environment where I am both physically and psychologically challenged. I’ve been in the situation where the dives have to be made regardless of which side of the bed one wakes up on, and its never a good one. Not wanting to make a dive (for any reason) causes psychological stress. Entering the water with this underlying stress complicates the entire process, and if not properly managed, can have considerable impacts on the ability to achieve the task at hand. To address this, I’ve developed (or rather extracted from deep within) coping mechanisms that are triggered when I first hit the water. These are changes in breathing patterns, creating visual focal points (particularly in blackwater), identifying physical references from the work area to the surface (generally false securities), and so on. These are all subconscious things I do that I’ve identified doing time and time again to get through the day. Adaptation is a wonderful thing.
I truly believe that it comes down to understanding personal limitations. To do this, you need a significantly heightened sense of self awareness and understanding how you cope when challenged with stress. Seeing this in advance is no easy task, and quite likely not possible for those who may have more severe psychiatric disorders. For that reason alone, psychiatric fitness to dive is in need of becoming an assessment point during medical evaluations.