Stress among UAV Operators: Posttraumatic Stress Disorder, Existential Crisis, or Moral Injury?

In recent years the media have reported with increasing frequency on the psychological stress incurred among pilots of unmanned aerial vehicles (UAVs) popularly referred to as “drones”. As recently as February 22, 2013, the New York Times reported that research sponsored by the U.S. Department of Defense showed that UAV pilots experience posttraumatic stress disorder rates similar to that of other, more traditional, combatants.¹ Despite the extensive media coverage, there is little scientific evidence to support the contention that UAV pilots are more or less prone to combat stress related disorders in comparison to ground forces or pilots of traditional combat aircraft. Indeed, a search of the PsychINFO database revealed only one published experiment on the topic of stress and UAV pilots.²

The researchers employed a quasi-experi­mental design to investigate the impact of flying a simulated UAV mission that resulted in enemy loss of life on stress as measured by the Impact of Event Scale–Revised.³ Half of the 30 participants flew a simulated UAV mission on a commercially obtained flight simulation game, and following the mission viewed actual videos of the aftermath of a UAV mission that resulted in enemy loss of life. The other half did not participate in a simulation but viewed the same video. The study also looked at the effect of gender on stress. The results showed a main effect for simulation versus no simulation, with participants who flew the simulated mission showing significantly higher levels of stress than those who did not fly the mission. Additionally, women reported higher levels of stress than the male participants. The interaction between the simulation condition and gender was not statistically significant. While these findings are congruent with the view that UAV operators may be vulnerable to mission-related stress, the authors underscore that additional experiments using trained UAV pilots and more sophisticated simulations are needed to establish the ecological validity of the results.

It is worth considering whether or not experiences of UAV pilots meet the definition of PTSD. According to the latest edition of the Diagnostic and Statistical Manual of the American Psychiatric Association⁴, PTSD is an anxiety disorder that occurs in response to exposure to a traumatic experience, such as in a victim of a violent crime, serious bodily injury, or threat of death or serious bodily injury. Typical symptoms include flashbacks, blunted affect, hyper arousal, social disruption, nightmares and disturbed sleep, and sometimes aggression. Symptoms must persist for a month to support a clinical diagnosis of PTSD. Because UAV pilots do not directly experience trauma as defined by the DSM-V, one can argue that whatever psychological distress they may experience after flying missions it is not, strictly speaking, PTSD.

Paul Bartone offers an alternative model for understanding the psychological impact of military service, particularly for situations that do not meet the diagnostic criteria for PTSD.⁵ Bartone suggests that combat may erode the sense of meaning of life among soldiers, leading to a form of existential neurosis. This existential crisis may be accompanied by changes in cognition, affect, and behavior that overlap with PTSD symptoms. In some cases, it could lead to suicide. This view may be especially relevant to UAV pilots. While they do not personally experience trauma, per se, they indeed see or can imagine the mortal consequences of their actions.

Psychiatrist Larry Dewey has spent his career providing care for veterans with psychological disorders. The common denominator among the thousands of veterans he has treated for a myriad of disorders is the impact of killing on meaning making.⁶ Dewey maintains that the majority of his clients suffer a loss of meaning in life, in many characterized by a loss of religion or spirituality, that leads to a host of psychological consequences, including PTSD and depression. For Dewey, how you kill matters less than the comprehension of the fact that you have taken the lives of others.

Nash and Litz⁷ suggest that moral injury may be a factor in causing psychological problems among military personnel. Closely related to both Bartone’s and Dewey’s views, the concept of moral injury holds that when a person engages in behavior that violates his or her personal moral standard, psychological disorder may follow. Almost all people in all societies, regardless of their particular religious or spiritual beliefs, sanctify life. When forced to take life, even under the auspices of legitimate war, military members are likely to experience a dissonance between long held belief systems and their own behavior. Because UAV missions may often result in the death of non-combatants, the dissonance between belief structure and behavior may be even greater, leading to an even more severe psychological reaction.

This view also suggests that the psychological challenge faced by UAV pilots is not substantively different from that faced by other military members. It follows that a variety of general strategies should be developed to prevent, treat, or reduce the severity of the psychological injuries that commonly follow combat. Some avenues for accomplishing this follow.

Improved selection. Potential UAV pilots should be screened for pre-existing conditions or experiences that may predispose them to stress-related reactions. Prior drug or alcohol abuse, a history of poor family or social adjustment, and pre-existing psychological problems may greatly increase vulnerability to combat stress.

Improved training. Programs tailored after the U.S. Army’s Comprehensive Soldier Fitness (CSF) Program may be designed to help UAV pilots develop the emotional, social, and spiritual skills needed to cope effectively with the demands of combat.⁸ Barnes, Banks, Albanese, and Steger describe actions leaders can take to improve meaning making among subordinates, providing protection against the existential crises that most people experience after taking lives.⁹

Hardiness training. Salvatore Maddi describes the concept of psychological hardiness and its role in psychological health, especially in trying circumstances.¹⁰ Military members high in hardiness perform and adapt better than those low in hardiness.¹¹ Valid hardiness training protocols exist, and UAV pilots could be given this training to increase their resilience to combat stress.

Cohesion. Members of highly cohesive military units are significantly less vulnerable to combat stress than members of less cohesive units. Among U.S. ground forces, elite units – Rangers, Delta Force, and the like – are less than 50 percent as likely to experience PTSD as members of standard units. One reason for this is the highly cohesive nature of military special forces. Zaccaro, Weis, Hilton, and Jeffries describe the relationship between unit cohesion and psychological adjustment, and outline ways of developing more cohesive teams.¹² For UAV pilots, the social support of peers in a highly cohesive team environment may provide a major protective factor against combat stress.

Treatment. More effective psychopharmacological interventions may be developed to reduce or prevent adverse psychological reactions among UAV pilots. Emerging digital technologies may be used to train improved resilience skills. For example, virtual reality systems are being developed to treat combat stress and to prevent it from developing in the first place.¹³

An interesting paradox is that, in the larger sense, some of the natural reactions that UAV pilots and other combatants have to killing and combat – while personally damaging – may be socially adaptive. I have speculated elsewhere that biological psychologists may soon be able to manipulate brain chemistry in ways that eliminate the sense of despair or guilt that accompany killing.¹⁴ While this might help the individual soldier be more effective in killing the enemy, such interventions run the risk of removing a natural barrier to killing that, once absent, could increase unsanctioned violence when the soldier leaves the war zone or returns to civilian society. Said another way, humans may be genetically wired to be repulsed by killing. In the absence of this repulsion, social chaos could ensue.

It is also important to note that social and cultural support for UAV pilots provides a critical protective factor. Besides unit cohesion, having a network of peers, friends, and family that understand and appreciate the value of the pilot’s work helps minimize guilt and moral injury. The military often attempts to frame and defend killing from a religious perspective, claiming that its own military objectives are on the side of good and justice. Military members themselves turn to religion to allay doubts about their actions. Finally, military members who enjoy the support of their fellow citizens may derive greater meaning. In the U.S., one can compare the hero’s welcome experienced by its troops following World War II with the hostile reception many Vietnam veterans received upon their return from the war.

In conclusion, relatively little empirical evidence exists about the psychological consequences UAV pilots experience after killing the enemy or noncombatants. In most ways, killing with a missile launched by a UAV is not much different than killing with artillery or other indirect fire weapons. A soldier does not have to personally see corpses to know he or she has taken life. While this may not neatly fit the concept of PTSD, it is consistent with the idea that existential threat and moral injury may cause lasting harm to UAV pilots. While psychologists may play a key role in preventing and treating these reactions, in the end human nature may dictate how effective these strategies may be. War always has been, and will continue to be, a morally hazardous endeavor.