Pilots and Fear of Heights

It’s Probably Normal 
By Richard R. Grayson, M.D.
Senior Aviation Medical Examiner
Geneva, Illinois

A pilot and I were talking about fear of high places, called acrophobia. (From the 
Greek ἄκρος, meaning summit.)  He related to me that he had no fear when flying an 
ultralight, even though all his supports were above and behind him. But when he tries to look out the window of a tall building, he can’t do it if he’s looking down. He has to back up to the wall so he’s not near the window.  And this pilot has 20,000 hours and flies airliners at 37,000 feet. 
That reminded me of the time I took the elevator to the top of the Washington monument in D.C. and tried to look out the window.  I had the distinct sensation that the building was falling over and I had to get back to the inner wall.  I had the same thing happen the last time I was in a room on the 40th floor of a high rise.  It doesn’t happen when looking out an airliner window, however.  And I spent many happy hours on my one story roof for 30 years maintaining my ham radio antennas. 
I have met many pilots in the course of my career as an aviation medical examiner who admitted a fear of height.  The pilots and I always have called this a phobia and  I think most of us have a sense of guilt for having this defect.  Now, however, I am not so sure that it’s a phobia. A phobia is an irrational fear and thus is a neurosis. But wait; maybe it’s a form of vertigo.  If it is, we’re off the hook. 
I checked the internet and found a forum for pilots who confessed acrophobia. Some of their comments follow: 
 “I looked up to see workers on a bridge tower at 400 feet and felt nauseous, but 3 hours before I was flying over the same bridge with no problem” 
“Put me up a tree and I’m almost paralyzed, but in the cockpit, I’m fine” 
“I’m horrified of heights but no problems sitting in the cockpit.” 
“As RAF I’m not bothered about inverted spinning at 18,000 feet, but the wife changes the light bulbs at home. I think the fear of heights is a fear of falling. In an aircraft you’re fastened to a chair and you brain thinks you can’t fall out.” 
“My friends think it’s hilarious that they know a pilot who’s scared of heights.” 
“Put me in a 737 at 35,000 feet and no problem.  Put me on a ladder at 6 feet and I’m in real trouble.” 
“Bizarre. I thought it was just me! I can’t bring myself to ride my bike over the Dartford Bridge, yet the other day I was happily doing a tight turn at 1,500 feet over the same bridge.” 
I don’t know what the prevalence of acrophobia is among pilots or among the general public, but I have read one author who thinks it is more common among pilots. It really doesn’t matter.  The main fact is that if you have this, you are not alone, and the fear of heights might be no hindrance to being a pilot. 
Some experts on the subject object to using the term vertigo for fear of heights. Maybe they are wrong. “Height vertigo” or “vertical vertigo” is defined as dizziness experienced when looking down from a great height or in looking up at a high building or cliff.” It has something to do with the wiring in your brain and the inner ear. 
A theory has been proposed that there is a geometrical explanation of height vertigo as “distance vertigo”. This seems to be created by visual destabilization of posture when the distance between the observer and the visible stationary objects become critically large. 
The fear of heights might be psychogenic in some cases and it might be caused by physiologic height vertigo in others. It might be a combination of both etiologies in some people. I have searched the literature in vain for a solution to the condition.  However, I just saw a possible therapy on television, on CNN. It was a demonstration of a new high tech treatment of post traumatic stress disorder (PTSD) in Iraq veterans by American military psychologists using virtual reality simulation hardware and software.  The patient undergoes reconditioning of his fears by reliving them in a safe environment.  I think we will see this technology applied to acrophobia and fear of flying.  I hope so. 
Some Wag suggested that we start a support group for those afflicted with this malady.  He wants to call the group (AAA) Altitude Avoidance Anonymous. -30