Outer space is terrifying — not just on the body, but also on the mind. Extreme environments and situations can stretch people’s minds to the brink of sanity, and outer space is no exception. Sure, astronauts are protected inside their multimillion-dollar spacecraft, but those confined little metallic boxes can make one feel isolated and trapped. And we’re also making strides to put humans on other planets.

All that time in the deep dark void — probably not good for the noggin, right?

Thankfully, NASA’s on it. Welcome to the world alternately called aerospace psychiatry and psychology — a field of medicine where one provides mental health support to aviation professionals.

Astronauts, in particular, have been the focus group for decades now. They’re people who we typically think of as the best of the best, “who are otherwise quite healthy, but operate in an abnormal environment,” says Gary Beven, NASA Flight Surgeon and Chief of Aerospace Psychiatry at NASA Johnson Space Center.

Although the U.S. beat Russia to the moon, it was the Russians who started aerospace psychology. Beven explains that during missions onboard the Salyut 6 (1977 - 1982) and Salyut 7 (1982 - 1991) space stations, Soviet cosmonauts began to experience noticeable signs of psychological distress (or physical problems with an underlying psychological cause) while in space.

Taylor Swift would do poorly in space.
Taylor Swift would do poorly in space. 

This most likely had to do with the longer durations of these missions. Salyut 6 had the first six-month space mission, while Salyut 7 upped the ante with the first-ever eight-month mission. Each mission put two or three cosmonauts in a fairly tight quarters with one another. Several crew stints had to be terminated before completion.

The Russians were spurred into establishing their own space psychology program. “They brought in experts within the field of psychology to work full-time with the Russian space program,” says Beven. “They were involved not only with cosmonaut selection, but also providing support and monitoring the psychological well-being of astronauts while they were in space.”

Until fairly recently, NASA wasn’t interested in long duration missions, so they had no need for psychologists or psychiatrists beyond the initial medical and mental health evaluation during the candidate selection process.

That changed in the mid 1990s, when the U.S. and Russia established the Shuttle-Mir Program to allow NASA to learn about Russia’s experiences with long-duration space habitation. At that point, NASA brought in a group of psychologists and psychiatrists to develop a behavioral health and support group for the NASA astronauts that were staying aboard Russia’s Mir space station.

Space Shuttle Atlantis docking to Mir.
Space Shuttle Atlantis docking to Mir. 

“Life aboard Mir was very arduous and very difficult,” says Beven. “Some of the (U.S.) astronauts even admitted they felt they had not been psychologically prepared for that type of a mission.” Some did exceptionally well, like Shannon Lucid (who stayed on Mir for seven months in 1996), but others publicly acknowledged the difficulty of living in an orbital spacecraft for months at a time. Part of the feelings of psychological anxiety and depression that crept up were simply the result of isolation, difficulty communicating with Russian counterparts on the station, the lack of leisure activities on Mir.

With all that qualitative data and feedback, NASA refined the aerospace psychiatry system as it and the rest of the world began moving forward with the International Space Station. Today’s aerospace psychiatry group supports astronauts from the time of training all the way through the end of the mission — and even beyond to assist with post-mission acclimation to life on the ground. “In some ways, we may be involved with astronauts all the way to the end of their career,” says Beven. “We get to know them very well, and we also get to know their families very well.”

Beven says the candidate selection process is probably the most important way to prepare astronauts for the mental rigors of space travel and life. The goal is to pick candidates who possess sound, sturdy minds. Beven and his team grade candidates on nine different “suitability proficiencies”:

  • ability to perform under stressful conditions
  • group living skills
  • teamwork skills
  • self-regulation of one’s emotions and mood
  • motivation
  • judgement and decision making
  • conscientiousness
  • communication skills
  • leadership skills

They also screen for any history of major mental disorders or disqualifying problems. For the most part, candidates come from occupations where good mental health and the aforementioned traits are already a necessity, sometimes in already extreme or stressful environments — such as fighter pilot living aboard an aircraft carrier, or a scientist who has done stints at research stations in Antarctica. When you’re talking about picking 10 astronauts to train out of a final list of 60 people, you’re really getting the most mentally and behaviorally qualified group, says Beven.

The vast majority of the aerospace psychiatry group’s work, however, revolves around proactively working with active astronauts. Beven says there are a little over 40 active astronauts currently working at NASA, and each one is notified they’ll be going up into space about two years prior to the mission launch.

Beven and his team start to work directly with the astronaut (and their spouse), and their work can be categorized into two parts. The first is behavioral medicine: evaluating astronauts’ mental health at regular intervals before launch (the last meeting happening 60 days before launch) and training them to identify and deal with instances of psychological detriment in other crew members.

Up in space, Beven or his colleagues will do a private video conference with each astronaut about every two weeks to go over everything pertaining to sleep, crew morale, if that astronaut is dealing well with the workload or experiencing fatigue (or even feeling underworked), their relationship with the ground team, concerns with family, and anything else. If they need immediate help, they can call Beven’s cell phone or send him an email in an instant, at any given moment. If any major concerns arise out of these avenues of communication, Beven and his team will confer with the flight surgeon to decide on a course of action.

What kinds of problems are we talking about? For the most part, the typical psychological problems you’d find in space are no different from what you’d find in a high-stress environment here on the surface. They include:

  • difficulty sleeping
  • irritability
  • mood lability
  • feelings of discouragement
  • heightened nervousness or anxiety

A nurse working in the E.R. or a long distance runner training for a marathon might experience these kinds of symptoms pretty regularly. But when an astronaut — who is trained more rigorously to withstand stressors — starts to experience these kinds of symptoms, there’s a much larger cause for concern, since they’re essentially trapped up there in space.

Beven says these problems are not unlike what you might find for someone who is unfamiliar to a long winter in a northern country, or a prisoner who is placed in solitary confinement. “There’s nothing unique about the symptoms themselves. What’s unique is that, given the spaceflight environment, there’s no analogue for them here on Earth, because of the microgravity.”

After getting back to Earth, the astronaut undergoes three more psychological assessments — at 3 days, 14 days, and 30 to 45 days after getting back — to go over lessons learned in hindsight and help the astronaut adjust to their new role on the ground.

“Many astronauts, when they land, might not fly again for several years, so they need to determine if they will stay with NASA, or do something else,” Beven says — which can be a very difficult, debilitating decision, even among the least neurotic among humans.

The other facet is what Beven calls behavioral support: it’s essentially the way he and his team make sure an astronaut has access to hobbies or forms of entertainment that they can indulge in in their leisure time to unwind and de-stress. It could range from music, to watching sporting events or television, having access to games — whatever. Even astronauts love to watch Game of Thrones, and it’s critical to keeping their sanity.

“Our belief is that if you’re forced for six months or more to live and work in your office, the downtime really needs to be rejuvenating,” says Beven.

So far NASA’s aerospace psychiatry program has been very successful. Beven says that every astronaut performs “exceptionally well,” for 95 percent or more of their mission duration. “Occasionally, they dip down to more mundane frustrations or frictions,” he concedes. Yet, for the entire time he and his team have been working with the ISS, “we’ve not noticed anything that would be of clinical significance,” nor anything that would terminate any mission or procedural activity due to psychological detriment.

Artist's rendering of Mars Semi-Direct/DRA 1.0: The Manned Habitat Unit is “docked” alongside a pre placed habitat that was sent ahead of the Earth Return Vehicle.
Artist's rendering of Mars Semi-Direct/DRA 1.0: The Manned Habitat Unit is "docked" alongside a pre placed habitat that was sent ahead of the Earth Return Vehicle.

This is all thanks to the constant communication and support the team can provide astronauts while they’re up there in space. But as space travel begins to expand — both in allowing more people access to space travel, and in sending more people out to greater distances beyond Earth’s orbit — aerospace psychology will need to change. “In the next 10, 20, or even 50 years, how are we going to provide the system to allow the first Mars crew the same opportunities for psychological support that the ISS crew has — even if there is a 45-minute delay in communications?” asks Beven.

One idea: using A.I. programs to that can provide instant cognitive behavioral therapy to astronauts onboard a spacecraft or working on a Martian or lunar colony. A future astronaut may be having bi-weekly meetings with an artificial robot on their iPad, instead of chatting so frequently with a human being here on Earth. “I don’t think anything on Earth right now has been proven to work in that realm, but that’s something we need to make certain is working,” says Beven.

And as spaceflight becomes commercialized and low-Earth orbit operations are turned over to private companies, it’s unlikely commercial astronauts will be as rigorously screened as NASA’s astronauts are right now. Beven predicts “there will be someone who does have the first psychotic episode in space,” or the first manic episode, or someone who develops a drug or alcohol problem in space.

But he’s optimistic: “The way in which those things are dealt with will spread into the psychiatric and psychological community.” He thinks, for example, an asteroid mining community will likely contract with a healthcare provider or institution, and work with them to provide on-call psychiatrist and psychologists who are available 24/7. Or, making sure a general physician who is there can detect signs of psychological problems and provide some sort of solution.

At some point, we’ll see the first marriage in space, the first child born in space, and more — especially once we see a colony in space or somewhere on another world. “Space travel is becoming normal,” says Beven. It’s only natural that mental health services acclimate to those changes as well.

Photos via NASA, NASA/Scott Kelly

Neel is a science and tech journalist from New York City, reporting on everything from brain-eating amoebas to space lasers used to zap debris out of orbit, for places like Popular Science and WIRED. He's addicted to black coffee, old pinball machines, and terrible dive bars.