Psychiatric problems at sea

Disturbed sleep, night watches, living in close proximity to relative strangers, stressful situations and unwanted side effects from seasickness tablets all contribute to an increased risk of mental illness at sea. There have been plenty of reports of people developing psychosis on long oean trips.

Sometimes sea sickness means that long term mood stabilising medication doesn 't get taken or the the medication just got forgotten in the packing list. We know of instances of delerium tremens being precipitated by acute alchohol withdrawl a few days into a "dry voyage". We, ourselves, have had experience of of a crewman member on one of our cruises whose depression was made worse by some of the above factors and became very poorly indeed.

I wonder if other Ocean Cruising Club members have come across psychiatric problems on their voyages and how these resolved themselves? What made things worse and how did the other crew cope with mental illness in their midst?

Simon

Hi Simon,
As a Clinical Psychologist/Psycho-analyst I can pretty much assure that interviews and even prior acquaintance and friendship will not ensure that problems could arise. The best defense is outright questions about prior problems that have diminished their effectiveness. This can be a general question covering such common areas like back vulnerability, general health concerns (diabetes) and segwaying into the topic of prior mental challenges. It would be reasonable to ask what the most stressful event in his/her has been and his reaction.
That said, offshore passages, can be unlike most other experiences in life and may entail unpredictable reactions. Interrupted: more to follow.
Dick Stevenson, s/v Alchemy

Back again,
The medication I know from anecdotal evidence to produce psychosis/hallucinations in some individuals is scopolamine patches. This is rare, but one is wise to have self and crew use the patch for a few days on shore prior to the trip to see if there are adverse reactions.
A good part of the prediction problem is that offshore sailing challenges are unlike most land based activities. I cover some of this in my article on key attitudes for offshore sailors that I wrote for the US Naval Academy publication, The Helmsman: http://www.ussailing.org/wp-content/uploads/DARoot/Offshore/SAS%20Studies/The_Helmsman_2015.pdf.
To summarize: little prepares us for the: sustained discomfort, fatigue, unknown timing of ending (not knowing when something will end is a big deal), sleep disrupting, physically demanding, personally intimate aspects of an offshore passage, especially a challenging one. It is hard to predict how some will respond to the fear inducing elements, the vastness and emptiness of the horizon, the ongoing need for attentiveness etc.
The questions Simon addresses are among the reasons that Ginger and I have not taken crew on our longer passages, at least to date. More for medical reasons than psychiatric, when we have had crew/friends visiting in out of the way places, I ask them to put a medical history in an envelope to be opened only if necessary. This may not be necessary if it is a couple visiting, but definitely is for those visiting as singles.
How to assess crew, especially friends, can be a whole topic in itself.
My best, Dick Stevenson, s/v Alchemy

Thanks Dick some good sensible advice there.

Dick, Simon - this topic could be the subject of another paper on best practices.

Vice Commodore, OCC 

Daria,
When chatting with another OCC couple this morning we wondered if we should develop a medical seminar for cruisers? I know there are a lot of such courses but the OCC obviously has a wealth of experience to offer.
Simon

Simon, I think it 's a great idea. I haven 't seen a medical seminar at the boat shows nor in the SSCA webinar series and the issue always comes up. Even the threads here have proven valuable.

In doing a search for medicine for sailors, I came up with a couple of listings but not many. I think it would be very valuable. I attended a seminar on wilderness medicine before we set off because there was nothing specific for sailors. I have Eric Weiss 's book aboard. And the Merck Manual as backup.

http://www.ocscsailing.com/school/courses/mariners_medicine.php

Vice Commodore, OCC 

Daria,

Interesting that there 's not much already out there so maybe it would be popular?

I had in mind an informal weekend workshop where folk could talk about their own experiences and concerns and build in some practical hands on stuff stitching pig 's trotters back together, playing with catheters and giving subcutaneous fluids etc.

More aimed at problem solving drawing on the experience of our members rather than a rigid course structure.

I will put some ideas down for the February Committee Meeting but would welcome any other comments or ideas on this thread in the Forum.


Simon

Hi Simon & Daria,
There are a number of wilderness medicine courses available on the US side of the pond. The best are aimed at those who wander where First Responders are not available.
Jeff Isaacs’ courses are well thought of (often done under the umbrella of Ocean Navigator magazine) and we (Ginger and I) feel his book(s) are among the best: in part as his focus is on first determining what is a true emergency (and whether an evac is warranted). He is very practical as well as follows because his experience base is in this area: wilderness medicine and emergency work where hospitals etc. are not available. We thought his weekend course superb.
In casual conversation with other cruisers and in running one medical (update skills) seminar one winter, my observation was that much of the training others had received was much too broad stroked and that time/effort/learning was spent on non-essentials or even skills contra-indicated.
For example, (if I may kick off Simon’s comment pertaining to stitching pig’s trotters): suturing is likely contra-indicated for all but the most skilled, practiced and prepared cruisers. Sterile arenas are likely too hard to come by (or maintain) on a vessel at sea (especially with a husband/wife team) so stitching wounds closed and isolating the “bugs” inside will foster infection. It is much more practical and pragmatic to use butterfly bandages (or more robust bandages) and not close things up so tightly. This will likely make scarring worse, but is pragmatic for the environment at hand and that anticipated during the recovery period (continued being at sea).
Finding a good wilderness medicine trainer should not be hard, I would think, but I would want one whose experience is with handling medical emergencies where hospitals/ skilled people and intervention are days or weeks away.
My best, Dick Stevenson, s/v Alchemy

Dick
So maybe 'sticking ' pigs trotters back together would have been a better term as glue is the easiest of all techniques for wound closure.

I will make a new thread for this so as not to detract from the psychiatric thread.
Simon