Mental Health at the Edge of the World
REVIEW



© Frans Lanting/NATIONAL GEOGRAPHIC CREATIVE — “Harsh winds whip a whaling station (left) in Grytviken on South Georgia Island.”



This October, we unite globally to raise awareness, break the stigma, and promote mental well-being for all. In 2022, we participated in the ESRC Centre for Society and Mental Health 2022 Festival and shared a piece of opinion proposing rethinking mental health and the characterisation of schizophrenia in clinical practice. The review was available online; you can still find it here: Towards a Better Characterisation of Schizophrenia.
In 2023, we explored the mental health issues of postgraduate researchers related to their doctoral responsibilities, emphasising the psychological burden of working under pressure.

This year’s theme set by the World Federation of Mental Health is workplace mental health. The theme highlights the importance of addressing mental health and well-being in the workplace to benefit people, organisations, and communities. At NeurAstra, our workplace is either behind a desk, surrounded by piles of notes and books, or in the field, with packed backpacks and surrounded by trees and rocks. This second setting offers interesting perspectives to investigate mental health, as expeditions are often guided by specific goals and rely greatly on human performance in the field. To celebrate Mental Health Day, we consequently decided to write about mental health during expeditions, that is, in challenging and/or extreme environments—the common workplace of many explorers.




The Mental Toll of Historic Expeditions



The field of mental health, as it relates to expeditions in extreme environments, has a long but often overlooked history. From early Arctic and Antarctic voyages to contemporary space missions, the psychological toll of isolation, environmental hardship, and separation from civilisation has been a central aspect driving the success—and the failure—of these expeditions. Thanks to diaries, testimonies, and diverse reports, personal experiences have been shared and proved to be valuable sources to understand not only the historical significance of these initiatives but also to highlight the psychological consequences of those who dared to explore the frontiers of human endurance.

Research conducted during polar expeditions, where crew members experienced isolation and confinement during extended periods, highlighted the importance of diary studies—that is, the exercise of writing and keeping a daily record of events and experiences. In addition to sharing valuable insight about participants’ experiences, potential issues, and areas of improvement for future expeditions, diary studies also proved to be an excellent exercise to alleviate depression and anxiety and help maintain a positive and healthy mindset in the team. Indeed, the use of diary studies, “thought diaries”, is often required in Cognitive Behavioural Therapies (CBT) strategies to capture mental processes and highlight patterns of thoughts and behaviours over time.

© Lady Philippa Scott — Robert Falcon Scott diary’s last page
Captain Robert Falcon Scott’s final diary entries, written as he and his team perished during their return from the South Pole in 1912, are perhaps the most poignant record of psychological strain in extreme environments. His writings reveal the emotional resilience and eventual psychological breakdown that accompanied his team’s physical collapse, especially as food supplies dwindled and hope faded.

The Franklin Expedition, which set out in 1845 to chart the Northwest Passage, is another interesting case of isolation leading to tragedy. Although no personal diaries survived from the crew’s final days, some official records and artefacts provide clues about their experience. Extensive forensic research, for instance, has painted a bleak picture of the men’s deteriorating physical and mental health, likely exacerbated by lead poisoning from their food supplies and scurvy. Symptoms of confusion and paranoia may have compounded the stress of isolation, contributing to the breakdown of their expedition.

Ernest Shackleton’s 1914-1917 Imperial Trans-Antarctic Expedition provides further evidence of the psychological pressure inherent in prolonged isolation. When Shackleton’s ship, the Endurance, was trapped and later crushed by ice, his crew faced months of isolation on the Antarctic floes. Shackleton’s leadership and insistence on maintaining daily routines were critical to their psychological survival. Reports from the crew, such as those of Frank Worsley and Tom Crean, highlight how communal activities and structured days helped to mitigate the mental strain. Shackleton himself described how he used routine and a shared sense of purpose to maintain morale in the face of threatening circumstances.

While Meriwether Lewis, of the famed Lewis and Clark Expedition (1804-1806), did not face such extreme isolation, he still documented moments of emotional strain and loneliness during their journey across the uncharted American West. Lewis wrote about the burden of leadership and the psychological outcomes of navigating unknown terrain with limited resources.

These historical accounts, whether from diaries, letters, or forensic evidence, reveal a common theme: the human psyche is deeply affected by isolation, harsh environments, and the anxiety of survival. The physical dangers faced by explorers are well-known, but these mental struggles, often undocumented or understated, played just as significant a role in determining the fate of many expeditions.



A Selection of Psychological Outcomes During Expeditions



The psychological burden of expeditions often arises from a combination of factors, including isolation, prolonged solitude, separation from familiar surroundings, physical hardship, uncertainty, and the ever-present threat of the unknown. Extreme temperatures, treacherous terrains, and unpredictable weather compound the physical and emotional exhaustion felt by teams. Moreover, as medical resources are often limited or non-existent, the constant threat of disease or the risk of injury in remote areas amplifies anxiety and helplessness, creating a cycle where fear, coupled with physical suffering, exacerbates mental strain. Against this backdrop of mental challenges, several specific psychological phenomena have been reported by explorers.

One such phenomenon is thefirst night effect,” a documented psychological experience in which individuals face difficulty sleeping during their first night in a new, and often hostile, environment. It manifests as difficulty falling asleep, frequent awakenings, and reduced deep sleep stages. The underlying cause is believed to be the brain’s heightened state of vigilance in new surroundings—a primitive survival mechanism. One hemisphere of the brain remains more alert to monitor potential threats, leading to a lighter and less restorative sleep.
In his diaries, Shackleton noted the restless nights his crew experienced upon setting camp on the Antarctic ice. The incessant creaking of the ice, howling winds, and the ever-present cold made the first nights particularly challenging. Percy Fawcett, a British explorer in the early 20th century, also wrote about the oppressive darkness and overwhelming cacophony of nocturnal wildlife that kept him awake, worsening his sense of isolation and danger in the dense Amazon jungle. Sleep disruptions on the first night often contribute to the physical exhaustion felt by explorers and the psychological toll of their journey. As the lack of restorative sleep leads to increased fatigue, this fatigue results in turn in physical exhaustion. For explorers who rely heavily on physical endurance, tired muscles and slower reflexes make navigating challenging terrains more dangerous, and the cumulative effect of fatigue can severely compromise an expedition’s success. Moreover, sleep deprivation adversely affects cognitive functions such as decision-making, concentration, and reaction times. In hostile environments where quick thinking and alertness are crucial, impaired cognitive function can have dire consequences. Poor judgment or slow responses can escalate risks, jeopardizing not only the individual but also the safety of the entire team. Ultimately, the emotional strain caused by environmental stressors combined with disrupted sleep further heightens feelings of anxiety, irritability, and depression. This adds a significant psychological burden, making it harder for explorers to cope with challenges and maintain morale. Ensuring adequate sleep is consequently not merely about comfort but is a fundamental component of safety and success in exploration.

© Joseph John Kirkbride — “Sleeping bag used in camping trip Oct 1888: formerly upon the Greeley expedition.”

Another well-known phenomenon is the third man factor. This experience, first recorded by British mountaineer Frank Smythe during his 1933 attempt to summit Mount Everest, involves the sensation of an unseen presence accompanying the explorer during moments of extreme hardship or isolation. Smythe vividly described the feeling of an invisible companion walking beside him during one of the most gruelling stages of his climb. The phenomenon is now understood as a psychological coping mechanism that occurs in response to severe stress and deprivation, providing the individual with a comforting sense of companionship in their darkest moments. Smythe’s account is not unique; other explorers, including Shackleton, also reported this eerie sensation of an unseen figure accompanying them, suggesting that this phenomenon may be a survival response to psychological trauma in extreme environments. Hallucinations, in general, have been commonly experienced during expeditions, particularly in environments where sensory deprivation is prevalent, such as deserts or open seas. The monotony of the landscape, combined with exhaustion and isolation, can trigger the brain to create visual or auditory stimuli in an attempt to fill the void, leading explorers to question their sanity and judgment. 

While the “third man factor” illustrates how the mind can conjure a comforting presence to cope with extreme isolation and hardship, the polar madness phenomenon highlights the harmful disturbances. Symptoms of polar madness include hallucinations, paranoia, anxiety, and depression, with individuals sometimes displaying erratic or irrational behaviour. This condition was particularly prevalent in early polar expeditions, where the long Antarctic winters forced explorers into months of darkness and confinement with limited social interaction. Similarly, the cabin fever effect describes the restlessness, irritability, and mental fatigue that arise from being confined to a small space for extended periods with the same group of people. In both cases, the lack of sensory stimulation coupled with physical and emotional isolation exacerbates feelings of frustration, tension, and helplessness. These psychological phenomena all highlight how the human mind reacts when pushed to the limits of endurance.



    Coping Strategies: 
    The Role of Rituals and Habits on Earth—and Beyond



    Confronted with such psychological outcomes, explorers have long sought ways to alleviate the mental strain of expeditions. These strategies often revolve around maintaining a sense of connection, purpose, and self-discipline, which help to counteract feelings of helplessness and isolation. Regular communication and mutual support reportedly helped to foster camaraderie among team members, which is vital for maintaining morale. The creation of structured tasks—whether they involved mapping, writing reports, or hunting for food—also helped explorers focus on tangible objectives rather than the uncertainty of their situation.

    In many cases, rituals and habits became particularly important as a means of maintaining mental stability. These routines offered structure and predictability in environments where control over external events was often limited. By creating their own internal schedules and practices, explorers could impose a sense of order on the chaos around them. Shackleton’s daily prayers and communal reading sessions are a good example of this mitigation strategy. His crew and he adhered to a strict routine that included moments of reflection, meals at set times, and specific duties, which fostered a sense of shared purpose and continuity. Similarly, during the 1897 Belgian Antarctic Expedition, Adrien de Gerlache de Gomery’s leadership emphasised the importance of routine in combating the effects of isolation and darkness. When his crew was trapped in the ice for an entire winter, enduring months of near-total darkness, de Gerlache de Gomery implemented regular meal times and strict rotating watch shifts to give his men a sense of purpose.

    In more modern contexts, such as aboard the International Space Station (ISS), astronauts and cosmonauts have similarly found themselves in the situation of living for short (from days to weeks) and long-term (from weeks to months) periods in a closed and hostile environment, only separated to the vacuum of space by a 15-centimetres thick wall. In addition to the documented physical alterations microgravity generates on the human body, understanding the psychological outcomes was critical to ensuring the team's well-being and performance and, ultimately, the success of the missions.





    © NASA — Life aboard the ISS with Scott Kelly

    In this regard, astronauts and cosmonauts are not exactly the typical explorers as the ones we mentioned earlier, embarking on uncertain journeys for several months or even years and not always prepared to confront diverse hazards. Here, before venturing on a mission, our space travellers undergo extensive psychological training, evaluation, and selection. This unique preparation includes learning coping strategies for isolation, mastering stress management techniques, and participating in team-building exercises designed to enhance group cohesion. Simulated missions in confined environments—space analogue missions—also help astronauts acclimate to the conditions they will face aboard the ISS, allowing them to mentally and physically prepare for long-duration spaceflight.

    During the mission, a consistent schedule that carefully balances work, exercise, personal time, and rest is established. Regular communication with Earth plays a significant role in alleviating feelings of isolation. Astronauts and cosmonauts have scheduled times to connect with family and friends via video calls, emails, and phone conversations, which helps maintain emotional bonds. Interaction with mission control also offers technical assistance and social engagement, reinforcing a connection to Earth and a broader support network. Physical exercise is another critical component of psychological support. Mandatory daily exercise combats the physical effects of microgravity but also serves as a psychological outlet. Engaging in physical activity releases endorphins, reduces stress, and improves mood, contributing to overall mental well-being. ISS inhabitants also have access to mental health resources, including confidential and remote counselling sessions with psychologists on Earth. These consultations allow them to discuss personal concerns and receive professional support, while regular self-assessments help monitor their mental states, enabling early detection of potential issues.

    Recreational activities to engage in personal interests such as reading, music, art, or watching movies are encouraged to provide a mental escape from the confines of the ISS, and efforts are made to make the living environment more pleasant through the use of colour, lighting, and design elements that promote relaxation and reduce stress. In recent years, virtual reality (VR) technology has been introduced aboard the ISS as a tool to help alleviate stress and combat feelings of isolation. By immersing themselves in VR environments that simulate natural landscapes or familiar settings, astronauts can experience a sense of presence on Earth, providing psychological relief and enhancing overall well-being. Viewing Earth from space, from the famous Cupola for instance, has also a profound psychological impact—known as the "overview effect"—often providing feelings of connectedness and awe that can alleviate stress and foster a positive mindset. Finally, sleep management is carefully considered to ensure astronauts receive adequate rest. Controlled lighting conditions help regulate circadian rhythms disrupted by the ISS’s orbit, which results in multiple sunrises and sunsets each day. Comfort measures such as sleep masks and earplugs are also used to improve sleep quality, which is vital for both mental and physical health.

    Ultimately, after returning to Earth, astronauts and cosmonauts receive support to readjust to gravity and everyday life. Psychological debriefings address any issues encountered during the mission, and ongoing mental health evaluations ensure long-term well-being. This post-mission care helps space agencies refine support strategies for future missions, enhancing the effectiveness of psychological support for space travellers.

    As space exploration advances toward longer missions, such as journeys to Mars, it has already been stated that in addition to the space radiation hazard, the biggest challenge space travellers will be confronted with during deep space missions is psychological. Psychological support systems need to evolve to address increased isolation and communication delays. Innovations include virtual reality therapies to simulate Earth-like environments and provide immersive entertainment, as well as autonomous support systems that function without real-time input from Earth due to communication lags. Future spacecraft and habitats are also being designed with greater emphasis on psychological comfort, incorporating natural elements and more spacious living areas to improve the overall quality of life.



    Translating Findings to Urban Workplaces



    © SO FM — 1980s Office
    The 1980s saw the widespread adoption of cubicle farms, where offices were filled with partitioned workstations. This was partly due to cost-saving measures and a desire to maximise space efficiency. While cubicles are a form of open-plan design, they also introduced new challenges related to employee satisfaction and productivity.



    The psychological principles uncovered in harsh, remote, and extreme environments—often referred to as Isolated, Confined, and Extreme (ICE) settings—have significant implications for the general population, particularly for those living and working in modern urban environments. While cities may not present the same physical dangers as polar regions or deep jungles, they introduce their own array of stressors—such as constant noise, pollution, overcrowding, high-pressure work demands, and social isolation—that similarly test mental resilience. One key parallel between ICE environments and urban workplaces is the experience of isolation, even when surrounded by people. In ICE settings, individuals are physically cut off from the broader world and confined to limited spaces, often with the same small group for extended periods. Similarly, urban workers may find themselves in crowded offices or bustling cities yet feel emotionally isolated due to factors like impersonal work cultures, long commutes that erode personal time, and limited access to meaningful social interactions. The demands of modern life—tight deadlines, relentless connectivity, and the pressure to perform—create conditions where individuals can feel overwhelmed and disconnected, mirroring the psychological challenges faced by explorers, albeit in subtler forms.

    The lessons learned from managing mental health in ICE environments offer valuable insights for improving well-being in urban settings. In extreme conditions, explorers have found that establishing routines and habits is essential for maintaining mental health. Structured daily schedules provide a sense of normalcy and control in unpredictable environments. Similarly, urban residents can benefit from creating routines that incorporate regular exercise, time for relaxation, and opportunities for social engagement. These practices serve as powerful tools for alleviating anxiety and building resilience against stress.
    Strong social networks and community connections are also critical in both settings. In ICE environments, camaraderie among team members provides emotional support and helps mitigate feelings of isolation. Just as explorers drew strength from their companions—real or imagined—people in cities can enhance their mental well-being by fostering close relationships and engaging with their communities.

    However, there are important differences to acknowledge. ICE environments often involve acute stressors and immediate physical dangers, while urban environments present chronic stressors that accumulate over time. The isolation in ICE settings is usually physical and absolute, whereas in urban areas, isolation is often psychological—a feeling of being disconnected despite physical proximity to others. Recognising these differences is crucial in tailoring mental health strategies appropriately.
    © Hannah McKeand
    © Getty Images — Robert Propst, a brilliant designer working in the 1960s for the office-furniture firm Herman Miller, invented the cubicle.

    As we mark World Mental Health Day, it is worth reflecting on the stories of those who have endured some of the world’s most hostile environments. Their experiences remind us that, while we may not be facing life-and-death situations, the mental health strategies they employed—such as establishing structure, fostering community, and cultivating resilience—are just as applicable to the stresses of modern urban life. By applying these lessons, we can improve mental health in our workplaces and communities, helping individuals not just to cope but to thrive amidst the challenges of contemporary living.







    References
    :
    • Angelo, J.A. (2007). Human Spaceflight
    • Bayliss R. (2002). Sir John Franklin’s last arctic expedition: a medical disaster.
      Journal of the Royal Society of Medicine
      , 95(3), 151–153. https://doi.org/10.1258/jrsm.95.3.151
    • Palinkas, L. A., Suedfeld, P., & Steel, G. D. (1995). Psychological functioning among members of a small polar expedition.
      Aviation, space, and environmental medicine
      , 66(10), 943–950.

    • Palinkas, L. A., & Suedfeld, P. (2008). Psychological effects of polar expeditions.
      Lancet (London, England)
      , 371(9607), 153–163. https://doi.org/10.1016/S0140-6736(07)61056-3
    • Stuster J. W. (2000). Bold endeavors: behavioral lessons from polar and space exploration.
      Gravitational and space biology bulletin : publication of the American Society for Gravitational and Space Biology
      , 13(2), 49–57.
    • Tamaki, M., Bang, J. W., Watanabe, T., & Sasaki, Y. (2016). Night Watch in One Brain Hemisphere during Sleep Associated with the First-Night Effect in Humans.
      Current biology : CB
      , 26(9), 1190–1194. https://doi.org/10.1016/j.cub.2016.02.063



    Further Readings:



    © NeurAstra 2024
    This article was first shared for the 2024 Mental Health Day (10/10/2024).
    The theme of mental health in ICE environments is also explored in our H.A.P.M.O.S. and ATNS-I Research Projects.