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'Instinctive' fear of falling (loss of stable support), of loud noises and of physical confinement are factors which facilitate the development of anxiety reactions in flight. The physiological changes resulting from decrease of air pressure, air density, and temperature are contributory causes. The development of anxiety, however, is inhibited by other factors—individual as well as social—such as the pleasure of flying (resulting from identification with the powerful ship), the stimulus afforded by danger, the fiction of personal invulnerability, and on the social level, a sense of duty and a desire for approval by the group, thus increasing self-esteem.
From a neurophysiological standpoint, pathological anxiety is defined as a persistent disturbance in the 'biphasic relationship existing between the cortex and the diencephalon (Grinker and Spiegel)'. The instinctive fears cause biological, alerting reactions which are manifest through excessive diencephalic activity. Simultaneously the cerebral cortex exercises control over the diencephalon. Thus, sensitization of an individual may result from his having experienced a plane crash; neutralization can be obtained by means of extensive and repeated exposure to flight ('aerial acclimatization'), and inhibition of diencephalic activtiy is effected by the cerebral cortex in response to the individual and social 'morale' factors.
Loss of this psychosomatic balance is very well demonstrated in eight case histories. In conclusion, Wegrocki finds that the individual with predominant passive-dependent trends is definitely predisposed to the development of anxiety reactions in flying.