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Watching from the sidelines, Macartney’s coach, Chris Brigham, judged the wreck “one of the worst I’ve seen.” Macartney was airlifted to a hospital in Innsbruck, where he was put into a coma. It was unclear at first whether he would live.

Back on the course, news of the disaster propagated quickly. Macartney had had an early gate time—he was only the second skier to descend—and the accident had been broadcast live to the other racers, including his teammate Marco Sullivan, who was in the lodge at the top of the course. On the room’s television, the crash replayed twice before the feed was cut, and Sullivan later told me he assumed Macartney had broken his neck. “The thing that freaked everybody out was the convulsions,” he said.

At the hospital, Macartney spent 13 hours unconscious while doctors tried to control the swelling in his brain. He was lucid when he woke up, although he had trouble remembering names and his vision was blurred in one eye.

Despite this, Macartney recovered, and soon announced his intention to return to competition—and to Kitzbühel. Over the summer of 2008, he met once with the Ski Team psychologist, Keith Henschen. Otherwise, he didn’t discuss the accident in public and seemed to find the idea of dwelling on his feelings unpalatable. Though the science of fear therapy has burgeoned in recent years, Macartney’s own plan for recovery remained decidedly old-school: He would keep his mouth shut and get back on the horse.

“In the end, it’s about the amount of risk you’re willing to take,” he said when asked about the wreck. “Either you get used to it or you don’t. The sport selects for the people who can.” Not long after, he reclaimed his spot on the U.S. Ski Team, and in September 2008 he left for the squad’s race camp at Portillo, a Chilean ski resort high in the Andes.

WORLD CUP COMPETITION demands mental fortitude, and downhill racers can seem almost supernaturally resilient. Austria’s Hermann Maier famously came back to win two gold medals at the 1998 Nagano Olympics just days after a horrifying 70-mile-per-hour wreck. Following a crash that shattered her femur, American Picabo Street watched videos of her wipeout obsessively, then insisted that she’d forgotten about it. “I took what I needed from it and moved on,” she said.

But for every skier who returns to winning form, there are others who never manage it. Not long after Macartney’s crash, 2006 Olympic downhill champion Antoine Dénériaz, of France, quit the sport abruptly when he was unable to shake vivid memories of a 2006 wreck. Dénériaz’s coach, Gilles Brenier, spoke frankly when he told a reporter, “Something was broken that day. Something…from which he could not recover.”

Coming less than two months after Dénériaz’s Olympic victory, his departure was startling. Or so it seemed. When I spoke with Phil McNichol, who coached the U.S. men’s alpine ski team for five years until his retirement in March 2008, he said Dénériaz stood out not so much because of his mental struggle but because he’d admitted it. “Most guys who quit lay it off to some other reason, like an injury,” he said.

In fact, insiders knew that Dénériaz’s problems were not uncommon. “It happens often enough that we have a term for it,” said Lester Keller, coordinator of sports psychology services for the U.S. Ski and Snowboard Association. “We say they get the Fear.”

Not surprisingly, the Fear afflicts athletes in almost any high-risk pursuit. One performance psychologist I spoke with had spent the past six months quietly assisting a Tour de France racer who’d lost his ability to descend at high speeds after a training crash. Another recalled a collegiate diver who’d developed a paralyzing reaction to reverse dives after watching a teammate fracture her skull on the edge of the platform. “It was a very physical reaction,” he explained. “The minute this person stepped onto the board, her heart would start to race. And then, when she started her stride, it felt like all her joints were locking up.”

Exactly what causes an athlete to develop a long-term feeling of dread is a mystery, but it’s known that the process starts at the initial moment of calamity. During an accident or a dangerous near miss, a complex network in the body, including a portion of the inner brain called the amygdala—an almond-shaped mass of tissue that’s found in creatures ranging from lizards to humans—takes in the information and sends out neurological alarm signals in the form of electrical impulses and a flood of chemicals like adrenaline, epinephrine, and cortisol.

When this happens, brain regions associated with higher-order mental functions, particularly the frontal cortex, receive the signals and coordinate a protective response, which varies depending on the level of threat. When the event is minor, the brain calms down fast. When it’s serious, the effects are usually long-lasting.

Roger Pitman, a professor of psychiatry at Harvard Medical School who studies traumatic stress, said that once the amygdala connects the feeling of terror with a particular experience, that link is branded into the brain. “You see it all the time,” he said. “The rational system says, ‘There’s nothing to be afraid of.’ But that kind of argument doesn’t penetrate to conditioned fear.”

The more times a memory is replayed, the more crippling the effect can be. Sean McCann, who worked as a sports psychologist with the U.S. women’s ski team for 15 years, recalled a skier who, having once crashed, would step out to inspect a race hill and be overwhelmed by visions of disaster. Because of this, she was unable to really let loose on the course. “The term we use is ‘hypervigilant,’ ” McCann told me. “You’re basically trying to survive the race instead of win.”

According to McCann, this anxiety is particularly debilitating in athletes who obsess over their accident—a process, he says, that functions like “a neurochemical loop tape reinforcing the message ‘Be scared of this.’ ” Interrupting that loop is difficult. The most widely used treatment is exposure therapy, in which patients confront their phobia by visualizing the same sequence of events but with a happy ending, the idea being to create an alternate “safe” neural pathway in the brain.

There are promising drugs that may help in the future—including D-cycloserine, an antibiotic with positive side effects in the treatment of phobias—but for Macartney, therapy and chemical aids weren’t part of the equation.

AT FIRST, Macartney seemed strangely immune to the trauma. Back home in Washington State after the accident, he updated his Web site with a YouTube video of the crash and even appeared on a local TV news program, where he gamely watched a replay as the anchors bantered.

This toughness was a family tradition. In 2006, Macartney’s mother, Laurie, had nearly died in a ski accident; she’d survived only because Macartney’s dad happened to notice her boot sticking out of the snow near a tree well. At the time, Laurie was undergoing chemotherapy for breast cancer. Determined to watch Macartney compete in the Olympics, she flew to Turin two months later. The next year, still suffering from lymphatic edema—which results in painful swelling of the limbs—she motorcycled from Seattle to Mexico. Stung by a scorpion en route, she kept riding.

Macartney absorbed the same attitude early. Growing up in the Cascades, he entered his first downhill race at seven, placing third. Several years later, his parents climbed Mount Rainier with Scott and his brother in tow. “We did a lot of stuff that wasn’t easy,” Macartney recalled. “There was an undercurrent of expectation: That’s what you did. You didn’t just quit.”

Up to this point, injuries hadn’t slowed Macartney—he sustained a concussion in 2001—and, in public, at least, he seemed to treat his blow­out like an interruption. “If, after Kitzbühel, I’d said, ‘I just don’t have it anymore,’ no one would have questioned that,” Macartney told me when we first spoke by phone, “but I never had any doubt that I wanted to come back.”

The question was whether Macartney’s determination would be enough. Studies of combat veterans suffering from post-traumatic stress disorder have found that vets who keep their fear to themselves tend to fare worse, but as Pitman pointed out, combat survivors aren’t usually planning to return to the front lines; they just want to stop panicking every time a car backfires.

Macartney’s case was different. Not only was he returning to competition; he was returning at a level that required him to operate at the very edge of his ability, under the most treacherous circumstances. Given all that, Pitman said, Macartney’s brain arguably was doing exactly what it should: replacing bad associations with positive ones. “Learning what is likely to hurt you is very useful,” Pitman observed dryly. “If you’re a World Cup skier who nearly died, fear is normal. Returning to take the same risk after a bad crash—that might be what’s abnormal.”

Shortly before the team left for Portillo, I contacted Coach Brigham to discuss Macartney’s return to competition. Since May 2008, Macartney had attended all of the team’s dry-land fitness camps—grueling weeks of gym work and agility drills held at altitude in Park City, Utah—and Brigham confidently described his physical condition at the last one as “fantastic, even better than normal.”

Even so, Brigham, who invited Macartney back onto the team and remained optimistic about his prospects, acknowledged that the Fear was unpredictable. “You see guys who’ve had a bad crash and that’s pretty much the end of them,” he said. “And then there are guys that you didn’t think would come back who prove you wrong. It’s a funny game.”

LOCATED AT 9,500 FEET in the Andes, the Portillo resort anchors a narrow valley abbreviated by abruptly rising sidewalls. For a training site of elite racers, the resort is surprisingly antique: A handful of old lifts feed the slopes, augmented, on the sheerest pitches, by steep Poma tows. The week I arrived, the U.S. team had staked out a super-G run on the resort’s southeastern wall—a steep, off-camber corridor of gates set below softening cliffs that periodically sent large black rocks barreling down the course.

On the first day of practice, six skiers were in the lineup, including Macartney, his close friend Marco Sullivan, and Ted Ligety, the 2006 Olympic gold medalist in the alpine combined and 2008 world champion in the giant slalom. Also present was Bryon Friedman, who’d shattered his leg in a training crash in 2005 and endured eight surgeries. In the years since, Friedman had struggled with anxiety and had yet to regain his old speed. Cut from the U.S. team the previous spring, he paid his way to Portillo, where he was allowed to train with the team so long as his performance was deemed promising. “If it doesn’t happen this year, it won’t happen,” he said.

Macartney appeared to be in a better position. Since entering World Cup competition in 2004, he had mostly placed in the top 40, and shortly before his crash had skied a breathtaking third-place run on the downhill course at Val Gardena: the best performance of his career. On the slopes, Macartney is known for being incredibly strong and, like all downhill racers, uncommonly agile. He was also mentally disciplined, displaying a level of concentration so intense that it could almost be frightening. Unlike many competitive skiers, who skip college in order to race professionally, he joined the World Cup circuit while working in semesters at Dartmouth, where he got a degree in economics.

“I used to tell him, ‘You’re too smart to race downhill,’ ” joked Peter Lavin, the team’s amiable start coach. “Then he got second at Garmisch. I said, ‘I guess you’re not so smart.’ He said, ‘That’s what comes from hanging out with all you dumbasses.’ “

Good-natured and goofy, Lavin—known on the team as Baby Huey for his large, egg-shaped body and fluting voice—was bullish on Macartney’s ability to bounce back. “He’ll do it,” Lavin said confidently as the racers towed to the start on a sheen of early-morning ice. “He’s got the desire.”

That day, Macartney seemed to struggle. As coaches with video cameras took up positions along the run, he cycled unsuccessfully through the short first pitch of the course, taking awkward lines that repeatedly left him out of position. With each missed gate, Macartney returned wordlessly to the lift.

The performance augured poorly. Fear makes an athlete tense, and that tension makes skis harder to control, in turn reducing confidence. Interrupting that cycle is difficult, and even a momentary fright can be enough to undo weeks of gradual desensitization. As one sport psychologist put it, “When you’re confident, everything feels easy. But how do you get confident?”

That question is particularly critical in World Cup racing, where margins are so slight—roughly a hundredth of a second over a three-mile course—that victories are determined largely by a skier’s ability to sustain a state of fearless abandon.

Shortly after one of Macartney’s runs, Ligety kicked out of the start and demonstrated how it was done: cutting sharply through the top gates and rocketing over the roll with a zippering sound like the whine of rope running fast through a ring. “Ted’s killing it,” one coach remarked admiringly.

Talking about the episode later, Friedman described Ligety’s descent on the steep first section as being “without fear.” Friedman noted that Ligety had never been badly injured in a crash, and his descent was correspondingly assured. “You watch the guys on that pitch and you can tell who’s been injured,” he said. “You can just see it.” Friedman seemed aware of a subtler loss: a shimmering, pure belief that had been irrevocably taken away. “It’s like you know what you need to do, but you can’t quite get there,” he said at one point. “Your body won’t let you, or your mind won’t let you—at least, mine won’t.”

But if fearlessness is an ephemeral commodity, it also entails a rather complicated self-deception. This is particularly true in the speed events, the downhill and the super-G. Run on bulletproof ice, on courses riddled with high-compression turns and hair-raising drop-offs, these races leave no margin for error. To push the limits under such conditions requires a breathtaking repression of protective instinct.

Jim Taylor, a performance psychologist and former ski racer who specializes in recovery among elite athletes, believes that the Fear has become more severe in the past decade as advances in surgical repair have enabled competitors to come back from accidents that would have been career-ending 30 years ago. That has tipped the recovery burden onto the mind, he said. “An athlete’s body may be rebuilt, but they can’t always get back in the game at 100 percent.”

The results of the morning’s super-G practice seemed to bear this out. In two of the five runs, Macartney failed to finish; in another two, he finished last—three seconds behind Ligety. “You know, he goes from having a good day to one where he struggles,” Brigham said when we talked about it later. “He was struggling right away today.” He paused, then added, “He’ll turn it around.”

THAT AFTERNOON, I arranged to talk with Macartney in a hotel lounge. In person, he was wary, with a deliberate reticence that masked a sharp eye for detail.

Since the crash, Macartney had begun to closely manage media interviews. “In every conversation, there was this underlying tone of ‘What if you never come back?’ ” he told me. “The frustrating part was that it started to affect my thinking. You start thinking, Well, maybe they’re right.”

At a video-review session later that day, he sat in silence, arms crossed, concentrating on the grainy footage of his runs. Video sessions are group events, and there’s inevitably a fair amount of commentary, often self-deprecating. During the replay of one run, in which Macartney took a bizarrely wide line through a turn, he deadpanned, “Around there is when I start losing my mind.” For the most part, though, he neither joked nor spoke, and his expression was tight. At the end, one of the coaches asked if he wanted to see another racer’s tape, to compare lines through the top of the course. Macartney shrugged.

“Had enough?” the coach joked.

“I know what I have to do,” Macartney said.

The capacity to re-create confidence after a psychological trauma is mysterious, and Macartney, who had already managed to come this far, seemed to offer a clue to how it was done. But the man himself was enigmatic. When I asked him about the prospect of injury, he grew brusque. “You’re taking risks that you need to take,” he said. “Such that most of the time it works out well.” And while Macartney remembered the crash in detail, up until the moment of his concussion, he had little to say about it. During the frightening seconds in the air, he said, he was focused on keeping his ski tips down, so they wouldn’t catch air. When I brought up the morning’s super-G, his cool became even chillier.

“I’m not forcing it,” he said tersely. “I’m a process person. I’m focused more on the execution than the results.”

In Macartney’s case, the challenge of moving beyond his crash had been compounded by the persistent curiosity of journalists like me. One day after practice, I casually asked him if we could arrange a time to watch a videotape of the crash together. We were seated at the hotel’s afternoon tea, and in the pause that followed, he stared at the tablecloth. He seemed at once infuriated by the request and frustrated by the revelation of his own discomfort. When I tried to apologize the next day, however, he shrugged off the exchange. “The reason I wasn’t so pumped to watch the video is that I’m trying to put it behind me,” he said.

When I spoke to Macartney months later, he explained his frustration with a story. That winter, he told me, not long after Portillo, a reporter from an Austrian paper had approached him when he was racing in Wengen, requesting an interview and adding that he’d brought a gift.

Macartney agreed, with the provision that he wouldn’t discuss his crash. “Two minutes later, the guy was asking me all this stuff—what I was thinking when I was in the air, whether I still had nightmares,” Macartney recalled. “And his ‘gift’ was a bunch of still photos of me crashing, blown up to 9-by-11! He wanted to get a picture of me looking at them. I said, ‘You do realize what I’m doing tomorrow?’ And he said, ‘Yeah, yeah, I’m really sorry—I can see how that would be tough.’ And ten seconds later he’s like ‘So…can we get the pictures?’ “

This clash produces a strange dilemma. “There are a lot of things that you do subconsciously,” Macartney told me at one point. “And it’s confusing. You can be doing things in your opinion the same way and have totally different results from one day to the next.” The result is that Macartney can, at times, seem eerily detached when discussing his own experience. When I pointed this out, he acknowledged that he was making a deliberate effort to disconnect. “There’s a lot of…management in racing, is the best way to put it,” he said. “I wouldn’t say I’ve completely shut down my emotional side, but you have to be smart about what you let yourself believe.”

SHORTLY AFTER GETTING back from Portillo, I contacted Antoine Dénériaz, the downhill champion who lost his nerve after a wreck in Sweden. Unlike Macartney, Dénériaz was quite open about his psychological struggle. “To say that you are afraid, it is like you are not strong,” he said from his home in the French Alps, “but when you have the real fear, you can’t ski—it’s not possible. It’s already difficult when you’re strong, when you have everything on your side. As soon as you’re scared, it’s too hard to fight for that last hundredth of a second.”

Like Macartney, Dénériaz said that he originally felt confident about his ability to return. “I didn’t have injuries—not big injuries, you know—so I was thinking that after a few weeks of rest, the feeling would come back and I would be OK.”

Instead, he found himself battling a growing sense of dread. He consulted a mental coach, who recommended visualization. “I was really motivated, because I knew the feeling when you win a World Cup, or Olympic gold, and wanted to have that again. And it’s strange because that winter I actually made a lot of progress technically. But parallel with that, it was growing more and more difficult to compete.” He sighed. “And at the end, everything went bad.”

Stefan Hofmann, a neuroscientist who studies fear in military veterans, speculated that Dénériaz’s collapse could’ve been “a threshold issue”: an accumulation of trauma that finally put the skier over the edge. Others pointed to Dénériaz’s age (at 30, relatively advanced) and the fact that his crash occurred late in the season, allowing more off-season time for the Fear to take hold.

Dénériaz had his own theory. When I asked what he thought had been different about the crash in Sweden, he described the fear he’d felt during the seconds in the air when he was falling. In that moment, Dénériaz said, he’d had a vivid vision of a wreck the previous year in Chamonix, where he’d severed the ligaments in his knee. He also remembered being struck by how much he stood to lose. “Three weeks before, I had won the Olympics and I was on top of the world: an Olympic champion with a gold. And then, in just a few seconds, I could have lost everything—maybe even lost my life.” He paused. “The difference was so huge. It was too much.”

Since Portillo, Macartney’s own comeback has proceeded unevenly. Just one week before he was scheduled to race in January 2009, he crashed during a practice run, tearing a ligament in his left knee—an injury that ended his season. When I spoke with him recently, he called the accident “frustrating” but emphasized that he was looking ahead to his World Cup return in November, and to the Olympics in February, where he hopes to make both the downhill and super-G squads.

Whether he’ll make it is unclear. Last year, Macartney’s performance was patchy: He finished 59th at Lake Louise, 24th at Beaver Creek. But there were also moments of brilliance. On the last day of the downhill at Val Gardena, he seemed to hit his stride, posting fast times and soaring 180 feet on the course’s biggest jump. That day, Coach Brigham told me, it was as though Macartney had never crashed. “He was right back in it,” Brigham said, “flying like you know he can fly.”