Psychiatric illness and pilots

Many of us heard or read reports last week about the Air Canada flight bound for London but diverted to Ireland when the co-pilot experienced a psychotic episode. I found this news story interesting and upsetting for several reasons.

First, I was surprised to see headlines across the country reading “Nervous Breakdown”. This is a term I hear occasionally from those uneducated in mental health, but I was surprised to see it used consistently by many reputable media. In reality, the phrase nervous breakdown is an antiquated saying with no medical definition or precise meaning. Not only is it used incorrectly to refer to pretty much any psychiatric condition, but it also tends to have an insulting connotation.

Aside from using incorrect terminology in headlines, many news articles I read asked questions about how something like this could happen or how a pilot could become psychotic on the job without anyone having prior knowledge of his or her mental health issues.

Pilots are required to have regular medical checkups and any health problems are monitored closely. Unfortunately, there are strong incentives for a pilot not to disclose health problems because an ongoing health issue could mean the end of his or her career.

For example, if a pilot experienced bipolar disorder and sought treatment for the condition, he would never fly again. Unfortunately, pilots are not allowed to return to work as long as they are taking any medication for a psychiatric condition– so even when there is effective treatment available which could manage a psychiatric condition, a pilot could not fly while taking the treatment. This is ridiculous considering the chronic nature of most psychiatric conditions.

Stopping medication is generally the last thing a person should do. If medication is stopped, it increases the likelihood of relapse and could result in exactly the kind of sudden, unexpected incident we witnessed last week.

A passage from the Civil Aviation Medical Examiner’s Handbook states:

Aviation personnel, although not basically dishonest, may not volunteer information which may affect their medical certification. They will, however, respond to direct questions and will sometimes give you much more information than you expect if you convince them that your prime interest is keeping them at work. Sometimes they have problems that may affect their medical certification that they would like to discuss with someone of good will. Of particular importance in the interview is any suggestion of substance abuse, mental instability, lack of insight or inappropriate reactions. You have an opportunity to decide whether this is the type of person with whom you would fly or to whom you would entrust your family. Remember, that the next time you climb on board as a passenger this may be your Captain!

I don’t know about you, but I don’t want to fly with someone who is forced to be dishonest about his or her problems and leave them untreated!

In the aviation industry even very treatable conditions such as anxiety disorders or depression will disqualify a pilot from flying if they require ongoing treatment.

I find this ludicrous. Many other professionals with the exact same health conditions would return to work and continue to consult with their psychiatrist while continuing their career – this includes doctors, lawyers, accountants, teachers, police and most other professions you can think of.

By not allowing effective treatment, the aviation industry creates a huge incentive for pilots to hide their problems and avoid or discontinue treatment.

At the same time, Air Canada was quick to reassure the public that no one was ever in danger and the situation was always under control. Personally, I find it worrisome to think of a pilot experiencing delusions and having to be forcibly removed from the cockpit and restrained.

I would much rather fly with a pilot or co-pilot who is open and honest about whatever psychiatric problem he or she experiences and who is receiving appropriate treatment.

The current regulations are from the dark ages and full of unsubstantiated, discriminatory assumptions that are not beneficial to the pilot or the flying public.


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