Ban On Falling in Love: Mental Health Conundrum in Aviation
- Erika Armstrong
Every person reading these words will experience a mental illness at some point in their lives.
Mental illness, just like any other sickness of the body, is often a temporary health condition that involves changes in emotions, thinking, and/or behavior. These changes are frequently due to an external event out of our control. It can affect the stability and status quo of life. Most simply stated, an illness of your mental health presents itself as looping thoughts that override your ability to be in the present moment.
We're All Mental
Even something as positive as falling in love can derail your ability to think clearly. Major changes in behavior are observable, but most minor mental health issues are kept internal. What you see on the outside is different than what's manifesting inside, so there becomes a misalignment with how we feel versus how we interact with our external environment. Too often, that internal ricochet of thoughts interferes with situational awareness, and by the time you realize it, it could be too late.
For most of us, mental illness is a temporary distress, but it can still affect your work, social, and family interactions because you become detached from the here and now while trying to heal or process your thoughts of a past occurrence. It's one of the challenges of being human and having self-awareness.
When we lose the ability to have realistic self-awareness, or our thoughts turn to wanting to cause harm, is when a mental illness becomes a disorder and a problem for everyone…especially when you're a pilot sitting on the flight deck of an aircraft, in charge of hundreds of lives.
Wounded Brain Thoughts
Anything that consumes our thoughts is an illness in our brains. Lovesickness can cause overpowering emotional and physical pain, but we don't ban pilots from falling in love. There's no stigma in that, so we need to learn how to speak freely about the safety of aviation and the known interference with allowing the aviation community to solve mental health problems.
There are infinite variables and levels of mental illness, but we'll all experience emotional trauma which can trigger mental illness. Basically, it's a wound to our brain thoughts. It can/will happen in a variety of life events including the big ones like death of a loved one (including pets), violence, and medical issues, but even life changes like divorce/breakup, loneliness, financial loss, career change/job loss, marriage, irregular or intense work schedule (circadian interference), or having children can shift your ability to deal with all the other responsibilities of life.
Our body and brain are always under construction. We're a constant chemical reaction and often, through no fault of your own, you can become chemically unbalanced. Something as simple as sleeping involves a chemical change and release of melatonin from the pineal gland. In seeking to repair an imbalance in the body is often when pilots hit a wall with the Federal Aviation Administration (FAA) and their Aviation Medical Examiner (AME).
Specific mental health conditions require an AME to deny or defer a medical, but those conditions are mental health disorders, meaning that there is an inherent potential within the diagnosis that you will cause harm to yourself or others—and you might not even realize it. Mental health conditions, like depression, are left to the discretion of the AME, and there are currently five selective serotonin reuptake inhibitors (SSRIs) approved for use under supervision.
The catchphrase now being benchmarked when examining pilot mental health is resiliency. Each of our life traumas and experiences will fall along a wide range of responses, but the challenge is that each personality will be redefined from challenges differently.
For example, there are people who have grown up in or have experience, abusive, traumatic, or neglectful situations, yet their resiliency allows them to succeed despite the challenges and they find joy from having broken free. Others in similar situations have deep psychological and emotional scars that they carry with them their entire lives and the trauma is deeper than any kind of drug or treatment can fix. It becomes who they are, and they cannot separate themselves from their external experiences.
The aviation industry is trying to figure out resiliency and how to teach it. The problem is that you can't be resilient unless you fail. With generations of kids who receive participation awards and are not being allowed to fail, resiliency has become an outlier. Once you're an adult, the tendency to recover quickly—or not—from a trauma or life disruption is already ingrained.
Most people who aren't resilient aren't drawn into the aviation industry in the first place because learning how to fly involves countless failures—not outside the circle of safety, but an infinite number of choices and levels of failure. There is no such thing as a perfect flight. A pilot can always do better. That philosophy requires resiliency.
However, there is another level of resiliency which can be taught through the Crew Resource Management process and procedures. Beyond the individual, a flight crew can be trained for resiliency. According to Airbus (Training Pilots for Resilience), it's "the ability of a flight crew to recognize, absorb and adapt to disruptions."
With that in mind, there is and should be a burden on a flight crew to recognize and support another pilot who is dealing with a mental illness. Flight crews, especially in business aviation, often spend more time with each other than they do with their own spouses/partners. By having a company-specific process for dealing with and confidentially disclosing an illness, it normalizes the idea that mental illness recognition is important to safety, and by following procedure, treatable.
Alcoholism/substance abuse used to be aviation's shameful open secret. The culture of pilots included the acceptance of drinking, often to excess, on layovers. Most pilots who were caught respected the rules so wouldn't drink on duty, but their blood alcohol from the previous layover far exceeded the limits during duty time. It ended many careers. It still does, but the industry has learned that with proper care, treatment, and rehabilitation, substance abusers can be returned to the flight deck. Safely. Proudly.
The International Civil Aviation Organization (ICAO) summed it up as, "There is a responsibility to get air crew with drinking problems to treatment before they reach the stage of alcohol addiction." The view on alcoholism changed once it was categorized as a disease, which implies there is a cure and a way to stop the progression. Mental illness can be viewed the same way. Fix it before it becomes a disorder.
Pilots are among only a handful of professions who are required to disclose any encounter with the health care system. This includes mental health visits. To compound the problem, the personality type that is drawn into the pilot world has characteristics of stoicism, independence, and the inability to acknowledge that they can't fix some problems on their own. The core of being a pilot is also wanting to solve problems on their own.
How bad is it out there? According to the FAA, who conducted a comprehensive evaluation of pilots with mental health challenges, the "FAA relies on applicants to self-disclose mental health conditions but FAA's ability to mitigate safety risks is limited by pilots' reluctance to comply with self-disclosure requirements.
While (the) FAA lacks substantial data regarding unreported mental health conditions, a 2016 study asked airline pilots to take a survey that included a questionnaire used to clinically assess depression. The study concluded that 12.6 percent of respondents were managing depression and 4.1 percent reported having suicidal thoughts without treatment because they feared negative impacts on their career. Further, in a 2019 study on pilots avoiding seeking health care, 38.8 percent of pilots feared losing their medical certificate and reported withholding information from their physician."
Instead of reinventing process or procedure, similar processes currently in place for occupational substance abuse treatment program (Human Intervention Motivational Study – HIMS) could serve as an outline. There is information on help for yourself, a colleague, family support, and a list of warning signs. Often the reason for substance abuse is a mental illness.
Angle of Repose
The industry knows there's a problem and it has been festering. FedEx 705. Germanwings 9525. Egypt Air 990. China Eastern Airlines 5735. It erupted again recently in the U.S. when a pilot, who was trying to hide that he had a mental illness, sought alternative methods for fixing his depression. He chose to try psilocybin mushrooms.
Despite it being days after using the substance, his inability to sort out delusional thoughts from reality motivated him to attempt to pull the fire handles because he thought by doing so, he could wake up from his daydream. The result was putting the lives of 83 passengers plus the crew in danger. This pilot is also a father so his motivation for hiding his illness was to keep being able to support his family. With 83 counts of attempted murder, he may never get to fulfill his role as father.
Pilots suffering from ANY illness that risks the lives of others should be grounded. Just because the system is broken doesn't give anyone the right or excuse to endanger others.
We forget that being a pilot is still just a job because being a pilot becomes a person's DNA. Seeking help becomes unthinkable because the thought of losing your ability to fly is like losing everything. It's not. Even if the worst happens, and you're grounded temporarily or permanently, there is loss of license insurance and other careers in aviation. That realization gets muddled in the moment.
Instead of waiting for a major air disaster, let's face the problem head on. Let's look at a pilot like an aircraft and realize sometimes they need maintenance and repair—sometimes a major overhaul—and it might take time and money, but it's worth the investment. If the damage is too deep and the airframe is too weak to hold the pressure, it can be repurposed and serve aviation in a different capacity.
It's up to everyone to keep the skies safe. It's not easy. Especially if you see a coworker, who is also your friend, struggling to get through a storm. Sometimes you must speak up and guide them out. It's dark in a storm. Shine a light for them.
"People don't fake depression. They fake being okay. Remember that. Be kind." ~ Robin Williams
This article is not medical advice. It's the view of Erika Armstrong who has worked in the aviation industry for twenty-five years. If you need help right now, dial 988. For confidential substance use treatment and info dial 1-800-662-4357. If you have an idea of how to help the aviation community, Erika can be reached at Erika@achickinthecockpit.com
If you'd like more information: