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Several years ago, I looked over my son’s shoulder as he completed the questionnaire for medical clearance for his pilot’s license. Some of the questions, being a person who successfully manages her depression, felt like a life sentence for past actions. Have you ever attempted suicide? Do you take psychiatric medication? Good thing I have no desire to be a pilot. My past history, no matter how ancient, disqualifies me. If my desire to fly loomed so powerful, there would have been an easy solution that no doubt some pilots employ. I could have lied.
Like many of you, I’ve read and listened to the news of the Germanwings crash with a mix of emotion. Horror. Sadness. Anger. An ache in my heart for the parents and spouses who lost loved ones on that plane. But perhaps unlike you, I’ve winced at some broadcasts for other reasons. One newscast speculated that perhaps psychiatric medication caused the suicidal plunge. Another suggested that psychiatrists break confidentiality and report those with suicidal thoughts. The FAA’s policy of having two people in the cockpit at all times is an excellent measure, one I’m glad to see other airlines rushing to adopt. Some of the other measures suggested, however, would create more problems than they would cure.
In our efforts to remove the risk to society by those with severe mental illness, we must be careful. Draconian measures to prevent the extreme action of a miniscule few must be tempered by a clear analysis of risk. One report showed that the percentage of fatal suicidal airplane crashes in the United States from 1993 to 2012 was .33%, most of those being private, not commercial planes. Regulation in an attempt to remove all risk could potentially drive thousands of those successfully managing their depression away from the preventative care they need.
The FAA already has a broad bias against those with mental illness, with a blanket disqualification for bipolar disease no matter how slight. For depression, only four SSRI medications are approved as can be seen on this FAA decision path. An aspiring pilot using a small amount of a well-proven antidepressant like Wellbutrin, however, would be completely disqualified because it is a NDRI (Norephinephrine and Dopamine Reuptake Inhibitor). If a pilot has a dopamine issue versus serotonin issue in the brain, s/he is sunk.
What does this regulation cause? It’s difficult to measure exactly. No doubt some would avoid taking any type of medication that would cause a employment disqualification, even if that medication would make him or her more stable emotionally. With that mindset, shouldn’t we disqualify pilots on high blood pressure medication because of the possibility of heart attack or stroke? Today, pilots on blood pressure medication require special evaluation and medical clearance, not an unquestioned rejection. Those with a long, stable history with regard to depression or bipolar disease, who have never attempted suicide and manager their illness well, should be offered that same level of consideration.
Depression is a complex disease, but in most cases easily managed. Suicide becomes logical for a small percentage, typically for those who in denial of a steady escalation of symptoms and who have refused help. As the research of Thomas Joiner shows, the vast of suicides in the US are non-murderous ventures, 98%. His research also shows that most who attempt to relieve the burden of their presence on those they love, not to take others down with them. Although this belief is illogical as well, it is not as dangerous as the 2% who murder others while taking their own lives. The Germanwings crash is the exceptional case even of unmanaged depression. Unfortunately, the exceptional case always makes the headlines, repeated ad nauseum, reinforcing the erroneous link between mental illness and murder.
My father, like my son, was a pilot. He took me up in a small plane a few times, a terrifying experience for his daughter who prefers solid earth beneath her feet. He explained to me that the risk of death in a plane is far, far less than any moment in an automobile. These days, when boarding a plane with my son as pilot, those odds reassure. My hope is when you hear the news this week about the Germanwings crash, you will remember the stats I’ve listed, remaining tolerant and supportive of the many who manage depression well. Preventative care and open communication works. Don’t let the irrational fear of one troubled pilot kill compassion and common sense.
For more information about Julie K Hersh, Struck by Living or Decidí Vivir, go to the Struck by Living website. For photography from my son’s and his business partner Michael Doorey’s views from the air, check out the website at DJD Productions.
