A Pilot Treated for Depression, on Why and How He Flies

I am a Captain with a major European low-cost airline. Over the course of my airline career, I have had my medical suspended on three occasions because of various issues.

The first was when, as a new first officer I developed a depression/anxiety disorder because of a combination of stress and fatigue. The second was [X years ago] when again I was suffering from chronic fatigue brought on by low-cost rostering and the third (which is still ongoing) most recently when I was diagnosed with mild sleep apnea.

On each occasion, I had to deal with both run-of-the-mill aviation medical examiners as well as the UK CAA's [counterpart to FAA] own in-house consultants/specialists. Whilst the AME's [Aviation Medical Examiners] had little option but to throw the matter upstairs, the consultants (when I finally got to see them) could not have been more helpful. Their attitude seemed to be more along the lines of "let's see what we can do to get you back in the air." They provided guidance and advice on how best to get treated/ diagnosed effectively and showed a great deal of pragmatism when it came to evaluating the more subjective or grey areas in the data that was available to them.

So whilst it is probably true that most pilots view many of the aviation medical professionals that they deal with as "looking for an excuse to ground them," at a regulatory level my experience so far has been exactly the opposite. Obviously I guess this would vary according to the nature of the illness.

On a more general note, I would say that for a young pilot who is looking for a career in the industry, the low-cost market is not a viable long-term option. Many of us are burning out and permanently losing our medicals long before the age of retirement purely because of the way that our employers are treating us in the same way that they treat the aeroplanes. If we are not flying, we are not generating revenue. The attempts by pilots' unions to raise this issue have been met with contempt by the mainstream media.

The thing that is most upsetting, to me, is the media coverage immediately jumping on the "He's depressed! That's why he did it! Ban all depressed pilots!" wagon.

I have depression, and with medication and therapy, I am pretty neurotypical. Depression is very treatable like that.

A well-treated, well-supported individual is as dangerous to others as any neurotypical person.

If a psychological diagnosis is what bans a pilot from his work, it's not going to stop depressed pilots from flying; it's just going to make pilots more likely to avoid seeking treatment at all.

Moreover, what this pilot did isn't typical of depression--we tend to commit suicide, not mass homicide.

Research tends to show suicidal impulses of depressed patients often comes from feelings of guilt: "I'm hurting people with my continued existence. Everyone would be better off without me." The thought is to end the suffering of others, not to cause it!

It is very rare for someone with major depression to want to become a mass murderer, and in such cases, it's not the depression driving their impulse to kill but some other co-morbid disorder.

But mental illness is so stigmatized, any diagnosis is used to comprehend an incomprehensible act—like people trying to blame autism spectrum disorder for Adam Lanza murdering small children at school. It's an easy answer to give [to] satisfy a complex question. But it's not correct, and it's quite damaging.

The truth is, we will never know what was going through his mind when he decided to commit a mass murder-suicide. We can speculate, but pinning it on a psychological condition is only doing harm, driving away from help those who need it.

I saw this in a BBC article:

"All pilots must undergo regular medical checks that include a cursory psychological evaluation, according to Dr. Hans-Werner Teichmueller, the agency's [German Aviation Medical Practitioners Association] head. But such tests rely on patients being honest with their doctors, and even a seriously mentally unstable person would have been able to put a ‘mask' on for the investigation, he said.

"You can't see anything beyond the face," Teichmueller said. "We have developed a very refined system in Europe and most of us are in agreement that this system is optimal. If we were to add more psychological tests or modify the way we test, then we can still not change a situation like this."

Very German. Very arrogant. And very, very wrong. Using the best available psychological tests as part of a thorough psychological assessment is as much art as science—psychologists frequently disagree about how a certain score should be interpreted—but highly skilled psychologists who have extensive experience in this area do it every day.

The process, which is labor-intensive, isn’t cheap, and except for extreme cases (of which Lubitz was apparently one) the results are usually probabilistic, which makes the question of what to do about a particular case a nasty one. But that’s very different than saying that “Even a seriously mentally unstable person would have been able to put a ‘mask’ on for the investigation” or that “if we were to add more psychological tests or modify the way we test, then we can still not change a situation like this.”

There is a certain type of American transportation expert who falls into the posture of reproaching Europe for being geographically compact, and not adopting certain American systems of transportation which are justified by American distances.

For example, Europe has a system of continuous canals connecting its many rivers, viz: the Rhone, Garrone, Loire, Seine, Meuse, Rhine, Ems, Elbe, Oder, Vistula (*), and Danube; and the associated ports, viz. Marseilles, Bordeaux, Nantes, Le Havre, Antwerp, Rotterdam, Bremen, Hamburg, Stettin, Danzig, Copenhagen, and Istanbul.

Over Europe's restricted distances, barges of coal, grain, cement, and containers full of inexpensive Chinese exports, moving at, say fifteen miles per hour, nonetheless reach their destinations in a reasonable time. These are of course the kinds of cargoes which represent nearly all of the revenue of American railroads, and a certain type of American railroad expert simply cannot understand why the Europeans are not running drag freights, clogging up the tracks and making it impossible to run fast trains.

European railroads make their living by providing passenger service, and carrying the kind of high-speed priority freight which would be air freight in the United States. The implication is that there is much less scope in Europe for things like puddle-jumpers and local air freight.

(*) There is also a canal across the Pripet Marshes, linking the Vistula with the Dneiper, and eventually with the Volga, but of course, by this time, one is getting into Russian distances which approximate North American distances.

European airlines started Ab Initio [JF: training people with no previous flying experience as future airline pilots] programs precisely because they did not have large globally aggressive air forces feeding them experienced jet pilots, and they did not have large "barnstorming" general aviation sectors.

I understand that low-cost European airlines tend to be dependent on "sun-tourism," that is, flying people who are fed up with winter to some place where there is sun ... This is a very cost-sensitive market, for which going somewhere by bus might often be a reasonable alternative. The tourists don't necessarily want warm weather—what they want is an escape from the depressing sleet, rain, and fog of winter in an oceanic climate. Quite possibly, they might accept a ski-trip in the Alps as a substitute.

The unstable young man was the copilot of an airliner carrying a hundred and fifty sun-tourists, because that was the first economic niche in which he could be employed.