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A Sad State of Affairs

It does not matter how one reads this title; sadness, the state of affairs – as in business or of the heart. Things are a mess.

Two massive warships, Covid-19 and international outrage surrounding recent domestic events, are leaving a great deal of sadness in their wakes.

Depression, whether innate or reactive to circumstances, has been a topic of many aviation discussions, by me and others; that of not flying when feeling an emotional low, on the anniversary of a distressing event, or when clinically depressed. It was just over ten years ago that FAA Administrator Randy Babbitt announced that airmen with mild to moderate depression, taking certain SSRI drugs (Fluoxetine (Prozac or generic), Sertraline (Zoloft or generic), Citalopram (Celexa or generic), or Escitalopram (Lexapro)) could be cleared to fly under specific circumstances.

Events bring this topic into sharp focus, whether current circumstances or
the GermanWings crash several years ago, a bellwether event that changed the attitudes of all civil aviation regulatory agencies worldwide, especially the FAA and the German CAA as both countries had found the suicide pilot qualified for a medical certificate.

With Covid-19, there are implications to our lives from an aviation perspective. First, unless one is blinkered or ignorant – not characteristics common to pilots – a degree of fear will have crept in. Will I, or a loved one, contract the disease? Or die? And fear not just about the threat to our mortality, but financial well-being – will I have a job and be able to pay my bills? Will I have enough money to be able to retire? What will happen to our country? Add to this the slow, insidious mental trauma of being isolated, either because one lives alone, or lockdown has prevented us from seeing those we love and care for. Of course, these same circumstances have impaired our opportunities to take flight to the skies and that induces concern about maintaining skills for when flight can return. These are all powerful stressors, any one of which might uncover a depressive episode or illness – together this is like a perfect storm. And storms in aviation are never a good thing.

Mental health experts believe there will be a massive surge in demand for a specialty already operating under duress. Calls to helplines have reached never before seen levels, and, as suicide rates tend to peak in the late spring to early summer anyway, just as Covid-19 stakes its claim as killer elite, there is concern that suicide will also become more common. We know that feelings of despair and social isolation are common triggers for the desperately depressed and that is now, sadly, a feature of our lives.

As if all this were not enough, the current decline in employment – the most rapid in history – also comes with the emotional roller coaster of an election year and a country rocked by the death of Mr. George Floyd and the resultant civil unrest. Such social schisms as these also play into our personal and societal psyches. These changes to the way we see the world are not likely to be short-lived, and the “new normal” merits that we think long and hard about our adaptation mechanisms.

As a doctor, I am seriously concerned for other healthcare workers; we are exposed to patients dealing with a coronavirus infection, are working very long hours with disturbed sleep which impairs immune function, and have the mental trauma of seeing a great deal of suffering. As with other front-line workers, there is already an increase in PTSD-like syndromes among healthcare practitioners, and I have friends who are at the edge of despair themselves. The recent tragic death by suicide of Dr. Lorna Breen, head of the ER at New York-Presbyterian Allen Hospital, is testimony to this worrying trend. A study that commenced in 2007 found that for every percentage point increase in unemployment, there was a 1.6% increase in suicide; currently, USA unemployment rates are around 14%.

I certainly do not want to contribute to the weight of negative press, as there is some evidence that this in and of itself encourages bad outcomes. Knowing our pilot community as I do, smart, driven, and very decent men and women, I trust that pilots can take leadership roles in their homes, communities, and country – heaven knows we need it. And I don’t want to initiate a political debate but have to make a very well-known epidemiological fact – guns are commonly used in suicide and domestic violence and gun sales have increased dramatically during the Covid-19 pandemic, and if I were a betting man, I would guess that recent events will also drive more gun sales. And guns, knives, and drugs make bad companions to people with depression. I’m just saying.

And of course, as we come out of this troublesome time, pilots will want to get back into the cockpit, and some will have either self-diagnosed or been treated for, and will then honestly report depression on a subsequent FAA medical application. This will lead to consideration of special issuance and will doubtless put a strain on the FAA system for dealing with such reports.

As we have discussed before, one tool FAA uses, neurocognitive testing, has criteria that are subjective, which makes it a controversial testing battery for consideration of pilot medical certification. The test battery is designed to identify possible cognitive deficits in executive functioning, decision making, short/long term memory, multitasking, reaction time, and task saturation. The testing obviously doesn’t include an individual baseline, and the testing the FAA requires is usually the first time such testing has ever been done for the individual who is being evaluated. Without the baseline data, the results of FAA required testing is “stand alone” and the results are not compared to any previous data sets. For that reason, those in aviation medicine rightly argue that the testing does nothing to enhance aviation safety except in certain conditions where there are clearly abnormal results in more than one area of testing. Most pilots who perform the neurocognitive testing will fall within a performance range that is subject to results interpretation that is generally evaluated with a decidedly conservative curve.  Additionally, the process is expensive and may not lead to certificate issuance.

So, for those of you reading this, what can you do? First, build routines that not only give purpose and distinction to each day, but prevent negative ideation. Ensure you exercise, eat healthfully, endeavor to sleep well, and avoid the temptation to self-medicate with alcohol or drugs. Consider exercising your mental muscle by learning new skills, taking quizzes and similar. Also, don’t be a spectator to what is going on – as leaders and take-charge people, consider what you can do to improve the lives of all Americans.

And if you or someone you care for expresses negative thoughts, please take them more seriously than before this pandemic and tragedies on our streets started; I, for one, have started taking some online courses in how to recognize and react to suicidal ideation. There has been enough tragedy; let’s reclaim the joy in our lives and consider what we can do to make sure everyone can live a joyous life.

As one who became an American, I read and incorporated American founding principles into my life. The Declaration of Independence (from my country of birth) states that there are unalienable rights of life, liberty and the pursuit of happiness. Let’s ensure that every one of us does our bit to protect these for all Americans. 

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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