I hope I am not alone in that phenomenon, but it is fascinating to recall those flashbacks that have been buried deep in our memories. I often have to text my sister in Texas and ask her for confirmation of some of those things that suddenly seem important in the context of living in the present while remembering our past. Things like, “Hey sis, do you remember anything about how Grandma made that banana pudding that we loved so much?” Or the expressions that our parents used that we thought were so corny back then, but now somehow seem relevant. My mom, my aunts, my grandmother, all of them used the common expression before we did just about anything outside the house. “You behave yourself, now, you hear me?” to which I would dutifully respond, “Yeah, okay.”
“Behave” is one of those words with several synonyms and definitions, including “control,” “conduct oneself properly,” “mind one’s manners” and “be good.” The word origin is interesting. It comes from the early fifteenth-century German, French, and Old English “behabben,” meaning “to contain” or “self-restraint.” In early modern English, the meaning evolved to “to govern, manage, or conduct.” Makes sense, then, that the meaning hasn’t really changed much.
There is much buzz nowadays about “behavior,” and “behavioral health” is a term that’s been adopted as a euphemism for “mental health,” which sadly still carries a negative connotation in many areas of society. In our world of aviation medicine, that stigma has managed to hang on but is now, thankfully, changing for the better. With all the outrageous craziness that bombards our senses every day, often referred to as “TMI,” too much information, one may often wonder anymore what drives the bizarre, aberrant behaviors of some individuals with whom we share society.
Behavioral health is a quite high-profile issue for the FAA, and the number of applicants who report medical history that includes some type of mental health–related diagnosis such as depression, anxiety disorder, PTSD, or ADHD is increasing. The CDC in a September 2020 report noted that in a three-year period between 2015 and 2018, over 13% of adults used antidepressant medications. I suspect that study may under-report the true usage. We certainly speak with many members who have questions about reporting a history of symptoms that can fall into the behavioral health category and/or the use of antidepressant medications, and how that history will play out when and if reported on a medical application.
Since 2010, the FAA has allowed the use of four SSRI medications, including citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro) and fluoxetine (Prozac). The process is complicated with a lot of “moving parts.” It’s also an expensive process, and it takes a long time to get a decision. That said, though, the FAA philosophy is to find a way to “yes” when the yes can be done safely. Not everyone who applies for a medical is going to be eligible for a special issuance, but the mechanism is in place, and there are several hundred pilots flying today with behavioral health histories.
Just recently, the FAA published new guidance for persons with “Situational Depression,” “Adjustment Disorder with Depressed Mood,” or “Minor Depression.” Considering the FAA’s reputation of moving at a “glacial pace” with respect to changes in certification policy and procedures, this is a huge leap and a significant advancement in the way the FAA handles the increasing numbers of pilots with these diagnoses. In many cases, with good documentation of a single episode of what we all experience from time to time, what I call “life getting in the way of living,” your AME can issue a medical certificate at the time of the FAA physical exam. There are still strings attached, but as is always the case, complete documentation that is “satisfactory to the FAA” will certainly make your experience with the aviation medical examiner a more favorable one than in the past when just about any declaration of anything related to depression or anxiety required a deferral and a long delay.
We as a pilot community need to recognize that mental health pathology is very treatable and is by no means necessarily a disqualifying and grounding condition. As with any medical condition, the sage advice is to “get healthy first,” then become educated about what the FAA needs to see to find a way to the “YES.” The FAA is not in the business of disqualifying pilots; quite the opposite. Most people who apply for a medical get certificated. It just takes time, good planning, and “good behavior”!
Enjoy the summer, and if you are going to AirVenture, “Behave yourselves, now!”