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Correspondence
Comments on Mental Illness Article
Dear Editor,
Thank you for pub lishing Dr. Seckler’s article “Diagnosing Men tal Illness, Medication and Certification” in the November 2016 King Air magazine. As someone who suffers from social anxiety, deciding to take an SSRI at the risk of losing my privilege to fly was the best decision I ever made, for the sake of my overall health and my relationship with my family. There is more to life than flying.
Airmen considering taking an SSRI though should consider the following: (1) Airmen should be prepared to be without a medical certificate for anywhere between a couple of days and several months. This year has been especially slow: I took my exam four months ago, and am still waiting for a decision (despite my condition being stable for years). (2) If an airman does receive a medical certificate, the date on the certificate will be the exam date, not the date [the] FAA makes the decision ... so for me this year, I will have lost more than four months (and counting) of useful life on my second class medical certificate.
Name Withheld
Editor’s Note: Dr. Seckler responded to the above correspondence with the following:
The writer is to be commended for getting treatment and then disclosing it to the FAA, even at the cost of having to go through the special issuance process.
In my opinion, the FAA’s position on nonpsychotic psychiatric illness is truly counterproductive and not in the best interest of either pilots or the general public. By making it so difficult for pilots like the writer to achieve and maintain medical certification, the FAA creates a situation where pilots are incentivized to either not get relatively simple and appropriate treatment for their condition or not disclose such conditions and treatment to the FAA.
There is no doubt in my mind that pilots with depres sion and a variety of personality disorders are far safer pilots when they are properly treated. The FAA should encourage such treatment rather than discourage it by making it absurdly difficult for treated pilots to obtain or maintain medical certification.
Diagnosing Mental Illness, Medication and
Certification
by Dr. Jerrold Seckler
Consider two patients. Patient A develops abdominal pain and visits his doctor, who notes the patient has a low-grade fever and tenderness localized to the lower right side of the abdomen. Additionally, if the doctor presses slowly on the lower abdomen and then suddenly lets go of the pressure, the patient winces. A CT scan or other imaging study is ordered and it’s obvious that there is fluid surrounding the appendix, which is itself swollen.
The patient is taken to the operating room where the appendix is removed. When examined by the pathologist, the removed appendix shows the typical findings of acute inflammation. The next day the patient feels fine. This patient had a clearly defined anatomic condition that could be objectively demonstrated by physical examination, radiographic imaging and then confirmed by pathologic examination of the abnormal tissue that was removed.
He had acute appendicitis. Furthermore, this patient could have gone to any of hundreds of doctors and all of them would have reached the same diagnosis and recommended the same treatment.
Patient B, on the other hand, complains of feeling tired, sad, and sometimes out of control. He is having trouble sleeping. His work performance is suffering and he is drinking or smoking more in an effort to relax and “get a grip” on it. If he sees a doctor, the physical examination will be normal. Any lab or imaging studies will be normal as well. The patient has no objective evidence of any disease, yet he will be given a diagnosis. 10 • KING AIR MAGAZINE
What’s more, that diagnosis might vary from doctor to doctor depending on how they interpret his subjective symptoms or how the patient himself explains them. The severity of the condition can only be based on those same subjective symptoms. Patient B is suffering from some sort of depression.
Why should this matter to pilots? The FAA is quite concerned about depression and other diagnoses that fall under the general category of mental or psychiatric disturbances. FARs 67.107, 67.207, and 67.307 list “mental conditions” and substance abuse issues that must result in the denial of a medical certificate. Because the diagnosis of these conditions are in large part highly subjective, how a given practitioner describes and classifies the condition can make a great deal of difference in how the FAA will react. Furthermore, the medications usually prescribed for psychiatric disturbances all work on the chemistry of the brain, modify behavior, and therefore are viewed with great suspicion by the FAA.
To add insult to injury, the conditions classified as “mental illnesses” vary with societal norms, which change over time. Yesterday’s psychiatric condition is today’s non- pathological lifestyle choice. For example, homosexuality was classified as a mental disease until fairly recently; and conditions that were previously classified as laziness, malingering, etc. are now bona fide mental “conditions” with specific diagnoses. In the classification of mental conditions, the only constant is change.
In an attempt to rationalize the methodology used to diagnose mental disorders, the American Psychiatric NOVEMBER 2016
2 • KING AIR MAGAZINE
JANUARY 2017
