The Sunday Read: ‘Why Airline Pilots Feel Pushed to Hide Their Mental Illness’
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My name's Helen O. Yang. I'm an emergency physician, and I'm a contributor to The New York Times Magazine. For decades, the Federal Aviation Administration had strict rules around the mental health of pilots. Pilots who were diagnosed with any kind of mental health disorder, like depression, were not allowed to fly. Almost half of all Americans will experience mental illness at some point in their lifetime.

So why would pilots working in one of the most demanding, isolating occupations be any different? Every single pilot I interviewed for my New York Times Magazine story had withheld some kind of underlying medical issue or knew of a colleague who did because they knew it was likely they would be out of work for months, maybe even years, if they had to go through the FAA's special certification process for medical conditions.

And the FAA might even conclude that a diagnosis would be caused to ground the pilot. So what I really wanted to dive into was, is the FAA so rigorous that it's making it less safe to fly? So here's my article, read by Emily Wu Zeller. Our audio producer is Jack D'Isidoro, and our music was written and performed by Aaron Esposito. Thanks for listening.

Troy Merritt, a pilot for a major US airline, returned from his 30th birthday trip in Croatia in October 2022, sailing on a catamaran, eating great food, socializing with friends, and cried. This wasn't back-to-work blues, but collapsed-on-the-floor, full-body-shaking misery. When he wasn't crying, he slept. "I've got to find a therapist," he told himself. And he did. Quickly.

If that therapist didn't write down depression, Merritt would be okay. He could still fly planes, keep his job, as long as he wasn't diagnosed with a mental illness. After several sessions, the therapist gently suggested that he might need medication. Merritt adamantly refused. The therapist never raised the subject again. Merritt's husband, also an airline pilot, hoped he would break out of this funk.

Let's go for a hike, he would say. We live in California. It's a gorgeous day. But Merritt wouldn't get up off the floor. I don't know what to do, Merritt sometimes mumbled. Other times it seemed as if he were in a coma. His husband worried about going to work and leaving Merritt alone at home. But when Merritt was at work, flying planes, he was much better, focused on the tasks in front of him.

It was when he reached his destination city and tried to settle into a strange hotel room that loneliness and sadness crept over him again. Coworkers didn't seem to notice because he was often flying with different crews. Later that autumn, Merritt slipped into extraordinary darkness. Crying became more frequent, the bouts less predictable. Whenever he tried to leave the house, his breathing grew shallow, his fingers numb.

When do I get medication? He asked his husband. Do I do that now? That's a big, big lever to pull, his husband replied. It was a big lever to pull. Merritt, like all pilots, knew that if he was formally diagnosed with a mental health condition, he might never fly a plane again.

Pilots and air traffic controllers must be deemed medically fit by the Federal Aviation Administration through a certification process, one that is particularly arduous when it involves mental health diagnoses. Merritt feared that what was best for his health might not satisfy the FAA's idea of public safety. Certain medications are disqualifying, for instance, even when recommended by a treating psychiatrist. Like a lot of pilots, Merritt stayed silent.

He hoped therapy would be enough. Because he felt okay at work, and even outside work every now and again, there seemed to be a chance he would get better. Then one night in December that year, Merritt was at home by himself when the realization hit him. Suicide had become an option. He did not consider it outright, but he felt as if someone were now showing it to him as a possibility, one that had never existed before.

The next morning, Merritt couldn't make himself go to work. He called his husband and told him, It's time. It's not hard to see why authorities take such a cautious approach to mental illness. When a suicidal pilot has intentionally crashed a passenger plane, the ramifications have perhaps been felt even more deeply than after other aviation disasters. The anger at regulators more intense. The media attention more outsize.

A fatal Germanwings flight in 2015, probably the most infamous such incident, continues to affect policy to this day. An investigation by French authorities determined that the plane was deliberately flown into a mountainside in the French Alps, causing 150 deaths, by a pilot who had been treated for depression and who previously held a medical certificate from the FAA.

While such events are exceedingly rare, it is quite likely that pilots have caused other crashes on purpose. In response to the Germanwings tragedy, Senator Dianne Feinstein commissioned a report from the Inspector General's office at the Department of Transportation. Eight years later, its findings were finally released.

Despite the FAA's comprehensive certification process, the agency's ability to mitigate safety risks is limited by pilots' reluctance to disclose mental health conditions. In an effort to get pilots and air traffic controllers the mental health treatment they need and keep aviation safe, Congress introduced the Mental Health and Aviation Act in September.

The legislation, which would relax some restrictions, is part of an ongoing debate over how best to manage mental health in a profession where split-second decision-making can mean the difference between life and death. The issue was touched on in remarks made by President Trump in late January, the day after a Black Hawk helicopter collided with a passenger plane in Washington, killing 67.

You have to go by psychological quality, Trump said, seemingly in reference to the FAA's standards for airline pilots and air traffic controllers. No evidence so far has suggested that mental health was a factor in the collision. The debate is now unfolding at a moment of upheaval for the FAA. Its director, Michael Whitaker, has resigned, and an acting director has been in place since Trump returned to the White House.

Last month, the administration fired close to 400 FAA workers. And the aviation industry is already facing serious shortages. More than 90% of air traffic control facilities today are understaffed. And according to some estimates, the United States could be short as many as 30,000 pilots in the next five years. Though flight safety has been at an all-time high in recent years,

A deadly crash like the one in Washington inevitably draws increased media attention to near misses and makes people more nervous about flying. Perhaps most concerning, those near misses seem to be on the rise. According to a 2023 investigation by the New York Times, there were 300 near collisions of commercial planes over a 12-month period.

When Jennifer Homendy, the chair of the National Transportation Safety Board, testified that year before Congress about their significance, she said, any one of them could have meant lives lost, a warning that has since proved prescient after the fatal crash in Washington. Close calls may stem from factors beyond pilots' control, but their swift responses are critical to avoid catastrophe. When something goes wrong, they need to be at their best,

It's the issues like Germanwings that kind of shock the world about the importance of pilot mental health. Gregory Kirk, a psychiatrist who evaluates pilots, told me, but the far more mundane risk is a pilot who has an untreated or poorly treated mental health condition that, as a result, may have difficulty in a complex threat environment.

Like the situation in which airline pilots found themselves before the collision with the Black Hawk helicopter, or the one Chelsea Sullenberger faced when a flock of geese disabled his plane's engines, Sullenberger landed it on the Hudson River, saving all 155 people aboard the flight. Every airline pilot and controller must go through the FAA's medical certification process at least once a year.

This requires that an aviation medical examiner, a physician who has completed a four-and-a-half-day training seminar with the FAA, reviews a pilot's medical history and performs a physical. Pilots age 40 and over undergo this process every six months, as do those with certain health conditions that also require additional tests and clearance from specialists.

But few certification pathways, if any, are considered more complex or take longer than the one for mental illness. Pilots are taught early, by those who went before them, by those around them, that being honest with the FAA about any aspect of their medical history can jeopardize their careers.

Several years ago, an investigation by the Department of Veterans Affairs that cross-checked VA and FAA databases revealed a wide discrepancy. Around 4,800 commercial and airline pilots were receiving VA disability benefits without reporting these medical issues to the FAA. While some of those pilots may have been fraudulently collecting benefits for non-existent or exaggerated problems,

Others were found to have conditions that should have grounded them. Unreported health disorders can be deadly. A study of 202 fatal aviation accidents that occurred in the United States in 2015 found that in 5% of the cases, pilots had not disclosed the diagnoses or medications that were later implicated in the crash, most commonly including psychiatric drugs of some sort, whether taken by prescription or recreationally.

Every pilot I interviewed for this article knew of colleagues who had hidden their medical issues from the FAA. Some admitted to doing so themselves, several of whom told me that their supervisors had urged them not to report a health problem. And then there are the pilots who simply do not seek medical attention. A 2022 survey of pilots in the United States found that 56% of them reported having avoided healthcare in some way.

Because pilots are often reluctant to seek medical care or disclose health concerns, the number of those who are struggling with mental illness, a condition that is often easier to hide and harder to be open about than many other ailments, remains unknown. A 2016 survey of airline pilots found that nearly 13% of them met the criteria for a diagnosis of depression, and more than 4% had suicidal thoughts in the preceding two weeks.

The pandemic, which forced pilots into furloughs, and upon return into facing more unruly passengers, probably made things worse, as it has for the general population. Almost half of Americans will experience mental illness at some point in their lifetime. There's no reason to think pilots are spared. If anything, given their schedules, their irregular sleep, and all the time they spend away from home and family...

it would be little surprise if they don't fare worse. For more than half a century, the FAA essentially barred anyone known to have a mental health disorder from piloting a plane. Then in 2010,

The FAA began allowing pilots with depression or anxiety into the cockpit on a strict case-by-case basis if, after a monitoring period no shorter than 12 months that begins when they start one of four designated psychiatric medications, they are considered to be stable. Though the minimum monitoring period is now six months and the list of medications has since expanded to eight,

Many pilots are still withholding their symptoms, reluctant to seek help and go through the FAA's onerous certification process around mental health. The hypothetical dangers of a system that makes pilots hesitant to disclose their mental health symptoms became frighteningly real one Sunday evening in October 2023. Joseph Emerson, an off-duty captain for Alaska Airlines, was returning from a guy's trip in rural Washington.

To get home more quickly to his wife and two sons in the Bay Area, he took a jump seat in the cockpit, available only to those who, even if off-duty, are qualified to provide assistance in emergencies. Emerson chatted with the crew about the aircraft and the weather before cramming his six-foot frame into the jump seat. As the plane took off, he felt himself separating from reality. You need to wake up. You're not going home. This isn't real.

Looped through his thoughts like a drumbeat, he says, I'm not okay, he told the other pilots. He then pulled the two bright red handles in the cockpit that cut the plane's fuel supply in emergencies, turning it into a glider. To the passengers, the plane seemed to nosedive. After the pilots wrestled Emerson away, he left the cockpit, and they locked the door behind him. He walked to the back of the plane and grabbed an emergency exit door handle.

A flight attendant put her hand on his, stopping him. Another flight attendant heard him say he had just tried to kill everybody. The plane diverted to Portland, Oregon, where Emerson was arrested. If I was operating in reality, if I understood how unsafe I was,

There's no way I'm getting on that flight that day in a jump seat, Emerson told me recently. He has sought therapy on and off for years, and at one point, a therapist suggested he start on antidepressants. Emerson refused, afraid of losing his job. But after the sudden death of his best friend in 2018, he often seemed sad, maybe depressed. So one day his wife, Sarah Stretch, also raised the subject of medication.

A big argument followed. He reminded her that without his job they wouldn't be able to afford their mortgage. "I learned early on in our relationship that I would never ask him not to fly," she told me. Emerson instead medicated himself with alcohol. What most likely triggered his episode that evening was the hallucinogenic mushrooms he had consumed two days before the flight. The weekend with his buddies had been a tribute to his best friend.

Emerson, still grieving, tried the mushrooms because, he says, he just wanted to feel better. His case was a wake-up call for the industry. Renewed scrutiny was directed at the FAA's medical certification process, and the National Transportation Safety Board was prompted to convene a mental health safety summit. Because a pilot's work is safety-sensitive, they are held to a higher standard.

Susan Northrup, the FAA's flight surgeon since 2021, told me in an email. Her duty is to safeguard the broader flying public, she added, which supersedes the needs of individual pilots. The worry, though, is that the FAA has inadvertently created a mental health process so burdensome and restrictive that it deters pilots like Emerson from being honest with authorities and seeking help when they need it.

Hammondy, the NTSB chair, told me that a system that drives pilots to hide any symptoms of mental illness is a detriment to safety. Still, despite what recent headlines might suggest, commercial aviation is remarkably safe. Statistically speaking, passengers are far more likely to die in a car accident on the way to the airport than from a plane crash.

That track record isn't just a function of medical screening. Policies like requiring at least two pilots to be on duty during flights offer essential protections. In such a reliable system, loosening mental health restrictions might not lead to any perceptible decline in safety. It might even improve safety by getting more pilots to seek treatment.

But the aviation industry in the United States has long operated on the assumption that the only way to ensure safety is to have a stringent, inflexible approach to medical certification. It seems to have worked. Do we really want to disrupt it? My name is Dan Powell. I'm Marian Lozano. We are composers at The New York Times. And we write a lot of music for The Daily. I'm currently working on a piece called Geometry. ♪

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After Merritt called his husband, he had to tell his airline that he needed to go on medical leave. He didn't explain why. A few weeks later, a psychiatrist started him on an antidepressant. His symptoms improved, faster and more significantly than he had hoped. He was even surprised to find himself enjoying a music festival with new friends, a situation that would have made him too nervous in the past.

Two months after starting the medication, he felt much better than he had in years. But he still had to wait out the full six months mandated by the FAA. Then another set of evaluations began. Merritt had to find doctors who were HIMSS specialists. HIMSS stands for Human Intervention Motivational Study, which was created in the 1970s and helps pilots recover from alcohol and drug abuse.

It is now an industry-wide program made up of airline management, unions, specially trained doctors designated by the FAA, and the FAA itself, which provides HIMSS with about $540,000 in annual funding. In 2010, the agency created a program, Drawing on HIMSS, for pilots taking certain antidepressants.

The agency decided that HIMSS specialists, who include psychiatrists and neuropsychologists, already had the expertise required for these assessments and could immediately transfer their skills to evaluate pilots with mental health conditions as well.

A HIMSS neuropsychologist put Merritt through a series of assessments, including a computerized cognitive screening exam designed to test whether he could meet the mental demands of flying, such as visual and auditory memory and spatial positioning. Merritt also had to see a HIMSS psychiatrist, as well as a HIMSS medical examiner who compiled a file for the FAA to review.

Merritt spent more than $10,000 for these medical evaluations, which weren't covered by insurance, and on the travel costs needed to get to them. Then Merritt waited. And waited. Nine months after his file was sent off to the FAA, and almost 18 months after he started the process, his "special issuance" medical certificate arrived in the mail. He could now begin retraining to fly again.

practicing and testing in a simulator, piloting with an observer in the cockpit. About a month later, he was back to transporting passengers. His experience was in some ways a best-case scenario. The very first medication worked, and his dose remained stable. A change in either would have reset the six-month monitoring period.

The FAA hadn't required additional information from him, like pharmacy records or further evaluations, which could have added months to the process. Because he worked for a major airline, he was paid 50% of his salary while grounded, support that pilots at smaller regional airlines rarely receive. Not all pilots are so fortunate. Some of them, faced with the long process, are too discouraged to undertake it.

Those who do may feel they need to turn to the cottage industry that has evolved to help pilots, often at significant cost, navigate this system. And for the pilots who make it through certification, the oversight doesn't simply end. Merritt will continue to see his HIMSS medical examiner and psychiatrist every six months. He has also had to divulge his mental health diagnosis to his chief pilot, who submits quarterly progress reports to Merritt's HIMSS examiner.

Pilots who misrepresent their medical history to the FAA risk as much as a five-year prison sentence and a $250,000 fine. But for some, full disclosure can lead to what might feel like a different kind of punishment. When Elizabeth Carl was training to become an airline pilot, she reported to her medical examiner her history of anxiety. She had been off medication for more than a year.

She had developed new coping skills. And above all, she had aged out of her early 20s and passed the angst that that time of life can bring. But the HIMSS psychiatrist, whom she had met only once, declared that she needed to restart her anxiety medication if she wanted to fly. She recalls her doctor and her therapist being surprised. Carl also needed to hand over all her therapy notes to the FAA.

That is such an invasion of privacy. Brent Blue, an aviation medical examiner for more than 40 years, says of the agency requesting therapy notes, what business is it of the FAA to have those kinds of details? Carl resumed her anxiety medication at the lowest dose available, but it still caused her to gain 30 pounds on her small frame. And against the advice of her therapist, she released the notes from their sessions.

It just seemed like a never-ending process, Carl says. In all, it took her about two and a half years to get her medical certificate. She has come to accept the medication's side effects, but sometimes she feels foolish for not lying, as other pilots do, which could have enabled her to avoid so much trouble. I feel like I brought it upon myself, she says.

Had Merritt or Carl hidden their psychological struggles, as Emerson did, aviation medical examiners would have been unlikely to catch them. The FAA advises these doctors, who get three hours of mental health instruction during their initial training, to evaluate pilots by merely observing their outward behavior and engaging them in casual conversation.

Not only is mental illness often easier to conceal than physical ailments, many examiners are not trained in the medical specialties that frequently deal with psychiatric disorders. Even for experts, however, psychiatry lacks the precision found in other areas of medicine. There are no blood tests to diagnose depression, and there is no CT scan to confirm suicidal ideation.

We're still struggling with that ambiguity, says Thomas Insull, a former director of the National Institute of Mental Health. Psychiatrists are left with the difficult task of making sense of what is not easily measured. I can't tell you how many times I've been fooled, Alan Francis, the emeritus chairman of Duke University's psychiatry department says. Well, first, I don't know how many times I've been fooled because a lot of times when I'm fooled, I don't know it.

Of all the situations aeromedical screenings are trying to prevent, an event like Germanwings is the ultimate failure. A pilot deliberately crashing a plane and killing every passenger on board. Yet predicting suicide is something that inherently challenges the FAA's medical certification process, because the risk can fluctuate over short periods.

Matthew Nock, a professor at Harvard and an expert on suicide, points out that suicidal thoughts, when someone has them, tend to change dramatically over the course of days and weeks and months and years. More than half of the people who die by suicide have seen a health provider within a month preceding their death.

Not all pilots who attempt suicide will do so by taking down a plane full of passengers, obviously, but the problem is that it can be hard to tell who will try. Suicide may be the most extreme concern, but other mental conditions also pose their own dilemmas for medical certification, such as ADHD. Pilots who are prescribed medication to treat it are disqualified.

But if they have been off treatment and satisfy certain criteria, they are allowed to fly. To Ned Hallowell, an ADHD expert, this situation is flawed. The result is comparable to having a sky full of nearsighted pilots who are forbidden to wear corrective lenses. This FAA allowance is intended for those who were misdiagnosed with ADHD or grow out of it.

The FAA's concerns extend beyond determining which mental health conditions should disqualify a pilot. They include deciding when such a pilot is ready to fly. Currently, the FAA relies on HIMSS to help make that determination.

Not only does HIMSS already have the structure in place to do these evaluations, it is also widely lauded in the airline industry and claims to have an 85% recovery rate treating pilots for substance abuse, its original mission. This apparent success rate led Congress to commission the National Academies of Sciences, Engineering, and Medicine to study its effectiveness for possible use elsewhere. But the result was surprising.

HIMSS doesn't look that great, and it certainly doesn't look like something you want everybody to emulate, says Richard Frank, who is the director of the Brookings Institution's Center on Health Policy and led the study. The study's report was released in 2023, stating that it found no solid evidence to support HIMSS's claims of success, which raises the question of why the program was adapted to evaluate pilots with mental health conditions,

The National Academies of Sciences Committee had been denied access to the de-identified data and the testimonies of the pilots in HIMSS, leaving its committee members to surmise that HIMSS did not really want to have a lot of scrutiny put on the actual performance of the program. Frank says, It made me less sanguine about flying.

The FAA, amid calls for change, has implemented some reforms after the DOT report commissioned by Senator Feinstein in Joseph Emerson's episode pushed the agency to establish the Mental Health Aviation Rulemaking Committee. Last May, the FAA adopted a fast-track pathway, one of the recommendations put forth by that committee.

Pilots with certain mental health conditions, like anxiety, depression, and PTSD, who could not previously get a medical certificate from their regular examiners, may now be able to receive one, provided they have been off psychiatric medication for at least two years. This means they can skip what Merritt went through, HIMSS or other in-depth evaluations and the FAA's long review.

Robert Novin, an internist who works full-time as an aviation medical examiner, has reservations about the new fast-track pathway. I actually think the FAA has gone too far in the other direction on this policy, he told me. I think it's going to open the door to people getting through who potentially have more serious mental health conditions. Novin currently cannot give clearance to a pilot who had kidney stones without, say, a urologist's evaluation.

But with the new pathway open, he can, without any psychiatric consultation, certify a pilot with a mental health history. That worries him. Is mental health less of a risk than a kidney stone? When I asked Northrup about concerns like this, she replied, "We'll adjust policy if needed." The FAA may soon be loosening policy further, whether it wants to or not,

The Mental Health and Aviation Act, pending in Congress, would force the agency to implement the Aviation Rulemaking Committee's remaining recommendations. Some of these include reducing the minimum monitoring period after a pilot starts on antidepressants to as few as two months from a half-year, closer to the timeframes observed in Europe and Australia, and eliminating mandatory HIMSS evaluations in uncomplicated cases.

Another would-be change could potentially allow people being treated for ADHD, which has been associated with fatal aviation accidents in the United States, to pilot planes. If the public knew that the rules were being relaxed so much, they probably wouldn't like it, Novin says. The Supreme Court's decision last year to overturn the 1984 Chevron doctrine may also have an effect on medical certifications.

Until that ruling, the FAA had essentially been the final authority on aviation-related issues. Ambiguities related to medical certification were resolved by deferring to the agency. But the new ruling means that judges can, in theory, decide differently than the FAA. I don't know a single aviation attorney that isn't excited. Joseph LaRusso, a lawyer whom pilots have turned to when facing certification setbacks, told me...

But given the limits of aeromedical examinations and of psychiatry itself, the greatest impact on airline safety is not likely to be rulemaking so much as honesty. Even with all the rules, Novin says, it really comes down to the person telling us the truth.

And at the end of the day, we just cross our fingers and hope the people that aren't telling us the truth don't become a safety risk, because we can't identify them. His remarks speak to why the Aviation Rulemaking Committee seeks to ease restrictions, to encourage more pilots to be honest, and to not rely on luck at all to ensure safety.

The committee's recommendations would allow people who currently would be considered not ready to fly to fly. Stephen Auchler, the psychiatrist on the committee, says, while letting these pilots fly may result in what he calls some unmeasurable increase in risk, he compares that unknown risk with the known safety of our current system.

Until the recent collision in Washington, the United States hadn't had a major fatal commercial airline crash since 2009, the longest ever such period. Even so, he says, that unknown risk would be more than compensated by getting more pilots the help they need, pilots who might otherwise hide their psychological symptoms. If these pilots are willing to get treatment, under FAA oversight,

The folks on the 10,000 other flights may end up doing better, Auchler says, by being even less likely to be involved in a crash. That's a trade-off. After all, zero risk does not exist unless you want to never fly.

Okay.

Got it. You could get out of high-interest credit card debt with a SoFi personal loan. View your rate at SoFi.com slash debt in 60 seconds with no impact to your credit score. Loans originated by SoFi Bank in A. Member FDIC. Terms and conditions at SoFi.com slash debt. NMLS 696891. While the FAA certifies pilots' medical fitness, it is their co-workers who see them doing their jobs, most critically, in the moments before takeoff.

After Emerson's episode, a class action lawsuit was filed claiming that if the captain had formally assessed Emerson, he might have detected something was wrong and prevented him from boarding the plane. Airlines and their unions have set up confidential peer support networks for pilots, which have shown promise in Europe. The Aviation Rulemaking Committee recommends expanding them.

But they are no cure-all. Brian Baumhoff, the founder and chairman of the Pilot Mental Health Campaign, warns, The programs still depend on pilots themselves to initiate help, and their peers aren't trained health professionals, nor can they force people to get care.

When pilots do show signs of trouble, airlines have protocols for mandatory assessments. If pilots underperform in a flight simulator or are heard to make an alarming comment, the company can refer them for a fitness-to-fly evaluation, allowing doctors to address potential early warning signs. But these evaluations have also been misused to sideline pilots who raise issues with their airline companies.

One well-known case is that of Carleen Pettit, a Delta Airlines pilot who in 2016 found herself subjected to a fitness-to-fly evaluation after she detailed potential safety issues in a 45-page report that she emailed to managers, including the chief executive. At least one issue, fatigue-related work-hour violations, was something that Delta was required to fix.

Another complaint accused management of following a rigid chain of command. She was soon told that she seemed mentally unstable and that her fitness needed to be assessed before she could fly again. Though she was based in Seattle, Delta sent her to a psychiatrist in Chicago named David Altman. Multiple messages and calls were exchanged between Delta's counsel and the doctor, and the airline paid him more than $73,000 to do the assessment.

Altman gave Pettit, at age 54, a first-time diagnosis of bipolar disorder, which all but ensured that she would never fly again. Altman based his decision on circumstances like Pettit's addressing the chief executive by his first name in an email, and her juggling work and night school while parenting young children. I don't know any woman who could do that. Altman later gave as his explanation for the diagnosis.

Pettit sought a second opinion from a panel of nine doctors at the Mayo Clinic. Cost? $3,300. Who concluded that she did not, in fact, have bipolar or any other psychiatric disorder. A third expert also did not think Pettit had any mental illness. Pettit filed a whistleblower complaint against Delta, alleging retaliation through its use of mental health evaluations. The administrative law judge ruled in her favor.

noting that it had been improper for Delta to weaponize this process for the purposes of obtaining blind compliance by its pilots. The judge also pointed out that Pettit's piloting skills had never been questioned before. By then, Altman had already surrendered his medical license. Delta appealed the ruling, denying retaliation, but finally settled with Pettit in 2022.

When asked about the settlement, a spokesman called it a business decision. Delta's misuse of the mental health evaluation has raised uncomfortable questions about how the airline industry handles mental health, especially when those evaluations appear to be used as a management tool. As the judge in Pettit's case put it, rather than public safety, not every pilot can fight back as Pettit was able to do.

The airline just needed to silence me, Pettit told me recently. They did it because they could. This case was big because it shed some spotlight on the shadiness that goes on. LaRusso, the aviation lawyer, told me, when fit-to-fly assessments are mistrusted and seen as a way to fire a pilot, they can lose their safety value.

Some pilots, after learning of Pettit's experience, have chosen to avoid the evaluation altogether, moving to smaller airlines and accepting cuts in pay and position. And, the judge noted, Delta did not immediately share its findings with the FAA. If Pettit were truly unsafe, shouldn't she have been grounded, rather than allowed, in theory, to work elsewhere?

After enduring years of legal proceedings, Pettit's health began to decline. She lost weight. She couldn't sleep. How did I sustain seven years of this? She asks now. In 2023, she retired early from Delta. The previous year, Stephen Dixon, a senior executive at Delta involved in Pettit's case, who went on to become the FAA administrator during the first Trump administration, stepped down.

For many pilots, though, her ordeal continues to have a far-reaching impact. As Troy Merritt puts it, the Carlene Pettit case shows the power of a mental health diagnosis. I met with Merritt one recent morning at the Los Angeles airport, before he was going to fly nearly 300 passengers to Tokyo. He had always wanted to pilot internationally, calling it the epitome of flying.

But before receiving mental health treatment, he didn't think he would be able to deal with long flights, changing time zones and disruptions to his sleep schedule. So he didn't even try. Now he greeted me with a wide smile, wearing his navy blue uniform but without the hat. He thought it made him look too young. We sat down at his gate. On his tablet, he showed me a map of the 11-hour flight, tracing the southern route they would take because of headwinds,

He seemed calm and confident, something he confesses he would never have felt before he began treatment. Yet Merritt remains frustrated by how closely he is monitored compared with other pilots. The FAA is scrutinizing me just because I revealed a diagnosis, he said. Why are we not scrutinizing everybody's cognition? Merritt's frustration is one that researchers are eager to sort through too.

The FAA currently relies on a pilot's diagnosis to make certain assumptions to try to predict safety risks. So it's a lot of deductive expert opinion, says William Hoffman, a neurologist and aerospace medicine researcher with the U.S. Air Force. Judgment instead of solid data, in other words. As far as Hoffman knows, no study has examined the performance of pilots with mental health conditions.

Hoffman spoke to me as a civilian only, and not on behalf of the Air Force. In theory, however, that information is available through a program that collects planes' black box flight data. If researchers could pair that data with accurate de-identified health records, they might discover that certain mental health problems or the medications used to treat them don't actually increase the number of small errors,

Errors that don't cause so much as a bumpy landing, but could indicate performance issues that may become future safety risks. Such information, Hoffman says, would be regarded as the golden goose.

A 2024 FAA-sponsored report by MITRE, a research and development non-profit that advises government agencies, suggests that this kind of evidence could help steer medical certification away from its rigidity when focusing on mental health diagnoses. But until then, the FAA must make decisions without it.

Which means, from Northrop's perspective, erring on the side of caution and continuing to subject pilots with these diagnoses to closer scrutiny. Homendy, the NTSB chair, disagrees and urges immediate reforms. You don't need more data. Diagnosis and treatment aside, what's most important to the hundreds of passengers on Merritt's plane is how well he's feeling, how sharply he's functioning, immediately before he flies.

No matter how comprehensive the FAA's medical screening process is, the evaluations are still only spot checks, snapshots of specific moments in a doctor's office. The more relevant question, as Hoffman and his co-authors ask in a recent paper, is, can the pilot perform their duties safely at the time of operation? Before getting into a cockpit, pilots are supposed to ask themselves the I'm safe quiz.

A set of six quick questions that include: Am I stressed? Am I fatigued? Am I emotionally upset? But the pilots I spoke with don't put much thought into it, if they do it at all. Scientists are also exploring technology-based screenings, possibly using bio-wearables that track heart rate variability and subtle skin changes, for example, to assess pilots' mental states before flights.

But doctors agree that while such tech is promising, it isn't ready yet for commercial aviation. Real-time screenings could bring new uncertainties to flight operations. Delayed or canceled flights, higher fares, that the public may resist. If they work as intended, though, these screenings could be used for all pilots, not just those who report mental health conditions.

and might even bar someone like Emerson from the cockpit before a flight takes off. Since his actions shook the industry, Emerson seems to have done some self-reflection. He comes off like a life coach and speaks like someone who meditates. He does. He says he refuses to play the what-if game. He and his wife have started a non-profit to improve the health of aviation professionals.

When Emerson talks about flying, though, his face becomes wistful and his voice quiets. There's a romance with it, he says. He is reluctant to call flying his identity, but, in so many ways, it feels like home. He is healthier than he has ever been, yet he may never fly again, a reality he has come to accept.

Northrup would not comment on his situation because, she emailed me, it is an ongoing case, but she says the FAA would entertain reconsideration if he did apply again. Hoffman says that if Emerson got the help he needed and undergoes the necessary evaluations, letting him return to the cockpit would be in line with safety culture. Then he adds, I hope to see a future where he can fly again.

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