Medical Madness

At some point towards the end of 2016, I chose to become a helicopter pilot. As a calculated, practical person it was a multi-year process during which I researched the industry, initiated my career exit from mountain guiding, and looked into various school options. I carefully mapped out my path toward flight school and set the intention to begin in January of 2017. The preparation process during the last months of 2016 included application and acceptance, financial aid and scholarships, online ground school study, and options for housing in the area. The part I was most excited about, however, was my appointment with an Aviation Medical Examiner, or AME.

Don’t get me wrong -  being poked and prodded by a doctor has never been top on my list of ways to spend time, much less spend money. However, receiving a medical certificate felt like taking my first committed step toward being a pilot. All the other tasks felt less significant, things that anyone could and should do to prepare for expanding their education in any area. A medical certificate sets pilots apart in that way-- it’s a mandatory stamp of approval to solo an aircraft or receive a pilot’s license.

I thought, at age 35 coming off a profession requiring a high level of athleticism, the medical exam would be a simple and easy box to check. I found out quickly I was mistaken.

Welcome to my story.

A few months prior, in early 2016, I was in a period of hardship in nearly every area of life- physical injury, career uncertainty, financial stress, deaths of multiple significant people, and past relationship trauma. It was not the first time I’d experienced feelings of depression and hopelessness. In the past, my usual go-to’s were therapy/counseling, drawing on the support of friends and family, and processing through writing and verbal communication. This time was different. Anyone who has experienced depression can describe the overwhelm and cloudiness that occupies your mind, the sticky tendrils of sadness pulling you down into the abyss like an evil octopus dragging you towards the darkness of the ocean’s depths. I beseech those who have not experienced depression to treat those who struggle with mental health with compassion. It’s not easy.

I have much to be thankful for and my life has been mostly joyful. This time, the helplessness caught me by surprise, and the “usual go-to’s” weren’t working their magic. After some time had passed, it was time for a more serious approach, and a friend recommended a psychiatrist who was well known in the community. I went without hesitation, willing to try anything that would bring back the light. I was completely clueless at the time on how that would impact my desire to be an aviator.

If I had known what I know now, I would have chosen differently.

Let’s read that again. If I had known back then what I know now about the challenges of receiving a medical certificate with depression in your medical history, I would have chosen differently- as in, I wouldn’t have made that appointment, and probably continued to struggle with depression with an uncertain outcome. Knowing my stubborn and goal-oriented tendencies, I also would have continued along my path toward becoming a pilot, also with an uncertain outcome.

After all, what’s the big deal? When you have a broken bone, you go to a surgeon and they fix it. When you have a malfunctioning stomach or thyroid, you consume a pill that helps correct the problem. When you have a troubled mind, the proper medication can rebalance the chemicals in your brain to help everything back to normalcy.

There’s no doubt that protocols and procedures around any medication should be in place for aviators. Similarly, mental health should be treated as one piece of the wholistic care puzzle. Instead, it has been ignored, put under undue scrutiny, and even shamed. It’s been made a big deal, but in ways that impair the health of the individual, often by discouraging them from seeking help.

The psychiatrist chose a medication for me and I went along my way, keeping regular appointments to monitor progress. The medication demonstrated its capabilities and I started feeling much better through the summer and fall of 2016. When it came time for my AME appointment, I filled out the paperwork, and nearly forgot to put the medication on the list of prescriptions- it was the first time in my life I’d been on a prescription medication for more than a week or two. During the appointment, the doctor informed me that there “might be some complications” with the antidepressant. Without volunteering additional details, he sent in my paperwork and I left the office feeling confident my second class medical would be in the mail soon.

Not long after, I received a letter that the FAA denied my application for a medical certificate due to my “history of depression”. A little puzzled, since the diagnosis was relatively fresh, I called to get more information.

If you’ve not yet had the pleasure of dialing up the FAA Medical Certification Division, I can spare you the suspense: it’s nearly impossible to get any information unless you’re a flight surgeon. Since snail mail is still the preferred form of correspondence, you’re also condemned to antiquity with communication.

Worried and confused, I started hunting for resources. Eventually I got in touch with two helpful AME’s who were willing to listen to my story, one of whom dug a little deeper by speaking to a flight surgeon directly. When we spoke again after, he skeptically questioned why I hadn’t mentioned my 30-year history of psychosis to him previously.

I’m sorry- what?

The FAA apparently believed I had lived a heavily medicated life of depression, suicidal tendencies, and psychosis. I was baffled. Where did this information come from? Can we confirm they’re looking at the correct medical file? How is this possible, when my “history of depression” had only spanned a few months? And why wouldn’t they share any information with me?

With a lot more digging, we pieced together that the psychiatrist who prescribed me the medication had written somewhere in his barely legible notes that I’d visited a therapist since I was young, which was true. However I largely went to therapy for the purpose of personal growth and development and the aforementioned “low spots” in life to help me process with an objective perspective. Rather than ask more questions about the therapy or query the professionals involved, the FAA chose instead to fabricate a wildly different set of reasons for seeing a therapist and made a series of decisions based on their manufactured reality that would affect my aviation path for years to come. They’d convinced themselves that I had a 30-year history of psychosis, and it was now my job to prove that wrong. I put my plans to start heli school on hold, and got to work.

I called in reinforcements, speaking to as many AME’s as I could about my situation and diligently dialling the FAA weekly for updates. I was advised by an AME highly experienced in the HIMS category-- Human Intervention Motivation Study, which addresses anxiety and depression-- to abandon the medication altogether in order to increase my chances of being issued a medical certificate. He’d seen enough cases similar to mine over the years to know that, if I could get by without the meds, my process would be simplified. I took his advice, the symptoms did not return, and I ensured that my psychiatrist communicated with the FAA regarding my progress.

Nearly a year of snail mail correspondence ensued, during which the FAA would request information, I would dutifully gather and send it, and they would continue to deny me. The hangup seemed to be their need for “a complete copy of all treatment records pertaining to your major depressive disorder”. I’m sure they were expecting a file the size of a phone book, but my “disorder” didn’t have any records beyond a few months, and they were already in possession of those records. In my weekly call to them it was recommended that as a replacement for the records, I should send additional letters from both the current psychiatrist and my therapist of 15 years stating that I posed no risk whatsoever to aviation.

Their recommendation failed, and the next letter of denial came with a request for a full-blown psychiatric evaluation. By this point I felt so beaten down and defeated by the process I considered giving up.

The irony was real—I’d been off medication for over a year, and the only life issue causing me feelings of depression and anxiety was fighting the FAA over a medical history that didn’t exist! Determined to persevere, I proceeded with the evaluation which was expensive in both time and monetary resources. I spent countless hours gathering 20+ years of records, letters of recommendation, positive work evaluations, and the results of past personality and learning tests such as Myers-Briggs. My accomplishments as a rock climber, setting groundbreaking records on one the biggest granite walls in the world, requires sound decision making and risk management skills; I used the articles and interviews documenting my brief brush with fame as evidence of a healthy mind and emotional body.

I became an intense investigator of my own life, committed to building my case beyond reasonable doubt that I could be a safe and capable aviator.

Meanwhile, I also made an appointment with yet another HIMS AME who could advocate for me through the remainder of the process, which would hopefully end with a medical certificate. Between the positive psychiatric evaluation report and the support of that AME, I was finally issued a “special issuance” second-class medical certificate in June of 2018, 20 months and roughly $4000 after initiating the journey. Still unconvinced, the special issuance was the FAA’s way of continuing to keep their eye on me as long as they deemed necessary. It took an additional four years to clear it from my record.

Looking back, I feel equally as frustrated as I did then about the ordeal. As it turns out, I was likely misdiagnosed with major depressive disorder, which may have prevented many of the issues I faced. That led me to believe there were some broader issues with the medical system and not just the aviation certification side.

Was my doctor trigger happy with medication? Did I make a mistake asking for help? What would have happened if I hadn’t made that initial appointment? Why did his positive endorsements of my mental health fail to subdue the FAA’s concerns? Since then, I’ve conversed with several aspiring aviators who face similar issues. Even the vast assortment of doctors I spoke to along the way expressed dissatisfaction with the rigidity of the system.

Many of my questions will remain unanswered. I am certain however that my intention in asking for help from a psychiatrist was rooted in the desire for self-improvement and the need to be the best human I can be, and I don’t regret that. Except here’s what’s interesting: Taking antidepressants helped me think through my career change more objectively by lifting the dark fog from my brain. The pathway to continue taking them became so outrageous, even from a doctors’ perspective, the best course of action was to stop. In other words, they helped to clarify my desire and inspiration to become a pilot, and also sabotaged the process of becoming a pilot!

I was ignorant to the ramifications of not involving an aviation psychiatrist in my process, since I hadn’t yet committed to becoming a pilot-- and I paid the price. Countless others have fallen into the same trap, a trap that wouldn’t exist if our approach to mental health were different.

If this article speaks you, please don’t give up. While my choice was to abandon the medication, it is possible to manage many types of medications and also maintain a medical certificate. For me, it was a test in resilience, and I’m thankful I stuck it out.

One of the most valuable lessons I learned from my records in rock climbing is that vulnerability is a pathway to deeper connections with ourselves and our loved ones. No matter what you’re dealing with, it’s impossible to stand alone when you surround yourself with empathetic and supportive people. It’s ok to lean on them, and it’s ok to lean into your own sadness.

We must remove shame from the conversation about mental health and create a framework in aviation medicine that reduces the susceptibility of a cookie cutter approach and instead promotes a more wholistic, individualized picture of well-being.

How will you get in action today?