The Daily
The Sunday Read: ‘Why Airline Pilots Feel Pushed to Hide Their Mental Illness’
Sun, 30 Mar 2025
Troy Merritt, a pilot for a major U.S. 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 OK. He could still fly planes, keep his job — as long as he wasn’t diagnosed with a mental illness.Merritt, like all pilots, knew that if he was formally diagnosed with a mental-health condition, he might never fly a plane again. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.
Chapter 1: Why are airline pilots hesitant to report mental illness?
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.
Chapter 2: What are the personal challenges faced by pilot Troy Merritt?
Troy Merritt, a pilot for a major U.S. 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 peacefully. 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.
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Chapter 3: How does the FAA's certification process impact pilots?
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.
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Chapter 4: What incidents have shaped the FAA's mental health policies?
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.
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Chapter 5: How has the aviation industry responded to mental health crises?
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 health care 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.
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Chapter 6: What are the potential risks of pilots hiding mental health issues?
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.
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Chapter 7: How can loosening mental health restrictions improve aviation safety?
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?
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.
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