When Joseph Emerson on a Horizon Air flight last week, the off-duty pilot was returning home from an intense and emotional weekend with friends and family of his closest friend, who died unexpectedly five and a half years ago.
The death hit Emerson hard. He became depressed. Emerson鈥檚 wife, Sarah Stretch, said that his depression and irritability worsened every year around the anniversary of his friend鈥檚 death.
鈥淚 had brought up during that, I was like, 鈥楳aybe you should talk to somebody,鈥欌�� said Stretch, who also asked her husband if he could take medication for his mental health struggles. 鈥淎nd then he expressed to me, 鈥楽arah, I can鈥檛 be out of work. We have to pay a mortgage. If I go do that, I have to go through all these other hoops 鈥nd we can鈥檛 afford to do that.鈥欌��
The Federal Aviation Administration, the government agency that regulates pilot licensure and medical clearance, has strict and 鈥� many pilots and aviation experts say 鈥� onerous and outdated policies around mental health. As a result, commercial airline pilots often avoid seeking help for what would likely be treatable depression or anxiety. A 2016 that 12.6% of commercial pilots had depression and 4.1% reported suicidal thoughts in the previous two weeks.
Researchers concluded that hundreds of currently active pilots are managing depressive symptoms and possibly afraid to seek treatment.
鈥淚f each aircraft requires two pilots, that means one out of four aircraft that are out there flying, are flying with a pilot that would qualify as clinically depressed,鈥� said Carl Eisen, a retired commercial airline pilot who spent years managing his own anxiety and now teaches meditation to other pilots. 鈥淚f that were dangerous, airplanes would be raining out of the sky on a regular basis. So it doesn鈥檛 seem that this poses a huge safety risk, although it鈥檚 less than ideal.鈥�
The FAA relies on pilots to self report any physical and mental health issues. If a pilot reports they have started seeing a therapist for depression, they are pulled from flight status. Regaining medical clearance to fly involves multiple steps 鈥� and can take years.
A long, costly process
Pilots and aviation experts told OPB many pilots choose to pay for a therapist out of pocket in order to avoid insurance claims and reporting to the FAA. But it鈥檚 a potentially enormous liability for the pilots if an accident were to happen.
If they follow federal policies, pilots must see , pass a battery of tests and voluntarily submit their therapist鈥檚 notes to the FAA, Eisen said. If they are prescribed medication for their depression, it鈥檚 even more complicated. Pilots are only allowed to take one of five , one type of antidepressant among many. If they choose to stay on medication, they must take the drug for six months before they can reapply for their medical clearance. If they stop taking antidepressants, they must wait 60 days before reapplying.
鈥淚t is not an easy process for them to get back into the cockpit,鈥� said Dr. Brent Blue, a physician and senior aviation medical examiner who also works with pilots with drug and alcohol issues. 鈥淭hey will have to go through these evaluations by a psychiatrist and a neuropsychologist to do that. 鈥� This is a pilot who basically is being responsible saying, 鈥業 am not up to flying because of my grief or whatever.鈥欌��
None of the FAA mandated steps are covered by insurance. And the process 鈥� the required tests, psychological evaluations, traveling to specialists 鈥� can cost thousands of dollars. It鈥檚 all happening while the pilot is grounded and can鈥檛 work.
OPB talked to a captain at a major U.S. airline who asked not to be named because they鈥檙e afraid it will negatively impact their career. About five years ago, they said, they made the hardest phone call they鈥檝e ever made. After life stresses mounted and their depression became too much, they called a psychiatrist, grounded themselves, and 鈥渨ent through the horrible process of trying to get certified as a pilot on antidepressant SSRIs.鈥�
鈥淚t was one of the hardest things I鈥檝e ever done,鈥� they said. 鈥淚t shouldn鈥檛 just be, 鈥楬ere鈥檚 some pills. Go fly.鈥� It should be a process, but it takes three years where you鈥檙e not getting an income.鈥�
Pilots can apply for short term and, after six months, long term disability while they wait for their medical clearance. The rates vary by airline but one pilot told OPB their long term disability pay was 50% of their salary.
The pilot said they felt great within six weeks of starting medication but remained grounded for three years while the FAA reviewed their paperwork and worked through the agency鈥檚 backlog. They eventually returned to flying but said most pilots still view depression as a career-ending diagnosis. Even if the FAA eventually approves your medical clearance, if you don鈥檛 have disability coverage or can鈥檛 afford the time away from work, it may be.
The stress of the job
Being a pilot is extremely stressful, Eisen said. That鈥檚 not because flying a plane is more stressful than other intense careers. For pilots, all of the mechanisms most people use to minimize stress in their lives are unavailable or difficult to incorporate regularly. Regular sleep and exercise, a healthy diet and vibrant personal life are all challenging because of the demands placed on pilots.
鈥淪leep patterns are frequently disrupted. That鈥檚 kind of a normal thing for airline pilots,鈥� Eisen said. 鈥淵ou鈥檙e gone half the time. That鈥檚 pretty stressful on your family life now, isn鈥檛 it? Have you ever tried to eat food at an airline terminal or the food that they give you on an airline? What about your diet?鈥�
After arriving at a hotel at the end of a 10-hour day, a pilot is more likely to have a glass of wine and watch TV than exercise.
鈥淚t鈥檚 very, very difficult just to have the foundational blocks in place to maintain good psychological and physical well being,鈥� he said. 鈥淧ut on top of that the stress of the schedules, the stress of the weather, the stress of the passengers, dealing with multiple crew members, all of these other things. It鈥檚 a very, very stressful life.鈥�
The FAA has made some changes. Before 2010, the agency didn鈥檛 allow pilots to take any antidepressants. Even pilots who had been on antidepressants in the past were prohibited from flying. The agency still prohibits pilots from taking more than one antidepressant at a time.
Blue, the Wyoming based senior aviation medical examiner, said the FAA鈥檚 policies make no rational sense. Being on two medications does not indicate more severe depression, Blue said. He said the agency should accept the judgment of a pilot鈥檚 treating psychiatrist.
鈥淭he FAA is so worried about a smoking hole in the ground that they鈥檙e scared to death that somebody鈥檚 going to be held responsible,鈥� Blue said, explaining that it鈥檚 very easy to say 鈥渘o鈥� to a pilot. 鈥淪o the fallback position is always to say no. That鈥檚 why pilots tend to withhold information.鈥�
In a statement to OPB, an FAA spokesperson said most mental health conditions don鈥檛 disqualify pilots from flying and that the agency encourages pilots to seek help if needed.
鈥淒uring the last several years, the FAA has invested resources to eliminate the stigma around mental health in the aviation community so pilots seek treatment,鈥� the spokesperson said.
In 2015, a pilot for Germanwings, a defunct discount airline owned by Lufthansa, crashed his Airbus 320 into the French Alps, killing all 150 people on board. The pilot had previously been treated for depression and his search history in the days leading up to the incident suggested he wanted to take his own life. And in 1994, a FedEx employee facing dismissal attempted to hijack and crash one of the company鈥檚 cargo planes to make his death look like an accident, allowing his family to collect life insurance.
Although astonishingly rare, Blue said the FAA is terrified of future similar incidents. Revamping policies, especially if the new policies appear more permissive, carries risk.
鈥淣obody wants to put their neck on the line, even if the chances are extremely remote that it鈥檚 a problem,鈥� Blue said. 鈥淭he FAA is fairly archaic in almost every regard.鈥�
Mounting stresses
These are the waters in which Emerson and other pilots swim. His friend鈥檚 death was one of a number of stressors in Emerson鈥檚 life exacerbating his depression, Emerson鈥檚 wife said.
He has been a commercial airline pilot since 2001, working for Horizon Air, Virgin America and then Alaska. He became a captain with Alaska Airlines in 2019 and has spent several years working in the airlines鈥� training department. Although that meant often-irregular hours at work 鈥� until recently they ran flight simulator training 24 hours a day, Emerson was still home and fully present for his wife and their two children, 8 and 6, Stretch said. Then, Alaska transitioned to a fleet that consisted entirely of planes built by Boeing. Emerson, an Airbus pilot, had to retrain on an entirely new aircraft.
The stakes were high. He would either pass the training or he would be out of a job.
Starting in May, Emerson was in Seattle training full time with a day or two home in San Francisco each week. For the first time in the eight years since they had their first child, Stretch was essentially a single parent.
鈥淲e would have arguments because I don鈥檛 understand the stress that he鈥檚 going through,鈥� she said. 鈥淎nd I would be like, well, 鈥榶ou don鈥檛 understand the stress I am going through taking care of these kids.鈥�
Emerson, who had wanted to fly since the fourth grade, began meditating and trying to work on himself on his own instead of seeking professional help 鈥� and potentially jeopardizing a career to which he had devoted his life.
It鈥檚 common for off duty pilots and flight crew to take flights to or from their work assignments. A short time into the Oct. 22 flight home to San Francisco, Emerson, who at 6鈥�1鈥� hated riding in the cramped jumpseat, threw off his headset and said, 鈥淚鈥檓 not OK,鈥� according to court records. He hadn鈥檛 slept in 40 hours. He was under tremendous stress at home and work, he was depressed and had just spent a weekend remembering his dead friend.
At some point during the preceding somber two days, Emerson took psychedelic mushrooms, he told investigators. Stretch was shocked when she found that out. She said her husband would never take anything more than allergy medicine and was afraid to be in rooms where people were smoking marijuana because it could have jeopardized his medical clearance.
Emerson told police he thought he had been dreaming when he reached up and pulled the handles activating the fire suppression system. He willingly left the cockpit and asked flight attendants to restrain him, fearing he might do something else.
An FBI affidavit suggested Emerson was on hallucinogenic mushrooms at the time he tried to activate the fuel suppression system. The agent who wrote the affidavit said Emerson told a police officer it was his first time taking the drug. The affidavit does not mention that Emerson told the officer he鈥檇 eaten the mushrooms about a day and a half prior or that the officer noted Emerson did not appear under the influence of any substance at the time. Mushrooms鈥� mind-altering effects last about six hours.
Stretch said her husband is obsessed with safety 鈥� so much so that Alaska Airlines made him the airline鈥檚 safety representative at San Francisco International Airport.
And he loved his passengers, telling them before each flight that they were all on this plane together and suggesting they 鈥渂e good to each other.鈥�
Among the dozens of state and federal charges, Emerson faces 83 counts of attempted murder but nothing about his behavior leading up to the incident suggests he had any intention of hurting passengers or himself. The day before returning home, Emerson made lunch plans with a friend. He texted his wife about how excited he was to see her and the kids.
鈥淚 want to come home. I want to cuddle,鈥� he texted. 鈥淐an we just sit on the couch and cuddle and watch TV when we get home?鈥�
Copyright 2023 Oregon Public Broadcasting. To see more, visit .
