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.
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,” Merrit 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. Co-workers 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 F.A.A.’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 OK 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 F.A.A. 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 F.A.A.’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 in 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 F.A.A.’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 F.A.A.: 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 F.A.A. workers. And the aviation industry is already facing serious shortages: More than 90 percent 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 Chesley 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 F.A.A.’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 F.A.A. — 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 F.A.A. 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 V.A. and F.A.A. databases revealed a wide discrepancy: Around 4,800 commercial and airline pilots were receiving V.A. disability benefits without reporting these medical issues to the F.A.A. While some of those pilots may have been fraudulently collecting benefits for nonexistent 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 percent 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 F.A.A.; 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 percent 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. A 2016 survey of airline pilots found that nearly 13 percent of them met the criteria for a diagnosis of depression and more than 4 percent 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 F.A.A. essentially barred anyone known to have a mental-health disorder from piloting a plane. Then in 2010, the F.A.A. 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 F.A.A.’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 guys’ 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 OK,” 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, Ore., 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 F.A.A.’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 F.A.A.’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 F.A.A. 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. Homendy, the N.T.S.B. 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?
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 F.A.A.
Then another set of evaluations began. Merritt had to find doctors who were HIMS specialists. HIMS 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 industrywide program made up of airline management, unions, specially trained doctors designated by the F.A.A. and the F.A.A. itself, which provides HIMS with about $540,000 in annual funding. In 2010, the agency created a program, drawing on HIMS, for pilots taking certain antidepressants; the agency decided that HIMS 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 HIMS 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 HIMS psychiatrist, as well as a HIMS medical examiner who compiled a file for the F.A.A. 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 F.A.A. — 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 F.A.A. 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 percent 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 HIMS 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 HIMS examiner.
Pilots who misrepresent their medical history to the F.A.A. 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 Carll 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 past the angst that that time of life can bring. But the HIMS 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. Carll also needed to hand over all her therapy notes to the F.A.A. “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 F.A.A. to have those kinds of details?”
Carll 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,” Carll 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 Carll hidden their psychological struggles, as Emerson did, aviation medical examiners would have been unlikely to catch them: The F.A.A. 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 Insel, 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,” Allen Frances, 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 F.A.A.’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 A.D.H.D. 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 A.D.H.D. 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 F.A.A. allowance is intended for those who were “misdiagnosed” with A.D.H.D. or “‘grow’ out of it.”)
The F.A.A.’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 F.A.A. relies on HIMS to help make that determination. Not only does HIMS 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 percent 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: HIMS “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 HIMS’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 HIMS, leaving its committee members to surmise that HIMS “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 F.A.A., amid calls for change, has implemented some reforms after the D.O.T. report commissioned by Senator Feinstein and Joseph Emerson’s episode pushed the agency to establish the Mental Health Aviation Rulemaking Committee. Last May, the F.A.A. 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: HIMS or other in-depth evaluations and the F.A.A.’s long review.
Robert Noven, an internist who works full time as an aviation medical examiner, has reservations about the new fast-track pathway. “I actually think the F.A.A. 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.” Noven 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 F.A.A. may soon be loosening policy further, whether it wants to or not. The Mental Health in 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 time frames observed in Europe and Australia — and eliminating mandatory HIMS evaluations in uncomplicated cases. Another would-be change could potentially allow people being treated for A.D.H.D., 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,” Noven 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 F.A.A. 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 F.A.A. “I don’t know a single aviation attorney that isn’t excited,” Joseph LoRusso, 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,” Noven 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,” Steven Altchuler, 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 F.A.A. oversight, “the folks on the 10,000 other flights may end up doing better,” Altchuler 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.
While the F.A.A. 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 Bomhoff, the founder and chairman of the Pilot Mental Health Campaign, warns: “The F.A.A. and airlines, to some extent, might be overemphasizing the role that peer support alone can play.” 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 Karlene Petitt, a Delta Air Lines 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 Petitt, 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 Petitt’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.
Petitt 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 Petitt had any mental illness. Petitt filed a whistle-blower 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 Petitt’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 Petitt 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 Petitt’s case put it, rather than public safety. Not every pilot can fight back as Petitt was able to do. The airline “just needed to silence me,” Petitt told me recently. “They did it because they could.”
“This case was big because it shed some spotlight on the shadiness that goes on,” LoRusso, 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 Petitt’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 F.A.A. — if Petitt were truly unsafe, shouldn’t she have been grounded rather than allowed, in theory, to work elsewhere?
After enduring years of legal proceedings, Petitt’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 Dickson, a senior executive at Delta involved in Petitt’s case who went on to become the F.A.A. 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 Karlene Petitt 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 F.A.A. 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 F.A.A. 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 F.A.A.-sponsored report by MITRE, a research-and-development nonprofit 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 F.A.A. must make decisions without it, which means, from Northrup’s perspective, erring on the side of caution and continuing to subject pilots with these diagnoses to closer scrutiny. (Homendy, the N.T.S.B. 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 F.A.A.’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 IMSAFE 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 biowearables 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 nonprofit 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 F.A.A. 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. I think that would be a really powerful message to people out there to say: ‘This is something in aviation that happened. We learned from it.’”
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