It’s Better To Get Treatment Than Not Get Treatment

The flying public and pilots alike want assurance that the people flying airplanes and airliners are not going to become incapacitated while at the controls. However, many pilots would also agree that the FAA’s approach to medical certification remains antiquated and is in need of an overhaul particularly with respect to mental health evaluations and treatments.

Xyla Foxlin is a social media personality who is an electronic engineer which allows her to build things she likes, such as campers, boats, airplanes, and rockets. As she says, “Things that travel and take you on adventures.”

She is also a private pilot and owner of a 1946 Cessna 140, which she purchased in 2021 with her YouTube earnings and flew from the East Coast to the West Coast. Flying has been her passion since she was a child, and that passion comes through as she describes her experiences on so many adventures in her airplane.

When she needed her medicated IUD replaced she knew that during the first year, it releases nearly double the amount of progesterone than during the subsequent four years. The flood of hormone caused Xyla to experience a prolonged period of depression that lasted well beyond what she had experienced previously.

Xyla discussed it first with her gynecologist who essentially dismissed her concerns. But her primary care doctor agreed and said Xyla may want to meet with a psychiatrist to help her. Unfortunately, Xyla admits, she did not make clear to her primary doctor that she was a pilot and her doctor entered “Major Depressive Disorder” on her chart so she could get a referral to the psychiatrist.

After posting a video describing her dissatisfaction with the gynecologist and women’s health care in general, someone reported her to the FAA. The agency demanded she send in treatment notes from her gynecologist, psychiatrist, and primary care doc, and also ordered her to see an aviation psychiatrist.

The psychiatrist session was very questionable in scope and tone, covering her relationships, sexual history and experiences going back to grade school. When Xyla said she was in a long-term relationship, he reacted with shock. The questions were very intrusive and irrelevant to a psych evaluation. Xyla’s therapist was equally shocked when told about the aviation psychiatrist’s questions and wondered what his agenda was.

After receiving all the reports, the FAA denied Xyla’s medical.

There are several issues with how the FAA handles pilot mental health issues. First, the agency could potentially deny a medical to almost every pilot who reports a therapy session involving depression. This forces pilots who depend on flying as a livelihood to not report any mental health issues at all, including Post-Traumatic Stress Disorder or, as in Xyla’s case, a short-term episode of depression due to hormonal imbalance caused by her IUD. The FAA appears to rely on a backward, one-size-fits-all approach with draconian decision-making which, as we are becoming more aware, is not the modern view of such issues among medical professionals. That is not to say there aren’t in fact cases of suicidal depression that should be taken more seriously and compassionately.

The second issue is relying on psychiatrists who seem to have an agenda promoted by Queen Victoria and have the same rigid, almost prudish attitudes regarding women’s mental health along with similar assumptions about their sexual health. This issue, by the way, is not limited to women — male  pilots are also subject to questions about their sexual histories and relationships. These should have zero relevance to a mental health professional.

Thirdly, if many pilots are not self-reporting because of the real possibility of losing their livelihood, it is because the FAA really doesn’t care about pilots or safety but rather about being insulated from legal liability. It puts the flying public at risk because a small fraction of pilots may in fact require longer term care for depression and suicidal ideation. If they don’t self-report, well, we know where that might lead.

We wonder how or even if the FAA’s Federal Air Surgeon Susan E. Northrup, MD, MPH, will weigh in on this critical aspect of airmen medical certification. The FAA needs to modernize its approach, methods, and outcomes for pilots who face short-term mental health issues.

The flying public knows that humans have mental health issues and that those issues are readily treatable. Importantly, they also know that it’s better to get treatment than not get treatment.

Finally, the Pilot Mental Health Campaign is a group petitioning Congress to take up the issue. Chris Finlayson is the Executive Director and they are holding an Advocacy Day on April 2, 2025 at which they will be introducing the Mental Health in Aviation Act in the U.S. House of Representatives.

FMI:  www.youtube.com/