Jet Blue Pilot Goes "Nuts"

JetBlue Captain Clayton Osbon has made quite an impression with his reportedly erratic behavior on a flight from New York to Las Vegas, which required diversion and passenger intervention to subdue the captain. No doubt this was a horrifying experience for those on board this flight, and kudos are due the first officer and cabin crew for their intervention. I have had more than one patient ask me my opinion about this situation, and thought I would share some ideas.

First, a very important caveat. I am not diagnosing Capt. Osbon with anything. Rather, I am asking questions that I believe are ultimately an attempt to be charitable to him without excusing poor behavior. With that said...

I saw a number of stories about the requirements for a first class medical certificate as well as the frequency with which a pilot of Captain Osbon's age would be required to have another medical exam. But I am not sure that any exam could have caught this problem. While it is possible for someone to lie about just about anything on that form, I have serious questions at this point about whether or not that is a useful explanation. Let me explain: the behavior described by passengers suggests paranoid ideation. Capt. Osbon reportedly was ranting about terrorists, Iran, others who don't like America very much, and the sins of "Sin City." When the general public hears this, they tend to think of serious mental illness such as schizophrenia or bipolar disorder with psychotic features. But it is unlikely that a person would have a first psychotic break in his 50's. Those who have known this pilot for years are simply shocked about what has happened here, yet if he were truly suffering from a serious mental illness then those who have known him would have seen strange behaviors and thought patterns. Person's with life-long struggles with that kind of serious mental illness are not usually able to hide it quite this well. Personally, I would not fly with someone I new had a penchant for this type of behavior.

There are other explanations worth considering. I started to wonder about medication changes, some type of toxicity, or the development of a new physical illness that could cause delirium. I hope that in addition to a proper psychological workup, Capt. Osbon was also given a thorough medical examination to rule out these types of problems.

Based on the evidence in the media at this point, it seems that some compassion may be in order. There is no evidence that this pilot wished ill on anyone, or that he has ever had any type of incident of this sort. If that existed, my guess is the media would tout it. And that brings me to another point: the causes of psychological distress are many, multifaceted, and complicated. There is often not a simple explanation, and certainly no single explanation covers all instances. Rather than focusing on failures of the medical certification system or the alleged psychosis of the pilot, perhaps it is better to wait until all the data are available before making a conclusion. If you were involved in some type of incident, would you not want the same consideration? Would you want to be tried and crucified in the media? I wouldn't.