March was a busy month for very public psychotic episodes.
First there was the flight attendant with bipolar disorder who disrupted a flight by shouting about a bomb on the plane. Then, the director of a popular documentary was taken to a hospital after running nude down the street. Finally, we hear about a JetBlue pilot who became agitated on a plane, ranted about Israel and Iraq, and demanded that the plane land. He reportedly was subdued by passengers, including a former NYPD officer and a correctional officer.
Besides the general concern about airline safety, as a clinician I can’t help wonder how these people can return to a normal life after such a public and dramatic breakdown.
I know the problems faced by my prisoners when they try to reintegrate into society: problems finding employment and housing, and the challenge of rebuilding disrupted relationships. If there are barriers due to being an ex-offender, imagine the challenges faced by someone who has had a psychotic episode broadcast to the world.
When a first episode happens to a young adult in his pre-professional years, adjustment is a bit easier. They may need to adjust goals or lower expectations. The patient may need to take time off from college or change schools, but eventually there is always the chance to quietly begin again somewhere else.
This option disappears when your breakdown makes national news. This is particularly true when the patient is a lawyer, a pilot, a doctor, a law enforcement, or other professional who holds a duty to public safety. These professionals have a requirement to report mental disability to a licensure board, and failure to do this is a crime in some states. Personal privacy is trumped by public security needs, and fitness for duty is closely scrutinized. A public breakdown could mean losing one’s career.
What are the options?
If the individual recovers completely and is otherwise qualified for the demands of the job, he would be protected by the Americans With Disabilities Act. If he needed some accommodation, he would be required to tell his employer about his disability and request it, but he could still work if he didn’t represent a danger to others.
Handling a relationship with a co-worker is a bit trickier. Do you go back to work and not mention what happened? Do you mention it in passing and reassure everyone that really, even though you almost brought down a plane, there’s nothing to worry about? Or do you become a public spokesperson and advocate for the mentally ill, like Carrie Fisher, who has created an entire show around her bipolar disorder?
There is no single right approach to this problem. Most people come to accept that an illness is part of who they are, but it does not become a public persona or part of one’s identity. But neither can it be entirely ignored or left unaddressed.
As Mark Vonnegut said in one of his memoirs, “Once you’ve been talked to by voices, it’s not possible to go back to a world where talking voices is not possible.”
—Annette Hanson, M.D.
DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.