Readers who follow our original Shrink Rap blog may be aware that we use the image of a yellow rubber duck for our blog logo and mascot. While the intent was never to suggest that we’re quacks (we’re not), the logo came about after a 2006 article, "Wagging the dog, and a finger," in the New York Times discussed the increasing presence of animals on airplanes. The dogs fly free to provide emotional support to their troubled owners. The article also mentioned that cats, monkeys, miniature ponies, and a duck dressed in clothing have all served as emotional support service animals. The image of a dressed duck quacking about on an airplane captivated our collective sense of humor, and the years have gone by, but the duck has remained with us.
More recently, the Times ran another article, "Emotional support, with fur, draws complaints on planes," about the burden such support animals place on other passengers. For those with trained service dogs, the support animals can be distracting. For those with allergies, animal fur in an enclosed flight cabin can pose health risks. I’ll avoid the question of whose rights are more important, those of the anxious flyer or those of the allergic patient, and move straight to the question of the psychiatrist’s role in authorizing the use of a support animal.
Initially, I assumed that those who required the use of a support animal must have a phobia of flying with severe panic attacks, and that the animal was an absolute necessity, without which a patient wouldn’t be able to board a flight. Then a patient asked me to write such a letter. She’d flown many times without a creature, and I tried to understand why now she needed her new dog to accompany her. She insisted the pet was calm and well trained, and this would allow her to transport the dog back and forth at no cost, which would be quite helpful to her. And she did love the dog and find her company to be comforting, as any pet owner might.
As much as I was uncomfortable with this (my patient didn’t "need" the dog in order to fly), I looked at the criteria and felt she met it. I wrote a single-sentence note saying she was in treatment for a psychiatric disorder and it would be helpful to her to have her dog at her destination. I defined neither the disorder nor what about the dog was helpful, and I never met the pet. Fortunately, the psychiatrist is not required to comment on the mental health or behavior of the support animal, just the owner.
From the Southwest Airlines website, here is a list of requirements:
Emotional Support Animals
Animals used for a Customer’s emotional support are accepted in the cabin. In order for a Customer to travel with an emotional support animal, the Customer must provide to a Southwest Airlines Employee current documentation (not more than one year old) on letterhead from a mental health professional or medical doctor who is treating the Customer’s mental health-related disability stating:
1. The Passenger has a mental or emotional disability recognized in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV).
2. The Passenger needs the emotional support or psychiatric service animal as an accommodation for air travel and/or for activity at the passenger’s destination.
3. The individual providing the assessment is a licensed mental health professional, and the Passenger is under his or her professional care, AND
4. The date and type of mental health professional\'s or medical doctor’s license and the state or other jurisdiction in which it was issued.
Assistance and emotional support animals must be trained to behave in a public setting.
It’s an interesting set of criteria, because there is nothing specific about what "trained to behave in a public setting" might entail, and there are no specific criteria to define a patient’s "need" for a psychiatric support animal either during travel or at the destination.
When you think about it, this gets very complicated. It puts us in the position of being gatekeepers in an area for which we have no training and for which there are no set standards. It’s almost psychiatric stigma and discrimination in reverse – the presence of the dog announces that the owner is a psychiatric patient, yet dogs are no longer rare sightings on airplanes.
While it might be easier to say that as psychiatrists we don’t do that, it risks putting us at odds with patients over an issue which the airlines seem to sanction. Really, who does need their dog or their monkey or their cat to fly? Why should psychiatric patients be exempt from paying for their animals to travel, and have the comfort of knowing the pet is with them in a temperature-controlled cabin rather than crated and unattended in the cargo area, while everyone else must pay a fee?