possible bipolar and sport pilot?

Discussion in 'Medical Topics' started by Unregistered, Apr 18, 2013.

  1. Unregistered

    Unregistered Guest

    What makes someone with bipolar disorder an unsafe pilot?

    I've got someone wanting to learn to fly who has no bipolar diagnosis, has never been medicated, but has multiple bipolar family members and considers it possible he would be diagnosed as slightly bipolar if someone were to do an assessment. Person is generally mature and collected, has a college degree, holds a stable job in a position of responsibility, though may be considered a bit 'moody' at times.

    Knowing that there is a possible undiagnosed bipolar disorder, would I be unethical instructing him as a sport pilot? How about for a PPL?
     
  2. Unregistered

    Unregistered Guest

    Oh yeah, he doesn't have any intention of seeing someone to find out if he's actually bipolar. He said what's the point as knowing either way isn't going to change anything for him.
     
  3. AdamZ

    AdamZ Administrator Management Council Member

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    You have to make that decision on your own but I'll tell you that I know and have represented a good number of people with Bi-Polar Disorder. I personally would not feel comfortable giving the person instruction. If the disease is well controlled with medication I'd actually feel much better about it but of course the FAA says it would be disqualifying so it would be moot.

    The problem lies in the two poles of emotion and thinking that the person who suffers with this disease can experience. When the person compensated and becomes manic they can literally think they can do ANY THING. Their judgment is severely impaired. They will often think that they can accomplish tasks and feats that they can't ie acrobatic flight, They can have grandiose ideas that they try an act on, ie barging into Bravo airspace and buzzing a tower its just an ugly situation. When people are hyper manic they don't believe that they are sick or need treatment.

    When they are in a depressed mode, they can have suicidal thoughts or actions.

    It is a tough disease and I feel deeply for those that suffer from it and for their families its very hard. I do know several people who are being successfully treated, maintain their meds and are stable but it is a very hard disease.

    P.S. I also know folks that have BiPolar disorder in the family but do not have it themselves. The concern I'd have in your situation is that from what you describes the potential student believes he may have the disorder but won't do anything about it. If he fears he has the disorder because it runs in his family but he has shown no symptoms I think that's just a natural concern and he may be good to instruct but if he fears he has the disorder because it runs in his family AND he has shown symptoms then that is a big concern for me.
     
    Last edited: Apr 18, 2013
  4. bbchien

    bbchien Touchdown! Greaser!

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    The trouble with bipolar is, that part of your brain that says, "I'm OK" or "I'm not OK" isn't working so well. That is why the condition is grounding. Even controlled with meds, the FAA has no control over whether a person took his medicine on a particular day....
     
  5. JHW

    JHW En-Route

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    Just a suggestion from someone with no experience or knowledge whatsoever. It appears to me that the OP is like me, clueless about these things. So being wholly unqualified to make judgements, why try to do it? Just take the person at face value on their own merits without regard to whatever problems their family might have. If you think they will be a good pilot based on their own merits then why put any more thought into it than that?

    I see plenty of kids at local schools being medicated for behaviour based on a (IMO questionable) diagnosis of an older sibling, with no real complaints about problems with the junior child. In my wholly unprofessional experience most of these kids suffer from nothing more than a disease called 'childhood' but we as a society can't wait to "improve them" through chemistry.

    There are enough examples of this that I find it hard to acknowledge psychiatry as a legitimate science. It's become something more akin to a religion.
     
  6. jnmeade

    jnmeade Cleared for Takeoff

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    Based on what you've said, I don't see any reason to refuse instruction on medical grounds. (Of course, I sometimes refuse to train people just because....) You're not a doctor and are not asked to play god. I'm leaping to the assumption that he holds a driver's license in good standing and has no history of using the car or a gun or poison or something else to commit murder or suicide. The system he lives in apparently has not sent out any signals that would lead you to conclude that he is a danger.
    I don't see any ethical problem whatsoever in you instructing him. If there is reason at a later date to arrive at a different conclusion, then you are called upon to reconsider when that info is presented.
     
  7. bbchien

    bbchien Touchdown! Greaser!

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    You need a one week rotation at the Illinois State Psychiatric Institute. Those guys do know what they're talking about.....:yikes:
     
    Last edited: Apr 18, 2013
  8. AdamZ

    AdamZ Administrator Management Council Member

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    Thats why I said he needs to make the decision on his own. Its also why I said there is a difference between thinking he has the disorder due to it running in his family or thinking he has the disorder becasue he has symptoms that he is not addressing. One of the last things any CFI wants, and I'm betting Bruce will agree is to be sitting in a small LSA inches away from a guy with access to the stick, throttle, canopy etc who is having a manic episode.

    A BiPolar disorder Dx does not compare to Diagnosing a kid with ADHD just to give the teacher some rest. If the guy is midly psychothymic that one thing. Full blow BiPolar is a whole different ball of wax.

    But in the end it is the CFI's decion and you are correct he is not likely able to medically Dx.
     
  9. JHW

    JHW En-Route

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    Granted, but we're not talking people who are institutionalized, we're talking about people who are productive at their job or school. Have we really reached the point that anyone who doesn't fit someone else's definition of "perfectly normal" must be medicated? I was shocked when I saw the numbers for how many kids in our schools are on zombie pills. Presumably that carries through to adulthood. OTOH it's given me a whole new outlook on the safety of pharma stock dividends.
     
  10. poadeleted20

    poadeleted20 Deleted

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    Absent "an established medical history or clinical diagnosis" of bipolar disorder, the FAA standard established in 14 CFR 67.307 is a "disorder that is severe enough to have repeatedly manifested itself by overt acts." So, to use the language of 14 CFR 61.53, does the individual "know or have reason to know" of a history of such "overt acts" rather than just "moodiness"? If yes, then s/he needs to stay on the ground. If not, then I don't see a problem.
     
  11. bbchien

    bbchien Touchdown! Greaser!

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    Jeff, this is like someone who doesn't understand the observational method of science criticizing engineering as a bunch of hocus pocus.

    The trouble we have in the community is we have sooo very many self proclaimed experts, that we have trouble figuring out who really knows. Just look at some of methodist's (oh. Healthpoint or somesuch) adverts.

    When the NPractitioners, school counselors, etc. say you don't fit- they are doing what you say. But when the psychiatrist with the five year residency and the fellowship beyond residency, and 4 years of medical school (lessee, that's about ten years after B.A of study) says something, it is something that EVERY OTHER psychiatrist would say and reproducibly so. And the POINT: The ISPI at Manteno is closed. They are ALL on the street. But these guys are pretty good at telling which ones, ten years from now, will be living behind shopping carts. Seriously.

    That would be like me tearing up your spreadsheet and dismissing it as a bunch of c_ap. Now it just does happen that I have a number of engineering courses and a physics minor and I hope you see where I'm going with this.....sort of like the vaunted George Braly Engine lab....."the newest latest and greatest....which we had readily on hand in ~1990 here in the city? Are you getting this?

    What is this thing you call an electrical field about a cylindrical conductor? I dont believe this F=iLB stuff.....and why the right hand rule? Isn't that discriminatory?
     
    Last edited: Apr 19, 2013
  12. Unregistered

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    Yeah, I'm gonna go ahead and admit I'm clueless here. Know nothing about bipolar other then its disqualifying. I am trying to do the right thing here I don't want him to end up in a plane if that's going to be unsafe for him.


    I'm thinking it may be that one. He doesn't act anything like how he describes his family members acting, although I felt there was some reason beyond genetics for why he thought he might have it. I think I will ask him to elaborate on that before making any further decisions. Don't know if that's the best idea, but we have an existing relation so that question isn't going to be out of line.
     
  13. Unregistered

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    Sounds reasonable. From what Bruce said, it also sounds like if he does suffer from it that he may not be a credible source of whether there have been repeated overt acts.
     
  14. poadeleted20

    poadeleted20 Deleted

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    Bingo. Problem is, the average CFI isn't qualified to sort that all out. Once the potential trainee tells you he "considers it possible he would be diagnosed as slightly bipolar if someone were to do an assessment," you now have reason to know he might not be safe for solo (the FAA regulation phrased "yes/no" rather than by degrees of bipolarity), and I can see some instructor liability arising from that if it turns out the trainee is right. I'd walk away from this one.
     
  15. jnmeade

    jnmeade Cleared for Takeoff

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    So, what happens when the CFI elects to not train the person, then a couple of months later sees the guy fly in from another airport on his Student Pilot solo cross country? The student has obviously gone to another CFI, this time being smart enough to avoid raising any question on his health (since the student, upon mature reflection, has decided he is not qualified to diagnose himself and was only speculating before, and feels fine). The student has obviously been signed off for solo flight.

    Does the OP have a moral responsibility to report his concerns to the FSDO? He was concerned enough earlier to not train him. Does the OP approach the student and grill him about how he got to fly? Does the OP attempt to contact the new CFI and pass on his concerns?

    Or, is the conclusion only that the OP wants to avoid personal potential liability and therefore if some other CFI takes the risk, it's OK ?
     
  16. TriGear28

    TriGear28 Pre-takeoff checklist

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    No. CFI's are not the enforcement branch for the FAA, are not trained medical professionals, and are not to play god in determining the safety of a 'possible' medical diagnosis for which they have no understanding. However, if that student comes in to get his log book signed from a XC and gets beligerant, or rants on about something that clearly indicates a sign of mental illness or instability that would be obvious to the average citizen, then YES it would be a good idea to report and let the feds sort it out.
     
  17. JHW

    JHW En-Route

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    Hi Bruce,

    I'll buy it except for the part I highlighted. There are far too many cases of one Dr medicates a kid for behaviour only to have another Dr 2 years later arrive at the opposite conclusion. I see it all the time on school board as families petition for enrollment or reinstatement. I have a lot of trouble putting faith in a science that has so little definitive information. An oncologist or cardiologist can explain cause and effect in a way that uneducated people like me can understand. Not so with psychologists, it boils down to "trust me".

     
  18. jnmeade

    jnmeade Cleared for Takeoff

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    Well, hopefully the guy wouldn't signed off to be on a flight if he was that way. Of course, if the student botched a cross wind landing and nearly ended up in the weeds and was shook up - well, one might curse many gods and I wouldn't report them to the FSDO.

    What we're talking about is does the CFI have the courage of his convictions - I think you're crazy so I won't train you and, oh, by the way, if I ever see you in the air I'll shoot you down - or is the CFI in the first place just uncomfortable and wants a way out, in which case why not just say "I make no judgment about your mental condition but I won't teach you" and let it be done with that? Or should the CFI say, "I'm afraid that you might be crazy and I don't want any liability to come my way when you flip out a few years from now."?

    If it were me, I'd just say I'm not flying with you because I'm old and cantankerous or I'd go ahead and fly with the guy and assess his judgment and similar skills that I am competent and expected to rate and I'd continue or quit training based on how he flies. If he botched a landing, slammed the yoke, started cussing and I had to take the controls, that would be our last flight. If he got so moody after a critique that he didn't maintain an objective demeanor in the cockpit, that would be our last flight. But the reason would be something I was responsible for and competent to judge, not a guess as to whether he or I thought he was bipolar.
     
  19. John221us

    John221us En-Route

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    I have known a couple of bipolar people. The problem with a single assessment, is that they are not the same from day to day (i.e. bipolar). One day they could be manic and the next they could be "moody". They may seem perfectly normal. You sign them off for solo flight and they go into a manic episode. One of the people I knew wasn't totally bipolar, he only went from normal to the manic side, but one day he found himself on a street in Mexico and couldn't remember how he got there.
     
  20. AdamZ

    AdamZ Administrator Management Council Member

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    FWIW acting quirkey or odd IMHO is no reason not to instruct. There is a HUGE difference between odd and quirkey and BiPolar. Hell most of the pilots I know are odd and quirkey.
     
  21. SkyHog

    SkyHog Touchdown! Greaser!

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    Correct me if I'm wrong, but if this is a Sport Pilot candidate, its his decision to ground himself, not the CFIs, right? You can advise him, but ultimately, I would say its inappropriate for you to ground him or refuse to let him fly.

    That is, aside from your normal right to choose who you are willing to fly with anyway.

    You can guide him, tell him "You should probably get evaluated for fitness," but ultimately, if he is undiagnosed, in the FAA's minds, he's a safe aviator. You can thank the FAA's awesome AeroMedical team for that one - better to be undiagnosed than to be safe.
     
  22. AdamZ

    AdamZ Administrator Management Council Member

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    Correct on most accounts Nick however it is the OPs decision as to whether he provides the person with instruction.
     
  23. bbchien

    bbchien Touchdown! Greaser!

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    The trouble with your example there is that the original guy is not equipped with the added 2 years of history. That study has been done, and it's valid. If you bring the subject to the original guy, after the other guy has seen him 2 years later, R>0.86 IIRC. It's been a long time since I've seen that trial....

    Now in our town, completely different matter. There is one doc, formerly associated with the number 2 hospital who says whatever's convenient. That's not the same thing. That's NOT expertise.
     
    Last edited: Apr 20, 2013
  24. poadeleted20

    poadeleted20 Deleted

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    Not on that basis alone. OTOH, if that CFI observed some "overt acts" which reflected a mental disorder, I'd say s/he should report those observations to the FAA and let them deal with it from there.
     
  25. poadeleted20

    poadeleted20 Deleted

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    Exactly. When you're a CFI, you are responsible for what your trainees do in the airplane. If for any reason you lack confidence in their ability to exercise in a safe manner the privileges you grant them, you don't grant those privileges.

    And let me emphasize that point about granting privileges -- it is the CFI who grants the Student Pilot his/her solo flying privileges, not the FAA. That is a singular power and responsibility. With the exception of upgrading from CP to ATP (by which time a lot of others have already signed on), a DPE or FAA Inspector cannot grant flying privileges without a second signature in the book, but a CFI can do that without any oversight or second opinion with any joker off the street who holds a drivers license (and not even that for balloons and gliders). That is a privilege and authority I do not take lightly.
     
    Last edited: Apr 19, 2013
  26. HumanSpirit

    HumanSpirit Filing Flight Plan

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    There is no science to the mental health industry. No medical model. NO evidence based medicine. No test for chemical imbalance of the brain to which the APA admitted to the falsehood in 2004. The industry is based on hearsay and is political.

    Inside the Battle to Define Mental Illness

    Every so often Al Frances says something that seems to surprise even him. Just now, for instance, in the predawn darkness of his comfortable, rambling home in Carmel, California, he has broken off his exercise routine to declare that “there is no definition of a mental disorder. It’s bull****. I mean, you just can’t define it.” Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt.

    There are no genetic tests, no brain scans, blood tests, chemical imbalance tests or X-rays that can scientifically/medically prove that any psychiatric disorder is a medical condition.
     
  27. RJM62

    RJM62 Touchdown! Greaser!

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    Umm... I have to take partial issue with that conclusion.

    Two of my degrees are in psychology, and I admit that there's a lot there that raises my eyebrows. It's the only science I know of where if you ask 10 experts the same question, you'll get 11 different answers.

    Not all of it is bunk, however. The neuro stuff is pretty solid, and a lot of it is, in fact, objectively provable using hard science. PET scanning, in particular, has been invaluable in understanding and charting the inner workings of the noggin, and has great promise for clinical application.

    Yeah, some of the "disorders" and diagnostic criteria are dubious at best, in my opinion; and I suspect that more than a few were included in the DSM primarily to give clinicians the ability to bill for "treating" the ordinary vicissitudes of life. I had to read the entire DSM-II and III in the course of my studies, and the thing that impressed me most was that I doubted there existed a living human being over the age of two who couldn't be diagnosed with some "disorder" or another based on DSM criteria.

    Still, I wouldn't trash the whole concept of mental illness -- especially now, when advances on the medical side are finally making it possible to apply objective science to the study of the brain.

    -Rich
     
    Last edited: Apr 30, 2013
  28. Skylane81E

    Skylane81E Final Approach

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    Yep,

    I won't call it bunk simple because we can take a nonfunctional person and make the quite functional. It ain't perfect but it is the best we have.
     
  29. bbchien

    bbchien Touchdown! Greaser!

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    Yes there is. Take a panel of board certified psychiatrists and have them watch the same inteview, R=>.92 (IIRC) that they all come to the same conclusions.
    The psychologists, no so much, but that's why they have normed statistical tools.


    Written like a guy who has a problem, and is excluded from Aviation: e.g: "It's everyone else, not me". And there is some predictive value to the future to that interview. Much much more predictive value, to that interview + 2 years of observational history....

    Bipolar and Sport Pilot- I know how I feel about that professionally!
     
    Last edited: Apr 30, 2013
  30. Unregistered

    Unregistered Guest

    There's no FAA rule against someone with bipolar disorder taking pilot training. The rule is against granting a medical to someone with bipolar disorder to solo. If you are uncomfortable with the prospect of him exhibiting symptoms of bipolar, keep in mind a few things - bipolar disorder varies in severity from overly 'moody' to suicidal or psychotic. It's generally classified as bipolar 2 (mild) or bipolar 1 (moderate to severe) with the threshold being a very subjective disruptive vs destructive. Someone with bipolar 2 does not get manic, only hypomanic, which is just high energy and highly emotional but devoid of any high risk behavior. It amounts to cyclical depression and represents about that level of danger. If he's over 30, it's likely as bad as it's going to get and his history should be a good indicator. Bipolar 1 is unlikely to have gone unnoticed by family, friends, coworkers or even the medical or law enforcement communities, so it is unlikely an issue. The FAA may still not grant him a medical if he were diagnosed, but you would have no reason to worry about having him with you at the controls. I know all of this because I have bipolar 2 and was considering pilot training. I was curious if anyone knew of a student pilot who managed to get a medical via appeal. I'm a successful mechanical engineer with a degree from MIT. I wasn't diagnosed until age 36 and could have gone on forever that way as I had never exhibited any high risk behavior to bring it to the attention of anyone else. I made the choice to seek treatment because I felt the swings were reducing my quality of life. The threshold at which 'moody' becomes bipolar disorder IS very subjective and I believe the suitability to fly of one with it should be subjective as well but determined with the guidance and monitoring of a qualified psychiatrist.
     
  31. poadeleted20

    poadeleted20 Deleted

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    Agreed -- as long as a CFI is acting as PIC, there is no restriction on who can take training.

    Also agreed. But speaking as a CFI, if someone diagnosed with bipolar disorder came to me for Sport Pilot training, I'd need to be cleared by that trainee for a full disclosure discussion with that psychiatrist before signing their Student Pilot certificate for solo.
     
  32. comanchepilot

    comanchepilot En-Route

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    Is ' a little bit bipolar' like a 'little bit pregnant?'

    I understand mental illness is a continuum but bipolar has some fairly specific diagnostic criteria that are well known and well understood - and I dare say - unmistakable for the most part. So one would not ever be diagnosed a 'little bit' bipolar. . . . you either are or are not - and - well - is autism grounding?

    Ergo, the comments above concerning Type I vs Type II.

    Moreover, mental illness does exist - just because we cannot discern physiological changes does not mean that the behavioral disorders do not exist. . . .
     
    Last edited: Nov 5, 2013
  33. bbchien

    bbchien Touchdown! Greaser!

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    Uh. NO.
    There is no way to tell a bipolar 2 from a bipolar 1 until they have full mania. The mean time for observation is about 17 years, IIRC before the full mania. And then you are no longer a bipolar 2, right?

    And the dividing line between bipolar 1 and 2, is well....fuzzy and not well validated, at least in the eyes of the Federal Psychiatrist, to say the least (validity vs accuracy).

    That's why the "culture of the FAA" is never to certify these folks.
    I personally would NOT feel able to sign off a light sport student for solo, with that diagnosis.
     
  34. Henning

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    Why don't you go ahead and start the guy out and observe him for a while? That he is cognizant and admitting that there 'may' be an issue due to genetics is IMO a positive in his favor. The fact that he has diagnosed and treated people in his family and is himself not diagnosed or treated is another (you can be sure that the doctors who are treating the rest of the family have cast a glance in his direction as well, and other family members have too). "Moodiness" is a far cry from a true bipolar condition, and the fact that it exists in some of his family is not proof that it exists in him. Over the course of a month if he does have a condition, it will likely make itself obvious especially under the stress of flight training. Since he already admits to and has concerns about the possibilities here, he should be open to an honest conversation about any concerns you may have over behavior he exhibits.

    Give him a chance and go fly with him. Better that you do it that someone else with no history with him and no warning of the possibilities.
     
    Last edited: Nov 6, 2013
  35. poadeleted20

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    Henning appears to be responding to a situation back in the original line of this thread, not the post which restarted it six months after it died. In the restarting post, the poster clearly states that he has been diagnosed as bipolar, and it is to that post several of us have responded in the last couple of days. Henning's post immediately above is not relevant to that situation.
     
    Last edited: Nov 6, 2013
  36. Henning

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    Oops, yep, I was responding to the OP, didn't catch the date.
     
  37. ClimbnSink

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    Train the bipolar they are fun to watch.
     
  38. Henning

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    Schizophrenics are fun to party with....
     
  39. RJM62

    RJM62 Touchdown! Greaser!

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    My ex-SIL has bipolar, and I have to tell you, I worried about her a lot. Frankly, I didn't even think she should have been allowed to drive a car. I certainly wouldn't want her flying an airplane. In fact, I wouldn't even want her being a passenger on an airplane if she was anywhere near the controls.

    When she was on her medications, Liz was a sweetheart. She was one of the kindest, funniest, and most engaging people I knew. Everyone loved her -- when she was on her meds.

    The problem is that many people with bipolar have this bad habit of thinking they're cured and stopping their meds without telling anyone, and no matter how many times this goes badly for them, they don't seem to learn from it. Liz is one of those people. And although I don't know if this is typical or not, when she went off her meds, she would seem fine for a while. And then all of the sudden, she would leap right off the deep end.

    Her depressive episodes consisted of either inconsolable despair or seething anger, depending on what else was going on in her life (or sometimes what she merely thought was going on in her life). Similarly, her manic episodes consisted of either extreme happiness and reckless, daredevil behavior, or destructiveness for the sheer joy of it. For example, she would throw dishes and glassware against the wall, laughing hysterically as they shattered.

    Liz's condition got her into legal trouble on several occasions. She would do irrational things like stealing stuff just for the sheer joy of it, and then giving it back, apparently thinking that the people from whom she stole it would share her amusement. They didn't.

    Thanks to smart lawyers and compassionate judges, Liz never did more than a few hours in jail before being transferred to a hospital, and most (if not all) of her charges were ACD'd in the end. But she did spend quite a few stints in psych wards waiting for her meds to kick back in after these escapades. She would then swear to never stop taking her meds again.

    Until the next time... there was, unfortunately, always a next time.

    I haven't seen nor heard from Liz in quite a while. My break-up with her sister was less-than-amicable, and I suppose there are some bad feelings surrounding that. The last time I talked to her we had a pleasant conversation; but since then she changed her number, and she hasn't seen fit to give it to me.

    I hope she's doing well. I have no hard feelings toward her, nor any reason why I would. She's a sweetheart. But she's sick. And as much as I like her, I certainly wouldn't want her flying an airplane.

    In my opinion, OP is in a tough situation. Bipolar, I am told, is highly heritable; so there's at least a chance that the prospective student has, or will eventually develop it. On the other hand, there's no reason to believe that he has it now, nor any certainty that he ever will.

    So from a strictly ethical point of view, I think I'd hope for a very long training period -- long enough to observe the student and become comfortable with his general stability over time. But I also would be careful not to read too much into normal moodiness, frustration over bad landings, and so forth.

    The thing is this: The law is what it is, and at this point, it doesn't seem like there's anything disqualifying this student from a medical (or from flying SP). But from a moral and human decency point of view, if he is in fact bipolar, then I wouldn't want it on my conscience that I gave him another a means to kill himself -- and possibly take a few others along with him.

    It's a tough call. I wouldn't want to be in OP's position, that's for sure.

    -Rich
     
    Last edited: Nov 6, 2013
  40. greghughes

    greghughes Pre-takeoff checklist

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    GregPDX
    Per FAR 91.1606 he should post it on POA in the Medical Topics section. Preferably anonymously.