What happened to the pilot?

Just a couple of weeks after a self-reportedly “bipolar” airline flight attendant disrupted a flight by rambling incoherently about safety problems and warning of an imminent crash, people are asking me what might explain the similarly-erratic behavior of a Jet Blue airliner captain whose erratic behavior necessitated his restraint by passengers and an emergency landing on Tuesday.  His erratic behavior reportedly began in the cockpit, with the captain suddenly pressing buttons and flipping switches haphazardly, whereupon a quick-thinking co-pilot asked him to check something in the passenger compartment then locked the cockpit door behind him.  The captain then reportedly tried to enter an occupied lavatory, tried to re-enter the cockpit, and ran down the aisle rambling loudly and incoherently about Al Qaeda, an imminent crash, and the need for passengers to pray.  Ultimately, passengers reportedly restrained the captain while an off-duty pilot who happened to be among the passengers went to the cockpit and assisted the co-pilot in the emergency landing of the aircraft.  Upon landing, the captain was evacuated from the plane to a waiting ambulance, but no details of his condition have been released at this hour.  So, was Tuesday’s incident another manifestation of a “bipolar” disorder, or was it something else?  It’s tough to say with so few details available, but here are some possibilities:

The behavior described above generally sounds psychotic — specifically, disorganized and delusional.  Statistically, it’s a little unusual for a person to experience his/her first psychotic episode in his 40’s or 50’s, the estimated age of this pilot.  If, for example, he were bipolar and experienced a manic episode with psychotic features on Tuesday, that typically wouldn’t have been the first time, and he probably wouldn’t have been able to maintain a pilot’s license.  I’ve done the kind of assessment that the FAA requires of pilots when there are concerns about mental fitness to fly, and I can tell you: 1) that bipolar disorders typically manifest earlier in life than the 40’s and 50’s, 2) bipolar disorders, once diagnosed, are almost always medicated, and 3) the FAA typically does not license people who take the mood stabilizers and anti-psychotics commonly prescribed to people with bipolar disorders.  In addition, the pilot’s wife stated in an interview that she had no idea what could’ve happened to her husband, and assuming that’s true, it supports my speculation that whatever happened on Tuesday was a new phenomenon for this guy.

So, what else could cause somebody to become psychotic suddenly for the first time in his 40’s or 50’s with no evident trauma to the brain?  Maybe he had some kind of cerebrovascular event — people sometimes behave in ways that look psychotic after strokes.  It’s also possible that he had some kind of chemically-induced psychosis, perhaps as a result of prescription or recreational drug use that started recently (I’d generally expect any established pattern of problematic drug use to have been identified by the FAA and to have already resulted in the loss of his license) or as a result of an interaction between two or more drugs not regularly taken together.  It’s also possible that he had a complex partial seizure, which can produce temporary psychosis, but again, it would almost have to have been his first one ever — which is possible — because the FAA typically doesn’t license people with seizure disorders.  Finally, it’s possible that an overwhelming amount of stress sent this guy into a panicked, psychotic state, but if that was the case, I’d generally expect the wife to have some idea what was going on and/or the co-pilot to have noticed something unusual about the pilot’s demeanor prior to takeoff.

Those are my initial, admittedly totally speculative, thoughts.  Stay tuned for more details about Tuesday’s incident, but if you’re flying in the meantime, I wouldn’t be too worried.  Incidents in which airline pilots have become mentally incapacitated in the cockpit are extremely rare, like maybe one per decade on average.

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