Note: This isn’t a blog post about writing. It’s not even a blog post about OCD—since COVID-19 forced me quasi-public earlier than I’d wanted, you can peruse my other blog posts to see how that’s affected my life and my writing. This is the story of how I picked myself up and did something I swore up and down that I’d never do. That I swore I wasn’t able to do.
And this during this year’s OCD Awareness Week, I’m happy to announce that I was wrong about both.
Part I
It’s Obviously Depression. . . Isn’t It?
Even though I wasn’t diagnosed until July 2018, I suspect OCD has stalked me for years. For a long time, my friends and family kind of danced around the subject, but I know what they were thinking.
She’s depressed. Or maybe she has anxiety. Why won’t she get help?
I eventually started thinking along those lines, even though neither seemed to fit. I visited therapist after therapist, explaining how I stressed and unhappy I was. One said I had postpartum depression. That didn’t seem to fit, but what else could it have been?
It was the wrong diagnosis, and that was partially my fault. In so much fear of losing my child, my freedom, and my ability to fly, I never told them about the perfectionism I’d struggled with so long—or about the thoughts that wouldn’t go away.
How I avoided my newborn son because I was afraid of shaking him, or smothering him, or driving him off a bridge. How I was terrified I’d end up in prison for accidentally picking up my phone while driving. How I checked the news every time the UPS driver knocked while my husband was deployed.
(In case this still isn’t clear, these aren’t common symptoms of PPD. It’s not clinical depression. In hindsight, so much is obvious.)
When I finally became desperate for help, I picked a therapist who specialized in Generalized Anxiety Disorder and OCD. I even boldly told her on my first visit that GAD was my problem. Because there was something wrong with me, right? It didn’t matter what.
Only it did matter.
The treatments for both depression and anxiety are exactly the wrong things to do for OCD. Anxious your spouse doesn’t love you anymore? Work through your reality, challenge that assessment, remind yourself of all the things he’s done that prove otherwise. Afraid your writing is terrible? Get betas. Hire an editor. Read those great reviews and revel in them. Prove to yourself that you don’t suck. Sounds easy, right?
Well, it works for anxiety.
It makes OCD worse.
Because (quick lesson here), the problem with OCD isn’t the thoughts themselves—it’s how you react to them. So, when my husband walked our screaming newborn around the kitchen one night and wondered what it would be like to throw him in the trash can, he thought, “Huh, that’s weird,” and kept walking and rocking and shushing. For someone without OCD, that’s how those intrusive thoughts go. They’re a mere blip, a weird brain thing that’s easily dismissed.
Me? I turn into an emotional wreck and avoided the entire situation. That avoidance—which, yes, is a compulsion—reinforced my brain’s incorrect notion that there was something wrong with the thought. That I was dangerous. That I was in danger. It’s a vicious cycle, and when most of your compulsions are mental, it’s really hard to see.
I can see compulsions now and identifying them as such was the first step. The second was exposure and response prevention therapy, the gold standard for OCD treatment. And I’m not going to sugarcoat this part—it sucks. It sucks a lot. It’s forcing yourself focus on the obsession without using the compulsion to reduce your anxiety. Sound unpleasant? Oh, yeah. It is. It’s massively uncomfortable and anxiety-provoking and just yucky.
I read my one-star reviews over and over without seeking reassurance until I rolled my eyes instead of feeling hot anxiety wrapping all around me (this is still tough for me, to be honest, but writers will be writers).
Maybe I do suck at writing—I’ll never know for sure.
I daydreamed about getting pulled over for speeding and ending up in jail without rationalizing to myself how unlikely that was.
Cops do awful stuff to show off their power. Good people make mistakes that land them in prison. It could happen to me.
I wondered what it would be like to leave my child to in a hot car. To see the ambulance and police cars and be taken away for questioning while all the neighbors judged and talked behind my back.
I learned in grad school and CFI training how complacency leads people to make mistakes—even ones as terrible as leaving your child in a hot car.
My breakthrough was unexpected. One day, while I sat writing detailed flash fiction about one of my greatest fears, I found myself saying, “oh my goodness . . . this is boring,” during a particularly horrifying piece. I knew then that I’d turned the corner—the goal of ERP is this exact reaction. I still don’t particularly care for accepting the uncertainties in life, but I’m coming around to realizing just how much healthier that acceptance is.
Then, as I found my thoughts drifting even further back in time, remembering the thrill of breaking out of the clouds at 200 feet, wishing I could introduce my son to the magic of flight, wondering if I could ever be issued an FAA medical certificate again, I knew it was time to keep moving forward. And even though my OCD screamed danger-danger-danger, and that I needed to avoid-avoid-avoid, I ignored it.
Then one day, in October 2019, I found myself back in Florida, sitting in my aviation medical examiner’s office, asking about certification after a mental health diagnosis.
Part II
Don’t Try This in Rural Georgia
It probably won’t come as a surprise to anyone when I say the FAA would rather mental illness simply not exist. When I began flying in 1999, any kind of psychiatric diagnosis was pretty much the end of the line. In 2010, they relaxed their stance, allowing medical certification under a special issuance procedure for airmen with depression treated with certain antidepressants. It was a step in the right direction, and I celebrated it from the outside, as an inactive pilot not affected by the change. But by 2015, after the intentional crash of Germanwings 9525 by a suicidal pilot, the pendulum had swung again, at least as far as public opinion went. So, when I made the drive to Florida to see the AME who’d last issued me a medical, I wasn’t hopeful.
I laid everything out for him, starting with the problems postpartum and ending with my diagnosis and the treatment the year before. It was the first time I’d ever said the words I was diagnosed with OCD, and even through my fear of what he was about to tell me, it was more freeing than I could have ever imagined.
No meds? he asked a few times.
(Meds are a very big thing for the FAA, in case you hadn’t figured that out)
No meds, I told him. Just ERP. No, no other mental issues in the last ten years. No dual diagnosis. No depression or anything else, no suicidal ideations, just the OCD. No, it hadn’t ever affected my flying.
To my surprise, he didn’t see it as a problem, and he assured me a deferral wasn’t the big huge deal pilots made it out to be (I am still in disagreement with this philosophy as a pilot who had never been deferred before). We would do the exam, he’d defer me, and then we’d wait and see what the FAA wanted—a psychiatric evaluation was certain, and that, he said, would likely be the end of it.
If it was, an unrestricted medical could be in my future. No special issuance required. Since my frightened lizard brain had been convinced the FAA would want to run me through the SSRI special issuance program, antidepressants, neuropsychological battery and all, this was better news than I expected. A psychiatrist? Yeah. I could pay a mountain of money to talk to a psych for a few hours.
He asked me if I wanted to do the exam right then.
I declined. In retrospect, I should have said yes, but I went home and thought. I second-guessed his confidence and experience and knowledge. I researched—thankfully there isn’t much information on flying and OCD out there, so that compulsion burned out pretty quick. I saw my therapist and talked about the entire process. I thought some more. (Did I mention reassurance is a huge thing with OCD?) I avoided my husband, because all I wanted to do was ask for reassurance. (Did I mention I should have just let the AME do the exam right then?)
And then, because I was getting pretty good at this whole exposure thing, I picked up the phone and scheduled my first FAA medical exam in seven years.
The exam itself went as expected—for the most part. To my surprise, I passed the near vision exam without reading glasses (very important for your pride once you hit forty). My history of a pediatric heart murmur and recent ear tube placement was a yawner for the AME once more. He hit send, everything went to the FAA, and that was that. For the first time in my life, I walked out of the AME’s office without a medical certificate.
After that, it was a waiting game. Truly a game, really, because I’d submitted my application for my biennial CFI renewal just four days earlier. Would Airman Certification send my new certificate first, or would the aeromedical people get their letter demanding more information in the mail before them? It made checking the mail a less than pleasant prospect.
My new CFI certificate came on a Monday.
My letter from aeromedical came that Friday.
Certified, of course. I underestimated how terrifying it would be to get a certified letter from the FAA. And when my heart started beating again…I read the bad news.
They wanted the expected psychiatric evaluation, yes—but also the full workup from a psychologist. My lizard brain panicked. But the 60-day clock they’d given me was ticking, so I let my mind run wild for a few days, imaging how I was going to be institutionalized once I failed the intellectual and neurological tests. Then I picked up the phone once more and started making calls.
Easy, right?
Not exactly. I’d known this process would require travel—a small in town in Georgia just didn’t have the specialists with the aerospace knowledge the FAA wanted. But wait! Delta Air Lines was just a few hours up the road—how tough could it be to find two of these two doctors near one of the largest airlines in the world?
More than a little, as it turned out. The first psychiatrist I found had just moved his practice from Atlanta to Pensacola, of all places. I sighed, banged my head on the desk, and booked a hotel. A psychologist was a lot easier to find. Harder to schedule. It was ten days from the receipt of the letter until I had everything booked—two and four weeks out. Talk about difficult to wait for.
But the day finally rolled around, and I headed back to Florida for the psychiatric evaluation. It was, like I’d predicted, only painful in the wallet. Unfortunately, the hope for an unrestricted medical slipped away during my conversation with him—he suggested that he would be recommending the FAA require biannual therapy sessions and an annual psych visit. But that was ok. I could handle a special issuance if it came down to it. I could handle monitoring, even though it carried the stigma of being associated with substance abusing pilots—which was one of the reasons I’d put this off for so long to begin with. Even so, it was done, and I could move on to the next phase: the dreaded neuropsychological evaluation in Atlanta a few weeks later.
But before I could visit the psychologist, all hell broke loose.
Part III
The End of the World Doesn’t Mean the End of Bureaucracy
When I’d gone to Pensacola on March 3 to meet with the psychiatrist, COVID-19 was a blip on my otherwise-occupied-with-work-and-kid radar. An interesting blip, with a case in Pensacola itself when I’d visited, but a blip nonetheless. I’d survived Disney World and flights from Orlando to Dallas to Atlanta safely a few weeks before, hadn’t I? I’d washed my hands and returned to my usual telework, fairly unconcerned about my personal risk. Everything was ok, right?
Well, no.
My six-year-old brought home a cold from kindergarten just after I returned to Georgia, and like usually happens, it was still hanging around my sinuses and middle ear the day before my testing was scheduled. When the psychologist’s office called to screen me for COVID-19 the day before my appointment, I was clearly ill, and they canceled. At the same time, I was desperately trying to get the FAA on the phone to get the status of my extension request. It had been granted and was in the mail, they told me, but there would be no further extensions granted because of the pandemic or national, state, and local emergencies.
Because of course.
I wanted to bash my head against the wall. Georgia wasn’t under lockdown, but here I was, too sick to complete the testing, and certainly too sick to leave the house when people were being quarantined. I wasn’t worried about getting sick—because exposure therapy works too well!—but the logistics had suddenly become impossible. The only glimmer of hope was that the FAA wouldn’t issue a denial until the psychiatrist had received my medical records—and they were running three to four months behind in sending out records.
It was the break I needed. I ramped up the fluids, rest, and Nasonex, and managed to clear up the sinus infection just days before Georgia issued their stay-at-home order. The psychologist’s office was closing for most of April because of the pandemic, but I got in under the wire and scheduled an appointment for April 2.
I won’t lie—it wasn’t fun. The traffic in Atlanta was almost non-existent, beating it into my head that something bad was happening. And no one needs it confirmed that they can’t do arithmetic in their head, right? But I survived, and at the end, the psychologist told me that everything looked good and that he didn’t see anything that would compromise flight safety (working memory and processing speed is what the FAA is specifically concerned in regard to OCD). The hurdle was cleared, and I could coast a bit while I waited the FAA to send my records out.
So, I waited.
And waited.
I saw my therapist a few times, per the recommendation of the psychiatrist. It would prove continued improvement to the FAA, he said, and I was willing to do whatever. We didn’t have much to talk about—turns out therapy is kind of boring when you’re asymptomatic.
And then I waited some more.
I did not, in some idiotic COVID-19-lockdown-induced apathy, request another extension.
Yeah, my fault there.
Then, one day in mid-June, the psychiatrist texted me, wanting the neuropsychological report. I played go-between for almost a week, trying to get the right paperwork to the right people—something I do a lot at work and don’t find particularly enjoyable in my personal life. And because I’d never requested the extension, I had every expectation that the FAA had a denial in the mail, setting me up for another medical exam and another attempt at certification.
But by June 23, everything was with the FAA in Oklahoma City.
And on June 29, I received a special issuance letter—with my third-class medical right behind it.
I could fly again.
Part IV
The Aftermath
So, what does this special issuance medical thing mean?
It means I don’t hold an unrestricted medical certificate like I did in past—I have to comply with certain conditions to keep my medical. In my case, I only have to provide a status letter from my LPC 60 days in advance of the expiration. This is a far cry from some of more onerous requirements they could have slapped on me, so I’m pretty happy about that.
It means my third-class medical is only good for a year after my exam—and since I’ve already eaten up six months of that with evaluations and waiting on records, it’s a bit of a pain. But going forward, things should happen a bit faster.
It means I have to notify the FAA if my symptoms worsen, and that I have to abide by the same prohibition during periods of medical deficiency as everyone else.
And lastly, it means this damn pandemic needs to end so I can GO FLY AN AIRPLANE.
Time and Money and Money and Time
More logistics—how much did this all cost?
I don’t like to talk money on the writing blog (you’ll notice I don’t even talk about editing/cover costs!), but the numbers running around the aviation community vary quite a bit, so I’m going to throw my experience in for any pilots who might cruise through here. I believe mine is on the low of the range, and I could have obviously saved by going local—even more local than Atlanta—but I’m not convinced that would have been a good idea. Having the right people involved is just too important.
So here we go.
<cringes>
Consult with AME: $0 + $137 hotel
Medical exam: $125 + $303 hotel = $428 (yeah, that’s two nights, because Pensacola, y’all)
Psychiatric evaluation: $1800 + $174 hotel (yeah, those Pensacola hotels aren’t cheap during spring break)
Psychological evaluation: $1900 (in Atlanta during a pandemic, so no hotel, though staying the night before would have been ideal)
4 x LPC appointments: $480
Records requests: $100
Forever stamp to request records when the FAA’s fax machine went down: $.55
Total: $4969.55
That’s right around the $5000 I’d expected, so I’m pretty happy with that.
While we’re talking numbers, let’s talk timeline. From my first appointment to discuss this with my therapist (October 30) to issuance (June 24) was almost eight months. Since my actual exam was on December 12 and the FAA sent their request for more information on January 23, I could have compressed this—a lot. But with COVID-19 as a wildcard, there’s no real way to know how much, so I’m not hung up on it. Six months is probably a very reasonable expectation in any case.
I think that’s it. I’m pretty much an open book here, so if you’ve surfed on in because you have OCD and are curious about treatment, or you’re a pilot wondering what to expect with a history of mental illness, I’m more than happy to talk! Just leave a comment or shoot me a message through the website.
Lastly, THANK YOU for everyone who’s supported me through this whole thing. I owe you guys so much…and maybe, eventually, a flight.