The FAA’s medical certification framework under 14 CFR Part 67 lists 15 congressionally mandated disqualifying conditions. The FAA didn’t invent these; Congress embedded them in federal law, and the agency is bound to enforce them. Among them, bipolar disorder, psychosis, and severe personality disorders remain the most difficult for pilots to navigate when seeking a medical certificate.

While regulatory flexibility—especially through 14 CFR § 67.401—has allowed many aviators to return to the cockpit after serious diagnoses like insulin-dependent diabetes, valve replacement, or even heart transplantation, the operational unpredictability of these three mental health conditions keeps them in a category where certification is rare [1], [2].

Severe Personality Disorders: in Life and on the Flight Deck

In regulatory language, a personality disorder becomes disqualifying when it is “severe enough to have repeatedly manifested itself by overt acts” [1]. This isn’t about a diagnostic label in a medical chart—it’s about observable behaviors that undermine safety.

In aviation, those “overt acts” can look like:

• Chronic defiance of structure—skipping preflight inspections, ignoring checklist discipline, or breaching controlled airspace despite repeated warnings.
• Aggression under pressure—verbally attacking crew or ATC when things get tense, silencing dissent rather than managing it.
• Impulsive escalation—turning a manageable situation, such as a weather deviation, into a hazard through rash decision-making.
• Lack of insight—refusing remedial training, rationalizing unsafe acts, and showing no remorse after near-miss events.

The 1994 Fairchild AFB B-52 crash remains a stark case study. Lt. Col. Arthur “Bud” Holland had a well-documented history of dangerous flying—steep, low-altitude turns and disregard for flight limits—yet his superiors failed to intervene. During an airshow practice, he executed a bank angle far outside the aircraft’s capabilities. The aircraft stalled and crashed, killing all aboard. Investigations described this as a product of unchecked personality-driven risk-taking [3], [4].

The same traits appear in different forms in non-aviation settings:

• A corporate executive who disregards compliance warnings, believing their instincts override legal obligations, repeatedly putting the company at risk.
• A sports coach who humiliates players to “toughen them up,” creating a toxic, unsafe environment.
• A driver who reacts to being cut off by tailgating at high speeds, convinced their aggressive response is justified.

The setting may change, but repeated, unsafe actions born of deep-seated personality traits that resist correction are not compatible with aviation safety. 

Bipolar Disorder

Bipolar disorder alternates between manic/hypomanic and depressive episodes. In mania, a pilot might attempt risky approaches in poor weather or deviate from ATC clearance “to save time.” In depression, that same pilot could miss altitude calls or hesitate to execute a directed “go-around” due to impaired focus.

For certification, the FAA demands evidence of long-term stability—often years without symptoms—under continuous psychiatric follow-up. The concern isn’t solely about the present state; it’s about the risk of recurrence during a certificate’s validity period. Operational safety depends on consistent judgment [1], [2].

Psychosis

Psychosis—often associated with schizophrenia—disrupts connection to reality. It causes hallucinations, delusions, and/or disorganized thinking. Even subtle symptoms can have catastrophic implications on the flight deck.

In JetBlue Flight 191 (2012), the captain suffered an acute mental health crisis mid-flight, shouting incoherently about terrorism and divine intervention. The first officer locked him out of the cockpit and diverted safely—an extraordinary demonstration of crew resource management [5]–[7].

The Germanwings Flight 9525 tragedy in 2015 drove the point home. The co-pilot, in the grip of severe depression with psychotic elements, locked the captain out and deliberately crashed into the French Alps. The BEA’s final report prompted sweeping reforms to pilot mental health reporting and evaluation in Europe and informed U.S. policy discussions [8].

FAA Mental Health Policy: Risk-Based Evolution

For decades, the FAA’s approach to mental health was shaped by a blunt reality: a psychiatric diagnosis—particularly one tied to in-flight safety risks—was often the end of a flying career. That stance was built on caution, but it also carried unintended consequences. Pilots avoided mental health treatment out of fear that disclosure would cost them their careers.

In recent years, the agency has begun shifting toward a more nuanced, risk-based model. Instead of treating every diagnosis as a fixed disqualifier, the FAA now asks: Does this condition, as it exists in this pilot, present an unacceptable risk to safe flight?

This change has opened the door for aviators with conditions like anxiety, depression, PTSD, and ADHD to be evaluated on the basis of stability, treatment effectiveness, and actual cockpit performance. FAA-approved medications for certain mood and anxiety disorders, once off-limits, are now permitted under careful monitoring [9].

Advisory bodies like the Mental Health and Aviation Medical Clearances ARC have reinforced this shift. Their 2024 report urged the FAA to streamline evaluation processes, reduce unnecessary barriers to disclosure, and make return-to-flight pathways clearer for those whose conditions can be treated to an acceptable level of safety [11].

Yet the FAA’s own oversight arm—the DOT Office of Inspector General—has warned of persistent under-reporting, driven by stigma and fear. Pilots are still reluctant to disclose symptoms that could prompt lengthy investigations or grounding [10].

The evolution is not complete. While bipolar disorder, psychosis, and severe personality disorders remain formidable barriers, the trajectory suggests a growing recognition that mental health, when managed and documented, need not be incompatible with safe, professional flying.

Misdiagnosis and the Path Back to the Flight Deck

Some pilots carry diagnoses that, upon modern reevaluation, no longer fit. A “bipolar” label applied after a single reactive episode years ago might not meet DSM-5-TR standards today. In such cases, the pilot’s path forward is procedural as much as medical.

Wingman Med routinely helps pilots navigate this process, ensuring that medical and operational evidence is presented in a way that speaks directly to the FAA’s core concern: flight safety.

While a true diagnosis of bipolar disorder, psychosis, or severe personality disorder will likely result in permanent medical disqualification, a mis-applied diagnostic term can be overcome with demonstrated stability and up-to-date psychiatric assessment.  

A More Human Epilogue

Picture Amelia, a veteran pilot who battled depression after a difficult personal period. Through appropriate treatment and careful follow-up, she returned to full operational readiness. Her reapplication included six months of psychiatric stability, endorsements from colleagues, and clear documentation that her condition posed no flight-safety risk. The FAA issued her medical certificate without special issuance—proof that recovery and return are possible.

Contrast this with David, another aviator whose severe personality disorder had left a trail of operational defiance: repeated airspace violations, insubordination toward ATC, and refusal to follow SOPs. Despite coaching and discipline, the pattern persisted. His denial was upheld because the core behaviors—those “overt acts” that merited Congressional concern—remained unchanged.

These stories illustrate the essence of the FAA’s evolving philosophy. For some, treatment, transparency, and time can rebuild trust and support return to the flight deck. For others, the very traits that define the disorder are incompatible with the cooperative, disciplined environment of professional aviation. In both cases, the ultimate measure isn’t just the name of the condition—it’s the proven ability to fly safely.

References

[1] eCFR, “14 CFR § 67.307 — Mental,” U.S. GPO, 2023 ed. [Online]. Available: https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-67/subpart-D/section-67.307. Accessed: Aug. 10, 2025.

[2] eCFR, “14 CFR § 67.401 — Special issuance of medical certificates,” current to Jul. 31, 2025. [Online]. Available: https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-67/subpart-E/section-67.401. Accessed: Aug. 10, 2025.

[3] Convergent Performance, Darker Shades of Blue: A Case Study of Failed Leadership, ca. 2006. [PDF]. Available: https://convergentperformance.com/wp-content/uploads/attachments/Darker_Shades_of_Blue.pdf. Accessed: Aug. 10, 2025.

[4] J. R. Huston, Czar 52: A Prelude to Disaster, 2014. [PDF]. Available: https://www.hptc-pro.com/wp-content/uploads/2014/01/CZAR-52-A-Prelude-to-Disaster.pdf. Accessed: Aug. 10, 2025.

[5] CBS News, “JetBlue captain subdued after erratic behavior,” Mar. 27, 2012. [Online]. Available: https://www.cbsnews.com/news/jetblue-captain-subdued-after-erratic-behavior/. Accessed: Aug. 10, 2025.

[6] ABC News, “Hero JetBlue passenger put unruly pilot in chokehold,” Mar. 28, 2012. [Online]. Available: https://abcnews.go.com/US/hero-jetblue-passenger-put-unruly-pilot-chokehold/story?id=16013298. Accessed: Aug. 10, 2025.

[7] FBI Dallas Field Office, “Statement regarding JetBlue incident,” Mar. 28, 2012. [Online]. Available: https://archives.fbi.gov/archives/dallas/press-releases/2012/statement-of-special-agent-in-charge-robert-e-casey-jr-regarding-jetblue-incident. Accessed: Aug. 10, 2025.

[8] BEA (France), Accident Germanwings Flight 4U9525—Final Report, 2016. [PDF]. Available: https://bea.aero/uploads/tx_elydbrapports/BEA2015-0125.en-LR.pdf. Accessed: Aug. 10, 2025.

[9] FAA, “Pilot Mental Fitness,” Aug. 22, 2024. [Online]. Available: https://www.faa.gov/pilot-mental-fitness. Accessed: Aug. 10, 2025.

[10] DOT OIG, FAA Conducts Comprehensive Evaluations of Pilots’ Mental Health but Barriers to Disclosure Remain, Jul. 12, 2023. [Online]. Available: https://www.oig.dot.gov/library-item/39561. Accessed: Aug. 10, 2025.

[11] FAA, Mental Health and Aviation Medical Clearances ARC—Final Report, 2024. [PDF]. Available: https://www.faa.gov/sites/faa.gov/files/Mental_Health_ARC_Final_Report_RELEASED.pdf. Accessed: Aug. 10, 2025.

[12] eCFR, “14 CFR § 67.409 — Denial of medical certificate,” 2024 ed. [Online]. Available: https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-67/subpart-E/section-67.409. Accessed: Aug. 10, 2025.

[13] NTSB Office of ALJ, “Airman Appeal Process,” 2024. [Online]. Available: https://www.ntsb.gov/legal/alj/Pages/process.aspx. Accessed: Aug. 10, 2025.

[14] 49 U.S.C. § 44703, “Airman certificates,” LII / Cornell Law, current. [Online]. Available: https://www.law.cornell.edu/uscode/text/49/44703. Accessed: Aug. 10, 2025.