Why Pilots Lie on Their Medicals—and Why Therapists Should Care
Over a year ago I took a risk and shared a reel on Instagram about a tough truth that no one was saying outloud: many pilots lie on their medical exams. Why? Because telling the truth can cost them their wings. If a pilot admits to grief, depression, or anxiety, they risk losing their medical certification—and with it, their identity, career, and livelihood. The feedback was overwhelming - both from aviators and therapists, that reel has had hundreds of thousands of views. Soon after I had a few guests on the podcast willing to share their stories.
Pilots often suffer in silence. They forgo treatment, downplay their pain, or hide symptoms from doctors and therapists. All because the system has conditioned them to believe that vulnerability means grounding.
Not long after, engineer and pilot Xyla Foxlin courageously shared her own story publicly. Soon after, the Pilot Mental Health Committee went to D.C. and began advocating for new legislation.
A Step Forward in Aviation Mental Health
This past week, Congress took a major step forward in supporting mental health in aviation. It’s a recognition that the old system—where honesty could ruin a career—doesn’t work. While the details will take time to play out, it signals a cultural shift: pilots shouldn’t have to choose between healing and flying.
Why Therapists Need to Understand the Stakes
For clinicians, this is critical. Working with pilots isn’t like working with other clients. A single diagnosis on paper—anxiety, depression, PTSD—can jeopardize a career. That doesn’t mean ignoring risk or shirking documentation, but it does mean approaching pilots with awareness, nuance, and empathy. Therapists who don’t understand the aviation world may inadvertently label a client in a way that costs them far more than they realize. I spoke about that in a reel here.
Beyond the Surface: The Role of Primal Wounds
At a deeper level, pilots—like all of us—carry primal wounds: beliefs like “I’m inadequate,” “I’m powerless,” or “I’m insignificant.” These wounds often drive Aeronautical Decision-Making (ADM) in subtle ways, especially under stress. A pilot who secretly believes they’re powerless may hesitate to speak up. One who feels inadequate may push harder, even past safe limits.
That’s why understanding primal wounds isn’t just “therapy talk”—it’s aviation safety. Healing these patterns can improve not only relationships on the ground, but also decision-making in the cockpit.
✈ Want to learn more about primal wounds and how they impact aviation and everyday life? Start by taking the 7 Primal Wounds Quiz and discover which hidden beliefs may be shaping your decisions.