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A couple weeks ago, my wife, kids, and I boarded a plane home from the “happiest place on earth.” We’d gone to Disney World so that my partners and I could attend Mass General’s course on evidence-based treatments for addiction. As the plane taxied to the runway, we became aware of a heated exchange from the row just in front of us. Apparently, a woman had boarded the plane intoxicated, and another passenger had complained about her condition. In the next 10 minutes, a series of capable flight attendants came to speak with the woman and assess her physical and mental state.  She deflected their questions with drunken bombast. As her eyes drooped with sedation, she insisted that the passenger who complained was the one causing problems.

My wife and I watched while the flight attendants quietly discerned whether or not we could take off given the woman’s condition. The longer the discernment lasted, the more evidence the woman provided that she was not fit to fly safely. As the plane taxied back to the gate and the woman realized that she would be put off the plane, she vacillated between grandiosity and and self-pitying lamentation. About the head flight attendant, she said: “You don’t know that I know people. He will lose his job. I will make sure that he loses his job.” At the same time, she complained that she would be on the streets of Orlando with no food or money and that her elderly mother would be waiting and worrying at her intended destination.

The flight attendants continued to do their best to placate the woman and avoid conflict, but her fellow passengers were less measured in their response. A woman behind us commented: “Oh no. After 9-11, we WILL restrain you.”  Another passenger began to antagonize the woman only to be chastened by one of the flight attendants. As the woman continued her complaints, there was an air of anger and derision among the passengers around us.

When we got home, my wife and I replayed the event. We tried to decide whether the flight attendants had decided to put the woman off due to her physical state or her mental state. The latter, we agreed could have been managed, but without knowing what the woman had ingested or how recently she had done so, the flight personnel could not know whether her medical condition would worsen in flight.

As we talked, my wife asked an important question: “I wonder what they did for her when she got back to the gate.” Did they send medical personnel to assess and treat her? Was she transferred to a local hospital? Or was she was she just put off the plane to fend for herself? Was her problem treated as a medical problem or an episode of bad behavior?

We’ll never know the answer to this question but our uncertainty (as well as the reactions of some passengers) demonstrates just how far we are from accepting mental health conditions (and Substance Use Disorders more specifically) as bona fide medical problems. While I don’t blame our fellow passengers for getting irritated, I hope that, after being escorted off the plane, this physically and mentally impaired woman was offered help rather than isolation or scorn–that she was treated more like someone having chest pains than someone who had stolen all the peanuts.

Ned Presnall

Ned is Executive Director of Clayton Behavioral and Adjunct Professor at Washington University in St. Louis, Missouri. He presents widely on the topics of addiction, mental health, and Medication Assisted Treatment. Ned is passionate about reducing the stigma against persons with addiction and against Medication Assisted Treatment through discourse and public engagement.


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