Inside the Mind of the JetBlue Flight Attendant

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On Monday, JetBlue flight attendant, Steven Slater lost control in a big way.

After the plane he was working on landed, Slater instructed a passenger to wait to take his luggage down from the overhead storage bin until the plane had arrived at the gate. The passenger then told Slater "to f__k off," according to a report in the New York Post.  

When the plane finally stopped moving, Slater made this announcement over the loudspeaker:

"To the f___king asshole that told me to f__k off, it’s been a good 28 years!" He then grabbed a can of beer from the galley area, deployed the plane’s inflatable emergency chute, slid to the runway and ran to his car in the employee parking lot, according to the report. He raced home, where he was arrested by Port Authority police. He was charged with criminal mischief, reckless endangerment and trespassing.

I don’t know Slater and I haven’t evaluated him, but I’m going to use his behavior to shed light on how psychiatrists evaluate people like him.  

First things first: The psychiatrist meeting Slater in an emergency room or at a court forensic clinic after he was arrested and charged would be wondering whether alcohol or drugs led to his impulsivity. He or she wouldn’t take Slater’s word for it, so blood and urine toxic screens would be ordered. In the majority of cases of violence and of inexplicable and outrageous public meltdowns, alcohol or drugs are at least partly to blame.

Slater lists spirituality and recovery as interests on his Facebook page and references the book "Alcoholics Anonymous, Twelve and Twelve." He grabbed a beer before popping the plane’s chute and sliding away. (Remember, Omar Thornton who killed nine people in Hartford, Conn., was being disciplined for stealing beer from the distributor where he worked).

Alcohol is at the root of millions and millions of cases of domestic, workplace and street violence in America.

The next question would be whether a mental illness unrelated to substance use might be a factor. Those suffering with bipolar disorder, for example, not only experience depression, but can become manic, showing symptoms including euphoria, grandiosity, irritability, vastly decreased impulse control and fixed and false beliefs called delusions. They can even respond to command auditory hallucinations—voices that insist they carry out certain actions.  

Those with schizoaffective disorder can have similar symptoms. And other people suffer with the repeated inability to control their impulses separate and apart from any other condition.  

It is also the case that some people end up in big trouble based on their personality structure—especially when it qualifies as a personality disorder. Narcissists can respond with overwhelming rage to perceived slights. Those with antisocial personality disorder can have no regard for rules or for the feelings of others.

Next, a psychiatrist would wonder about how any medication that Slater might have taken could affect him. Antidepressants, for example, can trigger manic episodes. Steroids used to treat asthma can, too. Even certain pain relievers can cause confusion and bizarre behavior.

Medical illnesses would need to be ruled out, too. Central nervous system infections can cause unwieldy irritability. Low blood sugar related to diabetes can cause confusion. So, a complete physical examination and a full panel of blood tests would be ordered.

A complete workup might well include a CT scan or MRI to check for the one in a billion possibility that Slater’s meltdown was the result of a brain tumor or a brain hemorrhage.  

Of course, you don’t need to be an alcoholic and drinking or using drugs, or be suffering with a major mental illness or personality disorder, or be toxic on medication or be medically ill to act impulsively and cause public chaos or even serious harm to others. You can be stressed to the breaking point. That may not sound very scientific, but folks who have been stressed to the breaking point end up in my office all the time.

Usually, those who break have been stressed for a very long time. They have been made fragile not only by annoying customers or increased expectations or long hours or unwieldy mortgage payments—they have been made vulnerable by a life history of feeling they have no control or are unworthy or are unsafe.

Yet these are special days, and we still have had no national discussion on how to maintain psychological equilibrium. These days will try men’s (and women’s) souls. We’re worried that our economy is broken. We are at war. We have record unemployment. We just learned that no one in the nation could stop one leaking oil well from spoiling untold miles of our coastline. The average man and woman not only feels disempowered, he or she has been disempowered by a government that fancies itself the father and mother of all citizens and asks us to surrender more and more and more of our autonomy.

One very bad morning may cost Slater seven years in prison. He has a long road ahead of him.  

And so do we. Each of us must find personal strength and balance in life. This has always been the case, of course, but it has never been more the case than at this very moment in our collective history.

Dr. Keith Ablow is a psychiatry correspondent for Fox News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life Through the Power of Insight and Honesty” has launched a new self-help movement including Dr. Ablow can be reached at