Suicide by aircraft: a case report.

A 36-year-old pilot took his plane on a brief, unauthorized flight that ended in a high-speed vertical crash next to the runway. A retrospective "psychological autopsy" yielded strong presumptive evidence of an unrecognized depression in a man with manipulative and mildly antisocial characteristics. His withdrawal from his usual patterns of behavior was, instead, regarded as a desirable return to "normal" behavior. This case report includes comments on the role of the psychological autopsy in aircraft accident investigation, anniversary reactions, the use of psychiatric diagnosis to support the agreed-upon decision on the desired disposition, some aspects of subintentional suicidal behavior, a brief review of the literature on suicide by aircraft, and consideration of the role of the flight surgeon in preventing such occurrences through early recognition of depression.