Sorry to dredge up this post after 6 months but an article I just read and another thread reminded me of it and I wanted to address a comment in here...
I dont necessarily disagree with Dr Bruce that one should get health first but there are limits to what you can do to get healthy and I disagree that a person is "unhealthy" purely because they take a medication.
Is having ADD/ADHD inherently unhealthy? I know many people who have been diagnosed with ADD/ADHD and lead perfectly normal lives without medication; yeah they have their idiosyncrasies (who doesn't), some of which would not be completely "socially acceptable" by society at large (again who doesn't) but that doesn't make them unhealthy or at least in my (admittedly non-medical) opinion, less capable as a pilot even though the FAA says they're not even eligible for the issuance of a class 3 medical. Similarly, I've known people who do take medication for ADD/ADHD who lead perfectly normal lives without the major idiosyncrasies or "socially questionable" behaviors and you would have no idea they had an ADD/ADHD diagnosis or were taking medications unless they told you; to all the world they are a normal functioning, healthy human being. And what about childhood ADD/ADHD that they've "grown out of" (arguably ADD/ADHD is over-diagnosed in many children who never had it in the first place) but according to the FAA they have a disqualifying history of ADD/ADHD that will take a lot of time, effort and money to get the diagnosis overturned.
At the time of this thread, a person with inherited Type 1 Diabetes had no option to "get healthy" at least by the FAA standard. Even though they have lived with it for pretty much all of their lives and it might be well managed/properly controlled having never manifested in an overt manner, according to the FAA they were bared from getting a Class 1 or Class 2 medical. They could otherwise be perfectly healthy, capable and safe private pilots but by dint of being born with a genetic illness, unlike their Type 2 Acquired Diabetes co-parts who could qualify for a Special-Issuance, they were unable to fly professionally. As of November, the FAA is moving forward with plans to allow them to qualify for a class 1 or 2 medical but that's a recent change to the status quo.
So yeah get healthy and then worry about flying sounds great but in practice getting healthy could just be a matter of getting treatment.
As to skipping medical care out of worry for your medical, well I again would generally agree with you but at least according to the psychology today article posted by
@PeterNSteinmetz, the majority (59%) would forgo treatment of depression than voluntarily disqualify themselves by taking an SSRI and a further 15% would accept treatment but would conceal it from the FAA. That means only 1 in 4 pilots would comply with both the course of treatment for their illness AND the FAA's disqualification on the basis of their illness/treatment.
Therein lies the entire point of my arguments... The FAA would be better served by moving in a direction of approval, monitoring and compliance, as they generally have with FAR violations, then continuing to maintain a policy of disapproval.
The results from the "compliance" method of enforcement are showing a higher willingness among all in aviation to self-report issues and errors contributing to a safer environment overall than the "punitive" methods of enforcement which saw pilots, ATC, et al do everything they could to keep the FAA out of it.