To fly a plane, pilots must prove to the Federal Aviation Administration that they’re physically and mentally fit. But when it comes to mental health, the rules are complicated and, some say, outdated.

Pilots who need antidepressants are limited to a short list of approved medications and must take a mandatory six-month leave. Even common diagnoses like anxiety or depression can trigger reviews that could ground them.

The F.A.A.’s rules are born out of desire to keep the public safe, but in this episode we talk to pilots, aspiring pilots, and medical aviation professionals about their unintended consequence: incentivizing people to stay quiet about their mental health issues.

Read: Why Airline Pilots Feel Pushed to Hide Their Mental Illness 

Podcast production by Zoe Azulay.

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