Probably the most challenging candidate for qualification in diving faced by a physician is the person with an emotional disorder. These are psychological conditions in which the major symptom is a pervasive disturbance of mood. Moods are sustained emotions, and in mood disorder, depression and elation tend to dominate, with anxiety and anger appearing less frequently. There are a few guidelines which may be helpful. A history of suicide attempts by an individual with a depression in partial remission is a clear contraindication to diving. Some scuba fatalities on record appear to be suicides which may have been decisions of the moment.
A history of claustrophobia (fear of confined places), agoraphobia (fear of public places), acrophobia (fear of heights), fear of new situations or fear of water may indicate unacceptable risk for the individual and companions. A panic-stricken diver underwater is hazardous to others and quite likely to drown. Instructors should be alert for the candidate who has been coerced into diving by a spouse, parent or friend and has little interest in diving. The individual may even repress his own feelings in order to please someone else. This person may be looking for a graceful way out.
The role of medication in diving is secondary to the reason for the use of the medication. A medication capable of altering a person's mood is clearly potent and must be used with caution in diving. Nearly all such products carry warnings about use in hazardous situations: driving, operating equipment and so forth. The interaction between the physiological effects of diving and the pharmacological effects of medications are rarely known. On the other hand, it is not wise to stop a needed medication in order to go diving. Each situation will have to be carefully evaluated, and there is no general rule which applies to all.