A Day in the Life ScenariosMental Health


A few years ago, on a flight to somewhere, my wife shared the legroom in front of her seat with the Golden Retriever brought on board by the woman sitting next to her. The passenger didn’t purchase a seat for her companion dog, but paid a $25 fee to the airline to permit the dog to sit at her feet. The only problem was this German Shepherd took up the leg room of her owner plus that of the person next to her—my wife. It was a very uncomfortable flight for her.

During the course of the flight, my wife had a conversation with the passenger and learned why her dog was traveling with her. Several months earlier, this woman’s husband had died of cancer. The dog had become a calming influence to the woman who was still grieving the loss of her husband. This German Shepherd was providing emotional support at this difficult time. This dog had become her Emotional Support Animal (ESA).

This concept has become very popular and has become a controversial subject as a result of the airlines’ reactions to it, and the fact that many ESA’s really aren’t trained to do what they’re supposed to do. Plus, many people claim their pet is an ESA when it really is not.

The real rub comes when animals not normally considered domesticated are brought on board as ESA’s and cause problems, ie. passenger allergic reactions, disruptive behaviors, and even attacks on other passengers. Passengers and/or their ESA’s have been removed from planes or denied boarding because of the inappropriateness of the ESA or the lack of documentation of necessity.

“Federal regulations require patients to obtain health care professional documentation for emotional support animals to allow these animals to accompany the owner on air travel or live in housing that might otherwise restrict pets. No professional practice guidelines are currently available to guide health care professionals responding to patient requests for emotional support animals to guide health care professionals responding to patient requests for emotional support animal documentation.” In other words, the doctor who has to verify the need for an ESA has no set of professional criteria on which to base that decision. He has only the patient’s word that he can’t function without the animal’s presence.

That means there’s little black and white and a whole lot of gray involved here. It also means that a lot of folks have trouble coping, and another large group of folks are traveling with their pets rather than paying to board them while away. Do I sound like a skeptical cynic? You bet I do! Who doesn’t love their pet? Most people would like to take them everywhere they go for companionship. But if your ESA is a squirrel, a duck, or a pig, the reaction of other passengers will not be that of approval.

Pets have been proven in study after study to “provide their owners with social support…offset negativity resulting from a rejection experience,” and “be every bit as effective as one’s best friend in staving off social needs deficits in the wake of rejection.” Pets can “serve as important sources of social support…and provide many positive psychological and physical benefits for their owners.”

The focus of this blog is a variety of pets called Companion animals. They come in three categories which are:

Service Animals

Therapy Animals

Emotional Support Animals

Service animals provide dedicated, specific assistance to a person with a specific disability. One example is “the Seeing Eye Dog.” They’re specially trained to help sight-impaired people walk and avoid obstacles, and they have guaranteed rights under federal law.

Therapy animals are trained by a handler to provide comfort and support to many people either in a group or individual setting in a public environment. They are used in physical or occupational therapy, in counseling or psychotherapy and in a treatment program setting. They are legally designated as pets and have no special rights.

Emotional Support Animals are intended to support the needs of individuals with disabilities. Their sole function is to provide emotional support and comfort to the their owner. They don’t help them walk, guide them through obstacles, or prevent falling. They merely make their owner feel better. Any person with a disability cannot be discriminated against according to the Americans With Disabilities Act. But whether this is a true disability remains unclear. Yet, I dare say, ESA’s are the majority of the animals one sees on airplanes these days.

No “mainstream medical or veterinary organization sanctions…any of the multiple online registries…or approves the use of animal vests…designed to be worn by ESA’s.” “At least 19 states have passed laws prohibiting misrepresentation of an ESA as a service animal.”

The onus is on the physician. He is the one who decides if the patient really needs this animal to keep him calm. A doctor can’t make such an assessment during a single visit unless he has been the patient’s family physician for many years and knows the patient’s personality and idiosyncrasies. Saying “no” to a patient you have known for a long-time can be difficult. Personal biases are hard to set aside. But this is an opportunity to assess, or re-assess, the patient’s mental health and decide if an ESA is appropriate to incorporate in their overall treatment plan. It just might be what they need. But when the individual’s choice for an ESA is an exotic animal, not a usual pet, doctors feel like they’re being taken advantage of.

It is surprising that no one or no agency has addressed this growing demand. Permitting animals on airplanes is not without problem, and I think airlines are right to deny access to animals which stretch the limit of reason. I wouldn’t want to be seated next to a person with a pet pig, iguana, or even a hamster. You just don’t know what to expect from the animal’s behavior. A dog is different unless it takes up all your personal space when space is already scant to begin with.

Dr. G’s Opinion: The relationship between man and dog is firm and enduring. A dog is always glad to see you, is happy to be with you, and will be your friend for life. It makes good sense that dogs are great at providing happiness in a person’s stressful, unhappy life, and can easily change a frown to a smile. But is life so dismal that so many people want to declare their pet an emotional support animal and force airlines to have to set limits. I’ve been on flights when as many as five ESA’s were present. They were well-behaved, as they should be, but were they all really legitimate? As the references cited here state, some organization must step up and establish realistic guidelines for legitimizing emotional support animals and make it a scientific determination.

References: Curbside Consultation. Tin AH, Rabinowitz P, Fowler H.Emotional Support Animals: Considerations for Documentation. Am Fam Phys 2020 Mar 1;101(5):302-304.


McConnell AR, Brown CM, et al. Friends with Benefits: On the Positive Consequences of Pet Ownership J of Personality and Social Psychology 2011;102(6):1239-1252.

Wlodarczyk J. When pigs fly: emotional support animals, service dogs, and the politics of legitimacy across species boundaries. Med Humanit 201Mar;45(1):82-91.



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