Monday, October 08, 2007

Are You A Threat To National Security?

Periodically I get these calls. My patient, or someone who was once my patient, or someone I can't recall ever having heard of, has identified me as their psychiatrist and this is the government calling as part of a security clearance for a job with the government.

Assuming I can recall the patient, the questions are short and sweet. Usually something along the lines of Might This Person Represent a Risk to National Security?

Without exception, these patients have not been disabled by their psychiatric disabilities, at least not recently. And without exception, they are already functioning in their job --- I've never been called for a security clearance before a patient assumes a sensitive position with a federal agency. None of these patients have been suicidal or homicidal. Only one has previously been hospitalized, and that was many years before I'd seen the patient.

So here's the thing: I have no idea.

There is an element of unpredictability to psychiatric disorder. Some people have Bipolar Disorder and go years between episodes. Their symptoms vary. If someone's never had an episode of mania where they've done something dangerously impulsive, do I know that they won't any time in the future? Some people are absolutely tormented by their anxiety, but keep it well-hidden from the rest of the world and they function just fine. Other people are so overwhelmed with anxious ruminations that they can't get out the door, can't make a decision. Because a patient did nothing dangerous during their last episode of psychosis, am I sure they won't the next time?

The investigator doesn't want details. He doesn't want to know about past history, psychosocial history, substance abuse issues, or details of past episodes. He doesn't care if the to-be-cleared has been hospitalized. He simply wants to know if they are reliable, trust-worthy and if their psychiatric illness or the medications they take for it, might impair their ability to handle sensitive information in such a way that national security could be compromised.

I'm left to rely on past history. I tell the investigator anything that might be relevant , and I mutter a disclaimer about how the patient has an illness and so far they've not been compromised by it, but I can't predict the future.


Anonymous said...

why bother with a disclaimer that the patient has an illness when you don't really even remember the patient? if you have had an illness can you never recover and get on with life? if you have never had an illness can you be sure you never will? do you really know that you will never ever crack? think.

Roy said...

I get these visits (they usually begin as a phone call, followed by a visit in person, I suspect so that they can say they actually met with the treating physician, who said such-and-such). They usually occur 3-6 months after a person with a security clearance is hospitalized (typically, after an ill-considered suicide attempt brought on by either financial or familial distress).

My usual comment is that I have no professional reason to believe that the individual represents a security risk. That's about all I say, and this seems to be all they need to hear. (I will point out that they always provide a signed authorization from the pt to release their info, and I always tell the pt about the request and what my response was, so that they do not fret about all the what-ifs.

Roy said...

Oh, my other comment... "There is an element of unpredictability to psychiatric disorder."

Umm, there is an element of unpredictability to human beings.

I guess I understand why they do this, because they think that looking into such things increases the chance that they will find a security risk. However, I believe that this artificial feeling of being in greater control may be an even greater security risk, as it permits a false sense of security about all the other people, who did not take an overdose after finding out about the husband's affair.

Greed is most likely the greatest national security risk. There is no DSM4-TR diagnosis for this affliction. No FDA-approved drug to treat it. No use of Emergency Petitions to force an evaluation. But, I guess it's like the drunk who is looking for his lost car keys under the streetlight, despite the fact that he lost 'em in the alley. The light is better here.

Sarebear said...

The public would crucify them if, say, a compulsive gambler, who'd been treated for such, in desperation to feed his habit, sold secrets or did some such thing, and no one checked on their psych history.

Now, in this hypothetical I don't know if a shrink would reply yes or no to the question, but the people haveta check. I think though that most people self-filter themselves out of applying when they see that question, if they have much question at all about themselves, and are afraid to proceed. The rest, well, either have problems they suspect wouldn't raise flags as security issues, or their judgement is enough out of whack they don't realize their kleptomania might not be a problem in applying for that job, or they think such things only apply to other people, or that they're invincible, or just aren't capable of using their judgement correctly in this situation.

It's those last that the question is for, really . . . but most people who would be a problem due to something like that, probably have other problematic things show up in the security screening process, before the check on the psychiatrist info gets done.

Or something, that's my reasoning, anyway.

Alison Cummins said...

Some of the physically handicapped people I used to work with divided the world into 'crips' and 'TABs' - TAB standing for Temporarily Able-Bodied. That is, the rest of us. We might be able-bodied today, but one day our destinies will catch up with us and we will join the crips in our experience of the universal condition of disability.

I like Roy's approach.

Anonymous said...

You might want to read this:

Psychiatrists’ Responses to
Requests for Psychiatric Information
in Federal Personnel Investigations


Bardiac said...

A sadly timely post given the recent murders in northern Wisconsin by a peace officer and the subsequent discussions about screening issues.

Anonymous said...

Hi, It's Camel here,
I receive MANY of these requests, practising where I do (close to a major agency). Never once in any of the personal or phone conversations, have the investigators asked me about my own status, despite the fact that I have a clearly ono-native accent. The truth is that I am not a US citizen, although I owe a debt of loyalty to this country, and feel very responsible to protect it's security.

Anonymous said...

Hmm, and does the psychiatrist need to disclose whether he or she has also been under the care of a mental health professional within the last seven years, and if so please provide their name and contact info so that the government can ascertain whether the psychiatrist is currently in a position to comment on the supposed threat level of a former patient?

Driving Miss Delusional said...

Wait- did you say that you're a psychiatrist?

I thought you were a psychic. So sorry about that.

Anonymous said...

Yes I am and damned proud of it.