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.