Comment by Mark Levy MD
forensic psychiatrist & Medical Director at Forensic Psychiatric Associates, LP
This is an excellent, comprehensive and balanced review of the behavioral issues pertaining to security clearance and how many of these were either missed or overlooked in the case of Aaron Alexis.One point I would add as a forensic psychiatrist is that psychiatric diagnosis is less important than symptoms. For example, many people with Bipolar Disorder who seek medical treatment and comply with that treatment including reliably taking appropriate medication should not automatically be considered to be security risks. But some people with poorly controlled Bipolar Disorder (often due to erratic compliance with medications) can become paranoid and even psychotic during a manic episode. Clearly these symptoms should be considered de facto reasons to deny or at least to closely scrutinize the individual’s application for or continued possession of security clearance.
The take-away point is that although the diagnosis of an acute paranoid psychotic disorder (specifically either Paranoid Schizophrenia or Delusional Disorder, Persecutory Type) are the two psychiatric diagnoses that carry a risk of dangerousness that is than the general population, nevertheless, people whose behavior does not justify either of these diagnoses may acutely manifest dangerous symptoms of paranoid psychosis from a variety of causes (including for example toxic psychoses or even brain tumors). Applications for or continuation of security clearance for these latter individuals need to be scrutinized carefully whenever an individual’s peculiar behavior comes to the attention of employers and other institutional authorities, not only the police. With the issue of security clearance (as with security in general), vigilance is appropriate rather than completely delegating oversight to the civil authorities