When applications ask about your psychiatric history

Sam is young man is applying for a summer program, a real resume builder.  Among other things, the application asks if he has been treated for a psychiatric disorder.  In fact, he’s seen a therapist and he’s felt anxious at times.  His internist gave him some Lexapro samples and he feels better.  The symptoms of his problems have been limited to his own subjective distress.  His anxiety is not something that has disabled him, in fact he has not missed a day of school in 3 years — and then for the flu– he sees his therapist on the weekends, and no one would know he’s been uncomfortable unless he told them.  He’s never been in a hospital, he’s ultra-reliable, and he has great grades and extracurriculars.  Any way you look at it, Sam is an energetic guy on the road to success.

What should he write on the form?  It’s a yes/no check box, no questions or place to clarify, so if he says yes, well, that could mean he has some subjective anxiety, or it could mean he has attention deficit problems, or it could mean he has been hospitalized 6 times after becoming violent, or has a severe mental illness.  He’s worried that his anxiety will throw him into a subset of applicants that the committee would rather not deal with: why choose someone for a project who has a mental illness if another equally qualified applicant is available without this issue to address?

Sam’s mother say he should check “yes.”  He has been in treatment and he has a diagnosis and he takes a medicine.  He has a psychiatric disorder and he needs to be honest.

Sam’s father says that the question defies the spirit of what the committee wants to know.  They want to know, Dad presumes,  if there will be issues or problems or things they might need to accommodate, and there is no reason to believe that Sam’s problem will interfere with his ability to negotiate life in a competitive or stressful environment.  Sam, he contends, does not belong in the same category as someone who has attempted suicide, been hospitalized, missed work, or behaved in a disruptive or dysfunctional manner. If anything, Sam’s anxiety drives him to focus and achieve and to be very conscientious.  He’s not ill, his father says, he’s just more anxious on a spectrum of normal anxiety.

I want to know why forms get to ask such questions and put people in the awkward situation of having to answer something that is none of anyone’s business versus being dishonest.  It seems that if someone wants to know this, it might be asked in terms of “Do you have any health issues that might require any special accommodation?”  Is there a limit to what random forms can ask and whether you’re behaving unethically if you choose not to answer their questions or answer it less then completely?  Sam tried leaving the question blank, but the computer wouldn’t let him submit the form without checking all the boxes first.  Can they ask if you have deviant sexual fantasies?  If you’ve ever committed a crime (regardless of whether you’ve been charged or convicted)?  If you say provocative things on your blog?

Dinah Miller is a psychiatrist who blogs at Shrink Rap and co-author of Shrink Rap: Three Psychiatrists Explain Their Work.

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  • http://twitter.com/Nrs4D_Hamlin Kim Henry

    What a slippery slope conundrum! On one hand the applicant does not want to be discriminated against (implying that he in fact has a mental disorder in which he would need to ask for accomodations). On the other hand the applicants morally wants to answer the question honestly. One could expect someone being treated for “anxiety” probably has aquired coping skills to handle his anxiety. Quickly pick 1 person to suddenly public speak, let’s see if he/she displays anxiety symptoms….

  • Anonymous

    I totally agree!  This is the problem with seeking help with a “disorder”.  I take Lexapro for mood swings associated with menopause.  I’ve never been to a therapist, I went to a doctor, told her my issue, she prescribed Lexapro and now I’m “labeled”.  I never miss work, I work hard, I manage a team of people; by all indications, I’m fine.  However, I am definitely discriminated against with these applications; specifically with the application for health insurance.  Some insurance companies won’t insure me or they will charge higher premiums just because I take these meds.  It makes no sense to me.  If I didn’t have such relief with Lexapro, I’d go off it.  What’s a girl to do?

  • ShrinkRap Blog

    Over on Shrink Rap, the original post got a lot of thoughtful comments.  It inspired a follow up post called “Is it ever okay to lie?”
    The original post (shown here) is at: http://www.psychiatrist-blog.blogspot.com/2011/11/tell-me-ethical-dilemma.html
    The follow up is at http://www.psychiatrist-blog.blogspot.com/2011/11/is-it-ever-okay-to-lie.html

    My thanks to Kevin for picking this up for KevinMD!
    Dinah

  • Anonymous

    Some aspects of the summer program need to be clarified. For instance, if it involved leadership training in the wilderness, a day and a helicopter flight from medical services higher than first aid, then questions about health issues are necessary. The question asking specifically about psychological difficulties apart from general health issues needing accommodation, and especially without any chance of clarification, is poorly designed.

    One avenue is to try and contact the program administrators directly and ask them about this question and its purpose in relation to the program. In a way, the question seems illegal and contrary to the provisions of the Americans with Disabilities Act, depending on the nature of the program. Perhaps a lawyer can chime in.

  • Anonymous

    The issue at hand here is not only how this questionnaire is poorly designed but how our healthcare industry/insurers in general punishes individuals with any type of mental illness such as depression, anxiety, bipolar disorder etc, etc. If someone takes medicine to correct serotonin imbalances why should this event be treated any different than taking meds for a cardiac condition? Our legislators need to a better job of protecting individuals and stop the discrimination and labels that currently exist.

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    I believe it is none of their business. So I would have no problem saying no.

  • http://www.facebook.com/profile.php?id=1214176602 Sue Martin

    There are HIPPA rules concerning the privacy of health information. It is completely at the discretion of the employee if he decides to share but it certainly is not a requirement for hiring. It’s a fishing question that I would avoid like the plague.

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