When someone is recovering from a severe mental illness like schizophrenia — a disorder that can seriously alter one’s perception of reality — sometimes awkward situations come up. Dr. Ron Pies, a contributor to Psych Central, discusses just such a case in The New York Times yesterday.

His patient, recovering from schizophrenia and doing quite well, wanted Dr. Pies to sign off on his application to get a driver’s license:

While schizophrenia may increase the likelihood of an accident, research in the 1980s by Dr. Russell Noyes suggested that, among patients with psychiatric disorders, those with alcoholism and antisocial personality traits accounted for most of the risk. The Utah Department of Public Safety asserts that most people under active treatment for schizophrenia are “relatively safe” drivers, and clearly says that one’s accident and violation record is a better predictor of driving risk than is a psychiatric diagnosis.

Still, drugs like clozapine can impair driving skills. And the doctor’s-office-based assessment of a patient’s driving skills is only moderately correlated with scores on standardized road tests.

The part of me steeped in Kraepelin’s pessimistic paradigm did not want to sign off on Harry’s certification. The part of me that had sat in my father’s lap, feeling the first flush of manhood as we drove together, wanted to help my patient move forward with his life.

I asked Harry how he would respond if one of his “voices” commanded him to do something dangerous while driving. “I wouldn’t listen, Doc,” he replied, looking me straight in the eye.

I won’t spoil how the story turns out; you’ll have to read the full article to find out for yourself.

Therapists, psychologists and psychiatrists often grapple with these types of decisions every day — the tradeoff between wanting to encourage your client’s independence and life improvement, and wanting to ensure you’re not inadvertently putting them (or the public) at greater risk before they’re ready. They are tough decisions with no black or white answers.

Read the full article: Cases – A Guy, a Car – Beyond Schizophrenia