Three days after his initial presentation in the emergency room, the patient was transferred to a locked psychiatric unit as a voluntary patient. He still refused to reveal any personal or demographic details about his life and expressed concern that if he were to do so, his friends would be able to find him, and that would burden them. He related a history including hopelessness, helplessness, insomnia, decreased appetite with weight loss, and low self-esteem over the past 4.5 years, after being laid off from a job as a health policy statistician. He had "given up" and had come to New York with a plan to kill himself anonymously. His appearance was quite disheveled, and he did not bathe or change his clothes daily on the unit. His speech was organized and coherent, his mood was depressed, and he denied psychotic symptoms. The treatment team's initial DSM-IV diagnosis was as follows: axis I, major depressive disorder, severe without psychotic features; axis II, deferred ("deferred" indicates that they were not ready to designate a specific category, although they believed that an axis II disorder was present).