The (Suicidal-) Depressive Position: A Scientifically Informed Reformulation

Golan Shahar

Abstract: Despite considerable progress in depression research and treatment, the disorder continues to pose daunting challenges to scientists and practitioners alike. This article presents a novel conceptualization of the psychological dynamics of depression which draws from Melanie Klein’s notion of the positions, reformulated using social-cognitive terms. Specifically, Klein’s notion of position, consisting of anxieties (persecutory vs. “depressive”), defense mechanisms (“primitive”/split based vs. neurotic/repression based), and object relations (part vs. whole) is reformulated to include (1) affect, broadly defined, (2) affect regulatory strategies (defense mechanisms, coping strategies, and motivation regulation), and (3) mental representations of self-with-others, all pertaining to the past, present, and future. I reformulate the depressive position to include—beyond sadness, anxiety, and anhedonia—also anger/agitation, shame, disgust, and contempt, all of which are down-regulated via diverse mechanisms. In the depressive position, the self is experienced as wronged and others as punitive, albeit seductive. Attempts to appease internal others (objects) are projected into the future, only to be thwarted by awkward and inept interpersonal behavior. This might propel the use of counter-phobic, counterdependent, and “manic” affect regulatory mechanisms, potentially leading to suicidal depression.

The (Suicidal-) Depressive Position: A Scientifically Informed Reformulation

email from DBH

Mr. Freedman,

We will pass on the information to the 64 New York Avenue office of DBH - Thank you for making us aware of your filing and keeping us informed.

Sincerely,

Hannah Ong

Hannah J. Ong, M.D.

Director of Psychiatric Services

Saint Elizabeths Hospital

Department of Behavioral Health (DBH)

1100 Alabama Avenue, SE

Washington, DC 20032

(202) 299-5199 (office)

hannah.ong@dc.gov

This email transmission and any included attachments are intended only for the person or entity to which it is addressed for their official and confidential use.   This communication, along with any attachments, is covered by federal and state law governing electronic communications and may contain confidential and legally privileged or protected information under the Health Insurance Portability and Accountability Act (HIPAA), the D.C. Mental Health Information Act (MHIA), or 42 CFR Part 2.  If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, use, or copying of this message is strictly prohibited.  If you have received this communication in error, please notify the sender immediately and delete/destroy all copies of the original transmission.

From: Gary Freedman [mailto:garfreed@aim.com]
Sent: Friday, March 18, 2016 2:10 PM
To: Hannah.Ong@dc.gov.
Subject: criminal complaint

Dr, Ong:

The attachment to this email contains a  criminal complaint I have filed against the D.C. Department of Behavioral Health (Tanya A. Royster, M.D.) relating to DBH's denial of services.  

Gary Freedman
3801 Connecticut Avenue, NW
Apartment 136
Washington, DC
Telephone: (202) 362 7064

Letter to the FBI -- Jerry Seinfeld Letters

https://dailstrug.wordpress.com/2016/02/10/thats-all-folks/

Letter to FBI WFO

February 5, 2016 
3801 Connecticut Avenue, NW 
Apartment 136 
Washington, DC 20008 

Mr. Paul Abbate 
Assistant Director in Charge 
FBI Washington Field Office 
601 4th Street, NW 
Washington, DC 20535 

 Dear Mr. Abbate: 

The enclosed documents constitute circumstantial evidence of acts of criminal fraud committed in violation of the laws of the United States and the District of Columbia. Said fraud may ultimately lead to a financial loss to the federal government of up to $500,000. 

 Sincerely 

 Gary Freedman

Approval of St. Elizabeths Hospital to Engage in Self Advocacy

Mr. Freedman, I hope your self-advocacy resolves this situation to your satisfaction. Best wishes, Maureen

 

Maureen Jais-Mick (I am currently in the office on Tuesdays, Wednesdays and Thursdays frm 8 am to 2pm.)

Program Analyst

Department of Behavioral Health

Saint Elizabeths Hospital

1100 Alabama Avenue SE

Washington DC 20032

202-299-5220 (office)

202-407-3162 (cellphone)

maureen.jais-mick@dc.gov

www.sehcommunity.org

 

"Saint Elizabeths: Shining the Light since 1855."

 

From: Gary Freedman [mailto:garfreed@aim.com]
Sent: Thursday, February 04, 2016 9:57 AM
To: Jais-Mick, Maureen (DBH)
Cc: dc.outreach@usdoj.gov; ATD OAG
Subject: doj petition

 

Maureen Jais-Mick

St. Elizabeths Hospital

Washington, DC

 

Ms. Jais-Mick,

 

Attached is a complaint I filed with the U.S. Department of Justice about the failure of DBH to provide psychiatric services.

 

Gary Freedman

Petition to Justice Department

February 2, 2016

3801 Connecticut Avenue, NW                  

Apartment 136

Washington, DC  20008

The Honorable Leslie R. Caldwell

Assistant U.S. Attorney General

Criminal Division

Office of the Attorney General

U.S. Department of Justice

950 Pennsylvania Avenue, NW

Washington, DC  20530-0001

RE:  Failure of State Agency to Provide Legally-Mandated Services

Dear Attorney General Caldwell:

I am writing to you pursuant to the Petition Clause of the First Amendment.

I hereby petition the U.S. Department of Justice to compel the D.C. Department of Behavioral  Health (DBH) to provide the psychiatric services to which I am entitled as a resident of the District of Columbia who is disabled and who has been diagnosed with severe (psychotic) mental illness.  I had been receiving psychiatric services continuously from July 1996 to until February 2, 2015 (20 years), on which date my treatment was abruptly terminated without warning and only two weeks after DBH dispatched an MPDC officer to my residence (January 13, 2016) out of concerns about the severity of my mental condition.

The District Government has made numerous admissions over many years that my situation is extremely serious.

Sincerely,

Gary Freedman

                                                          

cc: Dr. Royster (DBH); Karl A. Racine (DCOAG); FBI

                                                                        
February 2, 2016

3801 Connecticut Avenue, NW

Apt. 136

Washington, DC  20008

Tanya Royster, M.D.

Director

D.C. Department of Behavioral Health

Third Floor

64 New York Avenue, NW

Washington, DC  20002

Dr. Royster:

I have received psychiatric treatment provided by the D.C. Department of Behavioral Health (DBH) since the year 1996, 20 years.  On Monday February 1, 2016, I was advised by Monica Acharya, M.D., attending physician at the K Street Clinic (35 K Street, Washington, DC), that DBH was involuntarily terminating my psychiatric treatment with Alice E. Stone, M.D., a third-year psychiatry resident working under the supervision of Earle Baughman, M.D. (St. Elisabeths Hospital).  Dr. Stone had been providing psychiatric treatment to me since August 2015, five months.  My patient record will not disclose any conflicts with Dr. Stone throughout the treatment.

Dr. Acharya told me that I needed to see an experienced psychiatrist, and that DBH has no experienced psychiatrists who can treat me.  Dr. Acharya made no effort to help me locate alternative treatment.  Dr. Acharya admitted that my case is extremely serious.  On the evening of January 13, 2016 Dr. Acharya had an MPDC officer dispatched to my residence out of concerns about me.

I want to make it clear:  I did not refuse to see my treating psychiatrist, Dr. Stone.  I had simply requested to see a male therapist and/or a psychodynamically-oriented therapist (see attached).  I did not file a complaint against Dr. Stone to anyone at DBH; I had communicated my concerns about Dr. Stone’s professional competence to my case manager, Natalie Nichols at the McClendon Center (see attached).

I am a resident of the District of Columbia; I have been diagnosed with severe (psychotic) mental illness including paranoid schizophrenia.  DBH has a legal duty to provide treatment.   My case is of a nature that it must not be allowed to languish.

I need to remind you of troubling aspects of my history.

1.  Dennis M. Race, Esq., (202 887-4028) senior counsel with my former employer, the law firm of Akin Gump Strauss Hauer & Feld, determined, in consultation with a practicing psychiatrist, that I was potentially violent and unemployable.  Mr. Race concluded that I posed a direct threat in the workplace.

2.  I have been under federal investigation by the U.S. Secret Service (redacted) as a potential security risk to former President Bill Clinton.

3.  I have been under federal investigation by the U.S. Secret Service (redacted) as a potential security risk to President Obama.

4.  I have been under federal investigation by the U.S. Marshals Service (redacted) as a potential security risk to U.S. District Court Judge (redacted).  At the time of the investigation the USMS imposed temporary protective measures against me.

5.  I was advised by the U.S. Capitol Police (redacted) that my name has been placed on a federal watch list of potentially violent felons.

6.  In the year 2004 10 MPDC officers (including an MPDC Second District Supervisor)  and 4 FBI agents were dispatched to my residence based on concerns that I might become armed and extremely dangerous.  

7.  I am completely isolated socially.  I have no friends or social contacts of any kind.  My only relative is a sister who lives in New Jersey.  I rarely see her.  I live within walking distance of the federal district in Washington, DC.  I suffer from profound loneliness.  Psychological testing performed in the year 2014 disclosed that I am "severely paranoid."

I strongly urge the DC Department of Behavioral Health to locate appropriate counseling treatment for me.  I am sure several U.S. Congressmen would be interested to learn about DBH's handling of my case.

Sincerely,

Gary Freedman

January 15, 2016

3801 Connecticut Avenue, NW

Apartment 136

Washington, DC  20008

Monica Acharya, M.D.

Mental Health Clinic

35 K Street, NE

Third Floor

Washington, DC  20002

Dear Dr. Acharya:

I receive weekly out-patient psychotherapy with Alice E. Stone, M.D. at 35 K Street.  Dr. Stone’s technique is primarily supportive.  I require psychodynamic, insight-oriented therapy.  Could you help locate a therapist for me who offers psychodynamic, insight-oriented therapy?  The attached letter addressed to Dr. Stone outlines some of my psychological problems.

You can reach me at telephone number (202) 362-7064.

Thank you.

Sincerely,

Gary Freedman

January 12, 2016                  

3801 Connecticut Avenue, NW

Apartment 136

Washington, DC  20008

Tanya A. Royster, M.D.

Director

D.C. Department of Behavioral Health

64 New York Avenue, NE

Third Floor

Washington, DC  20002

Dear Dr. Royster:

I am a consumer of mental health services provided by the D.C. Department of Behavioral Health (DBH).  I receive supportive psychotherapy and medical management provided by Alice E. Stone, M.D., a third year psychiatry resident at 35 K Street.  Dr. Stone works under the supervision of Earle Baughman, M.D. (St. Elisabeths Hospital).

I am deeply concerned about the failure of DBH to provide appropriate psychotherapy for me, which would be psychodynamic, insight oriented therapy.  Supportive psychotherapy is inadequate for my needs.

I need to remind the DBH that the D.C. Office of Attorney General and others have grave concerns about my case and my potential for violence, including the potential for armed mass homicide.

1. The D.C. Office of Attorney General affirmed as genuine and credible a psychiatric opinion offered to my former employer, Akin Gump Strauss Hauer & Feld (Dennis M. Race, Esq.) (1991) that concluded that I suffered from severe mental illness that rendered me unsuitable for employment and a direct threat in the workplace.  The employer in a sworn statement stated that it feared, based on said psychiatric opinion, that allowing me to remain on the firm’s premises posed a negligence risk to the firm.  (The psychiatrist in question, Gertrude R. Ticho, M.D. (deceased) denied ever having offered said opinion to the employer.  See letter to William J. Earl, Esq. dated March 19, 1996 (enclosed)).

2.  The D.C. Court of Appeals did not find that my former supervisor’s published fear (1991) that I might commit a mass homicidal assault on the firm’s premises and her act of securing her office against such an assault was motivated by discriminatory animus.  See Record at 41, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 (Sept. 1, 1998).

3.  The D.C. Office of Attorney General found that my coworkers’ fears that I might become armed and extremely dangerous in August 1989 (two years before my job termination) were genuine and credible.  The AG concluded that my coworkers had genuine and credible fears that I might “buy a gun, bring it in, and shoot everybody.”  See Brief of D.C. Office of Corporation Counsel at 8 citing Record at 276, Freedman v. D.C. Dept. Human Rights, D.C.C.A. no. 96-CV-961 (Sept. 1, 1998).

4.  On October 12, 2004 the MPDC dispatched 10 police officers and four FBI agents to my residence to escort me to D.C. General Hospital for an emergency forensic psychiatric examination.  The MPDC feared that I might become armed and extremely dangerous.

I urge the DBH to heed the concerns of the D.C. Attorney General and the MPDC and provide the psychodynamic psychotherapy that I require.

Thank you.

Sincerely,

Gary Freedman

cc: DC AG (Karl A. Racine); USDOJ (Leslie R. Caldwell)

                                                                              
MEMORANDUM

TO:          File
FROM:    Dennis M. Race [initialed DMR]
DATE:      October 29, 1991 CONFIDENTIAL
RE:           Gary Freedman

__________________________________________

In the course of investigating Gary's complaints about working conditions (none of which, by his own admission, involved activity or conduct which had a direct impact on him), I concluded that Gary's inability to work or interrelate with others is a substantial problem for the firm. There is only so much work that can be done without any interaction among our staff (which is what he requests) and his continued presence in the firm has been extremely disruptive. Reported outbursts and arguably bizarre behavior have made it uncomfortable and sometimes disruptive for many of his co-workers -- some of whom have voiced fear in working with or nearby him. In addition he is very difficult to supervise.

Malcolm Lassman and I have also discussed this matter, including Gary's work habits (as well as his habit of putting negative meanings to even trivial events i.e., "ideas of reference") with two outside consultants and both concurred that termination was the sound approach to take. One outside consultant also cautioned about the possibility of violence.

Accordingly, on the basis of disruptive work habits, unusual behavior and discussions with outside consultants, I believe that termination is warranted. Indeed, to do otherwise may prove to be negligent. I have discussed this with representatives of the Management Committee and our Administrative Staff and everyone concurs.

Gary will be given an additional two weeks severance (a total of four weeks) not only to cover extra time to look for alternative work but also to help cover insurance costs which will be borne directly by him upon leaving the firm.

-----Original Message-----

From: Gary Freedman <garfreed@aim.com>
To: nnichols <nnichols@mcclendoncenter.org>
Sent: Thu, Jan 21, 2016 1:39 pm
Subject: psychotherapy -- Dr. Stone

Ms. Nichols,

I want to confirm that we spoke about the following issues concerning my psychiatrist Dr. Stone, today January 21, 2016.

It is my belief that Dr. Stone falls short of providing appropriate and effective psychotherapy.

1.  Dr. Stone gives the impression of having intellectual limitations.  She me told the the following anecdote: "Before I went to medical school people were saying to me, 'You're not smart enough to be a doctor.  You should be a nurse.'"  It is my subjective perception that Dr. Stone is not the intellectual equal of other residents I have seen.  Without intending to brag, I want to report that my overall IQ was measured at 125 (95th percentile) and my verbal IQ was measured at 136 (99th percentile).  On the School and College Abilities Test (SCAT) my verbal reasoning was measured at 97th percentile among a pool of gifted students.  The SCAT test is only administered to gifted students.  I find it a strain talking to Dr. Stone.

2.  Dr. Stone's professional demeanor is unprofessional and adverse to the process of therapy, which involves the disclosure of sensitive material by a patient.  Dr. Stone tells wisecracks and jokes throughout the session.  For example:  In late December 2015 I told Dr. Stone that I had lined up a possible alternative therapist for me in private practice who happened to be a woman.  Dr. Stone responded (knowing that I wanted a  male therapist), "Well, it sounds like -- if she got a sex change operation she would be the ideal therapist for you."

Dr. Stone said she told the following wisecrack to a fellow psychiatry resident, Dr. Youssefi, a Muslim from Iran: "Do you lock your wife in a room all day?"  When I told her that statement was offensive she said, "He laughed."

When I was talking to Dr. Stone about being on the Atkins Diet and the issue of fat metabolism she said, "Oh, it's been so long since I was a real doctor."

3.  Dr. Stone seems unable to maintain clinical distance and maintain appropriate professional boundaries.  She acts as if she were talking to a friend -- not a patient:

She has told me the following personal facts, which no doctor should reveal to a patient.

a.  Her daughter has autism.

b.  Her mother's birthday is December 20, and her mother gets angry if you only get her a Christmas present and no birthday present.

c.  Her father has suffered from sleep apnea.

d.  Her mother attended American University and complains about the high tuition.

c.  Dr. Stone reported her mother is about my age (62):  Dr. Stone said, "My mother says to me, 'Am I going to die soon?'"

d.  Dr. Stone has revealed that she suffers from ADHD

4.  Dr. Stone talks way too much.  It's as if she were holding conversations with me, not doing psychotherapy.  She's a chatter box.  This may be a symptom of her ADHD.

Gary Freedman
202 362 7064

Letter to DBH re: Treatment Refusal

Maureen Jais-Mick

DC Department of Behavioral Health

64 New York Avenue, NE

Third Floor

Washington, DC  20002

Ms. Jais-Mick:

I have received psychiatric treatment provided by the D.C. Department of Behavioral Health (DBH) since the year 1996, 20 years.  On Monday February 1, 2016, I was advised by Monica Acharya, M.D., attending physician at the K Street Clinic (35 K Street, Washington, DC), that DBH was involuntarily terminating my psychiatric treatment with Alice E. Stone, M.D., a third-year psychiatry resident working under the supervision of Earle Baughman, M.D. (St. Elisabeths Hospital).  Dr. Acharya told me that I needed to see an experienced psychiatrist, and that DBH has no experienced psychiatrists who can treat me.  Dr. Acharya made no effort to help me locate alternative treatment.

I am a resident of the District of Columbia; I have been diagnosed with severe (psychotic) mental illness including paranoid schizophrenia.  DBH has a legal duty to provide psychiatric treatment.  DBH's treatment refusal is a violation of DC law and may also be contrary to applicable federal law.

I need to remind you of troubling aspects of my history.

1.  Dennis M. Race, Esq., (202 887-4028) senior counsel with my former employer, the law firm of Akin Gump Strauss Hauer & Feld, determined, in consultation with a practicing psychiatrist, that I was potentially violent and unemployable.  Mr. Race concluded that I posed a direct threat in the workplace.

2.  I have been under federal investigation by the U.S. Secret Service as a potential security risk to former President Bill Clinton.

3.  I have been under federal investigation by the U.S. Secret Service as a potential security risk to President Obama.

4.  I have been under federal investigation by the U.S. Marshals Service as a potential security risk to U.S. District Court Judge Ellen Segal Huvelle.  At the time of the investigation the USMS imposed temporary protective measures against me.

5.  I was advised by the U.S. Capitol Police that my name has been placed on a federal watch list of potentially violent felons.

6.  In the year 2004 10 MPDC officers and 4 FBI agents were dispatched to my residence based on concerns that I might become armed and extremely dangerous.  

7.  I am completely isolated socially.  I have no friends or social contacts of any kind.  My only relative is a sister who lives in New Jersey.  I rarely see her.  I live within walking distance of the federal district in Washington, DC.  I suffer from profound loneliness.  Psychological testing performed in the year 2014 disclosed that I am "extremely paranoid."

I strongly urge the DC Department of Behavioral Health to locate appropriate psychiatric treatment for me.  I am sure several U.S. Congressmen would be interested to learn about DBH's handling of my case.

Gary Freedman

Washington, DC

202 362 7064

The Department of Behavioral Health Cuts me Loose

Ms. Nichols,

I met with Monica Acharya, M.D. this afternoon, February 1, 2016.  Dr. Acharya is Dr. Stone's supervisor.  Dr. Acharya has advised me that DBH is terminating my work with Dr. Stone and has talked to McClendon about Dr. Steury taking me on as a psychotherapy patient.  Dr. Acharya emphasized the fact that I need to see an experienced therapist and the only therapists available from DBH are residents.  Apparently DHB is refusing to offer me treatment.

I have serious concerns about DBH cutting me loose.  I have been diagnosed with psychotic mental illness.  Two psychiatrists have diagnosed me with paranoid schizophrenia.  Also the DC Attorney General affirmed to the D.C. Superior Court and the D.C. Court of Appeals that my former coworkers had genuine and credible fears that I could become armed and extremely dangerous.  My former supervisor took precautions against my carrying out a mass homicidal assault on my employer's premises.  Do you think I should contact the U.S. Attorney's Office about the refusal of DBH to provide treatment?

Gary Freedman

202 362 7064