Depression

Depression is the recurring condition through which Emma’s sense of time, feeling, identity, and future is repeatedly altered. It can leave her unable to feel love or grief, pull the past and future into a single landscape of despair, and make a suicidal imperative seem startlingly clear. The account does not present it as a passing sadness with a guaranteed cure: even when the immediate crisis eases, depression remains a possibility Emma must learn to recognize and live alongside.

Experience and the loss of feeling

Emma struggles to explain a change in her state to a psychiatrist. Asked how she feels now, she compares the task to describing sight to someone blind: what seemed like an ordinary sky can be understood as something far stranger once the fog lifts. Her answer, that she feels good and clear, is therefore both sincere and difficult to convey. The contrast makes mood more than a rating on a scale; it changes what reality appears to be and how certain its meanings feel.

Before her admission, depression had lasted for months. Emma recalls that, while preparing breakfast the day before she was hospitalized, an idea arrived with the force of obvious necessity: she had to die. She did not experience it as a suicide plan carrying the emotional weight other people assigned to it. Instead, she treated it as an item to cross off, imagining that removing herself and her troubles would allow her to return to what she regarded as truly important: work, productivity, and action unimpeded by feeling. In describing this state to Rajid, she also remembers emotional numbness toward the death of Dokter Visser’s husband. Even her reaction to learning that Dokter Visser had children was detached, marked by absurdity rather than grief. Depression had, in her account, left no room for other feelings because the overriding idea occupied everything.

The apparent clarity of that suicidal belief is sharply different from recovery. Emma’s metaphor of fog lifting captures the way a change in mood can make the world seem newly legible, but the account also shows how dangerous that certainty can be. What feels like a rational conclusion from inside the state is recognized by others as a reason for alarm. Depression is thus presented not only as suffering but as a condition that can alter the meaning a person assigns to survival and to her own future.

Time, recurrence, and the record of mood

Emma describes depression as a collapse of temporal perspective. In her reflection while waiting outside Rajid’s office, she contrasts it with mania: mania rockets away from past and future because only the present seems to matter, while depression lets the past, deprived of a usable present, swallow the future. Looking in either direction yields the same horizon of despair. Time loses its practical meaning when there is no longer a sense of what one is waiting for.

The mood forms make this pattern visible in a different way. Emma had previously held onto the idea that depression might be an intermittent, almost flu-like illness: if there were no clear logic to its arrival, perhaps one day it would simply skip a year and never return. The diagnosis of bipolar illness changes that hope. More painful than the label itself is seeing an endless line of marks wandering across her mood chart. A mark touching the normal line does not reassure her when, in memory, she was only passing through that point rather than feeling well. The chart turns a long series of lived fluctuations into a confronting visual record, making her question when she is not a problem, a risk, or a burden to the people around her.

That fear reaches beyond the current admission. Emma wonders whether she could keep returning to the PAAZ, repeatedly finding herself back at the beginning. She remembers that Lars was alarmed when she first departed from his treatment plan, while her relationship with Dokter Visser had already acquired a weary, static quality: medication and problems seemed to circulate without a clear movement toward either better or worse. The prospect she fears is not simply another episode, but a future in which repeated illness and an unchanging status quo exhaust both patient and clinician.

The body, memory, and the work of enduring

During a night on the ward, Emma tries not to feel, think, or remember. A brief encounter with the night nurses’ flashlight is followed by the return of tears before they have reached the next room. The memory she has been resisting is not an isolated thought but a sensation she recognizes as having followed her throughout her life: the depressive depletion that leaves only fragments of the self, still clinging to life while being pulled downward. Her image of the depth beyond the balcony gives the recurrence a specific and painful point of reference. The scene shows how an attempt to keep memory at a distance can fail abruptly, and how the emotional crisis returns through the body as well as through thought.

Later, alone in the television corner after an argument, Emma uses the hard chair to narrow her world. Its bar presses into her hip and its armrest into her side; attending to those physical facts briefly restores a world governed by cause and effect. She can hold onto the fact that she is hospitalized without having to turn it into an emotion. The chair does not resolve the depression, but its rigid physical limits offer a moment of containment when feeling has become overwhelming. Even Sergei’s wings, the image attached to his scarf, cannot comfort her that night.

When Beatrice questions why Emma is on the ward, Emma first gives the practical explanation that her medication is being increased. She recognizes this as incomplete. The deeper reason is that the PAAZ is the one place where she does not feel the full extent of what depression and mania have taken away. At home she has her belongings, hobbies, Sergei, and the things she loves, but she knows that love without being able to feel it. Improvement is therefore partial: she can be glad when Sergei visits and also glad when he leaves. Puzzles and the owl scarf offer only a fragile foothold over the emptiness, not proof that it has disappeared.

Care, institutions, and the fear of burdening others

Emma’s experience also exposes the difference between being technically treated and being accompanied. She describes inpatient access to a doctor as a chain of requests: a patient tells nursing staff, staff raise it at the next morning meeting, the psychiatrist asks the secretary to find time, and the appointment must then be relayed back through the same system. A five-minute process for an outpatient can take ten minutes to thirty years for an inpatient, depending on the weekends in between. By evening, she is told, nothing more will happen. The delay gives institutional procedure a direct emotional consequence: a patient seeking help must wait inside the very system meant to support her.

Staffing changes deepen that concern. Sandra explains that the planned merger has led to contracts not being renewed and dismissals, leaving as few as two or three staff members to run an entire PAAZ. Emma objects to the idea that patients on the open ward do not need nursing attention simply because they can occupy themselves. Therapy takes only a few hours a day, and a therapist may be seen for an hour a week; nursing staff, by contrast, are present across the day. If patients are left alone with a television, book, or puzzle, the apparent calm and independence can conceal loneliness. For Emma, attention is not an optional extra but part of what makes the ward different from being isolated at home.

Her fear of burdening others grows from the same conflict between visible functioning and internal danger. In talking with Beatrice about Sergei’s reluctance to remove Emma’s stockpiled medication, she recounts that it took more than three weeks and two conversations with Rajid before he finally did so, and not willingly. Emma worries this means Sergei does not take her illness seriously. Beatrice offers another possible reading: treating the danger as less serious may protect him from facing how close he came to losing Emma. The exchange does not settle what Sergei believes; it shows how a protective action can become a painful measure of whether Emma’s suffering is understood.

Living with illness rather than expecting an ending

Emma’s conversations with Beatrice expose a difficult form of recognition. Emma once regarded Beatrice’s despair as something distinct from her own, but comes to see that their outward ways of coping differ more than the underlying hopelessness. Beatrice turns toward her family, while Emma turns toward puzzles; both can be occupied without being well. Emma imagines that, in twenty or thirty years, she might be in Beatrice’s place, returning to the PAAZ again and again. This is not a prediction that their lives will be identical, but a challenge to her earlier sense that youth, insight, or being an agreeable patient guarantees protection from chronic suffering.

Beatrice’s account of losing her sense of God further complicates any simple equation between medication and relief. She says that after beginning pills during her first week on the ward, she stopped feeling God’s presence; she went home hoping that stopping the medication would bring it back, but it did not, and she later returned to the PAAZ. Emma cannot verify the cause. She suggests instead that depression itself may consume the energy needed to believe, laugh, feel happiness, or love, and that Beatrice’s sense of God might return if the depression recedes. Their exchange gives depression a relational and spiritual dimension without making Emma’s explanation certain.

Emma ultimately rejects the idea that every return of symptoms would mean that her life had failed to move forward. She asks to be allowed to go, while acknowledging that things will get worse again. She also distinguishes her hallucinations and delusions from depression: they can sometimes be troublesome, but she does not always feel them as a problem, whereas depression is felt continually and, when present, seems eternal. She believes she can manage the depression that remains in the background, though this is not a claim of cure. The movement is from hoping for an illness-free future toward recognizing recurrence and claiming responsibility for living within it. The PAAZ’s care and the people watching from the sidelines matter, but they cannot live that life for her.