Recurring depression and the hope that it will be the last time

Recurring depression and the hope that it will be the last time traces how Emma’s wish for one final depressive episode becomes entangled with her suicidal crisis. For a time, imagining that the worst has happened and will not happen again lets her endure. A diagnosis suggesting recurrence threatens that consolation: it makes depression seem not an isolated past, but a possible future. The resulting conflict helps explain why Emma stockpiles medication and why care must address both immediate access to lethal means and the despair attached to an imagined lifetime of repetition.

Depression, Mania, and Distorted Time

Emma’s depression is described as more than low mood. In a conversation with Rajid, she initially acknowledges that she had been depressed for months and that, the previous week, she had been so low that she considered suicide. Yet she separates that past from her present. When asked how she feels now, she struggles to convey a state in which the fog seems to lift and reality appears newly clear. Her images expand from the moon as a vast body moving through space to the blackness of the sky obscured by the atmosphere. What feels to her like seeing things as they truly are is difficult to communicate to a psychiatrist; she settles on calling herself well and clear.

That clarity is not the same as safety. Emma appears tense, and her plans after leaving include collecting pills. Rajid discovers that she has been receiving only seven days of medication at a time to reduce suicide risk, but that earlier prescriptions have left her with additional supplies. Emma has collected most of them and says that some of the pills at home have already been partly crushed. The discrepancy between her report of feeling clear and the danger represented by her preparations makes visible how little a reassuring account of the present can settle questions about the future.

Later, Emma gives Rajid a different account of the idea that preceded her admission. She recalls feeling almost nothing when she heard that Dokter Visser’s husband had died, despite Dokter Visser having been her psychiatrist for more than two years. Her attention was absorbed by what she describes as one enormous idea. The day before admission, while making breakfast, she experienced a sudden conviction that the time had come to die. She framed it not as a suicide plan but as a task to complete, imagining that removing herself and her distress would let her return to work, productivity, and action without being hindered by feeling. The ordinary setting of breakfast sharpens the contrast between an apparently practical thought and its catastrophic meaning.

Emma also gives depression and mania contrasting relationships to time. In her reflection on Beatrice’s words, mania becomes a present so consuming that past and future seem to fall away. Depression, by contrast, allows the past to swallow the future; both directions lead back to the same all-encompassing despair. The distinction clarifies why the prospect of recurrence matters so much: depression does not feel like a bounded episode when it erases the sense that anything lies beyond it.

The Childhood Balcony and the Promise of One Last Time

The hope that an episode might be the last is rooted in an earlier suicidal crisis. At twelve, Emma stood on a balcony overwhelmed by despair. She describes the memory as the depth beyond the balcony: a point at which depression has taken away her energy and left only fragments of herself clinging to life. During the later crisis, the memory returns as something she tries to keep from remembering, but it breaks through and brings her to tears.

At the childhood balcony, Emma eventually sits against the railing and cries rather than going over. Her reason for stopping is tied to Siem, a pony who has seen her: she cannot do it if someone else would be troubled by it. When she gets up, an airplane passes overhead, a dove is on a branch, and Siem is grazing again. The world continues while Emma feels left behind. Against that desolation, the thought that she can stop another day becomes a fragile reprieve. Perhaps, she believes, this will be the last depression and things will finally improve.

The belief works because its alternative is almost unbearable. Emma fears that a new diagnosis of manic depression would mean her earlier depressions were not accidental and that the hope of a final episode was false. The prospect of returning again and again to the same balcony turns recurrence into more than a clinical pattern: it is an anticipated repetition of a choice made under conditions of extreme despair. Her wish not to receive another diagnosis is therefore bound to what she thinks it would mean for the rest of her life.

Stockpiled Medication and the Crisis of Recurrence

Emma explicitly connects the fear of recurring depression to her stockpile. She gathered medication so that the previous depression could be the last and the depressed part of her could finally die, allowing her to move on. In her thinking, the stockpile is a way to end repetition permanently. The same preparation, however, creates immediate danger by making an overdose easier to carry out.

Rajid responds by setting a clear choice: Emma must go home and hand over all her medication and prescriptions, or be admitted. She objects that some pills have already been partly ground and that a prescription is already at the pharmacy, but Rajid says he will arrange those details. The decision turns her abstract fear of a future with recurrent depression into an immediate question of safety and care. Emma is admitted, and later describes the result as a shift in who has to decide: she is at the PAAZ, and for now the PAAZ decides.

The practical issue continues after admission. Rajid explains to Sergei that Emma had gathered enough medication to take it all at once and that she had nearly removed the barriers between suicidal intent and action. If the crisis returned, she would not need to visit pharmacies over two days; the means would already be within reach. It is not enough, he insists, to move the pills into Sergei’s home, because Emma would not truly be free of them while they remained in her life. The medication must disappear, whether it is discarded, taken to a pharmacy, or handed in at the hospital.

Sergei has initially resisted removing the supplies because Emma seems to be doing better and may need the medication again. Emma later tells another patient that it took more than three weeks and two conversations with Rajid before Sergei finally removed the pills, and that he did so reluctantly. She struggles with what his reluctance might mean, fearing that he does not take her illness seriously. The other patient suggests that minimizing the danger may be Sergei’s way of protecting himself from the possibility of losing Emma. The exchange shows how the same medication can stand for treatment, future need, and a readily available means of suicide, while loved ones may understand its danger differently.

Living With the Prospect of Return

The narrative does not present the loss of Emma’s hope for a last episode as a simple acceptance of a diagnosis or a cure for despair. In a later conversation with Sergei, she recognizes the weight of being seen as a patient for whom others feel responsible, someone who may need protection from herself. She does not deny that this is part of her life, but insists that she must live it herself. When Sergei says that he only wants to prevent another deterioration, Emma gently answers that things will get worse again. Her statement acknowledges recurrence without promising that she can control it.

This recognition changes the meaning of the earlier hope. Emma had treated death as a way to ensure that depression could never return; after admission, she can defer the decision while the PAAZ takes responsibility for the immediate crisis. The movement is from a story of final elimination to one in which recurrence remains possible and safety depends partly on other people and practical safeguards. Neither position offers an easy resolution. The possibility that Emma may become depressed again remains real, but it is no longer presented only as proof that life must be ended.

Emma’s conversation with Beatrice adds another distinction. Beatrice says that she no longer feels God, and explains that this loss followed her first experience with medication; she had left the hospital hoping that stopping the pills would restore that feeling, but it did not, and she has now returned. Emma does not claim to know the cause. She wonders whether depression itself may swallow the energy needed to believe, laugh, feel joy, or love, and suggests that Beatrice’s sense of God might return as the depression recedes. This exchange echoes Emma’s own uncertainty about what symptoms mean and what may follow them: hope can be necessary without becoming a guarantee.

The concept’s central tension lies between repetition and reprieve. Emma’s idea of one final depression briefly makes endurance imaginable, but the fear that depression will recur converts that promise into pressure toward suicide. The story counters neither fear nor risk with an assured happy ending. Instead, it shows how a future that cannot be guaranteed may still be approached through admission, removal of accumulated medication, candid recognition of recurrence, and continued connection with other people.