Reorganization and relocation of PAAZ

PAAZ’s reorganization and relocation unfold as both a construction project and a disruption to the community formed inside its old building. While a new PAAZ takes shape, the existing grounds are stripped away, the treatment group faces cuts, and staff confront an uncertain future. Emma encounters these changes during her stay and departure: the ward she wants to leave is also a place she will soon be unable to return to, because it, too, is disappearing.

Construction and the changing grounds

The approaching move becomes visible during a walk with Sergei. Emma has leave privileges and offers to walk him out, suggesting they pass the Eurasian coots: on an earlier admission, they used to walk there, but now staff take patients in the opposite direction. The familiar route has already been altered. Where a broad ditch, walking path, and small bridge once lay, there is a murky pool amid stacked steel plates, large concrete sewer pipes, a mound of sand, and mud where grass grew. Sergei identifies the activity as preparation for the new building. Behind them, its concrete frame is almost complete.

The construction changes more than the view. The nest where two coots raised four chicks over five months at PAAZ has nearly vanished, leaving only a few crooked sticks in the water; a heron stands watch. A small habitat that had persisted through the ward’s daily life is reduced to traces while the replacement building rises. The scene makes relocation concrete through altered paths, displaced natural features, and the contrast between the surviving nest fragments and the nearly finished structure.

Reorganization and uncertainty among staff

The building work proceeds alongside organizational upheaval. The treatment group is to be cut, and the reorganization affects Lars’s position and his sense of what his work has become. When he tells Emma he has submitted his resignation, he says the management was unhappy and that arrangements still need to be made. He initially begins to explain these complications, then stops, recognizing that they are not something with which he should burden her.

Emma has already begun to assemble the reasons for his decision. Listening to the construction, she connects the planned cuts to the way Lars returned from vacation and responded to her admission. She contrasts the imagined version of him, who would have handled the situation better, with the person she now recognizes: a human being under pressure, facing a treatment group being eliminated even as substantial resources go to the new building, and a merger that is gradually reshaping a job he no longer recognizes. Her realization complicates the therapeutic relationship without reducing the institutional pressures to a personal failing.

The cuts also affect the ward’s daily social structure. After Linda leaves, the group loses the person Emma describes as its usual referee; Iefke and Michiel are no longer speaking, and the atmosphere becomes tense. During the afternoon opening, the patients sit subdued in a messy lounge while the efficient pounding of construction carries in from outside. The sound seems to announce that the group is already becoming unnecessary. Yet the routine continues: with Iefke away at the doctor, the discussion turns, as it often does, to Michiel’s slogan T-shirts. The juxtaposition is pointed: the ward’s ordinary rituals persist even as the institution around them is being reorganized.

Departure while the ward is disappearing

For Emma, leaving PAAZ is not a clean break between illness and recovery. In conversation with Rajid, she asks him to let her go. She understands his concern that things may worsen, and answers that they will. Rajid offers to continue as her psychiatrist after the admission, pending discussion with colleagues, and thinks Lars may still be allowed to treat outpatients despite the restructuring and the loss of the therapy group. Emma says she is due to see Lars the next day. Her planned discharge therefore takes place amid uncertainty about which parts of her care and relationships can continue beyond the ward.

On her final day, Emma wants to go home, but seeing Karel, Gwen, the others, and PAAZ makes the impending loss hard to hold at a distance. The previous evening, she had brought farewell pie and joined a conversation about the future. Now the construction sounds echo through the office, and she recognizes that this was her last time at this PAAZ. In a few months, both she and the ward will be gone from this place. She does not want to return, but knows that soon she will not be able to return even if she wanted to; the thought brings her close to tears. Gwen prepares her final papers, including a letter for the general practitioner and prescriptions, as Emma’s mother is coming to collect her.

At the exit, Emma passes the therapists’ rooms, Rajid’s partly open door, and Lars’s closed one. She describes herself as living with manic depression, Asperger syndrome, and the difficulties of dealing with people, yet believes that life with these conditions is possible. The scene does not present discharge as a cure or the move as a solution to her illness. Instead, it places a practical transition home beside her recognition that her life will continue to include recurring difficulties.

A changing institution and a continuing illness

The contrast between institutional time and Emma’s experience of illness gives the reorganization a wider significance. She describes mania as an intense present that can break away from past and future, while depression makes the past consume the future and leaves only depression in view. Elsewhere, she evokes depression as a fog lifting into an overwhelming sense of seeing reality clearly; later, in a night-time crisis, memories return with the depression, and she feels herself being pulled toward the depth beyond a balcony. These descriptions resist a simple account in which a change of building or a discharge marks the end of distress.

The ward’s own time is also precarious. Its old routes and familiar outdoor life are disrupted before the new building is ready; its group routines carry on while cuts and resignations threaten their continuity. After leaving, Emma and Sergei pass the former site again. She stops at a large metal construction fence, trying to show him where PAAZ had stood. There are no walls, ruins, rubble, or machines—nothing remains. The empty site gives physical finality to the ward’s disappearance, but not to the experiences formed there. PAAZ’s reorganization and relocation thus mark a loss of place and institutional continuity, while Emma’s account insists that living with illness continues beyond the building.