4.48 Psychosis


I saw a performance of Sarah Kane’s 4.48 Psychosis on Saturday, performed by CommonPlace Theatre. It is an emotionally laden piece, but this review will be more clinical.

It was an interesting production. As we filed into the room lined with white tarps, we were given a seat number. The chairs were scattered throughout the playing area, and the numbers were non-consecutive. The only other staging were groups of suspended bare light bulbs, and a frame sticking over one of the walls, which suspended raised black curtains.

The soundscape contained a lot of susurrous, and occasional tones and bells. The hard clacking of the psychiatrist character’s shoes would announce her walking into the room. She was curtailed by a white sheet that stretched off stage, into the entrance.

She occasionally spoke with the main players, who seemed to be a male and female voice of “Sarah’s Mind.” They delivered a diatribe of her consciousness as she went through the depths of despair, and played these parts well. Costuming was simple, with shirts/dresses zippered at the back, and sleeves that were attached loosely with string.

They raged. And they moved around the chairs, forcing the audience to turn around and follow their movements. It made the audience a part of the setting, because we could see each other sitting there, reacting to the words. People were quite moved.

Sarah Kane’s works, in the words of my husband (who knows more about this sort of thing than I do) “are meant to feel like a punch.” For me, this seemed like a day at work. Many of my patients would find their experiences expressed through Kane’s work. 4.48 psychosis, according to Wikipedia, was her last piece. She was admitted to hospital shortly thereafter, and then committed suicide.

I wonder if she felt that the work was really finished; if it was not, then what we have is an artistic expression of despair. Even though it’s called 4.48 psychosis, I feel pretty strongly that what Kane describes is depression, plus the subjective feeling of “going crazy” that is associated with this condition.


It is uncomfortable for a lot of people to be so violently confronted by mental health, but in talking to a friend who also saw the performance, that person said that it was freeing to have the same feeling expressed accurately.

Sarah Kane’s view of the psychiatrist is generally uncharitable, but also realistic. She appreciates that the psychiatrist is only human, too.

For me, as an M.D., the most fascinating part was a sequence where a list of medications and their side effects/withdrawal effects were revealed. I knew all of the drugs, and, while I know the side effects, it is important for me to hear a visceral telling of the experiences they create.

When I learned that Kane had killed herself shortly after writing 4.48 Psychosis, and that the play opened posthumously, I felt grateful to the playwright. Her articulations of frustration with treatment and subjective mental experience moves us emotionally as we attend, but also educates us on mental health. Yes, it is tragic that she could not find the solution she craved, and that her voices disappeared behind the falling black veils, with her psychiatrist screaming for her to “open the curtains!” Equally, this is something that everyone, not just mental health workers, need to see.

Right now, I’ve only provided a description of the event, not so much how I felt about it. That is something I am still digesting, in the voices of my own mind.


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