4.48 Psychosis

Kane, Sarah. “4.48 Psychosis.” Sarah Kane Complete Plays. Intro. David Greig. London: Methuen Drama, 2001. Print. 202-245.

"My life is caught in a web of reason

spun by a doctor to augment the sane"

- Sarah Kane (233).

Sarah Kane’s 4.48 Psychosis is one of the most scathing critiques of psychiatry I’ve ever read. It is also one of the most disorientingly realistic representations of depression I’ve read. As the text describes itself: “this is the rhythm of madness” and fragmentation is central to that rhythm (and might this fragmentation of madness connect to the post-colonial fragmentation described by Rushdie and Gikandi?) (227). I first decided to read 4.48 Psychosis instead of Blasted when I read the introduction to the complete collection of Kane’s plays, written by David Greig. Greig describes the play as “a report from a region of the mind that most of us hope never to visit but from which many people cannot escape” (xvii). Sounded right up my alley. I found some of his comments positively ironic, however, such as his statement that “inevitably, the shadow of Kane’s death [by suicide] will fall across her plays and one can find oneself reading them in search of diagnoses, listening out for unheard cries for help” (xvii-xviii). Despite my agreement that there’s an obvious biographical connection, the irony here is that Kane’s play is an indictment against the idea of the cry for help and the discourse of suicide prevention as well as against diagnosis and many of the forms of psychiatric “help” available.

The play moves loosely from one voice to another, not giving a clear sense of who is speaking, even in the portions that seem to be dialogue, rather than monologue. It reminds me in many ways of R.D. Laing’s work, and given Kane’s anti-psychiatry bent in the play, I wonder if she was familiar with him. They were, however, both influenced by/interested in existentialism, so that might explain the similarity.

When 4.48 Psychosis was produced, shortly after Kane’s death, the director divided the play among three actors, whom he called Victim, Perpetrator and Bystander, roles which are borrowed directly from the body of the text (231). When I read it, I mentally assigned one voice to the protagonist/patient and one to a kind of doctor or therapist figure. At times, however, I thought the doctor/therapist voice might more appropriately belong to a lover or friend. I think those two voices (doctor, lover) could be the same actor, or could be divided among two actors, depending on how you wanted to play it. At any rate, it is clear that the protagonist-type voice, like Kane herself, is experiencing depression and undergoing psychiatric treatment, which is obviously failing to actually help her. As she puts it, “there’s not a drug on earth that can make life meaningful” (220).

She also discusses the choice (oft discussed in psych survivor/anti-psychiatry communities) between the chemical lobotomy which is the result of anti-psychotic drugs, and simply living with a depression so debilitating that death is preferable (221). Further to that, it also critiques the long term side-effects of psych-med––often not disclosed to patients––such as Tardive Dyskinesia (TD), a neurological conditional with symptoms similar to Parkinson’s Disease. In a monologue segment of the play which is set up to emulate a psychiatrist’s case notes––the play is quite critical of psychiatrists (209)––the patient’s suspicions that she may be developing TD are put down to “hypochondria” (225). I especially liked this segment of the play, because in the diagnostic notes it steps outside the language of psychiatry in the tongue in cheek lines: “Mood: Fucking angry. / Affect: Very Angry.” (224). I think, however, the frustrations of psychiatric care providers are present in the play as well, in a conversation between the doctor and patient type voices, where the doctor voice confesses that he/she cannot be friends with patients because “I fucking hate this job and I need my friends to be sane” (237). The relationship between the doctor (or doctor-friend/doctor-lover) and patient in this scene is one of friendship, but also dependency. There is a sense of grief throughout the play, and whether this is the grief of the patient/protagonist who has lost a lover/doctor/saviour or the grief of the lover losing the suicidal beloved, is unclear, and probably irrelevant. It’s the feeling, the sense that the whole play is weeping and shrieking out, that matters (233; 218-9).

Though she is obviously aware that it will be extremely painful for those who care for her (and from what I’ve read on a biographical note Kane’s suicide was a harsh blow to the artistic community of which Kane was a part) the protagonist/patient-voice believes that death, however imperfect a solution, is the only way out of her pain (244). There is a debate in the mad community over whether or not people who are chronically depressed and disconnected should be prevented from committing suicide, or whether they should be able to access euthanasia. If I were to attribute a position to Kane’s play, it is that suicide is justified for some people, when there are no other options left. As the protagonist/patient voice states:

“Nothing can extinguish my anger

And nothing can restore my faith

This is not a world in which I wish to live.” (210)

The protagonist in 4.48 Psychosis is aware of her own disconnection, her feeling of being in the wrong body (215, 206), of being in the wrong reality or outside of reality (212, 233) and of being outside of herself: “It is myself I have never met, whose face is pasted on the underside of my mind” (245).

She refuses to label this outsideness/in-betweeness as illness, however; instead she portrays it––through the very structure of the play––as an alternative mode of perception, one which, unfortunately, is so painful and disorienting that it can only be remedied by disappearing, that is, dying. The final line, “please open the curtains,” draws attention to the stage itself, breaking the fourth wall and forcing us to admit that like the actor(s), we really are inside the fragmented reality of the play too; it also complicates the idea of death (the close of the curtains) as the ending and of life (their opening) as the beginning, inviting us to examine our own performances, asking us to open the curtains of our own minds so that we might engage with the painful beauty of our own “rhythms of madness,” and our mortality (217).