4:48 Psychosis
4.48 Psychosis by Sarah Kane was the final play she wrote before her suicide in 1999. Premiering posthumously in 2000, it remains one of the most challenging pieces of contemporary theatre. The title refers to 4:48 a.m., the time Kane reportedly found herself awake and lucid during depressive episodes and mental turmoil. The play is an unflinching exploration of mental illness and despair, it does not follow conventional dramatic structures.
This 70 minute production, performed without an interval, comes with comprehensive content warnings (which I’ll list at the end of this review for those interested). It’s worth noting that the script itself contains no clear characters or traditional plot. Director James Macdonald has chosen to divide the lines among three performers, a choice that highlights the fragmented and fluid nature of the voice in the text. The result is disorienting, at times confusing, and occasionally bewildering. Without any prior knowledge of the play, one could be forgiven for finding it impenetrable or nonsensical, but that is, in many ways, the point.
What unfolds on stage is visually remarkable. Designer Jeremy Herbert has created a sparse yet layered environment: one table, two chairs, and a large mirror tilted above the stage to give the audience a bird’s-eye view of the action. This overhead perspective invites us into a world turned upside down. The performers write directly onto the table, but in mirrored script, so that the audience sees the words correctly reflected back at them. This alone must have taken extraordinary skill and rehearsal.
Projection Designer Ben Walden adds further dimension with a moving video feed of an exterior window view projected down onto the table and again visible properly in the mirror. This combines beautifully with Lighting Designer Nigel Edwards’ use of a gobo to throw the pattern of a window frame across the floor. There are so many interwoven visual elements at play here; I imagine a seasoned academic might have a field day working out all the possible interpretations.
A particularly striking effect occurs when projections on the floor appear as though tiled sheets of paper are scattered across the stage. I genuinely had to blink twice to figure out whether the floor was peeling or whether it was just a superb optical illusion. The ending of the production, which keeps in line with the text, sees the performers physically open the studio's black box windows and shutters, a moment charged with symbolism and ambiguity.
The constant shifts in physicality; standing, sitting, lying felt reminiscent of those improvisation games where each player must always be in a different position. It created a sense of dynamism and unpredictability, which helped keep the performance engaging despite its lack of traditional narrative.
4.48 Psychosis is not an easy watch. It’s not designed to be. What this production offers is a stunningly realised, highly original interpretation that does not shy away from the bleakness of its subject matter. It demands focus, reflection, and sensitivity. It’s an experience, not just a story.
Content warnings:
The play contains strong language and explores issues of mental health, including but not limited to:
depression and clinical depression, isolation, dependency, suicide; attempted & death by suicide, psychosis, schizophrenia, eating disorders and disordered eating behaviour, Borderline Personality Disorder (BPD), self-harm (cutting), violence, death, sexual assault, physical assault.
This show was reviewed on the 21st June 2025 at the Royal Court Theatre, London where it runs until the 5th July 2025. Tickets available here: 4.48 Psychosis - Royal Court
Review written by Valentine Gale-Sides
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Photo credit : Marc Brenner
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