4.48 Psychosis review: Sarah Kane’s last play still packs a punch
When 4.48 Psychosis was first staged in the year 2000, its author Sarah Kane had ended her own life just months earlier. Tackling mental illness and suicide, it seemed to offer a posthumous glimpse into the mind of a troubled genius, laying bare the anguish that led to her death aged just 28.
Kane has since become a legend of British theatre, with performances of her plays spoken of in hushed, reverential tones. It’s a slightly strange space for this enfant terrible to occupy: with all its baby-eating and rape and torture, her work still has the power to make audience members faint and tabloid reporters rub their hands in glee.
Over the years Kane’s work has been sporadically staged – I saw an excellent version of her debut Blasted at the Hammersmith Lyric in 2010 and Cleansed appeared at the National Theatre’s Dorfman in 2016. But 4.48 Psychosis has only once been seen since its maiden production (a relatively minor affair). Now it’s back for a 25 year revival at the tiny Jerwood Theatre Upstairs at the Royal Court where it all began, with original director James Macdonald once again working with actors Daniel Evans, Jo McInnes and Madeleine Potter. It’s an irresistible prospect for theatre nerds – it sold out in days – but does it have the same urgency after all these years?
The three actors all play the same unnamed woman – different aspects of her psyche, perhaps? – speaking in swirling, overlapping prose, never acknowledging each other, together but alone, like a Greek chorus that got lost and wandered into their own play.
Through meandering, fractured sentences – sometimes whispered, other times violently shouted – 4.48 Psychosis tells the story of a woman who, like Kane, spends her days being treated by various doctors in various psychiatric wards. She’s smart, talented, angry and completely set on her own destruction.

There’s an otherworldly feel to the production, from the sickly blue and orange lighting to the television static beamed onto the stage to the mirror that hangs ominously at a 45 degree angle above the actors, making it look like they’re perpetually frozen mid-fall.
When this trio first played the roles, they were fairly close to Kane’s age when she died. The fact they have now long outlived her lends a poignancy to the production but also makes it feel out of time, as if the central character has been trapped in theatrical purgatory for the last quarter of a century.
Indeed, everything we see is a reflection of a reflection of a reflection: videos are projected onto objects that are reflected in mirrors. Reality is always several points removed. And now we have the addition of a strange temporal reflection, the same actors retelling the same events 25 years years later.
It’s a lot of mental baggage for a 65 minute play that’s at best apathetic towards and at worst openly hostile to its audience. It’s deliberately opaque, rarely offering anything close to a narrative foothold, instead placing you amid the chaos of a traumatised mind. While the context of Kane’s suicide adds a harrowing edge, 4.48 Psychosis lacks the thrilling, awful immediacy of Blasted or Cleansed – both stronger plays, in my opinion – and this eerily preserved production can feel more like a historical artefact than a vital modern work.
But Kane has an uncanny ability to find poetry in ugliness and despair and this challenging play is a reminder of the prodigious talent that was lost.
• 4.48 Psychosis is on at the Jerwood Theatre Upstairs at the Royal Court