Sarah Kane’s 4.48 Psychosis: A Suicide Note For The Stage?

448Of 4.48 Psychosis, Michael Billington wrote: “How… do you award aesthetic points to a 75-minute suicide note?”  Considering the overt subject matter of Sarah Kane’s last play, which was produce posthumously following her suicide, it is easy to see the play as nothing more than a suicide note, but to dismiss it as such is unfair to the work.  It is very much about suicide, and depression, and may very well have been written in full knowledge that it would be produced and published posthumously, but that does not make the work something that functions exclusively as a suicide note.  The play functions as a documentation of ‘clinical’ depression, but also challenges misconceptions about depression whilst railing against the medicinal treatment of depression, suggesting that, for some at least, depression is not the result of a chemical imbalance in the brain, but the logical conclusion of a mind that has carefully considered the nature of reality.


This image was borrowed from here.

This image was borrowed from here.

To understand Kane’s depression, and I am openly conflating the protagonist of the play with the author her, we must explore what she views as the source of the depression.  It is not a chemical imbalance, but rather her ability to reason.  Early in the play she states ambiguously: “I am guilty”.  This is followed by a proclamation that she “cannot overcome [her] loneliness… fear… [or] disgust”.  This disgust is rooted in with her guilt.  In one of the most important passages in the play, Kane writes: “I gassed the Jews, I killed the Kurds, I bombed the Arabs, I fucked small children while they begged for mercy”.  This seems harsh and unrealistic, considering that Kane was not even alive when the Jews were gassed, and was far too young to have taken part in the bombing of Arabs and killing of Kurds, but there is a truth to this, and not simply a metaphorical one.  Living in the West, it is impossible not to take part in complacent and complicit consumption.  Whether it be via goods procured from conflict zones, clothes made in sweat shops, or food harvested by child labourers, there is a level of exploitation and oppression sewed into almost every stitch of clothing and built into every phone we buy.  Kane was very much aware of the nature of this as it is an important theme in his other dramatic works.  This is the source of her guilt.  To know that she is part of and benefiting from a system of oppression.



Kane's depression is not the result of a chemical imbalance, but like Orwell's protagonist Winston, the result of understanding the futility of life in an oppressive society.

Kane’s depression is not the result of a chemical imbalance, but like Orwell’s protagonist Winston, the result of understanding the futility of life in an oppressive society.

Kane recognizes that that some “will call this self-indulgence”, but suggests that these people “are lucky not to know its truth”, whilst others “know the simple fact of pain”.  Billington seems to be one such person as he dismisses the play as a suicide note.  He is O’Brien to Kane’s Winston.  Kane is not insane, or depressed, but rather she is simply one of the few sane ones in the asylum of Western hegemonic institutions.  Whilst others engage in double-think and hold two conflicting ideas as truth, Kane is unable to do this, and so recognizes her own guilt.  Those who had engage in double-think are rescued from the pain of guilt, as O’Brien was.  For the likes of Winston and Kane, however, they are too sane to accomplish this and so must “know the simple fact of pain”.  It is not self-indulgence, but quite the reverse.  It is those accusing the likes of Kane of self-indulgence who are the hedonists.  They are the ones who can live near the top of a kyriarchal system and not feel guilt for the exploitation of the people below them.


Elena Arvigo, who portrayed the protagonist in a staging of 4.48 Psychosis.

Elena Arvigo, who portrayed the protagonist in a staging of 4.48 Psychosis.

Whilst Kane is “drowning in a sea of logic”, her psychiatrist seems to be the type of person who is incapable of truly understanding Kane’s depression.  When Kane uses a simile, the psychiatrist identifies it as a metaphor.  Kane argues with him about the difference between a metaphor and a simile, and the nature of reality.  The passage demonstrates that the two simply do not understand each other.  The psychiatrist seeks to treat a chemical imbalance in the brain, whereas Kane feels the source of her depression is rooted in reality.  There is a lack of purpose in Kane’s life, and this is the source of her pain.  She writes that there “is not a drug on earth can make life meaningful”.  Eventually she concedes to the drugs, saying:  “Okay, let’s do… the drugs, let’s do the chemical lobotomy, let’s shut down the higher functions of my brain and perhaps I’ll be a bit more fucking capable of living.”  It seems as though Kane is choosing the blue pill here, but she is the one who chooses the red pill first, and. filled with the pain of reality, the only way she can alleviate the pain is to unlearn what she knows as truth.  To destroy her higher brain functions and agree to a chemical lobotomy. Once she takes the drugs, she says: “behold the Eunuch/ of castrated thought”.  Using the drugs to subdue her mind is a form of castration for her.  Eventually she says: “I know no sin. This is the sickness of becoming great”.  And this is the sickness.  To be devoid of guilt you must not know of or understanding your sin.  It is an excremental whiteness, akin to that which Milton speaks of in ‘Areopagitica’.  Kane’s summation of the process is not one in which the pills cure an illness, but rather, they create one in order to stave off the pain of reality.  The pills make us devoid of true feeling.


Can medication bring meaning to one's life?

Can medication bring meaning to one’s life?

The form of the drama is important as well.  Kane, as she did with Crave and Cleansed, employs dramatic poetry, but her challenging of convention goes further in 4.48 Psychosis than it does in any of her other dramatic works.  In Crave names were replace with letters.  In 4.48 Psychosis there are no symbols to identify the voices.  One can discern three distinct voices in the play, but none of them have names.  Kane also uses monosyllabic chanting (?) coupled with numerical countdowns known as ‘serial sevens’, a clinical test which is meant to determine brain function.  Once Kane finally performs the countdown correctly, she notes afterwards that sanity comes from convolution, where “madness is scorched from the bisected soul”.  The use of such disjointed from, especially on the page, seems to enhance the reader’s understanding of the poet’s frame of mind.  Kane also employs catalogs throughout the play to reinforce, most especially near the apex where she lists a number of things she wants freedom from: social restriction, coercion, constriction, convention, pain shame, humiliation, fear and weakness.  Looking at this list it is clear that no amount of Quetiapine or Cipralex is going to lift the weight of these things from Kane’s mind.



Sarah Kane

Sarah Kane

Far from being a suicide note, this play reads more like a confession, though admittedly the two are not mutually exclusive.  Kane addresses her guilt, and weakness, her fear and cowardice.  But she also displays a great deal of bravery, courage, self-awareness and fortitude.  She shows that simply throwing drugs at a problem is not going to cure it.  It is a system of oppression that is the source of depression, and drugs won’t change reality, only our perceptions of it.  In the end, it seems the source of Kane’s depression was not a chemical imbalance, but rather, the fact that she had both reason and a conscience.

If you enjoy this review on Sarah Kane’s 4.48 Psychosis, check out my review of her plays Blasted, Phaedra’s Love, Cleansed and Crave.

Rambler About Rambler

Jason John Horn is a writer and critic who recently completed his Master's in English Literature at the University of Windsor. He has composed a play, a novella and a number of short stories and satirical essays.

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