Play at Rhode Island theatre takes provocative look at mental illness

From The Providence Journal in R.I. In the picture, Casey Seymour Kim plays a woman in the throes of mental illness in the Gamm Theater’s "4:48 Psychosis."

On the page, it reads more like a poem than a play. There are no stage directions, no characters. Yet British playwright Sarah Kane’s “4:48 Psychosis” is one of the most intimate and powerful looks at mental illness ever staged.

“What makes it remarkable,” said Tony Estrella, who is directing this unusual work for his Gamm Theatre in Pawtucket, “is it’s a worm’s eye view, written from the inside out. The sufferer gets to tell the story.”

Most American audiences don’t know Kane’s work, said Estrella. Indeed, this is the first time any of her plays have been done in Rhode Island.

Kane burst on the London playwriting scene at 23 with a play about the Bosnian war called “Blasted.” Four plays later, in 1999 at the age of 28, she was found hanging in the bathroom of a London hospital. At first she was seen by critics as a playwright out to shock, a provocateur. But those same critics have begun to reassess her work since her death, said Estrella. He, in fact, thinks Kane is one of the most important dramatic voices of the past two decades, along with the English-Irish playwright Martin McDonagh.

First staged in 2000, “4:48 Psychosis” is a searing look at Kane’s battle with her inner demons. It takes its title from the moment in the early morning when she would awake to a brief period of clarity, before lapsing back into a world of darkness and despair.

“It shouldn’t been seen as just a suicide note, though” said Estrella. “It’s much more universal than that.”

Since the script makes no mention of characters, the play has been done with casts of various sizes. When it was first produced, three actors were used. For the Gamm’s production Estrella is going with just two — a patient, or Kane, and her doctor.

Estrella said he hadn’t studied up on other productions, because he wanted his own fresh take on the Gamm’s effort. So he’s not sure what part a third actor would play, perhaps a parent, or the inner ramblings of the mind. One production, he said, called for a dozen performers.

“Ours seems the most direct,” said Estrella, “the most obvious.”

The play sort of bounces between naturalistic dialogue between patient and doctor and expressionistic moments, when we’re not always sure what’s happening, as the playwright retreats inside herself. It opens with a therapist, or so it seems, asking a repeated question. That is followed by an unpunctuated paragraph where Kane likens her thoughts to 10,000 cockroaches on a shifting floor.

If this sounds a little confusing, Estrella wants people to know that there is a method to Kane’s madness.

“It looks like scatter-shot expressionistic poetry,” said Estrella, “but the structure under it is incredibly solid. It’s surprising that what you see came from the page.”

Besides, said Estrella, he’s not interested in confusing the audience.

“I’m not interested in leading people in the dark,” he said. “This is not theater for theater’s sake. We’ve got to get it clear. I never pick a play for a season if I think people will be baffled by it.”

For the Gamm production, Casey Seymour Kim plays the patient, and Tom Gleadow, fresh from the role of Dogberry in “Much Ado About Nothing,” is the doctor. That means Kim is on stage for the entire play, about an hour and 10 minutes of drama. She also has about 75 percent of the lines, she said, which makes the role a demanding one.

“You have to develop the stamina to sustain the mindset of the play,” said Kim, who began learning the part back in September. “It’s like you have been betrayed by the system, betrayed by your body.”

Both Kim and Estrella did considerable research for the project. They spoke with doctors at Butler Hospital and Gateway Healthcare, along with a mental health advocate who herself has battled mental illness. Each consultation made a difference in the direction the play took, said Estrella.

“We wanted it to sound authentic,” said Kim.

The play is pretty much a journey, where we meet Kane and learn of her treatment. There are moments when she does nothing but count backward from 100, list all the medications she has taken along with their doses, or obsessively repeat seemingly random words.

Then there is a move toward clarity, toward a period of stabilization and the discharge from the hospital, only to see the disease return.

Kim likens the trip to being in a hurricane, where Kane for a while gets to bask in the calm eye of the storm before facing its furious backside.

Actually, Kane never tells us where the action takes place. It could be staged anywhere, but Estrella has decided on three sites, a hospital room, a doctor’s office and the outside world, or maybe the landscape of Kane’s mind, which is after all, what the play is really about.

While Estrella sees the play as a work of art, he’s hoping it will also air issues surrounding mental illness. Doctors from Butler and Gateway will be on hand after select performances to field questions from the audience, he said.

“As long as it gets people talking, and inspires conversation,” said Kim, “then we have done our jobs.”