'4.48 Psychosis' review — Sarah Kane's deeply personal swansong is a monumental event in recent theatre history

Read our review of 4.48 Psychosis, starring Daniel Evans, Jo McInnes and Madeleine Potter, now in performances at the Royal Court to 5 July.

Upstairs at the Royal Court, on the same intimate stage where Sarah Kane’s bleakly questioning swansong was first performed a quarter of a century ago, the three actors who originally breathed life into her words resume their positions. They have aged by 25 years; the playwright has not: she took her own life aged 28, and 4.48 Psychosis, which is famously regarded as her suicide note, premiered just 18 months after her death.

Its staging was a bold and radical act that fuelled the Court’s reputation for staging groundbreaking work, and this milestone revival under the tenure of new artistic director David Byrne, which also reunites the original creative team with director James Macdonald, emphasises a renewed commitment to this mission.

Running like an irrevocably toxic stream of consciousness, it remains striking as a deeply personal play that terribly foreshadows and explains its writer’s death, offering a window onto her final punishing thoughts. There are no named characters in the play (and subsequent versions have been performed by anywhere between three and seven actors), but a clear sense that the nameless, placeless entities on stage are one fragmented person, internally isolated and suffering from an incurable, unbearable depression that’s led to an apathy for life.

Perhaps it’s the distance from the events themselves, or that in the decades since, we’ve grown more immune to witnessing others’ terrible suffering, but the production does not seem an especially daring conduit for Kane’s knife-sharp words – not nearly as confronting as Belarus Free Theatre’s 2015 take, for instance.

There is more sense of ennui than psychological distress to watching Daniel Evans (now joint head of the RSC, where the production will transfer), Jo McInnes and Madeleine Potter counting down numbers and listing similar-sounding words in an attempt to self-soothe or distract a frantic mind. It verges on being mechanical in places; overly conscious of protecting its original features like a precious museum artifact. And yet this allows Kane’s words, rather than the performances, to remain the posthumous star of the show.

Her character’s split persona argues with itself and battles with intrusive thoughts. She is a woman disillusioned with a tick-box-focused medical system and convinced “there’s not a drug in the world that could make life meaningful”. Yet there are glimmers of zest in her anguished longing for a lover who lives only in her imagination, and a dry, taboo humour to her musings on whether to swallow, slit or hang.

Jeremy Herbert’s original set design, in which a slanted mirror hovers over the stage, exposes the trio at all times as they lie sprawled on the floor, curled into a foetal ball or slumped in a chair – their bodies listless prisons for a caged mind. Nigel Edwards’ lighting veers from clinically bright to flickering, shadowy and sinister as the time of 4:48am comes around, signalling both despair and clarity.

Seventy minutes is plenty long enough to spend in the company of one so tortured. Kane’s words still shock, as does her unusual omniscience of how her life would end. If this particular production now seems muted, it is still a theatrical highlight of 2025, offering audiences a portal onto a monumental event in recent theatre history.

4.48 Psychosis is at the Royal Court to 5 July.

Photo credit: 4.48 Psychosis (Photos by Marc Brenner)