Vlog for the Wellcome | 4.48 Psychosis | Deafinitely Theatre

I’m Jim Cromwell, and this is my sign-name (two crossed hands). I am a clinical psychologist working for, I think, over 25 years with Deaf people with mental health problems; both adults and children. I have been supporting Deafinitely Theatre throughout this year with their production of Sarah Kane’s play “4.48 Psychosis”.

It has been fascinating to be involved in the various stages of the production, namely the research and development day, one of the rehearsals, a post-show question and answer panel session, and the symposium at the Wellcome Collection yesterday with five of us each giving presentations on Deafness and mental health. It was an interesting evening. I had never been involved in a theatre production in this way before and it was engrossing to be so immersed in the process from first opening the script to considering how to turn that into a production.

The Deafinitely team were hungry for information and did not hesitate to thoroughly interrogate me on issues of the history of Deafness and mental health, Deaf mental health services, issues with funding, politics, doctors from the NHS (or otherwise), the differences between psychiatrists and psychologists, what psychosis is, and what psychotic people might experience as a result. They really let me have it with their enquiries, and I’m certain that the other people consulting to the production felt much the same. It was wonderful to see a production team so ravenous for information and clarification, and then to work up that input and the script and so on to devise the most beautiful show.

As I say, I had attended a rehearsal, but actually walking into the theatre space on the night and seeing the physical embodiment of that whole process really hit me like a ton of bricks. It sent shivers down my spine. The company had quite evidently thoroughly understood the experiences and the contexts of Deaf people with psychosis and the play was able to embody that perfectly.

The script for 4.48 Psychosis is unlike any other. You cannot just pick it up, read it, and know what happens or what to do with it. One would expect in such a script to find a list of characters, so to start with you know who is in the play! Great. 4.48 does not have that. There is also no familiar structure to the script. No indication of who says what, or even of what is dialogue and what is stage direction. Usually it seems to be just a big section of words, but sometimes just numbers dotted around the page with no indication as to what that might mean. Consequently, the company had to examine each part of the script in turn and consider what use they could make of it to tell their story; how to be faithful to and give the script the respect it deserves while still producing from it a coherent play in real life.

The most important parts of this play, well - to me – are the related themes of separation and dislocation. For example, to be a psychotic client means to have experiences that are dislocated from reality and so disorienting. There is a gap between the reality and the experience of that reality. There is also a gap between clients with mental health problems and the doctors trying to work with them. There is a big space between them. Of course in a mental health unit for Deaf people most if not all of the doctors are hearing. This gives rise to a profound dislocation between the client and the doctor. Related to this of course is the separation between British Sign Language and spoken or written English.

Previously in my psychology work with Deaf people with mental health problems, my clients would very often describe feeling that they did not fit into either the Deaf or hearing worlds. Not only did they use (the signed equivalents of) these terms, they would place them in signing space very far apart as if they fell between them. Again – another important separation. As therapy progressed, these clients would begin to describe feeling better able to integrate into both Deaf and Hearing worlds, and they would naturally place them much closer together, as if it was that bringing together of worlds that facilitated moving between them; this being a coexistence of Deaf identity and ‘hearing world competence’. That conceptual joining of, and with, both worlds is to my mind what mental health is.

This production portrays mental health and illness through depictions of these separations, and most striking of these perhaps is via the separation of the audience from the action on the stage. It was that that first hit me on show-night.

The impact of the play has already been made manifest. I think that most nights so far have been sold out, meaning that hundreds of people previously naïve to the issues of Deafness and mental health have been clearly and memorably shown. They have learned about the paucity of service and funding, the profound challenges of hearing doctors treating Deaf people with psychosis, and what the bridge would be between those vital two parties involved in treatment and recovery – namely communication. I know from reports from audience and community members that there are already discussions ongoing and plans afoot amongst Deafness charitable bodies and Deaf campaigners about how to move the field forwards and improve the situation. So there has already been real activity and we will see if it can bring about real change.

Sarah Kent of course is no longer with us having taken her own life. However, I firmly believe that if she could see the way in which Deafinitely Theatre has dealt so competently and sensitively with her script, she would have loved it because of the real respect paid to her original script and to the way in which it clearly portrays her message. I assume that she would have known little if anything about Deafness and mental health, but she would see the Deaf and Hearing worlds as metaphors for patients and doctors, BSL and English, and those dislocations.

It has been a pleasure to be involved in the process of developing this profound and beautiful play.


Jim Cromwell

Jim Cromwell