Deafinitely Theatre break taboos on suicide with their production of 4.48 Psychosis


In communication with DAO, Deafinitely Theatre’s Artistic Director, Paula Garfield writes about what inspired the company to produce a bilingual adaptation of Sarah Kane’s 4.48 Psychosis, a play which foretold the writer’s own suicide.

A male actor with a pained expression, sits centre stage, another actor stands behind him and two more in white coats stand either side

4.48 Psychosis. Jim Fish, Brian Duffy, Matt Kyle & Adam Bassett. Credit © Becky Bailey.

I had read the script for 4:48 a number of years ago, and had considered it for adaptation, but decided at the time to focus on other projects. As time went on, I became more aware of the significant mental health issues in the deaf community, and I also became aware of the high risk of suicide amongst deaf men. I wanted to challenge the taboo that exists around open discussion of these issues and decided that 4:48 was the perfect vehicle for this.

We carried out robust research for this project, and invited a number of professionals into our process to learn from them. Dr Sarah Powell, a deaf Clinical Lead/Clinical Psychologist, works for SignHealth, a charity focused on improving the health and well-being of Deaf people, Dr Jim Cromwell Clinical Psychologist, who has worked with deaf children and adults for 10 years, and Herbert Klein, a deaf mental health practitioner, with over 30 years of experience working with deaf people in the mental health field. These professionals were an invaluable resource, and we all learnt much from them as we researched this project.

Our research around deaf people and mental health indicated that deaf people are three times more likely to experience significant mental health issues than the general hearing population. We also found that deaf men are at a significantly higher risk of suicidal behaviours. This accorded with my own understanding of the issues, and some of the causes can be identified – the fact that 90% of deaf children are born into hearing families, many of whom do not learn sign-language to communicate with their deaf children, leads to language deprivation and delayed language acquisition, with all the resultant consequences for their later mental health.

an actor poses on stage, dressed as a doctor

4.48 Psychosis. Jim Fish. Credit Becky Bailey

The significant issues many deaf children experience when attending mainstream educational establishments, where sign-language is not used or discouraged, also contributes to this, as does the lack of socialisation and friendship that mainstreamed deaf children can experience with their hearing peers. All of these factors, among others, contribute to the unique mental health challenges deaf people often face.

I chose to have a brave, bold approach in directing 4.48 Psychosis, even with its sensitive and emotive subject matter. I focused on the creativity of my cast, and deliberately cast Brian Duffy and Adam Basset, two superbly skilled users of BSL and Visual Vernacular, a rich visual language suited to poetic, artistic, and theatrical contexts. Working with movement director, Alim Jayda, we adapted some of the dialogue into visual, spatial movements on stage, and working with translator, Kate Furby, we focused on the meanings in the text, and were able to avoid artistic blocks, accomplishing our goal of bringing this piece to audiences.

The text itself allows a director to stage the piece as they wish – in this sense, it is both non-restrictive, and also a challenge. Therefore, we decided to stage it in such a way that it was relatively neutral, with a set that allows audiences to map onto it whatever they wish.

a group of actors pose behind a screen bathed in green light

4.48 Psychosis with Jim Fish. Credit Becky Bailey

In this regard, some audience members will see a mental health institution, some will see a hospital, some will see a room, and others may see something else. Allowing the audience the freedom to see what they wish to see was an important part of the design.

To capture the poetic elements of the text, we avoided the overuse of “everyday BSL”, the vernacular used throughout the UK everyday by Deaf people. Instead, we incorporated a form of what I call “sign-theatre”, a poetic form of BSL that suits theatrical productions, and Visual Vernacular, an artistic visual language based on sign-languages. This mix of BSL, Sign-Theatre, and Visual Vernacular, captures the essence and beauty of the poetic elements of Sarah Kane’s written text.

I hope deaf and hearing audience members leave the theatre with the distinct impression they have experienced something new and innovative, with the emotional impact the subject matter deserves. For my hearing audience members, I am aware the piece poses particular challenges, since there is not a full voiceover of everything that is signed, and the edited captions do not provide every signed word for them to read.

an actor sits on stage in subdued light against a wall with the words 'no hope' repeated several times

4.48 Psychosis with Brian Duffy. Credit Becky Bailey

As such, they too will sometimes experience the communication breakdowns, difficulties and challenges of this approach. I am aware this is a risk, but I believe it allows my hearing audience members a window into the experiences of deaf people, and will enrich my hearing audience. For both deaf and hearing audience members, my key goal is that they are immersed into our production, and come away with renewed appreciation of the issues.

To this end, we have an education program that accompanies this production. We have four post-show Q&A’s, taking place on 27th September, 4th October, 6th October, and 19th October. We have two panel discussions, taking place on 5th October and 12th October, and finally, we have a very important symposium taking place at the Wellcome Collection, on October 9th, from 4-6pm, featuring Dr Sarah Power, Dr Jim,Herbert Klein, James Clarke, and myself.

The symposium is entitled ‘A Safe Space to Break the Taboo’, and will be live-steamed on Deafinitely Theatre’s Facebook page, as each event detailed above is. We look forward to seeing our audiences and other interested parties in attendance, or watching the livestream, as we discuss the production, and the crucial subject of mental health.