Heleen De Boever

The Mind Sciences and the American Cultural Response, 2013-2014Prof. Bruce Michelson

Heleen De Boever

'The Sickness of Becoming Great': Creativity andMadness in 4.48 Psychosis

1. Introduction

"For the poet is a light and winged and holy thing, and there is no invention in him until he

has been inspired and is out of his senses and the mind is no longer in him; [...]” (Plato,

'Ion')

“There is no great genius without a tincture of madness” (Seneca)

The above quotes belong to two of the most famous Western

philosophers, the Greek Plato and the Roman Seneca. Apart from their

many ideological differences, the two do seem to agree on one thing:

that creative people should inevitably be susceptible to insanity. I

use these two quotes to illustrate that the infamous link between

creativity and madness can be traced back in history and is not, as

some presume, a mere Romantic invention. A very non-exclusive list

of examples of artists that suffered from mental disorders includes:

Michelangelo, Ludwig von Beethoven, Virginia Woolf, Sylvia Plath,

Marie Curie, Ernest Hemingway, Vincent van Gogh, Wassily Kandinsky,

Edvard Munch, Hans Christian Andersen, Antonin Artaud and Jonathan

Swift ‒ to name just a few. The range of their respective diseases

is just as varied as their professions. Painter, writer, scientist,

sculptor or musician, all proved to be prone to mental disorders as

varied as addiction to drugs and/or alcohol, schizophrenia,

depression, psychosis, eating disorders or autism. The trope of the

mad genius recurs not only throughout various creative domains and

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history, but globally as well. For example, some Sub-Saharan African

tribes practice ritual dances in order to enhance the community's

creativity. The transcendental state they bring themselves in shows

many similarities with those accounted for in the Dyonisian

Mysteries or, more contemporary, the use of recreational trance-

inducing drugs such as LSD and DMT. This already hints at the fact

that sub-rational states of mind can be intentionally provoked in

order to tap into concealed creativity.

The second part of my paper explores why artists themselves

are responsible for establishing and confirming the link between

their creativity and madness. I will offer an overview of how the

myth of the mad genius evolved historically. Various historical

periods and their societies interpret the trope differently and all

of these connotations influence the way we think about madness and

creativity today. I believe it is interesting to chart this

evolution and notice how different cultural paradigms enable artists

to make creative use of their illnesses, as well as how this

paradigm influences the reception of art. I will limit myself to

three distinct historical periods, namely Classical Antiquity,

Romanticism and Modernism, before discussing how the connection

between mental illness and creativity is perceived nowadays. I will

discuss each of these periods by means of one or more artists who

represent and illustrate the dominant view. The final part of my

paper, the analysis of Kane's 4.48 Psychosis, illustrates the

contemporary view on creativity and madness ‒ a view largely defined

by the pharmaceutical industry.

Two recent examples published in the Belgian press prove that

the concept of the mad genius continues to fascinate and inspire

both scientists and artists. The first example is concerned with a

research conducted at the KULeuven. Main author Rebecca Chamberlain

explained their findings to the BBC: comparing a group of art

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students with a test group of non-artists, the former were found to

have significantly more neural matter in a part of the brain called

the precuneus, located in the parietal lobe (Hogenboom). This part

is associated with strong visual competence and fine motor skills.

In the third part of this paper, I will elaborate on science's

investigations into brain processes and creativity and explain how

these compare to mental dysfunction.

Another example focuses on the interest in madness coming from

a field of art itself, namely literature. For the 2015 edition of

the Boekenweek1, the organisation chose madness as its central topic

because 'literature is filled with fascinating characters that

deviate from the norm' (boek.be, my translation). Flemish author

Dimitri Verhulst will write an entirely new novel that thematises

madness. During the week itself, publishers and bookstores will

foreground the many great novels that feature mentally disturbed

characters, such as Goethe's Werther and Annelies Verbeke's Slaap. The

organisation's choice for madness as its focal point clearly

indicates literature's special affinity with the deviating brain.

Not only do many famous writers suffer from mental instability,

fictional characters do too.

The fourth and final part of my paper explores madness in

literature by looking at 4.48 Psychosis by British playwright Sarah

Kane. I will begin this chapter with an introduction to Kane's work

and mental history in order to contextualise the play. I will then

look at how madness manifests itself in the text. How does Kane

represent the contents of the mind aesthetically? Which recurrent

1 The Boekenweek (Book week) is an annual event taking place in both Belgiumand the Netherlands. One week in March is dedicated to literary (non) fiction centered around a specific topic. Bookstores exhibit older and new publications that focus on that theme; one Flemish or Dutch author is chosen to write an entirely new book around the theme, which will then be handed out for free to every customer who buys €12,50 worth of books duringthat week; and a Book Ball is organised for readers and writers alike to celebrate literature.3

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motifs and formal innovations does she use to thematise psychosis?

Is it possible to distinguish psychotic from aesthetic power? Does

she consciously use her madness as inspiration in the writing

process? Furthermore, I ask myself if it is correct (or even useful)

to read 4.48 Psychosis autobiographically, i.e. as a concealed suicide

note.

2. Inspiration and the Myth of the Mad Genius

2.1. The Madness of the Muses

Plato reflected and wrote extensively on inspiration as the

requirement for great art. Like most of his contemporaries, he

believed inspiration to have divine origins:

Poets do not create from knowledge but on the basis of certain

natural talents and guided by divine inspiration, just like seers and

the singers of oracles. [...] There is a form of possession and madness,

caused by the muses, that seizes a tender and untouched soul and

inspires and stimulates it (qtd. in Feyerabend 700).

Plato attributes no special power to poets, except from them being

touched by the 'madness of the muses'. He agrees that they might

have 'special talents', yet these alone do not suffice without

divine intervention. This intervention is usually considered the

break-through moment we generally call inspiration. By insisting on

art as the result of a divine intervention, Plato implicitly suggest

that 'building a work of art contains an element that goes beyond

skill, technical knowledge, and talent' (Feyerabend 701) at best, or

that artists function as nothing but an instrument to the gods at

worst. In any case, artists are secondary in the creative process.

The Greeks (and the Romans, too) believed that 'poetry was first

born and bred in heaven and was then bestowed upon mortals to

sweeten their brief and stern existence' (Sperduti 213). This aligns

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with the mythological belief in gods being able to possess humans

and speak through them. The muses, then, are those goddesses

responsible for the creation of literature, science and the arts.

When they whisper into the poet's ear, the poet enters a state of

divine insight and creative potential. He or she must immediately

transform the muse's mellifluous voice into the language of human

kind. Because of the uninhibited state associated with flashes of

inspiration, the ancient Greeks attributed many abnormal states of

mind to divine possession. Fever, trance, inebriation were all seen

as signals of divine possession and, as such, potentially creative.

Although we no longer believe in the existence of muses and

gods as crucial in the creative process, we still carry traces of

the mythological conception of creativity in our language.

Archimedes' 'Eureka!' found its way to common speech to denote that

moment of pure, practically divine, insight. The word inspiration

literally denotes a spirit entering 'in' the artist. Sculptors,

painters and poets flatter their models by calling them their muse.

Not only in Ancient Greece did the notion of divine inspiration and

accompanying 'madness' prevail. Mythological explanations for the

frenzied state of creativity occur globally. The word 'genius' shows

etymological relations to the Arabian concept of the jinn or genie.

In Old Norse, othr meant 'poetry' as well as 'mad, frenzied'

(Sperduti 217).

2.2. Secularised Inspiration: the Cult of the I

Like in Ancient Greece, art in the Middle Ages2 was inextricably

connected with divinity. Christianity, with its one true God,

replaced the pagan polytheism, but art was still if not inspired,

then at least dedicated to divine creation. This changed

dramatically at the end of the 18th century. After the

Enlightenment, the I-centered cult of Romanticism conquered western 2 From now on I will limit my scope of reference to the western world.5

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Europe. Romanticism marked a shift from inspiration deriving from

external, i.e. divine, sources to an idea of inspiration that was to

be found entirely within the soul of the artist himself. Because of

this inward turn, individual feeling reigned supreme. Artists prided

themselves on their eccentricity as the source of creative

originality ‒ originality being the prime virtue distinguishing

great art from mere craftsmanship. Originality could only be reached

by tapping into those uninhibited states of mind that one had come

to associate with madness, dreams and drug-like trances. For

example, Samuel Taylor Coleridge allegedly conceived one of his most

famous poems, Kubla Kahn, during an afternoon slumber. The resulting

product is said to be a direct transcription of the lines and

phrases that came to him during his nap. His vivid vision might,

however, have had something to do with his heavy addiction to opium.

During Romanticism, opium often seemed the perfect solution for

the desire to reach that uninhibited mental state of heightened

awareness, one where originality and creativity could thrive. De

Quincey, Baudelaire, Coleridge and Keats all testified to the use of

opium in their work.3

Artists themselves partially encouraged their own mythification.

Reasons for perpetuating the myth of the mad genius are varied.

Often, it locates the artist in a realm unattainable for the

ordinary man. Their vision moves beyond what is common and, as such,

makes a claim to originality, superiority and sometimes even

divinity. In that sense, the Romantic and mythological 'mad artists'

have a motivation in common. If unable to reach that superior state

of mind by themselves, artists sometimes resort to drugs, alcohol or

other mind-altering substances to help them transcend the limits of

3 For a more detailed account of the effect of opium on literature during the nineteenth century, see Alethea Hayter's book on the topic: Opium and the Romantic Imagination (1968).6

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ordinary thought.

2.3. Pyschoanalysis and Artistic Explorations of the Self

In some sense, Modernism continued and perhaps even intensified

Romanticism's obsession with the self. In a rapidly changing

society, in which industrial development changed the appearance of

their world, society delved into their own personalities. With the

rise of psychoanalysis, psychological interest in the hidden realms

of the self peaked. In such a cultural climate, abnormal minds

become the object of not only (semi-)scientific research, but of

artistic research as well. Instead of glamorizing their mental

illness, like the Romantics did, modern artists struggled to make it

comprehensible for themselves. Through intense self-exploration and

introspection, they tried to identify the role madness played in

their creative process. Impressionist and expressionist artists

depicted the world as they saw it through their eyes, coloured with

their emotions and manipulated by their former experiences. In

literature, writers developed a strategy aimed at depicting

consciousness as realistically as possible: stream-of-consciousness.

Virginia Woolf's life and work beautifully illustrates the

modern zeitgeist. Her letters, diaries and novels are all concerned

with the profound exploration of the consciousness. Suffering from

manic-depressive disorder herself, she continuously questioned her

mind, perception and sense of self. This happened at a time when the

medical world often dismissed psychopathological illnesses as

'neurosis' or interpreted them in a Freudian way as manifestations

of suppressed trauma and/or desire. Both views are highly

patriarchal and typical of the Victorian age, in which sanity was

seen as conformation to the norms. Limits to who and what you could

be were especially imposed on women. Woolf's first therapist, George

Savage, considered his female patient to be susceptible to nerve

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weakness. He explained mental illness in terms of 'a defect in moral

character' (Caramagno 11).

Dissatisfied with the moralizing one-sided diagnoses, Woolf

ridiculed her therapists. She continued to explore the intricacies

of her illness through writing and readily acknowledged the effect

the illness had on her work:

As an experience, madness is terrific I can assure you, and not to be

sniffed at; and in its lava I still find most of the things I write about.

It shoots out of one everything shaped, final, not in mere driblets as

sanity does. And the six months ‒ not three ‒ that I lay in bed

taught me a good deal about what is called oneself (Letters 4, 180).

She extended her explorations of the 'self' in much of her fiction.

The reason her work is often seen as obscure, puzzling and

complicated might be because her characters have minds just as

erratic as her own. Through fiction, Woolf explored how

consciousness manifests itself. In this process she left no

idiosyncrasies out in favour of simplicity or at-hand explanations.

The Waves, for instance, captures six voices that interweave as if

they were part of one larger consciousness. We will see this concept

of different voices forming one self reoccur in Kane's 4.48 Psychosis.

Virginia Woolf's tragic end ‒ she drowned herself in the Ouse

river ‒ illustrates another, perhaps more morbid, aspect of the

cultural association of creativity with madness. Many artists

receive a boost in popularity after committing suicide. Writers

Sylvia Plath, Anne Sexton and ‒ more recently ‒ David Foster Wallace

are known among the general public for, first and foremost, their

suicide. The music and lyrics of Nirvana and Joy Division are

similarly interpreted in the light of their lead singers' death.

Self-inflicted death imbues the artists' work with a new, dark,

dimension which appeals critics and readers alike ‒ as if suicide

were an unmistakable sign for intellectual depth. Similarly, the

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work of Sarah Kane received much more serious critical attention

after her death than before.

2.4. The Pharmaceutical Turn

With the first publication of the DSM (Diagnostic and Statistical Manual for

Mental Disorders) in 1952 the world of mental illness underwent a

drastic change. The manual inaugurated a time in which disorder

could be neatly classified according to a list of symptoms: the

doctor checked off the symptoms present in the patient and could

thus accurately diagnose him or her. Accompanying each disorder is

another list of probable causes, which can then be treated by either

therapy or medication. As science finds more and more evidence for

chemical deficits and neurological short circuits being at the root

of the disorder, the tendency is to prefer treatment by medication

rather than therapy. In Belgium, the amount of prescribed anti-

depressants doubled over the last ten years (gezondheid.be).

The problem with the 'empirical' method of the DSM is that a

patient is reduced to his or her (often superficial) symptoms, while

mental disorders are in fact often the result of a combination of

genetic, social, psychological and neurological factors. The DSM

continues to be developed ‒ edition five was published in 2013 ‒ but

this fundamental problem remains. Critics also claim that the DSM

encourages medicalization and disease mongering. They assert that

psychotherapists and pharmaceutical companies reap the largest

profits from its existence, rather than the patients.

This objectifying of disorders into a neat list of symptoms and

accompanying medication led many artists to take on a distant or

critical approach towards their illness. Mental instability no

longer has a mythical status. Rather than glorifying it or taking it

as a starting point for introspection, this new generation speaks

openly about the mundane terror an illness, addiction or psychotic

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episode has on their lives. Stephen Fry's documentary The Secret Life of a

Manic-Depressive explores the effect his illness has on himself and on

other people like him. It shows, quite literally, the highs and lows

of the disorder and raises awareness without the sufferers being

portrayed as neither heroic nor tragic. Writer Charles Bukowski

writes similarly about his alcohol addiction and depression, often

with the added bonus of distanced sarcasm. 'Some people never go

crazy. What truly horrible lives they must lead', he wittily

remarks. In 'Love is a Dog From Hell' (1977) he poignantly analyses

the disease of our time: we live in a society handicapped by the

desire to perform and the inevitable loneliness that comes with this

rat-race. To cure this loneliness, people reach for drink or drugs,

as Bukowski's own life contests.

3. The Scientific Side of Things

The ubiquity of madness among artists shows that the link between

creativity and insanity is not just a myth perpetuated by the

artists themselves. There does seem to be a neural connection to be

found. Recent scientific research continues to expound the

connection.

One of the most extensive studies on the topic was conducted

two years ago, in 2012, by researchers at the Karolinska Institutet

in Stockholm, Sweden. The study encompassed more than 1.2 million

psychiatric patients and their relatives (up to second-cousin level)

as well as an equal number of healthy control subjects. It took

place over 40 years. The researchers investigated which parts of the

brain are involved in divergent thinking by asking the subjects

open-ended questions and comparing the originality of the answers

while simultaneously scanning the subjects' brains. They found that

the thalamus in both groups had a smaller density of dopamine

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receptors. Dopamine functions as a neurotransmitter and filters

information to the hypothalamus. The less dopamine receptors are

present, the more freely information flows to the interpretative

part of the brain. This could explain why both schizophrenic and

creative people make associations that normal people do not

necessarily think of. The difference was that the latter category's

answers were both novel and meaningful, whereas the schizophrenics

often responded in a downright bizarre, disturbing or even morbid

manner.

Analysing different creative professions and a variety of

mental illnesses, the researchers concluded that mental illness was

especially prevalent among writers. In fact, writers with an illness

were fifty percent more likely to commit suicide compared to the

other test subjects. The researchers also found that creativity is

likely to occur in families with a history of mental illness.

However: the psychotic and the creative subject in those families

did not coincide. Severe mental illness impedes rather than enables

the creative process.

Arthur Rothenberg puts a similar thesis forward: creative processes,

he claims, are innately healthy whereas psychotic ones are not. As

such, art that has its origins in psychosis might be interesting or

helpful for psychiatric therapy, it does, however, not provide

meaningful art. An artist might very well shift between episodes of

creativity and psychosis, but it are only the former that produce

great work (12). In other words: there is a valid distinction

between mental illness and mental 'skillness', even though they can

be part of the same continuum. Furthermore, Rothenberg says that

'the creative process always results from direct, intense, and

intentional effort on the creator's part' (9). He does not exclude

the possibility of flashes of insight that serve as inspiration, but

these flashes do not become art unless the creator actively develops11

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the idea.

In his book Creativity and Madness: New Findings and Old Stereotypes (1990),

Rothenberg distinguishes two types of cognition that play a role in

the creative process. The first one, the janusian process, refers to

the way an artist conceives of two, seemingly antithetical, concepts

or ideas as being simultaneously true or equally operative. This

paradoxical relation creates 'conflict, irony, tragic tension, and

aesthetic ambiguity' (16) in the work of art ‒ exactly those

elements that make great art intriguing. The janusian process occurs

in the initial stages of creativity and is as such responsible for

the generation of novel and original ideas.

The second type of cognition that Rothenberg distinguishes is

an elaboration on the janusian process. The artist articulates the

janusian concept, i.e. the merging of two antithetical concepts, in

a new consolidated entity. He does this through something Rothenberg

calls 'the homospatial process' (25). Derived from Latin,

homospatial roughly translates as 'occupying the same space'. The

abstract concepts conceived in the janusian stage are unified in

spatial terms. The artist visualises the separate concepts as

spatially intertwined, which in literature leads to the formulation

of metaphors. Rothenberg states that 'metaphorization is a prime

element in poetic creation, and it is also a crucial aspect of other

types of creation as well ‒ both artistic and scientific' (27).

Indeed, through metaphors the artist creates interpretative depth,

which adds to the artwork's value. The combination of the janusian

and homospatial process leads to the production of creative ideas.

To summarize: The janusian process serves to bring together specific interrelated

elements out of the relatively diffuse substratum of experience and

knowledge; elements that are opposite or antithetical, rather than only

divergent or unrelated, are crystallized and juxtaposed. [...] The

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homospatial process, when operating in conjunction with the janusian

one, serves at first to blur and change the contours of the specific

interrelated elements [...] in the janusian formulation by placing them in

the same space. [...] The resulting creation is an integrated unity in

which the discrete elements are still discernible and still generate

some degree of tension (33).

The janusian and homospatial process are thought patterns typical of

creative people. Both processes are translogical, i.e. they

transcend ordinary logical cognition (12). In this sense, they show

similarities to psychotic modes of thinking. In the next paragraph I

will link the healthy, creative cognition of the janusian and

homospatial to types of cognition associated with psychosis.

On the surface, the janusian process closely resembles what

psychiatrists call 'primary process cognition'. This type of

thinking is, like the janusian, characterised by an absence of

paradoxes. Two opposite ideas co-exist and 'may be substituted for

each other' (22). However, unlike the creative person, the psychotic

patient is often not aware of the irrationality of his/her thoughts.

He or she experiences them as true, whereas the creative person

realises their paradoxical nature and foresees the creative

potential of the contradictory formulation.

The homospatial process, too, has a psychopathological

counterpart: overinclusive thinking. This type of cognition consists

of unifying things as all belonging together. The homospatial

process limits itself to the janusian concepts, but with

overinclusive thinking the subject connects everything and everyone

and, like with the primary process, he or she is unable to

distinguish between what is real and what is a figment of the

imagination. Exaggerated overinclusive thinking may lead to

paranoia, superstition and the articulation of conspiracy theories.

This final point marks the most important distinction between

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creative and psychopathological thinking: during the former,

intellectual and emotional energy is aimed externally, i.e. at the

production of a work of art. Psychopathological thinking, however,

is directed only inwards: it serves as a coping mechanism. This

impedes the subject to conceive of the world as something

independent from him or her (35-36). Ultimately, the janusian and

homospatial thought processes are considered healthy and productive,

whereas primary process cognition and overinclusive thinking are the

opposite. Nevertheless, to conceive of two sides of a paradox as

equally true and occupying the same space generates considerable

mental strain. In this sense, the creative cognition might enhance

an artist's disposition to mental illness.

While it is true that many artists draw inspiration seemingly out of

nowhere, from their dreams (or dream-like trances) and psychotic

phases, it is incorrect to equate that flash of inspiration with the

entire creative process. Most art requires planning (which lays the

foundations for inspiration to strike, in which all the pieces of

the puzzle fall together), intensive elaboration and meticulous

editing. In other words: Artists are professionals. A work of art

never comes to its full fruition without the artist's intention to

be creative. Inspiration alone never accounts for the entire

finished product.

4. Sarah Kane and 4.48 Psychosis

4.1. Sarah Kane

Sarah Kane studied drama at the universities of Bristol and

Birmingham. Dissatisfied with the uninspired state of the

contemporary scene, she began writing her own plays. Although her

plays did not reach a large audience in England itself (where the

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audience was used to realistic text-based theatre), they were staged

all over Europe. As a literary associate at Bush Theatre and writer-

in-residence at Paines Plough, however, she had enough of a platform

to make her innovative voice heard and stir up the complacent

British theatre world. Nevertheless, her career was cut short at the

age of twenty-eight when she committed suicide.

Sarah Kane, despite her short career, remains a famous (if not

notorious) voice in the British theatre landscape of the late

nineties. Her first play, Blasted (1995), was infamously described by

a Daily Mail critic Jack Tinker as 'this disgusting piece of filth'.4

Kane was quickly labelled as the enfant terrible of British theatre. She

was at the forefront of the so-called In Yer Face Theatre, a

'school' of loosely associated playwrights who sought to break with

the naturalistic and traditional character of English theatre at the

time. Throughout her career, Kane continuously pushes theatre to its

edges. Her plays disrupt traditional narrative, make use of

impossible stage directions ('the rat begins to eat Carl's right

hand', Cleansed 130) or no stage directions at all, are rife with

sexual and physical violence and deal with themes such as desire,

pain, emotional abuse and death. The influence of her depression is

palpable in the darkness and brutality of her work. Furthermore,

her plays can be read as intricate explorations of the fragility of

the human self ‒ an existential issue she clearly struggled with

herself. Throughout her career, this focus on the self becomes more

and more apparent. Whereas Blasted still contains hints of an extra-

literary context (a hotel room in Leeds, the war in Bosnia), the

architecture of her final play, 4.48 Psychosis, is entirely that of the

mind.

4 Kane got back at him by naming one of the characters in Cleansed after Tinker. Tinker plays the sadistic doctor/drug dealer at the campus in whichthe play is set.15

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4.2. 4.48 Psychosis

With 4.48 Psychosis, Kane elaborates on the experimental voice she

started in Crave. The characters from Crave are named by initials

only: A, B, C and M. No further indications of gender, social or

political identity are given. The characters speak about love in all

its forms: friendship, family, lust, desire, care. Simultaneously,

the play thematises how love disrupts the continuity and coherency

of the self. In the theatrical production of the text, the four

voices were interpreted as belonging to one person: 'four different

bodies occupying one life [...] combine to evoke the powerful sense

of a self fragmented' (Greig xiv). The fragmentation of the self is

a theme that Kane tackles in all her pieces, but by the end of her

career it becomes clear that this is not a mere artistic obsession,

but a personal one as well. In Crave, Kane already smuggles

elliptical references into the text that refer to autobiographical

events (ibid.). 4.48 Psychosis is an even more deliberate exploration of

the self, of her-self5: the title refers to the time Kane used to

wake up during the night and have her most intense psychotic

episodes. The text is written as if it were a direct transcription

of her psychotic mind: '[...] my mind is the subject of these

bewildered fragments' (210), Kane writes. Grammatically,

stylistically and visually the text erupts from the boundaries of

language, just as the contents of the mad mind stray away from what

is considered the sane, healthy and socially accepted brain.

The play itself is structured as an internal dialogue between

different selves. This internal dialogue should not be comprehended

as a sign of illness. Although mental illnesses such as psychosis

and schizophrenia are indeed often characterised by delusions and/or

talking to oneself, Friedrich Schlegel argues that mental dualism is

5 For convenience's sake, I will equate the I-narrator with the voice of Sarah Kane. 16

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the foundation of every thinking process (The Philosophy of Language). In

other words: thinking, healthy or not, is always a kind of dialogue.

The dramatic quality of internal dialogue lends itself perfectly to

the structure of a play ‒ something Kane was well aware of. The play

thrives on a tension between the different selves as each

alternately claims authority within the mind.

In Psychology: A Briefer Course (1892), William James considers the

difficulty of defining the identity of the self. He describes the

self as constituted out of three Me's. The first one, the material

Me, comprises the body and the clothes we use to present our bodies

to the world. To a lesser extent, family and your home (property)

also belong to the realm of the material Me. The social Me, the

second category, relates to the recognition you receive from people

around you. This implies that one person is likely to have several

social selves, depending on who he or she interacts with. The

perception others have of you makes up a good deal of how you

perceive yourself and, as such, plays an important role in identity

construction. The most fragile social self is the image the one you

are in love with has of you: 'To his own consciousness he is not, so

long as this particular social self fails to get recognition' (James

180). In other words: without reciprocal love, one is apt to

conceive of him-/herself as nothing. The third and final constituent

of the self James describes is the spiritual Me. 'Spiritual' should

in this context not be understood as religious or ideological, but

rather as self-awareness. The spiritual Me entails 'the entire

collection of my states of consciousness, my psychic faculties and

dispositions taken concretely' (181). As such, the spiritual me is

metaphysical insofar it is concerned with thinking about yourself

and being aware of your own mind's contents and processes. For the

rest of my analysis, I will make use of William James' division of

selves into material, social and spiritual self and relate these to

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the motifs of 4.48 Psychosis. I do not mean to disregard the influence

Kane's severe depression had on her life and work. However, with my

analysis I would like to contribute to the creative aspect of Kane's

final piece. I hope to show that 4.48 Psychosis is more than the verbal

vomit of a psychiatric patient, but instead an artistic and

articulate rendering of the condition humaine.

4.2.1. Body versus Soul: The Limits of the Material Me

The central opposition in the play's internal dialogue is that of

the body versus the mind (soul). This dialectical relation shows a

close resemblance to the concepts as conceived by the janusian

process. Both the body and the mind are equally operative for Kane

and each asserts its presence in the text. The next step in creative

thinking would then be the merging of the two antitheses into a

unified structure. However, rather than this being a constructive

process, the I-voice of 4.48 resorts to destruction. First, she shaves

off her hair. This drastic transformation can be interpreted as a

first attempt to make her appearance match with her thoughts: the

shaved off head as a metaphor for the emptiness inside. Furthermore,

the I-voice resorts to self-mutilation as a coping mechanism for

division between body and soul. It is as if the desire to cut open

her skin is an attempt to bring body and the inner life closer

together:[...] cutting provides a sense of reintegration, like a jolt of

reality to the vanishes self. The sensation of pain and the sight of blood

break through the deadening depersonalization and prove that the cutter

is alive, human, whole (Singer 165).

A series of paragraphs that read 'wring slash punch slash float

flicker flash punch' concludes with 'beautiful pain / that says I

exist' (232). For Kane, self-mutilation functions as a confirmation

of her existence as a complete, whole human being.

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Heleen De Boever

However, the destructiveness of her coping mechanism inevitably

fails to bring her the homospatial solution she desires. Unable to

bring the paradox to a close through psychotic coping mechanisms,

she is exasperated 'by that smooth psychiatric voice of reason which

tells me there is an objective reality in which my body and mind are

one' (209). She has to conclude; 'body and soul can never be

married' (212) and 'Here am I / and there is my body' (230).

Nevertheless, I believe the insoluble character of the body-

mind division as presented here in 4.48 should not be attributed to

Kane's depression. While her depression might have prompted her to

self-mutilate, the nature of the paradox itself is characteristic of

the whole of Western philosophy. As neuropsychologist Paul Broks

argues,

the mind-body problem, the beast we grapple with today, is a legacy

of the dualist ideas formulated by René Descartes in the seventeenth

century. He was not the first philosopher to distinguish between mind

and body, but he crystallized that distinction and so set the terms of all

subsequent debate about their relationship. In the process he released

a pack of troublesome dichotomies into the Western way of thinking:

mind versus matter; subjective versus objective; observer versus observed'

(137).

This quote illustrates how the mind-body dilemma is not limited to

psychotic patients, but has existential repercussions for everyone

contemplating the nature of the self. If philosophers and

neuropsychologists like Descartes and Broks fail to formulate an

answer to the dichotomy, how is Kane to deal adequately? I feel like

4.48's contemplation on and reaction to the limits of the material

self offers a tragically human perspective on a topic that has

haunted us for centuries.

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Heleen De Boever

4.2.2. You: The Social Me

In Into the Silent Land (2002), Broks states that the 'self [...] can be

thought of as the device we human employ as a means of negotiating

the social environment' (51). Earlier on he specifies that "In any

relationship, each person is partly defined in terms of the other"

(50). In other words, we can consider the Other as 'a guide to self-

definition' (ibid.). What happens, however, in the absence of an

Other? In an interview, Kane noted with reference to Roland Barthes

that 'When you love obsessively, you lose your sense of self. And if

you lose the object of your love, you have no resources to fall back

on. It can completely destroy you' (Kane qtd. in Singer 152). Kane

reiterates exactly this aspect of the social self in 4.48.

Throughout 4.48 Psychosis, the I-voice ventilates her pain caused

by a past lover. This lover remains unspecified. At first she covets

her sleeping lover and 'his induced unconsciousness' (208). Later

on, the I-voice dreads 'the loss of her I've never touched' (218).

Even less specific than these gendered descriptions are the

monologues addressed to 'you'; monologues which burn with pain and

desire: I cannot fucking go on without expressing this terrible so fucking

awful physical aching fucking longing I have for you. And I cannot

believe that I can feel this for you and you feel nothing. Do you feel

nothing? (214)

Fuck you. Fuck you. Fuck you for rejecting me by never being there,

fuck you for making me feel shit about myself, fuck you for bleeding the

fucking love and life out of me [...] but most of all, fuck you God for

making me love a person who does not exist (215).

My love, my love, why have you forsaken me? (219)

Not just the lover, but also the one who loves remains abstract. On

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Heleen De Boever

the opening pages, Kane speaks of a 'broken hermaphrodite who

trusted hermself alone'. Because she can have no social self that is

constructed by the loved one, her identity disintegrates to the

point of blurring gender identification. The rejection of gender

identity further complicates a purely autobiographical reading.

Instead it invites the reader to identify and imbue the angry, hurt

monologues with his or her personal experiences. As such, the motifs

of desire and despair transcend the realm of the autobiographical

and take on a universal dimension.

4.2.3. Self-awareness: The Spiritual Me

The main argument for reading 4.48 Psychosis as more than the blabbering

of a suicidal mind is the profound self-awareness with which the I-

voice discusses her experience with madness. First of all, she is

well-aware of the connection of madness with her art, and how her

personal life will inevitably influence the reception of her work:

'They will love me for that which destroys me [...] the sickness

that breeds in the folds of my mind' (213). This fragment shows that

she realises that her work is susceptible to the myth of the

tortured artist and that she is, perhaps, even willing to succumb to

it if it encourages her creativity. Without her madness she seems

not able to work. It is 'the sickness of becoming great / this

vital need for which I would die' (242). She initially resists

medication because it will interfere with her writing: 'I won't be

able to think. I won't be able to work' (221). The doctor convinces

her and eventually she yields, although only in the most vicious way

possible: 'Okay, let's do it, 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' (ibid.).

The confrontation with the medical world is another motif in

4.48 Psychosis that elevates Kane from the status of mad artist to 21

Heleen De Boever

socially aware critic. The self-awareness of the mental illness

prompts her to seek help ‒ by seeing a psychiatrist, but also by

writing this play. Although the play is rife with many disturbing

images, she also addresses her madness directly and articulately. 'I

beg you to save me from this madness that eats me' (216), she

pleads, and: 'I am so afraid / I'm seeing things / I'm hearing

things' (225). However, despite the pain and the despair of madness

that the play expresses, Kane remains critical of her condition. She

attests the validity of her madness through criticising society's

standards. Who gets to decide what is sane and what is not? She

throws society their hypocrisy in the face: 'Embrace beautiful lies

‒ / the chronic insanity of the sane' (229). 'This is not a world

in which I wish to live' (210) might easily be interpreted as a

suicide note, yet it can also be read as a charge against society's

way of organising people dialectically; the sane versus the insane.

Throughout the text she plays with irony to ridicule the authority

of the doctors and the hospitals. She does this by making use of

intertextual references which, if anything, show her erudition on

the topic of madness and suicide. The ironic, playful

intertextuality6 highlights the objective, or rather: objectifying,

quality of the medical voice and, as such, criticises it.

The play features two list of psychological symptoms. The

first one sums up the feelings of despair, the personal sense of

failure and suicidal intentions: ' I feel that the future is

hopeless and that things cannot improve / I cannot overcome my

loneliness, my fear, my disgust / I am charging towards my death / I

cannot be alone / I cannot be with others / [...]' (206-207). It

reads like a transcript from a session with her therapist, which the

6 Kane explicitly admits to 'literary kleptomania' in her play and claims: 'Theft is the holy act / On a twisted path to expression' (213). It is indeed through copying from medical handbooks that she is able to express such a strong charge against the medical world. 22

Heleen De Boever

latter can use to neatly categorise his patient as suicidal and

depressed. However, Kane's list ends with 'My hips are too big / I

dislike my genitals', which undermines the seriousness and alleged

scientific method of the doctor's check-list.

The list of 'negative symptoms' on page 206-207 is contrasted

somewhat later with a passage listing symptoms of a healthy self-

affiliation. 'to achieve goals and ambition / to increase self-

regard by the successful exercise of talent / to be independent and

act according to desire / to draw close and enjoyably reciprocate

with another / to win affection of desired Other / [...]' (234-236).

Ironically, these symptoms are not a transcript from Kane's personal

experience, but are taken directly from The Suicidal Mind by Edwin

Schneidman (Diedrich 380). This book offers a psychological and

semi-medical guide for anyone dealing with suicidal thoughts or has

a loved one contemplating suicide. The list that Kane copied in her

play seeks to identify symptoms of recovering depression. However,

as Alicia Tycer argues, some of the proposed symptoms might very

well be interpreted as 'certain key needs to suicide attempts' (33).

Items such as 'to achieve difficult goals / to overcome opposition /

to be free of social confinement' acquire a morbid connotation when

read as signs of impending suicide. Tycer summarises: [...] these quotes contribute to the play's critique of a

hierarchical medical system in which the probability that a person will

commit suicide can be charted and rated. Even the comparatively healthy

psyche can identify with frustrations of meeting the listed needs

(34).

Kane further enhances skepticism about the mental health system by

listen the various medicines the doctors try on her. The list of

brand names is nearly as undecipherable as your average GP's

handwriting: Sertraline, Zopiclone, Melleril, Lofepramine,

Citalopram, Fluoxetince hydrochloride, etc. Once again Kane

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Heleen De Boever

concludes the list with an anti-climax. Insensitive to the

chemicals, the patient resorts to '100 aspirin and one bottle of

Bulgarian Cabernet Sauvignon, 1986' (225). The self-medication

results in the waking 'in a pool of vomit' and 'Severe stomach pain.

No other reaction' (ibid.). Once again the list, taken from fancy

medical jargon and juxtaposed with the anti-climactic reality of the

patient has the effect of ridiculing psychiatric care and its

arrogance. Through intertextual references to medical guidebooks,

Kane denounces the system's way of objectifying the patient and

reducing him/her to a series of symptoms that can be treated with

drugs. This political voice in the play is the result of Kane's

social awareness, and not of a delusional psyche.

4.3. Conclusion

4.48 Psychosis explores the grandest of existential questions: life or

death. As such, Kane places herself in a literary tradition

stretching back as far as Shakespeare's Hamlet and Goethe's The Sorrows

of Young Werther, which illustrates that 'to be or not to be' is a

question of all ages and all cultures. It is not at all exclusive to

people suffering from mental illness, but salient to everyone

questioning their own existence. This explains why, despite 4.48

being the staging of a psychotic mind, many aspects of the play have

universal resonance.

In the play, the janusian tension between life and death

imbues every sentence with ambiguity. It perfectly illustrates the

oscillation and inner dualism that characterises the psychotic mind.

Kane's command of language, however, suggests a mind well aware of

its limits and its demons. Phrases like 'I do not want to die [...]

I do not want to live' (207) and 'I have resigned myself to death

this year' (208) read with an urgency that compels the reader.

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Heleen De Boever

Similarly, while at first 4.48 am is the hour 'when desperation

visits / I shall hang myself' (207), she later refuses this claim

and transforms it into 'at 4.48 / when sanity visits [...] Now I am

here I can see myself' (229).

The play might thematise a mind that lost reins, but it is

only because Kane is able to hold a tight rein on the language that

the image she evokes is such a powerful one. The play's ending

illustrates the ambiguity of the janusian opposition between life

and death that is at the centre the play: the last four pages of the

play are increasingly marked by empty spaces, ruptured sentences and

incoherency. The visual fragmentation of language reaches its

momentum in the final page of the play. Sarah Kane ends with three-

fourths of the page blank, and a final sentence aligned right at the

bottom of the page. It suggests the ultimate ending, were it not for

the ambiguous content of that final sentence: 'please open the

curtains'. The opening of the curtains, usually a stage direction

(and as such, it should be typed in italics or between brackets),

appears here as a last plea of the I-speaker to the reader. Its

meta-theatrical dimension questions the self-evident assertions of

critics who read 4.48 Psychosis as nothing more than a suicide note. By

adding a note that traditionally appears at the beginning of the

play at the very end, Kane consciously directs the attention of the

reader to what she just did, namely staging the contents of a

psychotic mind. That it is a staged and not an autobiographical

rendering of that mind becomes clear through that final note. 4.48

Psychosis suggests that creativity is vital for an artist suffering

from mental illness ‒ and not the other way around. Seeing as

creative cognition is an ultimately healthy process, it often offers

the artist an escape from the disturbing contents of his or her

mind. The fact Kane wrote such a compelling piece while under severe

depression is a feat worth applauding. It should also be taken as an

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Heleen De Boever

encouragement for artists and therapists alike to invest in

creativity as a powerful antidote to mental illness.

Works Consulted

"Belg gebruikt teveel psychofarmaca." Gezondheid.be. gezondheid.be, 27/10/2011. Web. 26 May 2014.

Broks, Paul. Into the Silent Land. London: Atlantic Books, 2003.

Bukowski, Charles. Love is a Dog From Hell: Poems, 1974-1977. Santa Barbara, California: Black Sparrow Press, 1977.

Caramagno, Thomas. "Manic-Depressive Psychosis and Critical Approaches to Virginia Woolf's Life and Work." PMLA 103.1 (1988): 10-23.

Diedrich, Antje. "Last in a Long Line of Literary Kleptomaniacs: Intertextuality in Sarah Kane's 4.48 Psychosis." Modern Drama 56.3 (2013): 374-398.

"Dimitri Verhulst schrijft Boekenweekgeschenk 2015." Boek.be. Boek.be, 17 Apr. 2014. Web. 19 Apr. 2014.

Feyerabend, Paul. "Creativity ‒ A Dangerous Myth." Critical Inquiry 13.4 (1987): 700-711.

Gentleman, Amelia. "Playwright Kane kills herself. " The Guardian Online. The Guardian, 23 Feb. 1999. Web.

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Greig, David. Introduction. Complete Plays. By Sarah Kane. London: Methuen, 2001. ix-xviii.

Hayter, Alethea. Opium and the Romantic Imagination. California: University of California Press, 1968.

Hogenboom, Melissa. "Artists have structurally different brains." BBC Online. BBC. 17 Apr. 2014. Web. 19 Apr. 2014.

James, William. Psychology: A Briefer Course. New York: Henry Holt and Company, 1890.

Kane, Sarah. Complete Plays. London: Methuen, 2001.

Karolinska Institutet. "Link between creativity and mental illness confirmed in large-scale Swedish study." ScienceDaily. ScienceDaily, 16 October 2012. Web. 25 Mar. 2014.

Kyaga, Simon, et al. "Mental Illness, Suicide And Creativity: 40-Year Prospective Total Population Study." Journal Of Psychiatric Research 47.1 (2013): 83-90. MEDLINE. Web. 25 Mar. 2014.

Rothenberg, Albert. Creativity and Madness: New Findings and Old Stereotypes. Baltimore and London: Johns Hopkins University Press, 1990.

Schlegel, Friedrich. 'The Philosophy of Language', 1829. Course packet.

Singer, Annabelle. "Don't Want to Be This: The Elusive Sarah Kane." TDR 48.2 (2004): 139-171.

Sperduti, Alice. "The Divine Nature of Poetry in Antiquity." Translations and Proceedings of the American Philological Association 81 (1950):209-240.

Tycer, Alicia. "Victim. Perpetrator. Bystander: Melancholic Witnessing of Sarah Kane's "4.48 Psychosis". Theatre Journal 60.1 (2008): 23-36.

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