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This operatic adaptation of 4.48 Psychosis is as magnificent as it is ugly

Adapted for the opera in 2016 by composer Philip Venables, the Lyric Hammersmiths new production of Sarah Kanes last play is a work of magnificent, reverberating ugliness. Often reduced to a suicide note – Kane killed herself a year and a half before its first performance in 2000 – the play is an exploration of severe depression and dissociation which combines Beckettian formlessness with acidic portrayals of psychiatric care.

The opera addresses and elaborates upon these difficult textures beautifully. Six performers, each wearing the same shapeless grey cardy and faded jeans, alternately serve as doctors, patients or loved ones, or something more formless: spectres, tendencies, projections. At intervals theres the suggestion of a scene, a busy waiting room or a lonely apartment. Often, there is only a vortex of phantoms, a mind tearing at itself.

Singers roam disconsolately as lyrics are projected onto a clinical white set, sometimes embracing and leading one another, sometimes seizing and choking each other off. There are moments of relative lightness, but gravity soon kicks back in. An opening reassurance “but you do have friends” is cruelly transformed into “what do you offer your friends to make them so supportive?” A later sequence takes the form of a self-destructing self-help mantra, optimism tipping over into mania as the orchestra shifts relentlessly into a higher key.

The score is wondrous, abhorrent and enveloping. It bangs together traditions, instruments and makeshift effects, from the cosseting banality of lobby muzak to the demonic energy of a circus organ. It is also firmly of a piece with the writing. There is no sense of a text forced to serve the needs of a different form, though, partly because in reaching for the intangible, Kanes script already aspires to the condition of music.

Among the more brilliant decisions is to reframe conversations with a doctor as an exchange of percussion. Questions are tapped out with a ball hammer, syllable by piercing syllable, setting the teeth on edge. Answers are summed up by the doleful thump of a fist on a drum.

Howls of pain such as 4:48 Psychosis are often patronisingly held up as "socially useful" art, and Kanes play has only grown more relevant with age, as the UKs public services struggle to defuse a looming mental health crisis. This isnt, however, a play that seeks to instruct or uplift, beyond conveying the suffering depressive people often hide – indeed, it occasionally pleads with its audience to look away. As one of the scripts voices declares towards the finale: “I hope you never understand, because I like you.”

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