4.48 Psychosis was written throughout the autumn and winter of 1998/99. On 20th February 1999, Kane committed suicide.

For a period of her depression, Kane had found herself awoken, every morning, at 4.48 a.m. She took this moment, the darkest hour, just before dawn, and found in it a moment of great clarity, a moment when the confusions of psychosis seem to evaporate. The paradox in the play is that the moment of clarity in the psychotic mind is, to those outside it, the moment when delusion is at its strongest.

4.48 Psychosis sees the ultimate narrowing of Kane’s focus in her work. The struggle of the self to remain intact has moved from civil war, into the family, into the couple, into the individual and finally into the theatre of psychosis: the mind itself. `And my mind is the subject of these bewildered fragments,’ the play’s voice states.

4.48 Psychosis is a report form a region of the mind that most of us hope never to visit but from which many people cannot escape. Those trapped there are normally rendered voiceless by their condition. That the play was written whilst suffering from depression, which is a destructive rather than a creative condition, was an act of generosity by the author. That the play is artistically successful is positively heroic.

David Grieg (from Introduction to Sarah Kane, Complete Plays)