Randa Tawil, Brian Hemmingsen, Stacy Whittle, Lisa Hodsoll, Sara Barker, David Lamont Wilson, Cesar Guadamuz, Karin Rosnizeck, Mary Suib, and Julie Roundtree in 4.48 Psychosis. Photo by Marc Anthony.

It’s unlikely you’ve had a theater going experience in recent memory as uncomfortable as Sarah Kane’s 4.48 Psychosis. That might be a problem if it wasn’t also likely one of the most rewarding. The play is the final one ever written by Kane, a British playwright who battled crippling depression for much of her short life, and committed suicide at the age of 28 after this work was completed.

Kane’s text lacks stage directions or character delineations. It is less a dramatic work than a fevered brain-dump of the contents of a deeply depressed mind, the late night stream of consciousness of a young woman talking frankly about her impending suicide and the failure of family, friends, or modern medicine to fix whatever is wrong with her.

In other words, it feels not unlike a suicide note.

The lack of structure imposed by the writer allows any company a great deal of leeway in how the material is approached. It has been performed by varying numbers of actors, and the current production, the inaugural one by the brand new, artist-run Factory 449 company, employs ten, expanding on the cast of six that presented it at this year’s Capital Fringe Festival (where it won top festival honors for Best Drama and Best Overall Production). Director John Moletress arrays his cast standing on chairs, each lit from above with harsh hanging lights that cast exaggerated and frightening shadows on their faces. The subject matter is horrific, so Moletress and lighting designer Eric Grims quite effectively present it as horror, aided by sound design and compositions from Ryan Keebaugh that strike eerie chords and chimes, or the tension-building amplified hum of fluorescent lights. This is all augmented by more than a dozen television screens, playing disturbing news clips, anti-depressant pharmaceutical commercials, or short film clips made with the cast themselves.