Tag Archives: Science

“The Effect” by Lucy Prebble

at the Cottesloe Theatre, Wednesday 19th December 2012

Anyone who knows me will know that I’m a bit of a science fanatic. If there’s any topic which is likely to come up in a conversation with me other than theatre, it’s likely to be quantum physics, the cosmos or the like. Lucy Prebble’s The Effect, therefore, satisfies both these passions of mine, indulging each to excess and leaving me giddy with possibility. Along with director Rupert Goold, she questions the way in which we conduct clinical trials whilst probing the very notion of depression. If Three Kingdoms was my favourite production of 2012, then The Effect is without doubt my favourite play.

The play is essentially a dramatised amalgam of Ben Goldacre’s Bad Science/Pharma and Adam Curtis’ The Trap, involving two young people (Tristan and Connie) involved in a drugs trial for a new anti-depressant which increases dopamine levels in the brain. They fall in love, though its not quite clear whether this is due to the drug or their natural urges. In a beautiful scene, they escape the confines of the trial, heading to a disused asylum to question their attraction to one another; if they’re only falling in love because of the drug, does this make their feelings towards one another any less ‘real’, or is it just the same, seeing as what we call ‘love’ is only really a release of chemicals in the brain and around the body anyway.

If you haven’t seen the play yet and don’t want it spoiled, skip this paragraph; I’m about to set out the rest of the narrative, as I feel it’s important to a discussion of the ideas of the play. It transpires, towards the end of the first act that one of them is on a placebo, acting as a control patient for the trial. At the beginning of act two, Connie finds out this is Tristan, instantly making her question her feelings towards him and cementing her belief that he genuinely has feelings for her. About a scene later, however, Toby, the overseer of the trial, tells Dr Lorna James, the clinical psychiatrist conducting it that in actual fact she is the one being tested for practitioner bias and that Tristan is indeed on the drug after all. She was told about the placebo so they could see if it would change her behaviour. Connie, however, believing Tristan is not on the drug, slips him another dosage, causing him to seizure and lose his memory. During the last few scenes of the play, we see Lorna in a state of deep depression and Tristan being looked after by Connie after undergoing complete loss of memory.

Prebble’s text is extraordinary. She manages to explain all the central ideas and scientific concepts of the play without ever using exposition and creates some gloriously intricate scenes, like the one in the asylum and the final scenes between Connie and Tristan which move from day to day in a similar fashion to Duncan Macmillan’s Lungs. The discussion between Lorna and Toby about the nature of depression – whether it is a curable disease or simply a fact of life which has been exploited for financial gain – says more about this debate than many experts have in countless books.

Broadly, the questions raised by the script about clinical trials and depression are embodied by the design and performances respectively.

Miram Buether’s design immediately unnerves and unsettles. Walking into the pit of the Cottesloe, we are surrounded by lime green; it’s on the walls (which are padded, by the way), on our upholstered seats (the most comfortable I’ve sat on during a play) and on the plush carpet floor, which also has a frame of red. Bright, institutionalised strip lights on the floor and ceiling are countered with the dim, homely lamps surrounding us. Opposite us and to the sides are more ‘patients’ and the performances happen in the middle. Jon Driscoll’s projections appear on the floor and on the walls, shifting focus. Sometimes, Jon Clark’s lighting is so dim we can only see outlines and Sarah Angliss’ music is imperceptible enough to make us wonder if it is a figment of the imagination.

The immediate question the design raises is this: how is any kind of reputable, scientific trial which is supposed to benefit humanity able to occur here? It’s comfortable enough, but when measuring dopamine, a chemical which can affect who we are, surely the surrounding should be a little more, well, human. Prebble asks questions about confirmation bias (when the practitioner sees what they want to see based on hypotheses) and Buether’s set suggests that with as blank a canvas as this it’s no surprise any interpretation can be found to suit the sponsor’s needs. The many images of scanned brains, graphs and grids nod towards the neurobabble the production is taking a swipe at, suggesting we be more critical next time we read about fMRI scanners.

Goold’s direction mingles with the design to link the two themes of trials and depression. Often the stage becomes a split screen (at one point we can even see the seam), so that two similar scenes happen simultaneously, enforcing the contracting methods and ideas. After Tristan and Connie have been separated, they move around Dr James to ask her many questions about the other, mirroring one another’s movements and following the same contours in their conversation. Placebo is placed in opposition with drug, health with illness, depression with ‘normality’.

The most interesting argument in the piece comes from that final point, and its the one which will get the most people talking and spark the most debate. After hearing Curtis’ thoughts on depression, his belief that it is a normal fact of modern life (at any one time one in five of suffers from mental health problems) which pharmaceutical companies have capitalised on is hard to shake. Prebble addition to this that mild- to mid- ‘depression’ causes the person effected to see the world and its problems more clearly suggests that it is actually are view of normality which is problematic.

Tom Goodman-Hill (Toby) and Anastasia Hille (Lorna) embody the opposing viewpoints perfectly, and both seem equally plausible. Though Toby has an incentive to peddle antidepressants, his research does seem to be thorough and the suggestion that depression will be curable in the future is extremely engaging, whilst Lorna’s arguably more progressive response is problematised by her own issues. Their best moments come during mirroring scenes, when lecturing the audience on the nature of the brain; Goodman-Hill is authoritative and enlightening, whilst Hille in her act two scene breaks down in an uncontrollable sadness. Her performance throughout is, consistently, utterly believable.

As the patients, Jonjo O’Neill and Billie Piper are exquisitely matched and each show both physical and mental change due to the events of the play. O’Neill’s happy-go-lucky Irish charm is refreshing, making his final scenes all the more heartbreaking, and Piper grows as an individual even though she ends up arguably less ‘happy’ than she was. But have these changes in their personality been caused by chemical shifts or are they effects of their surroundings?

The very fact that Goold and Prebble chose to stage a play which tackles neuroscience and confirmation bias is commendable enough in itself. That The Effect is a resounding success is therefore worthy of utter admiration. It is a play which – appropriately – lodges itself deep within the brain and alters the way things are ordered and perceived. These debates have been going for years and will continue for a long time to come, but by placing them on a National Theatre stage they should begin to enter the public consciousness. As things stand, too many decisions are being made by too few people; with regards to such a moral question which effects people’s lives, however, the more of us educated about and involved in the debate the better.