Philip Venables is certainly not one to choose the lighter themes on offer. Sexuality and violence are frequent concerns in his work, which rarely stays within the confines of music, instead often including text in various forms, image or movement, in order to address the topics Venables is drawn to. With 4.48 Psychosis, the first musical adaptation of the eponymous play by Sarah Kane, which is the culmination of a three-year programme run jointly by the Royal Opera and Guildhall School of Music and Drama, Venables could be said to have added clinical depression into the mix as well. However, the piece is much more than that, being a continuation of the composer’s work in finding novel connections between sound and text, particularly, and a strikingly good match of ‘libretto’ and composer.

The text includes a lot of dark, even black, humour, which sometimes seems to act as a defence mechanism employed by the author, which Venables and the director Ted Huffman exploited without hamming up the effect, and which certainly helped refresh the audience’s attention. Indeed, anyone expecting jokes to fall flat in such heavily textured text and music would be surprised at the amount of laughs the show got. One might only wonder whether these moments were not too concentrated in the first half of the show, leaving the second half at greater risk of losing the audience.

Kane’s text specifies no characters, and Venables opted for a line-up of six female singers, one of which acted as the main protagonist while another periodically slipped into the role of the psychiatrist. Their identical everyday costumes of jeans and a cardigan, coupled with the absence of any markedly dramatic action on the stage, served to heighten the sense of commonality; of the lines which were spoken and sung illustrating a general reality – rather than expressing the author’s experience, illustrating the need to express. This was taken further by the use of the voices in their many registers – sung, spoken, whispered, screamed, and, in particular, pre-recorded and spatialised across the theatre.

The lack of physical action mentioned above was certainly not a fault – the frequent use of projected text would have made it hard to concentrate on it in any case, though, given the highly sectionalised structure, one wonders why some of the more singer- and movement-centred sections didn’t make more dramatic use of the stage. The lighting, on the other hand, featured some very effective jump-cuts between various scenarios, with synchronised cuts in the sound, between the orchestra (led by Richard Baker with his standard precision and dedication to detail) and white noise or other non-musical sound.

Whenever the music made use of multiple layers, and particularly when these materials were somehow archetypal or reminiscent of other music, Venables’ clarity of conception as a composer really shone through. From lullabies through sad electric keyboard pop songs to the descending bass of Baroque laments that surfaced repeatedly, these musics were always tending towards the past; towards memory, and in connecting with our own memories of them, lent depth and empathy to the ‘character’ presenting them.

These moments were also repeatedly scored for a single voice and possessed clearer musical continuity, often then interrupted by contrasting material from the ‘chorus’ of the remaining singers. This enhanced the profusion of subjectivities mentioned above in a particularly poignant and effective manner. The least convincing part of the music were the freely composed contrapuntal lines weaving the six voices together. The counterpoint was strong between these and the pre-recorded spoken voices, but the vocal lines themselves tended to sound like filler.

The use of non-instrumental sound was another effective extension, though the rumbling drone used to excellent dramatic effect at the end of the show was perhaps a little over-used throughout. Recorded sound was also present, in the form of courageously quiet, banal background music in the doctor-patient scenes. These scenes were some of the strongest elements in the opera, particularly for being so clearly defined in opposition to the rest of the action.

Dramatically, this was one of the few moments with clear characters interacting. Musically, these characters were represented by two percussionists at either end of the stage, whose varied gestures corresponded in various ways with words rhythmically projected under them – sometimes at the level of words, sometimes syllables, sometimes just punctuation and at other times entire utterances. This provided a very rarefied context for some powerful dialogue – with not a word uttered until the last of these scenes, in which all aspects of it were developed concurrently and at a very fast pace, to great effect.

Despite its openness, Kane’s text is certainly not easy to adapt. And seeing a list of the formal devices used by Venables, it would be easy to think that these were used as crutches. But Venables’ opera is a very assured and crafted work, placing Kane’s words in a formalised and estranged context which manages not to make the emotions overwrought, but not downplaying them either.