Introduction

Miriam Gillinson

By the time ‘The Effect’ premiered at The National Theatre in 2012 Lucy Prebble was already a well-established playwright with multiple awards and a certain ‘dazzle factor’ attached to her name. Her debut play ‘Sugar Syndrome’ (2003) picked up a cluster of awards and ‘Enron’, which Prebble describes as ‘the corporate world with jazz hands’, had made a considerable splash, first at The Royal Court Theatre and later on the West End. But Prebble felt that something was missing from her writing. Whilst her plays had always been praised for their intellectual flair and theatrical energy, the more emotionally charged side of her writing had not yet taken centre stage. With ‘The Effect’, though, something changed:

When I saw people visibly moved [by The Effect] that was profound for me because I’d never done that before. I’d written shows that amused people, perhaps annoyed people and sometimes informed people, but I had never moved anyone before that play. That was a huge deal for me because I thought deep, deep down that perhaps I’d never achieve that.

It’s perhaps no surprise, then, that ‘The Effect’, which marks the moment when Prebble began to fully combine the intellectual and emotional aspects of her writing, is all about the human heart.

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The first flash of inspiration for ‘The Effect’ came in 2006 when a drug trial run by the American pharmaceutical company Parexel, and held in Northwick Park Hospital in North London, went horribly wrong. Six male volunteers suffered horrific side effects, including organ failure and lost fingers and toes. The trial was dubbed the ‘Elephant Man trial’ and splashed all over the papers. Prebble was horrified – but she was also intrigued. This failed drug trial was a play in the making:

The enclosed nature of the trials was immensely theatrical: it was time limited and space limited but not it a way that I had to impose. Not only that but you are literally engaged in a process whereby you’re watching human beings trying to work out what their reactions mean, which is exactly what theatre is. It was never going to be a movie, it had to be a play: you want to see the sweat and skin.

The Parexel drug trial provided the intellectual spark for ‘The Effect’ but the emotional angle was equally important to Prebble, who was keen to use the trial to explore an ‘extremely intense and quite damaging love affair’. Alongside this Prebble had been reading a lot about anti-depressants. This had got Prebble thinking about the overlap between the effect of anti-depressants and the effect of love, both of which raise the levels of dopamine in the body. What was the link between anti-depressants and love and to what extent were both love and depression purely chemical experiences? And where exactly did human emotion fit in with all of this?

And so, through a combination of intellectual and emotional inspirations (alongside countless other ideas rattling around in the subconscious), ‘The Effect’ was born.

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The skeleton for ‘The Effect’ was in place; all it needed now was a body and heart. The play would unfold during a four-week drug trial run by a pharmaceutical company called Rauschen. The drug on trial would be a new anti-depressant, designed to increase dopamine levels and thus make the patient ‘happier’. A few key details about the trial set-up would have to be changed to allow Prebble to fully explore her ideas. Firstly, Prebble would need a female volunteer in her play. Women are often excluded from phase-one trials due to fertility risks, but Prebble was going to have to make an exception. She couldn’t very well explore the cause and effect of love between a man and a woman without featuring, well, a man and a woman falling in love.

Another modification would be required: unlike the Parexel volunteers, Prebble’s trialists would be paid for their time. This monetary aspect was important to Prebble, since it would help her to define her central characters, trialists Connie Hall and Tristan Frey. For psychology student Connie, the trial represents a chance to think more deeply about her area of study. But for long-term drifter and trial-aficionado Tristan, the trial is merely an opportunity to earn some extra dosh for travelling. Thus the intriguing idea is established that whilst one patient – Connie – is highly attuned to the possible side effects of the trial, the other patient – Tristan – couldn’t care less. He’s just along for the ride.

Finally, Prebble needed to find a way to tie together the themes of love and depression in her play. With this in mind, Prebble introduced two more characters into her delicate four-hander: Dr Lorna James and Dr Toby Sealey, both of whom have private and professional links with depression. Dr James, who is in charge of the trial, has suffered severe bouts of depression throughout her life and is deeply sceptical about ‘curing’ the condition with drugs. Dr James’s boss and ex-boyfriend Dr Sealey (Toby) lies at the other end of the spectrum. A leading figure in the psychopharmacological revolution (‘the scientific study of the effects of drugs on human behaviour’), Toby is convinced that the chemical solution to all mental health issues lies just around the corner. The two doctors’ impassioned debates about the nature of depression and the best way to treat it are some of the most troubling and compelling scenes in Prebble’s play.

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One final element needs to be taken into account, when considering the way in which Prebble pulled her play together after first reading about that failed Parexel trial: the audience. For in ‘The Effect’, the audience is just as much on trial as Connie and Tristan.

Over the course of the play, as Connie and Tristan fall in love, the audience’s reaction to their relationship is massaged and manipulated. We are drip-fed crucial pieces of information about the trial (such as which volunteer is on the placebo) at critical moments. These twists are designed to radically alter our perspective on Connie and Tristan’s relationship and the way we feel about the love between them. The characters’ back-histories are revealed gradually and this information, too, is engineered to make us rethink our original assumptions. At every twist and turn we are forced to ask the question: what exactly is it that makes us believe in the love between Connie and Tristan and why does this belief change at critical junctures throughout the play?

In the original National Theatre production, directed by Headlong’s Rupert Goold and designed by Miriam Buether, the audience was folded into the play in a very literal sense. The compact Cottesloe stage (now the Dorfman) was expertly reconfigured so as to pull the audience into the action. Spectators were sat on clinically coloured benches, as if perched in a posh medical waiting room. Before the play had even begun the idea was planted that the audience, too, was on trial.

This idea of the audience’s involvement is clearly established in Prebble’s play text. The play opens with the stage direction: ‘The Experiment Begins’. At the interval, Prebble writes: ‘End Experiment Here. Wait Fifteen Minutes. Begin Again’. And at the play’s conclusion: ‘End Experiment’. These stage directions establish the idea that ‘The Effect’ is a live and variable trial; one with new volunteers (the spectators) and a different set of results every night it is performed. Of course, the extent to which the audience is physically folded into the show is down to each individual director and designer, but – regardless of the production design – the audience remains a crucial component of Prebble’s play. Without an audience, ‘The Effect’ is rendered a fascinating, but controlled and closed experiment. With the audience, Prebble’s play becomes an unpredictable and untameable thing – and there’s no way one can explore the effects of love without a great dollop of chance, spontaneity and surprise.

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In her introduction to ‘Theatre and Feeling’, Anne Bogart discusses the audience’s attraction to theatre. It sounds a lot like the process of falling in love:

We are attracted by the sweep of feeling, of emotion, of adrenaline, surges of dopamine and serotonin, and new neural pathways forged in the brain and extending through the entire body. We crave the feelings engendered in the experience of theatre. (p. xiv, ‘Theatre and Feeling’)

Each visit to the theatre is, in effect, a mini-love affair in which we temporarily fall for the characters, the ideas and the worlds represented on stage. Those ‘surges’ of dopamine which Bogart references are created by the connections we forge with the characters on stage but they are also teased and augmented by theatrical special effects. According to the tone of a production, a wash of red light might nudge us towards feelings of love or fear; a nursery rhyme might draw us closer to the characters on stage or send us running in terror. Watching a show, then, is a bit like falling in love to a soundtrack created by an off-stage cupid, craftily tugging at our heartstrings from the wings.

There’s a crucial scene near the end of the first half, which brilliantly highlights the way that love – for both the characters and the audience – is both an emotional and chemical sensation, one that is deeply human but also strangely ‘other’. Connie and Tristan’s love is escalating at a dizzying pace and the two are beginning to succumb to its effects. Tristan, a natural born rule-breaker, has smuggled a mobile phone into the clinic. Phones are prohibited because they might interfere with the equipment but Tristan and Connie have long since chucked the rulebook out the window. That is, after all, a wonderful side effect of falling in love: all the normal rules of behaviour seem to slide away. Holed up in different rooms, Tristan and Connie send each other messages on their phones:

Tristan and Connie inhabit bodies racked with expectant, alert physicality, aroused and nervy in separate rooms. They begin texting each other on the phones that Tristan provided. Every glowing vibrating missive is a jolt of dopamine; a high, punctuated by a stressful low awaiting the response. They become faster. It has the quality of shared, separate electroshock therapy or cardiac paddles that shock. (p. 62)

It’s a fiercely packed image, in which the conflicting theories about the nature of love crash wildly against each other. The text messages that Connie and Tristan send each other are no doubt full of deeply personal – or perhaps just deeply horny – words. But the way in which these messages are sent is reflective of the chemical nature of love, with each flashing text message mimicking a jolt of dopamine sent surging around the body. So which element, the chemical or human, is really allowing these two to form a connection and which aspect is the audience responding to?

It’s interesting to note that this texting scene arises at a point when Connie and Tristan have broken the rules. Are these two becoming closer because they have moved beyond the bounds of the trial or are the effects of the drug merely taking a stronger grip on our volunteers? And are we, the audience, responding to this relationship because we truly believe in the love on stage, or is our response simply the effect of all those text messages – and resulting flashes of light – firing through our brains? In the same way that Prebble used the image of raptors in ‘Enron’ to visualize the complex idea of debt-transference, here Prebble alights on a seemingly simple but endlessly rippling image to explore the complex relationship between chemicals and feelings when it comes to love.

This idea is flirted with again when Connie and Tristan sleep with each other for the first time. During rehearsals, this scene became known as the ‘Lights up lights down’ scene and is made up of a series of snatched moments, which Prebble describes as ‘a compilation tape of people’s love affairs.’ Each little glimpse – ‘Where will we live?’ or ‘Ask me who’s in charge’ – is followed by the stage direction: ‘Darkness. Light.’ Just as with the texting scene, Prebble places us at the heart of a simultaneously chemical and emotional experience. As the lights flash up and down and we fall for Tristan and Connie falling for each other we ask the dazed question: Why?

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The idea of watching – and believing in – love on-stage is a thrilling and mystifying phenomenon, which is tightly bound up with the idea of chemistry. It is a deeply bizarre theatrical conundrum that a pair of actors, reading exactly the same lines under exactly the same conditions, might provoke hugely contrasting reactions from an audience. What is that mysterious and ‘extra’ component that creates a gorgeous heat around one pair of actors and a limp coolness around another?

When writing ‘The Effect’, Prebble was – of course – highly attuned to the impact of ‘chemistry’ in theatre. According to Prebble, chemistry is borne from some sort of imbalance between two actors: ‘I think on-stage chemistry – as with love – is often about someone having something you don’t have.’ In the original National Theatre production, Connie was played by TV-star Billie Piper and Tristan was played by stage stalwart Jonjo O’Neill. Both actors had something the other required:

What was great about these two characters and actors is that the statuses were good. Jonjo is a much more experienced stage actor than Billie, but Billie has a star quality – and that’s not just because she is ‘famous’. She has a warm quality that makes people want to be around her. So when we went into the rehearsal room Billie was actually quite deferential towards Jonjo because he knew exactly what he was doing and that mirrored so beautifully and perfectly the nature of the play.

Of course, chemistry is crucial to all successful theatre but rarely more so than with ‘The Effect’; without it, the whole experiment risks grinding to a halt. This profound need for a deep connection between the principal actors has had some intriguing side effects of its own. The ‘Effect’, says Prebble, is a play that has ‘sparked marriages and sired children’. Prebble recalls one particular incident involving a European artistic director, interested in staging the play abroad:

He came to London and he said, ‘Babies get born from this play, right?’ So many people who work on ‘The Effect’ end up falling in love. He then told me that he was thinking of hiring his ex-girlfriend for the role of Dr James. I said: do it. The play needs it. He did just that and, of course, they got back together.

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The connection between ‘chemistry’ and love explodes into full life during the asylum scene; an encounter, which Prebble believes, reflects the essence of her play. It is here, outside the confines of the trial, that both Connie and Tristan begin to let their guard down and give in to their emotions. Up until this point, notes Prebble, it has all been a game – especially for Tristan:

I think before the asylum scene Tristan is playing with Connie. He’s not a shag-about but he’s a huge flirt and he feels safe in the environment of the trial and he enjoys it. It’s not until this moment that Tristan gets in the water with her.

Even in this new environment, Connie struggles to let go of her psychology training and continues to question the ‘authenticity’ of feelings cultivated in such surroundings:

Connie It’s a chemical reaction, is what I’m saying.

Tristan But I’m still me.

Connie No, yes, you’re you, but under with influence of something. (p. 46)

The two circle around the play’s central concerns, with Connie falling back on intellectual reasoning and Tristan insisting that she place faith in the body, the moment and instinctive emotion. It isn’t until Connie and Tristan stop speaking that their situation is irrevocably transformed. Tristan quits reasoning with Connie and instead begins to dance:

Tristan performs a tap-dance to the music. It is surprisingly good. (p. 52)

Written down, it looks like a fleeting moment; but anyone who has seen ‘The Effect’ (as well as Prebble herself) will tell you that this is the moment when Connie and Tristan fall in love. There’s something deeply moving about the economy of this scene. With few resources at his disposal, Tristan fashions a pair of tap shoes by sticking a few drawing pins in his sneakers. And then, on a bare stage and with few special effects (except some tinny music from a mobile phone), Tristan dances for Connie. It’s an infectiously romantic moment that taps (!) into something almost supernatural about the nature of love; the way that it might transform a stage, a moment or a person with little more than a few drawing pins and a dazzling smile.

There’s an equally heart-punching scene in Nick Payne’s play ‘Incognito’ (2014), which touches on similar themes. The play explores a maze of interlocking relationships, one of which is between Margaret and Patient HM (Henry), a man with chronic memory loss. Payne depicts a number of harrowing meetings between the couple, in which Margaret attempts and fails to connect with her chronically forgetful husband. It seems like a hopeless case and, indeed, Margaret is eventually forced to leave Henry. But ‘Incognito’ ends on the most spectacular note with a scene that seems to reinforce the idea that there is something about mankind, and the love that mankind experiences, which over-rides the limits of the human brain; that there is something of the ‘self’ that endures even when the brain is left behind. The final stage direction in Payne’s play reads:

Henry plays the melody taught to him by Margaret. He plays with confidence and fluidity. It’s fucking brilliant. (p. 105)

It looks like such a little scene but, experienced in the theatre, it feels like everything. It is all the answers to the questions we have barely begun to ask about the brain and consciousness and the way in which love, some innate sense of self – whatever you want to call it – might form a bridge between the two.

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The asylum scene, then, is the moment that the audience becomes wholly invested in the idea of Tristan and Connie’s love for each other. It is no coincidence that Prebble folds the idea of depression into her play shortly after this encounter. For Prebble, love and depression cannot be separated and, if one is to believe in the emotional and relational quality of love, then these same beliefs must also be applied to depression:

I think it’s very wrong to look at love as purely relational and depression as something distinct, isolated, chemical. They are both very similar things but we have a great deal of trouble with that. When someone is what we call ‘depressed’ we don’t want to think it is someone else’s fault or in relation to something else, but it can be. If we are going to define love relationally – which I do – I wonder whether it is appropriate to think of depression in the same way.

These conflicting theories about the depression – the idea that it is either an isolated and purely chemical condition or a relational and more emotionally embedded disease – are explored in a series of arguments between Dr James and Toby, both of whom attribute Connie and Tristan’s burgeoning relationship to entirely different causes. Dr James, who suffers from depression and refuses to treat it chemically, is convinced that Connie and Tristan’s love is skewing the results of the trial. In short, she believes that the lovers’ emotions are over-riding the impact of the anti-depressants. Toby, on the other hand, is adamant that Connie and Tristan’s relationship is merely a side effect of the drugs. According to Toby, an expert in psychopharmacology, this so-called ‘love’ between Connie and Tristan is simply a trick the brain is playing on its hosts:

Toby The body responds a certain way to what it’s being given, they can’t sleep, they can’t eat, they’re in a constant state of neural excitement ever since they met, what’s the brain going to conclude?

Dr James You think it mistakes that for love?

Toby Not even mistakes it, creates it, after. To make sense of the response. (p.56)

In a pair of powerful and eerily mirrored scenes Toby delivers a scientific lecture whilst lovingly handling a carefully preserved brain; meanwhile, later in on the play, Dr James rips a brain to shreds with her bare hands. Whilst Toby believes the brain can be mapped and chemically controlled, Dr James fears – or perhaps hopes – that part of the brain will always lie beyond the reach of science.

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The scepticism that Dr James feels concerning the chemical treatment of depression is reflected with choking vividness in Sarah Kane’s final work, ‘4.48 Psychosis’ (2000). In Kane’s devastating play, the protagonist describes her depression as ‘that sickness that breeds in the folds of my mind.’ She struggles with her clinicians’ cool analysis of her gruelling and deeply emotional condition:

And I am deadlocked by that smooth psychiatric voice of reason which tells me there is an objective reality in which my mind and my body are one. (p. 7)

Later, Kane’s unnamed patient tries to describe the causes of depression to a sympathetic doctor: ‘Depression is anger. It’s what you did, who was there and who you’re blaming.’ It sounds an awful lot like Dr James’s definition of depression: ‘It’s about an interaction with the world. It doesn’t just appear.’ Later still, Dr James implores Toby: ‘It’s not an ‘it’, we’re talking about me. You want to cut a part of me out and call yourself a hero.’ Again, this idea is echoed in Kane’s play when she writes: ‘Please don’t switch off my brain by attempting to straighten me out.’

‘4.48 Psychosis’ and ‘The Effect’ both explore the way in which depression warps the connection between the brain and the self and ask the complicated question: what do we do if the brain seems to be working against the natural impulses of the person who hosts that brain? Is this a ‘defective’ state that should be corrected by chemicals, even if it means permanently altering the person in question? Indeed, is such a correction even possible? There is a devilishly arresting moment in Prebble’s first full-length play ‘The Sugar Syndrome’ (2003), in which a paedophile recollects a doctor’s attempt to ‘cure’ his condition using electro-shock therapy:

Tim It was a French doctor and you had to sign a bit of paper and then you got hooked up.

Dani To what?

Tim Some electro-machine.

Dani And they just fucking electrocute you?!

Tim No, that’s the death penalty. It’s tiny, tiny shocks…

Dani And did it work?

Tim (considers) It made me want to electrocute kids. (p. 19, AI S3)

It’s a funny and frightening interchange, which gently mocks any attempt to ‘cure’ the brain of deviant or damaging impulses. This idea is pushed to its limits in a harrowing scene in ‘The Effect’, as we watch Dr James wrestle – openly and agonizingly – with her inability to control her depression and the dark impulses it provokes within her:

Dr James I want to be happy. I want to work hard. I want to not shout out swear words on the street. I want to sleep. It [the brain] must know this. It must want that too. If it’s me. But. Here I am, where my father held me on a climbing frame and I can see my shoes on the bar. Here, how much I like meringue … Here’s my respiration control. Here’s my impulse to kill myself. Here is my controlling that impulse. ‘You’re disgusting. And you’re only going to get more disgusting. It’s too late. This all gets worse and you can’t even cope now … And you’re weak and you’re a coward and you’ve ruined people’s lives. And you should have done it a long time ago and you never will now’. (p. 89)

The scene culminates with a blazing image: ‘She tears the brain to pieces with her hands.’ If there is a stronger expression of the conflict between the brain and the self that depression provokes, I’ve yet to come across it.

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As ‘The Effect’ progresses, the scenes around depression and love are drawn closer together until they finally merge and implode. On one side of the stage, Dr James takes to bed with depression. On the other side, Tristan is hospitalized and Connie sat at his bedside. Having tried to ‘game’ the trial, Connie has inadvertently caused Tristan to take on over-dose, which has left Tristan with transient global amnesia. The chemical haze of early-love has been swept away and all that remains now is loyalty, affection and kindness. Connie tells Tristan: ‘You won’t believe this but I swear, I would rather get old and argue with you every day than ever love anyone else’ (p.96).

The couple’s flirty banter is replaced with banal everyday realities. The two talk about bus fares, shoelaces and schedules on a painful and endless loop. In this respect, the entire span of a relationship – from the heady days of initial attraction to the later days of enduring affection – is played out during ‘The Effect’, only with the timelines strangely warped. A similar technique is used in Duncan Macmillan’s play ‘Lungs’ (2011), which rattles through the ups and downs of the shared-life of two people in love. Again, time stretches in funny ways in Macmillan’s play: a thirty second wait for a pregnancy test result seems to last a lifetime and the desolate days following a miscarriage trickle by in a gloomy blur. In both plays, though, the resting points in life are held in place by love. Both Macmillan and Prebble explore the way in which love seems to stretch the laws of physics, be that the boundaries of time or the supposed limits of the human brain.

For Prebble, this final scene – in which passion has ebbed away and all that is left is an innate instinct to look out for one another – is the most moving moment in ‘The Effect’:

For me it was such a beautiful expression of a whole relationship in a lifetime being squeezed down into a moment. The sense of annoyance and repetition that comes with caring for somebody; the idea of trying to connect with them but failing and ending up talking about bus fares and keys, but that being beautiful and hopeful too. I felt that very deeply.

As the trial shuts down and ‘real life’ takes over, Prebble’s definition of love rises to the surface. It is there in the final scene with Dr James, as we watch her – doubled over with depression – reach for the pills that Toby has provided. Dr James might have decided to treat her depression with drugs but this desire to be cured has, implies Prebble, been inspired by love. This delicate interplay between emotional and chemical influences also underpins the final scene between Tristan and Connie, as the two leave hospital ‘and walk out into the real world for the first time.’ This is the moment when Tristan and Connie’s love affair truly begins. Love, suggests Prebble, is what happens once the dopamine surges have subsided. Love is what endures once the experiment is over.

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