The Knot of the Heart – play

Addiction is a difficult subject for dramatisation on stage. It is messy, complicated, highly emotive and easy to moralise over. Yet in David Eldridge’s new play, “The Knot of the Heart”, the harsh and deeply unpleasant realities of addiction are portrayed in a refreshingly direct way that leaves the audience oscillating between sympathy and revulsion for the protagonist almost as continuously as her sense of identity contorts and fluctuates as her addiction takes hold. Last night’s performance was also followed by an interesting panel discussion of addiction experts.

The play opens with Lucy, a bubbly children’s TV presenter on the verge of career success, revealing she’s been fired after being caught smoking heroin in her dressing room. She returns to the safety and comfort of her widowed mother’s house, to a mother who cares for and dotes upon her to the point of suffocation. We see a spiral into addiction as Lucy starts injecting heroin, with passing dark references about how she gets hold of the money to feed her habit. Eventually ending up (luckily) in a crisis intervention unit, she begins a slow, constantly faltering, painful and ultimately terrifyingly dull climb towards recovery. Lucy struggles both with the physical aspects of her addiction and her psychological mortification at having become a junkie and, in her own eyes, a monumental failure.

This is where I found the play’s most resonant chord: mid-way through the play, at her lowest ebb, Lucy angrily questions “why?” Brought up with all the comforts and securities of an upper-middle class childhood (although her father dies shortly after her birth), she sees herself as having no excuse for her addiction and the devastation it has wrought. She cannot comprehend attending group therapy as she believes she’s different from the “crack whores” who make up the other residents of the unit. Her mother, in particular, holds fast to the view that “things like that don’t happen to people like us”. But thankfully, there is no moralising tone to the play. It is rather a presentation of the destruction wreaked by addiction and an acknowledgement to an (inevitably) middle-class audience that this is not a subject relevant exclusively to council estates, broken homes and victims of abuse.

It is only later in the play that two things become clear. A strong genetic vulnerability to addiction is uncovered, and we learn the extent of the complexities of the familial relationships that have continued to enable Lucy’s addiction. This touches on the hotly-debated interplay between genetic predispositions and environmental triggers in many disorders, but does not favour one over the other. Knowledge of the genetic vulnerability clearly impacts upon Lucy’s perceptions of herself, but so does the realisation that her mother’s unbending determination to protect and shield her is in fact preventing her from taking control of her own life. This balance was reflected in the constitution of the panel for discussion afterwards: a biologically-minded psychiatrist and medically-trained psychotherapist (who did not disagree but did not quite agree on the status of addictions as an ‘illness’) both gave compelling biological and psychodynamic interpretations respectively of the sources of Lucy’s problems, both of which could be explanatorily powerful within the narrative structure of the play.

Another striking thing about this play which is not often evident in depictions of addiction is the stultifying, frustrating nature of recovery. Desperately trying to stay clean, Lucy is imprisoned in her mother’s home, unable to work and with no access to money. The temptation to relapse is overwhelming: heroin brought her a sense of completeness, a feeling that nothing in the world mattered. It seems like an inviting escape from a life of pain, boredom and being forced to acknowledge the impact of one’s own behaviour. Existential questions abound here: when claiming viciously that she wants to die, one is left wondering whether, in Lucy’s eyes, a life without the blissful oblivion of heroin is indeed one worth living. At the end of the play we are assured that Lucy has broken free of her physical addiction and her overbearing mother, but there is no triumphalism. She faces an uncertain and difficult future, rebuilding her self and self-worth, and we are left in no doubt about the legacy her addiction will leave. Like many disorders, particularly mental disorders, recovery’ in addiction is not a process that can be concluded once the physical traces and symptoms are healed. It is a sombre and thought-provoking note upon which to conclude.

The Knot of the Heart is currently showing at the Almeida Theatre in Islington. The panel discussion formed part of a series at the Almeida in collaboration with the Royal College of Pscyhiatrists about media representations of psychiatry.


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