Paula Garfield’s hands make perfect sense. They move swiftly, phonology flying about our circle. As one of the founders of the award-winning company Deafintely Theatre, she has helped to create the first creative body in the UK that works bilingually in British Sign Language and spoken English. Their most recent artistic programme also sees the troupe making history, as they become the only company to give life to Sarah Kane’s 4:48 Psychosis by way of integrated performance.

A champion of the In-Yer-Face Theatre movement of the 1990’s, Kane’s body of work was (and still is) demonstratively provocative. It was prior to the initial performance of 4:48 Psychosis that the playwright committed suicide. The searing and often shocking content within her final production is characterised by her own experience of clinical depression – a disorder spoken of in degrees of naturalistic and abstract language. This is something of interest to Garfield, who seeks to raise awareness about poor mental health within the deaf community. “The play is very poetic in form, and I want to show that sign language has an equivalent” she says, her words interpreted by co-founder Kate Furby.

Deafinitely Theatre create work for both hearing and deaf audiences, and so the visual elements of this production are key in terms of making the piece accessible. “I didn’t want two different languages going on at the same time on stage” Garfield confirms, “there are times when the action is just visual, through projection and captions.” The presence of the written word is an essential feature that the company feel will enhance the theatrical experience – a matter that Furby assisted with during rehearsals.

For cast member Jim Fish, this collision of primary and secondary languages has proven challenging. At this, Brian Duffy smiles, his signing glowing with good humour. As a performer, he finds the blending of movement and VV (Visual Vernacular) more difficult than learning lines: “It is like an expensive wedding cake. There is an intricate design. One little knock will [ruin] the whole thing”. In working with movement director Alim Jayda, the company have been able to translate instances of heavy description into a movement language. Garfield feels that more gravity has been added to the action, but there is a reluctance to reveal any further visual concepts. This is intriguing. “No comment” says Fish, laughing, though he does allude to the innovative nature of their designer Paul Burgess.

Due to Kane’s lack of specificity in terms of setting, stage directions and characters, productions vary greatly in their casting and design. Garfield decided upon four male actors to complete her vision, a choice grounded by the fact that deaf men are at higher risk of suicide than any other. “Deaf people are three times more likely to experience problems with their mental health” she says, her eyebrows furrowed with worry. Official research suggests that 90% of deaf children are given minimal access or exposure to language. This can lead to depression; the effects of which Garfield has had first-hand experience. “I’m aware that this is an unusual choice, given that [4:48 Psychosis] was written by a woman, but I hope it will help deaf men to realise that it’s okay to reach out and ask for help.”

The recent rise in technology has been a driving force for Deafinitely Theatre, as the team recognise how it has contributed to feelings of isolation. At present, this topic seems to be emerging through creative conversation, with Eleanor Oliphant is Completely Fine by Gail Honeyman atop The Times fiction bestseller list for 33 consecutive weeks. Most notably, Deaf Clubs have been closing down, which has led people to connect with others online, resulting in the breakdown of communication within the offline world. Now, there is silence growing between neighbouring communities, as well as decreasing levels of direct contact throughout society as a whole.

Garfield notes how the advancement of the cochlear implant is also a cause for concern, “having an implant doesn’t make [the wearer] a hearing person. Deafness will still affect you.” This confusion between the deaf/hearing binary can leave those diagnosed with hearing impairment in a precarious position. This turbulent sense of identity can also lead to a decline in mental health, a problem that has fuelled the team’s urgency in adapting 4:48 Psychosis. “I think audiences will see something that they have never seen before” Duffy signs enthusiastically, his passion explained by Naomi Gray. “It has our own soul in it and has grown out of a deaf vision, so it is something special.” The group nod in agreement, their features lifting with a sense of pride. “Having two perspectives in the room makes for an interesting dynamic” Garfield grins, “[our adaptation] will take people out of their comfort zones. I think that’s what Sarah Kane would have wanted.”

4:48 Psychosis is playing at The New Diorama Theatre until October 18. For more information and tickets, see https://www.deafinitelytheatre.co.uk/Event/448-psychosis