Billie Piper in rehearsal. Photo: Ellie Kurtz
The start of this week saw more re-capping of scenes that had already been rehearsed, as well as work on one or two small sections that hadn't yet been put up on their feet. Two of the scenes that need more work than others, in terms of line-learning and familiarization, come towards the end of the play. The character Tristan is suffering from a medical condition called Transient Global Amnesia. The key defining characteristic Transient Global Amnesia is temporary short-term memory loss and the inability to form new memories. Unsurprisingly, Jonjo (the actor playing Tristan) has found that section of the play especially difficult to learn. The words he speaks are a manifestation of this condition. He is constantly trying to understand what is happening to him, forgetting again and then asking the same questions all over again. It was funny to hear the director, Rupert, mention that at this stage in rehearsals he always knows the script really well, often better than the actors themselves simply because of the amount of times he has read it but with these two scenes, he honestly had no idea at all about whereabouts they were in the scene or what was coming next! The actors worked really hard and by the end of the week, Jonjo and Billie (also in the scene) had finally cracked this tricky section, and were beginning to feel more comfortable and freer with the text.
There were two small visitors waiting in their buckets when we arrived in the rehearsal room one morning. The buckets contained two prototype brains had been brought in by the props department. The brains were being stored in an unidentified gloopy liquid, which we later found out was the slime they use in children's television programmes! One of the brains was made from foam and the other from alginate, which is the same material used to make impressions of your teeth by dentists. The brains looked very realistic, especially the one made from alginate. I think they will probably use alginate for the final brains. Now they just need to add a few finishing touches, such as pink dye and blood vessels. I hope the audience aren’t too squeamish!
I joined Billie and Jonjo for a voice session with Jeanette Nelson, who is Head of Voice at the National Theatre. The session was held in the Cottesloe theatre, on the set of another of another of the National’s productions, This House. It felt very exciting to be in there and to work in the actual space. One of the exercises Jeanette set was for one of them to closely follow the other walking around the stage as they spoke their lines from a chosen scene in the play. The aim was for the person behind to get the one in front to stop walking away by engaging them and making them really listen to their argument and what they were saying. This felt particularly useful because one of the challenges of the play for the actors is keeping the physical inner life of the drug effect, while at the same time still committing wholly to the text (staying on the lines and very simply, meaning what they say).
In the middle of the week, we did an impromptu stumble-through of the second half of the play. The purpose of this was to walk through the practicalities of transitions between the scenes and to get an idea of the overall shape of this half of the play. It went really well. It was interesting to note the general arc of the characters, the development of their relationships and the story throughout. It was good to see how the end of the play informs the beginning and gives you a new perspective on earlier elements, such as: the fluidity and tone of scenes as the play progresses; the need for a constant awareness of the drug trial taking place; and the development of certain aspects of each of the characters in their journeys through the story. It has been a great joy to sit back and watch the play from a wider perspective and to be effortlessly engaged and to listen to what the characters are actually saying. It has reminded me just how fascinating the play is! By this stage, you get to know the text very well. It’s so enjoyable to look at things from a slightly different angle, and re-discover how brilliantly the ideas and provocations within the play are all woven together. The brain, neurology, the placebo effect, drug efficacy, the ethics of the pharmaceutical industry, depression, love and sanity are all such interesting topics.
I'm finding working on a new play fascinating and, as rehearsals progress, I’m discovering more about the play’s dramaturgy, such as overall structure and how the sequence of scenes flow and affect each other. During this particular production, I have been thinking a lot more about staging and commitment to the text, which has felt like working and developing a new muscle – in an exciting and good way!
Although we've still got a week of rehearsals ahead, I'm already looking forward to getting into the theatre and starting the technical rehearsals. I have heard exciting snippets of conversations between Rupert and the creative team about the different design elements, including a few amazing projection ideas, lighting effects and a particularly body-vibrating heavy use of bass!
The actors did their first scheduled stagger-through run of the play at the end of last week, in front of a small audience made up of the whole creative team and a couple of other invited guests, such as Jeanette Nelson, Miriam Buether (the designer) and Ben Power (dramaturg and associate director at the National Theatre) who hadn't seen any rehearsals until then. It was great to be able to watch the whole play. It gave me a perspective on the overall shape of the whole piece, the development of characters and their relationships, the arc of each scene and the general arc of the whole story. You also become aware of the audience’s journey and how the hierarchy of events or happenings within the play is structured. For example, in The Effect, it seems that the end of the play is where the bombs are dropped. This is where the scenes become most powerful, moving and a little strange too. This awareness of how the play is structured will inform how earlier scenes will be directed and played, now that we know where the play needs to go.
After watching this first run, I found myself thinking about how theatre can take big, important and often political questions, and bring them to a personal and therefore accessible level. The Effect does this brilliantly and beautifully, weaving big ideas and provocations into the characters' lives and relationships.
Crudely speaking, the first half of the play is about love and the second half of the play is about depression. These are the two main themes in The Effect. Previously, I mentioned the many dualities within the play. One of the most important of these is the two main relationships: between Connie and Tristan (the young lovers) and between Dr. James and Toby (the doctors). Some of the scenes between the two doctors are staged with Connie and Tristan present on stage but silent. During next week’s rehearsals, we will spend some time finding places in these scenes where the two worlds of the couples can collide. We want to find moments in these scenes where the doctors and the lovers physically connect through different staging/movement ideas, while all being in the same space.
The delicate balance between watching two people falling love and watching two people on drugs has frequently come up in rehearsals. For the audience, there should be a balance between the joy of watching two people falling in love and constantly having to ask the question "is it just the drug?" The fact that both characters are volunteers on a clinical drugs trial should always be present, as this would affect the characters’ thinking, the development of their relationships and the general atmosphere throughout. Suggestions for how to achieve this included the regular use of medical sounds, such as measurements, monitoring and announcements. We thought about the possibility of putting Dr. James into a scene that had previously just been between Connie and Tristan. This should add tension, a constant awareness of their clinical surroundings and an obstacle to their being alone together. I'm looking forward to seeing how these different ideas are implemented and how they might change these scenes in rehearsals next week.
The need for the audience to always be aware that the characters are taking part in a clinical trial came to the fore partly as a result of a fascinating trip, the company made on Thursday to a clinical trial centre. Hammersmith Medicines Research is one of the largest specialist clinical pharmacology units in Europe. It provides services to pharmaceutical companies for phase 1 trials in healthy volunteers and early phase 2 trials. It's a huge purpose-designed building with newly equipped wards with 100 beds, set up over 4 floors. We set off midway through our morning's rehearsals and Rupert even managed to give a few notes to the actors in the taxi on our way there!
At the centre, we met Malcolm Boyce, its Medical Director and Executive Chairman. He referred to the centre as a 'clinical trial factory'. They hold approximately 40 trials per year, 90% of which are conducted using healthy volunteers, who are fit, well and robust individuals between the ages of 20 and 45 years old. The centre is run very much like a hospital. It needs to be open 24 hours a day, 7 days a week, with constant access to the laboratory, pharmacy, laundry services and so on. He compared it to being a little like a hotel.
It was interesting to hear about the different stages that a new drug will go through during what he called the 'discovery' period. This refers to its invention and development in the lab, and can take as long as 10 to 12 years. This process costs an average of $1 billion for each new drug. The drug then needs to receive MHRA and ethics committee approval. Next, if there are no reported symptoms that cause concern, each new drug will be tested on healthy volunteers in a clinical setting - the Phase 1 stage of the trial - during which The Effect takes place.
Subjects who take part in these trials are advised to taper off their coffee drinking before coming in, as all the drinks in the centre are caffeine-free. All food is sugar-free. Caffeine and sugar need to be eliminated from the subjects' diet so as not to interfere with any monitoring and test results. Another such factor is something called 'White coat hypertension'. Many people's anxiety levels and therefore blood pressure increases significantly on seeing a doctor in a white coat, so apparently most doctors no longer wear them anymore!
Regulations state that 3 months need to have passed since finishing a previous trial, before someone can volunteer to take part in one again. These healthy subjects can be paid between £100-150 per day. It was interesting to note that they quite often get actors and scriptwriters as volunteers! On arrival at the centre, the subjects participating in a trial are all given wristbands as soon as they walk into the building. These wristbands contain all the information about the drugs trial they are on, as well as a photograph of them so that they can be quickly and reliably identified, if necessary. Volunteers apparently become institutionalised quite quickly in this environment.
Of these volunteers taking part in a trial, any 2 out of 10 will be on a placebo. This is called a control. As in The Effect, these trials are double-blind, which means that the subjects on placebo don’t know that they are not taking the real drug, but instead they believe that they are on the active agent. At the same time, the doctor administering the trial will not know which volunteers are on the real drug and which are on a placebo. This is achieved in the way the drugs are packaged. It eliminates any practitioner bias that might be present if the doctor actually knew who was taking what, as if the doctor knew who was on the placebo, she might treat those subjects differently.
I was amazed to discover that after this phase 1 stage, only about 10% of drugs tested ever reach the market, of which only 3% will actually be successful.
We then had an illuminating tour and chat with one of the nurses in the centre, Krina. She led us through the wards, where we saw several volunteers, members of staff, and most of the medical facilities. It looked very much like a hospital. You were very aware of the lack of privacy and constant testing of the subjects. The centre has security-locked doors and 24-hour control monitoring. There was a very impressive pharmacy and an industrious, staff-filled and futuristic-looking analytical laboratory. We also passed though testing rooms, a television room, the rec room and a games room with Wi-Fi, a Wii and an X-box. 'Risk games' are apparently by far the most popular with the volunteers who take part in trials!
After another incredibly productive and full week, I am really looking forward to the last week of rehearsals and seeing everything settle further, come together and develop.