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by Lucy Prebble, directed by Mitchell Cushman

Coal Mine Theatre, 2076 Danforth Avenue, Toronto

July 13-30, 2023

Connie: “It’s a chemical reaction, is what I’m saying”

The final play of the Coal Mine Theatre’s 2022/23 season is The Effect (2012) by British playwright Lucy Prebble. Nowadays if people know who Prebble is it is because she was one of the 13 executive producers of the hit television series Succession (2018-23) and wrote the scripts for two of its 39 episodes. Ten years ago people would have known her as the author of the hit play Enron (2009), which amazingly took an abstruse subject like the financial collapse of a company and made it into riveting, moving drama. In The Effect Prebble moves from finance to drug trials, but, unlike Enron, she has manipulated her subject in illogical ways for the sake of plot. The play could be a mine of fascinating ideas if it did not misrepresent its subject and was so internally inconsistent as to be nonsensical.

The Effect focusses on two people, Tristan and Connie, who are paid subjects in a twelve-week trial of an anti-depressant. The scenes are organized according to the gradual increases in dosage from 25mg to 250mg. The subjects have to follow strict protocols such as giving up their cellphones, staying in the facility, not smoking and not having sex to eliminate any variables in the psychological and physiological assessments they undergo every day. These assessments are carried out by a psychologist Dr. Lorna James, who was hired by Dr. Toby Sealey. Sealey hopes the trial proves that his drug has minimal side-effects so that he can publish a paper on it and add to his reputation as a speaker promoting drugs as the primary cure for mental health issues.

The problem that evolves is that Tristan and Connie fall in love. Connie, a psychology major, wonders whether this “love” is really just the effect of the drugs which raise the feel-good neurotransmitter dopamine, or is it really “love”. Tristan doesn’t care and is perplexed that Connie should care at all. Eventually, Connie presses Dr. James to reveal whether she or Tristan is on a placebo and James, under duress tells her which it is. Meanwhile, James, who suffers from depression herself, resumes a once broken-off affair with the married Dr. Sealey, who, as she learns, is simultaneously assessing her abilities in assessing the subjects.

The parallels between doctors and subjects are tidy and the idea of the assessor being assessed adds what might seem an intriguing layer of complexity to the story. The problem is that what Prebble presents as a clinical trial in no way represents the way a real trial is conducted. All her efforts to make the portrayed trial seem real – such as dosages projected on screens or countdowns to drug taking – can do nothing to dispel her misrepresentation of her basic subject.

Prebble purports to show a Phase 1 clinical trial, which means a trial on healthy subjects using ascending doses in order to determine whether the drug is safe, yet the inconsistencies within this trial are too great to make it believable. Tristan and Connie break out of the facility, use phones, smoke and have sex. Prebble emphasizes in the play that all four are forbidden to trial subject. When Dr. James finds Tristan and Connie outside the facility, the only permissible action she should have is to eliminate the two and their data from the study since they have compromised the results on four points. However, contrary to the very protocols Prebble has established (and common sense), she has Dr. James allow the two to remain in the study. This is necessary for the plot of Prebble’s play but it also nullifies its credibility.

Real Phase 1 drug trials may be double-blinded meaning that neither the subjects nor the doctors know who is receiving the real drug and who the placebo unlike the trial is completed. Therefore, the scene crucial to Prebble’s plot where Dr. James gives Connie that very information about her and Tristan, besides its inherent unethicality, could never happen because Dr. James would not know the answer.

The parallel plot involving Dr. Sealey and Dr. James also makes no sense. We learn that James suffers from depression and deliberately does not undergo therapy or take medication as treatment for it. Dr. Sealey knows this. Therefore, how could he choose her to work on a drug trial on antidepressants and how can she possibly evaluate subjects objectively in such a trial? Then, when the two doctors rekindle their affair, James’s objectivity in assessing subjects and Sealey’s objectivity in assessing James has become so totally compromised as to be useless.

The rekindled affair between Sealey and James feels artificial, as if Prebble felt she needed a story about depression to balance the love story of Tristan and Connie. In the present production the two doctors show so much animosity toward each other, it comes as a surprise when we find they have somehow come back together.

If The Effect were meant to be a satire of medical malfeasance, we might be able to accept the play’s fundamental lapses in portraying drug trials. The presence of velociraptors in Enron told any who didn’t get it that Prebble intended Enron as a satire. Yet, there are no such fantastic presences in The Effect. Prebble seems to want us to take what she presents as realistic and adds the projections of dose amounts and the timing of doses to the play to hammer home that what we see is somehow realistic.

Realism is also what director Mitchell Cushman wants to convey, although he does temper the realism with an emphasis on symmetry in the play’s design. The play is performed in alley staging and designer Nick Blais has created a perfectly symmetrical set with two screens for projections facing each other, two identical ceiling mounted dental lights and four six-slatted wooden chairs that convert to tables, the last a metaphor, perhaps, how the subjects are constantly being manipulated.

Cushman attempts to draw detailed, naturalistic performances from the cast, though only partially succeeds. Leah Doz, who plays Connie, is primarily an actor for the large and small screen. She habitually speaks at a conversational level which even in the small Coal Mine space makes her difficult to hear over the sound of the air conditioning. Her habit for lowering her volume to make important points makes her impossible to hear.

As Dr. Sealey, Jordan Pettle does what he can with a severely underwritten role. He is at his best when he delivers one of his corporate talks and exudes the kind of self-confidence and false charm so characteristic of self-promoters.

Aviva Armour-Ostroff plays Dr. James from the first as a depressive character. She makes it seem as if James has lost her sense of humour and views the endless repetitions in the drug trial as as tedious as the subjects do. When she confronts Dr. Sealey about her observations that the love between Connie and Tristan may be more responsible for couple’s increased happiness than the drug, she does so with anger. After all, she does not believe in antidepressants herself – a view that Sealey finds foolish and self-defeating. (So, indeed, why did he hire her?) James’s view is that “so-called depressed people have a more accurate view of the world” (a view known as “depressive realism”), but Prebble never explores this point just as she never adequately explores the “Is it love or drugs?” question at the play’s heart.

The one performance that gives the play its vigour is that of Aris Athanasopoulos as Tristan. It is his character who goes through the greatest change, from funny, flirtatious risk-taker to hyperventilating bundle of nerves worried about what is happening to him as a completely helpless and passive patient. Athanasopoulos traces this arc rigorously and visibly inhabits his character more fully than any of his castmates do theirs.

The number of playwrights able to write about medicine or science intelligently is very small. Two of the best plays about science and its relation to knowledge in general are Copenhagen (1998) by Michael Frayn and A Number (2002) by Caryl Churchill. Shaw’s The Doctors Dilemma (1906) is still the most powerful examination of how personal bias can affect decision-making in medicine. Prebble may wish us to ask whether we live in an over-medicated society, but her play veers off course and its central flaws prevent any of his points from hitting home.

That being said, Coal Mine Theatre is the company that most consistently brings Toronto the best produced, most thought-provoking plays. And I eagerly look forward to what the company plans for its 2023/24 season.

Christopher Hoile with Howard M. Clarke, Professor, Department of Surgery, University of Toronto; revised June 18 after receipt of further information concerning placebos.

Photos: Aris Athanasopoulos as Tristan and Leah Doz as Connie; Aris Athanasopoulos as Tristan and Leah Doz as Connie; Aviva Armour-Ostroff as Dr. James and Jordan Pettle as Dr. Sealey. © 2023 Dahlia Katz.

For tickets visit www.coalminetheatre.com.