KNOT HEART - Almeida Theatre

Team- u. KapitänsübersichtLiga: C --> Staffel IISaison: Frühjahr/Sommer 2011Lokal"Filou - Zeitlos"Lange Str. 2518055 RostockTel. 0381/2 02 14 34Lokal"Zum Litfass"Warnowallee 2618107 RostockTel. 0381/4 40 53 12Lokal"Saitensprung"Martin-Niemöller-Str. 2418147 RostockTel. 0162/5 68 91 42Lokal"Schlemmer-Pub"S.-Allende-Str. 4618147 RostockTel. 0170/2 83 64 23Lokal"Stamm-Lokal"Hamburger Str. 3018069 RostockTel. 0163/9 83 42 68Lokal"Rumpelkammer"Augustenstr. 7718055 RostockTel. 0381/2 01 69 59Lokal"Wossildo-Club"R.-Amundsenstr. 0118106 Rostock0381/1 20 00 47"Zeitlosen""Litfass""Los Wochos""Husky´s""WIR"Kapitän Name, VornameKrüger, Tini01520/7 70 71 26Kapitän Name, VornameZnanewitz, Mario0152/57 92 98 63Kapitän Name, VornameRiedel, Marko01520/3 08 70 59Kapitän Name, VornameBackhaus, Anja0162/4 48 90 93"Dauerbrenner"Kapitän Name, VornameDüwel, Thomas01520/3 84 31 27"Rumpelstilzchen"Kapitän Name, VornameTumat, Sophia0162/2 10 28 60Kapitän Name, VornameErhardt, Thomas0152/27 73 11 68

Lisa DillonPhoto: Keith PattisonSuccessful children’s television presenter Lucy sits in the back garden of her Islington family home, aGeorgian townhouse on Gibson Square, preparing some opium to smoke. Her mother, red wine inhand, reluctantly helps her by holding the drug. She didn’t mind when her daughter smoked a bit ofcannabis when she was younger. However things are now, whether they realise it at this moment,much more serious. Lucy has just lost her job presenting the popular Children’s BBC programmeAnimal House, caught by her producer smoking drugs in her dressing room: a sign that things will gofrom bad to worse.As Lucy loses touch with the normality of work and friendship, heroin becomes the be all and end allof her existence: her addiction spirals out of control and we see her plunged to the depths of drugdependency. Her mother, desperate to do the right thing, will go to any lengths to keep her daughterclose to her: from giving her money for drugs, to paying her debts and cooking her favouritechildhood food, all the while in a heartfelt - and perhaps misguided - attempt to keep her daughterfrom danger.Their family relationships come under heavy pressure: Lucy’s lawyer sister, the hard-faced Angela,urges the family to wake up to reality, but battles with dark demons of her own; and Barbara clings toher younger daughter for fear of losing another person she loves - but at what cost? In and out of thefamily sphere move a number of men - friends turned drug dealers, doctors and nurses: some thatcause harm and others there to help. Lucy, for her part, has to finally untether herself from the weightof expectation of others and the dangerous codependency of her family relationships, to find her ownstrength: unpicking the knot of the heart. Finally, revealing some truths from her past, and freeingherself from the grip of a family love that has turned dangerous, Lucy sees a life beyond the darktimes she has fallen into.Introduction to the PlayA detailed plot summary follows.Resource Pack: The Knot of the Heart4

CharactersLUCYLucy formerly worked as a children’s television presenter on apopular CBBC programme about wildlife. She was a bright,creative and outgoing child, a talented performer who studied atstage school Italia Conti, and went on to enjoy a successfulcareer in presenting – a career that is still potentially movingforward. She suffered from nerves, and used drugs to help relax,however rapidly developed an addiction to them. She is verymuch her mother’s daughter, and the two enjoy a closerelationship, although Lucy sometimes feels distant from hermother. She acknowledges that she has had a good and stablelife, with no small measure of happiness. However she holds astrong ideal of the person she ‘should’ be, and the expectationof her mother and social class.BARBARAMother of Lucy and Angela. Barbara is from a generation andclass where one’s personal family problems are not spokenabout openly. Barbara’s love for her family leads her to deny toherself the truth of situations. She feels instinctively closer toLucy than Angela, the latter whom she has never reallyunderstood. She has a warm heart and is desperate to helpLucy, wanting to keep her under the roof - this she understandsas safe. She can be selfish and dismissive of people sheperceives of lesser social or moral standing. Barbara was ayoung woman in the sixties, where she dabbled with drugs withher husband. Her husband was an alcoholic but Barbara is, tosome extent, in denial about this.ANGELAAngela is Lucy’s older sister, aged 36. She has never had a closerelationship with her mother but was more akin to her father;she has a fiery relationship with Lucy. She was an intellectualchild, and felt in the shadow of her outgoing sister. She is ahigh-ranking lawyer with a successful career that she hasworked hard to achieve. She has not had many lovers, and isstill without a partner, something her mother often reminds herof. She carries a lot of a bitter anger with hard-nosedpragmatism – she believes she can see the self-delusion hermother and sister indulge in and often lets it be known.5 Resource Pack: The Knot of the Heart

Margot LeicesterPhoto: Keith Pattisonsecond glass or bottle of wine. Barbara states that shealways feels that Angela treats her like a child. Angelarepeatedly challenges her mother, asking why she prefersLucy. Barbara says that the two girls have always beendifferent: Angela is tough and Lucy is delicate. Angelasays that it seems quite clear what Lucy is doing to herselfand to Barbara. Barbara feels hurt, and Angela retorts thatthis was her intention. Angela says she is leaving and willnot return. Barbara replies that this is her decision.Angela leaves.Scene 3Lucy is lying, seemingly asleep, on the floor, next to a pintglass of liquid. Barbara enters carrying Waitrose shoppingbags and sees Lucy. She notices something next to Lucyand bends to down to see what it is, knocking over theglass. She picks up a syringe and realises Lucy hasinjected drugs. She begins to shake Lucy toconsciousness, demanding to know what she has done.Barbara wants to know if Lucy has been out and remindsLucy that she promised she wouldn’t inject. Barbara thenrealises that the liquid in the pint glass was urine, andthat Lucy urinated in the glass because she couldn’tmove.Barbara is horrified and wants to know where Lucy got themoney to buy drugs and Lucy admits to prostitutingherself in Clissold Park. Barbara is deeply upset butbegins to clean up the mess telling Lucy that she mustnot leave the house, because people will find out the truthand that will only make it harder for Lucy to go back towork. Lucy reveals that her friend and drug-dealer Zac hasdied from an overdose by injecting. In turn Barbaradescribes an incident that just happened in Waitrose,where she feels a Jewish woman judged her for lookingsuspiciously at a tramp.Plot SummarySee? I’m still here. Lots of myfriends do it. Like no one’sinjecting anything. It’s only atiny bit of opium. And I’vehad such an awful day youwouldn’t believe it.LucyScene 1Lucy says that Barbara has to give her money or terriblethings will happen. Barbara asks what taking heroin feelslike. Lucy replies that it brings her calmness and that’s itslovely, that injecting has given her an experience thatsatisfied a longing she has and until today never knewwhat it was. Lucy reveals details about her life: she saysthat she was almost famous and has had a successfulcareer path, but now none of it matters because she nowknows a new completeness. We learn that Lucy hasinjected speedball, a mixture of heroin and cocaine.Barbara tells her she must say how much money sheneeds and must promise never to go to Clissold Parkagain.Scene 4Lucy is on a trolley in the Accident and Emergencydepartment of the Whittington Hospital in the early hoursof the morning. Pete enters, holding some cheap flowers,Resource Pack: The Knot of the Heart8

Plot SummaryLisa DillonPhoto: Keith PattisonWhy has this happened tous? Things like this don’thappen to families like our!Why? Tell me Angela why?BarbaraScene 5telling Lucy that it was easy to get into the ward. Lucywants to come and find him later, but she owes him drugsmoney. Pete wants his drugs back, that Lucy has not paidfor and searches Lucy’s body. Lucy does not know whereher bag and purse have gone. Pete reveals how he thoughtshe was dead and alerted the ambulance. Pete insists therewere two more wraps of heroin with her, although Lucywas unconscious and does know what happened to it. Petepulls a Stanley knife from his pocket, threatening her withit while he feels to see if she has hidden the heroin in hervagina. Lucy is angry but Pete is firm: she owes him £40.Pete says he never believes junkies and Lucy is outraged tobe called a junkie.As Pete threatens Lucy with the knife once more, Barbaraenters. Pete hides the knife and Lucy tells her mother he isfriend who is just leaving; Barbara thanks him for visiting.Lucy asks her mother to give Pete £40 and Barbara asks ifthe money is for drugs. Barbara gives Pete the moneybefore slapping him hard in the face. Pete threatens tostab Barbara if she ever does it again, and Barbara goadshim on – him going to prison would take him away fromher daughter. In this scene can see that Lucy’s drug habithas taken her into a harder world from the ‘social’ usebefore – Pete is tougher and more dangerous than Zac.We learn that Lucy was pronounced dead on admission,and that Barbara lost her husband, Lucy’s father, whenLucy was a baby – she could not bear to lose Lucy. Peteleaves and Barbara drinks some brandy from a hip flask inher bag, Lucy asks for some but Barbara denies her. Lucyand Barbara hug and say that they love each other.Scene 5A few weeks later in Barbara’s house. Angela and Barbaraare talking, and Barbara is drinking red wine. We learn thata whole year has passed since Scene Two, where Angelaleft refusing to return; they have not spoken in-between.Angela tells Barbara that she has had a relationship with aman, but suffered an ectopic pregnancy and that the manleft her two months ago – she feels terrible. Barbara saysthat she loves Angela and regrets saying the unkind thingsshe said previously, but also that she does not understandAngela as a person: Lucy is much simpler to relate to. Sheapologises and the women embrace.Barbara reveals that Lucy has been missing for two weeks,and these disappearances have become increasinglycommon. Barbara fears that Lucy will be found in a gutterand it will be spread across the newspapers, and that herlife will be ruined by this exposure. Angela challenges hermother, asking why and how she loves her; Barbara avoidsan answer. Angela believes that Barbara has never actuallybeen able to love her. She further believes her mother is9 Resource Pack: The Knot of the Heart

Margot Leicester and Kieran BewPhoto: Keith PattisonI want to change mylife. I want to so badly.Please.LucyScene 6out of touch with reality, because she refuses to accept the truth ofhow her father died.At this point, the phone rings and it is Lucy, saying that she needsmoney or her dealer will kill her. She screams and the line goes dead.Barbara is very distressed, convinced that Lucy will end up dead, andshe slaps her own face. She asks Angela what they should do, beforegoing down on her knees, pleading for help and repeatedly slappingherself. Angela believes there is nothing more they can do, that Lucyis better off on her own, because Barbara enables her habit. Barbarawants to know why this is happening to ‘a family like ours’ andAngela makes to leave. Barbara pleads for her to stay; Angelarelents, giving her mother back her wine glass.Scene 6The Accident and Emergency Department of the WhittingtonHospital. Lucy is sitting on a trolley blood running from a cut on herright hand. We see her in a completely altered and dishevelled state:a complete transformation from the beginning of the play. Brian, amale nurse, is attending to her and asks how she has injured herhand. Lucy is clearly under the influence of drugs and replies that shecan’t tell; she also tells him that she has been on television. Briandoesn’t recognise her and says he’ll stitch her wound and send herhome; Lucy becomes distressed by this thought. The nurse askswhere she lives and Lucy does not answer. Brian tells stories of adoctor and two homeless people who are also drug users. He askswhy Lucy is sleeping rough if she is a television presenter and shesays she is staying with some of her millions of friends; she has alsolost her job presenting CBBC’s Animal House, a job she loved. Lucyconfesses that she is in trouble and whispers to Brian that she hasbeen raped. Brian asks Lucy’s permission to make a telephone call toget her specialist help, but Lucy says she wants to leave and not bePlot SummaryResource Pack: The Knot of the Heart10

Plot SummarySophie Stanton and Lisa DillonPhoto: Keith PattisonGet in touch with who youreally are. As opposed to theperson you think you are andwho you think you should be.MarinaScene 7held prisoner, as her mother held her. Brian allows herto go, but she breaks down pleading for help. He asksher to wait while he goes to get the number for a CrisisIntervention team to see if they can help.Scene 73 days later, a basic room in City Roads Drug CrisisIntervention Centre in Islington. Lucy washes and looksat herself in the mirror: she looks and feels better.Marina, a care worker, enters and asks why Lucy did notcome down to breakfast. Lucy says she felt sick,because of the methadone and the smell of fried food;Marina tells her it is important for her to eat, to get herstrength up, and encourages her to socialise with theother people staying there. Lucy says her mother couldbuy her a better room and Marina points out she islucky to have a room at all – and a single room at that –as there are only thirty beds serving all of London.Marina reminds Lucy that she has made an agreementto stick to the rules of the Centre. Lucy does not want tosee anyone else and Marina points out that she hasmore similarities with them than she might realise, thatshe could learn from them. Marina reminds Lucy thather first group session is coming up and she had agreedto attend, but Lucy says that she is ashamed. Marinaquestions Lucy as to why she is here, and we learn thatLucy thinks she would rather be dead, that she has hadevery opportunity and that other people will think bad ofher for throwing it all away. Marina reminds Lucy thatshe called the centre because she wanted to get betterand that she will be safe, that she has presented on TVto millions so can cope with talking to a few people in agroup session. She says she will wait outside for Lucyand go with her to her first session. Lucy thinks for along time, takes a deep breath and walks out of herroom.Scene 8A room in the Crisis Intervention Centre, three weekslater. Barbara is waiting nervously when Lucy enters withMarina. Marina is surprised to see Barbara, asking wholet her in, as she shouldn’t be here. We see Lucy hasput on weight. Barbara has brought some of Lucy’sfavourite childhood food with her: spaghetti bolognaise,macaroni cheese, sandwiches and crisps. She suggeststhe food in this centre could not as good as a privaterehab clinic she suggested in Bath, and Lucy asks hernot to be rude. Barbara has also bought Mr Dog, Lucy’schildhood cuddly toy with her; Lucy does not want it.Barbara hugs Lucy, who is uncomfortable. Marina asksto talk privately with Lucy, but Lucy says it is fine to talkopenly in front of Barbara. Lucy is not keen to returnhome and Barbara tells her that she has invited Angelaaround for the weekend. Lucy announces that she wantsto stay longer; however, Marina points out that she has11 Resource Pack: The Knot of the Heart

Lisa DillonPhoto: Keith Pattisonalready stayed the maximum length of time, and that someoneelse has taken her bed.Barbara encourages Lucy to come home, saying that she hasbought new, more grown-up bedding for Lucy’s bedroom; welearn that Barbara hasn’t driven but has come in a cab whichmakes Lucy suspicious. Barbara confesses to feeling like a badmother and Marina recommends some family support groups.Barbara dismisses this but says that she has arranged for amasseur and a craniosacral therapist and booked a weekendhealth spa for them both, with Angela. Lucy asks her motherfor absolute honesty and Barbara confirms that there are nosecrets between them. Lucy says to Marina that her stay inthe Crisis Intervention Centre feels like a lifetime – rather thanthe three weeks it actually was. Marina says that Lucy shouldbe proud of what she has achieved: she hopes Lucy does nothave to return.Scene 9Lucy is speaking to Dr Harris, a consultant psychiatrist, in theDrug Treatment Centre at the Whittington Hospital: this is herannual review. Dr Harris has a thick folder containing Lucy’snotes and makes notes through their discussion. Lucy is atfirst reluctant to speak to him as he is not her usual doctor, ashe is away. We learn that Lucy is taking methadone, livingwith her mother and smoking cigarettes, although she hasn’tinjected for about 18 months. About one a month she smokessome heroin, which her mother buys for her and gets bymeeting her dealer in a café on Upper Street. We learn thatLucy has had Hepatitis C and just finished a six-month courseof Interferon and is waiting for a final blood test to confirmthat the disease has gone.Plot SummaryI am tired of this life. I amtired of getting clean, lapsing,getting clean, relapsing,getting clean and relapsing. Iam on the road. And I am notgoing back. I am never goingback. I want to detoxcompletely.LucyScene 9Lucy is very hostile towards the doctor, often being very rude.She wants to stop the methadone and get back to work, asshe is bored of her life and wants to be a normal personagain. She insists that she wants to be clean of all dugs by thetime she is thirty next year. Lucy last had a relapse six monthsago and Dr Harris advises her to take things slowly and buildon the stability she has found – it is too early to attempt atotal detox. Dr Harris asks Lucy why she is so angry andreveals that she has also been self-harming. We learn thatLucy has been suffering from depression for a long while. Lucysays that her mother is convinced that human touch can healLucy. Since Barbara sacked her masseur, who had been givingLucy cannabis, she has been massaging Lucy’s feet,something Lucy hates. Lucy says she imagines her mothereating her, starting with her feet, as a way of taking her backinto her stomach. Lucy is sure that the drugs, including themethadone, are doing this and if she was completely cleanshe could get rid of these thoughts. Lucy says she hasdecided to stop everything and Dr Harris says that he cannotadvise such a risky course of action.Resource Pack: The Knot of the Heart12

13Plot SummarySophie Stanton, Lisa Dillon and Margot LeicesterPhoto: Keith PattisonScene 10We are back at City Roads Drug Crisis Intervention Centre. Barbara, Lucy and Marina are together in aroom, as Lucy states that she is not returning home to her mother but instead is going to a hostel.Lucy has sent Barbara a letter saying that she wants to stand on her own two feet. Marina says thatLucy’s care worker will visit the hostel to help her. Barbara tries to understand what she has donewrong and reminisces about what a brilliant little girl Lucy was. Marina explains that after Lucysuddenly stopped taking her methadone, she had a significant relapse and that coming home iscurrently too much to deal with. Lucy is afraid to come home because Barbara will do whatever shewants, including bring her drugs. Barbara is still concerned with how Lucy will get back to work, aspeople will know she is living in a hostel. She asks what she should have done differently: by bringingher daughter drugs and clean needles she was protecting her from the dangers of dealers and crime,that when she had found her smoking cannabis at 13 she didn’t want to get her in trouble or push herbehaviour onto the streets. Lucy makes her mother promise that if she comes home she must neverenable her habit ever again, no matter how much she pleads. That she must always say no.Scene 11In a quiet corner in a café on Upper Street, Lucy meets Andrew, who is posing as an agent. We learnthat Lucy is no longer with her previous agent and Andrew flatters her saying that he used to love herpresenting on Animal House. Lucy says that she really misses working. Andrew has suggested that hemight have some work for Lucy but he has heard that the Executives at the BBC covered somethingup about the circumstances of her leaving, that he knows she had some sort of a breakdown. In orderto work together he needs her to be honest. We learn that it’s been over three years since the incidentat the BBC and Lucy reveals to him that she has been going to Narcotics Anonymous (NA) and thatshe has had a problem with drugs, which was what the BBC has covered up. We learn that the personwho covered up her drug use is now in charge of Children’s television at the BBC. Andrew challengesthat her addiction is not a real illness but just a dirty habit, and Lucy suddenly realises that he is notwhat he seems: far from being an agent offering to help her find work, he is actually a reporter from atabloid Sunday paper looking to get a juicy story. She is furious and throws her drink over him beforeleaving.Scene 12A few weeks later, a quiet Tuesday night in a bar in Islington. Lucy is meeting Angela as part of herResource Pack: The Knot of the Heart

Abigail Cruttenden and Lisa DillonPhoto: Keith PattisonNarcotics Anonymous programme, in an effort to makeamends and apologise for what she has done. Lucy hasbeen going to church and exploring other faiths. Throughthis she found a Sanskrit phrase about ‘the knot of theheart’, which must be broken in order to enable true selfknowledge; it means a lot to her.Lucy remarks that she thought they would both havechildren by now and that when she was little Angela gavethe best cuddles, much better than their mother. Lucyapologises for all she has done and gives Angela a longletter of apology, starting with the incident where Angelacaught her trying to steal from her purse. Angela does notbend. She says that it started way before then and that shehas no intention of meeting Lucy again after thisoccasion. Lucy describes having seen Angela cut herselfwhen she was ten and Angela was home from Universityfor the weekend, and that she knows that Angela is stilldoing it and has done it that evening. Lucy says she issorry that she saw her, and that she learned what to dowhen she was sad. Lucy does not want to attract attentionby making a scene in the bar; Angela asks if she fears forthe story being in the newspapers.Angela wishes Lucy’s drug use had come out three yearsearlier, to shame Lucy into stopping. We learn thatBarbara has spent half a million pounds of her ownsavings and accumulated another quarter of a millionpounds in debt, all consequences of Lucy’s drug use. Lucywonders how the press humiliation and scandal hashelped anyone and reveals that she knows her career isover. Angela wonders if their career choices were evertheirs, suggesting that their mother told them who theywere.Plot SummaryYou know in Sanskrit there’s aphrase Hridaya-ghranthi. Itmeans the knot of the heart.It’s meant something to me.The knot of the heart must bebroken. In order for selfknowledge.Enlightenment. I’vecome to realise a heart iseasier to break than a knot.LucyScene 12Angela then admits to calling the newspaper, tired ofplaying second fiddle to Lucy, especially while she seemedintent on killing herself. She apologises if she has madethe last few weeks difficult; Lucy thanks her for telling thetruth. The sisters then admit to having missed each otherand wonder why their family seems so messed up. Lucyfeels it is all her fault and Angela tells her that there issomething else, something that is not talked about, that itis time she knew about: the true circumstances of herfather’s death.Scene 13The garden of the family house in Gibson Square. Lucy isdrinking red wine and smoking, Barbara is gardening.Lucy announces that she is leaving. Barbara feigns not tohear and talks about the garden. They tell each other thatthey love each other. Angela has been handling Barbara’sdebts; Barbara says that the house is going to be sold topay for their debts. Lucy says she will find a way to pay hermother back. Lucy will not wait until the house is sold toResource Pack: The Knot of the Heart 14

15Plot SummaryLisa Dillon and Margot LeicesterPhoto: Keith Pattisonleave. Barbara asks if the need that Lucy had once talked about was actually the need for a father, butLucy says it isn’t. Lucy describes experiencing paralysing nerves before going in front of the televisioncamera and the need to be perfect for her mother, the fear of letting her down. She says that therehas always been a part of her that wanted to destroy things and that the heroin quietened that. Lucysays that while detoxing from heroin has never killed anyone, detoxing from alcohol quickly can killpeople. She then confesses that she knows how her father died, of how Barbara threatened to leavehim if he didn’t stop drinking, as Angela told her. Her father was addicted to alcohol and had aseizure and died from a heart attack by stopping drinking so quickly. Angela found out from thefamily doctor and Lucy asks if this is why Barbara was too afraid to stop her using drugs. Barbara saidshe wanted to stop any darkness in Lucy’s life and love her enough for two parents.Lucy feels that Barbara turned Angela away from her; suddenly Barbara throws her wine over Lucy,before apologising. Barbara emphasises her own need for love and insists she tried to do better withLucy than with her father. Lucy says she is not sure if she will see her mother again, that if she said itwas just a break she would have to come back and she’s not sure that is the best thing. Lucy saysshe is angry with them both for hiding the truth about her father; she knows her mother has tried todo her best but now needs to go. Barbara feels that it was her fault that Lucy’s father died andtherefore did not want to burden her daughters with it. Again, they confirm their love for each other.Lucy reveals that she is moving to South Africa, that Angela has given her some money to go and seewhat she can find. Barbara remarks on how ‘extraordinary’ Angela is, and Lucy asks her mother to tellthat to Angela.Scene 14The top of Table Mountain, Cape Town, South Africa, some weeks later. Lucy is looking out acrossthe ocean towards Robben Island when she is joined by Oscar, who is South African. He tells her thehistory of Robben Island and asks if she would like to visit. Lucy feels that South Africa is the closestplace to heaven she can think of, and that she is glad she came: like her, it is a place trying to find anew beginning despite its past difficulties. Oscar too is pleased that she came, as otherwise he wouldnever have met Angela, and they are now together. Angela appears and she and Oscar kiss. Lucy asksabout their mother and Angela tells her she is fine. Angela asks Lucy if she is OK and, after a pause,Lucy replies confidently: she says she is, and she is content.Resource Pack: The Knot of the Heart

DesignAlmeida Theatre - empty stagePhoto: Lara PlatmanA BRIEF HISTORY:The Almeida Theatreseats 325 people, andre-opened in 2003after extensiverefurbishment. Thebuilding dates back to1837, and wasoriginally the IslingtonScientific and LiteraryInstitution. During thewar it was used as aSalvation ArmyCitadel, and was latera toy factory, before itwas converted into atheatre in the late1970s.Design is one of the most thrilling aspects of theatrecraft. The look of a show helps to set mood,atmosphere, time and place. Design elements forany production include set, lighting, sound andmusic.At the Almeida Theatre the set design is the first and last thing theaudience sees. As soon as the audience enters they can see the setand this, together with any sound effects, or music, will begin todetermine how they will experience the production. This initialimpression helps to set the tone for the story to come.The designer, therefore, has to consider what impression he wantsto make on the audience before the play begins. The designer willlook for clues in the play text and will liaise with the director andthe playwright about these.There are also practical considerations for the designer, such ashow big the stage is; what kind of flexibility is required in terms ofentrances and exits; and whether the play is set in a specific timeperiod. The designer often has to be very creative designing a setwhich calls for several different locations.Designing for the Almeida TheatreThe Almeida Theatre was not purpose-built as a theatre so doesnot have the specialised architectural features which typify mostpurpose-built performance venues: a flytower, orchestra pit, wings,offstage area (indeed our ‘back stage’ is actually ‘sub-stage’ in theexcavated basement directly below the stage floor). This meansthat our designers and production teams have to come up withingenious solutions to create innovative sets in our ‘found space’.The building is famous for its large curved brick wall at the back ofthe stage. This feature of the building is used as part of the setdesign for many of the Almeida’s productions. Even when theactual wall is not visible in the set, the brickwork is often echoed asa feature in the design.Resource Pack: The Knot of the Heart 16

DesignThe Knot of the Heart is designed by Peter McKintosh.The Knot of the Heart Model BoxThe Knot of the Heart places immediate challenges for the Almeida Theatre stage because of itsmultiple locations. The play takes place in a variety of locations, of vastly different characteristics: fromthe family home (a Georgian townhouse in Islington’s Gibson Square), to City Roads Drug CrisisIntervention Centre, to hospitals and clinics and ultimately to the top of Table Mountain. With theAlmeida’s lack of wing space and flying space (sides and above stage respectively), the best solution isto use a revolve – a mechanism that rotates the stage enabling multiple locations to be presented inone set structure.The revolve is a circular shape and on top of that sits the set, divided into three distinct areas, each adifferent size. The largest takes up roughly half the stage, a semi-circle, the second and third divide asemi-circle into smaller and larger sections. These create different sized rooms which fit both thelocation and the emotional action of the play accordingly. So, for example, the play opens in the large,open playing space, which is then the garden at the Gibson Square house. However, in the followingtwo scenes, as Lucy’s drug habit descends into hard addiction, we move to smaller and smallerspaces, echoing the closing-in of Lucy’s world. Similarly, the treatment room at City Roads is madefrom the smallest space, and Table Mountain returns to the expansive half-stage layout.To enable the plausibility of multiple locations to be at its optimum, the construction and design of thewalls of the set have been kept very simple, with clean lines. However within this, selected realisticprops are carefully chosen to indicate location: garden chairs in the first scene, a hospital bed, thefunctional chairs of a doctor’s clinic or the floor cushions of an Islington townhouse. Because the playis set in the present day, we can pick up on the location easily with only a minimum of details. Thisbrings to mind the dual impression that minimalist decoration can bring, depending on context: it canbe an indicator of both artfully sparse luxury but also cold clinical sparseness. As the revolve turns,stage management will re-set a scene to create a different environment, ready for the next scene.The bare back wall of the Almeida is visible but covered in ivy; this gives the impression of the outsidewall of an old house, suggesting a wealthy sort of property, common in Islington, bringing back thevery local focus. However, the ivy itself may symbolise the enveloping power of addiction over thefamily’s life – ivy as a fast-growing plant that can cause serious structural damage particularly to wallswith existing weakness, and a plant that draws life and nutrients from other organisms growing nearby.17 Resource Pack: The Knot of the Heart

David Eldridge in rehearsalPhoto: Matt HumphreyDavid Eldridge is a British playwright,born in Romford in 1973. He has beenwriting for theatre since 1995.David Eldridge was born in Romford, Essex, in 1973.He grew up in Romford, educated at a localindependent school whilst also working his weekendsselling shoes at Romford Market. He went on to studydrama at Exeter University, where his love of theatrewas nurtured and he was drawn to writing.David Eldridge began writing whilst still at universityalthough he came into public note aged just 22 withhis play Serving it Up at the Bush Theatre in 1996.Since then, he has written a new play or more everyyear and his work has been presented at many off-West End theatres in London as well as the NationalTheatre and West End, with his production of Festentransferring to Broadway. He has also written widelyfor radio. As a writer, Eldridge’s drama often exploresfamily life, with a trademark of truthful, realisticdialogue and sharp social observation. Both Festenand M.A.D. explore the family dynamic, whilst many of his other works such as Falling and SummerBegins look at the intricacies of everyday life through the theatrical form. His play Market Boy takesreal life experience as its inspiration, being informed by his childhood working on a market stall inRomford. He has also adapted a number of works for the stage, particularly Ibsen.The Knot of the Heart sees Eldridge once again place family relationships under the microscope, witha closely observed, brazenly truthful account of one family’s co-dependency and damagedrelationships.David EldridgePlays include:1995 Cabbage for Tea, Tea, Tea!Sideways MovingFighting for Breath1996 Serving It UpDirtyA Week with Tony1997 Summer Begins1998 Thanks Mum1999 Falling2000 Under the Blue Sky2004 M.A.D.Festen (adaptation of the Dogme film)2005 Incomplete and Random Acts of Kindness2006 Market BoyThe Wild Duck (adaptation after Henrik Ibsen)2007 John Gabriel Borkman2009 Babylone(adaptation of Rue de Babylone by Jean-Marie Besset)The List2010 A Thousand Stars Explode in the Sky (written with Simon Stephens and Robert Holman)Lady from the Sea (adaptation after Henrik Ibsen)2011 The Knot of the HeartThe Stock Da’waResource Pack: The Knot of the Heart18

Interview: David EldridgeAlmeida Projects spoke to writer David Eldridge about his ideas and inspirationfor The Knot of the Heart, and his experience of creating the play for theAlmeida Theatre.Almeida Projects: What inspired you to write The Knot of the Heart?David Eldridge: Well I knew a little bit about the emotional impact of substance abuse on a family soit's a subject that I could write about if I chose to. The subject mattered to me. But the person I knowwho has struggled with heroin, has led a life quite similar to the stories we've seen a million times onstage and screen before. That is poverty stricken, parents not around, prison etc. I thought it wouldbe much more interesting to tell the story of someone who seemingly has all of life's advantages andfrom a middle class background struggling with serious addiction. Of course the play isn't reallyabout addiction. I think it's about a mother and a daughter and the conditions of love. And it waswritten for the actress Lisa Dillon. She was the trigger really.The play started life as a conversation with Lisa Dillon. I wanted to write something for her to do andshe said she'd love to play a leading role and ‘get to go on a journey like the boys get to go on’. Lisaalso mentioned a role ‘not defined by its relationship to a man’. I got the idea of writing somethingset in the world of addiction, and also the image of a middle class mother-daughter relationship hadbeen gnawing at me. I needed to research quite a lot in to the world of treating addiction. I relished itthough, and met some very special people in the hospitals, drop-in centres and refuges along the way.I suppose with Lisa I had an inkling of how I might push her acting in to an interesting andchallenging place. And in the process of writing something which challenged her I pushed my ownwriting in to a place I never expected to go.AP: When writing a play do you always have actors and a theatre in mind?DE: I think of actors a lot. Sometimes I just like to have a face in mind, sometimes I like to hear avoice, sometimes I imagine a particular actor very vividly. I think it helps when you're writing forperformance and I think many other writers agree. Shakespeare wrote for Burbage and Kempe,Chekhov wrote for Olga Knipper, Simon Gray for Alan Bates, Simon Stephens for Daniel Mays.Sometimes I have a theatre in mind. When I do, I imagine myself sitting in the middle of theauditorium as I write.AP: The play features many locations close to the Almeida. Why did you want to set the play inIslington, and why were you drawn to write it for the Almeida Theatre?DE: The Almeida has great intimacy so it's perfect for a story which reflects upon the humancondition, but I was also interested in challenging the Almeida's regular audience. I often think that indrama as in life it's best to be specific. I find a writer more often manages to touch on the biguniversal themes that move and challenge an audience by writing in a detailed and specific way. Forme location and place is always very important and I try achieve that sense of place in great particulardetail. I had a story to tell, but once I knew the Almeida wanted to commission it, then I decided toset the action of the play almost entirely in Islington and adjacent neighbourhoods. This is partlybecause I wanted the audience to feel stories like Lucy's are happening all around them. To try andget them to see Upper Street through new eyes when they leave the play. I also wanted to inculpatethe Almeida's generally quite affluent audience a little. To reference a line in the play: Stories likeLucy's do happen to people like them.AP: The play is rooted in a highly realistic, local portrayal of the area. How true to life is it?DE: I think the play has great veracity and is a highly accurate distilled version of one journey throughaddiction. But it's not documentary theatre. It's a play. Its highly theatrical. It's about the heart muchmore than it's about social issues. It was crucially important to me though to portray the19Resource Pack: Becky Shaw

Lisa Dillon in rehearsalPhoto: Keith Pattisonprofessionals who work in the area of drugs treatment accurately. I think it's not just the documentarymaker but the artist's responsibility to get things right if you're trying to create a realistic fiction. I'mproud the script has been checked by doctors and care worker's for accuracy. It was much more scarygiving the play to them to read than it was delivering the commission to the Almeida!AP: You no longer live in London. Is The Knot of the Heart London-based for a specific reason orcould you have set it anywhere else?DE: It’s London based because of the world Lucy moves in socially as a TV presenter. As I said beforeit's important to be specific and I know Islington, Holloway Road and Archway very well. I neverthought about setting the play elsewhere once I knew I would write it for the Almeida. I think thethemes the play explores are universal. Everyone understands the difficulties and joys of a parent-childrelationship either from the point-of-view of a parent or a child. I suppose where a difference lies isthat while parents often feel their love for their children is unconditional and unchanging, a child mayoften see the love for their parent change and shift as they become an adult.AP: What has your involvement in the rehearsal process been?DE: In the first week, I was there all the time. After that I've come backwards and forwards betweenwhere I live now, in north west England and the Almeida. But even if I'm not there every day, I keep intouch, speaking to Michael Attenborough and Lisa Dillon regularly and reading rehearsal notes eachevening. I think the writer's role in rehearsals varies dramatically. I think young writers should be thereas much as they can so they can learn. I think all writers should take time out in the middle whenactors are focused on learning lines. Sometimes you rewrite a lot and are needed to work a scene.Other times, after the first week, you find yourself at a loss and end up making a good contribution inother ways. Many is the time I've ended up making the tea as rehearsals progress. A few years ago Iseemed to spend the final week going out to buy a heart-broken actress chocolate, to keep her happy.Interview: David EldridgeResource Pack: Becky Shaw 20

Interview: David EldridgeAP: How long does it normally take to write a play and was The Knot of the Heart typical of thisprocess?DE: For me there's normally a long, pre-writing, gestation process of anything between a year and alifetime... For example, I've written a play this year for another theatre I've wanted to write for, forabout thirteen years! It's a period when I have an idea that won't go away, and I begin to feel my wayin to exploring it theatrically. It's also a time when I undertake research, read a lot and make notes.Physically getting the script down on to paper is normally a process I try to relate to the energy of thestory-telling and the structure of the play. For example my Royal Court play Under the Blue Sky waswritten in three weeks, taking one week for each of its three acts. The Stock Da'wa which playsHampstead Theatre later this spring was written in four days. I didn't get much sleep, but it wasimportant to write it that way, as that play is one continuous action, set in one room, and theprotagonist hasn't himself slept for a couple of days. The Knot of the Heart was a play I thought aboutfor year, and then got down to in August 2009. There is a chronological lapse of one year between thetwo halves of The Knot of the Heart, so when I physically wrote it, I took a few weeks over the first half,had a month away from the script and took a few weeks over the second half.AP: What environment do you find conducive to writing?DE: I'm very particular as I've got older and work off routine. On a writing day, I'm up at about seven. Ishower, read emails and surf the internet. I listen to The Today Programme and read The Guardian,while I eat my porridge. And then I walk my dog, Rascal, for about forty-five minutes. That walk iswhere the working day begins. I think about the script I'm working on and what I want to try toaccomplish that day. I suppose I normally get to work at my desk at about nine-thirty and try to keepgoing, taking a short lunch, until about 4pm.AP: What advice would you have for young playwrights wanting to get into writing for theatre?DE: Write whatever you like, just follow your passions. Read a lot of plays. See as much liveperformance as possible including theatre, dance, comedy, opera, live art, anything really. Enter yourwork for competitions, as it's how you get noticed, and look out for young writers schemes offered at anumber of theatres. But the most important piece of advice is to remember the life of any writer(including me) involves a lot of rejection. So you have to be prepared to keep the faith and keep going!AP: What would you like audiences to take away from the play?DE: I want audiences to see the world through slightly different eyes after seeing my play. The nexttime an audience member sees someone who is a homeless junkie, they remember the beggar is aperson, who has a story, and not necessarily one we expect. I'd like my audiences to consider theimportant relationships in their life. How the love, even between a parent and child, is not alwaysunconditional as it seems, and that a surfeit of love can be as problematic as a lack of love.You need to put your energy into what’s next, not whatcame before Lucy. None of it matters any more.MarinaScene 821 Resource Pack: Becky Shaw

In the Rehearsal RoomMichael Attenborough, Abigail Cruttendenand Lisa Dillon in rehearsalPhoto: Matt HumphreyAnd God darlings I did drugswhen I was young. It was thesixties. Don’t you think I wish Ihad done things differently?But I am only trying to do mybest. But whatever my best is itis the wrong thing.BarbaraScene 10It’s about the writer, who more often than not, will behearing their play read aloud for the first time, which iscompletely nerve racking for them.’ I’m suddenly awarethat we are all in this first day together. We are all feelingthat sense of not knowing what is to come and inknowing that I relax.The read through brings to life the words that already inmy opinion were powerful, heartbreaking and brutallyhonest. Excitement begins to build as I hear the voicesof the characters speak for the first time. I particularlysee why David wrote the role of Lucy for Lisa. Even inthis first reading I’m utterly mesmerised by herconnection to this woman’s decent into drug addiction.I’m profoundly moved by the play and utterlyembarrassed that tears fill my eyes on Lucy’s finalwords.Of course it is only the first reading and there is certainlya way to go before these actors are ready to tell thisstory to an audience. It’s inevitable that there would bethe odd moments of clumsiness, silences that areobserved almost religiously but what a fantastic cast wehave and I can’t wait to see the journey they go on andthe choices they make with these characters.The rest of the week begins to unfold rather quickly. Thenext day designer Peter Mckintosh shows us the modelbox: a scaled-down version of what the set will look like.This is one of my favourite parts of the process as gooddesigners can really bring the spiritual, unseen,unspoken world of the play to the physical realm. Petercertainly does this with the set. It’s designed on arevolve allowing the flow of time that is depicted on thepage to be seen effortlessly. It’s also a very sleek design.23Resource Pack: The Knot of the Heart

It has neutrality that allows us to go to many placesand it’s sense of space almost mirrors that of thewriting.By the third day we are well into working around thetable. Michael has already laid down the rules of thisway of working in his comment on the first day: ‘Noquestion is too stupid.’ So we go through the scriptscene by scene breaking down lines, relationships,deciding on histories of characters, even discussingthe practicalities of drug taking. This week has alsohad us immersed in the world of addiction and drugtaking and the amount of research that both Michaeland David had done on the subject was vast. We nowhad a research table that was filled with photocopies,books, newspaper articles and the like and we hadbecome like sponges soaking it up.I must say that by Friday it had become anoverwhelming feeling. We had seen and read sometraumatic stories, we had unpicked some of thedarker things within this play, there had been tears,laughter, secrets shared and by the end of the week ithad become very apparent just how open andtrusting of one another we would need to be in orderto honour this play.Next week begins to get this story on its feet and Ilook forward to seeing just how the cast take thathead knowledge, research and life, stick it in theirback pockets and free themselves up to becomethese characters.Week 2It’s a Monday morning and I’m watching actress LisaDillon in a rather perfunctory manner roll up a pieceof foil as she goes through the motions of replicatingchasing the dragon (smoking heroin off tin foil).Meanwhile Margot Leicester sits next to her, almostoblivious, fiddling with the binding on her script andI can’t help but smile at what is considered normalbehaviour in a rehearsal room.The rather imposing table has now gone from thecentre of the room and has been replaced withcoloured tape marking out the stage along the floor.As this play is set on a revolve, there are threedominating sections that the scenes will occur in andthese sections are now referred to as green, orangeand yellow. The first scene is in green and involvescharacters Lucy and Barbara sitting out in the gardenas Lucy has something to tell her mother. Much ofthe challenges faced in this scene were simply howand where lighters were going to go and whethercigarettes were to be stubbed out on the floor or notand what exactly happens to opium as it is meltedKieran Bew in rehearsalPhoto: Matt HumphreyEverything else is backgroundnow. Tap and modern andballet, horse-riding and learningto play the flute.LucyScene 3In the Rehearsal RoomResource Pack: The Knot of the Heart 24

In the Rehearsal Roomonto foil and if in fact the foil being used was large or deepenough for heroin. These conversations went on for the bestpart of an hour, with Michael allowing actors to go over thingsfor as long as was necessary. It’s occurring to me that whilstthis piece is very conversational in nature, the physical actionthat is there is so considered, so real and often so crucial tothe story being told that the actors have to get themselves asaccustomed to these physical transactions as they would theirlines.I watch Michael in the rehearsal room and see the ease atwhich he works. There is a real sense of letting the actorsmake choices. He does not dictate but suggests, gentlydrawing more from them as he delves deeper into the wordson the page. Immediately I notice that he is a director thatfocuses on the specifics of a scene. There is always more tofind, more to uncover and there is never any sense of thingsbeing hurried (although the control freak in me wonders if thispace can be maintained). There is also a balance betweenunderstanding what the actors need in order to feel connectedbut also a commitment to telling the audience what they needto know. It is the first time I hear the words, ‘in terms of thestory of the play,’ but it is certainly not the last and very soon itis coined as the director’s mantra (or Michael’s mantra at thevery least!).Abigail Cruttenden and Lisa Dillon inrehearsalPhoto: Matt HumphreyMy mother meets mydealer in a little café onUpper Street. And youknow she sometimes buyshim a cake. Apparentlyhe’s fond of meringues.LucyScene 9The actors are still unpacking a well of information this week.It’s one thing discussing things around the table, but nowtelling that story physically means some of the things thatwere discussed in theory have to be re-examined practically. Isaw this negotiation come up particularly whilst standing25Resource Pack: The Knot of the Heart

Sophie Stanton in rehearsalPhoto: Matt HumphreyI’ve seen a thousand girls likeyou in my time here. Feelinglike the world is coming toan end. And it’s hard but –But when they’ve thedetermination to effect achange in their life and gofor it they do Lucy.MarinaScene 8scene 2 on its feet. It involves the entire family of womenaround the kitchen table, each of them struggling forpower, each of them trying to protect something, orsomeone, and it’s fascinating to watch. A bulk of thework on this scene seems to be about blocking- whogoes where, who moves, who sits, who stands etc but itis not choreography. Things need to be specific becauseof this huge table as a centre piece, but what becomesgreat is how all these physical choices around it,highlight just how each woman fights to be heard. At onepoint Lucy thrusts her entire body over the table to taunther sister. She is childlike in her action but underneath, ithas a deliberate and manipulative intention.This week also brought Kate McKenzie to our rehearsalroom, a woman whose young daughter has been battlingwith heroin addiction for over 7 years. Before her arrivalwe had watched her in a cutting-edge documentary calledMum, Heroin and Me. Not unlike Barbara in the play,Kate is a middle-class woman who has two daughtersand so her presence must have been particularlyinvaluable and probably somewhat overwhelming toMargot who plays Barbara. Kate enters the room andthere are the usual smiles of strangers meeting for thefirst time. But as she tells us of how her life hascontinued since we saw her story on the documentary,there is candidness and the veil of a woman who is allcried out. Her humour is black and we hear some hardthings about the degradation drugs bring to her life. Mystomach turns and I feel irritated that I want to cry andrefuse to do so when this woman who has experiencedher own story first hand is a rock. Her being there reallybrought the reality of this play to the surface for me.We are also visited by a force of nature called Maria whois the manager in a crisis intervention centre called CityRoads. It is about a ten minute walk from the AlmeidaTheatre and it is the actual centre that character Lucygoes to in the play. Maria talks without any bitterness orcynicism of how she sees addicts come and go, many ofwhom continue in the cycle of addiction. She talks ofthose nuances and the dulling of the senses that causethe addict to appear sluggish. By the end of the week Iam seeing this sluggishness begin to manifest itself inLisa’s performance. At one point she stood probablyunaware in the room, her arms practically stuck to hersides, and I saw these glazed-over eyes. It was likelooking at some of the addicts we had seen indocumentaries in the first week and to be honest it waschilling.In the Rehearsal RoomBy the end of the week I hear one cast member state itperfectly: ‘Last week it was our minds being unzipped,this week it’s our hearts.’ I wonder if next week there willbe anything left to unzip!Resource Pack: The Knot of the Heart 26

In the Rehearsal RoomWeek 3I’m starting to feel the affects of life-long insomnia and food on the go and in my bid to stay alert Idrank my first cup of coffee in ten years last Monday, followed by more and more right through tillFriday. This week my mind is urging me to reach for the pot again. Just one cup, the devil on myshoulder is saying and the irony of the possibility of battling with a caffeine addiction whilst working onthis show is not lost on me.Resisting temptation, I sit in on a production meeting at lunch time with Michael, wondering where hegets his energy from. The production meeting consists of the stage management team, the designer,wardrobe and the likes, who pretty much use this time to talk through the physical needs of the play.The energy they bring to the room is completely different, it’s like a new shared language is beingspoken and it’s particularly noticeable after spending an entire morning with the actors. Michael speaksthis language too- it would seem, fluently. He has a different edge with this team. Everything is faster,blunter almost. They talk about the set and solve problems with how it is to be positioned in relation tothe audience. Also prosthetic hands and blood consistency are dropped into the conversation –someone asks, ‘should it be congealed, dry or dripping?’ There is a sense as Michael lists off his wantsand needs for the show, that this team can do anything: ‘a Boeing 747 flown in during the interval yousay, Mr Attenborough? No problem!’The actors are also making strides this week and are beginning to work off book. It’s a relief really assome of the action in this piece is so intricate that having the script in hand whilst trying to navigate themoves was becoming a noticeable frustration for them. But with actors off the book, one frustrationends as another begins: learning lines!It’s a difficult transition as much time has been invested in talking through the action, the thoughts andrelationships and so the very mechanical action of just going through lines and learning them verbatimcan sometimes feel at odds with this. It’s really this time when actors need to trust the script and that‘round the table’ process the most, and it’s this time when the layers of the process become veryevident. We’ve gone seamlessly from keeping the play in the head and in conversation, to tentativelystanding things up- encouraging the thoughts into the body and now the stripping of the script is a newjolt to the actors process that adds another challenge to the work.Michael is adept at talking actors through their objectives and intentions even at this point, subtlyreminding the cast that the line is found in the thought. Scene 11 sees this working successfullyparticularly with Kieran Bew - the only member of the cast with a Y chromosome. It’s a strong scenebetween him and Lisa and I am very relaxed watching him effortlessly play his objective. I see anaudience really enjoying this scene, especially the connection between the two characters - both wantingsomething from the other and both needing to appear relaxed and charismatic, even flirtatious to get it.The writer, David Eldridge also joins us briefly in the rehearsal room this week and after leaving us toget on with it throughout week two, it becomes perceptible that it’s a bit of a big deal that he’s back inthe room - not to him, of course, as he is delighted at what is being accomplished but this is a teamwho are working very hard each day to honour his words and so I suspect that there would be an everso slight tensing of the shoulders as he observes. David sits next to me as he watches Lisa and Abigailwork through Scene 12 and I notice he is at the edge of his seat. He watches actively like a football fanengrossed in a game on TV that his wife has told him to put on mute because it’s late and she’ssleeping. So he’s quiet, composed even, but beneath the surface this must be huge: seeing these wordsthat were once in his head not only off the page but now coming to life in the rehearsal room. It’s arevelation for me as I realise that this play is David’s baby and for a season he gives it over to Michaeland the actors whom he is trusting to bring the child up. Before he leaves his words confirm he is happywith how his ‘baby’ is being reared. I think the scene will be great he says. Perhaps the shoulders releasejust a little now!We also welcome another guest in the rehearsal room- Dr Owen Bowden-Jones who has worked closelywith David and Michael in providing a medical voice for the play. He sits with us to talk about the27Resource Pack: The Knot of the Heart

Margot Leicester in rehearsalPhoto: Matt Humphreyphysical and medical implications of somebody addicted to heroin.It’s a relief that he is there as we have pages and pages of questions to ask. It’s especially like golddust to Lisa and Kieran who both play addicts in the play and therefore need to know the answers toso much. What is the physical reaction to taking a hit of heroin? What happens when an addict startsto cluck? What would a user start to look like after years of abuse? Dr Owen answers these questionswith clarity and with insight that engages us all. We are in the room still talking hours after rehearsalsend and I am very aware of my ever-changing views about drug use whilst being a part of this project.Whilst David has not written a political play, one cannot help but notice that we all take a politicalview when it comes to the use of drugs. I still can’t conclude what my politics are but what I amconvinced of more and more is that this problem, currently part of the criminal system, is absolutely aproblem of health. Dr Owen talks of addiction in general, about predisposition, about genetics andeven about the frontal lobe of an addict. People who are prone to addiction have different shapedbrains he is saying . They are more likely to be impulsive or anxious... I think I stop breathing at thiscomment. I ponder at my own impulsiveness and start to think about my relationship with food.Suddenly, rejecting coffee this week seemed like a good idea.Again there is the feeling of a part of us within being unzipped. Something that this rehearsal processhas been doing constantly. I am not sure if I signed up to face my own personal demons here but Iam certainly fascinated by the concept. And if that’s what is going on with me, I can’t help but wonderabout the well of emotion and reflection that is going on within the cast.In the Rehearsal RoomWeek 4This week Michael has gone back to the beginning of the play, working through scenes at a quickerpace so we are getting much more of a sense of how things flow. This doesn’t stop him howeverfrom completely doing away with an idea, or adjusting, or even completely changing the blocking of ascene if needed. Just as I think we have found everything that could be found in a given moment orthat we’ve cracked it, Michael will go silent for a moment. Usually when he re-emerges, he will havesuddenly got a revelation about a particular line and how the delivery should be completely changedor how having the actress standing instead of sitting will raise the stakes. The control freak in me hasResource Pack: The Knot of the Heart 28

In the Rehearsal RoomLisa Dillon in rehearsalPhoto: Matt Humphreydecided to relax and go with the flow.I see this happen especially with Scene 10. Lucy is at the City Roads crisis centre and finds that hermother is there uninvited. This is almost a parallel to a previous scene in the play but as Lucy haschanged, there is an exposing light over the mother daughter relationship that I can see Michael istrying to pull out. The blocking has Lucy physically stuck a lot more, with moments where she is quiteliterally stuck between a rock and a hard place (Marina being the rock and Barbara the hard place!).It’s very freeing and indeed does raise the stakes for Lucy who is trapped between these authoritativefigures emotionally and now physically too.Margot also gets a bit of a treat this week as we are visited by fight director Bret Yount (although I’mnot sure ‘treat’ is quite the word she would use). At one point during the play Margot’s characterBarbara has to slap a drug addict who is harassing her daughter for money. Bret’s job is to make thisslap believable for an audience whilst keeping it safe for Kieran, the recipient of this honour! Margot isclearly not comfortable with violence (even the fake kind), and at first struggles to take ownership ofthe action. It’s absolutely choreographed and everything from the angle of Margot’s body to where onKieran’s face she should aim, to the cue word that would signal the slap, is marked precisely. Thismechanical approach can really take an actor outside of their character for a moment and Margot hasto remind herself of the circumstances that lead to this moment. Once rehearsed a number of timesin the context of the scene, she starts to own the moment more and I even wonder if she’s secretlystarting to enjoy smacking Kieran about a bit!In other news, as Lisa Dillon is currently performing in another production simultaneously with thisone, she has had the commendable duty throughout this process of spending her days in therehearsal room and her nights on stage. But a matinee day calls, so Margot and Abigail have thepleasure of my company as Lisa’s stand-in for the rehearsal. I’m basically there to walk through thescene and read in Lisa’s lines so the other actors have somebody to work off.I feel somewhat bemused by my half-hearted performance. The trained actor within wants to reallycommit and throw myself into the dramatics of it all but I fear my attempts at this will only bedistracting. I also recognise the absolute ownership Lisa has taken of her role over the weeks andeven if I wanted to, there would be no inhabiting Lucy as she has done so profoundly. It is at29Resource Pack: The Knot of the Heart

moments like these, when standing with a script in-hand trying to keep up with these actresses asthey effortlessly throw lines across the kitchen table that I realise, whilst the process of rehearsals isas crucial to the development of a character as the sea is to an ocean liner- the development andchange is so organic, you hardly see it happen. Suddenly I’m aware that this cast have gone fromdiscussion in the first week to now understanding the subtle nuances and idiosyncrasies that makethese characters real. And it wouldn’t matter if Laurence Olivier was Lisa’s stand-in: thesecharacters now belong to the actors who play them. It’s easy to take that change for granted whenone has seen the work from day one but here as I walk through the scene with them, it is hard tomiss.As the week progresses it’s like that bulb of tulips that only ever bloom when I leave the room, so Ican’t put my finger on when it has happened. All the actors have had a swift gear change. The workwith Doctor Owen Bowden-Jones must have informed both Lisa and Kieran’s work, as the druginduced haze they are now adopting is powerful. Sophie’s trip to City Roads Crisis InterventionCentre must have given her a new energy because now the character Marina has such gravitas andweight. She is a woman who has seen it all and is shocked by nothing but Sophie manages to stayabsolutely on the right side of the line and not slip into a self-worthy or preachy characterisation.So it’s all happening in the rehearsal room and that slow move into being ready for an audience ismanifesting but again I don’t really know when it has all happened. It’s a little annoying really as Iwas wanting to discover that precise moment, that day or week where the break-through happens,hoping it would teach me something new about directing. No such luck!Week 5/6It’s been a very active couple of weeks both in the rehearsal room and out! As for me, I’ve had mylaptop implode on me (wiping away what should have been last’s week’s entry!) and contracted amysterious bug that had me shivering, nauseous and had Michael ordering me home almost assoon as I had walked into the rehearsal room. But now that both my laptop and I are feeling better,I will attempt to regale all with tales from the final two weeks of rehearsing The Knot of the Heart.‘It’s amazing how often we as human beings say the exact opposite of what we want.’ Lisa Dillonsays this at around 11am on our first day back in the rehearsal room after the weekend and myfirst thought is, how ridiculously astute for a Monday morning. But by midday as we are rehearsingScene 6, I come to see how much truth there is in this, especially for Lucy. She is on a hospital bedhaving her hand sewed up expertly by Kieran who plays Brian. It’s so clear that Lucy has becomeaware of hitting rock bottom at this point. She is alone and she needs help and so the first thingshe does, naturally is to push away the one person who has come to give it to her. Lucy shroudsher wants in defensiveness and it is in this that she becomes even more vulnerable because it is soclear that she needs help but even still attempts to say, ‘I’m fine, I don’t need any help.’ I loveDavid’s writing of this scene and even more so when I take hold of Lisa’s earlier note on thehuman condition. It is absolutely someone trying to call out for help but too proud or embarrassedor weak to do so. But then there is a moment when the situation becomes so apparent to Lucy thateven her own pride deteriorates. And in this not caring about the mask anymore, it’s here I thinkwe see the first glimmer of Lucy’s strength.In the Rehearsal RoomDavid spends a big bulk of the week in the rehearsal room, which is great as he provides anobjective voice for us all. Even though it’s his play and one would think he was closer to it thananybody, he sees these scenes with a fresh set of eyes. Michael works so specifically and in detailwith each scene and so David’s focus on the overall arc of the play allows for another layer to beadded to the production. After watching some of the scenes he gives notes to Michael about thingsthat he’d like to see developed further. I am interested to see that David’s notes are few andparticularly focused on certain physical moments that he had written into the stage directions.Moments that he wanted to be more pointed, such as a glass being snatched out of a hand or afloor being cleaned, or a cigarette being lit. It was actually interesting to see the writer and directorof this play working effectively together whilst speaking their own respective languages. Davidwould describe in detail to Michael the importance of why this moment needed Margot forResource Pack: The Knot of the Heart 30

In the Rehearsal RoomMichael Attenborough with Dr Owen Bowden-Jones in rehearsalPhoto: Matt Humphreyinstance to clean the floor with gusto. He would describe what he felt it meant for her journey at thetime and what it meant for the journey of the play and the relationship between her and her daughter.Mike would then take a moment, inhale, then translate it into actor speak; and within minutes themoment had been transformed!As the end of the week approaches the actors are itching by now to do a run of the entire play. A fewweeks ago and I would have been very nervous about the fact that we hadn’t but Michael’s sense ofcalm always puts me at ease. It always seems as though everything is happening exactly as it shouldbe and even if it wasn’t I am sure he’d convince us all that it was!So it’s Friday and the cast are all more than ready for a stagger through but on arrival we are told thatLisa Dillon has been injured whilst performing in another show. It means that she will need rest andthe run has to be cancelled. Michael cuts the rehearsal short and an early weekend ensues. Injuriesare awful things for actors on a show as their body is limited and it’s completely out of their hands.And even when everybody around you is supportive and you know all you can do is just rest and letthe body heal itself, there is always this inevitable sense of guilt that one feels. There is the frustrationthat things have had to stop because of you and I am sure this is no different for Lisa.By the following week, Lisa is still not 100% but is determined to do the stagger through. It is nowthat I really appreciate the in-depth work that Michael has done with this play. Even with an actress inpain and a few days off, this stagger through is wonderful. In fact there were moments when Lisabeing in pain probably worked for her and other characters as well. AI see this especially at the pointwhen Lucy collapses into the arms of the nurse, Brian, confessing finally that she needs help. There isthe sense of her being so completely fragile, like she literally might break at any moment. I imaginethe actor in Kieran is treating Lisa with kid gloves, so as not to hurt her, but there is something aboutit that works. During this run I am utterly convinced by the play. I am totally invested in Lucy and herjourney and more so that I’ve been involved with helping to create it through rehearsals.31Resource Pack: The Knot of the Heart

The run is followed by notes and there are many from Michael, myself and David but Michael issensitive and skilled at how to deliver our notes to an actor so they not only receive it well but sothey are still finding something new right until closing night I should imagine. I’ve always foundthese note sessions oddly funny. Because actors need to actualise notes, it’s not just something thatwill go in a notebook and be done with, they will actually have to apply this physically- and so even inthat moment that they are receiving it, you see them almost literally feeding their character theirnote. So eyes suddenly enlarge and they are whispering that line with the intention the director hasgiven as they write in the notebook or on the script. But it’s all done so quietly and so internally thatits barely noticeable- until it’s noticeable that is! Then you can’t see anything else. Sometimes I canlook around a rehearsal room during a notes session and just see a room full of actors all nodding,frowning and muttering to themselves.The rest of the week flies by. Lisa seems to be in less and less pain by the day (or at the very leastshe’s gotten better at being in pain), and the stagger-throughs are turning into runs and the runs arelooking smoother and tidier. Michael watches these runs remarkably still and I wonder where all thedirector energy goes as he relinquishes all to the actors and then I see the little ball of blue tac in hishand being relentlessly squeezed and it’s comforting.The runs are now open to some of the Almeida staff and the power of the play can be heard in thosepin-drop silent moments, or it can be seen in the General Manager wiping her eyes as she hurriesout of the room. The play moves people. It engages people and it’s easy to overlook its power on anemotional level when you’re so familiar with it. By the end of the final run I am somewhat shockedthat we’ve made it this far. It all seems to have just become. Nothing mind-blowing about any oneday, just a series of small undetectable miracles that have produced a powerhouse of a play.The final day in the rehearsal room and Michael stalls for time by talking about the next week oftechnical rehearsal as stage management are preparing the treats of cakes and champagne topresent to the company. And then, just like that, it’s over.Soon I am pulling down research images off the wall and making room for the next cast that are duein to rehearse. The room is larger, emptier. A blank canvas ready for something new to fill it and I’mglad.Production WeekI walk into the Almeida Theatre and think I’m almost breathless. I have no idea how unbelievablypowerful Peter McKintosh’s set is. It was always very attractive on the model box and I loved thespare feel it had, but I had not realised just how beautiful it was until confronted with the life sizeversion. I see how powerful the reflective quality of the windows are and of the huge amount of ivydraped across the brick wall at the back . It absolutely screams urban garden in Islington and underthe worker lights it looks like a real life courtyard.The energy in the theatre I guess is a loud calm. There is noise everywhere. Hammers, drills,boisterous laughter from the technical crew all jovially teasing one another but the calmness comesfrom the efficiency of it all. We are about to start the first technical rehearsal in 30 minutes and Iknow without a shadow of a doubt that everything will be just so by then. Backstage the actors arestill and transformed in their costumes and through the tannoy I can hear blasts of composer DanJones’ haunting music for the play. The music is melodic and beautiful, but there is a stirring ofsomething darker underneath. As if something huge is about to happen. That’s how I feel right now.The stirring of something about to happen...In the Rehearsal RoomResource Pack: The Knot of the Heart 32

33Places in the PlayPlaces in The Knot of the HeartIslingtonIslington is an inner-city borough inNorth London. Often used as a bywordfor the latte drinking liberal arriviste,Islington is known for its thriving fringecultural scene and wealth of restaurantsand bars. Spiritual home to NewLabour, and with a vibrant history ofavant-garde liberal politics, the boroughis seen to attract the cream of London’sliberal, journalists, writers and artists.More recently, wealthy City workershave been drawn to the area, lured byits fine Georgian and Victorian terracesand upmarket luxury developments ofapartments and houses. However it isan area of extremes, with roughly a50/50 split in privately owned andpublic housing; and was once one ofthe most densely populated areas in allof London.Until the 18th Century, Islington was a major farming area and home to the Royal Agricultural Hall. Anumber of pubs and shops existed along the street to serve farmers and visitors to the hall – thesehave now mostly been transformed into bars and restaurants, serving Islington’s bustling eating anddrinking culture. Development of housing increased at the end of the eighteenth century, when terraceswere built in large numbers, and from the 19th Century, a number of music halls dominated UpperStreet and the area drew many for its lively entertainment. However the advent of the railways sawmany of he aristocracy move out of Islington, and many big houses fell into disrepair or weresubdivided. Since World War II, wherein 3200 houses were destroyed, there has been significantregeneration and gentrification. From the 1960s, the Georgian terraces were rediscovered by middleclass families, and many of the houses were rehabilitated, with the area becoming newly fashionable,taking housing back up to some of the most expensive in London. Among these new residents were anumber of the central figures in the New Labour movement, including Tony Blair before his victory inthe 1997 general election. TheGuardian has said of Islingtonthat it is ‘widely regarded asthe spiritual home of Britain'sleft-wing intelligentsia.’ TheGranita Pact, between GordonBrown and Tony Blair, is said tohave been made at a restauranton Upper Street.Houses in Gibson Square, IslingtonResource Pack: The Knot of the HeartThe completion of the Victorialine and redevelopment ofAngel tube station has createdthe conditions for developersto build blocks of small flats,popular with youngprofessionals.

Gibson SquareA classic late Georgian square located in the heart of Islington, between Upper Street and the parallelLiverpool Road. The housing in this area is most notable for its Georgian town house architecture, andmany houses in the square are Grade 2 listed – along with much of the neighbouring Liverpool Roadand Upper Street. Many of the townhouses are now subdivided, but they still represent some of themost desirable housing in the central part of Islington. The average property price in 2011 is £828,922.Upper StreetUpper Street is the main shoppingstreet of Islington, running roughlynorth from Islington High Street toHighbury Corner. The street datesback from at least the 12thCentury.Islington originally consisted oftwo streets in addition to the HighStreet: Upper Street and LowerStreet, which diverged from theHigh Street at Islington Green.Henry VIII hunted duck in theponds off Upper Street, whileWalter Raleigh lived in UpperStreet and owned a pub in LowerStreet. Lower Street has since beenrenamed Essex Road.Cafe culture on Islington’s Upper StreetIn the 1970s and 80s, Upper Street was a focal point of the radical left. It was home to Sisterwrite,Britain's first feminist bookshop, as well as the Trotskyist Pioneer Books, the anarchist Rising Freeshop (famous for stealing stock from other shops to sell in theirs) and the socialist Red Books. In the1980s, Upper Street was home to the Islington Action Group for the Unwaged, a major far leftcampaigning and activist group, and to the squatter-run Molly's Cafe, a focal point for the anarchistand squatting movement. Upper Street made headlines on 23 July 1995, when the Reclaim the Streetsmovement took over the street, barricaded it to traffic and held a long party in the street.Places in the PlayWhittington HospitalThe Whittington Hospital is ahospital with 470 beds in Archway, inthe northern part of Islington. It isnamed after Richard Whittington, andits logo incorporates Whittington'slegendary cat.Some medical services have beendelivered on the site since 1473,although the current hospital has itsorigins in the Small Pox andVaccination Hospital, built in 1848.Independently managed hospitalswere founded on the Archway Site and the Highgate Site. In 1946, all three hospitals were broughttogether. It includes the City of London Maternity Hospital, as well as Accident and Emergency and anumber of specialist departments. It is both a district general hospital and a teaching hospital for theUniversity College London.Resource Pack: The Knot of the Heart 34

Places in the PlayClissold ParkClissold Park is a 22 hectares (54 acres) community park inthe bohemian area of Stoke Newington, east of Islington.The park used to act as the front lawn to Clissold House, aGrade II-listed building, built for Joseph Hoare, a Quakermerchant and anti-slavery campaigner, in the 1790s. Theestate eventually fell to Reverend Clissold; when he died in1882, developers closed in, but activists John Runtz andJoseph Beck convinced the authorities to open it as a publicspace in 1889. It is commonly used by joggers and families,with a playground, café, and ponds.Cranstoun City RoadsCranstoun City Roads Drug Crisis Intervention Centre (in short throughout this pack known as ‘CityRoads’), is a residential detoxification and crisis intervention service for chaotic drug users whose livesare at risk. It remains a unique model of treatment, as the only centre of its kind in London, and its 18beds cover all of the Greater London boroughs, delivering opportunity for the most vulnerable. CityRoads is unique as a self-referral service, with patients admitted 24 hours a day.Once admitted to City Roads, people are supported to recover from their immediate crisis and todevelop longer term objectives in terms of ongoing support and specialist care. People stay for amaximum of 21 days, during which time they receive expert medical, nursing and social carefacilitating the opportunity to regain their health and self belief in a future without drug misuse.This service was commissioned by the Department of Health and opened in May 1978. It was thevision and result of years of work involving social and health care professionals from statutory andnon-statutory organisations. Key individuals grew to understand that supporting people to addresstheir drug use far extended the provision of a hospital bed and a detoxification regime. City Roads isrun by Cranstoun, a charity established in 1969 offering support and treatment services to thoseaffected by drug use.The Almeida Theatre islocated on AlmeidaStreet, just off UpperStreet’s main drag, andvery close to GibsonSquare.The theatre has a stronglocal focus, with manyaudiences drawn fromthe surrounding area.The theatre’s educationdepartment worksclosely with many localyoung people fromacross the borough ofIslington and itsneighbouring areas.35Resource Pack: The Knot of the Heart

Heroin is an illegal opiate drug, which is made from the opium poppy. It has anumber of physically and psychologically addictive properties that can lead toserious substance misuse. It is a serious criminal offence to both possess andto buy or sell heroin.There are an estimated 300,000 users of heroin in the UK. Other names for heroin include: brown,black tar, china white, dust, horse, junk, scag, smack and Mexican mud.Heroin is an opiate drug, an extract of opium. Opium is the dried 'milk' of the opium poppy Papaversomniferum, and it contains the two strong narcotic painkillers, or opiate analgesics, morphine andcodeine. Heroin’s scientific name is diamorphine, and is known as a semi-synthetic, because, whilst itdoesn't occur naturally in opium, it can be made from morphine.HeroinThe opium poppy was cultivated in lower Mesopotamia (the region now made up of parts of modernday Iraq, Iran, Syria and Turkey) as long ago as 3400 BCE. In the western world, as recently as 1898through to 1910 Heroin was marketed as a medicine as a non-addictive morphine substitute andcough suppressant. Although it can still be used in some countries for medicinal purposes, much haschanged since the turn of the last century and Heroin is now classed as a controlled drug owing to itshighly addictive properties and both the short and long term physical offence of taking the drug.Street deal of heroin normally costs around £20 to £30 a street deal with users normally having oneto two deals a day as a minimum, the normal heroin habit can cost up to around £100 a day. Inrelation to supply, heroin dealing is a big business; the drug is now said to command £40,000 a kilo -double the price of 2010.Heroin is most commonly injected however highpurity heroin can also be snorted or smoked. Heroincan often be heated, normally on tin foil and theninhaled; this process if often referred to as 'chasingthe dragon'.Heroin affects the body by slowing down itsfunctioning and reducing psychical and psychologicalpain. Most people feel a rush of a buzz when theyfirst take it as well as a feeling of warmth and wellbeing as well as dizziness and vomiting.Imagine me inside your tummyagain. It’s lovely. The best cuddleof your life. Calm. Calmness. Asnoring dog in a new basket.Lovely. Under the blanket. Likewhen I was small.LucyScene 3Heroin is highly addictive and creates feelings of craving and a strong psychological desire to keepusing the drug. It has a highly unpleasant effect when withdrawing from the drug, which makes manyusers simply take more to avoid the unpleasant effects which can include: restlessness, insomnia,diarrhoea, vomiting, cold flashes with goose bumps and muscle and bone pain.RisksHeroin bought on the streets is very rarely 100% pure; it is us usually somewhere between 30-80%pure, averaging 45-50% pure, and can be mixed or 'cut' with a number of different ingredientsincluding sugar, starch, milk powder, nutmeg, brick dust and ground-up gravel.Heroin use, often because of the means in which it is taken - by injection - is inked to a number ofother medical complications including: chronic liver disease, collapsed veins, pneumonia, infectiondisease including HIV and tuberculosis and abscesses. Statistics show that 75% of new AIDS casesamong women and children are directly or indirectly a consequence of drug use by heroin.Alcohol and drug-use disorders are complex and individuals with addiction can suffer from a numberof other problems as well. Substance-use disorders are often associated with interpersonal and socialResource Pack: The Knot of the Heart 36

Heroinproblems. Rates of divorce are high and children of substance-abusing parents are at increased risk forsubstance-use disorders themselves as well as mood and anxiety disorders. Individuals often have legalproblems from driving under the influence, disorderly conduct drug distribution and other illegalactivities because of the need to obtain money to acquire drugs; in the most severe circumstancesleading to homelessness and unemployment.Risks of overdose become high in regular users because the body's tolerance builds up and the desiredeffect reduces so that users have to keep taking larger doses to get the same effect.In 2009, a total of 1,000 deaths were attributed to heroin - more than half of drug related deaths in theUK.Heroin is a Class A drug: possession of heroin can lead to a prison sentence of up to seven years. Userspleading guilty on the first occasion are often able to avoid custody but being sentenced to a DrugRehabilitation Order which requires a strict drug-testing regime and co-operation with social workersand report monthly to a judge; failure to be drug-free can result in immediate imprisonmentPsychology and AddictionHistorically, addiction to drugs was seen to be a result of psychopathic characteristics but now it is seenthat addiction is indiscriminate: it affects all people of differing social-economic backgrounds; gender,racial and financial. There are multiple and complex factors that contribute to whether one personbecomes addicted or not, however there has been some research suggesting very strongly a geneticpredisposition through a difference in the way the frontal lobes (the decision makers) of the brain arebuilt. Alongside this, the two main factors that lead to likelihood of addiction are exposure to traumaalongside availability of certain substances that are used as a way of dealing with that trauma.Interestingly, it is very common for addictions to exist alongside a number of other psychiatric illnesses,in particular depression and anxiety disorders.Over recent years there has been a marked increase in drug use among higher society, and while menare typically seen to be significantly more likely in men than in women, this difference has decreasedover time.Thomas de Quincy's quote below, from his 1822 book Confessions of an English Opium-Eater, definesmuch of how drug use, particularly heroin in this instance is used to numb pain. Concealed in deQuincy's statement, a quote by one of the most famous addicts the world has ever known, is therelentless search for an ideal existence not unlike a ‘nirvana’ state (there being an interesting link toheroin though the term nirvana, the name of a band who's former lead singer, Kurt Cobain, sufferedwith a severe heroin addiction before his death in 1994); the denial of anything that might interfere withthe believing that such a state exists. Many psychologists believe there is some magical thinking in anaddict who believes that a chemical substance would make everything right and that it would solve themost complex personal problems, including the matter of simply existing.The following interview with Dr Owen Bowden-Jones, a consultant psychiatrist and specialist inaddictions, investigates some of the facts that are currently known, and examines Lucy’s condition inThe Knot of the Heart.‘I hanker too much after a state of happiness for both myself and others;I cannot face misery, whether my own or not...and am little capable ofsurmounting present pain for the sake of any recessionary benefit.’Thomas de Quincy: Confessions of an English Opium-Eater (1822)37Resource Pack: The Knot of the Heart

Almeida Projects visited the Chelsea and Westminster Hospital to speak toconsultant psychiatrist Dr Owen Bowden-Jones, to ask him about the factsbehind drug addiction, substance abuse, and his involvement advising the castduring the rehearsal process of The Knot of the Heart.Almeida Projects: Firstly, why do people become drug addicts? Can you explain the condition ofaddiction and its causes?Dr Owen Bowden-Jones: There are many different reasons why people run into trouble usingsubstances. People use substances in different ways, so when you use the term ‘drug addict’ you’retalking about a person who’s addicted to the substance; but the way we classify a person’srelationship to a substance can vary: you can use it recreationally, without any significant harm; youcan use it harmfully where it’s beginning to create problems either in your home life or in your worklife, or physical or psychological health; and the step beyond that is when you become addicted to thesubstance, and that’s typically a process where you become physiologically addicted, so that whenyou stop taking the substance, your body misses it, and it tells you that it’s missing it, by a series ofphysical symptoms known as withdrawal symptoms. The other thing people notice when they’readdicted is that they tend to use more and more of the substance, often not gaining any particularbenefit from increasing the dose. The substance becomes the focus of their life, above everythingelse. Rather than going out and seeing their friends, they’ll stay in and use the substance; rather thangoing to work, they’ll find ways to use the substance instead.In terms of why people reach that addiction stage, there are a many different reasons. What we doknow is that you can carry a genetic vulnerability to substance use. It’s particularly strong aroundalcohol, but it is present for other substances as well. This is not to say that if a person who’s had arelative with a substance abuse problem will definitely have a substance problem themselves;however, there is evidence that what they may carry is a vulnerability, in the way their brain is puttogether.There have been a lot of advances made in the understanding of addiction particularly in the last 10years, but we are still not there in having a perfect theory. The science at the moment is focusing on abit of the brain called the orbital frontal cortex. This is the decision-making part of the brain, the bitthat weighs up risk and makes judgments about what’s good or bad for you. There’s increasingevidence showing that this part of the brain is different in people who become addicted tosubstances. And there’s emerging evidence that people with addiction problems make poor choicesaround their substances and other areas of their life. And that there’s something that’s happening intheir frontal lobes that leads to this.Another theory of addiction is that people take drugs because they make them feel good. So whenyou take a drug, it releases chemicals in your brain and those chemicals make you feel nice, different,the feelings are good, and the brain gives you a reward for that. There are lots of other things we doin life that the brain rewards us for, and so we do them again; for example, drinking a glass of waterwhen you’re thirsty. But what the brain does is it shuts off that reward system when you’ve hadenough. So when you drink the water, your brain gives you a reward for that, but when you’ve hadenough, it shuts the reward off so you stop drinking. Now with substances, the rewards of the drugsof addiction are so powerful that they overwhelm this reward system, and so people have problemsswitching it off. People get a very intense reward from using a drug, which makes them feel reallygood in the moment but then they lose the ability to switch off the reward. So even though over time,people’s reward from using drugs decreases and decreases, the brain gets tricked into this cycle ofcontinuing use. If you ask someone who uses heroin what the effect of their drug is, almosteverybody will say, ‘the first few times I used heroin were amazing, and I’ve spent the last 10 yearschasing that first hit, but I never really got back to that first intensity of hit that I did in the first fewweeks I was using.’ And that’s because people develop something called tolerance, where they haveto use more and more of the substance to get the same effect. We see it very typically where peopleInterview with PsychiatristResource Pack: The Knot of the Heart 38

Interview with Psychiatristare drinking: when you first taste alcohol, at whatever age that is, your first drink makes you feel giddy.But if someone becomes dependent on alcohol, they can drink a bottle of whisky and appear sober.That’s because over time, they have increased and increased and increased the amount that they’redrinking and they have become tolerant to the alcohol – and it’s the same with heroin, cocaine and alldrugs of abuse, you see this process of tolerance developing.However, it is not just nature but it’s nurture as well: as well as any biological determinant orpredilection, there’s what happens in your life. There is very clear evidence that some life events canlead people into problems with substances. So that could be anything from the break up of arelationship, to losing your job, or exposure to trauma – those can be ‘trigger events’ for people to endup using substances. One common mechanism for why people use substances is as an emotionalanaesthetic – they use it to block out feelings that are too difficult. To summarise, there are probablybiological reasons, some ways in which the person is made that make them vulnerable; but also thereare a range of environmental factors – stress, trauma – which can lead people into substance use. It’sa combination of the two that leads people down the path of addiction.AP: Does socio-economic background play a part in whether people become drug addicts?Dr OBJ: It’s a difficult question because the key features are not necessarily which socio-economicpath you’re from, but rather how much trauma you are exposed to, and how available substances areas a way of dealing with that trauma. In some socio-economic groups you’re more exposed to drugsand trauma than others; although that’s just a generalisation of course. There is also a cultural issuein that the acceptability of drug use is different in different parts of society. Whether it’s people using aline of cocaine and thinking that’s fine but heroin is absolutely unacceptable; or whether it’s peoplegoing to clubs and saying ketamin is an acceptable drug to use but they would never drink – there areall these different expectations around drug use. I think that’s crucial in terms of how people weigh upthe risk. The understanding of the dangerousness of drugs is quite a complicated issue and it’saffected by socio-economic class, culture and where you get your information from.AP: So let’s think about Lucy in The Knot of the Heart. How typical is her case, as a middle class,successful young woman in television, who develops a heroin addiction?Dr OBJ: It’s interesting, because the play suggests that there might be some sort of pre-disposingvulnerability from her genetic make-up, in that it’s alluded to that both her parents have an alcoholdependence. So, firstly, you wonder whether Lucy is carrying a genetic vulnerability to addiction. Whatis particularly difficult for Lucy is that in a way she’s got a double stigma – the stigma of addiction, butalso the stigma of addiction to heroin in a socio-economic group that typically doesn’t use heroin. Ifshe was addicted to alcohol, the stigma would be less than it being heroin. Having said that, it’s verydifficult to generalise drugs to different socio-economic groups. What you do tend to see is that whenpeople start getting into real trouble around their substances, they tend to start un-tethering fromsociety, and falling through the cracks in society. So the moment you start losing your job, and yourrelationships with your family and friends, suddenly things go downhill pretty quickly and it doesn’tmatter which socio-economic group you’re drawn from – once you get into that process of addiction,things go wrong often quite quickly.AP: Which is what we see with the development of Lucy’s addiction?Dr OBJ: Absolutely. Lucy begins as someone highly successful, but the moment her addiction takeshold, things fall to pieces really very quickly for her.AP: How might Lucy have developed her drug addiction? Is there any evidence for so-called ‘gateway’drugs?Dr OBJ: There is some evidence around gateway substances; although probably the only robustevidence for gateway substances is tobacco – so, if you don’t smoke tobacco, your risk of being39Resource Pack: The Knot of the Heart

Dr Owen Bowden-Jones talking to Michael Attenborough and Lisa Dillon in rehearsalPhoto: Matt Humphreyaddicted to any other drugs is pretty low. Now of course loads of people smoke nicotine but don’t useany other substances, so I’m not saying it’s causal – that if you smoke you will automatically useother drugs – but the only actual evidence we have around gateway drugs is for nicotine. I think theimportant thing to think about with drugs is that people talk about ‘drugs’ as one thing, but actuallydrugs are all very different and create very different effects. So people who use cocaine use it to havea good time, to party, to get high; but heroin is a depressant, like alcohol. So when Lucy’s usingheroin, she’s using it to dampen herself, dampen her feelings and emotions, and sedate herself,emotionally.AP: Do you think the relationship with her mother has anything to do with her substance abuse?Dr OBJ: I think one of the really interesting aspects of this play is the relationship between Lucy andher mother. Although we talked about addiction and the effects of that on Lucy, in a way her addictionis the vehicle through which we see in Lucy and, to some extent, her mother, trying to understandtheir relationship. And the relationship begins as a pretty corrosive process for both of them, anddestructive and dependent. That’s illustrated very well in some of the scenes where Lucy’s mothercomes to pick her up from the rehab and there’s this incredible tension between Lucy trying to decidebetween staying in treatment and going back to this relationship with her mother, which then leads towhat she chooses and then leads to her relapse. However, the optimistic thing about the play is thatthrough this process of understanding her addiction, Lucy begins to understand the relationship withher mother and understand just how destructive and co-dependent that relationship is. I think thatgives a real richness to the play. And whilst the play is of course around addiction, it is as much abouthow mother and daughter find new ways to understand each other and relate to each other.AP: Do you think the play addresses the stereotypes around drug use?Dr OBJ: One of the ways in which the play is very successful is that it challenges our stereotypesaround drug use. The sort of stereotype of heroin addiction is injecting at a bus shelter – it’sTrainspotting, and it’s social deprivation associated with injecting drug use. I think one of the ways theplay is successful is that it challenges that stereotype, it shows us that addiction to substances issomething that is pervasive across society, it’s not just a particular group that suffer with it. Lucy is agood example of someone who has fallen into her addiction, despite having a pretty good start in life,Interview with PsychiatristResource Pack: The Knot of the Heart 40

Interview with PsychiatristAbigail Cruttenden in rehearsalPhoto: Matt Humphreydespite having lots of things going for her. I think it’s interesting that David Eldridge has chosenheroin rather than cocaine, which would have been a snugger fit with what the media stereotype is fora cocaine addiction. And certainly, we see plenty of people in our clinic who come from higher socioeconomicclasses who have got problems with heroin.AP: What are the addictive properties of heroin itself as a drug?Dr OBJ: At a neuro chronological level when you smoke or inject heroin, the drug gets into your bloodstream and it goes to your brain. When it’s in your brain it sits on what’s called opioid receptors, andin doing so gives the body a range of physical and psychological effects. It would make people feelrelaxed, it would make the pupils go to pinpoint and it would give muscle relaxation. One of thepsychological effects, which draws people into addiction, is this sense of being, what’s called an‘honoraic state’, it’s a dreamlike state, where people feel absolutely relaxed and calm and as if all theirworries have drifted away. That can be a very appealing – obviously, dangerously appealing – state forsome people. Heroin is also a very strong analgesic, a painkiller, and it’s also used in other forms likecodeine. Heroin is one of a group of drugs called opioids, and heroin is an illegal version but there arelots of legal versions of opioids such as codeine phosphate, which is used all the time to manage pain.Opioids are very successful as an analgesic, but of course along with those analgesic effects, by beingprofiled with the receptors they sit on, they have a range of other effects.Because both opium and heroin are illicitly manufactured from the poppy harvest, and so whereascodeine phosphate is pharmaceutically made, as a pure substance, opium and heroin are madedirectly from poppy seeds and so the danger for that is you don’t ever quite know what the purity of itis, because it’s made from plants and so the purity varies, sometimes dramatically. And that can haveits own risks for people using the drugs – in that they’re not quite sure what’s in the drug they’reusing, but also what strength it is.AP: How do you treat addiction? Is there a cure?Dr OBJ:There are some very good treatments available for people with drug problems in general andheroin problems in particular. Broadly speaking they are divided into treatments that reduce the harm41Resource Pack: The Knot of the Heart

of your drug use and treatments that then move you through the drug use to your abstinence. Itdepends a little bit on the clinical situation because every patient with a drug problem is an individualand their problem is individual, so the appropriate treatment would differ for every patient. Somepatients would come in and have a detox, and then following that detox they would have a range ofpsychological treatments, and those psychological treatments would help them move to a life wherethey didn’t need to use substances to control their emotions any more in the process of theirrecovery. For other patients that process is too quick and they need a stepping stone to abstinence,and that stepping stone in a substitute medicine called methadone – a clean, pure, safe drug – andthere’s another one called buprenorphine. This allows the patient in the short term to stabilise theirlife, get away from dealers and the culture of drug using, and to come into a clinic and to have thepsychological treatments whilst they’re on this substitute prescribing. What happens over time is thatonce that person is stable and ready to take the next step, then their methadone is slowly reduced tothe point where they’re not taking it any more. The length of time someone needs that treatmentvaries significantly from one person to another depending on how complicated their problems are.The average length of treatment for someone with significant heroin use is shown to be around sevenyears. And that doesn’t mean someone will be on methadone for seven years, but from the point atwhich they arrive at treatment to the point at which they achieve abstinence, that can take asignificant amount of time – often it is years rather than weeks or months.AP: What are the basics of medical treatments?Dr OBJ: The pharmacological treatments for heroin tend to be either a detoxification which usuallytakes about 5-10 days, and the other pharmacological treatments are substitute prescribing, somethadone, and there are also a number of other drugs we use that block the opioid receptors. Interms of the psychological treatments, there are two very good evidence based treatments. The first issomething called ‘relapse prevention’, which is helping the person understand their addiction,understand what the triggers are to their addiction – learning the lessons from previous relapses interms of where it went wrong last time and how they can stop that happening again. It involvesgetting the person to have more awareness of the dangers in their environment and to manage this ina way that they can avoid triggers, and to develop tools to manage things like cravings and impulsivebehaviour. The second thing that we suggest to all our patients is that they engage in mutual peersupport, and the main one people tend to go to for heroin is Narcotics Anonymous. And we alwaysencourage our patients to go and try that, because the advantage of that is that it’s a group of peoplewho have all managed to get clean who are supporting each other and that can be a very powerfulexperience for people. So broadly speaking, those are the two treatments for the addiction, but thenthere may be other psychological treatments for other conditions that commonly come with addictionand depression is a very common one, anxiety disorders, post-traumatic stress disorder, fromexposure to traumas – so we would have different treatments for all of those as well.AP: What factors affect the length of time it takes someone to recover from heroin addiction?Dr OBJ: What we know is that the length of treatment really depends on the complexity and severityof the individual. For instance many of my patients have not just a problem with addiction but theymight have other problems as well; so some of my patients have an addiction and depression, say, soyou need to treat both those problems; or some people will have all sorts of complicated socialarrangements, so if you are trying to get someone clean from drugs, there’s no point detoxing themand then sending them back to a hostel where every other person is using drugs, or back to anenvironment where there’s lots of drugs around. So you need to think not just of the person as anindividual, but about where they fit in society and what sort of risks and triggers are in theirenvironment. There’s the sort of ‘simple’ treatment of getting the person off the drug, but gettingsomeone off the heroin actually is the easy bit – but the hard bit is getting people to stay off thesubstance and to do that you have to think much more broadly than that person and their heroin –you’ve got to think about all the other things around them: their family environment, their socialenvironment, their work environment, and think about where the support structures are going tohappen, that are going to replace the drug. Because when people move away from drug use, drug useInterview with PsychiatristResource Pack: The Knot of the Heart 42

Interview with Psychiatristtakes up so much of someone’s time that when they stop it, there’s a big hole to fill. And if you don’tfill that hole with supportive, positive activities, then the danger is that the person slips back.AP: Like what we see with Lucy – it doesn’t work going back to her mother’s house. And then shegoes to South Africa. What do you think is her likely prognosis, given what we see of her in the play?Dr OBJ: I think one of the things the play shows very well is that sometimes people don’t crack theiraddiction the first time – and there’s no shame in that. It’s a fairly familiar story for people to try aperiod of abstinence and then run into difficulty again and perhaps learn some more lessons; andthen with those extra psychological tools, to be able to crack it later on. Lucy’s story of falling into anaddiction, getting clean, relapsing into her addiction again, and then getting clean is actually quite atypical story for many people with problems around substances.In terms of her prognosis, that is more difficult to say. At the end of the play, Lucy has a much moresupportive relationship with her sister, so you get the sense that she is moving to a situation whereshe has more control over relationships she had that may have even been drivers of her addictionduring the play, particularly that with her mother. Now, she is controlling some of those stresses,those triggers, much better than we see at the beginning of the play. I think the play is quite rightlyoptimistic about Lucy’s prognosis. Lucy’s a bright, articulate, creative, talented young woman who hasfallen into addiction and through the process of engaging in treatment and working hard on all of thethings in her life you get the sense that she is going to turn things around. We see many patients thatachieve that.AP: Can you tell us about your experience as part of the rehearsal process, and your involvement inthat?Dr OBJ: It’s been absolutely fascinating being involved in the process right from seeing the early draftsof the script from David and having a conversation early on when he set up a workshop where he wasknocking around ideas for the play. And then to see it through casting and starting to see it beingperformed – it’s been absolutely fascinating and there have been many parallels between the attentionto detail and the professionalism needed from a whole range of people in a team to put together aplay and actually the sort of similar things that need to happen in delivering a service in the NHS! I’velearned quite a lot about how people need to work together and really focus on getting every aspectabsolutely perfect and there are lots of parallels between the way groups of people work. In terms ofthe input into the rehearsal itself, I think the bit I was most useful with was helping with some of theaccuracy issues. So we had a very amusing session on suturing, because there’s a scene where Lucygets her hand stitched up and I was discussing with the actor who’s doing the suturing how he shouldhold a needle and it was quite amusing that it turned into a medical teaching session! And so I thinksome of it was around medical accuracy and some of it was around a sense of what a patient right atrock bottom would be feeling and thinking and saying and doing. Obviously I’ve got a lot ofexperience with working with people who are often at the lowest point of their addiction and I think itwas helpful to get some of that experience, particularly to the character of Lucy.AP: Why do you think the play is important?Dr OBJ: I think the play is really important because it challenges a number of stereotypes. Itchallenges the stereotype that addiction only happens to certain people. Lucy is articulate, with a greatcareer and yet she gets caught up in the addictive process. The other thing it challenges is thestereotype around which drugs different people use. I think it’s really important to understand thatheroin is not – although it is associated with deprivation – exclusively used by those people and thereare plenty of people from other walks of life that get into trouble with heroin. And the third thing isthat is strikes a note of optimism, and I think so often we only see horror stories around addictionwhere nothing ever works and people never get better. I think it’s great that this play has taken a boldmove in saying actually, Lucy has the opportunity here to make it out of this nightmare and actuallymove on to something fresh and new and hopeful.43Resource Pack: The Knot of the Heart

Margot Leicester and Lisa Dillon in rehearsalPhoto: Matt HumphreyAlmeida Projects spoke to Eileen Doyle, Service Manager, and Maria Robinson,Social Team Care Manager, from City Roads, about some of the issues raised byThe Knot of the Heart. City Roads have been involved in the rehearsal processand Eileen and Maria feature directly in the play through the character of Marina.Almeida Projects: You have been in rehearsals quite a lot, and helped David in his research. What wasyour experience like? How did you benefit the cast and what did they ask of you?Eileen Doyle: I hope the cast did benefit from our contribution to their knowledge of the effects ofaddiction and I was particularly pleased that David sought a variety of professional opinions. Thereality of addiction is remote from the popular perception that addicts do not form one homogeneousgroup, but rather, are drawn from all sections of society, with different attitudes and aptitudes.Maria Robinson: Generally the cast seemed open minded and were fairly well informed but there isalways a part of the issue that surprises those not well acquainted with addiction. I think that Ibenefited from the interaction in that it doesn’t hurt to be reminded that we in the field still need towork on getting some of the important messages about addiction fully understood.What does treatment at City Roads involve? What does the typical day/week/21 days include?MR: City Roads is part of part of Cranstoun Drug Services, it is a specialist pan London serviceemploying a crisis model of intervention. It provides safety and treatment to people who are in lifethreatening situations because of their escalating and chaotic drug use, i.e. in danger in thecommunity. The service is available 24 hours a day, every day of the year through direct access or selfreferralvia the 24 hour telephone referral and helpline service.Interview with City RoadsED: Clients present with multiple and complex needs including eating disorders, history of self-harmand overdose, legal problems, bad debt, homelessness, childcare, and family/relationship issues. CityRoads provides a comprehensive programme including medically supervised detoxification fromHeroin, crack, cocaine, benzodiazepines and alcohol in a safe environment away from chaotic druguse. Clients participate in a programme designed to help them manage the detox stage and preparefor rehabilitation. It includes one to one sessions, complementary therapies and group activitiesResource Pack: The Knot of the Heart 44

Interview with City Roadsincluding outings to the theatre. City Roads aims tohelp clients make sense of their lives and take that firststep towards recovery and reintegration into society.AP: Do you think there a cure for drug addiction?ED: Cure implies there is a disease but the biopsychosocialset of problems presented by someonedependant on a substance is a complex business thatas yet does not necessarily indicate a disease. Researchgoes on continuously and within the field there arepassionate exponents of differing theories. My ownview is that there is no cure but there are successfultreatment models that help clients address the problemand enable reintegration. No one treatment is likely toachieve recovery for all. A multidisciplinary approach isrequired and a recognition that people with the sameproblem may require very different treatment.AP: How many people do you treat at any one time? (Why are you the only centre in London?)ED: City Roads has up to 17 bed spaces. Why are we the only crisis service in London? It’s a goodquestion and one that I don’t know the answer to. It is a model that seems to have been forgottenabout in successive government’s strategies for drug abuse. The localisation policy with regard tofunding has an impact too: formerly central Government departments provided grants that helpedlocal authorities access our service. However these grants have ceased, leaving a problem in so far aslocal authorities have to meet certain targets and outcome criteria. It is not always the case that clientswho access City Roads will meet those criteria. It is like comparing an A&E department to the rest ofthe hospital’s outcomes: it is not comparing like with like.MR: That said we have support for the service in many quarters and we are working to raise the issueof the crisis model with influential people who make policy. Unfortunately these are not always themost accessible of folk and in the meantime we have a service to run.AP: What do you think is the role of families in treatment?MR: Families play an important part whether as part of the cause or part of the cure this has become amore recognised issue and the field is rising to the challenge of working with families ( if that is what aclient wants) . However it remains difficult when families find it hard to understand why they shouldbe drawn into discussion. There is still a lot of work to be done in this area.AP: Is it hard to detach from your patients?Sophie Stanton in rehearsalPhoto: Matt HumphreyED: When I first worked in the field I did find it hard to detach, although I think my training andexperience as a nurse had inculcated the attitude that it was important for the client/patient thatboundaries are adhered to. It is a fundamental error to think you are so important in a clients recovery,you run the risk of the client taking certain actions to please you rather than their best interests. Onceyou understand that it is actually the client that drives their own recovery and you (in whatever role youplay) help them to access the best routes, then you can detach knowing that you have contributed totheir moving on. If you cannot detach and continue to worry for them you take away the responsibilityof the client for themselves, effectively disempowering them.AP: How did you get into doing what you do now?ED: I worked as a staff nurse in an Accident and Emergency department and found that people coming45Resource Pack: The Knot of the Heart

in with problems related to substance misuse were treated in quite a judgemental manner. As I hadfamily memebrs with substance misuse problems I began to understand their reluctance to get helpfrom medical professionals. That and doing locum nursing to support myself when I had gone backto university, where I was sent to a detoxification unit run by the voluntary sector. There I foundsuch a different, innovative way of working with this client group that I went into the field on a fulltimebasis on completion of my degree.AP: You’re called a ‘Crisis Rehabilitation Centre’ – how do you define crisis?MR: At its simplest a crisis is imminent risk of an individual losing their life as a result of their druguse. This can be because of poor health, dangerous lifestyle (e.g sex working to pay for drugs),women being held in ‘crack’ houses, committing crime, trying to escape drug dealers who are owedmoney by them, homelessness and much more.AP: Do people tend to come back?ED: Yes people do come back - City Roads recognises that for many people accessing the service ata stage of crisis, the main aspect of care is a period of respite. City Roads operates to reduce thephysical and psychological harm resulting from an individuals substance use and reduce the impacton their own socialisation and society as a whole. In a crisis a person is sometimes forced toaccept, perhaps for the first time, that something has to change. In City Roads they can achieve theclear headedness required to consider their options realistically. For this reason we do not promoteany one approach but rather ensure clients have a clear understanding of what is available and helpclients reach a decision as to which type of treatment is realistic and achievable for them. It can takea few admissions to understand that complete recovery is possible.AP: What are the factors that tend to lead to crisis?MR: Crisis is different for different people but common in crisis situations is escalating drug useand the cost leading to crime or sex work and a lifestyle that reinforces a sense of self loathing. Theincreasing isolation from family and friends sometimes self imposed. Increased recklessness withhealth and safety, inability to manage routine tasks such as pay bills, often leading to eviction anddevelopment of impaired psychological functioning.AP: What are the chances at the end of the play of Lucy getting well?ED: Probably statistically higher than most in so far as she had certain advantages with educationand still has family support even though that might need some working on. Research shows thatthose who still have some anchor to family and friends often do much better than those who havelost everything before attempting to deal with the problem.AP: Why do you think this play is important?ED: For me the play is important as it highlights the problem of addiction within the middle classes.There sometimes appears to an assumption that people develop problems because of past traumaor other difficulties but this is partly because we only measure those members of society whopresent for state funded treatment which means that (to me) we still do not have an accuratepicture of just how wide spread and multifaceted the problem is.Interview with City RoadsMR: In addition the play brings out society’s ability to deceive itself that because something is legalit is not as problematic. Lucy’s mother has an alcohol problem but remains in denial. This is notuncommon and the point is made very well in the play. Hopefully the audience will gain someinsight into substance misuse.Resource Pack: The Knot of the Heart 46

Practical ExercisesThe Knot of the Heart deals with a number of issues that areparticularly interesting to explore in the classroom, particularly theideas of family secrets, manipulation and status. Below are just a fewsuggested exercises for use in lesson time to investigate the stylesand themes of the play in further depth.Exercise 1: SecretsIn The Knot of the Heart, a number of secrets are kept between the characters: Lucy’s dismissal fromAnimal House covered up by her producer; Angela’s self-harm; and the truth of the circumstances ofAngela and Lucy’s father’s death. Many of these secrets are about keeping up appearances - so thereis a dual layer of secrecy going on between the family keeping secrets from one another, and thenkeeping these hidden from the general public. This creates a complex, layered dramatic tension.Duration: 15 minutesAim: To introduce students to the idea of dramatic tension inherent in keeping secrets and the effecton the audience.Discussion: How might secrets be revealed - or discovered? What kind of secrets are common infamilies? Can keeping secrets always be a bad thing? What do you think the effect on an audiencemight be, of revealing knowledge of a kept secret?Practical Exercise: Split into groups of four. Ask students to create a short improvisation of a familycoming together after the death of a family member. One person has discovered something that theythink is a secret about the person who has died and they think that they are the only person whoknows. The secret must come out and we see how the other family members respond. Give groups 5-10 minutes to come up with a short, improvised scene, before sharing back.Evaluate: Did students want to defend or criticise the person who is dead? What does it feel like tokeep a secret from someone you are close to? What was the status in the scene and how did it shift?What is the relationship between secrets and power? Discuss the idea of open secrets, where peopleknow things but they are never discussed.Watching the Play: Think about how the characters use secrets: to threaten others, to strengthenbonds, to shock, to test people. How might things go differently if the characters in The Knot of theHeart were more open?Exercise 2: Manipulation and ControlIn the play, Barbara and Lucy have a co-dependent relationship where they are often manipulatingeach other - sometimes without realising this. Lucy persuades her mother to give her money to buydrugs - and even to buy drugs for her when she is in recovery; Barbara persuades Lucy to come backinto the family home after her first stay at City Roads.Duration: 10-15 minsAim: To introduce participants to the tactics people use to manipulate others and the idea of the effectof witnessing this on the audience - finding the theatricality of manipulation and its role in storytelling.Discussion: Discuss the idea of manipulation: how does it feel to realise you have been manipulated?Does anyone in the group feel they are good at manipulation? What do you think the word‘manipulation’ means? How and when can manipulation be useful? When can it be positive (i.e.47Resource Pack: The Knot of the Heart

telling a joke, telling a story, watching a film). Can you think of other examples?Practical Exercise: Set up the room end-on style with an audience and a playing space. Ask for avolunteer (person A) to leave the room. Ask for five further volunteers whose job it will be to try andmake the person who has left the room drink a glass of liquid (or, if water is not available, to doanother simple action as agreed). The five ‘manipulators’ can use any tactics they want and will havethree minutes to try and persuade person A to drink – the rule is that they can’t touch person A, butthey can drink the liquid or do anything else so long as it is safe. Ensure the five volunteersunderstand their task. Then brief person A outside the room – they should start from the position ofnot wanting to drink but after hearing all the five volunteers they can choose which one would makethem consider drinking and why. Ideally the liquid should look suspiciously like urine - to maximisethe effect of manipulation - so use apple juice rather than water and put it on a chair or table at thefront. Let each person take a turn and then ask A who would have persuaded them and why?Practical ExercisesEvaluate: What tactics were used? How were language and physical elements used? Were they highstatus or low status? What other ideas can the audience think of? What would have worked for them?Watching the Play: How do the characters in The Knot of the Heart control and manipulate eachother’s behaviour? Notice in particular how manipulation can often be unspoken - how is thisexpressed between Lucy and Barbara; between Angela and Barbara; between Angela and Lucy. Howmight the actors have created this tension through their rehearsal period?Exercise 3: Language and RepetitionIn the play, there are several instances where the dialogue is highly repetitive, and the same words areused multiple times in succession, but their meaning and emphasis may change.Duration: 20 minsAim: This exercise, a yes/no game, encourages students to look at how words can mean differentthings in various contexts.Practical Exercise Part 1: Split the group into As and Bs. The two teams will be arguing about aResource Pack: The Knot of the Heart 48

Practical Exercisessubject (any subject of your choice - something humorous, current or provocative, such as ‘Jordanshould be Prime Minister’ or ‘Footballers should not be paid more than the prime minister’).However, Team A can only use the word ‘yes’, and Team B only the word ‘no’. Ask students to thinkabout all the different ways they can use their word, considering meaning, tone, volume and pace.Evaluate: What tactics were used? How easy was it to tell what someone meant through their tone?Who won the debate?Practical Exercise Part 2: Ask participants to get into pairs of an A and a B. Then split these pairs intotwo or three different sets. They will all do the exercise at the same time, but each set will have adifferent context to work within. You can watch one example from each group.Group 1: you are brothers/sisters and A has seen B stealing money from your mother’s purse. A canonly say ‘I saw you’; B can say anything that they want.Group 2: A is the parent, B is the child. B, the child, has decided to leave home. A, the parent, canonly say ‘I love you’; B can say anything that they want.Group 3: A is the child, B is the parent. A, the child, has accused the parent of loving their sister morethan them. A can only say ‘Why do you love her more than me’; B, the parent, can say anything thatthey want.Evaluate: Repetition builds tension through rhythm, highlighting significance and building conflict.What do you think the repetition did in each individual scene? What does it tell us about characters?How much of an acting challenge is it? Sometimes the form, the writing style and the way language iswritten on a page can tell us as much about the character as the words they say.Watching the Play: When do the moments of repetition occur? What function do they serve?Exercise 4: Drug AddictionDuration: 15-20 minutesAim: To encourage students to think about the impact substance addiction has - as a medical illness -on family life, and to use drama to illustrate relationships.Discussion: What kind of substances do we often hear about people becoming addicted to? (Alcohol,49 Resource Pack: The Knot of the Heart

tobacco, prescribed drugs, illegal drugs). Do you know that addiction is a medical illness? Do youthink the media present addiction as an illness? What are some of the stereotypes and prejudicesabout addiction? You might want to read the interview with consultant psychiatrist Dr Owen-BowdenJones on pages 38-43.Practical Exercise: Split the group into smaller groups of five. Ask each group to create three frozenimages that are photographs of a family where one family member has a problem with substanceaddiction. Decide what they are addicted to and show, progressively with each image, the impact thataddiction has on the family. With a more advanced group, extend this exercise by asking them tocreate five images, then ask them to develop short transitional scenes between them. Ask each groupto share their work back with the rest of the group as audience.Evaluate: What are the ways that addiction impacts on emotional (fear, desperation, sadness),physical (passive smoking, alcohol related violence, neglect) or practical (cost) wellbeing? In thescenes, what part did the family have to play in supporting (or not) the addict?Watching the Play: In the play, in addition to Lucy’s heroin addiction, Lucy and Angela smoke, andboth Angela and Barbara drink a lot of wine. Lucy and Barbara’s relationship could be described asco-dependent: at points they use their relationship to define their identity. Ask the group to look outfor these points during the play. When do the characters turn to the substance that they aredependent? How does their dependency affect their relationships - and vice versa?Exercise 5: Family Relationships - Doing the Right ThingIn the play Barbara tries to support Lucy through her drug addiction, at different points she supportsLucy financially and lets her live at home when she is using drugs, allows Lucy to take heroin in thefamily home, and gets heroin for Lucy so that she doesn’t have to meet her dealer. However, she isdesperate to do the right thing for her daughter and believes she has no other option to keep her safe.Duration: 15-20 minutesAim: To encourage students to consider the theme of guilt and its purpose with the context of theplay’s dramatic action.You will need: Multiple copies of the three scenarios (see below) as hand-outs for the group.Practical Exercise: Split the group into threes to create a short scene where trying to support orprotect a family member you care about conflicts with doing the right thing. Share the scenes backwith the rest of the group.Practical ExercisesScenarios:1. In the living room, 3 brothers/sisters: one brother/sister has been accused of stealing alaptop from their college, they already have some minor convictions as a youth offender and ifthey are convicted they will probably go to a youth offender’s institute. They did steal it (topay off a final debt and try to cut ties with a group of people who are bad news). They say thatthey are trying to turn their life around. They are asking their brothers/sisters to cover forthem.2. In the kitchen, 2 parents & 1 child: you suspect that your child was one of a group ofyoung people who vandalised the house of an elderly man, who was so shocked and upset hehad to go to hospital and is quite ill. You think that your child has been bullied at schoolrecently.3. In the bedroom, 3 brothers/sisters: you think that your brother or sister is smoking toomuch weed. When you talk to them about it they say they aren’t smoking too much, and theysmoke because it seems to be the only thing that stops the horrible panic attacks that theyget, and are very embarrassed about.Resource Pack: The Knot of the Heart50

Practical ExercisesEvaluate: Who do you think was doing the right thing in each of the group’s scenes? What are thechallenges of trying to do the right thing? What about ‘tough love’? What did it feel like to play acharacter struggling to do the right thing - were the choices obvious?Watching the Play: What things do the characters do that they think is for best, but might not be? Ifyou were Barbara, what would do differently towards Lucy and Angela? Think about the othercharacters.Exercise 5: Script ExtractsDuration: 15-20 minutesAim: To encourage students to consider the theme of guilt and its purpose within the context of theplay’s dramatic action.You will need: A copy of the script (extracts available on request from Almeida Projects, or full copiesare available to buy from the Almeida Theatre Box Office or Kiosk).Practical Exercise: In pairs, look at the following script extracts. These are examples of how thethemes we’ve looked at are explored in The Knot of the Heart. Consider what we’ve learnt about thesethemes, and how they might influence the choices you make in staging your extract.1. Scene 2: Page 12 (start of scene with Lucy rummaging in Angela’s bag) to Page 16 (Angela:When are you going to leave?). Two-hander - 2 girls.2. Scene 2: Page 22 (Angela: Why do you prefer her to me?) to Page 26 (Angela: GoodbyeLucy. Goodbye Mum. [Cutting Lucy’s lines on page 23 and page 25]). Two-hander - 2 girls.3. Scene 4: Page 59 (Brian: So if you’re a TV presenter how come you’re sleeping rough?) toPage 64 (Lucy: Help me.). NB - this extract contains strong language. Two-hander - 1 girl, 1boy.3. Scene 9: Page 87 (Dr Harris: I have read your notes Lucy….) to Page 91 (Lucy: It’s cured….Iknow it’s gone.). NB - this extract contains strong language. Two-hander - 1 girl, 1 boy.4. Scene 10: Page 102 (Marina: Lucy’s care worker will be coming to collect her) to Page 105(Marina: Lucy’s decided…it must be very painful.). Three-hander - 3 girls or 2 girls, 1 boy:Marina could be played by a boy if needed.5. Scene 11: Page 110 (Andrew: And what we’ve got is a great new format for a kids natureshow…) to Page 113 (Andrew: Can I quote you on that?) NB - this extract contains stronglanguage. Two-hander - 1 girl, 1 boy.Share short extracts back and, thinking about your knowledge of the play, discuss which themes cameup in each extract.Evaluate: What was effective about each group’s staging of the scenes? How did they differ? What doyou feel you have learnt about the character you were playing? Was your status clear? Did you find thelanguage easy to perform?Watching the Play: Ask students to keep an eye out for the short scenes they performed. What did theactors do different under Michael Attenborough’s direction? How was this effective?Resource Pack: The Knot of the Heart

BOOKSBrand, Russell My Booky Wook (2007, Hodder & Stoughton)Coats, John No Big Deal: A Guide to Recovery from Addictions (2006, Sow’s Ear Press)De Quincy, Thomas Confessions of an English Opium-Eater (1994, Wordsworth Editions)Eldridge, David Plays 1 - Serving It Up, Summer Begins, Under the Blue Sky, M.A.D. (2005, Methuen)Jay, Mike High Society: Mind Altering Drugs in History and Culture (2010, Thames & Hudson)Kampusch, Natascha 3096 Lost Days (2010, Penguin)Lewis, David M et al Addiction and Recovery for Dummies (2005, John Wiley and Sons)Lowenthal, Rita One-Way Ticket: Our Son's Addiction to Heroin (2007, Beaufort Books)Mold, Alex Heroin: The Treatment of Addiction in Twentieth-Century Britain (2008, North IllinoisUniversity Press)Myerson, Julie The Lost Child (2009, Bloomsbury Publishing)Nakken, Craig The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior(1990, Hazelden)Twerski, Abraham J. PHD Addictive Thinking: Understanding Self-deception - How the Lies we TellOurselves and Others Perpetuate Our Addictions (1990, Hazelden)Woolf, Peter The Damage Done (2009, Bantam)Further ReadingWEBwww.talktofrank.com FRANK: the A-Z of drugswww.nhs.uk/livewell/drugs NHS website; lots of articles about drugs, their effects and treatmentwww.ukna.org Narcotics Amonymouswww.famanon.org.uk Families Anonymous - for relatives/friends concerned about drug usewww.rcpsych.ac.uk/mentalhealthinfo/problems/alcoholanddrugs Royal College of Psychiatrists -download leaflets about drug and substance addictionResource Pack: The Knot of the Heart

AlmeidaProjectsThe Knot of the HeartAlmeida Projects Resource PackWritten and designed by Charlie Payne,with contributions from Anne Langfordand Benjamin Long.The Knot of the Heart by David Eldridgewas produced at the Almeida Theatre10 March - 30 April 2011.The information in this Resource Packis correct at the time of going to Press.All rights reserved. © Almeida Theatre,Published March 2011.The Almeida Theatre is a RegisteredCharity No. 282167. The AlmeidaTheatre Company Limited, AlmeidaStreet, London N1 1TA. Use of thisAlmeida Projects Resource Pack isauthorised in connection with theAlmeida Projects work at the AlmeidaTheatre. Any further use in any formmust be approved by the creators. Thecopyright of all original materialremains with the creators.Almeida Projects photography: Ludovicdes Cognets, Lucy Cullen, Bridget JonesAlmeida Projects is the Almeida Theatre’sprogramme for young people.Inspired by the Almeida Theatre’s productions, Almeida Projects delivers arange of high quality, innovative activities to make the theatre accessible toyoung people, inspire them creatively and encourage an exploration of thepower and potential of theatre.Almeida Projects provides an active, creative link between ourtheatre and its audience, more specifically an audience that maynot have considered that the theatre might not be for them.Our aim is to act as a catalyst to their energies, to their hunger toparticipate - celebrating the creativity of young people in the best waywe know how: by offering them our experience, our expertise andour unique theatre.Michael AttenboroughArtistic DirectorAlmeida Projects’ work draws on all aspects of theatre, working withthousands of people each year, and includes: work in partnership with localschools; the Young Friend of the Almeida scheme; and a subsidised ticketscheme for schools. For more information please visit our website.www.almeida.co.uk/educationAlmeida Projects is supported by:National Lottery though ArtsCouncil EnglandRaymond Cazalet Charitable TrustThe Noël Coward FoundationThe Peter Harrison FoundationThe City Parochial FoundationPinsent MasonsMrs Sue BaringLady BoothbyMiss Deborah BrettPerdita Cargill-Thompson & Jonathan MartinStamos J FafaliosJoachim FleuryLord Hart of ChiltonTamara IngramJack & Linda KeenanCharles & Nicky Manby.Georgia OetkerChristopher RodriguesNicola StanhopeJane ThompsonSarka TourresSimon & Glennie WeilAndrew Goldstone, Jamie Arkell andAndrea Sullivan London MarathonRunners 2011