Which strategies are used in stories about the inexpressible world of mental illness? Voices of the ill or marginalized psyches are in equal measure victim to continued doubt and repression as well as symptomized as no more than the result of a chemical imbalance. Though, by examining certain marginalized voices within art, it is possible to address questions regarding narratives of illness, their worth and wisdom as fictional testimonies. It may be possible within fiction to create a meaningful language for the chaos of illness, but what happens if and when the storyteller’s voice is in so much agony that the story no longer has meaning? By engaging in an analysis of Sarah Kane’s play 4:48 Psychosis (2000) and other relevant texts from art and popular culture, the author investigates whether it is possible to outline different features of the marginalized voice. In Kane’s case, specifically, an argument can be made that this voice comes from within the depth of a devastating illness. This is done, in part, by challenging and fragmenting the very language used, but also by the technical use of silence within the play.