It is good to see this extraordinary play of love and decadence among medical students in Vienna between the wars brought into sharp focus at the National after several fringe productions in the last 20 years.

The Austrian author, Ferdinand Bruckner, was an American exile from Hitler’s Germany, but his career in the slipstream of Kraus and Schnitzler was fractured by the move – he returned to Germany in 1951 - and he remains best known for this torrid and tortured 1926 masterpiece.

The British premiere of Pains of Youth was a scalding affair at the Gate, with Joanne Pearce making a breakthrough appearance as the bisexual, suicidal Desiree in the boarding house where she’s completing preparation for her final exams.

Director Katie Mitchell’s approach is a clinical atomisation of the play, in a new version by Martin Crimp (the literal translation by Lucy Gribble goes shamefully unacknowledged in the NT programme) that is brilliantly conceived but crucially under-projected in one or two performances.

The boarders are presented like specimens in a laboratory and double as their own attendants in black suits and rubber gloves, removing plastic dust sheets and presenting medicines and alcohol in a cold grey light, the action then flashed up in full colour on Vicki Mortimer’s brown, spacious attic interior with twelve-tone musical accompaniment played live by Simon Allen.

Newcomer Lydia Wilson’s too mousy, too tentative Desiree is in love with Laura Elphinstone’s older, harassed Marie; she, in turn, has to deal with Leo Bill’s furious ex-lover Petrell and Jonah Russell’s hedonist Alt, who has served two years in prison for administering morphine to a sick child.

Petrell is debauching Cara Horgan’s virginal Irene while Geoffrey Streatfeild’s sinister, drunken Freder, revealed as the play’s amoral lynchpin, is corrupting the maid, Lucy (too wanly and inaudibly done by Sian Clifford), whom he transforms, Svengali-like, into a thieving accomplice and street-walker.

It’s a genuinely shocking and disturbing play, and Mitchell and Crimp finesse the final scenes into a stylistic inversion of a Noel Coward comedy, with an assisted suicide as backdrop to a desperate and macabre love scene between doomed participants.

- by Michael Coveney