Stage Left: Mental Illness and Treatment in NEXT TO NORMAL
[video: A still frame of the cover to the next to normal cast album, showing a woman's eyes and a house on a purple background. Lyrics to "I Miss the Mountains", the song playing, are at the link]
As a mentally ill musical theatre fan, depictions of characters who share that trait with me typically fall into one of two categories: they a) don't exist or they b) make me rage. next to normal comes closer than most shows to getting it right, in a lot of ways. But where it fails, it fails hard.
The show is unusual for being centred on mental illness, firstly. The main character, Diana, has bipolar disorder and this is what drives the central conflicts of the show (I'd love to see a musical where a character being mentally ill was just part of their character, but that's another issue entirely...). There are things about this approach that the show does right—Diana is a suburban mother, and a fairly ordinary one. She is not a Tortured Artist or Prodigy or any of the other tropes discussed in this New York Times article on the show. The writers consulted closely with professionals in crafting their approach, and in many ways it shows. In his review, Tony Brown of Cleveland.com writes favourably of the show and speaks openly of his own Bipolar II diagnosis, empathizing strongly with Diana's character.
So what's the problem? Well, there are several. But the one that I was personally most irked by was the show's irresponsible and harmful depiction of how mental illness is treated. Early in the show a series of medication adjustments is portrayed in an extended musical sequence, “My Psychopharmacologist and I.” Mostly the number is cute—Diana has an appointment, lists her side effects, gets a new treatment. I can empathize with that (and it has a hilarious riff on “My Favourite Things” midway through!). The resolution, however, features the following exchange:
DIANA: I don't feel like myself...I don't feel anything.
DOCTOR: Hm. Patient stable.
Every time I get to this exchange I want to scream at my CD player. Psychiatric medication, contrary to what the creators of the musical apparently think, is not supposed to stifle all feeling. As someone on a medication I am happy with, I still feel. What it does is regulate my feelings so that I am functional and not, y'know, sitting in a corner in the dark for hours on end (this has happened). And perpetrating the stereotype that psych meds “destroy feeling” or interfere with how one relates to the world? Is not at all helpful.
This is not the only glaring problem in the show's representation of psychiatric treatment, however. At the close of the first act, Diana undergoes electroconvulsive therapy. For starters, I would question whether her informed consent—a prerequisite for ECT and indeed most therapies!—was obtained, as the scene in which she signs the papers seems mildly coercive at best—it seems clear textually that she is not at all comfortable with the therapy, and may be acceding primarily due to pressure from her husband and doctor. Her reluctance is clearly displayed in songs like “Didn't I See This Movie?”
DIANA (sung): What makes you think I'd lose my mind for you?
I'm no sociopath, I'm no Sylvia Plath
So stay out of my brain
I'm no princess of pain
And yet...she goes through with it. Her husband talks her into signing, and she undergoes treatment. At which point she promptly loses some twenty years of memory. Which...no. Right upfront I will admit I don't know a lot about ECT. Much of what I do know is from research for this post. I know ECT can cause memory loss. I know this can affect memories of events from years prior. But all of the memory? A nineteen-year gap in which she remembers nothing about her family or living situation? That, I am pretty sure, does not happen. It's a way of sensationalizing a therapy course which, while controversial, has helped many people. (IMPORTANT SIDE NOTE: I do not know enough about ECT to conclusively support or condemn its use. I know it has both pros and cons. It still does not work in the way this musical portrays it).
next to normal won the 2010 Pulitzer Prize for Drama. And despite what I've talked about here, I am a big fan. I respect what the creators were trying to do, but at the same time feel they needed to do better. They needed to portray this in a way that did not alienate those who have chosen to pursue treatment through the medical establishment. Yes, it's just one show, but it's one of very few theatrical pieces that have tackled mental illness this centrally, and the creators have spoken about their desire to get it right. Which they did not. And the fact that the show won the Pulitzer...this just serves to reinforce the idea that it does get things right, that it is saying things that are meaningful instead of harmful. And that's a problem.
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