Next to inaccurate

As a critic, I am in a terrible bind: the Yellow Tree Theatre has just staged a beautiful production of an emotionally hard-hitting musical, and yet I struggle to recommend that you go see it.

I’m talking about Next to Normal, the Pulitzer-winning show that has been staged in the Twin Cities at least four times over the past four years, including productions by the Broadway touring company, the Mixed Blood, the Bloomington Civic Theater, and now the Yellow Tree. All of those productions have gotten rave reviews. It’s a powerful show with ample opportunities to showcase performers’ acting and singing abilities, and the Yellow Tree has done an amazing job from an artistic standpoint. But Next to Normal is also a show about bipolar disorder, and as one of very few popular musicals about mental illness, it carries a certain burden of responsibility.

Mental illness, and bipolar disorder specifically, falls prey to a great deal of misconceptions and misinformation, many of which come from media portrayals. At their worst, TV shows like Criminal Minds often blame mental illness for horrifying criminal acts, but even Homeland – which has largely done well at working to destigmatize bipolar disorder – has been criticized for portraying mental illness as a shameful and unmanageable attribute that must be hidden or somehow compensated for.

So when bipolar hits the stage, particularly in a show whose claim to fame is that it humanizes mental illness, I expect the librettist (Brian Yorkey) to have done his research.

In the interpersonal elements of the illness, I think he has done well. The show doesn’t glorify bipolar disorder, nor does it shy away from the harsh ways it can tear people and relationships apart. The Yellow Tree’s cast makes it easy to empathize with the entire family: while Diana (Jessica Lind Peterson) goes through a stunning emotional range as she tries treatment after ineffective treatment, her husband Dan (Jeremiah Gamble) struggles to be the rock for his family. In the meantime, their teenage daughter Natalie (Libby Anderson) resorts to perfectionism – and later, recreational drugs – as a way to cope with her messy family life.

The supporting cast is also excellent, but the process of trying to hold a family together is what makes the show so affecting. And from Eli Schlatter’s clinically-white set to Courtney Schmitz’s stunning lighting design to the excellent band and balanced sound design, the Yellow Tree has brought together all of the elements you need to support the emotional weight of the show. Some of Next to Normal’s great reviews come from the fact that it is, without a doubt, a show that will make you feel a lot of things. (If you often cry at theater, you will definitely cry here.)

So you can be satisfied that the Yellow Tree has staged a beautifully-executed and moving show. And maybe at some point over the past several years, you’ve already seen Next to Normal and decided you love it – in which case, the trip out to Osseo to see this production is more than worth it.

And now for the problem

But although the characters’ interactions and emotional struggles in the show feel intense and genuine, the scientific aspects of bipolar disorder did not. If Next to Normal is your only encounter with bipolar disorder, here are some of the wrong ideas to be wary of.

First, Diana’s disorder is portrayed as stemming from her unresolved grief for a loved one. This also implies that if she had just grieved in the “right” way, she wouldn’t have gotten her disorder. In fact, while outside events can trigger isolated episodes of mania or depression for bipolar patients, the disorder as a whole is generally caused by a complex array of genetic, chemical, and environmental factors. There is no easily identifiable single cause for bipolar, and certainly no event that patients can blame for their illness.

Both pharmaceuticals and electroconvulsive therapy (ECT), which can be a very effective treatment for acute mental illness, also come across poorly in the show. Diana ditches her meds due to the side effects; this act is portrayed as liberating, when it is actually extremely dangerous. And her choice to undergo ECT both feels coerced and causes her to forget 19 years’ worth of memories – an extremely unlikely occurrence in actual ECT. Portrayals such as these are discouraging to patients who might benefit from ECT, and also reinforce social stigma around an already-maligned treatment.

Finally, Diana’s choice to go it alone, without medication or the support of her husband and daughter, is a dangerous model for those with mental illness of any kind. Sure, it looks heroic to pursue a cure based on no more than grit and willpower, but the evidence (and common sense) says that patients are more successful with a combination of medication, talk therapy, and the social support that a loving family can provide.

This is a musical that seemingly portrays bipolar disorder in a realistic way, but its ultimate message is that mental illness is purely a matter of conquering one’s inner demons. Would you tell a patient with diabetes – another manageable but chronic illness – that if they just hadn’t eaten those doughnuts as a kid, they wouldn’t have gotten sick? Would you tell them that they shouldn’t bother taking insulin or managing their diet, because the injections are painful and they miss the sugar high? Or that they should probably leave their supportive homes, because they just need some time alone to beat their disease?

Of course you wouldn’t. And Next to Normal is particularly irresponsible in saying those things about bipolar disorder, because many audiences don’t have the information to recognize where the theatrical portrayals are straying from fact. This is a little-known diagnosis that can be devastating, both for individuals and families, but it can also be managed with patience, hard work, and the proper support. As much as I admire the actors’ amazing voices and raw emotion, and as impressed as I am with all of the artistic choices that went into making the Yellow Tree’s production so successful, if you see this show (or decide to stage it), I hope you take the time to educate yourself first.

If you’ve seen the show and are interested in reading more, I would encourage you to check out some other sources, from trained psychiatrists to scholars in theater and performance studies, who draw on a deeper base of research when discussing the show. And if you suffer from mental illness or know someone who does, NAMI MN has an excellent catalog of fact sheets and classes to provide support.