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Home , Brian Yorkey, David Auburn, I Am My Own Wife, Karl Leonhard, Kay Redfield Jamison, Kendra Kassebaum

Table of Contents

About ATC . 1

Next to Normal: Community Engagement Project. 2

Generous support. 3

Introduction to the Play . 4

Synopsis. 4

Song List...... 5

Meet the Characters. 6

Meet the Creators. 7

The Road to . 8

An Interview with . 9

The . 11

Mental Health and . 12

Inventory of Allusions and References. 14

Glossary of Medical Terms in Next to Normal. 16

Discussion Questions and Activities . 18

It is Arizona ’s goal to share the enriching experience of live theatre. This Play Guide is intended to help you prepare for your visit to Arizona Theatre Company. Should you have comments or suggestions regarding the play guide, or if you need more information about scheduling trips to see an ATC production, please feel free to contact us:

Tucson: April Jackson Associate Education Manager (520) 884-8210 [email protected]

Phoenix: Amber Tibbitts Education and Company Management Associate (602) 757-6289 [email protected]

Next to Normal Play Guide is compiled and written by Katherine Monberg, Literary Assistant and Christopher Pankratz, Dramaturgical Intern. Discussion questions and activities provided by April Jackson, Associate Education Manager and Amber Tibbitts, Education Associate. Layout by Esser Design About ATC

Arizona Theatre Company is a professional, not-for-profit theatre company. This means all of our artists, administrators and production staff are paid professionals, and the income we receive from ticket sales and contributions goes right back into our budget to create our work, rather than to any particular person as a profit.

Each season, ATC employs hundreds of actors, directors and designers from all over the country to create the work you see on stage. In addition, ATC currently employs about 100 staff members in our production shops and administrative offices inT ucson and Phoenix during our season. Among these people are carpenters, painters, marketing professionals, fundraisers, stage directors, computer specialists, sound and light board operators, tailors, costume designers, box office agents, stage crew – the list is endless – The Temple of Music and , the home of ATC shows in downtown Tucson. representing an amazing range of talents and skills.

We are also supported by a Board of Trustees, a group of business and community leaders who volunteer their time and expertise to assist the theatre in financial and legal matters, advise in marketing and fundraising, and help represent the theatre in our community.

Roughly 150,000 people attend our shows every year, and several thousands of those people support us with charitable contributions in addition to purchasing their tickets. Businesses large and small, private foundations and the city and state governments also support our work financially.

All of this is in support of our vision and mission:

Our vision is to touch lives through the power of theatre.

Our mission is to create professional theatre that continually strives to reach new levels of artistic excellence and that resonates locally, in the state of Arizona and throughout the nation. In order to fulfill our mission, the theatre produces a broad repertoire ranging from classics to new works, engages artists of the highest caliber, and is committed to assuring access to the broadest spectrum of citizens.

The Herberger Theater Center, ATC’s performance venue in downtown Phoenix.

1 Next to Normal : Community Engagement Project

RECOVERY IS POSSIBLE

Arizona Theatre Company is proud to partner with the following organizations in Southern Arizona as part of our Community Engagement Project for our production of Next to Normal. Join us as we take a look at the reality of coping with mental illness and how it is possible to live a “normal” life.

National Alliance on Mental Illness, Southern Arizona www.namisa.org (520) 622-5582

CODAC Behavioral Health Services www.codac.org (520) 327-4505

Community Partnership of Southern Arizona www.cpsa-rbha.org (520) 318-6946

The Haven www.thehaventucson.org (520) 623-4590

Interfaith Community Services www.icstucson.org (520) 297-6049

Fund for Civility, Respect and Understanding www.fundforcivility.org

September has been declared National Recovery Month by SAMHSA ( and Mental Health Services Administration) and October 3-7 is National Mental Illness Awareness Week. In recognition of these national events, Arizona Theatre Company is helping our local mental health service organizations spread the message that recovery is possible. We will be hosting a Panel Discussion in both Tucson and Phoenix to start a dialogue about the reality of mental illness and the many resources available to those in need. Informational materials from our community partner organizations will also be available in the lobby throughout the run of Next to Normal for our patrons who want to learn more about mental illness in our community.

For a complete list of our scheduled community events, visit our website: www.arizonatheatre.org or contact Associate Education Manager April Jackson: [email protected].

2 Generous support

Generous support for ATC’s education and community programming has been provided by:

APS Rosemont Copper

Arizona Commission on the Arts Stonewall Foundation

Bank of America Foundation Target

Blue Cross Blue Shield Arizona The Boeing Company

Boeing The Donald Pitt Family Foundation

City Of Glendale The Johnson Family Foundation, Inc.

Community Foundation for Southern Arizona The Lovell Foundation

Copper & Gold Foundation The Marshall Foundation

Cox Charities The Maurice and Meta Gross Foundation

Downtown Tucson Partnership The Max and Victoria Dreyfus Foundation

Enterprise Holdings Foundation The Stocker Foundation

Ford Motor Company Fund The William L. and Ruth T. Pendleton Memorial Fund

Freeport-McMoran Tucson Medical Center

JPMorgan Chase Tucson Pima Arts Council

John and Helen Murphy Foundation Wells Fargo

National Endowment for the Arts

Phoenix Office of Arts and Culture

PICOR Charitable Foundation

3 Introduction to the Play

Next to Normal Book and Lyrics by Brian Yorkey Music by Directed by David Ira Goldstein

Next to Normal, the Pulitzer-Prize winning portrayal of a modern family dealing with mental illness in their midst describes the powerful, agonizing, and beautiful journey of pain, hope, anger, and love that lines the long road to recovery. Diana Goodman, suburban housewife and mother, suffers the symptoms of bipolar disorder as her loyal husband and teenage children struggle to remain supportive and emotionally intact through the jigsaw puzzle of treatments, medications, therapies, and all the day-to-day challenges of growing up and growing older in America. Each member of the family accrues their own emotional scars and baggage as they dream of their individual versions of, if not an ideal existence, then one that could be at least be described as “next” to normal. The winner of three and the first musical to be awarded the Pulitzer Prize since the incarnation ofR ent, Next to Normal expands the entire scope of the and invites a modern audience into a challenging discussion of the emotional, intellectual, and personal implications of mental illness and its place in our lives, our world, and amongst ourselves.

Synopsis

Dan and Diana Goodman have a beautiful suburban house and two beautiful children. It becomes instantly clear, however, that the Goodman house is far from the “normal” nuclear family. Early in the play Diana is seen performing a very natural task of parenthood: making lunches for her children to take to school. The routine suddenly takes a turn for the manic and unsettling. Diana loses control frantically slapping Actress , Actor Joe Cassidy, who plays together a mountain of sandwiches hurtling her towards a nervous breakdown, the who plays Diana in ATC’s Dan in ATC’s production of production of Next to Normal. Next to Normal. first of many throughout the show. As the household unravels onstage, character relationships and dynamics are exposed within the dysfunctional family.

Natalie, the over-stressed academic of the family, retreats to the music room at school to practice her piano sonatas and dream of a life complicated. There she meets Henry, a carefree teenage musician who helps her to relax and enjoy the music. When he takes an interest in Natalie, she shies away, her parents’ complicated marriage fresh on her mind.

Dan, the loyal and patient head of the family, routinely waits in the car while Diana visits Dr. Fine, her psychopharmacologist, who attempts to level out her depressive episodes through a maze of trial, error, and prescription. After weeks of adjustments, the drugs finally subdue her emotions completely, leaving her with little feeling at all – a state Dr. Fine refers to as “stable.”

Diana witnesses Natalie and Henry sneak a kiss on the doorstep and laments the dull emotional numbness the barrage of medications has caused. With the support of her son Gabe, Diana flushes away her store of pills, sacrificing her newfound stability to regain the emotions she has blocked out. After an embarrassing episode at dinner, Dan insists she return to the doctor. Cornered, Diana tells him he couldn’t possibly understand what she is going through.

The family is again thrown into torment. Natalie begins to feel insecure and questions her relationship with Henry. Dan takes Diana to a new doctor who tries less conventional methods of treatment, including hypnosis and electroconvulsive therapy (ECT). Natalie struggles with her mother’s decline and begins to experiment with drugs and parties to escape.

Dan tries everything he can to keep his family together by being the father that Natalie deserves and the care-taker Diana requires. Gabe continues to support his mother and appears in her times of greatest need to give her confidence and reassurance – but the family has more hurdles to climb. The journey they must travel is one of the most complex and original plots written for the musical stage, leaving no emotion unsung.

4 Song List

Act 1 Prelude (Light). Orchestra Just Another Day . Diana, Natalie, Gabe, Dan Everything Else. Natalie Who’s Crazy/My Psychopharmacologist and I. Dan, Diana, Doctor Fine, Voices Perfect for You...... Henry, Natalie I Miss the Mountains. Diana It’s Gonna Be Good. Dan, Gabe, Henry, Natalie He’s Not Here. Dan You Don’t Know. Diana I Am the One . Dan, Gabe Superboy and the Invisible Girl. Natalie, Diana, Gabe I’m Alive. Gabe Make Up Your Mind/Catch Me I’m Falling. Dr. Madden, Dan, Gabe, Diana, Natalie I Dreamed a Dance. Diana, Gabe There’s a World. Gabe I’ve Been...... Dan, Gabe Didn’t I See This Movie?. Diana A Light in the Dark . Dan, Diana

Act 2 Wish I Were Here. Diana, Natalie Song of Forgetting...... Dan, Diana, Natalie Hey # 1 . Henry, Natalie Seconds and Years. Dr. Madden, Dan, Diana Better Than Before. Dr. Madden, Dan, Diana, Natalie Aftershocks . Gabe, Diana Hey # 2 . Henry, Natalie You Don’t Know (Reprise). Diana, Dr. Madden How Could I Forget?. Diana, Dan It’s Gonna Be Good (Reprise) . Dan, Gabe, Henry, Natalie Why Stay?. Diana, Natalie A Promise. Dan, Henry I’m Alive (Reprise). Gabe The Break . Diana Make Up Your Mind/ Catch Me I’m Falling (Reprise). Dr. Madden, Diana, Gabe Maybe (Next to Normal) . Diana, Natalie Hey #3/Perfect for You (Reprise). Henry, Natalie So Anyway . Diana I Am the One (Reprise). Dan, Gabe Light. Full Company

5 Meet the Characters

Actor Jonathan Shew, Actress Andrea Ross, Actor A.J. Holmes, Actor Mark Farrell, who plays Gabe in ATC’s production who plays Natalie in ATC’s production who plays Henry in ATC’s production who plays Dr. Madden and Dr. Fine in of Next to Normal. of Next to Normal. of Next to Normal ATC’s production of Next to Normal

Diana Goodman: A devoted wife and mother with a full heart but broken life, suffering from bipolar disorder and clinical . For the last 16 years she has struggled with delusional episodes and breaks from reality coupled with crippling anxiety and loss of self. “I will keep the plates all spinning with a smile so white and winning ‘cause what doesn’t kill me doesn’t kill me, so fill me up for just another day.”

Dan Goodman: The caring and supportive husband, Dan is perpetually optimistic about Diana’s treatment and recovery, but longs for the stability and devotion he recalls in memories of their youth. Having to put his own needs behind those of his wife and family, Dan is growing tired and worn between Diana’s appointments and breakdowns, but is unfaltering in his loyalty to the family. “And every day this act we act gets more and more absurd…and all my fears just sit inside me, screaming to be heard… I know they won’t, though – not a single word.”

Gabe Goodman: The 18-year-old son of Dan and Diana, Gabe is a ray of comfort in Diana’s depressive states, exuding pure energy and youthful vibrancy. Gabe is said to be Diana’s favorite and her pride and joy, heroically appearing when she needs the reassurance and hope that only a son can give. “And though you made me, you can’t change me – I’m the perfect stranger who knows you too well.”

Natalie Goodman: Dan and Diana’s 16-year-old daughter who spends her days at the piano practicing Mozart’s sonatas and losing sleep for the sake of homework and goals. Natalie hopes a music scholarship to Yale will be her ticket out of a stressful household but secretly fears she will end up like her mother, as she holds fast to her deepest wish: for a life that is at least “next” to normal. “…some days I think I’m dying. But I’m really only trying to get through.”

Henry: A persistent love interest for Natalie, Henry uses his music and humor to convince her that they are perfect together. Henry, a self-proclaimed slacker and pot smoking teen is the perfect complement for the over-worked Natalie; his light-heartedness and faith in their relationship neutralizing her insecurities and fear of commitment. “I might be lazy, a loner, a bit of a stoner – it’s true. But I might be perfect – I‘ll make myself perfect…perfect for you.”

Dr. Fine: Diana’s psychopharmacologist, who leads her journey through the world of drug therapy to determine the correct combination of medications. “The round blue ones with food but not with the oblong white ones. The white ones with the round yellow ones but not with the trapezoidal green ones. Split the green ones into thirds with a tiny chisel.”

Dr. Madden: Diana’s less conventional doctor, devoted to finding the answer to Diana’s pain and willing to try everything to get her back on her feet. “Make up your mind to explore yourself. Make up your mind you have stories to tell. We’ll search in your past for what sorrows may last, then make up your mind to be well.”

6 Meet the Creators

TOM KITT (Music) received two Tony Awards in 2009 for Next to Normal (Best New Score and Best Orchestration), as well as the for Drama which he shares with lyricist Brian Yorkey. Next to Normal also received the 2009 Award for Best New Score. He graduated from Columbia College in in 1996, leaving with a degree in economics and a promising partnership with fellow student Brian Yorkey. Kitt’s credits as a composer include the music in (Broadway), From Up Here ( Theatre Club), and The Retributionists () as well as new orchestrations for the CTG/DeafWest production of Pippin and numerous original songs for film and television as the leader of the Tom Kitt Band. His show credits as a musical director, conductor, and arranger on Broadway and Off-Broadway include Green Day’s , ’s 13, Hair, Laugh Whore, , and Debbie Does Dallas, and his string arrangements were featured on Green Day’s Grammy-winning album, 21st Century Breakdown. Tom Kitt and Brian Yorkey BRIAN YORKEY (Book and Lyrics) received the 2009 Tony Award for Best Score and was also nominated for Best Book of a Musical for his work on Next to Normal, for which he also became the co-recipient of the 2010 and won the Outer Critics Circle Award for Best Score. Theatre credits include Making Tracks, which has played Off-Broadway and regionally, the musical adaptation of Ang Lee’s The Wedding Banquet, and the country musical Play It By Heart. For seven years he was Associate Artistic Director at Village Theatre in Issaquah, Washington, one of the leading producers of new musicals in the . Recently, Yorkey’s latest work with Next to Normal collaborator Tom Kitt, In Your Eyes, workshopped at the Village Theatre’s Festival of New Musicals in , 2010, and he is currently working on a piece with singing legend based on the text of the singer’s concept album The Soul Cages. Yorkey has directed Off-Broadway and regionally, and has worked extensively in TV and film where his credits includeT ime After Time, in development with Universal Studios, Love Undercover, Fashion Show, Paramount, and Chase. He is a graduate of Columbia College, and a proud member of the Dramatists Guild and WGA.

7 to Next to Normal

Brian Yorkey and Tom Kitt first began their long relationship of collaboration while working together as undergraduates on Columbia College’s annual production, the . They reunited a few years after graduation at the BMI/Lehman Engel Musical Theatre Workshop in New York, and teamed up for their final project: a ten-minute musical. One night, Yorkey came across a Dateline program about electroconvulsive therapy, and the spark of an idea that would grow into Next to Normal was ignited.

Under the title Feeling Electric, the duo set out to tell the story of a woman undergoing electro- convulsive therapy as treatment for her depression, to mixed reactions. For the next few years, the two went their separate ways. Yorkey became the Associate Artistic Director at the Village Theatre in his hometown of Issaquah, Washington, while Kitt worked on and Off-Broadway as a musical director, conductor and arranger. Years later they came back to their final project, revising

Second Stage Theatre in Washington, DC, Feeling Electric to be about a woman navigating the psychiatric establishment, seeking treatment where Next to Normal first appeared under for the violent mood swings of bipolar disorder. Researching, writing, and rewriting led to a the current title in February, 2008. significant collection of music – over three hours’ worth – without any real central plot line.

The pair undertook a reading and workshop at the Village Theatre before bringing Feeling Electric to the 2005 New York Musical Theatre Festival. While the show wasn’t quite right yet, David Stone, the producer of , saw something in it. He encouraged Yorkey and Kitt to keep working, and to tell the story of the people in the show rather than focus on the medicine. Carole Rothman, the Artistic Director of Second Stage in , shared Stone’s impression of potential and began negotiations to produce the show, bringing in () to direct. With the promise of a production, Yorkey and Kitt went to work with renewed vigor, reworking the music, redefining the story and the character relationships, and transforming Feeling Electric into Next to Normal, a more sincere reflection of the impact of mental illness on the people it touches.

Once again, when the show opened at Second Stage in February 2008, the reviews were divided. Some saw honesty, some saw and satire, some saw camp and insincerity, and some saw flashes of all of those characteristics. Instead of transferring directly to Broadway, as the creative team had originally hoped, they went back to work, convinced by continued audience reactions that this was a story that desperately needed to be told. After some drastic cuts and rewrites, the reactions shifted toward positivity and when Next to Normal opened at in Washington, D.C. in December 2008, their years of toil were rewarded with rave reviews and a resonating story of truth, humor, and impact. Now producer David Stone decided to take the leap onto Broadway, and see what New York thought about this new Next to Normal.

Next to Normal opened on Broadway at the on April 15, 2009 and ran for a remarkable 733 performances, loved by critics and audiences alike. It was honored with eleven Tony nominations that year, winning two, and received the 2010 Pulitzer Prize for Drama – only the eighth musical to do so since the Pulitzer was established in 1917, and the first to win it since Rent in 1996. The show’s Broadway – and continued – success is a testament to the years of work, the hours of revisions, rewrites, and redirections, and the fundamental core of humanity that Yorkey and Kitt allow audiences to access night after night.

8 Interview with Brian Yorkey

Writer and Lyricist of Next to Normal A Musical About Bipolar Disorder By Marcia Purse, About.com Guide Updated May 17, 2009

Interview by Kimberley Read

One family is about to meet the music. Next to Normal opened in Spring 2009 on Broadway at the Booth Theatre in New York City, following its sold-out engagements at both New York City’s Second Stage Theatre and Washington DC’s Arena Stage.

The tale of this musical deals with bipolar disorder from the perspective of a suburban household. The character Diana, played by , is a mother careworn and struggling with bipolar disorder.

Brian Yorkey is the and lyricist for the text and songs of this musical. I had the opportunity to ask Mr. Yorkey a few Model of the set for Next to Normal by John Ezell, set designer for ATC’s production. questions about this production.

KR: By far and away the number one question asked by everyone is regarding your inspiration for the musical? I recall reading in one interview that you and Tom Kitt began collaborating on this project in college. Was there someone in one or both of your lives that struggled with bipolar disorder?

BY: Tom and I each have a number of people in our lives who have struggled with mental illness. They have certainly been on our minds throughout our time working on the show. We wanted to get the story right and have the medical part of it be as accurate as possible, for them and for all people who have similar struggles.

Our original inspiration for the show came when we were in the BMI workshop for musical theatre songwriters. The final project of the first year of the workshop is a “10-minute musical” on the topic of your choosing. We wanted to do something a little different. So one night, when I saw a “Dateline” news report about ECT, I had the idea: What about a story of a woman who has struggled with mental illness her whole life and all the men who have tried to help her? From this kernel, over the course of many years, Next to Normal grew.

KR: I...was floored by the realism in the lyrics, not something often found in fictional representations of mental illness. What research was involved that allowed you to so accurately touch the heart of what makes bipolar disorder such a devastating illness?

BY: We did a tremendous amount of research as we wrote. Often every new plot point would send us off for more research. We read first-person accounts like AndyB ehrman’s Electroboy, Kay RedfieldJ amison’s An Unquiet Mind, Kitty Dukakis’s Shock, Terri Cheney’s Manic, and ’s Darkness Visible, among others. An invaluable resource was ’s The Noonday Demon. We also looked at more clinical texts like Andre Green’s On Private Madness and seminal works like Listening to Prozac, by Peter Kramer. We also read many, many articles and personal accounts, doing our best to look at both sides of potentially controversial aspects of the story.

KR: I read that you held workshops in 2002 as part of the writing process. Did you consult with individuals who have bipolar disorder, significant others to those with this mental illness, medical professionals such as or psychologists?

9 Interview with Brian Yorkey Continued

BY: We were fortunate to have both a and a psychologist consulting with us along the way. They read drafts of the show, saw the productions along the way, and gave us recommendations for language, diagnosis, treatment and such. We told them that while the “civilians” in the show might not always make the best decisions, we wanted the doctors to behave as competent, well- meaning, helpful doctors would – as, indeed, we believe most doctors do. Our goal was not to indict medicine in any way – far from it. Our goal was to show how insidious the disease is, how challenging to diagnose and treat. And survive.

We didn’t directly consult with individuals who have bipolar disorder. But every time we did a public presentation of the material, we were blessed to hear from numerous people who suffered themselves or loved someone who did. Their feedback, both positive and constructively critical, certainly informed our work.

KR: [There was a] long development cycle for Next to Normal. [Do] you think living with the process of change and unpredictability over this long period of time mirrors, in some way, the morphing nature of your subject matter – mental illness and family life?

BY: That’s a fantastic metaphor. It hadn’t occurred to me, but it makes perfect sense. In fact, I think it speaks very well to the evolution of the story. As we rewrote, with each draft we got a little more precise with Diana’s symptoms, a little better at diagnosing her and clearer on the impact these things would have on her and her family. At one point, her psychopharmacologist says, “Well, we’ll try again and eventually we’ll get it right,” which is something we kept telling ourselves.

With the aforementioned help from our consultants, we zeroed in on her specific case and exactly what course her treatment and ongoing struggle should take. In that way I think it mirrors the experience of many patients who must take a long-term approach to living with and fighting a disease that changes shape over time. Very interesting. I’m going to use that metaphor again, if that’s OK.

KR: There have been a lot of comments in reviews regarding the fact that some significant changes were made to the content when the show moved to Broadway. Some scenes were changed, some new songs added, etc. These changes seem to have breathed raw, unshielded emotion into the musical. Were these changes in response to how people with bipolar disorder perceived and related to the production?

BY: In part, absolutely. We never changed our goal through the many years of working on this show. We wanted to tell, as truthfully and humanly as possible, a story of a woman who struggled with mental illness and the family who struggled with her. What did change is how our work went over with audiences, with critics and especially with those who knew the subject matter intimately. Obviously, every single person has a different take on it, but over time you start to hear a consensus from these groups. There are things you hear again and again, and those are the ones you take to heart. We wanted this show to be an emotional experience, as honest as it could be, and we wanted people to experience emotions with Diana and her family – to empathize, to share the experi- ence, rather than just witness it.

KR: Next to Normal has received 11 Tony Award Nominations, including Best Musical. Congratulations! Clearly, you don’t have to know someone with bipolar disorder to appreciate this musical. Why do you think so many people are connecting with the show?

BY: Thanks for the congrats! I think there are a few reasons why people are connecting with the show including an incredible cast under Michael Greif’s smart, sensitive, yet powerful direction, and also Tom Kitt’s wonderful music. As far as the story goes, I think two things.

First, I think many more of us are closer to these issues than others may know. Mental illness has touched someone we love in some way and I think Next to Normal is rare (certainly for musicals) in bringing these struggles to light and to some catharsis. I also think, even if our immediate families haven’t experienced these exact issues, we’ve all struggled with a family dynamic that’s...challenging. We recognize ourselves and our family members in the Goodmans. Some of the PR for the show says it’s about “a family in crisis,” and I always add, “But really, what family isn’t?”

I also think the show provides a few laughs and a really good cry, and we all need those. 10 The Pulitzer Prize

The Pulitzer Prize is an award for achievements in and online journalism, , and musical composition. It was established in 1917 by provisions in the will of newspaper publisher , to be administered by . Nominations for the 21 categories are made by 103 judges, who serve on 20 different juries (one jury is selected to serve for both photography awards). Each jury nominates three potential candidates, and the Pulitzer board selects the winner by majority vote. However, the board has the option of selecting no winner, or selecting a winner who was not nominated by the jury with a 75% majority vote. The Pulitzer Prize There was some controversy when Next to Normal was given the Pulitzer, because it was one of the rare cases where it was not one of the three shows nominated by the jury, and the Pulitzer Board overrode the nominations.

The Pulitzer Prize for Drama was first awarded in 1918, and has gone to a musical a total of 8 times in the nearly 100 years since its creation, with approximately one musical winner each decade from the 1930s into the present. Next to Normal in 2010 was the first musical to take home the Prize since it went to ’s Rent in 1996.

The other musical recipients of the Pulitzer Prize are: George and ’s (1932), Rodger’s and Hammerstein’s (1950), Bock and Harnick’s Fiorello! (1960), ’s How to Succeed in Business Without Really Trying (1962), , Ed Kleban, James Kirkwood, and ’s (1976), and and ’s Sunday in the Park with George (1985).

Other Pulitzer Prize winners produced by ATC:

1937: You Can’t Take it With You by and George S. Kaufman 1980: Talley’s Folly by

1938: by 1983: ‘night, Mother by

1948: by 1984: by

1949: by 1987: by

1955: by Tennessee Williams 1991: by

1957: Long Day’s Journey into Night by Eugene O’Neill 1998: by

1965: by Frank D. Gilroy 1999: Wit by

1967: A Delicate Balance by 2001: by

1971: The Effect of Gamma Rays on 2003: by man-in-the-Moon Marigolds by 2004: by 1973: by Jason Miller 2011: by Bruce Norris 1978: by Donald L. Coburn

11 Mental Health and Bipolar Disorder

Understanding the Misconceptions of Mental Illness

The topic of mental illness in America is traditionally shrouded in negative stereotype, emerging from myth and misunderstanding. The image of a hostile, unstable, potentially dangerous psych patient pervades our films, television, and popular culture, providing a massive social hurdle over which mental health professionals and organizations are forever trying to climb. As many as 1 in 5 persons in the United States will personally experience a mental illness at some point in their lives, indicating that for many of us, “normal” does indeed include mental health issues, and the battle with stigmas and stereotypes that often accompanies them.

However, as common as mental illness actually is in our personal existences, statistics indicate that less than one half of those experiencing symptoms of mental illness will seek professional or medical assistance. The stereotype of the socially isolated, “crazy” mental patient encourages people to avoid categorizing themselves and their loved ones as mentally ill.

These stigmas stem from a lack of understanding. While physical illnesses often provide observable symptoms on the body that our visually stimulated culture is accustomed to drawing explanation from, the symptoms of mental illness often manifest in behavior, and traditionally we are taught that behavior is a choice. Therefore the inability to make a socially “correct” choice must mean that the source, the brain, is damaged or abnormal, which leads to the incorrect assumption that the condition is therefore permanent. However, the brain is still a part of the body even if it can’t be seen on the surface, and mental illness is just like any other illness: most are treatable, and recovery is possible. There may not be one successful treatment, but rather a variety of options that may require time and trial to find the best balance for each particular person.

Bipolar Disorder

Bipolar disorder, defined by the National Institute of Mental Health (NIMH) as a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks, is perhaps one of the more difficult mental illnesses to detect and to treat. It is characterized by occurrences of intense moods at both ends of the spectrum, excitedly happy and joyous – a manic state – and an intensely depressed and hopeless state – a depressive state. People can also experience a “mixed state” or a prolonged period of time in which manic and depressive symptoms occur simultaneously, often resulting in irritability and changes in energy, sleep and behavior.

Part of the difficulty in understanding bipolar disorder is its relatively recent understanding in the medical and mental health communities. Only within the last hundred years did Sigmund Freud’s Sigmund Freud, whose investigation into psychoanalysis provides much of the exploration into psychoanalysis and mental illness lead the medical community to generally agree basis for modern . that biology wasn’t the only causation of mental illness, but that environment and development also played a role. It wasn’t until the 1950s when German psychiatrist first arrived at the term “bipolar,” emphasizing “both poles” and separating bipolar disorder from what we commonly recognize as depression, or more specifically, unipolar depression. Prior to that important distinction, bipolar disorder was known as manic-depressive disorder, and was commonly referred to as such even into the 1980s and 1990s.

Additionally, bipolar disorder has a high frequency of presence among other illnesses, increasing the complexity of knowledge required to reach a realm of understanding about its diagnosis and treatment. Substance abuse is a common cofactor in bipolar disorder, and is itself a mental illness that carries with it its own stereotypes and judgments. Post-Traumatic Stress Disorder, or PTSD, is also a frequent partner to bipolar disorder, which can be triggered or intensified by an experience of extreme emotional stress. Other anxiety disorders, migraine headaches, diabetes, and obesity have also been linked to bipolar disorder, all of which can obscure its presence, and add to the carbonate in its powdered form, a common component in mood stabilizing medications. 12 Mental Health and Bipolar Disorder Continued

negative perceptions held by the general public which, in turn, intensify the experience of mental illnesses which have social or behavioral expressions. Scientists agree that there is no single, identifiable cause of bipolar disorder; rather it is likely caused by a complex and multifaceted combination of genetics, personal experience, and brain structure and chemistry that makes it nearly impossible to predict.

The complexity of the causes of bipolar disorder also makes it understandably difficult to treat. There is no single cure for bipolar disorder, but many possible combinations of therapy and medication that can help manage the symptoms and mood swings. These include many types of drug therapy which can include mood stabilizers, , sleep medications, or which, when combined with counseling and psychotherapy, have been shown to help many people relieve the symptoms of the disorder.

Photo by Sage Ross, Wikipedia Commons. The reliance on drug therapy for the treatment of bipolar disorder has received negative criticism in recent years, largely due to the risk of side effects many of the medications can produce, particularly when interacting with other medications for other symptoms. Not everyone experiences the same systems or experiences symptoms to the same degree, nor does everyone respond to specific medications in the same way, making it a complex and specialized practice to create an individualized treatment plan for each and every patient. It is also generally agreed that the use of medication is most effective when closely monitored and combined with supportive behavior-cognitive counseling and care.

It must also be noted that even with effective medication and counseling, it is normal for people with bipolar disorder to still experience lingering symptoms or relapse occasionally into a manic or depressive state. Careful awareness and monitoring and an open relationship with doctors, psychiatrists, and caregivers is the surest way to effective long-term treatment.

Dealing with Mental Illness in Our Own Lives

If you are experiencing mental illness or symptoms of bipolar disorder, there are things you can do to begin to recover. The most effective means of managing the illness and its effects is to ensure a proper diagnosis and treatment, requiring medical attention. Talk to your doctor about treatment options and remember that with time, you can get better. For more information about bipolar disorder or for help dealing with a mental health crisis:

• visit the Mental Health America of Arizona’s website at www.mhaarizona.org for free information, referrals, hotlines, and advice in navigating the mental health care system.

• visit www.namiarizona.org for more information on local NAMI affiliates and crisis centers in your community.

• if you are in immediate crisis, whether it be for you or a loved one, call the Community Wide Crisis line at (520) 622-6000 or (800) 796-6762.

• if you need to call 911, ask for a CIT (Crisis Intervention Trained) officer who is equipped in handling a mental health crisis situation, or ask for the MAC (Mobile Acute Crisis) Team.

The Substance Abuse and Mental Health Services Administration (www.samhsa.gov) has declared September National Recovery Month. Their Recovery Toolkit can be found online at www.recoverymonth.gov.

13 Inventory of Allusions and References

Lyricist and script writer Brian Yorkey never misses an opportu- Mozart: Natalie rehearses one of nity to work pop culture or historical references into the text of Mozart’s sonatas while reflecting on the the play. Throughout the score, the references characters make fact that he, too, was crazy. There are offer meta-theatrical commentary on the action of the play by multiple theories and opinions about the drawing on the cultural significance of other events or works of composer’s sanity, which is questioned fiction. Understanding the allusions can offer insight into the in the movie . Natalie admires characters. Wolfgang Amadeus Mozart because despite his “doubts, debts, Mozart, 1789. or disease” his music continues to be praised as great art. Flowers for Algernon: During the song “Just Another Day,” Natalie rattles off an intimidating list of homework assign- Beethoven and Mozart: Natalie ments including an essay on floral imagery reacts to Henry’s argument by stating that in Flowers for Algernon. Written by Diane Beethoven did cocaine and Mozart wrote Keyes and published in 1966, the novel was poems about farts. She makes the point based on an earlier short story. The science that even the master composers of classical fiction drama follows Charlie Gordon, who is music were free spirits. Mozart’s poetry is First Edition cover of Flowers for Algernon, scheduled to be the first human test subject startlingly bawdy and altogether unex- 1966. for a new brain surgery aimed at increasing Ludwig van Beethoven pected – and yes, he has written about intelligence. Algernon is a lab mouse who flatulence. has already undergone the treatment. After Charlie’s treatment is a success, he begins to lose his former friends and becomes MacGyver: When Henry mentions making a marijuana pipe out depressed. Algernon begins to regress to his pre-surgery condi- of an apple, Natalie calls him the “MacGyver of pot.” MacGyver tion giving Charlie cause to worry. After Charlie has reverted to was a popular television action hero in the late 1980s. He is his former IQ, he makes a final request that flowers be left on the famous for his ability to use household objects to achieve tiny grave of the now deceased Algernon. incredible feats of escape. A paperclip, rubber band, and some dental floss might be all he needed to thwart the weekly villain. Oscar Peterson and Miles Davis: Henry tries to convince Natalie that classical music isn’t the be-all and end-all. He encourages her to loosen up and find room for improvisation in her music, citing

Oscar Peterson these two artists as examples of classically trained musicians who became icons of jazz because they deviated from the strict rules of classical composition.

Miles Davis (Photo by Tom Palumbo)

14 Inventory of Allusions and References contINUED

Superboy and The Invisible Girl: : In a rebellious outcry, Diana exclaims that she Natalie sings her angst about always taking is “no Sylvia Plath.” Plath is a Pulitzer Prize winning poet with second seat to her brother and having to a history of depression and ECT treatment resulting in repeated compete for Diana’s affection. Superboy is a attempts. She finally did take her own life by carbon young version of the more popular Superman, monoxide poisoning in 1963, but she lives on in the legacy of a DC comic book hero from the 1930s still her poetry. popular today. The Invisible Woman, a Marvel Comics character has the gift of invisibility. : Diana mentions Marvel Comics’ While the comic book heroine uses this to her Invisible Woman, Frances Farmer in the same line as Sylvia the inspiration for advantage, Natalie’s invisibility is tearing her Plath. Farmer was a Hollywood actress in Natalie’s song. apart inside. the 1930s who, like Plath, received ECT for mental illness. Farmer was later loboto- One Flew Over the Cuckoo’s Nest: mized. Her life has been dramatized in the When faced with ECT (shock therapy), Diana film Frances (1982). sings the song “Didn’t I See This Movie?” Actress Frances referencing the 1975 film adaptation of Farmer, 1931. Ken Kesey’s novel. The movie starred Jack Nicholson as an institutionalized criminal Princess of Pain: Diana claims, “I’m no princess of pain,” who is administered ECT after repeated while protesting shock treatment. The Princesses of Pain (POP)

First edition cover of run-ins with hospital staff including Nurse is an international women’s fighting league whose mission is One Flew Over the Ratched. to empower women through training in mixed martial arts. Cuckoo’s Nest, 1975

Black Hole: In the song “I’ve Been,” Dan Christopher Columbus: Diana likens compares Diana’s struggle with depression the process of searching through her own to a black hole opening wide. Black holes memories to the expedition of Christopher are one of the magnificent mysteries of the Columbus. Columbus mistakenly discovered cosmos and are thought to be created by the the Americas while trying to find an death of a star. Dan sees Diana’s illness as alternative trade route to the east. Diana A simulated image of a black hole. something with the potential to consume relates his journey in the lyrics: “I’m some everything around her. He later makes Christopher Columbus sailing out into my another celestial reference, this time to the Explorer Christopher mind…With no map of where I’m going, or Columbus constellation Orion, in the song “A Promise.” of what I’ve left behind.”

Image of Orion, 9th century.

15 Glossary of Medical Terms in Next to Normal

Electroconvulsive Therapy (ECT): the treatment of and especially depression by the application of electric current to the head of a usually anesthetized patient that induces unconsciousness and convulsive seizures in the brain – abbreviation ECT; called also electric shock, electric shock therapy, electroshock therapy.

Psychopharmacologist: a specialist in , or the study of the effect of drugs on the mind and behavior.

Bipolar disorder: any of several mood disorders characterized usually by alternating episodes of depression and or by episodes of depression alternating with mild non-psychotic excitement. Old-fashioned ECT machine, 1960.

Zoloft: a trade name for the serotonin-inhibiting hydrochloride.

Paxil: the trade name of a selective-serotonin reuptake inhibitor commonly prescribed as an antidepressant.

Buspar: the trade name for a drug designed specifically to treat anxiety.

Xanax: an anti-anxiety agent of the benzodiazepine class.

Depakote: trade name of a valproic acid anticonvulsive used to treat seizures or episodes of mania in patients with bipolar disorder.

Klonopin: trade name of the benzodiazepine medication clonazepam, used to control panic attacks and certain types of seizures by decreasing abnormal electrical activity in the brain.

Ambien: trade name of the drug zolpidem, used to treat . Classified as a sedative-hypnotic, it works by slowing activity in the brain to allow for sleep.

Prozac: a trade name for , used to treat depression, obsessive-compulsive disorder, some eating disorders, and panic attacks by increasing the amount of serotonin, a substance that helps maintain mental balance, in the brain.

Valium: a brand of used as a tranquilizer that relieves muscle spasms, anxiety, seizures, and agitation caused by alcohol withdrawal.

Attention Deficit Disorder (ADD): a syndrome of disordered learning and disruptive behavior that is not caused by any serious underlying physical or mental disorder. ADD is characterized primarily by symptoms of inattentiveness, hyperactivity, and impulsive behavior (as in speaking out of turn) or by the significant expression of all three.

Adderall: trade name of a medication used to treat attention deficit disorder and attention deficit hyperactive disorder, consisting of a combination of dextroamphet- amine and amphetamine. Part of a category of medications classified as central nervous system stimulants, it works by regulating the amounts of certain natural substances in the brain.

Psychotherapy: treatment of mental or emotional disorder or maladjustment by psychological means especially involving verbal communication.

Schizophrenia: a psychotic disorder characterized by loss of contact with the environment, by noticeable deterioration in the level of functioning in everyday life, Adderall capsules. Photo by Patrick Mallahan III. and by disintegration of personality expressed as disorder of feeling, thought (as in

16 Glossary of Medical Terms in Next to Normal Continued

), perception (as in ), and behavior.

Risperdal: a trade name of the drug risperidone, an used to treat , bipolar disorder, and behavioral problems.

Hypnosis: an artificially induced trance state resembling sleep, characterized by heightened susceptibility to suggestion.

Sociopath: a person who exhibits asocial or antisocial behavior or an antisocial personality and who lacks a sense of moral responsibility or social conscience.

Robitussin: trade name of an expectorant that loosens phlegm and makes it easier to cough up.

Robotripping: the state of being high on cough syrup containing dextromethorophan hydrobromide (DMX). Robotussin is one such cough syrup, creating the “robo” prefix.

Psychogenic: originating in the mind or in mental or emotional conflict.

EMDR: acronym for eye movement desensitization and reprocessing, a type of therapy conceived in the late 1980s and used to treat trauma and Post-Traumatic Stress Disorder. It is an information processing therapy that uses an eight phase approach designed to maximize treatment effects of many different . rTMS: the acronym for repetitive Transcranial Magnetic Stimulation, a noninvasive treatment tool for many neurological and psychiatric disorders including migraines, strokes, Parkinson’s disease, and depression that works by using electromagnetic induction to induce weak electric currents in the brain.

Pathological: caused by or involving disease; caused by or evidencing a mentally disturbed condition.

17 Discussion Questions and activities

Discussion Questions

1 what is “normal”? Is there such a thing as a “normal” family? Is “normal” the same thing as “perfect?” Where does the pressure to be “normal” and “perfect” come from?

2. Can you think of any recent movies or television shows that are exploring the idea of a “new normal?” when it comes to family dynamics? What do you think they are suggesting is the “new normal?” Do you agree with them?

3 discuss how each member of the Goodman family deals with loss, or the fear of loss. Is any one character’s coping mechanism “better” than the others’? Is there a correct way to grieve?

4 throughout the play Diana’s happiness does not often coincide with the overall happiness of the Goodman family, and vice versa. Why is this? What do you feel was given more importance in the play – Diana’s happiness as an individual, or the family’s happiness? Which would you say is more important?

5 what is Natalie afraid of? Is she honest about her fears? How does fear affect her choices throughout the play?

6. Natalie’s methods of coping with her mother’s mental illness change throughout the play. How and why do you think they changed?

7 henry says he would never touch prescription drugs, and yet he admits he is “a bit of a stoner.” Why do you think he makes that distinction? Is Henry’s drug use different than Natalie’s?

Activities

1 think about your idea of “normal” as it pertains to your family. Then interview different members of your family, from multiple generations if possible, to find out their idea of “normal.” Has that idea evolved or changed over the generations? Has anything remained the same? Write a short personal essay, create a piece of visual art, or write a poem or song expressing what your family’s idea of “normal” has come to be.

2 write a paper exploring how mental health and behavioral disorders are portrayed in popular culture. Using the “Inventory of Allusions and References” from this Play Guide as a starting point, find examples in literature, music, and visual art to help you examine the way our society views and stigmatizes people living with mental illness.

3 medical treatment for mental illness has evolved a lot over the past few decades. Write a research paper examining the history of the treatment of mental illness, starting with the earliest diagnoses and first usage of the term “mental illness” and ending with current day treatment options.

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