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Student ID Number: 784928

BA Musical Theatre
Professional Studies 2 AS2

Next to Normal
The portrait of mental illness on stage through the eyes of Brian Yorkey

Brian Yorkey is an American lyricist, playwright, librettist, screenwriter, and theatre
director whose storylines had a clear impact on Broadway. He has inspired a new generation of
young playwrights and composers by dealing with complex and accurate matters that affect our
society nowadays and that aren`t usually portrayed on stage (Kenrick, 2008). A major example
of his work is Next To Normal, for which he wrote the book and lyrics and partnered with Tom
Kitt, who wrote the music. Next to Normal opened on Broadway on April 2009 (Green, 2014:
368). This musical follows the story of Diana, a mother who struggles with worsening bipolar
disorder and the effects that her illness and its management have had on her family (Green, 2014:
This essay aims to explore how Brian Yorkey, with the help of Tom Kitt managed to
portray mental illness on stage and how theatre can be a tool of awareness and can actually help
people deal with very serious matters.

Next to Normal and mental illness

Brian Yorkey and Tom Kitt conceived the idea for Next to Normal in 1998, first
presenting it in the form of workshop called Feeling Electric in 2005 (Balcazo, 2009: online).
From there, over the course of many years, Next to Normal came to life, starting with an Off-
Broadway premiere in 2008 and then transferring to Broadway in 2009 (Green, 2014: 368).
According to the authors, this was a very touchy subject to portray on stage and, according to the

“I think that this is a subject matter that affects most people. We have very heightened
emotions about mental illness. Music in theatre is meant to convey those heightened emotions.
The saying goes that you sing about something in a musical when emotion becomes so great that
you have to. So I felt that a story like this, filled with many heightened emotions, was a natural fit
to sing and the only thing was to make sure that I wrote appropriate music for each dramatic
moment in the show and not try to over think it but just go naturally where I feel like Brian’s
writing is taking the music. And he really led the way in that beautifully” (Kitt, 2010: online)

While writing the book and the lyrics, Brian Yorkey was very aware of how important it
was to portray mental illness in a truthful way and partially that is why it took them so many years

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

to have the show put together. In Next To Normal, we follow one woman’s struggle with mental
illness and the effect of the illness on her whole family. Diana is the focus of a complex
exploration into bipolar disorder, its treatment and the damage and consequences it causes not
only in the patient’s life, but also in everyone around her (Green, 2014: 368)
In the show, Diana is diagnosed as “bipolar depressive with delusional episodes”
(Yorkey, 2010: 82 - 83), which is now identified according to the American Psychiatric
Association’s (APA) as ‘Bipolar I’ (APA, 2013).
‘Bipolar I’ is a mood disorder that is characterized by alternating periods of depression
with episodes of mania. The periods of depression are known as major depressive episodes, which
consist of distinct periods of time in which a person suffers about of depression. These usually
last at least two weeks and can cause the individual to have hypersomnia (sleeping too much),
fatigue and loss of energy, and recurring thoughts of death or suicide. Those with the disorder
often have periods of recovery between mood episodes (APA, 2013). On the other hand, a maniac
episode is defined as a distinct period of time of an abnormally elevated mood that lasts for at
least one week and is present for the majority of the day (APA, 2013). In Next to Normal, the
creators were extremely accurate with the appearance of these kind of episodes throughout the
show. Right in the opening number, “Just Another Day”, Diana is seen during a manic episode
when she is awake most of the night and then further in the song, she makes an absurd amount of
sandwiches in order to "get ahead on lunches" (Yorkey, 2010: 71), and later in act 1, we assist to
another maniac episode, during the song “It's Going to Be Good” when she goes off her
medication (Yorkey, 2010). Apart from these, we can also identify several periods of depression
that include the moment when in “There`s a World”, Diana decides to cut her writs to kill herself
(Yorkey, 2010)
Additionally, the specifier “psychotic features” refers to psychotic symptoms—most
often delusions and hallucinations—that are undergone in conjunction with the manic or major
depressive episodes (APA, 2013). This is something we can observe throughout the whole show
as Diana has constant hallucinations with her son Gabe, who she “sees” around the house all the
time as a 16 year-old boy, but who actually died while he was still a baby (Yorkey, 2010).
This disease is not curable and it is mostly treated through psychopharmacological,
psychiatric, and biological means. These types of therapy can be seen throughout Next to Normal
as an attempt to help Diana control her disease.
The psychopharmacological therapies, commonly known as drug therapies, involve the
use of antipsychotic, anticonvulsant, and antidepressant medications, which aim to stabilize the
patient's mood. Such drugs include Lithium, Ativan, Valproate, and Valium (APA, 2013). In the

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

song “My Psychopharmacologist and I”, we see Diana walking through her drug therapies, with
Dr. Fine adjusting medications to ultimately stabilize her as we can see in the following lyrics:

“Zoloft and Paxil and Buspar and Xanax

Depakote, Klonopin, Ambien, Prozac
Ativan calms me when I see the bills
These are a few of my favorite pills”
(Yorkey, 2010: 83-84)
In these lyrics, Brian Yorkey explored a further comment on the amount of medication
Diana is taking or has already tried, as well as the extreme costs that were involved.
This form of treatment is also often accompanied by side effects ranging from drowsiness
to sexual dysfunction, which are all seen and mentioned at many points throughout the show, for

“Dizziness, drowsiness, Nervous laughter, palpitations

Sexual dysfunction, Anxiousness, anger,
Exhaustion, insomnia,
Headaches and tremors, Irritability,
And nightmares and seizures Nausea, vomiting”
Diarrhea, constipation,
(Yorkey, 2010: 87-88)

Another available mean to treat this problem is psychotherapy. This is the type of therapy
most often associated with mental illness, where patients talk to psychologists and aim to work
through the psychological component of their disease (APA, 2013). For ‘Bipolar I’, patients work
to maintain a healthy level of day-to-day functioning and learn to manage their manic and
depressive symptoms (APA, 2013). In Next to Normal this is seen through Diana’s sessions with
Dr. Madden, her psychologist, where she talks through her struggle to cope with her loss of Gabe
and, later on in the show, when she loses her memory and there are some bits in her past that she
cannot remember (Yorkey, 2010).
Finally, the third form of therapy is biological treatments, which mainly consists in
Electroconvulsive Therapy (ECT) in which seizures are induced by sending an electric current
through the brain (APA, 2013). However, it is not the a first option when it comes to the treatment
and it is often viewed as a last resort option for treatment of bipolar disorder, usually considered
for manic patients who are incredibly ill and extremely treatment-resistant or whose symptoms

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

include very serious suicidal or psychotic symptoms, or in pregnant women (APA, 2013). This is
the second most central form of treatment seen throughout Next to Normal and a turning point in
the story. At the end of “Didn´t I See This Movie” Diana is convinced by her husband and her
doctor to try ECT and then loses her memory (including her memory of her son Gabe), which
later, she slowly gains back. It is also very important to refer that ECT is only brought up to Diana
by Doctor Madden because she is getting into an extremely advanced state of the disease even
attempting suicide by cutting her wrists after being prompted by her hallucination of Gabe to kill
herself to be with him (“I Dreamed a Dance”/”There’s a World”). It was only after Diana’s
condition became resistant to drug therapy and she became severely suicidal that Dr. Madden
suggested Dan talk to her about using ECT as a treatment option (Yorkey, 2010).
With all of the mentioned above, it is very clear that in order to get the realism of the song
and lyrics, there was a lot of work and research about the disease in order to make the show not
only available, explicit and understandable for the general public, but also very truthful and
accurate to the reality of the people that actually suffer from this disease and the impact it has on
their families and everyone else around them.

The Impact of Next To Normal in Musical Theatre community

Broadway musicals have the unique ability to appeal to a wide range of audiences. The
amount of people attending musicals in New York every year is extraordinary. There is a very
wide range of shows that you can appreciate when going to the theatre, from light-hearted fun
stories to very serious and concerning topics. This is what makes Broadway musicals a wonderful
platform to discuss and portray complex social issues. The portrayal of this kind of topics is a
mechanism to both entertain and educate an audience. According to the investigator John Steven

“Besides providing entertainment, the theatre has always been a social laboratory where
dramatic experiments are performed for the benefit of investigators. These researchers are called
‘audiences’. The stage is therefore an ideal medium in which to introduce complex social issues
to a receptive audience. Since 2000, the shows nominated for Best Musical at the Tony Awards
have dealt with sexuality, drug abuse, death, mental health, identity, and many other serious
topics. I agree when saying that the musicals that deal with complex social issues have the ability
to create a discussion and initiate change. One such topic that has increasingly been incorporated
into Broadway musicals in the last decade has been mental health. According to analysis of the
evolution of shows that deal with complex social issues and controversial subject matter, and
having in big account Next to Normal, it is plausible to assume that a new outlook on complex

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

social issues in theatre has led to more believable characters and plot lines in musicals. Knowing
also that a significant portion of the population is affected by mental illness either as a patient or
as a loved one. The integration of this topic into musical theatre is relevant since mental illness
is both relatable and realistic. In creating characters that people can relate to, writers are
appealing to a larger, more receptive audience, thus increasing the chances of a successful
production”. (Paul in Rensburg, 2013: 10-11)

According to what was mentioned above, we can clearly say that when Next to Normal
premiered, back in 2008, it joined a group on new musical theatre work that started to give more
importance to the story, the characters and their journeys and not to the costumes, the sets, the
orchestras. Musical theatre has slowly started to challenge the audiences, to make them think,
reflect and even to help and make them aware of certain issues and subjects. This is seen in Next
To Normal, Brian Yorkey created what seemed to be the typical family next door but it actually
ended up by being much darker. For instance Diana that was the perfect mother with “the perfect
family so adoring” (Yorkey, 2010: 53), actually suffered from ‘Bipolar I’ disorder, Dan, the caring
husband who was always there for his wife, could not take it anymore; Natalie, the prodigious
daughter never felt loved by her own mother; Gabe, the dead son who was just a product of
Diana`s hallucinations; Henry, the stoned high schooler who is interested in Natalie but doesn’t
know how to reach her; And Dr. Madden, a psychologist who tries to help Diana never knowing
how hard her disease will progress (Yorkey, 2010).
It is also very important to mention that the show was very well accepted by the public,
winning several awards, such as the Pulitzer Price, being classified as “a powerful rock musical
that grapples with mental illness in a suburban family and expands the scope of subject matter for
musicals” (Pulitzer Board, 2010: online). This is why we can say that Next To Normal opened
doors to other musicals that go deeper into mental illness and its portrait on stage. An example of
this is the successful Dear Evan Hansen which deals with the matter of social anxiety and suicide.
Once again, it is shown on stage that no one is alone and all over the world there are other people
going through similar situations (Green and Evans, 2017).

As it was possible to observe, Next to Normal has created a huge impact in musical theatre
community as it dealt with an accurate and realistic problem that isn´t always taken serious
enough and that affects people all over the world – mental illness, more specifically bipolar I.
With the lyrics and the music and thinking about musical theatre as a heightened emotion based
form of art, Tom Kitt and Brian Yorkey produced a masterpiece that would somehow change a

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

lot of people`s perspectives in musical theatre and would make it more real and relatable for
everyone watching it (Kenrick: 2010).
Next To Normal clearly opened a door and led the way for contemporary musical theatre
work to take more risks when it comes to the topics approached but it also led the way for the
actors to keep searching for the realness and simplicity in their interpretations in order to convey
the message and the story to the audience and allow them to connect (Kenrick, 2010).
And, above all, it leaves us with a message of hope because no matter how dark the times
might be, at the end of the day, there is always hope, a reason to fight and even when everything
seems lost, “there will be light” (Yorkey, 2010: 343).

Bibliographical references:

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental

Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

D.K Limited et all (2015), Musicals: The definitive Illustrated Story. London. D.K Penguin
Random House.

Green, A and Evans. S, (2017). Dear Evan Hansen: Through a Window. New York. Grand
Central Publishing.

Green, S. (2014), Broadway Musicals – Show by Show. 8th ed. United States of America.
Applause: Theatre and Cinemas Books.

Kenrick, J. (2008), Musical Theatre: A History. New York. Continuum.

Rensburg, S. (2013). The Integration of Mental Health into 21st-Century Broadway Musicals.
Vancouver : University of British Columbia Library.

Yorkey, B. (2010), Next To Normal. New York. Theatre Communication Group.

Other sources:

Balcazo, D. (2009) “Next to Normal – Review”. Theatremania Online, 15th April.

Available at
normal_18568.html (Accessed 2 April 2018)

Breslow, J. (2010) “Conversation: Pulitzer Prize Winners in Drama, Tom Kitt and Brian Yorkey
of ‘Next to Normal’”. PBS News Hour, 14th April. Available at
brian-yorkey-of-next-to-normal (Accessed: 2 April 2018)

Cohen, P. (2009) “Mental Illness, the Musical, Aims for Truth”. The New York Times –
Newspaper online, 16th April. Available at (Accessed: 3 April)

Student ID Number: 784928
BA Musical Theatre
Professional Studies 2 AS2

Louiseirpino (2017) Contact “The Impact of Next to Normal”. Project Theatricality, 28th
February. Available at
to-normal/ (Accessed: 3 April)

Peterson, C. and Gifford, S. (2016) “The 100 Most Important People in Modern Musical Theatre
History”. Onstage Blog, 27th June. Available at
musical-theatre-history (Accessed: 3 April 2018)

Pulitzer Board (2010) “Next to Normal, by Tom Kitt and Brian Yorkey”. The Pulitzer Prizes,
(n.d). Available at (Accessed: 4 April

Trinchero, B. (2011) “Musical Moment, an interview with Brian Yorkey”. Make Musicals, (n. d)
Available at:
yorkey/ (Accessed: 4 April 2018)