STUDY GUIDE

Next
to
Normal

Alliance Theatre
October 17-November 11
Book and Lyrics by Brian Yorkey
Music by Tom Kitt
Directed by Scott Schwartz
This Study Guide was researched and prepared by students in Robert Connors
Musical Theatre Class at Tri-Cities High School in East Point, GA, under the guidance
of Alliance Theatre Teaching Artist Barry Stewart Mann.

Study Guide Contents

Story Elements
Plot Summary
Setting
Characters
Bipolar Disorder
What is Bipolar Disorder?
Treatments and Medications
Electroconvulsive Therapy
Delusions and Hallucinations
Statistics about Mental Disorders
Case Studies: From the Literature and the News
In Person: A Class Visitor
Being a Caregiver
About the Play and the Production
The Composer & Lyricist
Production History
A Musical About Mental Illness?
Music and Text
Humor
The Director
Theatre Etiquette
Before and After
Vocabulary
Class Activities
Resources
High School Dramaturgs

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Plot Summary
Next to Normal is a contemporary family drama, about a womans
struggle with mental illness, and the effects of her illness on her family. At
the opening of the show, Diana seems to have an ideal life she is educated,
well-off, and happily married with two teenage children. But it soon
becomes clear that all is not as it seems. Diana has bipolar disorder, plagued
with anxieties, mood swings and delusions that trace back to a family
tragedy 16 years earlier and are growing worse with time. During the course
of the play, Diana goes through a series of doctors and treatments, in
response to and sometimes triggering the ups and downs of her illness.
Under the care of her primary doctor, Dr. Madden, Diana takes medication,
talks through her issues and problems, and undergoes the more
controversial option of electroconvulsive therapy. Meanwhile, her husband
Dan confronts his own confusion and depression; daughter Natalie deals
with isolation and a budding romance with a fellow music student, Henry;
and son Gabe serves as Dianas confidante and link to a happier past.
Though the family strives to establish some sort of normality, and each
character seeks his or her own peace and happiness, the ties that bind slowly
and inexorably unravel around them.
Next to Normal is considered a rock musical, and much of the story is
told through song. The melodies are often interwoven, and the action moves
back and forth among simultaneous scenes, as well as between literal and
psychological realities. Though serious in focus, the play is full of surprises
and humor as well.

Setting
Next to Normal is set in an unidentified suburban American
community. Much of the action takes place in the family home - in the
kitchen, living room, and family bedrooms. Additional locations include
various doctors offices, Natalies school, Dans car, Henrys house, the
hospital, and the dark corners of Dianas tortured psyche. Settings shift
frequently and quickly throughout the play.

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The Characters
Diana
by Rubin Barksdale and Mya Yorke
Diana is the main character of Next to Normal. She is a housewife in her late
thirties or early forties. In the character list in the script, the authors describe her as
sexy and sharp. From the outside, it would seem like she has it all, but Diana
suffers from bipolar disorder, which keeps her from living her life fully. She begins
to become delusional and live in a world that goes back and forth between reality
and fantasy. Before Diana was diagnosed with Bipolar Disorder, she enjoyed
climbing mountains. In the song, I Miss the Mountains, she explains, I miss the
highs and lows, all the climbing, all the falling, and all the while the wild wind
blows. Diana wants to move forward with her life, but she is unable to do so
because her past haunts her. The trauma caused by past losses has produced
distant relationships between her and both her husband and her daughter. Diana
and Natalie do not have a real bond or connection because Natalie feels that she is
invisible in her mothers eyes. Diana and Dan do not have a strong marriage
because they do not support each other when they encounter in an emotional
conflict. As time passes, she feels more isolated, and her bipolar disorder only
becomes worse. Diana strives to at least become next to normal, but in all actuality
the reality that has developed over the years is not normal at all.

Dan
by Jai Rodgers & James Young
Dan is the husband of Diana and the father of Natalie and Gabe. He is a man that
wants nothing more than for his family to be normal. As a husband, he is protective,
worried, and stressed; as a result, he can be selfish and even passive-aggressive. The
bottom line is that he struggles with an ongoing dilemma, the choice between his own
personal interest and happiness, and what he feels he needs to do to care for his wife. His
search for the best decisions for his family often just leads to additional problems. Dan
tries to keep his household together the best he can, but in reality it doesnt turn out the
way he would want, and he realizes that he has little control over his destiny. Still, he
chooses to stay with Diana and give her whatever support he can.

Natalie
by Samantha Axam-Hocker & Kaya Camp
Natalie is Diana and Dans daughter, and Gabes sister. She is a teenage girl
basically just trying to find herself. Dealing with her mothers mental illness, she is on a
emotional rollercoaster which she doesnt know how to get off. As a result, she pushes
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away the people that care for her most because she doesnt know how to accept their love
and concern. She is attracted to Henry, and to the attention he gives her, but also
frightened and intimidated. Her relationship with her father is ambiguous, and, as
evidenced in the song Superboy and the Invisible Girl, she is jealous of her brothers
central position in the familys emotional life, and in her mothers psyche. At times,
Natalie just wants to get away from all of it, but doesn't know how. She is eager to leave
and start her life and to stop feeling like a shadow at her own house.

Gabe
By Patrick Coleman and Tessence Pearson
Gabe is the son of Diana and Dan, and brother of Natalie. Toward the
beginning of the play, Gabe comes off as daring and rebellious. He is somewhat rude
and flippant when it comes to the other characters, such as Natalie, Dan, and Doctor
Madden. The only character for whom he ever shows any affection is his mother
Diana. Because of this, the two are very close.
Gabe is an enigmatic character, and as the play progresses, his role in the
family is more fully revealed. Gabe is scared of losing her, and scared that if shes
not around he will no longer be relevant to his family. This fear causes him to cling
to her and to prevent her from fully living her life. Gabe is also extremely jealous,
and gets upset whenever someone challenges his hold on Diana. His songs often use
irony to fully convey the nature of his character. They are usually upbeat, in sharp
contrast to the dark subject matter. Gabe is in some ways on the periphery of the
action of the play, and, paradoxically, also central to the dramatic conflict and
resolution.

Henry

By Jenai Howard

tude d'un violoncelle taille trois-quarts,

(Study of a Three-Quarter Size Cello)
Michael Maggs (2008)

Henry is a 17-year-old boy, a

musician who is clearly interested in,
and perhaps in love with, Natalie. He
meets Natalie in the Music Room at
school, hearing her practicing on the
piano, and finds that music is
something they have in common. He
is a stoner, but not showy or
obnoxious about it; he is very much a
free spirit. When Natalie says Oh.
Youre one of those pretentious stoner
types, he replies, Thats totally
unfair. Im not pretentious. And Im
definitely not classical. Its so rigid
and structured. Theres no room for
improvisation. You have to play the

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notes on the page. Henry admits his

character weaknesses when he sings,
I might be lazy, loner, a bit of a
stoner-its true. But he takes pride in
being the master of the lost art of
making a pipe out of an apple.
Although he seems to have his
priorities a bit confused, he is very
much a romantic person. Throughout
the play he expresses his feelings,
telling Natalie, Perfect for you, I could
be perfect for you . . . Ill make myself
perfect . . . perfect for you. His role in
the story is the love interest for
Natalie, and he is also an important
outlet for her feelings about her family
and her mothers illness.

Dr. Madden
Dr. Madden is Dianas primary
physician through the action of the
play. He attempts to reach her
through a variety of treatment
methods, and in the course of their
relationship he unearths crucial family
secrets. He is fairly easygoing and
hip, and in Dianas mind he assumes
glamorous roles a rock star! providing excitement and fulfilling
fantasies. In reality, he is a proficient
doctor, clearly concerned for the
welfare of his patient and her family.

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What
is
Bipolar
Disorder?
Four Moods of Humanity, by John Rudolph (2011)

by Elyakeem Avraham and Richard Hatcher

Bipolar Disorder is a condition in which an individual goes back and forth
between very good, or manic, moods and very sad, irritable moods, or depressions.
The "mood swings" between mania and depression can be very quick. The disorder
affects men and women equally, and usually begins to appear between the ages of
15 and 25. The exact cause is unknown, but the disorder is known to occur more
often in relatives of people with bipolar disorder.
Bipolar Disorder is classified into different types. People with Bipolar
Disorder Type I have had at least one manic episode and periods of major
depression. In the past, Bipolar Disorder Type I has also been called manic
depression. People with bipolar disorder type II have never had full mania. Instead
they experience periods of high energy levels and impulsiveness that are not as
extreme as mania (referred to as hypomania). These periods alternate with episodes
of depression.
A mild form of Bipolar Disorder called cyclothymia involves less severe mood
swings. People with this form alternate between hypomania and mild depression.
People with Bipolar Disorder Type II or cyclothymia may be wrongly diagnosed as
having depression.
The symptoms of Bipolar Disorder are numerous. They include:
distractability; sleeplessness; poor judgment; lack of temper control; reckless
behavior and general lack of self control; binge eating, drinking, and/or drug use;
sex with multiple partners (promiscuity); spending sprees; extremely elevated
moods; excess activity (hyperactivity); increased energy; racing thoughts and
extreme talkativeness; inflated self-esteem (false beliefs about self or abilities); and
severe agitation or irritation. An individual may be diagnosed with Bipolar Disorder
on the basis of different combinations of these symptoms and behaviors.

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Treatments by Kennedy Bright and Carly Savoy

Studies show that the best
treatment for bipolar disorder is the
combination of medications and
psychotherapy. Even though everyone
experiences changes in emotion, people
with bipolar disorder have more frequent
and intense emotional swings from the
normal ups and downs that everyone
goes through from time to time. Bipolar
disorder symptoms can result in
damaged relationships, poor job
performance, and even suicide. But
bipolar disorder can be treated, and
people with this illness can lead full and
productive lives.
Successful bipolar treatments are usually grounded in medications. The primary
treatment for bipolar disorder is a type of medication called mood stabilizers. Mood
stabilizers are used to prevent or control episodes of mania or depression. Proven mood
stabilizers include lithium, and anticonvulsants such as valproic acid (Depakote),
carbamazepine (Tegretol), and lamotrigine (Lamictal). Such medications allow patients to
clear their minds, and relieves them of intrusive thoughts that can distract them from their
work and interactions with others around them. Because bipolar disorder is a lifelong and
recurrent illness, people with the disorder need long-term treatment to maintain control of
bipolar symptoms. Therefore, most people with bipolar disorder use medications plus
psychotherapy for effective results.
Psychotherapy, or "talk" therapy, can be just as effective for treating bipolar
disorder as medication. It can provide support, education, and guidance to people with
bipolar disorder and their families. Doctors use six main types of psychotherapy:
cognitive, interpersonal, family-focused, behavioral, psychodynamic, and reality-based.
The first three types are considered especially helpful in the treatment of bipolar disorder.
In cognitive-behavioral therapy, the patient and therapist examine how thoughts and
negative thinking patterns affect emotions and behaviors. Interpersonal therapy focuses
on reducing stress by addressing relationship issues and building strong intimate
relationships. Family-focused therapy considers stresses on family dynamics and seeks
to educate family members to create a healthy and supportive home environment.
Psychotherapy is most successful when the individual enters therapy on his or her
own accord and has a strong desire to change. Change means altering those aspects of
ones life that arent working any longer, or are contributing to ones problems or
ongoing issues. With the help of medications and psychotherapy, many people suffering
from bipolar disorder find they can function fairly normally.

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Simple Coping Strategies for Bipolar Disorder: View an original Public Service
Announcement created by the High School Dramaturgs at
[Link]

Medications
Compiled by Odjkni Simmons & Leonardo White
In Next to Normal, a variety of medications are mentioned and/or prescribed for
Diana. Here are some, with details about what they are and how they work.
Ambien (zolpidem) is a sedative, also called a hypnotic. It affects chemicals in the brain
that may become unbalanced and cause sleep problems (insomnia).
Ativan (lorazepam) is in a class of medications called benzodiazepines. It is used to
relieve anxiety. It works by slowing activity in the brain to allow for relaxation.
Buspar (bupirone) is an anxiolytic psychoactive drug of the azapirone chemical class that
is used to treat anxiety disorders, helping to alleviate fear, tension, irritability, dizziness,
pounding heartbeat, and other physical symptoms.
Depakote (divalproex) is a anti-convulsant. It is usually prescribed for persons who are
Bipolar (Manic Depressive), or a similar illness. It is sometimes prescribed for people
who experience chronic migraine headaches.
Klonopin (clonazepam) is in a group of drugs called benzodiazepines (ben-zoe-dyeAZE-eh-peens). Clonazepam affects chemicals in the brain that may become unbalanced
and cause anxiety.
Paxil (paroxetine) is an antidepressant in a group of drugs called selective serotonin
reuptake inhibitors (SSRIs). Paxil affects chemicals in the brain that may become
unbalanced.
Prozac (fluoxetine) is a selective serotonin reuptake inhibitors (SSRI) antidepressant.
Prozac affects chemicals in the brain that may become unbalanced and cause depression,
panic, anxiety, or obsessive-compulsive symptoms.
Xanax (alprazolam) belongs to a group of drugs called benzodiazepines. It works by
slowing down the movement of chemicals in the brain that may become unbalanced. This
results in a reduction in nervous tension (anxiety).
Zoloft (sertraline) is an antidepressant in a group of drugs called selective serotonin
reuptake inhibitors (SSRIs). Zoloft affects chemicals in the brain that may become
unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

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Zoloft and Friends: If the Meds Could Talk . . .

For an original spoken-word ensemble presentation about BPD medications, created by
the High School Dramaturgy Program, go to [Link]

A BPD pharmacopia, clockwise from top left: Ambien, Ativan, Buspar, Paxil, Zoloft,
Xanax, Prozac, and Klonopin. (Prozac photo by Tom Varco, 2006.)

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Electroconvulsive Therapy
by Kristen Armour and Jahmad Juluke
Electroconvulsive Therapy (ECT) is a treatment in which electric currents are
applied to the head to induce small seizures for specific patients. These patients
include those who are mentally diagnosed for severe depression and other mental
illnesses or conditions, including schizophrenia, obsessive-compulsive disorder, and
Tourette syndrome. This treatment is administered after patients are given
sedatives and/or muscle relaxers. It can be given in different amounts, with
different frequency, and for different durations, depending on the individual
patients case. It is often used together with other forms of treatment, including
drugs and talk therapy.

Siemens Konvulsator III ECT machine, circa 1960

ECT has been used since the 1930s, when it was first developed by
neuropsychiatrists in Italy. In spite of almost a century of use, there is still no theory
to explain how the process actually works. Supposedly, it causes alterations in how
the brain responds to chemical signals. Mental health providers agree that it works
best in producing short-term results, but it is unclear what long term effects are.
There are many positive aspects to electroconvulsive therapy: it is quick and
easy to administer, fairly efficient in achieving results, and not reliant on patients
taking a confusing variety of pills everyday. On the other hand, electroconvulsive
therapy has side effects: patients have frequent loss of memory, including
disorientation from family affiliations, location, and time of year; they experience
headaches, stiffness, and confusion as well. Also, ECT can be fatal; the death rate is
estimated at 1 out of 1,000.
There are strong opinions on both sides of the ECT issue. Some people are
appalled at the idea of basically electrocuting patients, even if in very small doses,
and they worry about the long term effects and other aspects that are not yet
known. But many people feel that anything that can work to ease patients suffering
should be used.

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Delusions & Hallucinations: Whats the difference?

by Bobbi Bass and Toni Robinson
The terms delusion and hallucination can sometimes be confused, but there are
clear differences. A hallucination is a false or adrift experience that dose not exist
outside of the mind, it stimulates the senses to make it seem like reality. The word
hallucination comes from the Latin word meaning a wandering of the mind. A
delusion is a fictitious belief or opinion; in a medical context, it is an abnormal mental
state characterized by the experience of being deluded, misled or deceived, especially by
oneself or ones own judgment. Thus, a hallucination is a more specific occurrence, like
a vision; a delusion in generally a more continuous belief or awareness.
The causes of hallucinations and delusions are different. Causes of hallucinations
include drugs, withdrawal from drugs, stress, lack of sleep, exhaustion, or brain damage.
Delusions are commonly caused by dementia, neurochemical activity in the brain, and
major depressive disorders, such as BPD.
Both hallucinations & delusions can be treated but not cured. Delusions are more
likely to stop; hallucinations are more likely to be chronic. Hallucinations are treated
based on individual condition. Delusions can be treated by psychotherapy, self-help or
medications.

Schizophrenia, by Marco Castellani (2010)

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Some Statistics about BPD and

Other Related Disorders
Compiled by Alex Albritton
and Kayla McCrary
Bipolar Disorder
Bipolar disorder affects approximately 5.7 million American adults or about 2.6
% of the U.S population age 18 and older in a given year.
The median age of onset for bipolar disorders is 25 years.
More than 2/3 of people with bipolar disorder have at least 1 close relative with
the illness or with unipolar major depression, indicating that the disease has a
heritable component.
Schizophrenia
Approximately 2.4 million American adults, or about 1.1% of the population age
18 and older in a given year, have schizophrenia.
Schizophrenia affects men and women with equal frequency.
Schizophrenia often first appears in men in their late teens or early twenties.
Anxiety Disorder
Approximately 40 million American adults ages 18 and older, or about 18.1% of
people in this age group in a given year, have an anxiety disorder.
Anxiety disorders frequently co-occur with depressive disorders or substance
abuse.
Most people with an anxiety disorder will have a first episode by age 21.5.
Panic Disorder
Approximately 6 million American Adults ages 18 and older, or about 2.7% of
people in this age group in a given year, have panic disorder.
Panic disorder typically develops in early adulthood (median age of onset 24), but
the age of onset extends throughout adulthood.
About one in three people with panic disorder develops agoraphobia, a condition
in which the individual becomes afraid of being in any place or situation where
escape might be difficult or help unavailable in the event of a panic attack.
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is one of the most common mental disorders in children and in
adolescents.
ADHD affects 4.1% of adults, ages 18-44, in a given year. ADHD usually
becomes evident in pre-school or early elementary years. The median age of onset
of ADHD is 7 years, although the disorder can persist into adolescence and
occasionally into adulthood.

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Case Studies
Compiled by Tessence Pearson
I. Jessie is a 30 year-old married female. She has a very demanding, high stress job as a
second year medical resident in a large hospital. Jessie has always been a over achiever.
She graduated in the top honors in both college and medical school. She always has had
very high standards for herself and can be very self-critical when she fails to meet them.
Lately, she has struggled with significant feelings of worthlessness and shame due to her
inability to perform as well as she always has in the past.
For the past few weeks Jessie has felt unusually fatigued and found it increasingly
difficult to concentrate at work. Her co-workers have noticed that she is often irritable
and withdrawn, which is quite different from her typically upbeat and friendly
disposition. She has called in sick on several occasions, which isn't like her. On those
days she stayed in the bed all day, watching TV or sleeping.
At home, Jessies husband has noticed changes as well. Shes shown little interest
in wanted to be physically involved and has had difficulties falling asleep at night. Her
insomnia has been keeping him awake as she tosses and turns for an hour or two after
they go to bed. Hes overheard her having frequent tearful phone conversations with her
closest friend, and that causes him to worry. When he tries to get her to open up about
whats going with her, she pushes him away with the reply everythings fine.
Jessie has found herself increasingly dissatisfied with her life. Shes been having
frequent thoughts of wishing she were dead. She gets frustrated with herself because she
feels like she has every reason to be happy, yet cant seem to shake the sense of doom
and gloom that has been clouding each day as of late. Yes, these thoughts are extreme but
she isn't suicidal. (Source: [Link]/Casestudies/[Link])
II. Carmen is 46-year-old female who suffered from bipolar disorder for 30 years prior
to seeking help from upper cervical chiropractic care. The episodes of depression and
mania started during adolescence and she had tried numerous medications over the years.
During her upper cervical chiropractic evaluation, an upper neck injury was
discovered. She recalled experiencing a horseback riding accident during her junior high
years in which she sustained a concussion. She concluded her neck injury could have
occurred then. After receiving treatment for her neck injury, she reported a marked
improvement in her health; specifically, the bipolar problem was reduced tremendously.
She reported that she received more results from upper cervical care than any other
treatment or medication she had tried over the years.
(Source: [Link]/[Link]?ConditionID=4)

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Famous People
(who have been discussed as having signs of Bipolar Disorder)
Note: inclusion in this section should in no way be construed as an attack on
these individuals. Many people throughout society exhibit symptoms of bipolar
disorder; this list is intended to further the open discussion of this topic by
providing common points of reference among individuals in the public eye. Only
these individuals and their physicians know the details of their personal lives and
medical histories.

Britney Spears
"While the pop princess, 28, kept quiet about possible mental health problems,
speculation and rumors about a possible bipolar diagnosis swirled around Spears since
the infamous shaved-head photos surfaced in 2007. A parade of psychiatrists and
psychologistsnone of whom actually treated Spears, mind youdiagnosed her as
bipolar in various media outlets. A January 2008 People magazine cover story about
Spears referred to a likely bipolar disorder, and in it, a Santa Monica, Calif.-based
psychiatrist said Spearss actions suggested classic bipolar behavior, including
hypersexuality, poor judgment, and impulsivity. Whatever mental health condition
Spears may (or may not) have been suffering from, the beleaguered singer seems to have
regained her footing."
Demi Lovato
"It wasnt until she entered a treatment center for her struggles with anorexia,
bulimia, and cutting that teen pop star Demi Lovato found out she had bipolar disorder.
"Looking back it makes sense," she told People magazine of her diagnosis. "There were
times when I was so manic, I was writing seven songs in one night and I'd be up until
5:30 in the morning."
The Disney darling has since completed treatment and will continue to see doctors
at home in L.A., but says, "I feel like I am in control now."
Kurt Cobain
"The grunge rocker took his own life at age 27 despite the success of his Seattle
based band, Nirvana. Noting that one of the bands songs is titled Lithium, which is
also a mood stabilizer used in the treatment of bipolar disorder, Time magazine included
him in a 2002 list of manic geniuses who made great contributions to music, art, or
literature and who may have had bipolar disorder. "
(Source: [Link])

Portret van een man (Portrait of a man), Gert Germeraad (2004-06)

Page 15 of 31

In Person:
A Class
Visitor

by Odjkni Simmons
and Leonardo White

During the course of our Dramaturgy work on Next to Normal, a visitor came to
speak with our class about his own journey with Bipolar Disorder (BPD). He was a tall,
thin middle-aged man with dark hair; to respect his privacy, for this essay we will call
him Jack.
Though Jack seemed unique in ways, he was not someone we would have
immediately identified as having a mental illness. He sat with his legs crossed, was a
little fidgety, and messed with his hair a lot. He seemed very intelligent and a little
intense, as if he were an artist or performer. As he introduced himself, Jack explained
that he first discovered he had BPD in college when he was studying depression and
schizophrenia and recognized some of the symptoms in himself. He explained that
people sometimes treat him differently because he has BPD. People with BPD are often
marginalized or isolated from their families and friends. He suggested that the scenario
in the play is unusual for someone with such extreme symptoms to be living a fairly
normal life as a wife and mother.
Jack suggested that BPD is in some ways similar to how life is for high school
students: we go through things that constantly cause changes in our feelings and moods.
We all know the emotional roller coaster of adolescence. Jack said that for someone
suffering with BPD, the emotions and changes are more extreme, happen more
frequently, and last longer. He also explained how his emotions can mix, meaning that
he can simultaneously experience two emotions that usually don't go together, like
feeling unhappy and mad at the same time, or sad and anxious at once. Thinking of our
Musical Theatre class, Jack also said that having so many emotions could be great for
singing and acting. It may be easier to reach the emotions that the singer or actor must
convey. However, with BPD, the emotions last longer for those without the disorder; he
said he cant just cut emotions off. But, he reminded us, sometimes normal people
cant control their emotions either. In some ways, its really a difference of amount and
intensity for a person with BPD.
Jack explained there are medications for BPD, and that he had taken some in the
past. The medications helped, but the side effects for him were sometimes rough: the
whole day would feel like a blur or he couldn't remember certain things. He gave the
analogy of being drunk. He also said it wasn't good to drink or smoke while on
medication there can be bad interactions. He had taken medication for a while, but he
doesnt take them currently simple because he feels he doesn't need them. He said he has
a variety of coping strategies, and that his doctors tell him he copes well without the
medications. But he may decide to go on them again at some point.
It was fascinating to the class that Jack was very comfortable telling us about his
life with Bipolar Disorder. He provided interesting insights into this fascinating topic,
and our study of Next to Normal.

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Being a Caregiver
by Bobbi Bass and Toni Robinson

In Next to Normal, the main

focus is on Diana, a wife and mother
with a mental illness, bipolar depression.
The audience sympathizes with Diana,
and the story follows her ups and down
with her illness. With such a central
character, some may give little thought
to her husband Dan and his role as the
primary caregiver in the relationship.
But the role of caregiver is complex and
important.
A caregiver is someone who gives support and assistance to someone suffering
from an illness. The illness can be mental or physical. Being a caregiver can be an
extremely stressful responsibility. Because of the pressures they feel, caregivers may
become confused, frustrated, angry, and more impatient than usual. A caregiver may
suffer the same stress, if not more, than the patient with the illness. He or she empathizes
with the loved one, but also feels the guilt and worry about not doing enough, or doing
too much, or being ineffective. These feelings are completely normal. Caregivers may
also experience financial stress from the potentially exorbitant costs of medication,
treatment, and therapy. Often, the patient is receiving several types of treatment at once,
which can be very expensive. Just dealing with bills and insurance companies can be like
a full-time job. Of course, a caregiver generally has his or her own career, and balancing
work and caregiving can be difficult, if not impossible. Time and management is key.
Not only does the caregiver have to manage his or her own life, but also that of the loved
one, who is incapable of making life decisions. For all these reasons, caregivers often
need support of their own. Like patients with mental illness, their caregivers develop
ways of coping, and seek out help of a medical or psychological nature. Though it brings
challenges, many people are successful in providing the care that is needed by their
mentally ill family members, and help them lead normal lives.

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The Composer and Lyricist

By Elyakeem Avraham and Richard Hatcher
Tom Kitt is an American composer, conductor, orchestrator and musician. For
his score for the musical Next to Normal, he shared the 2010 Pulitzer Prize for Drama
with Brian Yorkey. He also won the Tony Award and 2008 Outer Critics Circle Award,
and was nominated for a Drama Desk Award for American Idiot and Everyday Rapture.
Kitt attended Byram Hills High School in Armonk, NY, where he participated in
various theatrical productions. After graduating in 1992, he attended Columbia College
in New York City, graduating with a degree in economics in 1996. During his time at
Columbia, Kitt was also a member of the Columbia Kingsmen.
Kitt composed the music for the musicals High Fidelity and Next to Normal and
the play From Up Here. He met Brian Yorkey while they were both students at
Columbia University, and they attended the BMI Lehman Engel Musical Theater
Workshop as a team. He won the 2008 Outer Critics Circle Award Outstanding New
Score, and was nominated for the Drama Desk Award Outstanding Music; and Tony
Awards for Best Original Score Written for the Theatre and Best Orchestrations, all for
his rock score to Next to Normal. He also shared the 2010 Pulitzer Prize for Drama with
Brian Yorkey for Next to Normal. The Pulitzer Board called it "a powerful rock musical
that grapples with mental illness in a suburban family and expands the scope of subject
matter for musicals."

Tom Kitt

Kitt & Yorkey

Brian Yorkey

Brian Yorkey is an American playwright, lyricist, and theatre director. He shared

the 2010 Pulitzer Prize for Drama and the 2009 Tony Award for Best Original
Score with composer Tom Kitt, and was nominated for the Tony Award for Best Book
of a Musical for Next to Normal.

Page 18 of 31

A native of Issaquah, Washington, Yorkey graduated from Columbia University,

where he served as the artistic director of the Varsity Show. He also is an alumnus of the
BMI Lehman Engel Musical Theater Workshop.
Prior to bringing Next to Normal to Broadway, Yorkey was affiliated with Village
Theatre, where he began as a KidStage student and eventually progressed to a six-year
tenure as associate artistic director. Five musicals written by Yorkey - Funny Pages
(1993), Making Tracks (2002), The Wedding Banquet (2003), Play it by Heart (2005),
and A Perfect Fall (2007) - were staged there.
Next to Normal began as a ten-minute-long piece called Feeling Electric recent
college graduates Yorkey and Kitt wrote as a final project for the BMI Musical Theatre
Workshop at the end of the 1990s. Their inspiration was a segment about
electroconvulsive therapy Yorkey saw on Dateline NBC. Yorkey has observed that it is
"exponentially harder to write an original musical. Musicals that go wrong can be
ridiculous because its a ridiculous art form. People bursting into song can be ridiculous.
But musicals that go right can be sublime."

Production History
Next to Normal is a musical with book and lyrics by Brian Yorkey and music by
Tom Kitt. The piece began in 1998 as a short sketch about a woman undergoing
electroconvulsive therapy, under the title Feeling Electric. Over the next decade, the
script and score grew and developed through a series of workshops, and was retitled Next
to Normal. The play debuted off-Broadway in 2008, and won the Outer Critics' Circle
Award for Outstanding Score, with Drama Desk Award nominations for Outstanding
Actress and Outstanding Score. After the run off-Broadway, the show was reworked, and
then produced at Washington, DCs Arena Stage from November 2008 to January 2009.
The musical opened on Broadway in April 2009. It was nominated for eleven Tony
Awards for the 2009 and won three; Best Original Score, Best Orchestration, and Best
Performance by a Leading Actress in a Musical, for Alice Ripley. It was also awarded the
2010 Pulitzer Prize for Drama, becoming only the eighth musical in Pulitzer history to
receive the honor. In awarding the prize to Next to Normal, the Pulitzer committee called
the show "a powerful rock musical that grapples with mental illness in a suburban family
and expands the scope of subject matter for musicals." The Broadway production closed
on January 16, 2011 after 21 previews and 733 regular performances. Since then, the
show has toured nationally in the U.S., and received productions abroad in Canada,
Australia, Holland, Argentina, Brazil, Peru, Korea, Israel, and several countries in
Scandinavia.

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A Musical about Mental Illness?

By Jai Rodgers and James Young
When people go to see a play, what are they expecting? They expect family
drama or madcap comedy, having tears from feeling the characters pain, or belly laughs
because it is just that funny. It is very rare to come across plays with characters who
suffer from mental illness, and it is even more unusual when they are musicals.
In the musical Next to Normal, the main character Diana suffers from Bipolar
Disorder. This musical has received a good deal of attention because of its frank and
sometimes even sarcastic tone, and the irony of the lyrics heard throughout in the musical
exploration of mental illness.
Plays and musicals of this genre are hard to come by, but they exist. For example,
Woyzeck is stage play written by Georg Buchner where Franz, the main character, tries to
earn money for his family by doing experiments for a doctor. As the play develops,
Franzs mental health suffers because of the experiments. He later stabs a man merely
because he suspects the man of having an affair with his childs mother. Shakespeare
also wrote of mental illness: King Lear goes mad because of the ingratitude of his
daughters, and Ophelia commits suicide, driven insane upon being spurned by Hamlet.
Even though not discussed often, there are many more plays on this topic. There
are novels and movies as well. People may not think that characters with mental
disabilities are prominent in the entertainment community, but they exist with some
frequency. There have even been studies about favorite characters form popular films
and stories: there has been speculation about Ariel from The Little Mermaid being a
hoarder, or the crime fighter Sherlock Holmes having Aspergers Syndrome.
In conclusion, even though they may not fill the most famous plays, books or
musicals, characters with mental illnesses make many appearances in what we watch
today.

Ophelia, by John Everett Milllais (2009)

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The Music and the Text

By Kristen Armour
and Jahmad Juluke

In the musical theatre, how does music relate to text? Songs and musical numbers
are interjected periodically throughout a show. There are a plethora of reasons as to why
this happens. Some believe that words can no longer express how the character feels; the
emotions are so strong that he or she has to sing. The tone, mood or style of music
perfectly expresses way the character is feeling. When the characters sing in a specific
key, tone, or melody, the song directly connects to how the audience and performers feel.
For example, early in Next to Normal, there is a scene in a doctors office. Diana is
speaking with Dr. Fine about how to take her medicine; when all of a sudden Dan sings:
Whos crazy? The husband or wife?
Whos crazy? To live their whole life
Believing that somehow
Things arent as bizarre as they are?
Dan is clearly frustrated that the love of his life is losing her mind. He is
genuinely wondering who is crazy, the person with the illness or the one who stays with
the ill person, and his inner confusion bursts out in song, basically interrupting the
doctors explanations about the pills. A few minutes later in the same scene, distant
voices are heard singing, listing medicines in the style of a radio commercial. This is a
unique way the lyricist and composer connect the text to music. The exaggerated list of
medicines gives the audience a mental image of how strenuous it is to have an illness
where many pills are needed on a daily bases. The song lets the audience see, hear and
feel how exhausting and tedious a mental disorder can be for the sufferer.
In the play, songs and text are constantly interwoven. Also, sometimes characters who
are not in a scene come out to become part of a song. Each character sings from his or
her own viewpoint. Often the same lyrics can mean different things to the different
characters; in songs words and phrases can be repeated many times for emphasis.
Sometimes the songs express what the characters might actually be saying, but much of
the time the songs convey the psychological reality of the character their inner thoughts
and feelings. They are often part of the imagination of the characters that sing them, and
the style of the song relates to the specific character at the specific moment of the action.
It is the job of each audience member to determine how each song helps to tell the story
of the play.
Finally, the music provides pleasure in itself. Music can connect to the
audiences emotions in ways that simple spoken words cannot. So the audience has the
experience, in a way, of attending a concert as well as a play.

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Humor in Next to Normal

by Rubin Barksdale and Mya Yorke

People use humor in life to cover or add joy to pain. Playwright and lyricist Brian
Yorkey employs humor in the musical Next to Normal to balance and lighten the plays
serious and painful situations.
For example, Dianas fantasies to add humor to her doctor visits. At one point,
she imagines that she and her doctor, Dr. Fine are in a romantic relationship when she
says, My psychopharmacologist and I . . . . Its like an odd romance, intense and very
intimate, we do our dance. Later, she also fantasizes that another of her doctors, Dr.
Madden, is a rock star; as she deals with him, the play shifts back and forth between
reality and fantasy. Humor is also brought into the play when Diana blurts out random
comments or does random things that are not normal. For example, Diana tells Natalie
that she is going to have sex with her Dan, Natalies father, and she calls her son a twat
-- these are not common things a mother would say to her children. Early in the play,
Diana makes sandwiches on the floor, also very unusual. All of these examples are
drawn from Dianas illness, and the abnormal ways that such a patient might act.
Diana is not the only source of humor; Yorkey also uses the character of Natalie.
When Natalie meets Henry, she thinks hes a creeper because he knows so much about
her and she has never met him before. Natalies relationship with Henry is humorous
because their personalities are so different. Natalie is a fairly structured person, and
Henry is more free-spirited, so their interaction brings up contrasts and contradictions.
Yorkey also finds opportunities for humor in Dan. As Dianas husband, he tries to cope
with and help her, but when he talks to the audience, it becomes clear that he really
doesnt understand her.
Given the seriousness of the plays topic, the funny lines and situations provide
welcome balance and relief and add to the plays humanity.

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The Director
by Kennedy Bright and Carly Savoy
Scott Schwartz is internationally known for his
works off and on Broadway, across the United States,
Great Britain, and Asia. For nearly two decades, he has
built a reputation for working with a wide range of
productions, from new plays to operas, and everything
in between.
Mr. Schwartz is a graduate of Harvard
University, an Associate Artist at the Alley Theatre in
Houston, and a member of the Stage Directors and
Choreographers Society.
Schwartz made his Broadway career debut as
co-director (with John Caird) of the musical Jane Eyre,
a national tour of the musical Godspell, and the British tour of Godspell as well. He has
directed for many of the nations premiere theatres, including the Ahmanson in Los
Angeles, Alley Theatre, Cleveland Playhouse, Colorado Shakespeare Festival, Dallas
Theater Center, Denver Center Theatre, San Jose Rep, the Old Globe Theatre in San
Diego, Virginia Stage Company, Pasadena Playhouse, Arizona Theatre Company,
Berkshire Theatre Festival, and the Alliance. Credits in New York and around the
country include Goldas Balcony, Sance on a Wet Afternoon, Bat Boy, Shakespeares
Othello and Much Ado About Nothing, the world premiere of Theresa Rebecks What
Were Up Against, and many more.
Schwartz is the son of Stephen Schwartz, renowned composer and lyricist of such
stage classics as Godspell, Pippin, and Working, and such well-known films as
Pocahontas, The Hunchback of Notre Dame, The Prince of Egypt, and Enchanted. A
book about the life and career of Stephen Schwartz, Defying Gravity, includes interviews
with Scott and a portrait of his relationship with his famous father.

Theatre Etiquette
When you attend a play at the Alliance Theatre, you are in the same room as a lot
of other people, including the actors, who can both see and hear you. For your own and
everyone elses enjoyment, there are simple rules to follow. Turn off any electronic
devices that you brought in, and leave them off. Sounds can be distracting, even loud
whispers; and stray lights can as well, so refrain from texting and checking email.
Responding to the play is fine, with laughter, tears, gasps, and the like, but anything
louder or more verbal will take the focus off the play and put it squarely on you. If you
must exit the theatre, do so quietly, and at an opportune moment in the action. If you are
coughing a lot, please discreetly leave the theatre. And the most important rule:
pay attention, listen, watch, think, feel, and enjoy.

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Vocabulary
by Alex Albritton and Kayla McCrary
Here are some interesting, unusual or unfamiliar words from Next to Normal, with the
lines from the script showing their usage.
Twat - A foolish or despicable person

Gabe: Why does he hate me?

Diana: Because youre a little twat.

Coke An illegal narcotic drug, the shortened name for cocaine

Diana: Are you snorting coke?
Grappling - seizing with a firm grip, wrestling, clinching, struggling
Diana: When its up to you to hold your house together . . .
A house you built with patience and with care . . .
But youre grappling with that grey and rainy weather
And youre living on a latte and a prayer . . .

grappling

nimble

Nimble - Quick and light in movement; moving with ease; agile; active; rapid
Natalie: But his musics not crazy,
Its balanced, its nimble,
Its crystalline clear.
Therapeutic - Having or exhibiting healing powers
Henry: Dude. Its therapeutic.
Oblong - Having an elongated, esp. rectangular, shape
Dr. Fine: The triangle yellow ones are taken with the oblong green ones with food
but not with the pink ones.

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Psychopharmacologist a scientist or doctor who specializes in the study of drugs and how they
affect the mind.
Diana: My psychopharmacologist and I
Its like an odd romance.
Predisposition - Tendency to a condition or quality, usually based on the combined effects of
genetic and environmental factors.
Traumatic- Psychologically or physically painful
Dr. Madden: Sometimes theres a predisposition to illness, but actual onset is only triggered
by some . . . traumatic event.
Sedated - Calm, quiet, or composed; undisturbed by passion or excitement; calmed through the
administration of drugs
Restrained - Held back from action; kept in check or under control; repressed
Dr. Madden: Saline rinse, sutures, and gauze. I.V. antibiotics. Isolated, sedated, and
restrained.
Anesthesiologist - A physician who specializes in anesthesiology, the study of medications and
procedures that temporarily take away or block sensation and feeling.
Dr. Madden: I see youve met our anesthesiologist. Now, just breathe normally.
Lethargy- The quality or state of being drowsy and dull, listless and unenthusiastic, or indifferent
and lazy; apathetic or sluggish inactivity
Diana: Its like someone let my brain out,
Set my frozen mind to thaw,
Let the lethargy and pain out
While I stood and watched, in awe.
Euphoria - A state of intense happiness and self-confidence
Natalie: Its euphoria, its anger.
Its the winter wind, its fire.

lethargy

euphoria

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Psychogenic - Originating in the mind or in mental

or emotional processes; having a psychological
rather than a physiological origin.
Dr. Madden: This much loss is rare, but it has
been reported. It may be partly psychogenic at
times like this the mind tends to repress troubling
memories.
Lithium - a substance used, in its carbonate or
citrate form, in the treatment or prevention of
bipolar disorder or mania
Diana: It was the year of too much
lithium
I hid out in the car.
Sear - To burn or scorch injuriously or painfully
Gabe: Theyve managed to get rid of me
Im gone without a trace,
But sear the soul and leave a scar no
treatment can erase.

sear

Defied - Challenged; boldly or openly resisted

Gabe: Im alive
Im alive
Im death defied
Im alive . . .
Regimen - A regulated course, as of diet, exercise, or manner of living, intended to preserve or
restore health or to attain some result
Dr. Madden: We have to look at . . . a new drug regimen.

defied (smoking in front of above the influence signs)

Page 26 of 31

regimen

Circuitry - The detailed arrangement of electronic circuits (complete pathways of electric currents)
Diana: And then they told me chemistry,
The juice, and not the circuitry,
Was mixing up and making me insane.
Relapse - To fall or slip back into a former state, practice
Dr. Madden: Relapse is very common, Diana. Its upsetting that the delusional episodes
have returned, but not entirely unexpected.
Reprieve - respite or temporary relief
Gabe: Your heart is in your chest again, not hanging on your sleeve.
Theyve driven out your demons and theyve earned you this reprieve.
Pathological - Relating to, involving, or caused by disease
Diana: My first psychologist told me that according to the manual, grief that continues past
four months is pathological and should be medicated.
Lucid - Clear; pellucid; transparent
Diana: Maybe Ive lost it at last.
Maybe my last lucid moment has passed.
Stolid - Not easily stirred or moved mentally; unemotional; impassive
Steadfast - Firm in purpose, resolution, faith, attachment, etc., as a person
Stoic maintaining or affecting the mental attitude advocated by the Stoics, characterized by
strength, freedom from passion, and indifference to pleasure and pain
Diana: Why stay?
Why stay?
So steadfast and stolid
And stoic and solid.

steadfast

stolid

Page 27 of 31

stoic

Activities
Developed by Barry Stewart Mann and the High School Dramaturgs
Here are some activities to prepare students for Next to Normal and to help them
reflect on their experience of the play.

Before the show:

Emotional Changes
Objective: To give participants an experience of the swiftness and randomness of
emotional changes that can occur in mental illnesses such as bipolar disorder.
Format: Full group.
Procedure: Class mills about in open space. Facilitator calls out a series of prompts
combining a random subgroup with a physical or emotional action to portray.
Possibilities include: If youre wearing shoes with shoelaces, be very excited; If you
have older siblings, dont let people look at you, If you have an a in your first name,
talk nonstop about your clothes, If you had a sandwich for lunch, have a really bad
headache, etc. Facilitator targets prompts so that each participant has a unique
experience of shifting moods and intentions.
Life in Song
Objective: To explore entering the stylistic world of musical theatre by creating a
conversation in song.
Format: Pairs or small groups.
Procedure: Partners improvise an emotional conversation or debate on a random topic; if
interpersonal in nature, the content should be fictional. Then partners recreate the
conversation in song. Utilize a variety of musical styles, from rap to county to blues
ballad to opera. Explore repeating phrases and overlapping lines in different voices to
see what refrains arise.
After the show:
Group Discussion Questions
Objective: To reflect on some of the central issues in the play.
Format: Pairs, small groups, or full class
Procedure: Discuss, with reference to how the issue was presented in the play.
- If you believed electroconvulsive therapy could bring you clarity and peace of mind, but
might affect your memory and awareness, would you choose to accept it?
- Should people who behave differently from the majority of society, who are next to
normal, be treated in order to fit in, or should society adapt to them and accept them as
they are?
Page 28 of 31

- Which characters in the play were selfish, and which were generous and giving? When
and why?
- Remembering that Bipolar Disorder includes behaviors that most people manifest at
some time or another, explore the question: what should qualify a set of behaviors as a
mental illness?
Character Tableaux
Objective: To explore the characters and their interrelationships through physicalization.
Format: Small groups of 5 or 6
Procedure: Groups assign roles based on characters in the play; then create a tableau
(frozen group pose) to express individual character qualities as well as interrelationships
through facial expression, shape, spatial relationships, etc. Present tableaux to the class
and allow the observers to guess at characters, or simply to comment on what the tableau
expresses. Variation: do tableaux for the beginning, middle or end of the play. Have
each student choose or improvise a line of text to express the characters thought or
feeling, then activate the tableau one actor at a time to speak the chosen text.
Sample tableaux:

Page 29 of 31

Resources
Bipolar Disorder
Gold, Susan Dudley. Bipolar Disorder and Depression. Berkeley Heights, NJ: Enslow
Publishers, Inc., 2000.
Roleff, Tamara L. & Laura Egendorf, Eds. Mental Illness: Opposing Viewpoints. San
Diego: Greenhaven Press, 2000.
[Link]
[Link]/health/.../bipolar-disorder/[Link]
[Link]/health/bipolar-disorder/DS00356
Treatments
Board, A.D.A.M. Editorial. "Bipolar Disorder." Bipolar Disorder. U.S. National Library
of Medicine, 18 Nov. 2012. Web. 25 Aug. 2012.
<[Link]
Bradley, Bob. How to Survive Your Bipolar Brain (and Stay Functional). Houston, TX:
Emerald ink Publishing, 2001.
Burgess, Wes. The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers.
New York: Avery, 2006.
Fawcett, Jan, Bernard Golden, and Nancy Rosenfeld. New Hope for People with Bipolar
Disorder. Roseville, CA: Prima Publishing, 2000.
Grohol, John M. "Psychotherapy - Psych Central." Psychotherapy - Psych Central. Psych
Central, 1992-2012. Web. 24 Aug. 2012. [Link]
Guyol, Gracelyn. Healing Depression and Bipolar Disorder Without Drugs: Inspiring
Stories of Restoring Mental Health Through Natural Therapies. New York:
Walker & Co., 2006.
National Institute of Mental Health. "Bipolar Disorder." NIMH Bipolar Disorder.
National Institutes of Health, 2008. Web. 23 Aug. 2012.
[Link]
[Link]
Electroconvulsive Therapy
Dukakis, Kitty & Larry Tye. Shock: The Healing Power of Electroconvulsive Therapy.
New York: The Penguin Group, 2006.
[Link]
[Link]
[Link]
[Link]/health/electroconvulsive-therapy/MY00129
[Link]
Caregivers
[Link]
[Link]
[Link]

Page 30 of 31

The Alliance Theatre High School Dramaturgs

Tri-Cities High School, 2012

Top row (kneeling on rear shelf unit): Tessence Pearson, Samantha Axam-Hocker
Back row (sitting or leaning on rear shelf unit): Kaya Camp, Maya Yorke, Bobbi
Bass, Leonardo White, Carly Savoy, Jai Rodgers, James Young
Middle row (standing between shelf units): Richard Hatcher, Kayla McCrary, Rubin
Barksdale, Kristen Armour, Jahmad Juluke, Teaching Artist Barry Stewart Mann
Front row (leaning on front shelf unit): Musical Theatre Teacher Robert Connor,
Odjkni Simmons, Toni Robinson, Elyakeem Avraham, Kennedy Bright, Patrick
Coleman, Jenai Howard, Alex Albritton.

Page 31 of 31