Singing About Mental Illness In 'Next to Normal' The Tony award-winning musical Next To Normal portrays a family struggling with mental illness and the treatments offered by modern psychiatry — with rock songs about Valium and bipolar disorder.
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Singing About Mental Illness In 'Next to Normal'

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Singing About Mental Illness In 'Next to Normal'

Singing About Mental Illness In 'Next to Normal'

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You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow.

You know, sometimes an issue lies dormant until Hollywood or Broadway uses it as a theme. It could be nuclear power in "The China Syndrome," global warming and "An Inconvenient Truth" or mental illness in "One Flew Over the Cuckoo's Nest." We are now in an age of pharmacology, where psychiatrists who used to try to talk therapy into you now rely on drugs to do the work. And the struggle between traditional psychotherapy and psychopharmacology is at the center of a Tony Award winning play on Broadway called, "Next To Normal." It's a musical with an unusual subject of mental illness. With songs about bipolar disorder, valium and rock star therapists, this is not a light and happy musical.

It's raw and emotional and true to life. It's the story of a suburban family struggling with the mother's chronic bipolar disorder. And trying to navigate the world of therapists and pill cocktails while finding a way to be normal, or at least, "Next To Normal." And this is all set to tune up rock music. The writers are here to talk about their motivation in creating "Next To Normal" and the vetting process they put their script through with mental health professionals. "Next To Normal" won three Tonys this year, including best score. Here is a clip from the show.

(Soundbite of play, "Next To Normal")

Unidentified Woman (Actor): Actually I'm fine.

Unidentified Man (Actor): I'm myself lost (unintelligible) depression.

Unidentified Woman: Actually I'm fine.

Unidentified Man: You have lost to anxiety.

Unidentified Group: (Unintelligible).

Unidentified Woman: Actually I'm fine.

Unidentified Man: Why do you go down to something you lost?

Unidentified Woman: Please hear me calling.

Unidentified Man: I wanted to hear these things.

Unidentified Woman: Catch me before it's too late.

Unidentified Man: Depression, anxiety.

Unidentified Man: One gives rise to the other.

Unidentified Group: Catch me I'm falling, catch me I'm falling, catch me I'm falling.

FLATOW: Depression, anxiety, bipolar, mental health, those are the topics of "Next To Normal." And we're going to talking about "Next to Normal" with my guests. Brian Yorkey is the lyricist and the librettist of "Next To Normal." Welcome to the show, Brian.

Mr. BRIAN YORKEY (Lyricist, Librettist, "Next To Normal"): Hello Ira, thanks for having us.

FLATOW: You're welcome. Tom Kitt is the composer of "Next to Normal." Thanks for being here Tom.

Mr. TOM KITT (Composer, "Next To Normal"): Thank you for having.

FLATOW: Our number 1-800-989-8255 if you'd like to talk about "Next To Normal." 1-800-989-TALK. And as always you can Twitter us as @SciFri, at S-C-I-F-R-I. We'll be taking questions from your Tweets. A very interesting play. I saw it this week. It was terrific I thought. And congratulations to both of you for that. But whenever I go to see plays with these themes, I'm always wondering, what was the motivation - what was the motivation for writing a play like this, Tom?

Mr. KITT: Well, certainly Brian and I wanted to do something a little off the beaten path. We were in the BMI Musical Theater workshop and the final assignment the first year is a 10-minute musical. And we were searching for subject matters. And actually, it was Brian's idea. If you want to talk about that, Brian.

(Soundbite of laughter)

FLATOW: Brian, fill us in.

Mr. YORKEY: Well during the time that we were sort of casting about looking for a topic for a final project, I actually saw a television news report on electroconvulsive therapy, which is, you know, commonly known as shock therapy. And I think I, like many people, was surprised to find out that it still was practiced. And in fact, as I learned, a very important, you know, element in the psychiatrist's sort of armature of treatments for a certain kind of patient.

And from that, you know, the report which was, you know, this was many, many years ago but the report also included a statistic that stated that a disproportionate number of patients who received ECT were women and the disproportionate number of the psychiatrists who prescribed it were male. And since I have learned that there are many reasons for that. Depression and similar illnesses in general are more reported in women than in men in our country. There are cultural reasons for that, et cetera, et cetera. But at the time it made be think of a woman who had struggled with mental illness for some time and of all the men in her life who had tried to treat her and make her well. And that really was the germ of the idea.

FLATOW: It is referred to in the play "One Flew Over the Cuckoo's Nest." It is referenced to it in there. Was that on your mind at all, in both of your minds when you thought about this?

Mr. YORKEY: I think it absolutely was. I mean, that was the last sort of information or impression I had of ECT was "One Flew Over the Cuckoo's Nest." And I think that that's true of a lot of people.

FLATOW: Mm-hmm.

Mr. YORKEY: And in exploring - starting from there and exploring the sort of, as you said in the intro, the pharmacological spectrum that currently exists to treat patients that didn't exist in the same way even 20 years ago, much less, you know, forty years ago, when "Cuckoo's Nest" was first written, more or less. It really sort of became a fascinating topic to…


Mr. YORKEY: …explore. And also, you know, a really kind of compelling one to think about someone trying to navigate that to cure themselves?

FLATOW: How much research and how did you do your research for learning about the drugs and the interaction with people?

Mr. YORKEY: Sure, we did a tremendous amount of research. We, you know, an awful lot of reading, much of it was first person memoirs. There are a number of fantastic memoirs about depression and about bipolar. Kay Redfield Jamison in his one of the most famous, her book, "An Unquiet Mind." She is a psychiatrist and is bipolar, and so has a very sort of unique point of view.

There are a number of bipolar people and depressed people who have written memoirs about undergoing shock therapy. Kitty Dukakis is one of the most famous, Andrew Behrman has a book called "Electro Boy." So a lot of these and then a lot of sort of general interest psychiatry books, books like Andrew Solomon's "Noonday Demon." There is a tremendous amount of reading out there. We ventured a little bit into less general interest and more sort of academic and medical texts. But being laypeople we could only go so far with that.

(Soundbite of laughter)

Mr. YORKEY: But there was a tremendous amount of sort of reading research that went into it.

FLATOW: And Tom, as a composer how difficult is it to write the music for this?

Mr. KITT: It's funny. I was inspired by the subject matter right away and the music kind of poured out of me. First, because Brian's lyrics are so visceral and moving on the page, and so when I get a lyric first, I find it easy to write the music. But, you know, we're telling a story of heightened emotion that goes into many different realms. And the rules of a musical are that you -sing when emotion is so great that you have to. So, I found in this, in this show that it really, it sung right away and the music for me was, I found myself very inspired constantly.

FLATOW: Sitting in that audience intermission and then at the end, you know, you get that impression that you have struck a raw nerve with everybody. You know, everybody has been through this somehow, some way, from the reaction of the audience, you know. And is that something you were certain you were looking for? Did you expect that to happen, was this surprising?

Mr. KITT: I personally was gratified and surprised by that from the beginning of our process. Because when you're writing something, you're so in it, you're not always aware of how it's being felt, especially because you do a lot of work before you have a reading or a public presentation of your material. So from the first days of these public performances people were coming up and talking about their personal stories. So, certainly we didn't see it happening on this level, especially with a story like this. But it's been very gratifying to see the personal stories that have come out of people and the real visceral reactions people have in the theater.

FLATOW: Hmm. And without giving away the conclusion of the program, how it turned out, did you spend some time, a lot of time figuring out how you wanted this to end? Or did it happen - the ending that most of these stories have?

Mr. KITT: Hmm.

Mr. YORKEY: Well I think that without giving too much away, I think that the ending is not necessarily a fully happy ending in the tradition of Broadway musicals. As my mom says, hymns doesn't go home to hymn's mama. But the ending is what we actually had wanted it to be from the beginning, which is an ending that is true to the sort of destructive nature of these diseases. And of the fact that a family dynamic sometimes can't overcome them but at the same time also true to the thought that if we open up our lives and look at these issues in the light of day and take them head on, there is an opportunity to begin the heal. And I think - I hope that's what the ending of our show says.

FLATOW: What were - what did you think, Tom, what were some of the biggest challenges in creating a musical about such a serious subject?

Mr. KITT: Well, certainly the subject matter and getting the show exactly right because we don't want to create a show that people find so heavy and emotional that they wouldn't necessarily recommend it to people or, if they look back on the experience, they didn't necessarily feel positive about it.

So I think that Brian and I wanted to strike that balance between telling a truthful, emotional story but also creating a positive experience in the theater. And I think that honing the material and making sure it was doing that was probably one of the biggest challenges we faced.

FLATOW: It's interesting because there are two doctors, two MDs in the program. There's a Dr. Madden, who's a psychopharmacologist, and the - Diana, the character, stops seeing him because she doesn't want to take the meds that make her feel numb, and Dr. Fine is a psychotherapist. You had to walk a fine line between the distinction between the two. What was your motivation in adding two different doctors here?

Mr. YORKEY: Well, there were originally actually more doctors in the program because we spent more time exploring the different treatments that Diana attempts. And over the course of sort of the story evolving, we realized that it was much more about her experience of the illness and how it impacted her family. So we ended up spending more time with her family than we did with her doctors.

We decided to have two because we felt that we wanted to, as you do, you start a story at the latest possible moment. So we wanted to start the story at a moment where she had been stable and had been relatively healthy, you know, give or take, for a number of years. And oftentimes the experience of being relatively stable comes once a psychopharmacologist or a psychiatrist has been able to balance a cocktail of psychotropic drugs.

And so that's where we found her. And then as the show sort of opens, a number of things occur to her, and she realizes that with that stability for those years has come a certain kind of numbness that she would like to get rid of.

FLATOW: Alice Ripley, the actress who plays Diana, won a Tony Award for her portrayal. How much work did she have to do to get this character right?

Mr. KITT: I think she did a tremendous amount of work. Certainly having seen the show, you know how much music is in the show and how many places Diana's character goes just in terms of the composition of the score.

So I think that Alice had to really do a lot of work just to get the piece in her physically. And then on top of that, I think she did a lot of research, a lot of reading, you know, and she has said that she really took to this character right away, and it was something that she wanted to explore and bring out in herself.

Mr. YORKEY: One of the things I think has helped Alice tremendously, and certainly helps Tom and I in developing the show, is that people do want to tell us their stories. And so there is not only sort of an ability to really come into contact with many different people in different kinds of ways of having this illness in your life but also really sort of understanding at a deep level what it is. And I think that, you know, Alice has worked so incredibly hard and such a deserving Tony. And also, you know, she, as were Tom and I, was guided by Michael Greif, who was our director, and also did a tremendous amount of research and really took pains to get the details of the experience right.

FLATOW: All right, we're going to take a break, come back and talk lots more with Brian Yorkey and Tom Kitt, who are a terrific writing team. Brian is the lyricist and librettist for "Next to Normal," and Tom is the composer.

We'll take your questions. I know you have lots of them. Stay with us. We'll be right back. I'm Ira Flatow. This is SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking this hour about mental illness and modern psychiatry on the stage of the Broadway musical "Next to Normal." My guests are Tom Kitt and Brian Yorkey, the creators of "Next to Normal." Our number, 1-800-989-8255.

Let's go to the phones. Let's go to Barbie(ph) in Gainesville. Hi, Barbie.

BARBIE (Caller): Hey, how you doing?

FLATOW: Hi there.

BARBIE: You've probably already sort of addressed this question, but when I first heard this subject, what this was about, my husband was in this sort of this situation, had a family situation like this, and when I first heard the topic of the play, I was inclined to think, oh, I need to tell him about it. And then when I heard the song clip, it was very, very heart-wrenching. And I guess I'm just sort of wondering, is this the kind of thing that is sort of recommended, would you consider it sort of a therapeutic thing for somebody that's been involved in it to go see, or is it something they should maybe stay away from? I guess that's sort of what I'm wondering.

FLATOW: Okay, good question.

Mr. YORKEY: I think that - that is a good question, and I think that our experience has been, by and large, it's very therapeutic. I won't say that it's been easy for people who have bipolar or other mental illnesses in their lives to sit through it necessarily all the time. But our experience has been, and we've heard from so many people both in person at the stage door and, you know, letters after letters. We just got a letter today from a 17-year-old girl who has been severely depressed and has a few other mental illnesses and had been hospitalized with suicidal ideation and discovered the recording of "Next to Normal" and found it a tremendous source of solace and hope.

So I think that, by and large, people report that it's a very therapeutic experience. It's heavily emotional. It's not necessarily an easy one but definitely a worthwhile one.

FLATOW: And the portrayal of the two doctors, Dr. Madden and Dr. Fine, by Louis Hobson, is so true of doctors. How did you get that doctor character down so well? I mean, he just played a perfect - did you talk to doctors who you knew?

Mr. YORKEY: We did. We certainly did. I mean, obviously, the lion's share of the credit has to go to Louis, who's fantastic, and also to Michael Greif, who guided him through it. But also, you know, we had a number of doctors, most prominently a psychiatrist by the name of Dr. Anthony Pietropinto and a psychologist by the name of Dr. Nancy Elman(ph), who read drafts of the script for us and saw workshops and saw productions. And we said to them, the civilians in this play may make some bad decisions. We would like the doctors to always behave as well-meaning, competent doctors would behave. And they were very helpful for us in guiding us to writing those kinds of doctors.

FLATOW: Tom, is it true that your father-in-law is a doctor, is a therapist?

Mr. KITT: Yes, yes, my father-in-law, Anthony Pietropinto, he was very helpful. He read multiple drafts of the show. And some of the moments that really Brian and I were kind of stuck on, and he threw out some ideas, were very, very helpful.

FLATOW: 1-800-989-8255. Stephen(ph) in Nottingham. Hi, Stephen.

STEPHEN (Caller): Hi. I'm actually a psychiatrist, and I saw - first of all, this is fascinating, and I agree that the connection between theater and movies and how people perceive mental health is incredibly critical. For example "One Flew Over the Cuckoo's Nest" set back ECT about a generation in terms of people being afraid of it.

I find that there's two things going on. Number one is that medication is both over-prescribed and under-prescribed. And back to the dilemma of the play, the dilemma is that medication does make a difference. But at the same time, I think it always diminishes a person's ego when they take a medication, when they say, I can't do it on my own. And I think that's the eternal struggle of prescribing medication that does work but the dilemma that people have to have of saying, my God, I need something because I can't be without it.

FLATOW: That's a good point. How much, as writers of the play, did you have to decide you were going to make medication the good guy or the bad guy here?

Mr. YORKEY: That's an excellent question. You know, we went through many different sort of attempts at writing, for instance, one of the early numbers of the show, which is called "My Psychopharmacologist and I," because we very much wanted to write a woman who decided to go off her psychotropic drugs, which is a decision many people in our life had made. And we wanted to explore what happened when that happened, but at the same time, we wanted to do it without in any way trying to be an anti-medication screed because I think Tom and I both feel very strongly, as do, I think, all of us working on the show, that medication is essential for many, many, many patients with bipolar and other mental illnesses.

And so it was a tough line to walk, and I think in this case, as in all others, we tried to have the show present both sides as clearly as possible and to make very clear that the choices being made were the choices of these specific characters in this story and not necessarily meant to be sort blanket statements in any way.

FLATOW: 1-800-989-8255. Melanie(ph) in Jordan, New York. Hi, Melanie.

MELANIE (Caller): Hi. I just want to say I have bipolar, and I'm 17 years old. And it's just great to have a musical where a lead character is bipolar and how you can, like, relate to the person so much. Like, the drugs that the character is on, I have been on many of those drugs. And it's just amazing. I just want to thank you and just the cast and crew and just the creative team, and everyone who's a part of it. It's just amazing, and I love it. And I'm seeing it Monday. So I'm really excited.

FLATOW: All right. Have a good time.

MELANIE: Thank you.

Mr. YORKEY: Thank you.

Mr. KITT: Thank you.

FLATOW: So what kind of - have you gotten positive reaction from the medical community on this, or have they been a little lukewarm?

Mr. KITT: It seems that - I mean, we had one evening where there were a number of doctors in the audience, and we had a talk-back afterwards. And the response was really positive, and I think that, you know, a lot of doctors have been like that second caller, who are glad that these issues are out, that some of that taboo is being taken away, that they're not being sensationalized and that a true, emotional story about these issues is being told.

FLATOW: And it's interesting that part of the conclusion of the play, and if you deal with people who have mental illness or in the mental health business as doctors in hospitals, this is a lifelong thing that goes on. This is not something…

Mr. YORKEY: Absolutely, yeah.

FLATOW: And you portray that very well. Let me see if I can get another caller or two in here. Hi, Ryan(ph) in Grand Haven. Hi.

RYAN (Caller): Hi, my name is Ryan, and yes, I'd just like to say I really like the idea of bringing, you know, this issue out and getting the taboo away of it. And I'd like to know: Where can I see the movie, or the play, I should say?

FLATOW: Yeah, are you going to do a national tour on this?

Mr. YORKEY: There is a national tour in the works. I'm not sure all the details, but right now, it's running on Broadway in New York, and I think the national tour is going to start in fall of 2010.

FLATOW: And is there an end to the run here that - or is this an open-ended run?

Mr. YORKEY: As long as people keep coming, it keeps running.

(Soundbite of laughter)

FLATOW: Well, from the - you know, it was standing room only when I went this week during a weekday. So do you…

Mr. YORKEY: It's been very well-received. We've been just surprised and delighted by the reception we've had.

FLATOW: And what I was surprised, when I first walked in, is that there must be people coming to see this two or three times because people were already applauding before the play started.

Mr. KITT: Yes, there are a number of repeat viewers. And that was the case at Second Stage, when we were off-Broadway, as well. And I think certainly, a large part of that is the brilliant work of our design team, led by Michael Greif, because if you see the show more than once, you catch different things.

There's all - it's so multi-layered in terms of the visual that seeing it again I think is a different experience, but I think also people get - like we've talked about, they're very into the subject matter and the emotions of the piece, and they want to experience it again.

FLATOW: Yeah, and I think there are a lot of people who, you know, can relate to this. I call it the hair-dryer moment, and my experience when I've talked a lot about medicine, especially mental health, people do not like to say anything in public about mental health until they happen to be getting their nails done or a hair dryer or a barbershop, and they hear somebody next to them talking, and then suddenly they say something, right?

(Soundbite of laughter)

FLATOW: And then that person next to that other person says something, and you all realize that this is something that is more universal than you thought.

Mr. YORKEY: Absolutely, and I think that, you know, this show is particularly about bipolar, but I think whatever the mental illness or dysfunction your family is struggling with, there is a lot that you find out is in common.

FLATOW: One last question before we have to go. Why did you make her a housewife? She says in one song: I ain't no Sylvia Plath.

Mr. YORKEY: You know, early on, we had a number of people said, you know, you should make her a painter. You should make her outlandish and this and that. And I said, you know, this is a story about something that happens to many, many people, including many suburban mothers. And we wanted to make her a person from our lives and not in some way sort of make the character, and therefore her illness, exotic and different and other. She is very much one of us, and that was very important to the story, we thought.

FLATOW: Well, you certainly have succeeded in this play, and I wish you very good luck in its run and hope that other people around the country will get a chance to see it. Good luck to you. Thank you both for coming on to talk with us today.

Mr. YORKEY: Thank you so much, Ira.

Mr. KITT: Thank you, a pleasure.

FLATOW: You're welcome. Tom Kitt and Brian Yorkey, the creators of "Next to Normal."

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