BETTER UNDERSTANDING BIPOLAR DISORDER

Next to Normal has been praised and awarded not only for its evocative music, but for expanding the scope of musical theatre to focus on mental health and illness. Its nuanced depiction and destigmatisation of neurodiversity have also won acclaim.

In Next to Normal, mother and wife Diana experiences bipolar. As she and her family endeavour to find that elusive ‘cure’ to her bipolar disorder, the struggle to be ‘normal’ profoundly affects all members of the family.

DOCTOR FINE: “Goodman, Diana. Bipolar depressive with delusional episodes. Sixteen-year history of medication. Adjustment after one week.”

Bipolar disorder affects approximately 2% of the population. Known as manic depression until 1980, it is characterised by changing mood states veering from extremely high (mania) to extremely low (depression); this can be continual and cyclical. When in a period of mania people may undertake risk-taking behaviour; talk very fast; become agitated and find it difficult to sleep. In a period of depression they may lack energy; suffer feelings of worthlessness and low self-esteem; have difficulty concentrating, remembering or making decisions; and experience suicidal thoughts. Delusions and hallucinations can also occur. There are different types of bipolar disorder, differentiated by the pattern of or tendencies to mania and depression.

DIANA: “I was diagnosed bipolar, um, wow, sixteen years ago? But it turned out bipolar didn’t totally cover it.”

People usually develop bipolar disorder in early adulthood (late teens or early 20s), as Diana does. There is no definite explanation as to why people develop bipolar, but genetics, triggering experiences and environment all seem to play a part. While there is no known cure, recovery can be possible and, like many incurable disorders, illnesses and diseases, bipolar disorder can usually be managed and wellness maintained. That management typically involves medication to rebalance chemical imbalances and talking therapies. The latter include cognitive behavioural therapy (CBT), through which new ways of thinking are nurtured in order to create new associations and, ultimately, new behaviours. Another is interpersonal therapy which focuses on the individual and their relationships with other people. Common wellbeing therapies (such as mindfulness, exercise or yoga, amongst others) can also assist in achieving and maintaining overall emotional, mental and physical health.

DOCTOR MADDEN: “It’s safer than crossing the street and the short-term success rate is over eighty percent.”

One of the therapies mentioned in the show may be controversial, and people (like Dan, Diana’s husband) may be surprised to know that it is still a used treatment. Electroconvulsive therapy (ECT) is available in Aotearoa New Zealand, under limited circumstances (e.g. when standard treatments used over a long time have not worked) and with many provisos. A course of ECT is mainly used only for treatment of severe depression, catatonia and - rarely - mania. ECT typically wears off after four-six weeks and medication is prescribed for ongoing wellness.

Diana also experiences the most commonly reported side-effect - temporary memory lossalthough this by no means affects everyone and memories about events more than two years old usually do not change.

DOCTOR MADDEN. “Diana. You have a chronic illness, like diabetes or hypertension.”

While some of the exact terminology surrounding Diana’s diagnosis has changed since the time of writing, Next to Normal has retained its relevance because questions around mental health and wellbeing are universal to the human experience. Since the world experienced a pandemic which changed everything about how we live, and lived together, we all better understand how easily our mental health can change. Challenges to mental wellbeing are experiences “that we can all lean into” says Director, Hayden Tee. “Everyone now has a point of reference to this. Mental health and its challenges are just as normal as any other lived experiences.”

For more information about Bipolar Disorder visit:

Bipolar disorder | Mental Health Foundation

Ministry of Health

The Mayo Clinic