Content warning: bipolar disorder, medical trauma, suicide, electroconvulsive therapy.
This review contains spoilers for Next to Normal and One Flew Over the Cuckoo’s Nest.
I recently watched a local production of Next to Normal, a 2008 musical about Diana, a mother who has had bipolar disorder for 16 years. I walked out during the intermission, after the end of the first act. I don’t know how the story ends, and I’m not sure I want to.
The musical was actually quite good. It also don’t think it was bad representation, like I had feared going in. The story of Diana actually articulates something I’ve been thinking about ever since I got my diagnosis.
In the opening scene we’re introduced to Diana’s family. And despite her complicated family dynamics, she’s thriving. She’s getting the housework done and then some, she’s initiating and enjoying sex with her husband for the first time in months, she’s staying up until the early hours of the morning just to see her son get home safely…
She’s having a manic episode.
Her husband Dan recognizes the symptoms, and takes her to see her psychopharmacologist.
Diana starts a new medication regimen. She tries medication after medication, slowly titrating up and down, the sessions dragging on for weeks, meanwhile each time she reports to her doctor that her depression and anxiety persist, while the side effects only get worse. There’s a surprisingly hilarious musical number where they list off all the horrible side effects of the meds commonly prescribed for bipolar. At the end of the scene, Diana reports that she doesn’t feel anything, she’s numb. Her doctor confidently declares: “The patient is stable.”
I chuckled.
This story resonated with me. I have a great deal of frustration and distrust of the field of psychiatry—not in the sense of distrusting modern medicine, but because:
- Prescribing psych meds is more throwing-shit-at-the-wall than it is an exact science. That isn’t for lack of expertise on the part of doctors—we just don’t know how these meds work, why these meds work, why they work for some people and not others, or how to choose which meds will work best for a given person. You just try one drug after the other and hope one of them sticks.
- The process is agonizingly slow. Titrating up on a new medication takes weeks or months. And there’s no telling how many drugs you’ll have to try before you find one that helps, if ever. Meanwhile, you’re suffering. It can be difficult to see a light at the end of the tunnel.
- When it comes to bipolar, cessation of symptoms is often your healthcare provider’s primary goal—not your quality of life. Diana achieved “stability,” but at what cost? She couldn’t feel anything; she was numb to her emotions. No happiness, no joy. I see a lot of bipolar people who report having this experience on meds.
That last point in particular is where a lot of the anger comes from. When the news media reports on a high-profile case of some famous bipolar person having a breakdown, or even hurting someone, the question is always, “Why weren’t they taking their meds?” As if it’s like taking your daily vitamins. In “You Don’t Know,” Dan tries to empathize with her, assuring her that he understands, Diana lashes out—and rightly so—telling him he couldn’t possibly understand the pain she’s going through.
These meds are brutal. They make you obese and sedated and unable to focus, they kill your libido, they make you lose your memory, they make your hair fall out. Lithium can outright kill you if you’re not diligent about getting your blood work done every three months. And as in Diana’s case, they often numb your emotions, robbing you of your happiness. Bipolar people often describe it as being turned into a zombie.
Diana eventually flushes her meds down the toilet, and I deeply empathize, because I’ve been there. In “I Miss the Mountains,” she sings about how she misses the peaks, and even the valleys. Mania is a hell of a drug; it was one of the most challenging and scary experience of my life, and I miss it every day. Having the self-confidence I always wanted, having no shortage of energy for hobbies and personal projects, feeling like I could do anything… I don’t judge her for quitting her meds. People tell you to take your meds, but they don’t know what they’re robbing you of. They’re also not the ones who have to live with the side effects.
That being said, mania doesn’t just affect you, but the people around you, the people you love. During her episode, Diana experiences psychosis, and her family has to deal with the consequences. You take your meds, and unless you’re one of the lucky ones who finds a regimen that works for you (I’ve been remarkably lucky in this regard), they can make life a living hell. You don’t take your meds, and you can hurt people. This is the bipolar experience; having to make an impossible choice about what sacrifices you’re willing to make to protect the people you love. It’s not fair.
Eventually Diana faces the consequences of her decision to stop taking her meds: she tries to end her life. This isn’t something medication can always prevent—these medications are generally much less successful at treating depression than they are at treating mania—but in Diana’s case, this was a risk she took so she could experience happiness again, and people got hurt because of it.
While in the hospital, her doctor recommends electroconvulsive therapy (ECT), an operation in which electric current is passed through the brain to induce a seizure. It’s used as a last-resort intervention for medication-resistant depression and bipolar disorder, and it commonly results in permanent memory loss. When the treatment is proposed, Dan and their daughter Natalie are both horrified, surprised that the the procedure is even still carried out.
However, Diana’s doctor eventually convinces Dan, who is required to give his consent to the procedure in addition to Diana. From there, Dan pressures Diana into going through with it. This scene in particular was the breaking point for me. The decisions bipolar people have to make—the sacrifices they have to make—to protect the people they love. For Diana to have her agency and bodily autonomy stripped away by her husband and the medical system, pressured to undergo to a procedure that will change her life in ways nobody can predict.
What are humans besides a collection of memories? When those are gone, what’s left?
Ernest Hemingway once said to his biographer:
Well, what is the sense of ruining my head and erasing my memory […] It was a brilliant cure but we lost the patient.
ECT did not save Hemingway’s life.
I left the theater because I didn’t want to know what happened next. Would the ECT “work” and alleviate her symptoms, tacitly condoning it as an effective method of treatment? If that was going to be the message, I didn’t want to stick around to hear it. Would the ECT leave her lobotomized, her memories gone, a shell of her former self? I didn’t want to bear witness to that, even in fiction.
Clearly Diana saw the latter outcome as a real possibility. She compares herself to McMurphy from the classic novel One Flew Over the Cuckoo’s Nest, who is forcibly lobotomized at the end of the book; a fate portrayed by the book as worse than death, given how the story ends with the main character murdering him as an act of mercy.
In the end, Dan convinces her to go through with the procedure. She signs her life away to protect the people she loves from getting hurt.
My friend held me as I choked back sobs. I left the theater in tears while they comforted me. I can’t recall the last time a piece of media made me cry.
It’s not fair.