Introduction:
Bipolar disorder as defined by the National Institute of Mental Health is a brain disorder that causes a patient to experience unusual mood shifts, activity levels, energy, and the ability to go on with day-to-day activities (Mondimore, 1999). The disorder is classified according to occurrences of the intense moods, that is the excitedly and joyous moods, normally referred to as manic state, and intensely hopeless and depressed states known as the depressive state. The patient can also experience prolonged moments where both states occur simultaneously. These moments are characterized by irritability and changes in energy, behavior, and sleep. The disorder affects both men and women equally and it mainly starts from the age of fifteen years to the age of twenty-five years. The exact cause is undefined but it is mostly known to occur to people with relatives with the disorder. It is classified into two types, Bipolar Disorder Type I and Type II. Patients suffering from Type I experience one manic episode followed by periods of major depression. For Type II, the patient never experience full manic. As it will be evident from this paper, the patient in question suffers from Bipolar Disorder Type I (Mondimore, 1999).
Signs and symptoms:
The main character of the musical shows signs all the classical signs of bipolar disorder. The condition is associated with violent and manic mood swings that may interfere with an individual’s functioning in everyday life since it may lead to manic, hypomanic, and depressive states. Manic episodes are one of the key elements of bipolar disorder. In this state the individual suffering from the illness have an irritable mood that can easily change from time to time. In addition, they are unable to sleep and have a lot of energy (Reiser & Thompson, 2005). It is possible for a person in a manic state to stay up for long periods at a time with some periods lasting over a number of days. This leads to impaired judgment and some may feel out of control. In this state an individual could easily lose their grip on reality and would be lost in hallucinations (Miklowitz & Cicchetti, 2010). The other state is the hypomanic state. This is a mild form of the manic state. Mood swings are not as violent as those in the manic state. Depression also couples bipolar disorder. An individual feels sad and hopeless in this stage. They are indifferent and may tend to hate themselves or those who are around them. This leads to lack of motivation and this may lead to suicide. Delusions and hallucinations also accompany this stage.
The last stage is the mixed stage that is a combination of the manic and depression phase. This is the most dangerous stage of the disorder since the person suffering from the disorder experiences multiple aspects at the same time. This greatly increases the risk of self-harm, suicide or even harm to others around the person affected by the disorder (Reiser & Thompson, 2005). The musical Next to Normal exposes to the audience to the symptoms of Bipolar disorder and the effects it has on the family of the patient. Diana is the woman character in the musical who is suffering from the disorder. Her condition is plagued with unpredictable mood swings, anxieties, hallucinations and delusions. These are classical signs of bipolar disorder as discussed earlier.
Diana is showing both the manic and depression stages of bipolar disorder throughout the musical. In addition others show that she is suffering from delusions and hallucinations. Even after sixteen years, it is evident that Diana has not accepted that her son died. She carries on daily activities with the illusion that her son is with her. This is a clear sign of a delusion. The first time the family realizes that all is not well with Diana, is when she is seen to be preparing lunch then all of a sudden, the lunch-making turns to a dramatic moment. Diana moods change drastically and the sandwiches she was making are seen on the floor. In this scene, we see the presence of Gabe, their dead son. He is portrayed to be real and not just one of Diana's illusions. Dan is seen to help her and then it dawns on the family that all is not okay. Something has to be done to help Diana. It is evident from this scene that Diana is not in touch with reality. She is ready to abandon her living family to be with her dead son. The disorder is critical and now proves fatal.
In another scene the audience sees Diana suffer from a mixed stage of bipolar disorder as she is cleaning out her Gabe's things. She pauses to listen to a music box. Gabe takes this opportunity, dances with his mother, and convinces her to join him. The only way is through death. Diana attempts suicide by cutting her wrists. This is a sign of depression. As stated earlier, according to Reiser & Thompson (2005), individuals in the depression stage of the disorder may attempt suicide due to factors such as self-loathing or a loss of reality. In addition, this case shows impaired judgment on the part of Diana due to her condition.
Causes:
It is important to first trace the cause of Diana’s bipolar disorder. According to Miklowitz & Cicchetti (2010), three causes can explain bipolar disorder. These are genetics and environmental factors. Genetic factors relate to the condition being passed down in a family from parents to children. Miklowitz & Cicchetti (2010), suggest that children of individuals suffering from bipolar disorder are genetically predisposed to the condition. Environmental factors on the other hand are the external factors that surround an individual. In the event that external factors are traumatizing then an individual is likely to develop the condition. In addition, the external environment is likely to aggravate the disorder for people who already have developed the disorder.
It is evident that Diana has developed her condition from environmental factors. Her bipolar episodes are seen to be caused by a family tragedy that occurred sixteen years ago when she lost her son. Diana has been suffering from this disorder for sixteen years yet her family still stands by her. Her environment at home is very supportive and has helped to control her disorder. At one point after treatment the doctor declares her stable. The family is hopeful that happy times are here. However, the worst has not passed as they come to realize. Diana’s environment still reminds her of her son. This leads to Gabe's ghost being seen guiding Diana into flushing away her medication. A few weeks without her medication, she goes back to her worst. When the family is waiting for Dinner, she appears holding a cake and singing happy birthday to her dead son.
Natalie also seems to suffer from bipolar disorder. Her disorder can be traced to genetic predisposition by her mother. In addition, environmental factors contribute to Natalie’s condition. Due to her mother’s condition Natalie slowly loses it. In the first act Natalie is seen to be very disturbed by her mother’s manic episodes and she fled to school and seeks refuge in the piano room. From this act, it is clear that Natalie does not feel safe in her own home. Her need to escape to school shows how uncomfortable her mother's disorder makes her. A teenage daughter needs to have a dependable mother for constant guidance. Natalie has had to live as if she has no mother. Her father cannot be there for her all the time as he is mostly taking care of the mother. Natalie is now exploring clubs and drugs. She acts as a neglected teenager seeking her parents’ attention.
Treatment:
According to Miklowitz (2002) there are various methods that can be used to treat and control the condition. Miklowitz (2002) discusses the use of psychotherapy as well as medication. Psychotherapy involves finding the trigger of the bipolar condition in an individual. It mainly involves therapy and trying to get to the bottom of the root cause of the condition in an individual. Miklowitz (2002) suggests that this can only be achieved in earlier stages of the condition, in later stages this method has proven to be ineffective. Medication involves the use of drugs to stabilize the mood of the affected individual. Drugs have been effective in reducing mood swings and hallucinations. According to Miklowitz (2002), two types of drugs have been effective in dealing with this disorder. These are atypical antipsychotics which are effective with controlling mania and antidepressants that are effective with controlling depression. During the musical, Diana goes through several treatments under a series of doctors. Diana goes through a series of medical and psychotherapy treatment. The play also introduce ECT as a form of treatment for bipolar disorder. In the second act, Diana goes through a series of ECT treatments. However, after the ECT treatments, Diana comes home with a nineteen years’ worth of memory loss.
The role of family:
Mondimore, (1999) suggests that family support for a patient is very important. In addition, he writes that a family is likely to suffer in case they do not come together in support. Miklowitz (2002) also presents the role of the family when it comes to caring for an individual affected by bipolar disorder. He writes the family plays a very important role in supporting individuals who have the developed the condition. The play demonstrates how families taking care of bipolar patient suffer from worry of losing their loved one at any time. When one problem seems to be overcome, bipolar disorder never stops presenting a new one. The family is now responsible of trying to bring back these memories. Dan guides the family to do this. However, in attempts to bring her memory back using pictures, mementoes and the like, Natalie finds the music box from a pile of keepsakes. Dan rushes out at her and takes it away. From this act it can be gathered how the disorder keeps introducing new conflicts among the family members. Natalie and Dan suffer a rough patch from this incidence. Diana is also puzzled by the incidence and keeps demanding for answers. Dan's patience is being pulled to the limits. He in the end crushes the music box on the ground.
The end of the suffering does not seem to come. Dan however, does not give up. He tries explaining to Diana that their son died years ago. When he mentions a return to the doctor, Diana becomes aggressive and refuses to go. She insults her daughter and talks down on Dan. She feels that no one can hurt as much as she does. Dan however, does not give up. He tries to coax her into seeing a doctor but his efforts are shot down by Gabe's appearance. Since Gabe and the mother are very close, he uses this to make her trust in him over Dan. Natalie is depressed and she is seen to vent her disappointment and anger to Henry. Their relationship is suffering because of her mother's behaviors. The mother-daughter relationship becomes a strained one as Natalie refuses to forgive her mother. Diana's disorder does not seem to have an end to causing harm to the family.
Conclusion:
In conclusion, through Gade's character, the play shows how parents suffer from the loss of a child. One maybe affected more than the other as in the case of Diana did. Through the characters of Gabe and Diana, the pictures of this suffering are perfectly painted. According to "Next to Normal,” mental illness must have a root. It however, could exist without accompanying tragedies. Mental illness is painted as a family responsibility. When one member is sick, every family member is affected. We see Diana's family going through moments of intense pain, anger, disappointment, and shreds of hope. The play also shows how family is supposed to support the patient unconditionally. Patience is the key to keeping it together. As much as the illness is seen to cause harm to the family, there are some good moments the family share. Treatment sessions for the patient are moments that bring the family together. An example is, in the end, we see Natalie comforts Dan when she finds him in tears. She assures him that she will stick with him and all will be okay.
References:
Mondimore, F. M. (1999). Bipolar disorder: A guide for patients and families. Baltimore: Johns Hopkins University Press.
Miklowitz, D. J., & Cicchetti, D. (2010). Understanding bipolar disorder: A developmental
Psychopathology perspective. New York: Guilford Press.
Reiser, R. P., & Thompson, L. W. (2005). Bipolar disorder. Cambridge, MA: Hogrefe.
Miklowitz, D. J. (2002). The bipolar disorder survival guide: What you and your family need to know. New York: Guilford Press.
