Next to Normal
Next to Diana
Diana is diagnosed with “bipolar disorder with psychotic features,” which would now be classified as Bipolar II Disorder. This previous diagnosis was probably given to patients like Diana due to hallucinations. Dr. Madden even explains that sometimes patients are given a label that covers a variety of diseases. Gabe’s death was the initial cause of her disorder, and these hallucinations and delusions stem from the idea that Gabe is still alive (ex. the birthday cake Diana bakes for his birthday.) However, these “psychotic features” are actually a result of schizophrenia.
Schizophrenia is caused by imbalances in the chemical reactions and neurotransmitters in the brain. These neurotransmitters allow brain cells to communicate with each other, and scientists are starting to link this to schizophrenia. There is actually a lack of distribution of brain cells, and their characteristics, before birth with this condition.
However, schizophrenia is most likely detected during puberty, as major changes in brain activity happen during this time. These changes can cause psychotic features, like in Diana’s case. Schizophrenia is also hereditary, like bipolar disorder, so Diana could have a family history.
If you look at Diana in Next to Normal, you can link many moments in the show with schizophrenia. People with this disorder hear voices that other people can’t hear, like Diana hears Gabe. In fact, I think Gabe is probably the strongest evidence of Diana’s schizophrenia. During “I Am the One”, Diana tries to get Dan to see Gabe, but he sees nothing. There are countless moments where Gabe is manipulating the world around them and only Diana is witness (“I’m Alive”.)
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Diana also doesn’t like to be touched or be in close vicinity with anyone. This is a symptom of schizophrenia, where those affected can believe anything from people reading their minds to plotting to harm them. Dan tries to hold Diana during “I Am the One”, but she pushes him away (“Can I touch you?”) Dan also talks about the lack of sex since Diana’s disorder was first apparent during “Who’s Crazy?” She also tells Dr. Madden that she didn’t hold Natalie in the hospital when she was born.
“I couldn’t hold her in the hospital. I couldn’t let myself hold her.” – Diana
People with schizophrenia also have the inability to hold a job or even care for themselves. Dan has to drive Diana to her appointments and Diana for the most part stays at home. She relies on Dan and Natalie to take care of her.
“When she gets like this, she’s useless. She can’t use the phone, can’t drive” –Natalie
“But now I believe I would settle for the one who can drive.” – Dan (“Who’s Crazy”)
There is also plenty of evidence pointing to the fact Diana does indeed have Bipolar II Disorder.
The optimistic attitude she gives off during the majority of Act 1 is due to a hypomanic episode, which gives a person a sort of high. The opening scene (“Just Another Day”) shows the effects of this hypomanic episode. She is staying up all night; having sex with people she doesn’t normally have sex with (Dan), and getting a lack of sleep because of her high energy. She is also losing her sense of reality by seeing and interacting with this vision of Gabe. This symptom of loss of reality connected to hypomanic episodes proves Diana has Bipolar II Disorder, not bipolar disorder with psychotic features.
Once she is placed on the drug regimen, she starts to feel the lows of bipolar disorder. Drugs like Lithium balance out her moods, as Lithium controls the highs of hypomania. However, the kind of treatment Diana receives in Next to Normal is a cocktail of drugs including anti-depressants, anti-psychotics, and mood stabilizers. This is normally not recommended because it causes side effects like dizziness, hence Diana asking why the room is spinning at the end of “Just Another Day.” On all these medications at once, Diana starts to feel numb as she slips into a depression episode of her bipolar cycle. That is why she sings “I Miss the Mountains”, because she misses the feeling of the high. The mix of the drug cocktail and depression drives her to a more serious side effect, suicidal tendencies. This is also influence by her delusions, or in this case Gabe, which is her mental illness fueling the suicidal thoughts.
After Diana becomes resistant to the drugs, as her mental illness is too strong for them, Dr. Madden decides to resort to electroconvulsive therapy (ECT) as a last resort. ECT is normally used in the cases of Treatment-Resistant Depression and Severe Mania.
The days following ECT treatment, Diana comes home and doesn’t recognize her house or Natalie, her own daughter. Though it is common for patients to lose memories weeks, even months before treatment, usually losing years of memory is very rare. However it is interesting that Diana loses memories dating back 19 years, the time that Gabe died, which is the very event that triggered her bipolar disorder. This is only explained when Dr. Madden instructs Dan to uses photos to bring back Diana memory, but to hold off on any memories of Gabe at first. This is probably partly due to the fact that since Gabe is the trigger of her delusional episodes, any mention of him will bring back her illness. This is why Dan hides memories of Gabe during Diana’s recovery. This is witnessed when Diana finds the music box and Gabe’s presence rushing back to her, and her illness along with it.
Though Dan and Dr. Madden want to continue treatment again, Diana decides to move out on her own and find her own road to recovery. Many think she is wrapped up in her own reality of Gabe and her decision making is being influenced by her disorder. While this is partly true, I also believe Diana is discovering this cycle of treatment from drugs to ECT is not working for her, as is her cycle of depression of hypomania. Everyone’s disease is different and the best road to recovery is finding what treatment works for you.
With bipolar disorder, even with drugs and electroconvulsive therapy, all these treatments are meant for the long-term. There is no short-cut in treating mental illness, as there is with the flu or common cold. Bipolar disorder is something Diana would have to deal with her entire life, which is what is hard for the family members, like Natalie and Dan, to understand. Patience and planning is the key in treating bipolar disorder and other mental illnesses, so the disease is fought in the safest, most manageable way without bringing harm to the patient. That is what Next to Normal does so well, not only highlighting the treatment of the illness, but the emotions of the person behind the illness.
Sources
"Schizophrenia." NIMH RSS. National Institutes of Health. Web. 11 Aug. 2014. <http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml>.