'Next to Normal,' coming to 5th Avenue, tries to paint authentic picture of mental illness

Psycho killers. Homicidal maniacs. Raving lunatics. Artists touched by madness and genius. Such images have fueled many a compelling drama — and much shlock-pulp entertainment.

But while such embodiments of destructive and creative derangement are plentiful, more varied and authentic visions of mental illness are starting to emerge — in compelling TV shows like HBO's "In Treatment," about psychotherapy, and such movies as "The Soloist," which starred Jamie Foxx as a mentally ill homeless man.

For the millions of Americans who experience a serious degree of mental illness (about 1 in 17 adults, says the National Institute for Mental Health), and their loved ones and advocates, it's about time.

A recent musical hailed for its accuracy and empathy is an unlikely Broadway hit and 2010 Pulitzer Prize winner: "Next to Normal." The national touring production of the three-time Tony-Award honoree comes to the 5th Avenue Theatre this week.

Written by Seattle-area native Brian Yorkey, "Next to Normal" centers on an articulate, intelligent suburban woman who is neither flamboyant nor violent. At the mall, on the street, she'd easily pass for someone our society considers "normal."

But Diana (played by Alice Ripley, who'll reprise her Tony Award-winning performance in Seattle) is afflicted with "bipolar disorder with delusional episodes and depression," explains author Yorkey. Translation? "At the extreme ends of her mood swings, Diana has delusional episodes where her grip on reality is not entirely firm."

Diana's struggle to maintain an even keel, and a fulfilling family life, are unflinchingly explored in song and story in "Next to Normal," which has a Tony-honored score composed by Tom Kitt with lyrics by Yorkey.

The latter underscores that he didn't make Diana up out of thin air, nor base her on a friend or loved one. She is the product of intensive research, and many drafts — including one workshopped in 2005 at Issaquah's Village Theatre, where Yorkey was associate artistic director.

"Tom and I had an initial idea for our story, but we learned a lot as we went along. The more we worked on it, the more we talked with doctors and patients, the more we wanted to get it right. We felt we had a responsibility to a lot of people who are dealing with this disease."

Getting it right meant avoiding two common tendencies of stage and screen dramas in this vein: either criminalizing and stigmatizing the mentally disturbed, or romanticizing them.

Examples of the former are especially plentiful. Not only are we bombarded with news coverage of horrific crimes, like last month's lethal shooting spree in Tucson by a deranged gunman that left Arizona congresswoman Gabrielle Giffords among the wounded, but our pop culture is awash in crime dramas, slasher flicks and other grisly tales.

An academic study by Donald Diefenbach and Mark D. West, published in 2007, found mentally ill characters portrayed on several major TV networks were 10 times more likely to be violent criminals than those who weren't ill.

Other studies suggest that the Americans who watch the most television are more likely to stigmatize the mentally ill and believe they're a danger to society, and that could have an effect on housing, employment and judicial policies in relation to those with such conditions.

Attitudes are shifting — somewhat. "Because many more people know about the prevalence of mental illness in their families, neighbors, co-workers, and know that these are diseases of the brain, there's more awareness and sensitivity now in the media," suggests Barbara Bate, past present of the Washington chapter of the advocacy group National Alliance on Mental Illness.

"On the other hand ... many shows sensationalize a single experience, grab onto a label like 'bipolar' or 'schizophrenic' to create stereotypes that make it worse for people. Statistically, those with mental illness are much more likely to be victims of violence, than perpetrators of it."

Conversely, more nuanced, "uplifting" movies and plays (i.e.,"A Beautiful Mind," "Equus"), can falsely imply that mental illness is linked to great wisdom, or artistic/mathematical brilliance.

"Romanticizing the mentally ill as truth tellers and artists everyone is just trying to oppress — we weren't interested in that," says Yorkey. "We wanted to write about a woman, a suburban mom, with a regular life. Because that's the story that doesn't often get told."

Ripley says her own eyes were opened by the show. "I've learned a lot about the stigmas attached, the labels placed on people like Diana, and my personal view of mental illness has changed. Before we went into rehearsal, I had no knowledge of that world."

Yorkey's research, and input from mental-health consultants (New York psychiatrist Dr. Anthony Pietropinto, and Pennsylvania psychologist Nancy Elman), inspired him to include some common but rarely dramatized experiences in the show.

For instance, a recurring motif has a frustrated Diana visiting numerous specialists, in search of a definitive diagnosis and cure for her condition. "I learned the process of getting a workable diagnosis can take years," says Yorkey. "For many diseases they just culture your blood, send off tests to the lab and find out what you have.

"But as one character in our show says, sometimes the best doctors can do for a mental illness is put names on collections of your symptoms and go from there."

"Next to Normal" also doesn't deliver pat reasons for Diana's illness — in keeping with the current medical belief that a complex nexus of factors (genetic, neurological, social) can contribute to such conditions as bipolar disease and schizophrenia.

A traumatic trigger for some of Diana's symptoms is suggested, but Yorkey says that's only part of her story. "My idea of Diana's history is that her mother was also mentally ill, so there was a genetic predisposition that didn't become a full-blown illness until Diana went through a major tragedy. Some recent research shows that traumatic incidents can actually alter how your brain looks on a brain scan."

"Next to Normal" departs from familiar dramatic/musical formulae in other ways, too. It is light on searching ballads — and includes ironic rock tunes. (A lyric from one goes: "I'm no sociopath/I'm no Syliva Plath/ I ain't no Frances Farmer ... ")

The heavy subject matter is liberally peppered with sardonic humor. (Quips Ripley, "it's about a family trying to put the fun back in functional.")

Michael Greif (also the original director of "Rent") has staged the musical on a single, abstract set. And, unlike more pat disease dramas, the finale is ambivalent and open-ended.

A hit Off Broadway, "Next to Normal" cleared an unlikely path to a two-year stand on Broadway. The touring version will next visit the East Coast, Midwest and Canada.

Responses from viewers directly affected by mental illness have been especially gratifying for the company. Ripley says she's often thanked profusely by fans dealing with similar issues, and she's instituted three Facebook pages so they can share thoughts and resources with each other.

Says Yorkey, "We hear from a lot of people that their experience is represented onstage, in a way it never has been before.

"We're saying these conditions are hard to resolve but the hope is to open the subject to the light, to find out more, because the outlook and research are changing all the time."

Bate will get her first glimpse of "Next to Normal" at a March 1 performance benefiting NAMI Greater Seattle. As someone with personal experience of bipolar illness, she will be asking several questions as she watches: "Is it a story that rings true, and allows you to see someone's experience from the inside, not just the stereotype?

"To see what it feels like to get better, and to be discouraged and despairing? Is the take-away message, 'these people are scary'? Or is it, 'let's understand each other?' "

Yorkey sums up his own intentions with a thought from the late novelist David Foster Wallace, whose clinical depression led to his suicide. "He said something like, the point of fiction is to make us feel less alone," says Yorkey. "That hit home. And that's what this show is about."

Misha Berson: mberson@seattletimes.com