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The Integration of Mental Health into 21st-Century Broadway Musicals Janse van Rensburg, Suzette 2013-12

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  Suzette Janse van Rensburg December 13, 2013 MUSC520A            The Integration of Mental Health into  21st-Century Broadway Musicals !! 2!Broadway musicals have the unique ability to appeal to a wide range of audiences. The sheer number of patrons attending musicals in New York every year is extraordinary. In 2011, approximately 13 million people attended Broadway shows touring across North America.1 But what makes a Broadway musical so popular? Is it the financial success or overall longevity of the concept? Is it the light-hearted nature of a show such as Shrek The Musical or the controversy of Spring Awakening that captivates audiences? In the evaluation of success, the Tony Awards allow for a measure of popularity based on votes from approximately 868 theatre professionals.2 Although a Tony Award does not dictate the longevity of a musical, it is a testament to its excellence in theatre in the year of its nomination. Additionally, in a survey completed by The Broadway League in 2011, 21% of theatergoers were influenced by the Tony Awards to attend a specific show.3 When compared to the 8% of audiences that experienced this same inclination in 2005, it appears that the Tony Awards are garnering increased interest in specific Broadway musicals in recent years.4 As stated previously, although the awards do not dictate the fiscal success or longevity of a musical, the Tony awards offer a mechanism by which to compare the popularity of specific shows. That being said, Broadway musicals span a variety of topics, from light-hearted fun to serious topical !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1!The Broadway League, “The Audience for Touring Broadway: A Demographic Study 2011-2012,”, Accessed December 12, 2013.  2!The Official Website of the American Theatre Wing’s Tony Awards, “Rules & Voting,”, Accessed December 10, 2013. ! 3!The Broadway League, “The Audience for Touring Broadway: A Demographic Study 2011-2012.”  !4!Ibid.!! 3!concerns. Although both of these topics have their merits, it is the controversy-based musicals that generate conversation and are sometimes at risk of offending viewers. Since 2000, the shows nominated for Best Musical at the Tony Awards have dealt with sexuality, drug abuse, death, mental health, identity, and many other serious topics. While most Broadway musicals are intended to entertain rather than educate viewers, a director cannot discount the fact that each show will reach a substantial number of individuals. Taking this opportunity to address serious subject matter allows for a non-confrontational method by which to inform audiences. The shows are not meant to be purely educational but rather a subtle mechanism to invoke change through intellectual theatre. The musicals that deal with complex social issues have the ability to create a discussion and initiate change. One such topic that has increasingly been incorporated into Broadway musicals in the last decade has been mental health.  Although mentioned in several shows prior to the 21st century, the recent integration of this topic has been more direct and integral to the plot of musicals, including The Light in the Piazza and Next to Normal. The incorporation of mental illness into Broadway musicals of the 21st century could be a result of increased mental health awareness and the assurance of possible success owing to the achievement of musicals with controversial subject matter. In order to comprehend the role of mental health in society today and its role in theatrical productions, it is important to consider the history of the field of mental illness. Although mental health and treatments have been studied by individuals like Sigmund Freud since the mid-19th century, it was not until the late 20th century that research teams !! 4!began to focus specifically on non-lethal mental disorders.5 Health care needs throughout the 20th century led scientists to focus on mortality-related conditions in order to prolong life expectancy. Since mental illnesses did not threaten lives,i this field did not receive financial priority. As quality of life improved with the advent of modern medicine and improved personal hygiene, the issue of mental health was addressed more directly at the turn of the twentieth century.  Richard Neugebauer, the Associate Editor of the American Journal of Public Health, writes, “mental health problems contribute substantially to the overall disease burden of developed and developing societies.”6 This statement, published in 1999, emphasizes the importance of mental health research going into the 21st century. The subsequent exploration of the topic has led to alternative treatment options and new diagnostic tools to define mental disability and disease.ii In the study of mental retardation for example, the definition of the term has changed numerous times since the 1920s.7,iii Since mental conditions vary in complexity and severity, it is often a struggle in order to diagnose or treat these patients. Hypothetically, these changes to the diagnostic systems over the past two decades have resulted in varying levels of diagnosis or in some cases lack of diagnosis. As David Felce, the President of the International Association for the Scientific Study of Intellectual Disabilities, writes, “the ‘administrative’ prevalence of mental retardation (or intellectual disabilities) is substantially lower than the assumed !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!5!R.!Neugebauer,!“Mind Matters: The Importance of Mental Disorders in Public Health’s 21st Century Mission,” American Journal of Public Health 89, no. 9 (September 1999): 1309. !6!Ibid.!!7!Harvey N. Switzky and Stephen Greenspan, eds., What is Mental Retardation? : Ideas for an Evolving Disability in the 21st Century (Washington, D.C.: American Association on Mental Retardation, 2006), xi. !! 5!‘true’ prevalence.”8 It is therefore reasonable to assume that a significant portion of the population is affected by mental illness either as a patient or as a loved one. The integration of this topic into musical theatre is relevant therefore since mental illness is both relatable and realistic. Although mental health has been incorporated into Broadway musicals before the 21st century, the last two decades have yielded many Tony nominated Broadway musicals that have dealt directly with mental health issues. Shows such as Next to Normal and The Light in the Piazza appeal to audiences not only as a result of the music and performances but also because of how relatable the characters and the plot are to their everyday lives. Next to Normal, created by Brian Yorkey and Tom Kitt, was inspired by a Dateline news report about electroconvulsive therapy.9 Outlining the story of Diana, a woman with bipolar disorder, the show focuses on her familial relationships and treatment progress. Nominated for a Tony Award in 2009, Next to Normal has received positive feedback from both health care professionals and those suffering from bipolar disorder.10 Kitt comments,  It’s a touchy thing, because it’s an illness that affects our families, our loved ones, our friends. So we never wanted anyone to feel like we were trivializing or glossing over anything.11  !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!8!Switzky and Greenspan, What is Mental Retardation?, xiv.   9!Brian Yorkey, interview by Kimberly Read,, May 17, 2009,, accessed November 15, 2013.    10!Juliet M. Ross, “The Mother, the Son, and the Holy Ghost: An Interview with the Creators of the Pulitzer Prize-Winning Musical Next to Normal,” Psychoanalytic Perspectives 7, no. 2 (2010): 391-392.  11!Ibid.,!382.!!! 6!Although Kitt and Yorkey were dedicated to the accuracy of the subject, Diana’s motivations and actions as a result of her condition are sometimes unclear. Diana’s son for example, appears as a figment of her imagination since he died several years prior. Her affection towards her son appears to be a longing for a younger version of her spouse. This aspect of the plot was perplexing since this it is not a characteristic of the disease but rather a manifestation of Diana’s inner longing for affection. This point aside, the portrayal of bipolar disorder was both scientifically accurate and not excessively exaggerated. Scott Wallin believes that in an effort to de-stigmatize mental illness and relate to individuals with these conditions, Next to Normal actually normalized varying patient reactions and medical stresses. He writes,  Perhaps the creators sought to make it possible to broach a taboo subject by channeling representations of disability into characters who were relatable for the audience. But their adherence to a packaged, sellable representation implicitly encourages the audience to focus on a narrow medical model that doesn't consider the factors that continue to oppress and create distress within those who contend with psychological and emotional difference.12  Although Wallin addresses the problem that each individual experience is unique, it is important to consider that writers must relate to a varied audience with many previous life experiences. Diana is one example of a patient with this condition and her experiences and reactions to treatment are what allow for such a relatable character. In The Light in the Piazza, Clara suffers from emotional and mental retardation. Nominated for a Tony Award for Best Musical in 2005, The Light in the Piazza focuses on Clara’s struggle to understand why people treat her differently and her mother !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!12!Wallin, Scott, “Next to Normal and the Persistence of Pathology in Performances of Psychosocial Disability,” Disability Studies Quarterly 33, no. 1 (2013). !! 7!Margaret’s overprotection of her mentally ill daughter. The character of Margaret is both believable and honest in her attempts to protect Clara from the hardships of adulthood. Written by Elizabeth Spencer in the 1960s, the novella of The Light in the Piazza was developed into a musical by Adam Guettel in 2005. What prompted a musical adaptation in the 21st century rather than in the late sixties? Perhaps Adam Guettel was drawn to this topic with the increased awareness surrounding mental health and retardation towards the end of the 20th century. It is possible that librettists and composers were not interested in creating a musical about mental health in the 1960’s. Whatever Guettel’s inspiration, Spencer’s story was clear in its desire to decrease the stigma surrounding mental retardation. It is for this reason that The Light in the Piazza is relatable to those suffering from these conditions, loved ones affected by mental illness or to those trying to increase awareness. In creating characters that people can relate to, writers are appealing to a larger, more receptive audience, thus increasing the chances of a successful production.  Although over-exaggeration was usually avoided in Next to Normal and The Light in the Piazza in order to achieve a realistic situation, the use of over-exaggeration is often used in theatre in order to exhibit the extremes of a mental condition. In Sweeney Todd for example, Lucy lost her husband, was raped and subsequently attempted suicide. Although not explicitly stated, one can assume that she suffers from Post Traumatic Stress Disorder (PTSD).13 Her behaviour throughout the musical is crude and intense. Although Lucy’s extreme reactions are not common for this condition, her actions and language represent an extreme exaggeration of PTSD symptoms. Since Sweeney Todd !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!13!Lawrence C Rubin, Mental Illness in Popular Media: Essays on the Representation of Disorders (Jefferson, NC: McFarland & Company, 2012), 134-135. !!! 8!was premiered in 1979, it is possible that with the increasing awareness surrounding mental health in the last few decades, musicals have progressed towards more relatable characters in the 21st century. The contrasts between the melodrama of the 1979 Sweeney Todd and the practical Next to Normal exhibit a shift in theatrical mechanisms. It is plausible to assume therefore that a new outlook on complex social issues in theatre has led to more believable characters and plot lines in musicals. The increase in mental health awareness therefore has resulted in believable characters affected by mental illness in Broadway musicals. The increased use of mental illness topics in 21st century musicals is not only a result of increased mental health awareness but also a product of the success of previous controversy-based musicals. Shows that deal with complex social issues have both shocked and impressed audiences with their daring language and controversial subject matter. Although shows such as Avenue Q, The Book of Mormon, and Rent may not appeal to all viewers, these three shows have all dealt with important topics such as religion, sexuality and disease.iv Historically, this incorporation of complex issues into Broadway musicals became more notable by the influx of Jewish immigrants into New York at the turn of the twentieth century.14 The musicals that were produced in the early 1900s exhibited this population’s attempt to find a balance between new experiences and old traditions. This was demonstrated in themes surrounding the conflict between traditional immigrant parents and their children who embraced the new American !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!14!Stuart Hecht, Transposing Broadway: Jews, Assimilation, and the American Musical (New York: Palgrave Macmillan, 2011), 1.  ! 9!culture.15 The musicals of that time period therefore inform audiences of the issues experienced by the authors or general public when the pieces were written. Stuart Hecht paraphrases Shakespeare’s Hamlet to express, “theatre rarely leads the times; instead it tends to reflect the times.”16 The integration of mental health into musicals in the 21st century can therefore be attributed to the current concerns of the American public.  The success of musicals such as Sweeney Todd and Rent demonstrate the power of a controversial topic in the accessibility of a piece.v Although a contentious topic does not dictate success, a well balanced musical combining a thought provoking concept and stirring music has the ability to increase popularity and sometimes contribute to the longevity of a piece. References to sexuality for example were integrated into several musicals throughout the 20th century and homosexual characters and blatant sexual acts for example have been incorporated more frequently over the past two decades. As hypothesized by John Steven Paul, PhD, he suggests that this change is a result of an increasing community of directors and playwrights who are supportive of sexual identity and sexual activity.17 Additionally, he draws attention to the decline in decency standards in modern America.18 In making this statement, Paul is not spurning this decline in decency but is rather emphasizing the increased acceptance and tolerance for sexual subject matter in 21st-century America. The integration of sexuality into a musical such as !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!15!Hecht, Transposing Broadway, 2.!!16!Ibid.,!2.  17!John Steven Paul, “Body of Work: Sexuality in Recent American Drama,” Annual Review of Sex Research 17, no. 1 (November 2012): 200.   18!Ibid.!!!! 10!Spring Awakening for example, demonstrates the importance of relevant subject matter in the success of a Broadway Numerous directors have used Broadway musicals as a platform to discuss complex social issues over the past fifty years. The integration of contentious subject matter into shows is a mechanism to both entertain and educate an audience. John Steven Paul writes, “Besides providing entertainment, the theatre has always been a social laboratory where dramatic experiments are performed for the benefit of investigators. These researchers are called ‘audiences’.”19 The stage is therefore an ideal medium in which to introduce complex social issues to a receptive audience. The challenge, however, is to integrate conflict to a degree that is minimally offensive for the Broadway stage. Theatre that utilizes overly sexual, explicit, or radical topics may sometimes be perceived as inappropriate and no longer enjoyable. The incorporation of these complex topics is an indicator of the thoughts and issues of society at the time of the work’s conception. Stuart Hecht however disagrees with this statement, claiming, “[theatre] often addresses larger, more universal issues rather than the problems of a particular time and place.”20 He argues that topical concerns should avoided in musicals since these subjects will be considered passé once the show actually reaches the Broadway stage.21 Although the problems addressed in some musicals often represent overarching issues that must be addressed, they also reflect the history and emotions of the time. Paul !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!19!Paul, “Body of Work,” 214.  !20!Hecht, Transposing Broadway, 5.  21!Ibid.!! 11!Ricoeur writes, “we tell stories because in the end our human lives need to be told.”22,vii The integration of mental health into musicals is therefore the result of increasing mental health awareness over the past two decades and the assurance that specific controversy-based musicals such as Sweeney Todd and Spring Awakening have historically been both well received and successful. Mental health musicals increase awareness about illness, treatment and stigma. Continued integration of this subject into theatre will hopefully educate both patients and their loved ones, as well as other interested parties. At the University of British Columbia, the Collaborative RESearch Team gathers information about bipolar disorder from health care professionals, community members and researchers in order to advance their understanding of the subject. “That’s Just Crazy Talk”, a play created by this organization, outlines a woman’s experiences with mental illness.23 The goal of the project is to create a dialogue between patients and health care providers in order to refine diagnosis and treatment options. The continuation of these efforts will impact the future of mental health care. Looking forward, young directors may look at this integration of mental health as a piece in the theatre history puzzle. If this topic is so successful, what complex social issue is next in line to create a Tony award winning musical? !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!22!Gérald Préher, “A Southern Belle in an Italian Setting: Elizabeth Spencer’s ‘The Light in the Piazza’ and its Musical Adaptation,” South Atlantic Review 74, no. 2 (Spring 2009): 34. !23!Dr. Erin Michalak et al., “’That’s Just Crazy Talk’: Using Theatre to Address Mental Illness Stigma,” Slideshare, April 18, 2012, crestbd/using-theatre-to, Accessed October 22, 2013.   !!! 12!Notes!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! i Although mental illnesses may sometimes result in personal harm or death, these were not considered urgent medical concerns since the injuries was often self-inflicted.  ii Released in 2006, The World Health Organization released an updated Composite International Diagnostic Interview (CIDI) to be carried out as face-to-face interviews with civilians in 28 countries around the world. Questions include information about mental disorders, unsatisfied treatment needs and the burden of mental health in their society.  iii This refers to the definition by The American Association on Mental Retardation (AAMR) published in 1921. Their tenth revision of the definition was published in 2002. It is important to note however that the referenced supporting document was published in 2006.  Since this time, the AAMR has changed its name to the American Association on Intellectual and Developmental Disabilities (AAIDD).  iv Avenue Q, The Book of Mormon, and Rent were awarded Best Musical at the Tony Awards in 2004, 2011 and 1996 respectively.  v Sweeney Todd was awarded a Tony Award for Best Musical in 1979.  vi Spring Awakening was awarded a Tony Award for Best Musical in 2007.  vii Gérald Préher translated this quotation from Ricoeur’s native French.    Bibliography Diverty, Brent, and Marie P. Beaudet. “Depression: An Undertreated Disorder?” Statistics Canada Health Reports 8, no. 4 (Spring 1997): 1-18.  Everett, William, and Paul Laird. The A to Z of the Broadway Musical. Lanham, MD: Scarecrow Press, Inc., 2008.  Greenspan, Charlotte. “Death Comes to the Broadway Musical.” The American Academy of Arts & Sciences 141, no. 1 (January 2012): 154-59.  Hecht, Stuart. Transposing Broadway: Jews, Assimilation, and the American Musical. New York: Palgrave Macmillan, 2011.   Jensen-Moulton, Stephanie. “A Long View of Adult Musicals through 1970’s Culture.” American Music Review 42, no. 2 (Spring 2013): 1-3.  Jones, John Bush. Our Musicals, Ourselves: A Social History of the American Musical Theatre. Lebanon, NH: University Press of New England, 2003.  Kessler, Ronald C., and T. Bedirhan Üstün. “The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).” International Journal of Methods in Psychiatric Research 13, no. 2 (March 2006): 1-29.  Kitt, Tom, and Brian Yorkey. Next to Normal. New York: Theatre Communications Group, Inc., 2010.  Mays, Vickie M., and Susan D. Cochran. “Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States.” American Journal of Public Health 91, no. 11 (November 2011): 1869-1876.  Michalak, Dr. Erin et al. “’That’s Just Crazy Talk’: Using Theatre to Address Mental Illness Stigma.” Slideshare. April 22, 2011. crestbd/using-theatre-to. Accessed October 22, 2013.    Most, Andrea. Making Americans: Jews and the Broadway Musical. Cambridge, MA: Harvard University Press, 2004.  Neugebauer, R. “Mind Matters: The Importance of Mental Disorders in Public Health’s 21st Century Mission.” American Journal of Public Health 89, no. 9 (September 1999): 1309-1311.  Paul, John Steven. “Body of Work: Sexuality in Recent American Drama.” Annual Review of Sex Research 17, no. 1 (November 2012): 200-214.   !! 14!Préher, Gérald. “A Southern Belle in an Italian Setting: Elizabeth Spencer’s ‘The Light in the Piazza’ and its Musical Adaptation.” South Atlantic Review 74, no. 2 (Spring 2009): 20-36.  Read, Kimberly. “Interview with Brian Yorkey – Writer and Lyricist of Next to Normal.” May 17, 2009. od/mediaportrayals/a/brian_yorkey.htm. Accessed November 15, 2013.  Ross, Juliet M. “The Mother, the Son, and the Holy Ghost: An Interview with the Creators of the Pulitzer Prize-Winning Musical Next to Normal.” Psychoanalytic Perspectives 7, no. 2 (2010): 380-396.  Roy, William, and Timothy Dowd. “What is Sociological about Music?” Annual Review of Sociology 36 (April 2010): 183-203.   Rubin, Lawrence C. Mental Illness in Popular Media: Essays on the Representation of Disorders. Jefferson, NC: McFarland & Company, 2012.  Spencer, Elizabeth, and Robert Phillips. The Light in the Piazza and Other Italian Tales. Jackson, MS: University Press of Mississippi, 1996.   Sunderland, Adam, and Leanne C. Findlay. “Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey – Mental Health.” Statistics Canada Health Reports 24, no. 9 (September 2013) 3-9.   Switzky, N. Harvey, and Stephen Greenspan, ed. What is Mental Retardation? : Ideas for an Evolving Disability in the 21st Century. Washington, D.C.: American Association on Mental Retardation, 2006.  The Broadway League. “The Audience for Touring Broadway: A Demographic Study 2011-2012.” Accessed December 12, 2013.  The Official Website of the American Theatre Wing’s Tony Awards. “Rules & Voting.” Accessed December 10, 2013.  The Official Website of the American Theatre Wing’s Tony Awards. “Search Past Winners.” Accessed November 25, 2013.  Wallin, Scott. “Next to Normal and the Persistence of Pathology in Performances of Psychosocial Disability.” Disability Studies Quarterly 33, no. 1 (2013).  


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