Next to Normal (2009) is a rock musical with book and lyrics by American playwright Brian Yorkey. The book follows Diana Goodman, a suburban mother who has bipolar disorder, and her family as they reckon with the impact that Diana’s mental illness has on their lives. When it becomes clear that Diana’s medical treatment has failed to eliminate her hallucinations, the family chooses to explore alternative treatment methods, including electroconvulsive therapy. The musical explores The Illusion of Family Normalcy, The Limits of Emotional Repression, and Breaking the Cycle of Inherited Trauma.

The musical evolved out of a project Yorkey wrote for the BMI Musical Theatre Workshop with his frequent collaborator and the songwriter for the musical, Tom Kitt. Inspired by a Dateline report on electroconvulsive therapy, Yorkey wrote about a woman who has mental illness and how she relates to the men in her life who are trying to help her. The musical premiered Off-Broadway in 2008 and moved to Broadway the following year. It subsequently won three Tony Awards and received the Pulitzer Prize for Drama in 2010. 

This study guide uses the Kindle edition of the book, published by Theatre Communications Group in 2010.

Content Warning: The source material and this guide feature depictions of sexual content, mental illness, ableism, substance use, emotional abuse, suicidal ideation and self-harm, illness, death, child death, and cursing. 

Language Note: The book describes Diana’s mental illness as bipolar depression with delusional episodes, which may be an outdated description according to more recent editions of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Plot Summary

Act I of the musical begins on a day with the Goodman family. Diana waits for her teenage son, Gabe, to return home before his father, Dan, gets up. Natalie, Diana’s teenage daughter, stresses over her schoolwork and her upcoming winter recital. Diana believes she has the “perfect” family, though this is quickly undermined by hints that each member of the family is struggling to maintain stability in their lives. When Diana causes a mess preparing meals for her family, Dan suggests that they should consult Diana’s psychopharmacologist, Doctor Fine. Diana has bipolar disorder with delusional episodes, for which Doctor Fine prescribes her varying medication regimens in the hopes of finding one that will help her to clear her mind.

Natalie practices for her recital, dreaming of becoming a classical musician at Yale. She meets a boy named Henry, whose penchant for jazz and improvisation both charms and irritates her. The two begin dating, though Natalie is anxious about letting Henry meet her family for fear that they will alienate him. As Diana continues to consult Doctor Fine over several weeks, Dan wonders if he has wasted his time hoping for Diana to become functional. In her sessions, Diana wonders why Dan cannot be emotionally available to her, even though he is highly supportive of her treatment.

After seven weeks of medication adjustment, Doctor Fine declares Diana “stable.” Diana learns that Natalie has a new boyfriend, which triggers her memories of falling in love with Dan, having an unplanned pregnancy with him, and getting married. She feels nostalgia for the sense of adventure she felt in her youth. This, along with Gabe’s encouragement, inspires Diana to dispose of her medication.

One day, when Henry walks Natalie home, Dan, who has become optimistic over the past few weeks of stability, invites Henry to join them for dinner. After the meal, Diana brings out a surprise birthday cake, which Natalie explains is for her brother who died before she was born. It is then revealed that teenage Gabe is one of Diana’s hallucinations, and that no one else in the family is aware that she has visions of him. Natalie feels distraught, fearing that Diana values her dead son more than Natalie herself. Dan tries to assure Diana that Gabe isn’t there and expresses empathy over what she is experiencing. This causes an argument between them, in which Diana accuses Dan of having no understanding of the emotional challenges she faces each day. Dan retorts that he has stood by her side all these years, but it is hinted that this is merely a smokescreen for his need for the emotional support Diana’s presence provides.

Dan brings Diana to consult a new therapist whose methods don’t rely on medication, Doctor Madden. Through their consultations, Diana begins to explore her trauma and navigate the challenges of revisiting her past experiences. Meanwhile, Natalie starts taking Diana’s unused medication, treating them like recreational drugs to cope with the changes in her family life. Diana’s focus on her therapy sessions causes both her and Dan to miss Natalie’s spring recital, which Natalie ends up sabotaging in frustration. 

Doctor Madden suggests that Diana should clear away Gabe’s things to help her resolve her grief. She comes across a music box that she used to play to help Gabe sleep. She soon experiences a vision of Gabe encouraging her to join him in a world without pain. Diana attempts suicide and survives. While Diana recovers, Doctor Madden suggests electroconvulsive therapy as a possible treatment option. While Diana is reluctant to undergo the procedure, Dan encourages her to consider it with hope for their family’s future.

Act II begins with Natalie engaging in self-destructive behavior as she uses her mother’s drugs to numb her emotions and spends each night out in different nightclubs, eliciting Henry’s concern. Natalie dismisses his concern, causing them to grow apart. Meanwhile, Diana undergoes electroconvulsive therapy and experiences mental clarity, but at the cost of losing her memories, many of them associated with her family life. Natalie is upset that Diana no longer recognizes her. Doctor Madden encourages Dan to help Diana recover her memories using keepsakes. Dan carefully mediates Diana’s recollections, allowing her to remember everything about her past except Gabe. Though Diana gradually recovers her memories of family life, she also keeps looking for the source of the pain she continues to feel.

One day at therapy, Doctor Madden accidentally mentions Gabe to Diana, triggering her recollection of his death. Meanwhile, Henry reaches out to Natalie, inviting her to the spring formal dance. Natalie is reluctant to resume their relationship, fearing that she will eventually become like her mother and cause them to mirror her parents’ relationship.

As Diana regains her memories of Gabe, Dan tries to convince her to return to Doctor Madden for another round of electroconvulsive therapy. When Diana insists on recalling Gabe, Dan smashes the music box. He tries to appeal to Diana, reminding her that he will love and support her. Diana runs off, ending up at Doctor Madden’s office. Despite Madden’s pleas to resume treatment, Diana resolves to find her own alternative pathway for treating her illness. She urges Natalie to focus on her own happiness, bringing her to the spring formal to reunite with Henry. 

Diana then returns home and prepares to move out of the house, explaining to Dan that she needs to find a solution that works for her on her own terms. Left alone, Dan acknowledges Gabe’s presence for the first time, and later accepts an offer from Doctor Madden to speak to a mental health professional. Diana moves back into her parents’ house, and Natalie and Dan try to rebuild their family life, holding out hope that they can achieve an approximation of “normalcy.”