Interview: Paul Panico, Erik Sternad, Joelle Vessels of NEXT TO NORMAL at Panic! Productions

With two shows dealing with mental illness playing this month, Conejo Player's recently concluded One Flew Over the Cuckoo's Nest and Panic! Productions' Next to Normal, which closes June 17, we thought it would be appropriate to speak with mental health professionals about the conditions portrayed in those two shows. Paul Panico, co-executive director of Panic! Productions, is producing Next to Normal in conjunction with Interface Children & Family Services of Camarillo in helping make aware the fact that there are services out there to assist anyone who feels the need to be referred to professionals for help. We talked about this with Paul, along with Erik Sternad, Interface's Executive Director, and Joelle Vessels, director of Interface's Youth and Mental Health Services.

VCOS: I'd like to ask you about the accuracy of One Flew Over the Cuckoo's Nest and Next to Normal as far as the treatment of the main character, Diana, in Next to Normal and the abuse caused to patients by Nurse Ratched and the staff in Cuckoo's Nest.

ERIK: Well, we don't have facilities like that, so I think we're operating off the same information that the public gets in terms of reports generated about the plight of the mentally ill in prisons. I haven't seen Next to Normal yet but I appreciate Paul Panico opening up this partnership with Interface so we can use the show as a way to highlight the fact that there is treatment available for people who are struggling with mental illness, whether it's bipolar disorder as in the show or depression, anxiety, or troubles dealing with divorce, child abuse, things like that. Mental illness is common. We have it in our families so we created a community that is welcoming for people who are struggling with these things so that it is not stigmatizing. You can call 2-1-1 or the informational referral line that Interface runs that gives anyone access to health or human services, 24 hours a day.

VCOS: Paul, can you talk about the partnership between Panic! and Interface and tell us how that is working?

PAUL: Absolutely. That's a great story. Interface approached us last summer after we did Little Shop of Horrors and asked if we could do a drama to go with their biggest benefit of the year.

ERIK: That was called "Hope and Harvest." This year's benefit is called "Hope and Light."

PAUL: So with that, we went to a meeting and I met Erik and a bunch of counselors who work here and we developed an idea where we would integrate stories from kids in this area who had been abused or had experienced some family trauma. Then I employed Elijah Malcomb, who played Seymour in Little Shop, to write a rap around the story and we had ten young actors - kids we've used like Jessica Wallace, Roxanne Chevalier, Marcello Silva, amazing kids who were coached by Ginny Grady - and we had a picnic table set up and they surrounded the guests and dramatized their stories. Elijah kind of weaved in and out of the story with the rap that he wrote. It was pretty powerful. And these were all true stories. It was so incredibly moving that I could barely watch it.

ERIK: The audience was quite impacted and we actually had a couple who had to walk out and compose themselves because it was so intense. When you have 300 people in a room, you are bound to have 10 or 20 of them who have experienced abuse or traumas in their family. That was part of the point that we wanted to make - this isn't somebody else's story, it's our human story and we all struggle with it and that there is hope for working through these traumas.

VCOS: With regard to Next to Normal, there are two things at work here. First is the recognition and diagnosis of Diana's problem. When does she decide or recognize the cause of her problem and how her family deals with that. The other aspect is the delay in getting proper treatment. These are the two conflicts that are working against each other in this show.

PAUL: Those are very important concepts. But also, there is the dynamic of the daughter, Natalie, because she's the one who is left out. Natalie is an over-achiever, a talented musician about to head off to college, and has received scholarships and all these accolades, yet she's "the invisible girl," as one of the songs goes. Natalie's story is part of the side effect of Diana's illness.

JOELLE: It's a huge piece about how families are affected.

PAUL: So when all of that comes into play, it's her anger, Diana coming to grips with the issue, and the father, Dan, kind of balancing between the two of them that causes all of the conflict. Dan is kind of a sympathetic character because he really doesn't know what to do. He's trying to help but he's not sure whether she is coming or going; the spikes in her behavior is just dramatic, and you see that throughout the show. In this particular show, there is a resolution. It's not a happy ending, but it's ambiguous.

JOELLE: Which is real life. If you have a parent who has a mental health issue, the kids are left behind because all the energy goes into helping get resources for that parent. The children don't know what to do or how to process that and for lots of kids, it's really traumatizing because that parent is not really available to meet their needs. We see children suffering from depression or anxiety, having difficulty concentrating in school because there really isn't anybody there to help them at home. We also see kids who are having trouble just moving through the normal developmental process. They could be having an emerging mental health issue. Oftentimes the school will recognize developments that are not within the normal expected range and they will make a referral to Interface and we'll begin to access and diagnose and provide interventions to help the child cope with some of these transitions.

VCOS: In the case of Next to Normal, there is a single incident that triggers Diana's current condition, but this might be an unusual case. How often are you able to determine the cause of a disorder or illness?

JOELLE: The ideology of bipolar disorder is always biophysical. You don't just have an event instigate it. Diana is somebody who probably has managed symptoms all of her life in one way or another. She may be on a very high functioning scale and suddenly experienced an event, as it did in the pre-story to the play, where the coping skills that worked before just don't work anymore. If, in this scenario, she is truly diagnosed with bipolar disorder, it doesn't just happen because an event occurs.

VCOS: The play doesn't really address that, does it?

PAUL: Interestingly enough, my wife and I had a very good friend who passed away after being diagnosed with bipolar disorder. She would drink too much and manage it with alcohol or drugs, but then she had twins and her parents got divorced. The trauma of the childbirth and the parents' divorce caused her to spiral down. She went off the charts and finally killed herself. So there is probably something missing in the story because it starts with her already out of control.

ERIK: I think that from the family's perspective, sometimes the family experiences it that way. They thought they were doing fine and things were going okay and then this thing happened. Most people might say having twins is a great family event, yet it is still traumatic, so families can get caught off guard and these things break through. It sounds like the play is dealing with that sort of emerging recognition and the resultant coping with it. It's really great that this production brings this out and gets us to say, let's think about this a little. Maybe there's something you ought to be attending to in your own family. It's OK to do that.

VCOS: Another aspect about the play that goes front and center is the relationship between Diana and her initial treatment, which is ineffective, and the apathy that the doctors have toward her condition.

PAUL: This is so interesting because in the beginning of the show there's a song called "My Psychopharmocologist and I" Where she lists all kinds of pills that she's taking. After concocting all kinds of mixtures, they finally come up with one that works and stabilizes her in their mind.

VCOS: But the cocktail she has been taking doesn't really make her stable, it masks her emotional peaks and valleys, and she sings about this in the next song, which is "I Miss the Mountains," which leaves one to wonder which is worse, the symptoms or the cure.

ERIK: Let me modify that a bit. Clearly, we're still learning a lot about treatments. There are medications that are helpful for mental illnesses, more so for some than for others. Everybody's different, some people respond in a truly amazing way and their lives are really changed for the better. Others aren't, and there is still a lot happening in the field. Sometimes it feels like we're just at the beginning of understanding how the brain works.

VCOS: With the play, though, it's the doctor's dispassionate attitude that show that they are just guessing and in the end, they don't really care.

ERIK: Certainly that does happen, and I think that what you're raising is both a scientific and medical moment as well as a human moment. Just because she may be "stable" clinically may not mean that it has answered all of the needs that she has. It's not uncommon for bipolar disorder for folks to miss the incredible features of going through that manic phase, which can be destabilizing and dangerous. Clinicians can forget that they're working with a real human being for whom "stable" may not be great.

JOELLE: The one thing that I remember from friends who went to med school is that mental health is a soft science, so oftentimes what doctors will be exactly what you said - they'll be trying to find the right cocktail that will help alleviate symptoms but still help that person maintain a life they can enjoy. Some doctors have poor bedside manners and it happens in psychiatry as well. Part of medical school is taking scientific minds and working with them on the human side as well.

PAUL: Because we've all been touched by this, I just wanted to mention that Interface deals with matters other than mental health. I was reading statistics about trafficked children in Ventura County and how we lead the state in that category.

ERIK: There is a concentration of human trafficking on the east and west coasts and our proximity to L.A. means that there is a high level of that happening here. The dots to connect on this issue brings us back to a program that Joelle oversees, which is our runaway/homeless youth program. We had someone come in for shelter - a runaway - who came to us because his mom was schizophrenic and was not treated. She was doing very, very disturbing things at home to the point where this young man finally said that he couldn't bring anyone to his house and that it was intolerable for him. Where that links into human trafficking is that this kid is really at risk of being approached for sexual exploitation. Experts tell us that kids are approached within being on the street after just 48 hours. This is where traffickers know where they can find their victims, the vulnerable people on the street. So you can't really separate the mental health story from the homeless story, or from the trafficking risk story. They're all related. That's part of the reason why Interface provides so many different programs.

VCOS: What message do you want to give to people who see the show, Paul?

PAUL: What we're trying to get at is that 2-1-1 is the number to call. It's easy to remember and so that's our focus. If you have a problem, and it doesn't really matter what that problem is, dial that number and they'll connect you with the right person. It's a 24-hour phone and text service. 98211 is the text number.

ERIK: It's anonymous, and a live person answers the phone. These are trained call specialists who will perform a brief screening, find out what the issues are, and then refer people to any service in the community.

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Interface Children & Family Services is located at 4001 Mission Oaks Blvd., Suite I in Camarillo. Their phone number is (805) 485-6114. Next to Normal concludes its run at the Hillcrest Center for the Arts on June 17. For dates and showtimes, see the VC On Stage Calendar.

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