• Bipolar disorder affects an estimated 45 million people worldwide and around 7 million in China.
  • The Broadway show 'Next to Normal' is touring China, telling the story of a mother with bipolar disorder and how it affects her life.
  • According to China’s national mental health survey, the annual prevalence of bipolar disorder in the country increased to 0.5% of the population in 2019.

It’s Thursday evening, and there’s a long line snaking around the ticket office at Shanghai Culture Square Theater. People are waiting to collect their tickets to see a Chinese adaptation of the Broadway musical “Next to Normal.” Among them is 25-year-old Liu Mingzhu, who has bipolar disorder, and her best friend, for whom Liu is desperately trying to contain her excitement and not spoil the plot.

“You’ll see a woman who experiences extreme ups and downs with her emotions,” Liu said. “That’s exactly what I’m dealing with.”

Bipolar disorder is a mental illness characterized by alternating episodes of mania and depression that affects an estimated 45 million people worldwide and around 7 million in China.

You’ll see a woman who experiences extreme ups and downs with her emotions. That’s exactly what I’m dealing with.

—Liu Mingzhu, “Next to Normal” fan

“Next to Normal” debuted on Broadway in 2009, winning three Tony Awards and a Pulitzer Prize the following year. The rock musical tells the story of Diana Goodman — a mother who, after the death of her infant son, is struggling with bipolar disorder — and the toll the illness is taking on her life.

The show was introduced to the Chinese market by Seven Ages, one of the country’s leading musical production companies. Established in 2012, Seven Ages had long hoped to bring “Next to Normal” to Chinese musical lovers, but it wasn’t until 2018 that the company first managed to put on a test version of the show at a small venue, to gauge interest from a local audience.

“We feel that, over time, Chinese people have become more accepting of the reality of psychological problems. They’re more willing to discuss them now,” Yang Jiamin, the CEO of Seven Ages, told Sixth Tone. Mental illness has long been a taboo subject in China, and as such many people in the country who suffer from depression, bipolar disorder, schizophrenia, dementia, and related conditions go undiagnosed and untreated.

Liu watched the two-hour test version of the musical when it was put on in Shanghai in 2018, the year after she was diagnosed with bipolar disorder. Initially, she said, doctors had assumed her childhood malaise was just another case of depression.

“In the theater three years ago, I cried the whole time,” Liu told Sixth Tone before Thursday’s show. Now that she’s feeling more stable, she decided to invite her best friend so that she, too, might better understand the challenges faced by people with mental illness.

The 2018 Mandarin version of “Next to Normal” was a fairly modest production, Yang of Seven Ages admitted. But the feedback from the audience and the participating actors was positive enough to convince the company that it might be worth trying to promote the show more widely.

A promotional photo for the 2021 Chinese production of the Broadway musical “Next to Normal.”
The show highlights the struggles of those suffering with bipolar, in a bid to educate the general public.
Image: @音乐剧近乎正常 on Weibo

Fast-forward to the version of “Next to Normal” that premiered Thursday. It’s a steep upgrade from the test show: To make full use of the grand Culture Square Theater, the stage features a 7-meter-high, four-story structure. An elaborate, upside-down staircase suggests the set to be the world as Diana sees it, and hints at her family’s downward trajectory.

After Shanghai, the musical will go on tour in Beijing and Guangzhou. To shed light on bipolar disorder and generate pre-production buzz, an 11-minute documentary, also titled “Next to Normal,” debuted in January on streaming site Tencent Video, where it has been viewed nearly 350,000 times.

According to China’s national mental health survey, the annual prevalence of bipolar disorder in the country increased to 0.5% of the population in 2019.

“The number of people affected has risen nearly tenfold since 1982,” said Luo Yanli, director of the psychology department at Renji Hospital in Shanghai. “In the past, bipolar disorder was often missed, and this was a big reason for the change in data.”

People living with bipolar disorder not only experience severe depression, but can also be easily angered during manic episodes, Luo told Sixth Tone. “Bipolar disorder is understood to be more dangerous than depression, and some data also suggests that the suicide rate among bipolar patients is higher than among people with depression,” she said.

Zhang Yao, a certified psychological consultant in Shanghai, described how people with bipolar disorder experience “uncontrollable mood swings, as if they’re on a rollercoaster.” Over the past few years, he has dealt with clients who can no longer work, or who have had to withdraw from school to be treated for bipolar disorder.

Most of my patients don’t see themselves as normal people. They and their families feel that the illness carries a strong stigma.

—Zhang Yao, psychological consultant

“Most of my patients don’t see themselves as normal people,” Zhang told Sixth Tone. “They and their families feel that the illness carries a strong stigma.”

Amid the coronavirus pandemic and the psychological toll it has taken on the world, “Next to Normal” may be more relatable than ever, according to Yang.

“COVID-19 is a mass-trauma event, and everyone who lives through it has something to heal and face,” she said. “Although most people haven’t experienced trauma to the same degree as the characters in the play, I think everyone, every family, has gone through changes in their life.”

Central to the production’s success is Cheng He, who translated the script from English to Chinese. Cheng has battled depression herself, so she found the story and its protagonist relatable. But certain parts, such as the use of electroshock therapy and strong prescription drugs, made her uncomfortable.

In 2017, Cheng fell ill several times while working on the script and would have to go to the hospital to get medication. During these times, “every word of the show jogged my memory,” she told Sixth Tone. “(I saw) Diana with a particularly enthusiastic smile, or convulsing from an electric shock, or being pushed in a wheelchair in her hospital gown.”

Despite these episodes, the translation went smoothly, Cheng said, taking only five months instead of up to a year, as is typical with such assignments.

After the 2018 production, Cheng made some 200 changes to her translation. “Some lines were adjusted to be more consistent with the way young people talk, and others were given semantic tweaks to better capture the dramatic effect of the original text,” she said.

Cheng hopes the musical will help educate the Chinese public about bipolar disorder and broaden their understanding of the condition. “Currently, Chinese audiences may only have a superficial or biased understanding of mental illness,” she said. “The musical imagines a real psychiatric patient, and her process of self-healing and self-awareness is enlightening to those who have the condition. It also shows the ‘inner world’ of a typical bipolar patient.”

Currently, Chinese audiences may only have a superficial or biased understanding of mental illness.

—Cheng He, translator of “Next to Normal”

Wang Biying, a 27-year-old musical lover, told Sixth Tone that prior to watching “Next to Normal,” she had only heard about depression and mania — she didn’t know there was also a condition involving both opposing states. She has since watched the accompanying documentary on Tencent Video and looked up educational resources online.

“After the show, I understood the amount of effort these people expend to be ‘normal,’” Wang said. “But their struggles also resonate with normal people, so in this way we are the same.”

In preparing for the role of Diana Goodman, actor Zhu Fu spent time with two bipolar patients in Beijing. “I used to think depression was, to some extent, just people being melodramatic,” Zhu confessed. But after meeting with them, her perceptions changed. “When I looked at the world from their perspective, I suddenly realized that my own thinking was very narrow,” she said.

Interacting with the two patients not only helped Zhu better understand her stage role, but also made her realize that depression isn’t just some abstract, far-away concept — it affects people she knows and cares about.

Zhu recalled meeting several fans who waited around to talk to her after the 2018 production. They told her they had been living with bipolar disorder, just like her character, but had been successfully treated to the point that they felt “cured.”

“I was happy then,” Zhu said. “For these people to see the show when they are well, it feels as if they’ve been redeemed.”

What is the World Economic Forum doing about mental health?

One in four people will experience mental illness in their lives, costing the global economy an estimated $6 trillion by 2030.

Mental ill-health is the leading cause of disability and poor life outcomes in young people aged 10–24 years, contributing up to 45% of the overall burden of disease in this age-group. Yet globally, young people have the worst access to youth mental health care within the lifespan and across all the stages of illness (particularly during the early stages).

In response, the Forum has launched a global dialogue series to discuss the ideas, tools and architecture in which public and private stakeholders can build an ecosystem for health promotion and disease management on mental health.

One of the current key priorities is to support global efforts toward mental health outcomes - promoting key recommendations toward achieving the global targets on mental health, such as the WHO Knowledge-Action-Portal and the Countdown Global Mental Health

Read more about the work of our Platform for Shaping the Future of Health and Healthcare, and contact us to get involved.

Although “Next to Normal” deals with weighty subject matter, it also shows audiences hope of finding love and strength, according to Joseph Graves, the director of the Chinese production. “She (Diana) finally realizes that if she ever wants to attain a life with some level of happiness, she has to do it herself,” Graves told Sixth Tone. “She needs a lot of help, but she really has to make the decision alone.”

This sentiment resonates particularly with viewers like Liu. Over the past few years, she has learned to live with her disorder and fight for control of her emotions on her own. “I don’t expect others to empathize with me,” she said. “My only hope is that they can be more tolerant.”

Additional reporting: Zhang Shiyu; editor: David Paulk.