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Study investigates mental-health themed musicals’ ‘significant’ toll on performers

Current blockbuster productions like “Dear Evan Hansen,” “Next to Normal” and “Heathers: The Musical” all focus on mental health themes.

photo of theatrical production showing one actor comforting another who appears distraught
A scene from Ashland Productions’ 2019 performance of "Next to Normal."
Photo by Sam Monk

People often think of musicals as an escape, an opportunity to sit in a darkened theater and get away from the troubles of the world. But the truth is that musicals have never shied away from difficult topics like physical abuse, alcoholism, serious illness and suicide. It’s just that those serious subjects are often camouflaged by costumes, choreography and show tunes.  

In recent decades, more musicals than ever are taking on challenging subjects. Current blockbuster productions like “Dear Evan Hansen,” “Next to Normal” and “Heathers: The Musical” all focus on mental health themes. 

While critics and audiences have praised these shows’ creators for their bravery in tackling important issues, some theater insiders are raising concerns about the toll that intense exposure to these difficult topics can have on the professionals who stage them night after night. 

Michelle Sherman
Michelle Sherman, a clinical psychologist and professor of family medicine and community health at the University of Minnesota, wanted to measure the impact that these plays had on theater professionals. Last winter, with the help of two colleagues, she interviewed 15 actors and directors about how working on musicals with mental health themes impacted their personal and professional lives. The resulting study, titled, “Shining a Spotlight on Issues of Mental Health in Musical Theater and Ways Psychologists Can Help: Perspectives of Theater Professionals,” was published this spring in “Professional Psychology: Research and Practice,” a journal of the American Psychological Association

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Sherman explained that participants, who were interviewed via Zoom, represented a range of theater professionals: “They are all professional actors, directors and choreographers based in the Twin Cities. About half are male, half female. One was non-binary. It was a nice variety of racial backgrounds. About half were members of AEA [Actors Equity Association].”

Qualitative analysis of the interviews revealed the study participants felt significant emotional impact from their participation in productions with mental health themes and that they believed that support from a behavioral health professional during the production of such shows could be helpful for themselves and audience members. 

“Actors work hard to embody and personify their characters,” Sherman said. “If they just pretend to be a character, their performance is not genuine.” When a musical’s character experiences mental illness and other characters react to that illness, she continued, actors “really want to portray the illness accurately. They have to get in touch with that emotional internal experience to portray a character accurately on stage.”

While inhabiting a character is central in a performance, Sherman said her study participants told her it can also present personal challenges. 

“What you take in you become,” Sherman said. “That is why musical theater is so potent. It can do beautiful things, but it can also do damage.” 

Increasing focus on challenging themes

Born into a theatrical family, Sherman grew up dancing and teaching in her mother DeAnne’s home dance studio and performing in musicals put on by their local community theater company.

“I have always had a passion for musical theater,” Sherman explained. “Theater has always been a huge part of my life.” 

Though many classic musicals — like “Oklahoma!”, “Man of La Mancha,” or “Kiss Me, Kate,” include depictions of alcoholism, mental illness and physical abuse, modern musicals go further,  taking on once-taboo subjects like mental illness (“Next to Normal”), and suicide (“Dear Evan Hansen” and “Spring Awakening”).    

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Some of the actors who participated in Sherman’s study had been in productions of “Next to Normal,” “Spring Awakening”  and other musicals with mental health themes.

“They talked about the emotional toll of being in the plays,” she said. “Many talked about going offstage and crying and having real difficulties separating their role and their personal life.” 

But not all participants’ reactions are emotional. Sherman’s study participants reported physical reactions to performing in these productions. “When you are on stage and portraying these kinds of things, your heart rate and your blood pressure increase,” she said. “It takes a toll on the body.” 

In recent years, some theater companies have begun working with behavioral health consultants, mental health professionals who come to rehearsals to educate company members about the mental health issues depicted in the productions and also talk through potential emotional and physical reactions that portraying these characters can trigger. 

Sherman and her colleagues asked study participants if they’d had experience working with behavioral health consultants. “I learned that only a few of them had behavioral health folks involved  in the productions of their plays,” Sherman said. “Universally they were very eager and thought it was a good idea.” 

photo of cullen wiley
Cullen Wiley

Working with difficult themes

In 2019 Cullen Wiley directed a production of “Next to Normal” for Ashland Productions, a youth-focused community theater company based in Maplewood.  

“Next to Normal, ” Wiley explained, “Is about a pretty typical suburban family. It has a mom, a dad, two kids, a picket fence.” But the plot goes deeper than that: “It deals with the mom’s mental health,” Wiley continued. “She is diagnosed with bipolar depressive disorder. The musical is about her going through all the treatment — medications and lots of shock therapy [ECT] — and how it impacts the rest of the family.” 

Willey knew that this musical carried difficult themes, and so he began his work on the production with a careful eye on the well-being of the cast and crew. “There were a few people in our cast who had dealt with mental health stuff in their lives,” he said. “There were only seven or eight people in the cast. They are in the thick of it the whole time. It is very intense, especially for certain characters.”  

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To make sure that the cast and crew were taking care of their mental health, Wiley set a few ground rules. 

“We had a lot of conversations about mental health and our experience with it and how it is important to not just take care of yourself but also take care of others,” he said. “We created a really safe space where we had a safe word. If we were in the middle of a scene and it was too emotional or too tough for the actors, they would say the word and walk away for five minutes, collect themselves and keep going.” 

When the play was in the midst of production, Sherman reached out to Wiley and offered to volunteer as the show’s behavioral health consultant. “I had been hoping to find a mental health specialist who could come in at some point and do a Q&A about mental health with the cast and crew,” he said. “I wanted to make our depictions realistic. I didn’t want it to be a caricature of a person with mental health issues. I’ve seen shows like that and they are brutal to get through.” 

Sherman came to one rehearsal and met with the cast and crew. “She was super helpful,” Wiley said. “She told us the history of ECT and its pros and cons. We talked about grief and how losing a family member can trigger people’s mental health. We also took pieces of paper and wrote down words that described each character and how mental health would affect them.” Sherman  also wrote “trigger warnings” that were displayed in the theater lobby to alert theatergoers that the production featured themes of mental illness, grief and suicide.

Wiley said that he’s heard criticisms from theater old timers who say that in their day they went by the adage “the show must go on,” struggling through performance after performance without special supports like trigger warnings, safe words or behavioral health consultants. 

“I personally don’t like that saying,” Wiley said.” “I think it’s really outdated. We’re entering a phase where we’re putting ourselves first. If someone broke their leg onstage, it would be OK to stop the show, get situated and have someone else go on for them. In the past it was, ‘You’ve just got to suffer through.’ But it’s not safe. We’re a lot more safety conscious these days, which is good.” 

photo od deanne sherman
DeAnne Sherman
DeAnne Sherman recalled that back in her musical theater days, performers were expected to play emotionally difficult roles with no support. She remembers back in 1982, when she was working as a choreographer for a local production of “Kiss Me, Kate.” 

She explained that the play, a musical version of Shakespeare’s “The Taming of the Shrew,” is filled with offensive attitudes: “He ‘tames’ her with abuse and violence and submission. It is all fun and games, and there’s music over the whole thing, but at the end of one scene he throws her over his lap and spanks her.” 

DeAnne Sherman said that no attention was paid to how the performers felt about acting it out onstage.  “I don’t believe there was a great deal of time spent with things like, ‘Is it OK if I touch you here?’ “What if the woman who played Kate had some abuse in her background? That was never addressed. These days, I’m looking back at all the things we could’ve done differently had we been aware.” 

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She added that she takes objection to people who criticize modern theater professionals for wanting more mental health support. 

“The emotional and mental well-being of the cast is paramount and always has to come first,” she said. “If the rehearsal process is indeed comfortable and dynamic and safe and creative, the end product will really turn out to be something amazing.”

Musical ‘catharsis’

Musical theater has the power to reach people deep in their core, Sherman believes. There’s something about telling a story using song and movement that can be particularly powerful and potent, touching people’s hearts — and even changing societal attitudes and beliefs. 

This may be why more and more modern musicals are built around social issues, Sherman said. Her research subjects agreed: “They talked about how music can create a catharsis, how it can inspire hope and sorrow and trauma.” 

Throughout her own decades’-long history in musical theater, DeAnne Sherman said she has witnessed its ability to move performers and audiences, to change minds and start social movements. Musicals like “Elegies for Angels, Punks and Raging Queens,” “Rent” and “Falsettos” helped to change attitudes about people living with HIV/AIDS, she said. The recent focus on mental illness could have a similar impact.

“There is such an opportunity for musical theater to teach and educate.  When you have a straight play you have a marvelous opportunity. But when you add music to that experience it can take the message to a more profound and impacting level.” 

That impact is often deeply felt by the audience, Sherman said.

“Ninety percent of the theater professionals I interviewed — almost all —  talked about how seeing mental health themes on stage can be super-validating. It gives audience members a chance to be seen. Half of them talked about how seeing mental illness on stage can spark discussion and reduce stigma.” 

During Wiley’s production of “Next to Normal,” Sherman said she participated in post-performance talkback sessions with audience members: “I was able to answer some specific questions about bipolar disorder and provide local resources.” 

While art that focuses on tough topics like mental illness presents challenges, Sherman said that musicals are a good way to reveal prejudices and suggest solutions. Bringing troubling issues to light is important if we want to find a solution, she said: Musical theater is a powerful way to do that. 

“Hiding this stuff is not going to be the way to bring light. That’s why my article’s title is ‘Shining a Spotlight on the Issues.’ I think it needs to be done authentically, sensitively and with  proper supports for the audience and the performers. This is a good movement. It should continue.”