Mental health on the cusp

Myself and a colleague had no real idea of what to expect from this performance. I am so glad that we went.

The play tells the story of Anna, who has recently turned 18-years-old and is seeking help from a psychiatrist. As the play begins, we are in Anna’s kitchen and she is sharing food with a friend, and Anna is reading descriptive stories she has written aloud. As the play progresses the reader is led to believe that Anna has a diagnosis of bipolar disorder. Anna is going through a period of changes in her life from a child to an adult – with this comes the transition from child and adolescent mental health services (CAMHS) to adult mental health services. Anna has to move on from the psychiatrist, Vivian, she has seen since the age of 11. The impact of losing Vivian is unsettling for Anna.

As Anna approaches adulthood she is questioning the purpose of her medication and what each pill is for. So often we take the medication we are prescribed without knowing what it's for, or the negative side effects it can have. Throughout the play Anna questions the medication, saying “I’ve got a gym membership now. I’m reading the backs of cereal boxes. And then I started thinking how strange it was to know the calorie intake of a bowl of cereal but not the contents of my own medication'. At one point she admits she's not taken the pills for a few days, and Vivian reminds her that she cannot stop taking her medication as ‘your body has got used to it.’

Another key dimension is the relationship Anna has with Oliver, who she's known since primary school. An intimate relationship develops during the course of the play. Ups and downs in that friendship illustrate the devastating impact that mental health illnesses can have not only on the individual but also their wider family and friends. 

Renee in the middle of the play has the realisation that all those questionnaires she completed years ago before Anna’s initial assessment. Renee questions whether she should have responded ‘sometimes’ and asks herself whether this has led to Anna experiencing mental health difficulties now.

The roots of Anna's mental health difficulties are alluded to. Anna lost her father at a young age, which chimes with current research suggesting that  individuals who have experienced childhood adversities are more likely to experience severe mental health problems later in life (e.g. Varese et al., 2012). 

Anna's relationship with her mother, Renee, is also interesting. Both are strong-willed characters, determined women. In the final scene Anna is in hospital with Renee visiting her, and Renee explains she is now seeing a doctor for her own mental health difficulties. Anna asks Renee if she can shave her legs for her: even though Anna is entering adulthood, she is still a young girl at heart and needs caring.

The play was difficult to watch at times, inevitably hard-hitting given the reality of the issues raised. Children’s mental health is one of the biggest and most pressing issues in society today. It is estimated that 75 per cent of mental illnesses start before a child reaches their 18th birthday. This play is a timely exploration of the difficulties faced by families coping with mental illness. If it gets people talking about mental health, it can be only be a positive thing!

- Isabelle Butcher, Division of Psychology and Mental Health, University of Manchester.

The play is on at the Royal Exchange until 24 February.

Reference

Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J. and Bentall, R.P. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), pp.661-67.