Watching a Stage Play Can Reduce Stigma of Bipolar Disorder

Source: Victoria Maxwell

“Stigma determines not only how people feel, but how they behave, whether they take treatment and so on,” said Sagar Parikh, part of the CREST.BD (Collaborative Research Team to study psychosocial issues in Bipolar Disorder) network in an interview at the American Psychiatric Association Annual Meeting. “It's a concern in people who you might not think would have stigma—that's mental health providers.”

I have bipolar disorder 1, anxiety, and psychosis. I’ve ‏written five one-person shows about my own experience. I’ve worked as a keynote speaker performing these shows, or theatrical keynotes as I like to call them, for more than 23 years. They open up dialogue and give insight to health professionals and help people with mental illness and their families have hope, feel less alone, and talk about their own experiences.

I perform to do my part in dismantling stigma, to show one face of recovery. My audiences range from organizations to associations, from conferences to corporations in a wide variety of sectors and industries. My aim is to destigmatize mental illness, increase understanding of workplace mental illness and the challenge of returning to work, and explain which management strategies helped and which didn’t.

I’m also a member of the CREST.BD team. Erin Michalak, the head of CREST.BD, initiated a research study to look at the effectiveness of theatre as, what I learned, was called an anti-stigma intervention. No, not that kind of reality TV show intervention with lots of tears, denial, cringy moments of voyeuristically witnessing people’s downward spiral to rock bottom, and then, if lucky, slow rise to the start of recovery. Well, wait; it is sort of like that. My theatre shows.

We were interested in finding out if this intervention, a theatre piece, could shift people’s beliefs and reduce stigma about mental illness. Can a first-person, lived-experience, one-person show influence viewers' attitudes?

Now, I make my living as a keynote speaker performing my theatrical keynotes. It’s my livelihood. In hindsight, this study might not have been an optimal initiative to be part of. If we found that my shows didn’t reduce stigma or, worse yet, actually increased stigma, that definitely would affect business. I’d need to find a way to spin that, reposition my product, and pivot, so to speak.

But maybe, if stigma didn’t shift (or even if it did), other elements might be positively impacted, like compassion, insight, meaning, or acceptance.

CREST.BD recruited people to be part of the study. On the evening of the performance, audience members completed pre- and post-show questionnaires and then were interviewed three weeks and three months after attending the show. With each interview, they also filled out an assessment. It was both a qualitative and quantitative research project.

I was given free rein to write about any of my lived experiences. The only guideline was that the focus was to be on stigma. But I knew you can't just write about a theme. It becomes really boring and really didactic, really quickly. You need a narrative arc with conflict, whether that’s internal or external conflict. To help me in the process, I worked with a dramaturge (the equivalent to an editor but for playwrights), Rachel Peake. The result was my solo show entitled "That's Just Crazy Talk."

We held two shows, and did all the assessments, questionnaires, and interviews. The findings were impressive. Phew! The impact on stigmatizing attitudes was statistically significant and clinically meaningful. I didn’t know then, but significant and meaningful are a pretty big deal in the research world. Statistically significant means results are a true effect, not due to chance. Clinically meaningful indicates the intervention has positive practical and real-world importance on quality of life and patient care.

Parikh described the results like this: "If we were to talk about it in numerical terms, it would be similar to the kinds of effects that you see after 8 weeks of medication for depression or 8 weeks of psychotherapy for depression.”

Individuals who saw the play shared that it made them reflect about decisions in terms of taking or not taking treatment. Some research participants shared they could identify much more clearly a very stigmatizing comment, and the play helped them think about how they might handle situations at work or in their relationships when somebody said something stigmatizing. Parikh said, “It’s kind of like teaching somebody what is racism. They then recognize it and say, 'You know, I'm not going to the back of the bus anymore.'” Yeah, now I’d say those results are pretty significant and meaningful.

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Note: The research paper is an open-access article. Search for "Using theatre to address mental illness stigma: a knowledge translation study in bipolar disorder."

© Victoria Maxwell