For Life: Opera on Psychiatry and Its Drugs

Editor’s Note: When this interview was first published, the premiere of the opera was scheduled for January 15. The premiere has been pushed back to Feb. 19.

Dawn Sonntag and Kermit Cole have collaborated on creating a 30-minute opera, For Life, that explores the possible harms that can come from psychiatric drugs. It’s a novel subject for an opera, which premieres online on February 19 at 9 p.m. EST. The opera will be performed by students at the Baldwin Wallace Conservatory of Music.

Dawn is an award-winning composer whose works have been commissioned by the Cleveland Opera Theater and the Hartford Opera Theater and performed at numerous music festivals in the United States and Canada. Her first opera, for which she also wrote the libretto, titled Verlorene Heimat, was a finalist in the 2021 American prize for opera. She wrote the composition for For Life.

Kermit Cole is well known to Mad In America readers. He cofounded madinamerica.com, and served as our editor for the first four years. He has a background in street theatre, having toured Europe as part of a mime troupe, and in the 1990s, produced a documentary about living with HIV. He has worked in various residential settings for people struggling with psychiatric difficulties and is trained in Open Dialogue therapy. He wrote the libretto for the opera.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

 

Robert Whitaker: Dawn, before we dive into the story behind the opera, can you tell about your path to becoming a composer and themes you have explored in your previous works?

Dawn Sonntag: I always had a strong inclination to compose, but my path first began as a performer. I was trained as a vocalist and as a pianist and I also studied conducting.  It was not a straight and narrow path towards composing, but I always knew that I would land there at some point. I studied voice performance and composition during my doctoral studies at the University of Minnesota, and because I have sung opera myself and worked extensively as a vocal coach, and as a pianist who works with singers, suddenly composing opera became an obvious choice.

Dawn Sonntag
Dawn Sonntag

I started looking for librettos and I couldn’t find anything that really spoke to me. I decided I needed to write my own libretto. I needed to find a story. My first opera, Verlorene Heimat, which is German for “Lost Homeland,” is a true story of my family’s experience. They were ethnic Germans living in Eastern Europe, and during World War II, they were refugees and Nazi resisters. They sheltered a Jewish girl and hid her, or her identity, from the Nazis, and they were penalized for the resistance.

It was my mother-in-law who shared this story with me. I made that into an opera, and it won honorable mention in the American prize for opera this year.

Whitaker: That’s an extraordinary story. Did you live in Germany for a time?

Sonntag: I lived in Germany for nine years. I studied there and worked there and I met my husband there. His parents lived in Germany, and so I was living there when I first heard the story.

Whitaker: Where has Verlorene Heimat been performed?

Sonntag: I directed it at Hiram college with my students when I was teaching there. The first performance was in 2015, and from that recording, I sent excerpts to the Hartford Opera and to the Cleveland Opera Theater and both of them first performed scenes from the opera. Then the Cleveland Opera’s artistic director, Scott Skiba, produced the entire opera. The professional premiere was on world Holocaust Memorial day in 2018.

Whitaker: You can see that this opera came from a personal story close to you. How did you become interested in this world of psychiatric drugs and the possible harm that can come from them?

Sonntag: After the Cleveland Opera performance, Scott Skiba said that he was interested in creating an opera about the opioid epidemic, which in Northeastern Ohio was a huge problem. I said I’d be interested in working on that. But then I forgot about it, because it was not at all a part of my life, or at least I didn’t realize it was. Then I learned about benzodiazepines through the experience of a family member who was very adversely affected. I started reading and searching for answers, and searched through PubMed articles.

I have to take a short step back. A few years earlier, I had taught a course on music and the brain with a colleague who is a neuroscience professor at Hiram college. He told me how dangerous psychiatric medications were, and this was back in 2013. He talked about Finland and how they had stopped using these medications and were using other methods to help take people out of their stressful environments,  and how they had had much success with this approach. So when I started seeing what was happening with the benzodiazepines, I started reading and I learned that it wasn’t just the benzodiazepines, but also antidepressants and antipsychotics. It was like opening the veil of hell.

So, so many questions suddenly were clearly answered, things that I had observed in more than one family member who were severely adversely affected by these medications. I wondered if there was anything on social media about this, and I found there were many groups for individuals who had been harmed by these medications and who were trying to withdraw from them. They were experiencing the same things that I was seeing in my own family members, and there were thousands of people in these groups.

I was encouraged that there were others that recognized the problem, but I was also  horrified about how widespread the problem is. Most of all, I was appalled about how the members of the support groups would repeat, over and over again, that they would go to their physicians and say, “I’m having these effects,” and the physicians would say, “it can’t be the drugs,” and that they didn’t know what these drugs really do to the brain. Many of the administrators of these support groups are very well organized. They have resources available for the members, and this is where the members are going to get help. In many cases, they’re not getting any help from their physicians.

Whitaker: You discover this subject, you think it’s important, and you have this personal connection to it because of family members. But why did you think this would be a good subject for an opera? There are many people that write about the harm that psychiatry can cause, but in what ways can an opera explore these themes and explore the suffering?

Sonntag: An opera can make it personal rather than some abstract problem that’s happening to other people. The combination of the text and the music is the subtext for the things that the words fail to capture. So if you’re a lay person, and when I say lay person I mean someone who has no idea about the harm that these medications do, and you say the word akathisia, and they’ll say, what’s that? And then you’ll say, it’s a movement disorder. And then they’ll say, you know, that must be better than anxiety or psychosis. So what’s the big deal? In opera, the viewer is drawn into the story so that they’re feeling and experiencing this themselves. And I think that’s why people who do love opera that’s, that’s why they go.

Liam and his mother, Leyna, relate about akathisia…
Whitaker: There’s an intimacy with opera that that brings the audience in close contact with the emotional tenor of that subject.

Sonntag: That’s really it. And many people, if they are not very familiar with opera, think of the big opera houses that repeat the old 19th century operas by Puccini, Mozart, and so forth, but opera today, especially American opera, presents all kinds of subject matter, and there are stories told through opera of all sorts of issues. And operas are not always two hours long. Our opera is 30 minutes.

Whitaker: We do have this stereotyped image of what opera does. So how did you come to meet Kermit and get him to join you in this effort? Also, you had written librettos before. So why did you recruit Kermit into this collaboration?

Sonntag: I’ve had a half full-scale opera done called Coal Creek. It’s about Alaska. I did research for that and wrote my own libretto. And then I wrote another mini opera on the story of Longfellow’s poem, Evangeline. I was very fearful of writing librettos before I started doing it. Then I figured out my own system and my own way of doing it. But for this opera, I didn’t want to be alone in the responsibility for talking about this issue. I feared that without the collaboration of someone, a professional in the mental health field, that I would be viewed as completely off the wall, a conspiracy theorist, not knowing what I was talking about.

So I wanted to ask for advice on this libretto and I had seen on the Mad In America site that Kermit had a background in theater and film. I contacted him and I was thrilled that he said, well, I’d like to write it. And I thought this is really good because it does take a lot of the burden off of me.

Whitaker: Kermit, I’ve known you for a long time. You bring a variety of talents to this work. You have a background in film, having made a documentary about living with HIV, and you toured Europe a long time ago as a member of a mime troupe. You’ve spent 20-plus years very much engaged with the psychiatric world, as an editor for Mad In America and as a therapist who has studied Open Dialogue therapy. I know you love words. Still, what made you think you could write a libretto, and especially in collaboration with such an accomplished composer?

Kermit Cole: Well, I didn’t think I could write a libretto, but I would say it dawned on me that, as we talked about it, a number of things crossed my mind. The first was that if we could create something that had half the depth of the conversations that Dawn and I were having, and if it was a fraction as entertaining as it was for Dawn and I to speak with each other, then we’d probably make something pretty good. And the story she wanted to tell was just the kind of thing I have been looking for all along.

Kermit Cole
Kermit Cole

I  mean, whether it was theater or film, it’s all been about trying to understand the world, trying to make sense out of things I’ve seen and experienced, and to come up with some way to talk about them. And so that led me to make that documentary. There were things happening in the world, the world of people with HIV at the time, which was a world I didn’t understand at all. When I went to make that film, I had the opportunity to go into that world and learn about it and experience it. And that gave me a taste for working with people who were confronting real life challenges.

Ultimately that led me to going back to school because I wanted to go deeper. I didn’t want to be encumbered by a camera or an obligation to tell a story to people who may or may not understand it. Ultimately, I spent the past 20 years focusing on being with people in crisis without trying to disentangle myself from any political or other intentions other than being with that person. But one of the big pivotal moments for me was going back to school after making that AIDS film and realizing I needed to understand more than I did before.

Now that I know what I believe about psychiatry and feel comfortable in believing it, I feel comfortable trying to create something to go out into the world that will touch people on a level beyond words, beyond research, beyond arguments, and where people will be caught up in the poetry and the beauty of what’s being said.

Whitaker: That explains why you think this would be a good subject for an opera. Now when you look at this subject of harm from psychiatric drugs, you see a lot of suffering, you see a lot of lost lives. Yet, the title of your opera is “For Life.” How did you come up with this title and, and why?

Sonntag: I had come to realize that the term “for life” [in psychiatry] was like a prison sentence. For example, the belief that antidepressants unmask a serious mental illness, when it really seems like they’re causing it. This is a great sales marketing plan for the drug companies, because now they can sell these drugs for life. At the same time, while are many different ways of improving your mental health—it all depends on the individual, what they’re going through and what the causes are—the one thing that everyone needs for life is a caring community that they can go to. And that will never change. And I didn’t want the opera to end in despair. I wanted there to be hope because I knew people that had gotten through and off of these drugs and that while they had experienced a lot of loss, they now were recapturing their lives. The words “for life” have two meanings in this opera.

Liam, plagued by nightmares and insomnia, wakes from a troubling dream in which he is wandering, lost in the woods as the trees watch him…
Whitaker: That’s really interesting. I can see the two meanings provide a narrative arc for the opera. Kermit,  you wrote the libretto and on very first uninformed glance, it seems like a subject that might be good for a Gilbert and Sullivan treatment—to play with words and double meanings of words.  What was your approach to the language you used in the libretto?

Cole: First, I really considered my role to help Dawn and one of the greatest things that’s come out of this is our working relationship. One thing I know now, better than I did, is that you don’t just write a libretto. You talk about the ideas, you put down some ideas about what the words might be, what the important words you’re aiming for, but the process ideally is done together. Just because I write words, or somebody writes words, doesn’t mean that a composer should, or even could, just set those to music. It’s an interactive process of really understanding what is the deep meaning and what are the fewest number of words that can convey it.

But to go back to your original question, there’s this legal term called “the learned intermediary” that’s been an instrument that pharmaceutical companies have hid behind in lawsuits and escaped lots of judgments by basically passing the responsibility off to the doctors. And the doctors of course, they’re basing all of their decisions almost solely on research that’s been provided by the pharmaceutical companies. It’s this perfect catch 22, and so many lawsuits run up against that wall, this, that impenetrable wall against culpability. And for a long time, I thought, how is it possible to describe the elegance and exquisite venality of this? I’ve actually tried over the years to write something about it. Nothing came close to it until suddenly I realized that the phrase “learned intermediary” felt perfectly as a substitute for “modern major general” [from Gilbert and Sullivan’s comic opera, The Pirates of Penzance].

You referred to Gilbert and Sullivan a little off-hand as wordplay and games, but when you really watch what they’re doing, they’re often taking very deep social quandaries and ironies, and setting them to music in a delightful way. They work because the energy is driven by the fact that they’re capturing aspects of their society that are absurd.

When I realized that we could do that, I thought, oh my God, we, we could really do something here. And that exists in the opera, in the finished form, there’s an echo of that joke. But really the main thing driving this is that I’ve talked to so many people on so many different psychiatric drugs where the level of suffering, and the absolute Kafkaesque, or, or maybe better word would be Wagnerian, level of the almost mythical world that they’re lost in [is so great]. It is just hard to convey to people who have never had to come in direct contact with it. It’s hard to express it, but I realized we have a chance to give it a shot here.

Whitaker: This brings up a question for both of you. What conceptions will the audience bring to this opera? There may be people that have personal experience with psychiatric drugs and have been in the support groups you’re talking about and they will be primed to understand this narrative that you’re telling. But Dawn, you also said you came to Kermit because, in part, you were worried about being seen as a conspiracy theorist. I’m wondering how you conceive of your audience and how you will negotiate the fact that your audience will be bringing different understandings to this subject, and quite contradictory understandings.

Sonntag: I thought about this a lot before I wrote the opera. In the music world there are many people who are taking psychiatric medications. I have different theories about why that is. I think that part of what makes us musicians is that we have a physical hypersensitivity and awareness of our surroundings. This can be hard emotionally, and it is not popular to say anything negative about these medications. I can only say that if you look at the marketing strategies of the drug companies and if you start looking under the surface to where the money flows, then if you’re a thinking person you can at least acknowledge that if you yourself are not feeling that these medications harmed you, that it’s wrong to deny that it’s happening to others.

I have the deepest, deepest empathy for emotional crises, mental health crises, and we need a society that offers support. I’m not shaming anyone who is on these medications because they certainly experienced something that they needed support for. And I think that it’s possible that for a very serious crisis situation that medications could be used if there are no other possibilities and it’s a lifesaving issue. The problem is that then people are being told they need them forever. I’m aware that there will be criticism. The other thing I have to say is that I would never claim that this opera, that the music comes close to actually capturing the suffering that occurs. It’s an attempt.

Whitaker: I think it’s a brave thing to do, because you are opening yourself up to criticisms of an unfair sort, criticism for the subject matter as opposed to the creativity and the artistic representations of the opera. And people do feel very defensive.

Cole: I wanted to pick up on this theme of being painted as a conspiracy theorist, or whatever it is people want to say. This is why it was good for Dawn and I to have a  dialectal process. For instance, we had a lot of fun creating the character of a psychiatrist that we could just ridicule and who got what he deserved. That was fun and satisfying to do, but at a certain point we just looked at each other, online of course, and said, we’re not being truthful if we don’t also show the humanity of this person. We’re obligated to do that. It would be a failure not to.

Sonntag: I can just say that Kermit captured this biting satire in the character of the drug rep. It’s just wonderful. And we laughed a lot when we talked about that, but the words that come to mind right away is she screams, “I curse you all with anosognosia.” Then, at the end of the opera, Kermit has very moving lines. This is a dialogue between a son who has been harmed and the mother, and the mother says, “I saw your face before you were born.” This opera has biting satire, but also just beautiful intimate language in it.

Leyna – “I saw your face”…
Whitaker: Last question. Whenever you engage in creating a work of art ,you usually come out of it different than you entered it. In other words, your own thinking about the subject changes, evolves, deepens. For each of you, in what ways did your own thinking and your own emotional approach to the subject change as the result of co-creating this work of art?

Sonntag: I realized I was just peeling layers, that there was always more to learn and that that there are many facets to this issue. But one thing that became really clear to me is this, what is art? Because that word is used, for example, in psychiatry to say, well diagnosis is an art and a science. And I don’t think someone who says that for making a diagnosis actually knows what art is.

Art is not guesswork. And it’s not just throwing out your emotions and your feelings without any knowledge. It’s a very detailed work. If you are the artist, you’re making decisions. It’s very detailed and there’s not room for big errors in music. If you want to say that prescribing is like an art, then you have to throw away this big, huge margin for errors.

Cole: I would say it’s hard to be engaged in this field and not be drawn into despair. And I’ve seen a lot of it. As you know, we lead a group for Mad in America every week of parents and family members who meet to talk about what they’re going through. And I’ll be honest, there was a time where for me participating in that meeting was hard because there was just story after story after story of people with so little to hope for. But somehow or another, I think we have started to see a little bit of light, just through the gathering, just through being with each other to reinforce for each other the things that we see that we know are wrong, and then to find the pieces of hope that we didn’t know were there and then to celebrate them, and feel them together.

Being able to do this project was kind of an echo of that, a parallel to that, of just realizing that you don’t get to experience some of the great joys in life unless you are willing to go down into some of the hardest places. Everything else is just pretending or whistling past the graveyard. I mean, when you really go in there, then you say this was real, and this mattered. That’s what I got out of this. This is a reminder that it’s worth doing, it’s worth engaging, both with suffering this deep and with aspirations this great, just to arrive at a point of realizing this was worth it.

Whitaker: I like that ending as a hopeful moment and a moment of light on a subject that can be so dark. Thank you both for being with us today.

(Editor’s note: You can register to participate in the post-premiere Talkback here.)

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MIA Reports are supported, in part, by a grant from the Open Society Foundations

For Life: Opera on Psychiatry and Its Drugs